Earwax: Should It Be Removed?

W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD


US Pharmacist. 2005;30(5) 

In This Article

Precautions in Home Removal of Cerumen

Healthy ears need no cleaning beyond the use of a soapy washcloth on the outer rim of the ear during the daily shower. Medical literature contains several reports of the dangers of home earwax removal beyond the obvious loss of its protective properties. The common use of cotton-tipped swabs to remove earwax is ineffective and potentially dangerous, increasing the risk of otitis externa and leading to perforation of the eardrum.[2,9,10] Using any device with adhesive on the end can rupture the tympanic membrane.[11]

Some individuals attempt to use oral irrigation devices to cleanse the ears (perhaps following the advice of some Web sites), but this can lead to perforation of the tympanic membrane, ossicular disruption, fistulae of the round and oval windows, and dislocation of the footplate of the stapes.[2,12,13] Using the device on a lower setting apparently does not help. In two thirds of cases, perforation occurs when the irritator is only at one third of the maximal power level.[2,12]

Additional dangerous earwax removal devices are ear candles or ear cones. Their use is becoming increasingly popular in the era of Internet medical advice. A Google search using "ear candle" as a search term returns 608,000 results. They were once sold mainly through health food stores, but some pharmacies have begun to sell them. The ear candle is a rigid 9-inch long, hollow tube made of beeswax-coated fabric.[14] One tip is tapered with a small hole. The other end of the cylinder is fully open. The patient lies on the side with the ear to be treated pointing upward. The tapered tip of the candle is inserted into the ear, and the distal end is lit with a match. After the candle burns to perhaps one third of its length, the flame is extinguished. At that point, the patient is directed to scissor the candle open, whereupon he discovers a mass of black waxy material. Proponents say that burning creates a low pressure within the center of the candle and the liquefied wax is drawn into the candle through capillary or negative pressures. They sell the candle, promising it will remove excess wax and help with sinus irritation, "glue ear," colds, flu, headaches, migraine, tinnitus, and stress.[15] Apparently, supporters believe the outer otic canal is connected to the sinuses, nasal passages, and brain.

The truth is far more mundane than supporters reveal. First, there is no evidence that a burning object 9 inches away from solid cerumen will liquefy it, which is the core claim of their validity. Furthermore, research demonstrated that there is no negative pressure created by the candle that would draw cerumen into it.[16] This makes sense. If negative pressure were created, it would be relieved immediately by air entering the large hole at the end of the candle, not the earwax-immersed hole at the tip. Thus, there would be no pressure-induced phenomenon acting on the cerumen itself. A pressure strong enough to remove solid wax from the ear would also perforate the tympanic membrane due to the pressures of barotrauma.

Supporters point to the mass of black wax in the interior of the candle as proof that it has worked. Again, research indicated that this residue did not emerge from the patient's ear; it was composed of the beeswax of the candle combined with the burning pieces of the fabric. A pharmacist can demonstrate this to skeptical patients by burning a candle in open air, then opening it. The same black waxy material will be found inside.

The candles would be amusing if they were simply a waste of money due to demonstrated inefficacy. However, they can cause severe injury to patients. Initial alerts were published in otology journals a decade ago.[17—19] Complications include external otitis, temporary hearing loss, burns of the ear due to hot wax from the candle, perforation of the tympanic membrane caused by extreme heat, and occlusions of the ear canal caused by the candle wax.

Because of the dangers they pose to the public, local, chain, and online pharmacies must cease sales of these devices. Patients asking about them must be urged to cease their use before serious damage to the ear and tympanic membrane occur.