Dear Dr. Jeff: I've been told not to use Q-tips to clean my ears. What should I use? L.B.
Dear L.B.: Wax is normally produced by apocrine glands in the outermost portions of the ear canal, and it serves a number of protective functions.
Earwax traps dust and dirt particles that might otherwise collect in the ear canal, possibly blocking it. Earwax causes water to bead up and run back out of the canal. Because it is acidic, and therefore noxious to most bacteria and fungi, ear wax also prevents infection. Finally, earwax coats and protects the delicate skin that lines the ear canal and eardrum.
Most of the time, our ears are self-cleaning. There is a slow and orderly migration of ear canal skin cells from the eardrum to the outer ear opening. Earwax adheres to these cells, and so is continuously transported out from the deeper parts of the ear canal. At the same time, it dries out, normally if imperceptibly flaking and falling off on its own.
Different individuals vary considerably in the amount and consistency of their earwax. The lipid (fat) content of earwax can vary from 20 percent to 50 percent. Dryer wax is common in Asian populations, while wetter wax is more common in those of African and European descent. Researchers have even identified the specific gene, on chromosome 16, that codes for the richer or leaner fat content of earwax!
Uncommonly, excessive earwax can block an ear canal, resulting in decreased hearing, discomfort, and tinnitus (ringing). But far more often, however, blocked canals are the result of cleaning with Q-tips.
Ear, nose, and throat specialists are famous for their advice never to clean your ears with "anything smaller than your elbow." Cotton swabs just tamp down the wax, compacting it and pushing it deeper into the canal. They can also perforate the eardrum, if pushed in too far or used with too much force.
Water jet devices are more effective, but can be unpleasant. They can also cause perforations if not used with care. "Candling" is not felt to be a particularly effective method of ear wax removal.
So, if you feel like you need to clean out your earwax, what are your best options?
One method is to put a few drops of mineral oil or olive oil into your ears every few days. Let it sit in there for a few minutes, to soften and dissolve some of the wax, and then let it drip out onto a washcloth or towel.
You can do the same thing with the OTC Murine or Debrox drops, or the prescription preparation Cerumenex (which is enzyme based).
Earwax can be easily and safely flushed out in the shower, with a gentle stream of water. Pull back some on your ear to straighten the canal, and tilt your head just right so that a jet of water pours in. Make sure the water is barely warm?not too warm or too cold?so that it doesn't make you dizzy. If your wax tends to be dry and hard, try using softening drops first.
You should never attempt to clean out an ear that is painful or presumed to be infected. And you should never clean out an ear that has tubes or a perforated eardrum.
And of course, you can always come into the health center for us to take a look and lend a hand!
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center