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New guidelines discourage earwax removel.

The age-old advice to clean out earwax on a regular basis is discouraged under the first published guidelines from health care professionals on the subject. "Unfortunately, many people feel the need to manually remove earwax, called cerumen, which serves an important protective function for the ear," says the guidelines' lead author, Peter Roland, chairman of otolaryngology at the University of Texas Southwestern Medical Center, Dallas.


"Cotton swabs and some other home remedies can push cerumen farther into the canal, potentially foiling the natural process and instead cause build-up, known as impaction."

Guidelines recommend that professionals use wax-dissolving agents, irrigation, or ear syringing, or remove it manually with a suction device or other specialty instrument to avoid damaging the ear or further impaction. The guidelines warn against using cotton-tipped swabs, and the home use of oral jet irrigators. In addition, people with hearing aids should be checked for impaction during regular physician visits because cerumen can cause feedback, reduced sound intensity, or damage the hearing aid,

The guidelines were created with input from family practitioners, pediatricians, internists, nurses, audiologists, and emergency room doctors and have been endorsed by the American Academy of Otolaryngology, Alexandria, Va.

There are no proven methods for avoiding impaction, according to the analysis, so when should a professional be sought out? "When cerumen builds to the point of causing symptoms such as pain, ringing, itching, or hearing problems, it's a sign you should see a physician," explains Roland, who also serves as chief of Pediatric Otology at the Children's Medical Center, Dallas.

The problem affects one in 10 children, one in 20 adults, and greater than one-third of the elderly and cognitively impaired, according to the academy. About 12,000,000 people annually seek treatment for impacted or excessive cerumen, resulting in nearly 8,000,000 cerumen removal procedures by health care professionals.

"Earwax" is not actually wax, but a water-soluble mixture of secretions produced in the other third of the ear canal, along with hair and dead skin. The mixture serves a critical protective function for the ear and should not be removed unless it is causing symptoms or interfering with assessments of the ear, stresses Roland, who heads the Clinical Center for Auditory, Vestibular and Facial Disorders at UTSW.

Other conclusions and recommendations include:

* Individuals at high risk for cerumen impaction, such as those who wear hearing aids, should consider seeing a clinician every six to 12 months for routine cleaning.

* Wax dissolving agents are effective, but evidence is lacking regarding the superiority of any particular agent.

* Irrigation or ear syringing is most effective when a wax-dissolving agent is instilled 15 to 30 minutes before treatment.

* Ear candling, an alternative to traditional methods of earwax removal, does not work, is potentially dangerous, and is condemned by the Food and Drug Administration.

* Manual removal with special instruments under medical supervision is a final option and is preferred for patients with narrow ear canals, eardrum perforation or tubes, or immune deficiency.


"The complications from cerumen impaction can be painful and include infections and hearing loss," Roland concludes. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes."
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Title Annotation:Auditory System
Publication:USA Today (Magazine)
Geographic Code:1USA
Date:Oct 1, 2008
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