Natural Standard Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
Arnold's nerve, auditory canal, auricular, bees wax, candle wax, candling, cerumen, cerumen impaction, ceruminolytic agents, ceruminous glands, coning, ear, ear canal, ear candles, ear candling, ear cones, ear coning, ear drum, ear impaction, ear oil, ear wax, external auditory canal, fainting, hearing loss, home remedies, otitis externa, otologic, outer ear, paraffin, soy wax, swimmer's ear, syncope, temporomandibular disorder, TMD, thermo-auricular therapy, tinnitus, tympanic membrane, vagus nerve, wax softeners.
Ear candling, also called thermo-auricular therapy or "coning," is a home remedy used for outer-ear hygiene and for general well-being. During an ear-candling session, the ear to be treated is oriented upwards: the patient's head faces left or right so that one ear is up and one ear is down. A wax-impregnated fabric tube is inserted into the outer ear, is ignited, and burns for about 10 minutes. (Since the tube is hollow, wax and burnt fabric may enter the outer ear.)
Some proponents claim that ear candles address problems such as ear aches, sinus infections, tinnitus (ringing in the ear), sinus pain and pressure, and vertigo. Some ear candlers claim that the process removes ear wax during the ear-candling session. Others say the procedure warms and softens ear wax, thus aiding its subsequent elimination. Another benefit cited is that smoke and heat directed into the outer ear dry up moisture that might otherwise cause infection.
The origins of ear candling are unclear. Among the ancient civilizations said by ear candle distributors and ear-candling practitioners to have used the technique are the Chinese, Indian, Tibetan, Egyptian, and Aztec civlizations, as well as the Hopi tribe in North America.
Earwax, or cerumen, is the soft, brownish yellow, waxy secretion (a modified sebum) of the ceruminous glands of the external auditory canal (outer ear). According to some researchers at the Royal Infirmary in Edinburgh, Scotland, some patients may have the misunderstanding that ear wax is a pathological (harmful) secretion and its mere presence is reason for its removal. In fact, the American Academy of Otolaryngology (AAO) advises that ear wax is a naturally occurring substance that cleans, protects, and lubricates the external auditory canal. In other words, ear wax is beneficial. Normally, earwax is eliminated by self-cleaning mechanisms, aided by chewing and other jaw movements, which cause old ear wax to "migrate" toward the outside of the ear, where it flakes off.
The American Academy of Otolaryngology (AAO) states that cerumen impaction (earwax buildup, or blockage in the ear canal) is a problem in one out of 10 children, one out of 20 adults, and one-third of geriatric or developmentally delayed populations. As a result, every year in the United States some 12 million persons seek medical attention for ear wax buildup, with eight million medical procedures performed.
Ear wax buildup may cause discomfort, hearing loss, or tinnitus. In some individuals, built-up ear wax may stimulate the auricular branch of the vagus nerve (Arnold's nerve), which may cause chronic cough, vomiting, or fainting. Ear wax may also contribute to otitis externa, or swelling of the outer ear and ear canal. (Otitis externa is commonly called swimmer's ear because of the relationship between excess moisture and swelling of the inner ear or ear canal.)
In addition, the presence of excess cerumen may obstruct the physician's view of the outer ear and ear canal, making visual examinations difficult.
Some research suggests that four percent of patients consult primary care physicians for cerumen impaction and that removal of earwax is the most common ear, nose, and throat (ENT) procedure performed in primary care.
Secondary sources suggest that ear candles may cost (in 2009) from $1.00 to $3.00. Spas and natural health practitioners sell ear-candling sessions at prices ranging between $25.00 and $75.00 per session.
According to the medical community and government overseers, such as the U. S. Food & Drug Administration (FDA), ear candling does not appear to offer health benefits. On the contrary, they say ear candling may cause burns to the face or hair and damage to the ear.
Ear candles are different from candles used for home decoration or birthday celebrations. An ear candle is a tube of fabric, usually linen or cotton, that has been soaked in food-grade paraffin wax, soy wax, or beeswax, and formed into a slender conical tube about 10 inches in length. Ear candles are available in 1/4-inch, 1/2-inch, and 3/4-inch diameters.
Ear-candling sessions are not self-administered. The person being treated lies with one ear down and the ear to be treated facing up. The candle is lit. Once smoke begins to emerge from the slender end, the slender end of the candle is placed in the outer ear canal to make a tight fit. As the candle burns, the practitioner trims burnt material or ash. When the candle is about three inches from the patient's ear (after burning about 10 minutes), it is removed and extinguished.
After the candle stub is removed, the outer part of the ear is cleaned with a cotton ball or swab. Then a cotton ball with a few drops of "ear oil" is placed on the outer ear. White Egret ear oil contains olive oil, lobelia, mullein, and garlic.
Ear candles are available with additives, such as essential oils (echinacea, tea tree, and eucalyptus, for example), and scents, such as lavender and peppermint.
Some who administer ear-candling sessions may also use massage, aromatherapy, music, and other relaxation aids.
