Q. I suffer from wax buildup in the ears and have heard that ear candling can help. Is there any evidence to show that it works and, most importantly, that it's safe? If not, can you suggest any other options?-T.E., via e-mail
A. Ear candling is a traditional remedy that's become increasingly popular in recent years. It's mainly used to remove ear wax, although it's also said to relieve sinus pain, cure ear infections and even strengthen the brain (Can Fam Physician, 2007; 53: 2121-2).
The procedure involves placing a hollow tube (the 'candle') made of wax-dipped cloth into the ear canal, then lighting it at the outer end. This is supposed to draw wax (cerumen) and other debris out of the ear canal, thus clearing any blockages. However, some have labelled ear candling 'quackery', claiming that it's not only useless, but actually dangerous. So, what does the science say?
Proponents of ear candling offer two main theories for how it works: one claims that the burning candle creates a vacuum ('chimney effect') that gently sucks wax out of the ear; the other believes that the flame causes the ear wax to melt and flow out of the ear over the subsequent few days.
However, there's no evidence to support either of these theories. In fact, laboratory studies show that ear candling produces no significant heating or suction in the ear canal (Can Fam Physician, 2007; 53: 2121-2).
Worse, there's research suggesting that ear candling does more harm than good. In a trial of eight patients, not only did the candles not remove wax, but they
left candle wax deposits in the ears of several patients (Laryngoscope, 1996; 106: 1226-9). The same study also looked at reports from 122 otolaryngologists and identified 21 ear injuries resulting from ear candling. These included burns, infection, perforation of the eardrum (or 'tympanic membrane') and temporary hearing loss (Can Fam Physician, 2007; 53: 2121-2).
Thus, although it's an extremely popular treatment, the evidence clearly indicates that ear candling is neither safe nor effective. So, what are the alternatives for getting rid of excess ear wax?
The first option is to simply do nothing. Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery stress that ear wax serves an important purpose-it cleans, protects and lubricates the external auditory canal-and does not always need to be removed. In most people, wax is naturally cleared from the ear, so a wait-and-see approach may be all that's needed (Otolaryngol Head Neck Surg, 2008; 139 [3 Suppl 2]: S1-21).
If your ear wax is causing you trouble, however-for example, you suffer from pain, hearing loss, tinnitus (persistent ringing in the ear) or other symptoms-then a number of treatments may be able to help.
Ear-syringing (where water is squirted into your ear through a tube) is the method most commonly used by GPs, although the procedure is associated with a number of side-effects, including pain, cough, eardrum perforation, vertigo and inner-ear infection (J R Soc Med, 1992; 85: 346-9).
A safer option is to use ear drops-known as 'cerumenolytics'-to soften or break up ear wax. The British National Formulary (BNF) recommends sodium bicarbonate, olive oil or almond oil for this, but even plain water can be effective (Br J Gen Pract, 2004; 54: 862-7). In a study comparing water, sodium bicarbonate and an oil-based cerumenolytic, all three agents were better than no treatment at all. After five days, moderate or complete clearance of the ear canal was achieved in 50 per cent of the water group, 46 per cent of the sodium-bicarbonate group and 60 per cent of the oil-based group (Otolaryngol Head Neck Surg, 2008; 139 [3 Suppl 2]: S1-21).
Providing you don't have a damaged eardrum, you can try this treatment at home. Tilt your head to the side and, using a pipette or a cottonball soaked in the liquid, squeeze a few drops of the cerumenolytic into the ear. Stay in this position for a minute or two, then tilt the head in the other direction to allow the fluid and wax to drain out. If necessary, do the same for the other ear, and repeat the procedure for four or five days (Harv Health Lett, 2008; 34: 3).
Alternatively, you could use a bulb syringe (a plastic tube connected to a bulbous section that you squeeze) to gently rinse out the ear with water. One study found that the home use of ear drops and a bulb syringe was successful in clearing ear wax in about half of patients. However, the bulb syringe can cause some of the same problems as traditional syringing. To avoid complica-tions or injury, always use body-temperature water and make sure you don't squeeze too hard or force the syringe too deeply into the ear canal. After use, tilt your head accordingly to allow the water to drain from the ear.
Whichever options you decide to try, make sure you avoid the use of cottonbuds or bobby pins to clean the ear canal. This is because the prodding action can make things worse by pushing wax back into the ear and may even cause damage to parts of the ear (Otolaryngol Head Neck Surg, 2008; 139 [3 Suppl 2]: S1-21).
Vol. 20 05 August 2009