effect pushing against the eardrum and causing pain. This may be caused by pressure on the ear while lying down on the side, and is also the case when completely expanded foam earplugs are pushed further into the ear. To bypass the latter risk, such earplugs are instead removed, compressed and inserted to the desired depth. Vice versa, when pulled out, the resultant negative pressure pulls the eardrum. Therefore, some earplugs are better carefully screwed or jiggled out rather than yanked out. Yawning does not help to equalize this air pressure difference, since it equalizes the pressures between the middle ear and the environment, while this overpressure rather is located in the outer ear, between the eardrum and the earplug. If pushed too far into the ear canal, they may push earwax and debris into the canal and possibly against the ear drum. As a precaution, earplugs should not be pushed further into the ear canal than they may be grabbed and rotated. Earwax impacted by earplugs can be removed by irrigation or other remedies, as described here. There is a possibility of allergic reactions, but this is likely rare, as earplugs generally are made of immunologically inert materials. Long-term use Custom shaped plugs are recommended for long-term use, since they are more comfortable and gentle to the skin and won't go too far into the ear canal. Nevertheless, prolonged or frequently repeated use of earplugs has the following health risks, in addition to the short-term health risks: They may cause earwax to build up and plug the outer ear, since it blocks the normal flow of earwax outwards. This can result in tinnitus, hearing loss, discharge, pain or infection. Excess earwax should be carefully removed from the ear, and earplugs should be cleaned regularly with water and mild soap. However, foam type earplugs are usually designed to be disposable, and will expand and lose their memory property upon drying after washing with water and soap. From then on, they will expand very quickly after being compressed, making proper insertion into the ear canal quite problematic. They also lose a large proportion of sound attenuating capability after such washing and drying. They may cause irritation of the temporomandibular joint, which is located very close to the ear canal, causing pain. Individually fitted non-elastic earplugs may be less likely to cause this irritation compared with foam ones that expand inside the