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January 11, 2017

Why you shouldn't clean your ears with a Q-tip

Daily Briefing

Editor's note: This story was updated on August 1, 2017.

Put down that Q-tip—or any other object "smaller than your elbow"—and leave your earwax alone, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) advised in guidelines released in January.

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In an update to its 2008 guidelines, AAO-HNSF said earwax—or cerumen—is good for you, and sticking objects like cotton swabs into your ear can be harmful.

'You name it:' Everything from Q-tips to nails

Physicians have long recommended against removing earwax—the journal Medical Brief as early as 1901 warned that "much harm often follows the use of probes, forceps, and hooks in untrained hands" to remove earwax.

According to STAT News' Eric Boodman, "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." But "they do it anyway."

One 2013 study found that more than 90 percent of participants at a medical center cleaned their ear canals with objects like Q-tips or matchsticks.

That might be the case because "it feels nice," Vito Forte, a professor of otolaryngology at the University of Toronto, said.

And doctors have seen it all when it comes to earwax removal.

David Jung, an otolaryngologist at Massachusetts Eye and Ear said, "You name it: bobby pins, pencils, pens. I've had some construction workers say, 'Gently, with nails.'" He added, "I've seen and heard it all."

New guidelines focus on the 'why'

In the January guidelines, AAO-HNSF focused more on why earwax should not be removed.

For starters, earwax is good for you: It can prevent dirt, dust, and other small items from getting into your ears.

Seth Schwartz, an otolaryngologist at Virginia Mason Medical Center and chair of the AAO-HNS guideline update group, said, "It's not a bad thing to have wax in your ears. Everybody does and should. It's more of an issue when it becomes too much."

The process of removing earwax also can be harmful. For example, sticking cotton swabs, paper clips, or toothpicks into your ear can cause cuts in the ear canal, perforate an eardrum, or dislocate hearing bones. Those issues could lead to hearing loss, dizziness, ringing, and other symptoms.

"Even though cotton swabs are fairly soft, the skin within the canal is very delicate, and easy to scratch and abrade," Schwartz said. He added that another "problem is that this effort to eliminate earwax is only creating further issues because the earwax is just getting pushed down and impacted further into the ear canal."

And in most cases, normal activities like talking and chewing can help remove earwax, the guidelines state.

Dos and Don'ts

The guidelines include a "Do and Don't" section that aim to make the recommendations more user-friendly.

The guidelines advise that people shouldn't over-clean their ears or use ear candles, should seek medical attention if they experience ear pain or hearing loss, and should ask their provider about how to treat earwax compaction at home.

The guidelines also aim to help clinicians identify patients who might actually benefit from intervention. They outline steps providers can take to diagnose cerumen compaction and ways to relieve it.

"We really have come to appreciate that clinicians are not the only users of (the guidelines), that patients are really interested in their own care and people are really taking ownership of their own care," Schwartz said (Boodman, STAT News, 1/6; Murphy, McClatchy/Sacramento Bee, 1/6; Scutti, CNN, 1/5; AAFP release, 1/9).

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