The Good, The Bad And The Eww Of Earwax Removal 清除耳垢的好处与坏处
Ears are supposed to be self-cleaning. So what's behind the fascination some people have to help nature along?
Some 12 million Americans visit medical professionals annually for earwax removal. Millions more have it done at spas and ear-candling parlors, which theoretically suck out earwax with a lighted candle. North Americans also spent $63 million last year on home ear-cleaning products, from drops to irrigation kits, according to market research firm Euromonitor International. 约1,200万美国人为了清除耳垢而每年看医生。还有上百万人在水疗院和耳烛美容院清除耳垢，后者理论上是借助点燃的蜡烛把耳垢吸出来。根据市场研究机构欧睿国际(Euromonitor International)的数据，去年，北美人还花了6,300万美元购买各类家用清除耳垢产品，从滴耳液到灌耳工具包，不一而足。
On Internet health forums, people wax rhapsodic about the guilty pleasure of having their earwax removed -- though some wonder if it's wrong to enjoy it so much.
Others are unabashed. 'I absolutely love to have my ears cleaned, ' says Holly Kile, an online business manager from Indianapolis who says she uses cotton swabs daily and has her ears candled every couple of months, as does her 12-year-old son. 'It's generally a competition to see who has the grossest things come out, ' she says.
Doctors strongly discourage using cotton swabs or ear candling to remove earwax and say that unless it's causing bothersome symptoms, earwax should be left alone.
Officially known as cerumen, earwax is part of the ear's own cleaning system, designed to stop incoming dust, dirt, bacteria -- even bugs -- in the ear canal and ferry them out again. The wax and trapped debris are propelled along by the movements of the jaw, at about the same speed that fingernails grow. When it reaches the ear opening, the wax usually dries, flakes and falls out, often without the human host noticing.
The process isn't always smooth. Having too much earwax, or wax that is too dry or too sticky, can create a buildup. Much of that is genetically determined. 'When it comes to earwax, choose your parents well, ' says Richard Rosenfeld, chair of otolaryngology at SUNY Downstate Medical Center in Brooklyn.
这个过程并非总是一帆风顺。耳垢太多、太干或太黏都会导致耳垢堆积。这主要是由基因决定的。位于布鲁克林(Brooklyn)的纽约州立大学下州医学中心(SUNY Downstate Medical Center)的耳鼻喉科主任理查德?罗森菲尔德(Richard
Wearing ear-bud headphones, hearing aids or ear plugs for long periods can also interfere with orderly extrusion.
When excess earwax hardens or gets pushed back down the canal, it can become impacted, which afflicts approximately 10% of children, 5% of healthy adults and up to 57% of older patients in nursing homes, according to the American Academy of Otolaryngology -- Head and Neck Surgery.
当多余的耳垢变硬或被挤回耳道下方时，可能会导致耳塞。根据美国耳鼻喉-头颈外科学会(American Academy of Otolaryngology-Head and Neck Surgery)的数据，儿童的耳塞发病率约为10%，健康成人的耳塞发病率约为5%，而养老院中的老人耳塞发病率高达57%。
Symptoms of earwax buildup include a feeling of fullness, itching, vertigo, pain, tinnitus (a persistent ringing in the ears) or coughing -- due to a nerve pathway that connects the ear with the diaphragm, explains Dr. Rosenfeld, who co-authored the American Academy of Otolaryngology's 2008 guidelines for treating earwax.
Excess earwax is also the most common cause of partial hearing loss -- and the most treatable.
'Those are the happiest patients of my day. You clean out their ears and they say, 'Oh my God, I can hear!', ' says Sarah Stackpole, an otolaryngologist (also known as an ear, nose and throat specialist) in New York City.
Removing it at home is an option -- if you can do it safely.
That doesn't mean poking cotton swabs, bobby pins or any other implement into the ear to retrieve it, doctors implore. Putting anything into the ear canal risks piercing the eardrum. In fact, attempts to dig earwax out generally pack it in further -- 'like loading a Civil War cannon, ' says Rod Moser, a physician assistant at Sutter Roseville Pediatrics, Roseville, Calif.
医生劝告说，这并不是说可以用棉签捅、用发夹或其他工具伸进耳朵里挖。将任何东西伸入耳道都有令鼓膜穿孔的危险。实际上，越想把耳垢挖出来，通常越会把它捅得更深──加利福尼亚州罗斯维尔(Roseville)Sutter Roseville Pediatrics的医师助理罗德?莫泽(Rod Moser)说：“就像为加农炮装弹一样。”
'Do not go mining for it, ' adds Mr. Moser, who writes the Family Webicine blog for WebMD.
