From the Guidelines
Q-tips should never be used to clean the ear canal as they can push cerumen through the tympanic membrane, causing potential harm and complications. When considering the management of cerumen impaction, it is essential to prioritize methods that minimize the risk of pushing earwax further into the ear canal and potentially damaging the tympanic membrane. According to the clinical practice guideline update on earwax (cerumen impaction) published in 2017 1, patients should be advised against putting anything smaller than their elbow into their ear, as this can cause injury to the ear canal, perforation of the eardrum, and dislocation of the hearing bones, leading to hearing loss, dizziness, and other symptoms. The guideline emphasizes the importance of seeking medical evaluation if symptoms of hearing loss, ear fullness, and ear pain are present, and advises against overcleaning the ears, as this can irritate the ear canal, cause infection, and increase the chances of cerumen impaction 1. Key points to consider when managing cerumen impaction include:
- Understanding that cerumen is normal and should be left alone if not causing symptoms or blocking the ear canal
- Recognizing the symptoms of cerumen impaction, such as decreased hearing, fullness, tinnitus, and distortion or changes to hearing aid function
- Seeking medical attention if home remedies are unsuccessful or if ear pain, drainage, or bleeding are present
- Avoiding the use of ear candles, as they can cause serious damage to the ear canal and eardrum 1. In terms of safe earwax removal methods, gentle irrigation with warm water, over-the-counter earwax softening drops, or professional cleaning from a healthcare provider are recommended. It is also important to remember that some earwax is beneficial, as it protects the ear canal by trapping dust and debris while providing antimicrobial properties.
From the Research
Cerumen Impaction and Q-Tips
- The use of Q-tips to remove earwax is not recommended, as it can push cerumen further into the ear canal and potentially damage the tympanic membrane 2, 3.
- Insertion of objects like Q-tips into the ear canal can cause complications, including pushing the wax deeper into the ear canal, and potentially leading to hearing loss, itching, pain, or tinnitus 2.
- Instead of using Q-tips, effective treatment options for cerumen impaction include cerumenolytic agents, irrigation with or without cerumenolytic pretreatment, and manual removal by a healthcare professional 2, 3.
Risks of Using Q-Tips
- Using Q-tips to remove earwax can increase the risk of bleeding in the external auditory canal, especially in patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications 2.
- The American Academy of Otolaryngology-Head and Neck Surgery recommends against the use of Q-tips for earwax removal, as it can cause more harm than good 4.
Alternative Methods for Earwax Removal
- Ear drops, such as carbamide peroxide, can be effective in softening and removing earwax, and are a recommended treatment option for cerumen impaction 5, 6.
- Irrigation with a bulb syringe may be appropriate for selected adults, but should be done with caution and under the guidance of a healthcare professional 2, 3.