It's an old saying, but one some parents are sure to admonish their children with at bath time, repeating what they heard as kids from their own parents once upon a time.
And many of those adults still adhere to the notion that the only clean ear is an ear devoid of wax.
But doctors say wax has nothing to do with poor hygiene and is merely the body's way of shielding the delicate inner workings of the ear and protecting precious hearing.
"The first thing that everybody should recognize is it's not dirt, it's not something that has to be removed," says Dr. Ronald Fenton, an otolaryngologist (ear, nose and throat specialist) at St. Michael's Hospital in Toronto.
"A lot of people think that their personal hygiene is less than perfect if they don't remove their wax," he says. "That's the first thing they've got to be disabused of."
Ear wax, known medically as cerumen, is comprised of sloughed-off dead skin and a sticky substance secreted from glands in the outer third of the ear canal.
"Basically, it is a protective barrier," says Fenton, stopping dirt, microbes, insects and water from making their way into the middle or inner chambers of the ear.
The type of ear wax a person has — wet or dry — seems to be determined by genetics: Caucasians and Africans typically have wet wax, which can range in colour from golden brown to dark brown, while Asians and Aboriginals are more likely to have dry wax, which is greyish in colour and tends to be flakier.
No matter which kind a person has, it serves some important functions," explains Dr. Charles Beatty, an otolaryngologist at the Mayo Clinic in Rochester, Minn.
"It can be a bit of a lubricant for the skin — it keeps (the ears) from getting too dry and the skin from getting scaly and itchy — and can protect against fungus and bacterial infections in the ear canal," he says.
Still, most people seem determined to root out wax from their ears — using a variety of implements, from cotton swabs to gadgets better left to their intended purposes, the doctors say.
"There's sort of the old adage: Don't put anything bigger or smaller than your elbow in your ear," says Beatty, who lists hairpins and car keys among the devices some people employ.
Even a cotton swab, seemingly designed for the job, will often end up "just pushing a fair amount of the wax deeper and deeper into the ear canal," he says.
"We see far more problems from over-aggressive or overzealous attempts to clean wax by individuals or even occasionally by health-care providers than we see from having an accumulation of wax."
While many people have likely managed to clean the wax out of their ears without incident for years, there are those who haven't been so fortunate, says Fenton.
"In trying to remove it, people often get into trouble ... they've got a Q-tip in their ear and somebody nudges their elbow and all of a sudden they've done serious damage to their middle ear."
The Toronto physician gets about two or three cases referred to him each year in which the patient has inadvertently punctured an ear drum or pushed the three tiny vibrating bones of hearing, called ossicles, out of position.
These injuries cannot always be resolved, even with surgery, and can lead to permanent hearing loss.
"That's the most severe injury that you can self-inflict," Fenton says.
Beatty also sees his share of patients who have damaged the inner workings of an ear, all in the pursuit of wax removal.
"We've seen tiny bones in the middle ear fractured because of excessive pressure or inadvertent injury with a Q-tip or another rigid instrument in the ear," he says.
While people are generally encouraged to do no more than clean their outer ears with a warm, damp facecloth, there are cases when excessive wax will form a plug in the ear canal, potentially causing ear ache, a feeling of fullness, ear noise called tinnitus, and diminished hearing.
"For most patients, a healthy amount of wax is a good thing," says Beatty. "Too much or impacted wax, anything blocking the ear canal, can be a problem.
"Sometimes, when it's really dried and hard, it's almost like a little pebble in the ear. It can be uncomfortable or painful. So that's when we have to remove the wax and get it out of there."
Using an otoscope, an instrument that lights and magnifies the inner ear, the doctor can remove a wax plug using a small, curved instrument called a curette, a suctioning device or a rubber-bulb syringe filled with warm water.
Before visiting the physician, the patient is usually advised to soften the wax for three or four days by applying a few drops of baby oil, mineral oil, glycerine or hydrogen peroxide into the blocked ear canal.
Fenton suggests putting the drops in before going to bed and stuffing some cotton batten in the ear to stop the liquid running out.
Both he and Beatty advise against "ear candling," an alternative medicine practice believed to treat a number of conditions, including the removal of excessive wax.
An ear candle is a narrow, hollow cone that has been soaked in beeswax or paraffin and allowed to harden. The cone is inserted into a person's ear, lit at the top and allowed to burn for a few minutes. The heated cone is said to soften and draw up the wax.
But research suggests ear candling has no medical benefits and is potentially hazardous, and both Health Canada and the U.S. Food and Drug Administration warn consumers to avoid the practice.
"There's no scientific data to support this as an effective mechanism of removing wax from one's ear," says Beatty.
"There have been ear-drum and ear-canal injuries from trying to insert this into the ear. There have been hair fires and facial burns from someone trying to light (the cone) and get it angulated properly and tipped — and they end up catching their hair on fire."
And after all, it's only ear wax — something most people really shouldn't be concerned about, says Fenton.
"There's probably no great magic. But when in doubt, leave your ears alone."
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