That edict also includes imaginative ear-cleaning implements such as bamboo ear spoons and miniature Samurai swords. ('When you're going to war, you don't take just any old weapon -- you take the baddest weapon you can find, ' boasts the Katana/Sword Ear Pick Cleaner, sold for $10 on Amazon.com.)
专业人士的建议还包括不要用富有想象力的工具，包括竹挖耳勺和微型武士刀。（《武士刀耳挖勺》(Katana/Sword Ear Pick Cleaner)称：“当你打仗时，不要拿旧武器──否则就是选择了你能找到的最差的武器。”这本书在亚马逊网站
Frequent cleaning can also strip the protective wax from the ear canal lining, leaving it exposed to moisture and vulnerable to the infection. 'Some people -- and you know who you are -- are literally addicted to Q-Tipping their ears after every shower, ' says Mr. Moser.
Instead, doctors recommend softening impacted earwax with a few drops of mineral oil, baby oil, commercial ear drops or hydrogen peroxide. Then allow the loosened wax to work its way out naturally.
If it still needs help, try gentle irrigation with a bulb syringe or tilt your head in the shower, say doctors. After a few minutes, straighten up and let the water run out again. 'Water works just as well as a $10 bottle of ear drops, ' says Dr. Rosenfeld. But doctors say high-pressure water streams, including repurposed jet-tooth cleaners, can be damaging.
Over-the-counter 'ear vacs' are also generally ineffective. In a British study of 16 patients, published in Clinical Otolaryngology in 2005, none reported hearing better after using an ear vac. There was no improvement in visibility of the ear drum and in fact, no ear wax removed at all.
Another problem with do-it-yourself earwax removal: It's hard to see what you're doing, unless you pop for a pricey product like the Coden Ear Scope TV ($150 to $300 on eBay), a lighted magnifying camera that relays images of your ear canal to a computer or TV screen.
Doctors are particularly scornful of ear candling. 'I think it's the work of the devil, ' says Dr. Stackpole. The process uses a long, hollow cone-shaped candle. The patient lies down on one side, the bottom of the candle is placed in the ear and the other end is set ablaze, theoretically creating a vacuum inside that draws out the wax.
自己挖耳垢还有一个问题：很难看到自己在做什么，除非你购买了像Coden Ear Scope TV（eBay上售价为150美元至300美元）这样昂贵的产品，它有一个发光的放大摄像头，可以将耳道中的图像传输到电脑或电视屏幕上。
Many physicians -- and the Food and Drug Administration -- warn that it can drop hot wax into delicate ear tissues, cause burns or even set hair on fire. Doctors also say it doesn't work -- that brown, gooey stuff inside the cone is candle wax, not earwax.
If softening drops and irrigation don't work, it's time to seek professional help -- from a nurse, physician's assistant, primary-care physician or ear, nose and throat specialist. Many rely on drops and irrigation, but some also use small suction devices and a wired loop instrument called a curette. Some ENTs also have microscopes that attach to the wall and give them a 3-D view into the canal.
许多医生──以及美国食品和药物管理局(Food and Drug Administration)──警告说，这可能使热蜡滴入娇嫩的耳组织，导致灼伤，甚至点燃头发。医生们说，这种方法不管用──锥管内的棕色胶状物是烛蜡，而不是耳垢。
Even trained specialists can get carried away when it comes to removing earwax, says Robert Folmer, an investigator at the National Center for Rehabilitative Auditory Research in Portland, Ore. He co-authored a 2004 survey in which 11 of 2, 400 patients at an Oregon hearing clinic said their tinnitus was caused by a professional earwax removal.
Other studies have found that eardrum perforation, infection and hearing loss occur at a rate of about 1 per 1, 000 irrigations. 'Some doctors are really determined, but it isn't like it's a construction project, ' Dr. Folmer says. 'You've got to be gentle.' He suggests that patients ask a clinician what method they plan to use, and how many times they've done the procedure.
Aside from earwax 'overproducers, ' who can benefit from a professional cleaning a few times a year, doctors say the average person should not require ear cleaning unless the wax is causing bothersome symptoms or impeding a doctors' ability to examine the eardrum. 'I'd tell the doctor, 'I really like my earwax. Leave it alone, please', ' says Dr. Rosenfeld.
俄勒冈州波特兰(Portland)美国国家听力康复研究中心(National Center for Rehabilitative Auditory Research)的调研员罗伯特?福尔默(Robert Folmer)
But some patients can't. Dr. Stackpole says she gives earwax-removal addicts an antibiotic cream to dab at the opening of their ears once a day. 'I do that rather than telling them to do nothing, because they are not capable of doing nothing, ' she says.