Ear Cleaning: Do’s and Don’ts

I’ve seen people employ strange methods to clean their ears.  Words of advice: don’t clean your ears with foreign objects or ingenuous instruments such as bobby pins, crochet needles, bamboo skewers, wire clothes hangers, not even those cotton swabs known as Q-tips.  I’ve seen patients traumatize their ears using these and sundry other devices.  Many people ignore this advice, even coming from an ENT doctor, insisting they “won’t go too deep,” or reassuring me that “I’m very careful, I know my body, doc.”  But alas, the unexpected occurs, and these same people can be found in their doctor’s office, referred to an ENT specialist, or even in the E.R. due to excruciating pain they’ve inflicted upon themselves or causing a terrible ear infection as a result.

How can this be?  The ear is a very delicate structure.  For instance, take the ear drum (tympanic membrane).  You probably know that the ear drum is a paper-thin, nearly translucent, membrane overlying tiny bones of hearing.  It doesn’t take much to damage that ear drum.  The ear canal leading from the ear drum to the outside also is quite fragile, where the inner (medial) two-thirds is virtually skin on bone.  As the figure above demonstrates, even a blunt instrument such as a cotton swab can hit the canal, which can easily disrupt the skin, creating a nidus for infection.  Bacteria invaded into this disrupted area, infecting the skin and soft tissue further inward and outward to involve the outer ear (auricle) and areas around it, such as the face, head and neck. 

I’ve seen patients with swollen and red ears, sometimes needing hospitalization and intravenous (i.v.) antibiotics.

A few words about “candling” the ears to remove wax.  Don’t do it.  It doesn’t work.

How should you clean your ears?

One of the simplest methods is via a gentle irrigation.  I usually recommend a 1:1 mix of white vinegar (which is also known as acetic acid) and isopropyl (rubbing) alcohol.  Apply this into the ear with a dropper—do not use an object such as a cotton swab for the reasons just explained—and fill the canal with this solution.  If you don’t have a dropper, use a cotton ball saturated in the solution and use it as a make-shift dropper by squeezing it into the ear.  Massage the solution into the ear by compressing the tragus—the flap of skin and cartilage that lies in front of the entrance into the ear canal.  This allows the solution to mix around to clean the ear.  Alternatively, you can use a small syringe to gently irrigate the ear.

Caution: make sure the solution is close to body temperature.  Otherwise if too cold, you could experience a caloric effect which then caused vertigo or dizziness which is a highly unpleasant experience, so I was told. 

People have irrigated their ears with warm water or rinsed the ear under the shower.  This is an acceptable method, but avoid drying the ear with a cotton swab.  If you feel water trapped in the ear, use the solution above just isopropyl alcohol by itself.  Alcohol evaporates at a lower temperature than water, and since it easily mixes with water, it helps to remove water and effectively dry the ear.  It is paramount to remove any excess water, for this too can cause otitis externa or “swimmer’s ear.”

Another method is the use of hydrogen peroxide.  This is helpful for firm or very dry ear wax.  If you are to use this method, fill the ear canal with the peroxide and allow it to effervesce for about 15 minutes.  The by-product of hydrogen peroxide is water, and thus you need to remove the water by the methods just explained above.

There you have it: the do’s and don’ts of ear cleaning.  If you simply must ignore this advice and clean your ears with strange elongated instruments and injure yourself, please visit your common-sense counsellor.

©Randall S. Fong, M.D.