NEW YORK (Reuters Health) - When ear wax builds up to the point of causing symptoms, people should turn to their doctors rather than the old-fashioned cotton swab, according to new guidelines.

About 12 million Americans visit the doctor each year complaining of ear wax buildup. The new guidelines, issued by the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF), are the first comprehensive recommendations to help doctors determine which patients need treatment, and which treatments are best.

Ear wax -- known medically as cerumen -- is normal and necessary for healthy ears, the guidelines stress. Despite its name, ear wax is not "wax," but a mixture of secretions from the outer ear, along with dead skin cells and hair. It helps protect the ear, acting as a self- cleaning agent with lubricating and antibacterial properties.

Usually, the body takes care of excessive ear wax on its own; older ear wax is continually being transported from the ear canal -- assisted by motions of the jaw, such as chewing -- to the ear opening, where it dries out.

Sometimes, however, it accumulates inside the ear to the point where it causes an impaction and symptoms such including hearing loss, "ringing" in the ears, pain or a feeling of fullness in the ear. In these cases, a trip to the doctor may be in order.

"Unfortunately, many people feel the need to manually 'remove' cerumen from the ears," Dr. Peter Roland, the lead author of the new guidelines, said in a statement. "This can result in further impaction and other complications to the ear canal."

Effective treatments include wax-dissolving agents and ear "irrigation," where a doctor uses a jet of warm water to flush out the wax. In some cases, such as when a patient has a narrow ear canal or eardrum perforation, the doctor may need to use special instruments to manually remove the ear wax.

People should not use cotton swabs, which tend to only push the wax farther into the ear, according to the AAO-HNSF. They should also avoid home "oral jet irrigators" and so-called ear candling, which involves inserting a hollow cone-shaped device into the ear canal and lighting the exposed end.

There are no proven ways to prevent ear wax impaction, according to the guidelines. But people at high risk of the problem -- such as those with hearing aids and anyone who has had an impaction in the past -- may want to visit their doctor every six to 12 months for routine cleaning.

"The complications from cerumen impaction can be painful and ongoing, including infections and hearing loss," Roland said. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes."

SOURCE: Otolaryngology - Head and Neck Surgery, September 2008.

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