Ears are supposed to be self-cleaning. So what's behind the fascination¹ some people have to help nature along?

耳朵被认为有自我清洁功能。那为什么有些人还喜欢多此一举？

Some 12 million Americans visit medical professionals annually² for earwax removal. Millions more have it done at spas and ear-candling parlors³, 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 kits⁴, according to market research firm Euromonitor International.

约1,200万美国人为了清除耳垢而每年看医生。还有上百万人在水疗院和耳烛美容院清除耳垢，后者理论上是借助点燃的蜡烛把耳垢吸出来。根据市场研究机构欧睿国际(Euromonitor International)的数据，去年，北美人还花了6,300万美元购买各类家用清除耳垢产品，从滴耳液到灌耳工具包，不一而足。

On Internet health forums⁵, people wax rhapsodic about the guilty pleasure of having their earwax removed -- though some wonder if it's wrong to enjoy it so much.

在网络健康论坛上，人们狂热地讨论着挖耳垢的罪恶快感──尽管有些人怀疑如此爱挖耳垢是否有问题。

Others are unabashed. 'I absolutely love to have my ears cleaned, ' says Holly⁶ 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.

还有些人不以为然。印第安纳波利斯(Indianapolis)的网络商务经理霍利?凯尔(Holly Kile)说：“我很喜欢把耳朵掏干净。”她说，她每天用棉签掏耳朵，每隔几个月用耳烛吸一次耳垢，她12岁的儿子也是如此。她说：“我们通常会比赛，看谁掏出的耳垢最多。”

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.

医生们强烈反对用棉签或耳烛清除耳垢，并称除非耳垢导致不良症状，否则应该不要去管它。

Officially known as cerumen, earwax is part of the ear's own cleaning system, designed to stop incoming dust, dirt, bacteria -- even bugs⁷ -- in the ear canal and ferry them out again. The wax and trapped debris⁸ are propelled along by the movements of the jaw⁹, at about the same speed that fingernails grow. When it reaches the ear opening, the wax usually dries, flakes¹⁰ and falls out, often without the human host noticing.

耳垢的正式名称是耵聍，它是耳朵自我清洁系统的一部分，目的是阻止进入耳道的灰尘、污物、细菌──甚至是虫子──并把它们赶出去。耳垢和沉积的废屑被活动的下颚推动，它的增长速度和手指甲大致相同。当耳垢到达耳道口时，通常会变干、变薄并掉出来，且通常不会被人类注意到。

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 genetically¹¹ determined¹². 'When it comes to earwax, choose your parents well, ' says Richard Rosenfeld, chair of otolaryngology at SUNY Downstate Medical Center in Brooklyn.

这个过程并非总是一帆风顺。耳垢太多、太干或太黏都会导致耳垢堆积。这主要是由基因决定的。位于布鲁克林(Brooklyn)的纽约州立大学下州医学中心(SUNY Downstate Medical Center)的耳鼻喉科主任理查德?罗森菲尔德(Richard Rosenfeld)说：“在耳垢这个问题上，要选好父母。”

Wearing ear-bud headphones, hearing aids or ear plugs for long periods can also interfere¹³ with orderly extrusion¹⁴.

长期戴耳塞式耳机、助听器或耳塞都可能影响耳垢的规律性排出。

When excess earwax hardens or gets pushed back down the canal, it can become impacted, which afflicts¹⁵ 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.

当多余的耳垢变硬或被挤回耳道下方时，可能会导致耳塞。根据美国耳鼻喉-头颈外科学会(American Academy of Otolaryngology-Head and Neck Surgery)的数据，儿童的耳塞发病率约为10%，健康成人的耳塞发病率约为5%，而养老院中的老人耳塞发病率高达57%。

Symptoms of earwax buildup include a feeling of fullness, itching¹⁶, vertigo¹⁷, pain, tinnitus (a persistent¹⁸ 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.

耳垢堆积的症状包括感到耳塞、耳痒、眩晕、耳疼、耳鸣（耳内持续鸣响）或咳嗽──美国耳鼻喉学会2008年耳垢治疗指南的作者之一罗森菲尔德博士解释说，这与连接耳朵和隔膜的神经通路有关。

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

耳垢过多也是部分听力丧失的最常见原因──也是最好治疗的。

'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.

纽约的耳鼻喉科医生萨拉?斯塔克波尔(Sarah Stackpole)说：“他们是我一天中见到的最高兴的病人。你为他们清除耳垢后，他们说：‘哦，天哪，我能听见了！’”

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

在家清除耳垢也是一种选择──如果你手法安全的话。

That doesn't mean poking¹⁹ cotton swabs, bobby pins or any other implement²⁰ into the ear to retrieve²¹ it, doctors implore²². 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 cannon²³, ' says Rod Moser, a physician assistant at Sutter Roseville Pediatrics, Roseville, Calif.

