“Don’t put anything smaller than your elbow in your ear,” my mom would yell at me as I spun a Q-Tip in my external auditory canal. She was worried I would jam the cotton swab in too deep and injure my eardrum. “You’ll make yourself deaf,” she would say when she wasn’t concerned about me “putting my eye out” by doing something else equally stupid (in her mind). Susan Scutti comes to my mother’s defense and tells us why we should leave our earwax alone and not try to clean things out ourselves:

Here’s why not: Cotton swabs, hair pins, house keys and toothpicks — the many smaller-than-our-elbow-objects we love to put in our ears — can cause cuts in our ear canals, perforate our eardrums and dislocate our hearing bones. And any of these things could lead to hearing loss, dizziness, ringing or other symptoms of ear injury.

Instead, most people can just let nature do its job. Our bodies produce earwax to keep our ears lubricated, clean and protected: Dirt, dust and anything else that might enter our ears gets stuck to the wax, which keeps any such particles from moving farther into the ear canal. Our usual jaw motions from talking and chewing, along with skin growth within the canal, typically helps move old earwax from inside to the outside the ear, where it is washed off during bathing.

 

Earwax (cerumen) isn’t a trivial issue. The American Academy of Otolaryngology – Head and Neck Surgery estimates that about 12 million Americans suffer from cerumen impaction (defined as “an accumulation of cerumen that causes symptoms or prevents a needed assessment of the ear canal, tympanic membrane, or audiovestibular system or both”). In 2012, $46.9 million was spent on 1.3 million office encounters to remove impacted wax by doctors and other health care providers. New clinical guidelines, published last week in the ENT group’s  journal, discourage the removal of earwax unless patients are having specific symptoms related to cerumen impaction:

Patients seek treatment for cerumen impaction for a host of symptoms. Reported symptoms include pain, itching, sensation of fullness, tinnitus, odor, drainage, and cough. Complete occlusion can also result in significant hearing loss. Hearing loss can range from 5 to 40 dB depending on the degree of occlusion of the canal with cerumen. While cerumen impaction may be asymptomatic in some cases, management may be necessary for diagnostic purposes so that the ear canal and/or tympanic membrane can be visualized or diagnostic assessment can be performed.

 

Also included in the new guidelines is a Dos and Don’ts list that stresses the main point — if it doesn’t bother you, leave earwax alone. Don’t try to pull it out or draw it out or flush it out by using cotton swabs, candles, or over-the-counter irrigation kits. If it does bother you with hearing loss or discomfort, or if you have a history of prior ear problems, then talk it over with your doctor. If a better view of your child’s eardrum is needed, your pediatrician may skillfully scoop the wax out with an ear curette or have an assistant flush it out with warm water. However, in most circumstances, we are most likely to let earwax lie where it is.

Some of us produce more earwax than others. If cerumen becomes a problem (ie. impacted), it may because of over-cleaning. Put away the cotton swabs and let nature handle it.