Eric Boodman, StatNews
Earwax is useful stuff. Some ancient physicians smeared it onto wounds as a soothing salve. Others thought its taste should be used as a diagnostic tool: a hint of sweetness, one doctor wrote, was a sign of impending death. Even today, doctors say it’s the most natural of soaps, carrying dead skin cells and debris out of hearing’s way.
But the near-magical properties of earwax — or cerumen, as scientists call it — don’t stop people from going to extraordinary lengths to get rid of it. No tool seems too pointy for people to want to stick into their ears.
“You name it: bobby pins, pencils, pens,” said Dr. David Jung, an otolaryngologist at Massachusetts Eye and Ear, when asked how his patients attempt earwax removal. “I’ve had some construction workers say, ‘Gently, with nails.’ I’ve seen and heard it all.”
In case you were thinking of cleaning inside your ears — gently or otherwise — a revised set of guidelines from the American Academy of Otolaryngology has some advice: Don’t. Not even with Q-tips, no matter how innocuous they look.
This recommendation is nothing new. Back in 1901, the monthly Medical Brief advised that “in the removal of impacted cerumen, as little instrumentation as possible should be indulged in. Much harm often follows the use of probes, forceps, and hooks in untrained hands.”
Few pieces of medical advice have been so consistent for so long, and by now, people know they’re not supposed to put foreign bodies in their ears — as evidenced by the sheepishness with which Jung’s patients admit to their wax-scraping tricks.
The problem is, they do it anyway. The new guidelines cite one study — titled “What health professionals at the Jos University Teaching Hospital insert in their ears”— in which over 90 percent of the participating staff at a medical center were found to clean their ear canals with objects such as Q-tips or matchsticks.
“When you put it on the inside of your ear and move it around, it feels nice, it becomes a sensual thing. You become like a drug addict, a cigarette smoker,” said Dr. Vito Forte, a professor of otolaryngology at the University of Toronto, who runs the company OtoSim, which makes ear-exam simulators.
Your ear canal is a tube closed off at one end by your eardrum. When you chew and talk, that helps move wax out towards the opening so it doesn’t impede hearing. Inserting a Q-tip or a screwdriver actually reverses that motion, pushing wax back where you don’t want it to be, sometimes creating hardened balls of wax. Then it becomes a job for an otolaryngologist, who might use a tiny suction-tip or beak-like forceps to pull it out.
The tools involved might be minuscule, but the impact isn’t: In 2012, the Medicare program paid nearly $47 million for over a million removals of earwax balls. Not all of those blockages were caused by rogue ear-cleaners — but their picking and scratching is certainly part of the problem.
Sticking things into your ears is not only ineffective — it’s dangerous. “Even though cotton swabs are fairly soft, the skin within the canal is very delicate, and easy to scratch and abrade,” said Dr. Seth Schwartz, an otolaryngologist at Virginia Mason Medical Center in Seattle and the first author of the revised guidelines. “It can be quite painful but can also lead to infection. And you could actually traumatize the eardrum.”
In that case, he said, sometimes the only option is surgery, in which the eardrum is taken out and patched up with bits of the patient’s own tissue.
The new guidelines were written expressly to be more accessible to non-scientists, in the hope of finally getting across medical advice that has been ignored for centuries.
Yet ear canal cleaning is a hard habit to kick. It may be as innate as tool use itself. Forte was once called to the Toronto Zoo to treat an orangutan that seemed to be having ear trouble — and found out that the ape was known to pick up secondhand wads of chewing gum, check them for stickiness, and then use them to extract whatever might have been buried in its ears.
If only the ape had read the latest guidelines.