剖析耳屎 清除耳垢的好處與壞處大綱

Ears are supposed to be self-cleaning. So what's behind the fascination some people have to help nature along?

耳朵被認爲有自我清潔功能。那爲什麼有些人還喜歡多此一舉？

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.

約1,200萬美國人爲了清除耳垢而每年看醫生。還有上百萬人在水療院和耳燭美容院清除耳垢，後者理論上是藉助點燃的蠟燭把耳垢吸出來。根據市場研究機構歐睿國際(Euromonitor International)的數據，去年，北美人還花了6,300萬美元購買各類家用清除耳垢產品，從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.

在網絡健康論壇上，人們狂熱地討論着挖耳垢的罪惡快感──儘管有些人懷疑如此愛挖耳垢是否有問題。

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.

還有些人不以爲然。印第安納波利斯(Indianapolis)的網絡商務經理霍利?凱爾(Holly Kile)說：“我很喜歡把耳朵掏乾淨。”她說，她每天用棉籤掏耳朵，每隔幾個月用耳燭吸一次耳垢，她12歲的兒子也是如此。她說：“我們通常會比賽，看誰掏出的耳垢最多。”

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.

醫生們強烈反對用棉籤或耳燭清除耳垢，並稱除非耳垢導致不良症狀，否則應該不要去管它。

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.

耳垢的正式名稱是耵聹，它是耳朵自我清潔系統的一部分，目的是阻止進入耳道的灰塵、污物、細菌──甚至是蟲子──並把它們趕出去。耳垢和沉積的廢屑被活動的下顎推動，它的增長速度和手指甲大致相同。當耳垢到達耳道口時，通常會變幹、變薄並掉出來，且通常不會被人類注意到。

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.

這個過程並非總是一帆風順。耳垢太多、太乾或太黏都會導致耳垢堆積。這主要是由基因決定的。位於布魯克林(Brooklyn)的紐約州立大學下州醫學中心(SUNY Downstate Medical Center)的耳鼻喉科主任理查德?羅森菲爾德(Richard Rosenfeld)說：“在耳垢這個問題上，要選好父母。”

Wearing ear-bud headphones, hearing aids or ear plugs for long periods can also interfere with orderly extrusion.

長期戴耳塞式耳機、助聽器或耳塞都可能影響耳垢的規律性排出。

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.

當多餘的耳垢變硬或被擠回耳道下方時，可能會導致耳塞。根據美國耳鼻喉-頭頸外科學會(American Academy of Otolaryngology-Head and Neck Surgery)的數據，兒童的耳塞發病率約爲10%，健康成人的耳塞發病率約爲5%，而養老院中的老人耳塞發病率高達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.

耳垢堆積的症狀包括感到耳塞、耳癢、眩暈、耳疼、耳鳴（耳內持續鳴響）或咳嗽──美國耳鼻喉學會2008年耳垢治療指南的作者之一羅森菲爾德博士解釋說，這與連接耳朵和隔膜的神經通路有關。

Excess earwax is also the most common cause of partial hearing loss -- and the most treatable.

耳垢過多也是部分聽力喪失的最常見原因──也是最好治療的。

'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.

紐約的耳鼻喉科醫生薩拉?斯塔克波爾(Sarah Stackpole)說：“他們是我一天中見到的最高興的病人。你爲他們清除耳垢後，他們說：‘哦，天哪，我能聽見了！’”

Removing it at home is an option -- if you can do it safely.

在家清除耳垢也是一種選擇──如果你手法安全的話。

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.

醫生勸告說，這並不是說可以用棉籤捅、用髮夾或其他工具伸進耳朵裏挖。將任何東西伸入耳道都有令鼓膜穿孔的危險。實際上，越想把耳垢挖出來，通常越會把它捅得更深──加利福尼亞州羅斯維爾(Roseville)Sutter Roseville Pediatrics的醫師助理羅德?莫澤(Rod Moser)說：“就像爲加農炮裝彈一樣。”

'Do not go mining for it, ' adds Mr. Moser, who writes the Family Webicine blog for WebMD.

