I am a primary care physician, so ear wax is something I deal with every day (or every other day).
Medical advice is tailored to meet the needs of everyone, erring on the side of extreme caution.
Do I trust myself to insert a q-tip into my ear and not rupture my eardrum? Yes. Do I trust most highly intelligent hacker news readers? Probably.
Do I trust the bottom 10% of the general population (in IQ, dexterity, and good judgement)? Hell no.
Our medical system is a "no-miss" culture that has extreme life altering penalties for physicians that give medical care that leads to harm. Is rupturing an ear drum a big deal? I'm not so sure, but I bet you can find a plaintiff's attorney hungry enough to sue over it.
> Our medical system is a "no-miss" culture that has extreme life altering penalties for physicians that give medical care that leads to harm.
That is the problem. We expect physicians to be faultless, but they're not. If we applied the same standards to everything in life, then life would stagnate, if not grind to a halt.
This idea that everyone who passed their exams is equally qualified is a fiction. Let quacks back in and end defamation lawsuits that silence critics and leave it up to reputation and the market, contracts and standard criminal law. A much more dynamic market in medicine is necessary.
> end defamation lawsuits that silence critics and leave it up to reputation and the market
How can anyone rely on reputation in a world where there's no accountability when people systematically and mercilessly destroy someone's reputation?
Even most people who oppose copyright and patents still seem to understand that trademarks serve a singularly critical role in permitting a free market to operation. But the existence of trademarks necessarily require the ability to sue those who violate them. The same is true of reputation--reputation has no meaningful substance if the law does not provide a means for people to defend it. Without legally (i.e. community) enforceable accountability, a person's reputation is whatever the most powerful person or group says it is. That's literally a world where might is right; where free market is synonymous to law of the jungle.
Physicians are not at all expected to be faultless. They are expected to not provide advice that runs contrary to the current average assumption in their practice. That's the standard for malpractice.
> If we applied the same standards to everything in life, then life would stagnate
Which is exactly why we don't, and essentially no one is advocating for it. But different domains of life need different risk tolerances. Some amount of greater caution, to say the least, is warranted when you're dealing with people's health.
I noticed there are several medical doctors on Hacker News which is interesting.
My son is currently attending college in the USA. His dream is to get accepted into medical school. When you posted "Don't go to medical school.", are you being sarcastic? Or are you serious. Is medical school a dead end in 2022 in the USA?
I work with a few Drs and will pass along some common thoughts, doing this quickly on mobile so apologies.
In general:
If you want a nice balanced life, you should aim to open a private practice. However private practices are a dying breed due to cost for renovating/acquiring an office (150k at the very least for renovating yourself here in LA), shitty payouts by insurance (and getting worse), I saw a pay stub just today for $37 for a specialist visit (cash visit would be around $250 so Drs really hate taking even PPO insurance these days), etc. Few specialties can pull off a private practice such as: Plastic/Aesthetic, ophthalmology (doing LASIK and cataract surgery), and some others but usually these two have it the best. It's even harder if not in a very populous area, but then competition is rife, should be ready to shell out for marketing. The majority of physicians work in groups or hospitals. There is a lot of stress and responsibility if you are a surgeon, you should know that this kind of life is what you want.
In the end it depends on his goals, these days and evermoreso going forward physicians are just cogs in the system. You can get away by opening a private practice but there are plenty of challenges there. Getting into a nice residency program is mostly luck and medical school is rough. Not to mention the costs if you aren't well off.
If anyone wants to ask anything I'd be happy to answer in a bit more detail when I get time.
I can't speak to this personally but my brother is a physician and despite scoring well on his exams it took years to get a residency. Pedigree is still an issue, as-is nepotism and age discrimination it seems.
There are a limited number of residency slots allotted by the government each year so if you don't get one it's a whole year before you can apply again. It's certainly an archaic system, and the incentive by the medical lobby to expand residency programs is low presumably to protect wages. Even if you do jump through all the hoops, life as a doctor is a grind. Hospitals are businesses and your job is to see as many patients as possible. This is all coming from him and other family members who went through the whole ordeal.
I use a q-tip at least weekly, I've always produced a lot of wax, and keeping it in check is very important for my well-being (and ability to hear well).
