Q-Tips (Photo credit: willc2)

As an Ear, Nose, and Throat Specialist for children, I am not only the self proclaimed “snot queen” but also the “wax queen”! Every clinic day I meet children of all ages who may be referred by their pediatricians and family doctors to having too much ear wax in the ear canal, making it impossible for their physician to tell if they have an ear infection or fluid behind their eardrum.  First, why do we have ear wax? read a great blog by Dr. Chris Chang on this, you will find in his blog lots of pictures, and explanation of the different type of wax that we see depending on race and background, and lots of other great information.  Ear wax serves many functions! Since our entire ear canal is lined by skin, ear wax that is produced keeps our ear canal from getting “pruny” much like the skin on your children’s fingers after swimming too long! once the skin is “pruny”, there may be tiny cracks in them, and the natural bacteria that lives in our ear canal can go through those cracks and cause “Swimmer’s Ear” or otitis externa.

However, too much wax of course could “block” the ear canal”, such that air can’t reach and vibrate the eardrum, and a whole lot of wax may even cause your child not to hear very well, and lead to turning up the TV volume and you having to repeat everything and child saying “Huh?” and “What” often!  Too much wax can also cause itchiness, discomfort, weird feelings when a child yawns or open jaw widely, as it shifts around in the ear canal and may rub up against the ear drum .  Bottom line, we need the wax but it’s important there is not too much build up to cause discomfort and possible decrease in hearing.

The ear canal is generally  “self-cleansing”, meaning the wax should typically come towards the outside “hole” or entrance of the ear canal. This way when we adults use the tip of the Q-tip and do a  gentle circular swab, we should be getting most of the build up on the outer part of this “canal” made up of cartilage.  Compared to adults, babies and children have much smaller ear canals! As they grow and their head grows, the ear canal size will increase but this takes years.  You can understand why then, in babies and young children, a good ear exam is not always easy and small amount of wax can easily block the view of the ear drum.

If your baby failed a newborn hearing screen, you should be referred to an ENT specialist as well as an “Audiologist”, which is a hearing professional for further testing. Babies who have excessive wax really need an ENT specialist to exam their ears under magnified microscope and special tools to gently clean out their ear canal without causing any trauma to the skin or worse, ear drum and related structures.

Here is what I recommend to parents about “cleaning” your child’s ear wax:

1.  For babies less than one year of age, parents really should not be inserting Q-tip into the “meatus” or opening of the ear canal. After bathing, if you see “yellowish” or “brownish” wax on the outside of the ear, in the “conchal bowl” or “cupped” part of the ear, you can gently wipe that away with a wash cloth.Once your child is older than one, you can clean their ears with only the very tip of the Q-tip, with care to never lose sight of the “white” and cotton part of the Q tip.
2.  Clean no more than 1-2 times per week, there is  no need for daily cleaning even though many of us adults do it as a habit.
Best time to clean if after showers and baths, since warmth and humiditiy will likely “soften” the wax.
Different people  make different types of wax, some are dry and flaky, some are moist, and wax comes in all different colors! so yellow, orange, dark brown, color does not mean anything!
3.  Pull ear gently and slightly backward and upward to straighten out the ear canal and allow the Q-tip for gentle insertion, no more than 4-5 mm.
If your child’s ear canal is big enough, you can make a “circular” rotation/motion with Q tip to hug the skin and ear canal as the wax is on the skin part.
4.  If your child says “Ouch”, then you’ve gone too far, or are too forceful,so PLEASE STOP.
5.  Keep all Q-tips away from children younger than 6, they should not be playing with it or trying to clean themselves.
6.  In case of accidental Q-tip injury, resulting in crying, pain, and even some bright red bleeding, you may need to take your child to see a physician to see if there was perforation of the ear drum.
7.  If your child won’t stay still, please do not WRESTLE with them trying to use a Q-tip,  since as they are whipping their head from one side to the other you may cause unintended injury with the Q-tip.
8.  There are “safety” Q-tips made for “babies”, basically a bigger cotton tip so that it can’t go too deep.
9.  Everytime you clean with Q-tip, look at the Q-tip when you are done to make sure cotton tip did not come off the plastic stick somehow and then is left in the ear canal, this can happen. (I do not buy the “cheaper” brands for this reason).
10.  I am not a fan of any “IRRIGATION” to the ear. Many ENTs and family doctor, pediatricians recommend water/vinegar/hydrogen peroxide to gently flush the ears.  People , including children, can get very dizzy and have vertigo as a “caloric response” from warm or cold liquid touching the eardrum. Also, it can be very scary and traumatic to children, so for my entire career I have never recommended irrigation by parents and in my office I do not use irrigation. You can if you want to, but please know you can’t be gentle enough and if your kid is screaming, I would not bother.
11.  For excessively hard wax, you can use 1-2 drops of baby oil /olive oil , place in ear canal with dropper, every night at bedtime for 3-4 nights and then still you should see ENT so we can gently remove it or suction it out in office with our special equipment under magnification and directly visualizing it to avoid trauma.
For school aged kids and older, if there is that much wax and you are instructed by health professional, you can use the over the counter “DEBROX” which you put in and then hopefully wax will come out. Again, it may not work for everyone, and only a health care provider who looks into the ear canal can tell you if all the wax has come out and now the ear drum is in plain sight.
12.  I DO NOT RECOMMEND “CANDLING” in children for fear of any burn injury. As you can see from the previous 16 points, there are so many options.

13.  Daily complaint about ear itchiness, pain, difficulty hearing, are not normal, so if your child is not getting better, or despite trying my tips, they keep complaining of their ears, PLEASE go see an ENT or pediatric ENT. Right diagnosis, right tools, right treatment, can make everything better quickly.

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Dr. Julie Wei is a pediatric ear, nose, and throat specialist and the author of A Healthier Wei. As a mother herself, Dr. Wei is a passionate advocate for improving children's health through better diet and dietary habits. She has been committed to helping parents learn how to eliminate their child's ear, nose, and throat problems simply by reducing excessive sugar and dairy intake, as well as minimizing habitual late night snacking. She hopes to raise awareness for the need for accountability by both medical professionals and parents to ensure that children are not prescribed or take unnecessary medications long term.

When she is not in the clinic, operating room, or conducting research, you will find her in the kitchen preparing food with love along with her daughter Claire. If you sit next to her on the plane, she will likely share with you information about how to minimize choking hazards in young children, and many other tips for improving your child's health.