医生劝告说，这并不是说可以用棉签捅、用发夹或其他工具伸进耳朵里挖。将任何东西伸入耳道都有令鼓膜穿孔的危险。实际上，越想把耳垢挖出来，通常越会把它捅得更深──加利福尼亚州罗斯维尔(Roseville)Sutter Roseville Pediatrics的医师助理罗德?莫泽(Rod Moser)说：“就像为加农炮装弹一样。”

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

为WebMD撰写“家庭网络医药”(Family Webicine)博客专栏的莫泽说：“不要去挖它。”

That edict also includes imaginative ear-cleaning implements²⁴ 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 Amazon.com.)

专业人士的建议还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)称：“当你打仗时，不要拿旧武器──否则就是选择了你能找到的最差的武器。”这本书在亚马逊网站(Amazon.com)上有售，价格为10美元。）

Frequent cleaning can also strip the protective wax from the ear canal lining²⁵, leaving it exposed to moisture and vulnerable to the infection. 'Some people -- and you know who you are -- are literally²⁶ addicted²⁷ to Q-Tipping their ears after every shower, ' says Mr. Moser.

经常挖耳垢可能会刮掉耳道内的保护性耳垢，导致耳道暴露在潮气中，容易感染。莫泽说：“有些人──你知道你属于哪种人──对每次淋浴后用棉签掏耳朵上了瘾。”

Instead, doctors recommend softening²⁸ 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.

医生建议的是用几滴矿物油、婴儿油、市面上有售的那些滴耳液或双氧水软化硬耳垢，然后让变软的耳垢自行掉出。

If it still needs help, try gentle irrigation with a bulb syringe or tilt²⁹ 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.

医生们说，如果还不管用，就试着用洗耳球小心灌耳。或者在淋浴时歪着头，几分钟后，直起身让水再次流出来。罗森菲尔德博士说：“水和10美元一瓶的滴耳液一样管用。”但医生们表示，高压水流，包括改造过的洗牙器，可能会造成伤害。

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.

一位母亲在清理儿子耳朵中的耳垢

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.

药店卖的“真空吸耳器”通常也没有效果。2005年英国一项针对16名病人进行的研究的论文发表在了《临床耳鼻喉科学》(Clinical Otolaryngology)上，这些病人中，没有人称使用真空吸耳器后听力有好转。鼓膜能见度也没有改善。实际上，耳垢根本没有被清除。

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 cone³⁰-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 ablaze³¹, theoretically creating a vacuum inside that draws out the wax.

自己挖耳垢还有一个问题：很难看到自己在做什么，除非你购买了像Coden Ear Scope TV（eBay上售价为150美元至300美元）这样昂贵的产品，它有一个发光的放大摄像头，可以将耳道中的图像传输到电脑或电视屏幕上。

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.

医生们对耳烛尤其不屑一顾。斯塔克波尔博士说：“我认为那是魔鬼干的勾当。”这种方法使用一根细长中空的锥形蜡烛。病人侧躺着，蜡烛底部放在耳朵上，并点燃另一端，这样理论上可以在内部产生真空，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.

许多医生──以及美国食品和药物管理局(Food and Drug Administration)──警告说，这可能使热蜡滴入娇嫩的耳组织，导致灼伤，甚至点燃头发。医生们说，这种方法不管用──锥管内的棕色胶状物是烛蜡，而不是耳垢。

Even trained specialists can get carried away when it comes to removing earwax, says Robert Folmer, an investigator³² at the National Center for Rehabilitative³³ 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.

如果软化滴耳液和灌耳不管用，那么是时候找专家帮忙了──可以是护士、医生助手、初级护理医生甚或耳鼻喉科专家。许多人依靠滴耳液和灌耳，但有些人也使用小吸管或被称作耳刮匙的铁圈形工具。有些耳鼻喉科专家还使用附在耳壁上的显微镜，好看到耳道中的3D图像。

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.

使用耳刮匙让诊疗过程更像是“手术”，它有自己的诊疗标准，医疗费用可高达100美元。只用水冲洗不能保证符合诊疗标准。许多药店的坐堂医生还提供60美元至80美元（根据方法而定）的清除耳垢服务。

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 impeding³⁴ a doctors' ability to examine the eardrum. 'I'd tell the doctor, 'I really like my earwax. Leave it alone, please', ' says Dr. Rosenfeld.

俄勒冈州波特兰(Portland)美国国家听力康复研究中心(National Center for Rehabilitative Auditory Research)的调研员罗伯特?福尔默(Robert Folmer)说，即使是训练有素的专家在清除耳垢时也可能会失手。他在2004年参与了一项调查，调查对象是俄勒冈州一家听力诊所的2,400名病人，其中11人称，他们的耳鸣是专家在清除耳垢时导致的。

But some patients can't. Dr. Stackpole says she gives earwax-removal addicts³⁵ an antibiotic³⁶ cream to dab³⁷ 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.

还有些研究发现，每1,000次灌耳中，大约会出现一次鼓膜穿孔、感染和听力丧失。福尔默博士说：“有些医生很自信，但这不是盖房子。你必须手法轻柔。”他建议病人询问医生他们计划使用的方法，以及治疗将进行多少次。