Mimikaki and manual ear wax removal

People usually come across the word mimikaki after watching an ear-cleaning video or spotting a set of steel ear picks online. It covers two different things: a household habit from Japan, and a clinical technique that uses tools that look much the same. One is far safer than the other.

What is mimikaki?

In Japanese, mimi means ear and kaki comes from the verb to scratch or scrape, so a mimikaki is, quite literally, an ear scratcher. The traditional one is a slim bamboo stick with a small, shallow scoop at one end. Many have a fluffy tuft, called a bonten, at the other end. Metal and plastic picks are common too, some with a tiny built-in light.

Cleaning the ears with a pick is an everyday habit in Japan and elsewhere in East Asia, and Japanese cities even have ear-cleaning salons. Part of the reason is the wax itself. Many people of East Asian descent make dry, flaky wax rather than the sticky kind, because of a single gene, ABCC11. Dry flakes lift out on a scoop far more easily than wet wax. Our guide to what ear wax is and why it builds up explains the difference.

Manual ear wax removal by a clinician

Manual removal is the nearest thing to a professional mimikaki, although clinicians rarely use the Japanese name. A trained clinician looks into the ear canal with a good light and magnification, then lifts the wax out with fine instruments. The NHS describes it as scraping the wax out with a very small device. NICE names ‘manual removal using a probe’ as one of the methods trained practitioners can use, alongside electronic irrigation and microsuction.

The instruments

• A Jobson Horne probe. A slim metal instrument with a tiny ring at one end for lifting wax and a fine, roughened tip at the other, which can be wrapped in a wisp of cotton wool.
• A wax hook. A fine probe with a small bend at the tip, eased past a plug to draw it out.
• Curettes and loops. Small scoops and wire loops in different sizes, for flakes and softer wax.
• Crocodile forceps. Very fine forceps that open only at the tip, for picking out a loose flake or lump.

Seeing what they are doing

This is the real difference between a clinician and an ear pick at home. Manual removal is done under direct vision: through a speculum with a head light, through magnifying loupes, under an operating microscope or with an endoscope. The clinician straightens your ear canal, sees the wax, the skin beneath it and the eardrum beyond, and moves the instrument only where they can see it.

What happens during manual wax removal

Manual removal is usually part of an ordinary ear wax removal appointment. Allow around half an hour, although the removal itself may take only a few minutes per ear.

1. Questions and a look. Expect questions about ear surgery, perforations, grommets, infections and any medicines you take, including blood thinners. The clinician then checks both ears to confirm the problem is wax.
2. Getting comfortable. You sit or recline with your head tilted, and the clinician gently draws your outer ear up and back. Keeping still matters.
3. Lifting the wax. They ease the edge of the wax away from the skin, then draw it out whole or in pieces. Smaller fragments may be suctioned away.
4. A final check. With the canal clear, they look at your eardrum and tell you what they found. If some wax is too hard to shift, they may suggest a few days of drops and a second visit.

Most people find it quiet and comfortable. You may feel pressure or a slight scraping as wax comes away, and a touch on the canal wall can set off a cough. It shouldn't hurt: say so if it does.

When clinicians use manual removal

In practice, manual removal is less a separate treatment than one of the tools in an ear care clinician's kit. It tends to come into its own for:

The clinician decides as they go. If an instrument isn't shifting the wax, they may switch to suction, suggest drops or refer you to an ear, nose and throat (ENT) clinic. Our guide to impacted ear wax covers the stubborn cases.

Why picking your own ears is risky

Using an ear pick on yourself is a different matter. You are working by feel, in a canal you can't see, with a tool held at an awkward angle. The problems it causes are familiar to anyone who treats ears:

• Pushing wax deeper. A scoop catches some wax and nudges the rest further in, packing it towards the eardrum where it is harder to shift. NICE advises against cleaning the ears with small objects for this reason.
• Scratching the canal. The skin in the inner part of the canal is very thin and lies almost directly on bone. It grazes easily, bleeds, and a graze can turn into an outer ear infection (otitis externa).
• Hurting the eardrum. A slip, a sneeze or a nudge from someone else can drive the pick against the eardrum. A perforation usually heals by itself within a couple of months, but it is painful and needs checking.
• An itch that keeps coming back. Scraping irritates the skin, so it itches more and you scrape again.

Camera ear picks, which show the inside of your ear on your phone, look like the answer to the seeing problem. They aren't: depth is hard to judge on a small screen, and the scoop at the end is still a scoop. Our guide to home ear wax kits and camera tools looks at them in more detail.

Is manual removal by a clinician safe?

Yes, in trained hands. Side effects are usually minor and short-lived: brief discomfort, a cough, or a small graze that bleeds a little. Less often a graze becomes infected, and injury to the eardrum is rare. What keeps it safe is everything missing at home: a clear view, a straightened canal, the right instrument and someone who knows when to stop.

Manual removal, microsuction or irrigation?

NICE doesn't rank the clinical methods, and many clinicians combine them. The practical differences:

Read more about microsuction and ear irrigation, or compare the two in our guide to microsuction vs ear irrigation.

Cost and where to have it done

You won't often see manual removal priced on its own. It is part of an ear wax removal appointment, and the clinician uses whichever method works best on the day. As a rough guide, a private clinic appointment for both ears typically costs between £45 and £100, and home visits cost more. Our guide to ear wax removal costs explains what affects the price.

On the NHS, it depends where you live. Some GP surgeries still remove wax, but many have stopped. Ask at yours or at a pharmacy, and see our guide to ear wax removal on the NHS.