Ear Candling Is Not Safe or Effective for Earwax Removal
Ear candling (ear coning) is ineffective and potentially dangerous and should not be used for removing earwax. 1 This recommendation is based on clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery, which strongly advises against this practice due to lack of efficacy and risk of serious complications.
Evidence Against Ear Candling
Ear candling does not create the claimed "chimney effect" vacuum that supposedly draws wax out of the ear - tympanometric measurements in ear canal models have failed to demonstrate any negative pressure generation 1
Clinical trials have shown no removal of cerumen from the external auditory canal in ears with cerumen impactions, and some cerumen-free ears actually developed new deposits after candling 1
Mass spectrography analysis reveals that the dark brown waxy substance left in the candle stub contains no cerumen constituents but is actually composed of candle wax (alkanes) 1
A critical assessment of ear candling shows that its mode of action is implausible and demonstrably wrong, with no data suggesting effectiveness for any condition 2
Documented Complications of Ear Candling
Ear blockage, ear canal burns, tympanic membrane perforation, conductive hearing loss, otitis externa, and hair fire 1
The Food and Drug Administration (FDA) has issued a warning to consumers not to use ear candles due to risks of serious injuries, which can occur even when ear candles are used according to manufacturers' recommendations 1
A survey of the Northwest Academy of Otolaryngology–Head and Neck Surgery found that of 122 respondents, 21 had treated ear injuries associated with ear candling 1
Recent reports during the COVID-19 pandemic lockdown period documented various complications from ear candling, with ear pain being the most commonly reported 3
Safe and Effective Alternatives for Earwax Removal
1. Cerumenolytic Agents
- Clinicians may use cerumenolytic agents (including water or saline solution) as a safe and effective method for managing cerumen impaction 1
- Options include:
2. Irrigation
- Ear irrigation with water is an effective method for removing earwax 1
- Provides immediate resolution of symptoms caused by cerumen impaction 1
- Can be performed by a clinician or as self-irrigation at home 1
- Contraindicated in patients with pressure equalization tubes, nonintact eardrums, or susceptibility to ear infections 1
3. Manual Removal
- Removal by a clinician using curette, forceps, or suction provides immediate resolution of symptoms 1
- A nonrandomized comparison showed that manual removal by a clinician with a Jobson-Horne probe is significantly more effective than "do it yourself" ear vacuum kits 1
Important Considerations for Earwax Management
Earwax (cerumen) is part of the ear's self-cleaning mechanism and is usually naturally expelled from the ear canal without causing problems 4
Complications from professional earwax removal methods are rare but can include tympanic membrane perforation (up to 1% of cases) 5
Systematic reviews suggest that softeners followed by self-irrigation may be more cost-effective than softeners followed by professional irrigation in primary care 6
Proper documentation of earwax removal procedures should include pre-procedure examination findings, specific agents used, techniques employed, and post-procedure condition of the ear canal and tympanic membrane 7
Patients should be advised to avoid self-cleaning with cotton swabs, which can push wax deeper into the canal 7