Q: For the last 10 years I have, on my doctor's recommendation, used a syringe to wash out my ear canals to prevent excessive wax accumulation. This has kept my ears clear, but I do wonder if long-term use of this method will have any adverse effects that could impair hearing or cause other problems.

A: Wax helps protect the delicate lining of your ear canal, so having some wax is natural and desirable. In most cases, your ears have a self-cleaning mechanism to keep the canals clear, and rinsing out your ears is unnecessary. But if too much wax builds up and plugs your ear canal, there are a few things you can to remove it safely.

First, never put cotton swabs into your ear. They may push wax further in, packing it into a harder lump, or damage the sensitive skin lining your canal, possibly leading to infection. If you use cotton swabs, clean only your outer ear with them.

Even worse is using something smaller and sharper, like a paper clip or bobby pin to clean or scratch your ear canals. These are more likely to set up an infection or even puncture your eardrum.

For wax that plugs your canal and cuts down on your hearing, you can try gently spraying it with warm water and a bulb syringe to clear away the wax. If this doesn't work, first soften the wax with ear drops like Debrox or Murine Ear Drops, which you can buy without a prescription. The Murine Ear Wax Removal System comes with both ear drops and a bulb syringe. Plain mineral oil also helps soften wax.

Once you've irrigated your ears, you can put a few drops of rubbing alcohol in your canals to prevent swimmer's ear, an ear canal infection. You shouldn't irrigate your ears if you have a hole in your eardrum, an ear infection, or a previous hole that's healed, because it may be weak and unable to withstand the pressure.

If home remedies don't work, your doctor may prescribe Cerumenex, a stronger but potentially more irritating ear wax dissolver. If all else fails, your doctor can remove the wax with special instruments and an irrigating syringe.

If done gently, so as not to damage your ear canal or puncture your eardrum, washing out your ears to remove excess wax should not cause any long-term problems.

Q: My teen-age son has been complaining of feelings of lightheadedness on and off for over a month. Sometimes he also has tingling in his hands and fingers. I'm worried he might have something like a brain tumor, but all the tests he's had have been normal. What could be doing this?

A: Hyperventilation, or over-breathing, is a good possibility, and I'll tell you a simple way to see if this is what's going on.

When people are anxious, excited or in pain, they tend to breathe faster than normal. When this happens, they exhale more carbon dioxide than usual, which changes the body's chemical balance. This change alters blood flow and the way nerves and muscles work and can lead to a surprising array of different symptoms:

weakness, fatigue, feeling "run down";

chest pain, heart pounding (palpitations);

faintness, dizziness, lightheadedness;

numbness and tingling; "pins and needles" sensations, especially in the fingers, hands and face;

chest tightness, difficulty getting a deep enough breath, sighing, frequent yawning, a feeling of suffocation;

muscle aches, spasms of the hands in severe cases;

anxiousness, feeling strange, a sense of impending doom.

Because the symptoms of hyperventilation are alarming, people experiencing them tend to breathe faster, making matters worse.

One of the misconceptions about hyperventilation is that it only occurs in obviously anxious people who are panting and gasping for breath. Not so. In fact, most people with hyperventilation aren't aware they're breathing fast, usually by taking short, shallow breaths, and neither are the people around them. It's often not easy to recognize.

There are two ways to tell if your symptoms are from hyperventilation. One is to intentionally breathe faster than usual for two or three minutes and see if that reproduces your symptoms. Most people will experience some hyperventilation symptoms with this maneuver, particularly lightheadedness and tingling in the fingers. The key is whether your symptoms during this trial are similar to the ones you experience at other times.

Another way to tell is to see if your symptoms improve with treatment to reverse the changes brought on by hyperventilation. This technique is especially good during sudden attacks. To do it, slowly breathe in and out while holding a small paper bag over your mouth and nose for a few minutes. This procedure keeps you from losing too much carbon dioxide from your body, and keeps your chemical balance on an even keel.

Hyperventilation infrequently occurs with certain lung and brain disorders and when the body's chemical balance is off, such as in people with diabetes who've gotten too much acid in the blood (diabetic acidosis).

But the vast majority of cases of chronic hyperventilation stem from anxiety. If this is the case with your son, treatment includes reassurance that there is nothing seriously wrong physically, and counseling to look into underlying emotional difficulties. People often learn to recognize the symptoms of hyperventilation and control them with breathing control exercises, temporary breath holding, or paper bag rebreathing.