I also own an endoscope camera that I use to check my ear canals, very clean ears, no sign of irritation, no visible wax deposits. Tympanic membranes always clean (of course I don't clean them! I guess they stay clean from the fact there's nothing in the canal to get onto them).
The "pushing the wax in" idea always seemed ridiculous to me, like, you'd only ever have that much wax if you never cleaned your ears in the first place, and your hearing would surely worsen a lot from it?
But yeah, I wouldn't trust my 2 year old with a q-tip and ears either..
To me, the way you've signed off with "Don't go to medical school" reads vaguely like "Carthago delenda est" - I have no idea if you actually say this all the time, but I wonder if you do.
If you’re a guy, then it usually flourishes later in life. Also your eyebrows. Most higher-end barber shops these days offer ear and eyebrow waxing to keep them trimmed.
Or you can let them grow out and scare old ladies and young children.
The thing that's lost on a lot of the discussion around earwax is that your ears will generally adjust to producing the right amount of wax, taking into account what activities you do. In the spring, when I first swim, I won't have enough earwax because I haven't been swimming, and water gets stuck in my ears. By the summer, they adjust, and water stays out of my ears. In the fall, when I stop swimming, I find that I now have too much ear wax and it feels uncomfortable. It tapers off in the winter back to the proper level.
Note also that if I use q-tips, this will also increase ear wax production, but will remove the protection it provides, and water will get stuck in my ears until it builds up again.
I've also found that using earplugs will increase production, as will drinking alcohol.
This is interesting to me, because water doesn't get stuck in my ears, ever. I can literally fill my ear with water and it flows right out as soon as I tip my head.
I don't have much earwax, but I do have an unusually large head 2XL hats barely fit), so I wonder if it's just that my ear canals are too big for surface tension to hold water against gravity.
Yes, this one surprising realization I came to during the pandemic. I habitually cleaned my ears before leaving for the office. When I needed to WFH, I stopped cleaning them because the habit had been disrupted. There was a lot of wax at first, but now I have just the right amount and never need to clear them.
The secret behind grooming (I've made it, I've finally discussed proper hygiene on HN and its contextually relevant) is that it boils down to 3 types:
1) Preference/Social - This is primarily smell and appearance-based. For example, you won't see medical problems from irregular bathing (as long as you keep wounds/orifices clean), not cutting your hair, or not wearing deodorant, society just politely asks that you do those things.
2) Modern-life Adaptions- This is things like tooth brushing. We need to do it more because of our modern diets than anything else.
3) Comfort - This is things like cutting your finder nails so you don't scratch yourself.
Using this framework, you realize you can get away with not doing a lot: pretty much everything except 2 is medically optional (especially after you let your body get back to homeostasis) - but keep in mind just because you and those close to you can't smell you, that does not mean strangers can't smell you.
Ear cleaning, FWIW falls mostly in 3, but maybe in extreme cases it becomes 1; if you're swimming a lot maybe it's a 2, but rarely is that true.
But also, given the above, please be considerate of others and do as much 1 as you're capable of.
Interesting fact, ear-cleaning can be medically necessary in extreme cases. Some rare people overproduce earwax to the point that it impacts their hearing. I knew a kid in middle school who was perfectly articulate but had a strange, guttural accent, because he'd been nearly deaf for his first several years of life, and hadn't quite caught up on intonation after diagnosis and treatment.
How does water get stuck in an ear? How could earwax possibly prevent water getting stuck? I.e. disallowing entry of water would also mean disallowing air and thus being clogged by wax.
Have you ever seen (in real life or a movie or a cartoon) when someone is hitting the side of their head against their hand after being submerged? Or hitting their hand against the side of their head, but this can be harmful. That's a thing people do when they get water stuck in their ear. You can feel it rolling around inside but it doesn't get out no matter how you orient your head. Only force, time, or special ear drops will dislodge it.
That isn't the question. It's how does earwax stop water from staying in your ear. I suspect it's the opposite. If you have almost no earwax and your ear canal is fully open, water can drain out. But if the canal is say 80% smaller at one point due to wac buildup, then perhaps water can be forced in from pressure and be difficult to drain.
It's a water repellant. My guess is that it's hydrophobic and causes the water to bead and roll out instead of smearing over the surface and clinging on.
PSA: they sell Ear Wax Removal Kits which contain bottle of diluted peroxide and washer bulb.