The American Academy of Otolaryngology (AAO) recommends that individuals clean the outer part of their ears with a warm, moist washcloth. The AAO does not state how often individuals should clean the outer part of their ears. If earwax buildup is a problem, the AAO says individuals may try placing a few drops of mineral oil, baby oil, glycerin, or commercial wax-softening drops in the ear to moisten the earwax so that it may be ejected naturally. The AAO cautions that one should never insert any object in the ear canal.
Conventional clinician-administered procedures for cerumen impaction or blockage of the ear canal include warm-water irrigation with an ear syringe or oral jet irrigator, and manual removal using a curette, probe, hook, forceps, or suction. Such in-office treatments may be preceded with administration of mineral oil, baby oil, glycerin, or over-the-counter earwax softeners.
There are two principal theories about how ear candling works. One theory says that the burning candle creates a vacuum, which draws wax out of the ear. The other theory claims that no earwax is drawn out at the time of the candling. Instead, the earwax heats up, melts, and comes out of the ear over the following few days. One ear candle wholesaler in the "heat-melt" group states that earwax is not removed, but instead the smoke being directed into the ear canal dries moisture in the outer ear canal, moisture that otherwise might cause infection. (Excess moisture may cause otitis externa, an inflammation of the outer ear or ear canal, a malady that is commonly known as swimmer's ear.)
Skeptics have conducted both rigid and informal experiments to demonstrate the effectiveness of ear candles. Researchers at the Spokane Ear, Nose, and Throat Clinic in Spokane, Washington, built an artificial ear and took tympanometric measurements in their ear canal model, demonstrating that ear candles do not produce negative pressure. (A typanometer generates a sound that is directed toward the ear drum. The instrument then measures energy reflected back by the ear drum.) The researchers concluded that ear candles provide no benefit in the management of earwax, and their use may result in serious injury.
A limited clinical trial consisting of eight ears by the same Spokane-based research team showed no removal of earwax from the ear canal. In fact, candle wax was deposited in some.
Health Canada sponsored a study that tested the claim that heat helps melt earwax. It measured air temperature 10mm from the base of an ear candle while it was burning. The researchers measured a temperature of 22° C (72° F), well below normal body temperature.
The American Academy of Otolaryngology (AAO) advises that ear candles appear to be ineffective for earwax removal. The AAO cautions that ear candling may cause burns to the face and hair, obstruct the ear canal with candle wax, or perforate the membrane that separates the ear canal and the middle ear.
A survey of 122 otolaryngologists identified 21 ear injuries resulting from ear candle use, including burns, occlusion (blocking) of the ear canal, temporary hearing loss, otitis externa (inflammation of the outer ear and ear canal), and tympanic membrane perforation (ruptured or perforated eardrum).
Since ear candling is not an effective therapy for ear disorders, those using the technique may delay proper diagnosis and treatment.
The U. S. Food & Drug Administration (FDA) has received complaints directly from consumers about injuries received from ear-candling sessions.
Several ear candle distributors received letters from the FDA informing them that because ear candles are used to diagnose or treat a medical condition or are used to affect the structure or function of the body, they are considered to be medical devices. In their correspondence, the FDA informed the ear candle distributors that medical devices require marketing clearance from the FDA in order to be sold. The FDA's correspondence further stated that ear candles are dangerous to one's health when used as suggested in the company's literature. Other documents from the FDA cite burn hazards.
The FDA also said that no scientific evidence exists to demonstrate that ear candles work.
Both the FDA and Health Canada have issued directives banning the import of ear candles. The sale of ear candles for the purpose of ear candling is illegal in Canada, but is permitted in the United States.
Probably because of FDA attention, many sellers of ear candles state that their candles do not diagnose, treat, prevent, or cure disease. Several ear candle sellers indicate that their ear candles do not actually remove earwax, but rather use heat to soften earwax. Others say their products are for entertainment only and are not to be used for medical treatment. According to Health Canada, there are no reasonable uses for ear candles aside from medical uses. Health Canada says that those who claim their candles are for entertainment purposes are trying to get around Health Canada's Medical Devices Regulations and are selling ear candles illegally.
According to Health Canada, ear candles require a license from Health Canada to be used for therapeutic purposes, and they have issued none.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
American Academy of Otolaryngology (AAO). www.entnet.org
Ernst E. Ear candles: a triumph of ignorance over science. J Laryngol Otol. 2004 Jan;118(1):1-2. View Abstract
Health Canada. www.hc-sc.gc.ca
Jegoux F, Legent F, Beauvillain de Montreuil C. Lancet. 2002 Aug 24;360(9333):618. View Abstract
McCarter DF, Courtney AU, Pollart SM. Cerumen impaction. Am Fam Physician. 2007 May 15;75(10):1523-8. View Abstract
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com
Rafferty J, Tsikoudas A, Davis BC. Ear candling: should general practitioners recommend it? Can Fam Physician. 2007 Dec;53(12): 2121-2. View Abstract
Seely DR, Quigley SM, Langman AW. Ear candles--efficacy and safety. Laryngoscope. 1996 Oct;106(10):1226-9. View Abstract
Sharp JF, Wilson JA, Ross L, et al. Ear wax removal: a survey of current practice. BMJ. 1990 Dec 1;301(6763):1251-3. View Abstract
U. S. Food & Drug Administration (FDA). www.fda.gov
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017