Should I be Using Cotton Swabs to Clean my Ears – Earwax Removal

by malam53, posted in Blog

Many patients often use a cotton swab to remove cerumen (medical term for earwax). While it may provide temporary relief from itching or remove some superficial cerumen, majority of research suggests against its use. Otolaryngologists advise against the use of cotton swabs worldwide and complications need to be raised in the public (1). Todays post will further explore information about cerumen, benefits, symptoms of excessive cerumen, management approaches used and recommendations for public regarding cerumen management.

What is Cerumen?

It is a common misconception for the greater public to associate cerumen as negative or a sign of dirty ears. However, having cerumen that is not blocking the ears may serve many benefits for ones hearing health. Cerumen is known to be naturally produced via skin cells, secretions from our cerumen and sebaceous glands (located in the outer third of the ear canal) and a combination of sweat and moisture (2). It further serves as a protective mechanism for certain infections and foreign bodies that may enter the ear canal. Cerumen is naturally secreted via jaw movements which gradually excretes it towards the outside of the ear canal. However, in certain individuals, this mechanism cannot fully clear cerumen and may lead to further impaction leading to symptoms of an impacted ear canal (3).

Symptoms of Impacted Cerumen

In certain cases, cerumen can become impacted in which removal is recommended. Common symptoms of cerumen impaction may include hearing loss or elevated hearing loss in certain individuals, tinnitus, vertigo, ear pain, itchiness or even an outer ear infection or related symptoms (3,4). Some patients may be prone to excessive earwax buildup. For example, having anatomically bendy canals not allowing for natural secretion and self cleaning of cerumen, obstructions including excessive hair, and/or overproduction which exceeds the rate of natural migration of wax out of the ear canal. Also, as one ages the amount of cerumen glands atrophy resulting in dryer wax and may lead to increased build-up (4).

Diagnosing Impacted Cerumen

A physical examination from a licensed hearing care provider can allow one to inspect the extent of impaction. It is important to note that one may have cerumen that is non-occluding and is acceptable not to remove and allow for natural self-migration. Upon visible inspection of the earcanal (via otoscopy), a hearing care professional can run a quick middle ear test (known as tympanometry) which can further suggest if eardrum movement is being impacted potentially due to cerumen build up, however, in severe impaction tympanometry cannot be performed. In these cases, cerumen is recommended to be removed (3).

Treatment for Impacted Cerumen

Many modalities exist for the management of ear wax professionally including manual removal, aural suctioning, and water irrigation. However, research suggests there is no best way to remove cerumen and may vary based on the medical history and situation one presents. A hearing care professional may start with manual removal using a curette if the wax is superficial and easily removable. If cerumen is deeper or harder to take out, other means exist to extract cerumen. For example, research suggests prior to removal of cerumen using a cerumen softening agent can help facilitate wax removal via irrigation. Water irrigation is a common method for deep cerumen; however, contraindications must not exist. This includes perforation of the eardrum, previous ear surgery, active ear infection (otitis externa/media) or history of ear infection to moisture or presence of a foreign body in the ear canal. Furthermore, aural suctioning is often a method used when irrigation is not successful or if the patient has contraindications to irrigation. Furthermore, research suggests that irrigation is much safer than ear syringing due to the associated risk of trauma with syringing (5). Also, in recent years, a popular method of removal involving ear candling may produce more harm than benefit and it is recommend that doctors and hearing care providers discourage its use (6).

Recommendations

Presently, there seems to be lack of awareness in the public about the harmful effects of cotton bud use for wax removal. While it may be normal and healthy to have some degree of cerumen, excessive cerumen can lead to improper inspection of the outer ear, hearing loss and improper use of hearing aids for hearing aid users. If one feels that cerumen is impacting their hearing health, it is important to see a licensed healthcare professional to further assess the situation and receive appropriate treatment.

References

  1. Nagala S, Singh P, Tostevin P. Extent of cotton-bud use in ears. Br J Gen Pract. 2011;61(592):662-663. doi:10.3399/bjgp11X606546
  2. Okuda I, Bingham B, Stoney P, Hawke M. The organic composition of earwax. J Otolaryngol. 1991;20(3):212-215.
  3. Sevy JO, Hohman MH, Singh A. Cerumen Impaction Removal. [Updated 2023 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448155/
  4. Horton GA, Simpson MTW, Beyea MM, Beyea JA. Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians. J Prim Care Community Health. 2020;11:2150132720904181. doi:10.1177/2150132720904181
  5. National Guideline Centre (UK). Hearing loss in adults: assessment and management. London: National Institute for Health and Care Excellence (NICE); 2018 Jun. (NICE Guideline, No. 98.) 10, Management of earwax. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536541/
  6. Rafferty J, Tsikoudas A, Davis BC. Ear candling: should general practitioners recommend it?. Can Fam Physician. 2007;53(12):2121-2122.

Leave a comment