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Treatment

Movement of the jaw helps the ears' natural cleaning process. The American Academy of Otolaryngology discourages earwax (cerumen) removal unless excess earwax is causing health problems. There is a risk of perforating the eardrum when removing earwax. If the earwax problem is not urgent, soften the earwax with a cerumenolytic agent, which may lead to the wax coming out on its own. If earwax problem is urgent, you can try gentle irrigation with a syringe or going to an otolaryngologist. If irrigation does not work, you must see an otolaryngologist, who may use either irrigation, vacuuming or a curette to remove the earwax.

Softener

The process of softening the earwax (cerumen) is referred to as cerumenolysis and is achieved using a solution known as a cerumenolytic agent, which is introduced into the ear canal. It usually makes the wax come out, and if it doesn't, it facilitates removal by syringing or curettage.

Commercially or commonly available cerumenolytics include:

A cerumenolytic should be used 2–3 times daily for 3–5 days prior to the cerumen extraction. A review of studies found that topical preparations for the treatment of earwax were better than no treatment and that there was little difference between oil based and water based preparations (including plain water).

To prevent earwax buildup, one method is to put baby oil or olive oil into the ear on a regular basis. Put in a few drops every week, let it sit in there for a few minutes, then lie down on a towel to let it drip out again. However, be sure that the oil is clean, as you don't want to introduce bacteria. This should not be done if you have an eardrum perforation or if you don't know whether or not you have a perforation.

Irrigation

Ear wax may be removed from the ear canal by irrigation. This should be done in the shower with water temperature at body temperature as dizziness is a common side effect of syringing with fluids that are colder or warmer than body temperature. A syringe should be used to gently stream water into the ear. For children the rate and speed should be lower. After irrigating, the head is tipped to allow the water to drain. Irrigation may need to be repeated several times. If the water stream hurts, then the flow should be slower. It is better to irrigate too gently for a long period than irrigate too forcefully attempting to remove wax quickly. Irrigating too forcefully may result in perforation of the tympanic membrane.

This procedure can be done at home in the shower using an ear irrigation syringe with a right angle tip; however a trained practitioner would do a better job with less risk of damage to the tympanic membrane. After the wax is removed, the ear can be dried by tipping the head and gently pulling the ear upwards to straighten the ear canal.

Curetting

Earwax can be removed with an ear pick/curette, which physically dislodges the earwax and scoops it out of the ear canal. In the west, use of ear picks should only be done by health professionals; a modified curette having a safety stop to prevent deep insertion for self-use is available. A postal survey of British general practitioners found that only 19% always performed cerumen removal themselves; many delegated the task to practice nurses, some of whom had received no instruction. It is problematic as the removal of cerumen is not without risk. When having earwax removed, you must ensure that the practitioner has training.

Curetting earwax using an ear pick is common in East Asia, as the earwax of most East Asians is of the dry type, it is extremely easily removed by light scraping with an ear pick, as it simply falls out in large pieces or dry flakes, often on its own.

Vacuuming

Vacuuming of the ear may be done by professionals or by home-vacuum kits. However, home “ear vacs” were ineffective at removing ear-wax, especially when compared to a Jobson-Horne probe.

Cotton Swabs

Cotton swabs (Q-Tips or cotton buds) should not be used for removing earwax, as doing so can push the wax farther down the ear canal, and if used carelessly, perforate the eardrum. Cotton swabs push most of the earwax further into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibres of the swab. Abrasion of the ear canal, particularly after water has entered from swimming or bathing, can lead to ear infection. Also, the cotton head may fall off and become lodged in the ear canal. Cotton swabs should be used only to clean the external ear.

Complications

Irrigation can be performed at home with proper equipment as long as the person is careful not to irrigate too hard, although even then there is a risk of perforation of the tympanic membrane. All other methods should only be carried out by individuals who have been sufficiently trained in the procedure.

The author Bull advised physicians: “After removal of wax, inspect thoroughly to make sure none remains. This advice might seem superfluous, but is frequently ignored.” This was confirmed by Sharp et al., who in a survey of 320 general practitioners, found that only 68% of doctors inspected the ear canal after syringing to check that the wax was removed. As a result, failure to remove the wax from the canal made up approximately 30% of the complications associated with the procedure. Other complications included otitis externa, pain, vertigo, tinnitus, and perforation of the ear drum. Based on this study, a rate of major complications in 1/1,000 ears syringed was suggested.

Claims arising from ear syringing mishaps account for about 25% of the total claims received by New Zealand's Accident Compensation Corporation ENT Medical Misadventure Committee. While high, this is not surprising, as ear syringing is an extremely common procedure. Grossan suggested that approximately 150,000 ears are irrigated each week in the United States, and about 40,000 per week in the United Kingdom. Extrapolating from data obtained in Edinburgh, Sharp et al. place this figure much higher, estimating that approximately 7,000 ears are syringed per 100,000 population per annum. In the New Zealand claims mentioned above, perforation of the tympanic membrane was by far the most common injury resulting in significant disability.

Harmful

Ear candling, also called ear coning or thermal-auricular therapy, is an alternative medicine practice falsely claimed to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear canal. The Ear Candles Efficacy and Safety study proved that it is both dangerous and ineffective. Advocates say that the dark residue remaining after the procedure is extracted earwax, proving the efficacy of the procedure. Studies have shown that in fact the same residue is left whether or not the candle (which is made of cotton fabric and beeswax and leaves a residue after burning) is inserted into an ear. Do not ever practice ear candling, it is a really bad idea.

Disclaimer

The information presented is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.


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