爲WebMD撰寫“家庭網絡醫藥”(Family Webicine)博客專欄的莫澤說：“不要去挖它。”

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 .)

專業人士的建議還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)稱：“當你打仗時，不要拿舊武器──否則就是選擇了你能找到的最差的武器。”這本書在亞馬遜網站()上有售，價格爲10美元。）

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.

經常挖耳垢可能會刮掉耳道內的保護性耳垢，導致耳道暴露在潮氣中，容易感染。莫澤說：“有些人──你知道你屬於哪種人──對每次淋浴後用棉籤掏耳朵上了癮。”

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.

醫生建議的是用幾滴礦物油、嬰兒油、市面上有售的那些滴耳液或雙氧水軟化硬耳垢，然後讓變軟的耳垢自行掉出。

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.

醫生們說，如果還不管用，就試着用洗耳球小心灌耳。或者在淋浴時歪着頭，幾分鐘後，直起身讓水再次流出來。羅森菲爾德博士說：“水和10美元一瓶的滴耳液一樣管用。”但醫生們表示，高壓水流，包括改造過的洗牙器，可能會造成傷害。

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.

一位母親在清理兒子耳朵中的耳垢

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.

藥店賣的“真空吸耳器”通常也沒有效果。2005年英國一項針對16名病人進行的研究的論文發表在了《臨牀耳鼻喉科學》(Clinical Otolaryngology)上，這些病人中，沒有人稱使用真空吸耳器後聽力有好轉。鼓膜能見度也沒有改善。實際上，耳垢根本沒有被清除。

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.

自己挖耳垢還有一個問題：很難看到自己在做什麼，除非你購買了像Coden Ear Scope TV（eBay上售價爲150美元至300美元）這樣昂貴的產品，它有一個發光的放大攝像頭，可以將耳道中的圖像傳輸到電腦或電視屏幕上。

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.

醫生們對耳燭尤其不屑一顧。斯塔克波爾博士說：“我認爲那是魔鬼乾的勾當。”這種方法使用一根細長中空的錐形蠟燭。病人側躺着，蠟燭底部放在耳朵上，並點燃另一端，這樣理論上可以在內部產生真空，吸出耳垢。

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.

許多醫生──以及美國食品和藥物管理局(Food and Drug Administration)──警告說，這可能使熱蠟滴入嬌嫩的耳組織，導致灼傷，甚至點燃頭髮。醫生們說，這種方法不管用──錐管內的棕色膠狀物是燭蠟，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.

如果軟化滴耳液和灌耳不管用，那麼是時候找專家幫忙了──可以是護士、醫生助手、初級護理醫生甚或耳鼻喉科專家。許多人依靠滴耳液和灌耳，但有些人也使用小吸管或被稱作耳刮匙的鐵圈形工具。有些耳鼻喉科專家還使用附在耳壁上的顯微鏡，好看到耳道中的3D圖像。

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.

使用耳刮匙讓診療過程更像是“手術”，它有自己的診療標準，醫療費用可高達100美元。只用水沖洗不能保證符合診療標準。許多藥店的坐堂醫生還提供60美元至80美元（根據方法而定）的清除耳垢服務。

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.

俄勒岡州波特蘭(Portland)美國國家聽力康復研究中心(National Center for Rehabilitative Auditory Research)的調研員羅伯特?福爾默(Robert Folmer)說，即使是訓練有素的專家在清除耳垢時也可能會失手。他在2004年參與了一項調查，調查對象是俄勒岡州一家聽力診所的2,400名病人，其中11人稱，他們的耳鳴是專家在清除耳垢時導致的。

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.

還有些研究發現，每1,000次灌耳中，大約會出現一次鼓膜穿孔、感染和聽力喪失。福爾默博士說：“有些醫生很自信，但這不是蓋房子。你必須手法輕柔。”他建議病人詢問醫生他們計劃使用的方法，以及治療將進行多少次。