You put liquid in your ear and wait for it to soften wax for the few minutes. Then you turn over so the ear is facing down and use washer bulb with water to wash it out. You can wash out most plugs like this without going to the doctor.
Also they sell bluetooth ear cameras on Amazon so you can take a look inside to see if it requires additional cleaning.
This is what I do. Whether genetics or what, my ears get stopped to the point of deafness once or twice a year. Tried cleaning them out with just water and ended up with an ear infection. It's excruciating.
Now: Use Debrox (etc) following directions. Several applications of the liquid over a day or two. But most importantly, flush with bulb with very warm water (as hot as you can stand). Repeat, over and over. Once you start, don't stop, because you won't be able to fully dry your ear canal until you get all of the wax out. Water means infection. Make sure everything is very clean throughout the procedure.
Do it over a stopped sink or bowl, so that you can observe what's coming out.
After it's done, dry completely. I use the twisted end of a tissue, etc., to sop up most of the water. Then blow warm air into my ear for several minutes.
That seems completely different—the active ingredient in debrox is peroxide, which foams up and in theory loosens the earwax (a cerumenolytic). If you want to be cheap use diluted hydrogen peroxide.
But there seems to be mixed evidence as to whether it's any better than distilled water.
Continuing the theme of the article, there is no evidence that peroxide or whatever else they put in those kits works any better than lukewarm water. But peroxide is definitely more dangerous if you have an ear injury. I highly recommend just going with the water.
Also, it's definitely possible to rupture your eardrum with a squeeze bulb too. Given how incredibly loud it sounds when you do it, I bet it can damage your hearing even if you don't rupture your eardrum. Furthermore if you're doing it yourself there is no way to know if you've actually cleaned everything out or you need to do it harder, so you just have to go for it until you get tired. I find it exceedingly unpleasant.
My approach is to use an endoscope designed for earwax cleaning. Works great and (in the absence of reliable evidence) it seems to me to be the least risky way to do it since I can see exactly what I'm doing and know when I'm done. I highly recommend getting one, preferably the fiber optic kind rather than electronic, for latency and reliability reasons. They make them in Japan.
According to my ENT the weak peroxide solution is very safe to use, even with grommets.
As someone who has suffered barotrauma ear perforation, I find it hard to believe you would persist in using a squeeze bulb at that pressure as the pain is excruciating. When you get a perforated drum it's not a volume problem, sounds are actually muted, the cilia will be fine.
If you use plain tap water, make sure it is boiled in a kettle or on the stove first to kill any microbes. Hot tap water is not hot enough to kill microbes.
I swam a lot, and got a few ear infections as a kid, at least once resulting in a pretty extensive manual cleaning at an ENT's office.
As an adult, I would get my ears similarly stopped up at least once a year, and I found Debrox and what have you infuriating - that stuff would itch abominably as it worked, and make the problem worse for a week at least before the wax came out. I never saw instructions on flushing with water; likely that's my fault.
... but since I became engaged to a Japanese woman, I've had a mimikaki (a Japanese ear pick, often made of bamboo) which I use regularly, and never once have I plugged up since.
Yes, flushing with water is the important part. Temperature matters too, warm/hot water works better.
I swim a lot too and get a blockage at least once or twice a year. I used peroxide on it to varying results, sometimes it would work, sometimes not. Then I read that hot water flushing after the peroxide is the key part, and that works consistently for me now. I do it by getting in the shower and aiming a stream of hot water into the ear for a minute or so.
No less than an hour ago I found myself googling "endoscopy wifi password" and laughing.
The bluetooth endoscopy / ear camera I have has its own little wifi router inside. The thing looks like a pen flashlight. You stick it in your ear, use your "smartphone" to connect to the wifi and using an app shows the video inside my ear. And I'm wondering what happens if I can't recover the password. Vaguely wondering if there is somebody in China who can see inside my ear now (er... no)
I stopped using q-tips because after like 20-something years of using q-tips safely, it took one bad left-handed cleaning job to hurt my ear. I think I mostly got lucky. I went in too far with my non-dominant hand and caused some sharp pain on what is probably my ear drum. No hearing loss, nothing major, but it was pretty painful and more than enough to get me to stop. I was just like the author! I was like there's no way this can be bad as long as you don't go in too deep.
