New guidelines discourage earwax removel.

• Position: Auditory System

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.

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"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...