DEAR DOCTOR: I understand that poking cotton swabs into the ear is dangerous. But how is one supposed to clean the ears otherwise? I don't want to see goopy yellow wax in anyone's ear canal or to have it in my own.
DEAR READER: This is a very good question -- and one that poses another question: Why clean your ears?
Let's assess the potential health benefits (or lack thereof) of doing so. This so-called wax, called cerumen, is a necessary product for the ear canal. Produced by glands under the skin, cerumen is composed of many different chemicals that mix with the skin cells that slough off within the ear canal. Cerumen moistens, cleans and lubricates the ear canal. It also acts as a barrier to dust, water and particles from the outside world. Further, cerumen creates an acidic environment within the ear canal that works against invading bacteria, even as its antibacterial enzymes and antibodies further protect the ear from bacteria.
I know that it may be unsightly and seem unhygienic to have yellowish material coming out of the ear, but letting cerumen come out on its own is actually the more hygienic course. First, removing the cerumen dries out the canal, which can lead to skin irritation within the canal. Often, this causes the ear canal to feel itchy, leading to more use of cotton swabs and even greater irritation of the canal. Second, the cotton swabs can make cerumen itself drier, reducing its ability to come out on its own. Swabs also can push wax further into the canal toward the eardrum.
In some instances, the tips of the cotton swabs or the cotton fibers themselves can dislodge and remain within the ear canal. The fibers then can mix with the cerumen, leading to closure of the ear canal and loss of hearing. Finally, putting a cotton swab in the ear canal can perforate the eardrum.
In short: Cotton swabs should not be used within the ear.
Nonetheless, the belief that the ear canals should be cleaned is widespread. Two surveys have found that 90 percent of people think that they should clean their ear canals, with many people cleaning their ears on a regular basis. This practice appears to be passed from parents to their children as a part of normal hygiene.
That said, even without the use of cotton swabs, cerumen can harden and remain lodged within the ear canal. This is especially likely to occur in people with ear infections, psoriasis or eczema, or in those who use hearing aids, ear plugs or ear phones. In such cases, ear drops can help soften the wax, so that it comes out on its own. Irrigating the canal with water -- at home or within a doctor's office -- can provide additional relief. If such hardening is a recurrent problem, the answer is to more regularly use ear drops.
To sum it up, cerumen (ear wax) is necessary to lubricate and protect the ear canal from infection. Cotton swabs can be used to clean the outer ear, but -- please -- don't put them inside the ear.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles. Send your questions to email@example.com, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.