This is quite salient, two days ago I did the same thing. Left non dominate hand with a q-tip, no pain at all though really. I don't think i went too overly deep but the entire left side of my has felt blocked since, this article is making me think maybe I pushed the wax deeper and might have a blockage? Is this something you would consult a doctor over or does it usually work itself out?
Your local drug store has cleaner that can sit in your ear and dissolve ear wax, along with a special ear pick. In my experience it works well, especially if you have someone to do the awkward scooping after. YMMV if it works better than hydrogen peroxide and a qtip
It’s really not a big deal! It might work itself out over time but you can get one of those ear wax cleaning kits. In my uneducated experience, the formulation they come with doesn’t help a whole ton, but the key part is the rubber bulb you get to flush water into your ear. You’re gonna want to follow the kit’s instructions around safety, but it’s overall pretty easy and doesn’t take too long to clear up some fairly significant blockage.
When I was in school, there was a guy with a large over-ear hearing aid in one of his ears. I asked him about it.
He said he was cleaning his ear one day with a q-tip. His sister snuck up behind him with an aired up paper bag and popped it. "BOO!" He jumped and smashed the q-tip into his ear.
I did the same thing recently, after many decades of no accident. I woke up that night with blood dripping out of my ear. I taped a cotton ball to the outside of my ear, to prevent bedding from getting bloody. Next morning, I pulled the cotton ball off and it has a 1 in "blood worm" (that's what I'm calling it) attached. I called my PCP. It took 6 weeks for the last of the dried blood to fall out of my ear and for it to feel normal.
Mine was when the tip of one snapped off one day with no warning. Normally they bend a fair bit, maybe threaten to break. This one just broke and getting it out was very clearly one of those things where it could easily go wrong and become a real problem. Like others were saying my ears adjusted after a few months of crustiness and now it's all pretty reasonable in there.
I stopped doing it not because of real or imagined wax impaction, but because I had been doing it exactly the same way forever and one day it actually did perforate my eardrum. I guess my luck finally ran out. Now that's healed and I don't feel it's worth the risk to start again.
Not much pain. I significantly lost hearing in that ear immediately. There was not really any way to treat it apart from waiting for it to heal itself, which it did after about 4 weeks. Hard to tell whether it's truly as good as new though.
If you've only done it once and you're not too old it should be fine. But I would be careful flying with a blocked nose or doing any diving. Depends on how big your eustachian tubes are.
My biggest issue is ear hair that grows around and around and never comes close enough to pluck out. Drives me nuts. I know this because I've stuck a camera thing down there and have seen it. I suppose I need to see a specialist. This wasn't in the getting old brochure.
Once, after watching a video of a giant earwax plug being removed, I realized I probably had quite a bit stuck in there.
I very gently slid a q-tip into my ear, and all it did was push some earwax to a funny angle in my ear canal. It was quite painful. I went to the doctor and they used pressurized water to get the earwax out.
Unfortunately, they dumped the bin before I could see how much came out.
I had a plugged ear and had to get it cleaned out by a doctor. It was problematic for about 5 years, but I could just push on my ear a bit and hear again. Eventually, that stopped working.
When the doctor cleaned it out, a chunk of earwax about the size of a cigarette butt came out.
I used a few drops of paraffine oil in both ears, then in the next few weeks some small pieces of dark and hard earwax came out. I am using q-tips too and had slight worries about pushing wax into my ears. Turned out to be rightful worries somewhat.
Randomized control trials are great, and doctors are sometimes wrong, but RCTs are not the only way to reason about things. As a contrast, there are no RCTs about the effects of poking yourself in the eye with a sharp stick, but it's generally agreed to be a bad idea even without this evidence.
My anecdote is that I've tried to clear out wax with a Q-tip only to "clog" the ear. I could still hear a little out of the affected ear, and it wasn't painful, but it was very annoying. The only thing that eventually fixed it was flushing the ear with lots of warm water to get the wax plug out.
I often spend entire shifts with foam ear plugs in, they fairly regularly come out with some earwax on them. I found my replacement for q-tips, with no danger of perforating my eardrum!
Only tangentially related, non-scientific, probably not interesting to anyone else comment checking in. My puppy always licks the inside of my ears and since then they are super clean all the time (like no external earwax at all) but I am scared of getting an ear infection.
