Recently a friend told me to try an "ear candle," a product that can be found at health-food stores, which somehow extracts wax from the ear by convection. Is this safe?

Kathryn

Ear candles have to be one of the stupidest inventions in the history of ear wax. The unlit end of the candle is placed in the ear canal (so the ear functions as a candleholder). The opposite end is lit. This is supposed to create a mild vacuum at the opposite end, "gently" suctioning wax from the canal. Needless to say, the world just doesn't work that way.

As the candle wax melts, it turns brown. I'm not sure how this happens. Perhaps the candle smoke mixes with the wax, or perhaps there is something special about the chemical composition of this type of wax. In any event, when you miraculously pull gobs of brown wax from your ear, you may not realize that most (if not all) of this wax comes from the candle, not YOU. Candles rarely accomplish a thorough cleaning of the ear canal. There have also been case reports of candle wax dripping into the ear canal, causing painful burns of the ear-canal skin or eardrum. These burns are easily infected, causing further problems. And I am still dreading the inevitable report of a human torch due to candle use.

What about other methods to remove ear wax? Over-the-counter remedies are usually peroxide-based. A common problem with the use of these "wax-dissolving drops" is that the user may convert a partial blockage of the ear canal into a total one. No permanent harm is done, but you will be miserable (from the hearing loss) until someone gets the wax out.

If the over-the-counter kit includes a bulb syringe, a more serious risk is that the user will wash out his or her ear too vigorously. I have a similar gripe with primary-care physicians (and their assistants) who irrigate ears too vigorously. I see about two eardrum perforations each year that are due to aggressive irrigation. If a patient already has an eardrum perforation, irrigation can lead to infection, even permanent hearing loss.

My recommendation on ear wax (which I admit is rather self-serving) is that you have your primary-care physician diagnose but not treat this condition. If you need cleaning, see an ear, nose and throat specialist (ENT). The one exception to this is the primary-care doctor who is skilled in the use of a curette or hook to remove earwax, since this is (in trained hands) much safer than irrigation. I would be delighted if the practice of irrigation would go the way of the dodo.