cleaned out. it's not as effective as a chemical cleaning, but it gets all of the gunk out of your horn. i do it about once every 6 or 8 months and it takes about an hour or two. the more you do it, the faster and easier it is. if you have any questions feel free to e-mail me. p.s. brushing your teeth before you play is a really big plus and try not to drink coffee and practice (that's a tough one for me) it gets real nasty if you do. 