Me too. This article is missing one obvious detail. If you rub a Qtip back and forth against your skin, you will find that cotton fibers rub off. It doesn't take much to imagine this same phenomenon is also happening inside your ear canal when you rub the Qtip in there. When it does, those fibers stay inside there, collecting oil and dirt, leading to more earwax build-up, leading to more Qtips, leading to even more cotton fibers, etc. It's just a really bad solution to the problem. You don't need a study for something you can just observe first-hand yourself.
They do make plastic earwax cleaners that don't leave any debris inside your ears when used. Roughly shaped like a Qtip but without the cotton. Pretty cheap and also reusable, unlike Qtips. Available at any local pharmacy.
This is gross but I wish I could clear my ear wax like blowing my nose. I make way too much ear wax and hate it. I have a camera that connects to my phone for clearing it out. Wish I didn't make so much.
I agree that q-tips are next to useless but, there's a much better solution. In Japan, instead of q-tips, they use little (very little) bamboo spoons that are super effective at scooping out ear wax. They are about no more prone to mistakes than q-tips. Check out the Japanese specialty store near you, you'll never go back to q-tips.
I wear hearing aids, so I use q-tips every day after I shower to dry and clean my outer ear. Never had any problem with wax compaction, but I have scratched my ear canal which resulted in an infection a couple of times. You have to be gentle, don't grind away like you're brushing your teeth in a big hurry.
Funny I just had the thought this morning that the common held view of q-tips being bad feels bogus. I couldn't imagine not using them as after a day or two my ears start to feel noticeably clogged. My strategy is to twirl the q-tip around the outer edge of the inner ear, gently moving it further up a tad. It seems to work well.
I agree with the author, "you shouldn’t listen to me over actual doctors"
The article completely misses the medicolegal aspect of do no harm.
Not sure why people would risk safeguarding one of their main senses in name of "There’s Basically No Evidence For This"
Ignorant is, as ignorant does. ¯\_(ツ)_/¯
Has anyone seen blood leaking out of the ear when the crochet hook was retracted? How about stench of pus and dealing with infection from toothpicks, q-tips, bobby hairpins and other assorted instruments. Doctors and other providers see this more frequently than probably most HN readers.
As a former ex-NP student, I know syringe irrigation works, the patient was profusely 'life altering' thankful with a souvenir chunk of cerumen to prove it.
I really believe it takes real world experience, personal or clinical to provide evidence of outcomes, until then Dr. Google, like talk is cheap.
OR
dismiss clinical experience, keep on with the internet home remedies and support your local EENTs to clean up the mess :-)
I always assumed that the reason that the guidance was against using Q-Tips to clean your ears was one of legal exposure for the cases where there is a problem.
Western medicine says "don't put q-tips in your ears". Japanese (and Chinese?) seem very different. You can find these at any medicine store in Japan, possibly even every convenience store
You drag the stick around until you find the hotspot (background changes when you're close). Then, once you find it you need to drag it back out. The joke is it either tells you how many grams if "ear-shit" you pulled out or you find some random silly item. In the Apple app store screenshots one card shows pulling out a dandelion.
Not that even in Japan, some doctors advise you shouldn't do it
All that said, my father told me he had a friend that lost hearing in one ear when he had a q-tip in and his wife bumped his elbow. I have no idea if that was true but it stuck with me and I although I use q-tips to clean my ears I stop if there is anyone in the same room.
Personal anecdote, but I have a strong feeling that if you never clean your ears, you never feel the need to. But once you start cleaning them, and you feel the difference it becomes something that is hard to stop doing. I wish I had never started.
Medical advice is tailored to meet the needs of everyone, erring on the side of extreme caution.
Do I trust myself to insert a q-tip into my ear and not rupture my eardrum? Yes. Do I trust most highly intelligent hacker news readers? Probably.
Do I trust the bottom 10% of the general population (in IQ, dexterity, and good judgement)? Hell no.
Our medical system is a "no-miss" culture that has extreme life altering penalties for physicians that give medical care that leads to harm. Is rupturing an ear drum a big deal? I'm not so sure, but I bet you can find a plaintiff's attorney hungry enough to sue over it.
Don't go to medical school.