As someone who had a persistent ear infection that took months to go away, let me respond to everyone at once...
Q-tips are ok, just don't use them all the time and when you do only gently clean the outer part of the ear canal. i.e. where normal iems would fit, not deep insertion ones. For normal ppl who don't like waxy ears I'd suggest using qtips after a shower a few times a week just so your ears don't get super waxy.
However, doctors recommend not using qtips. They can scrape the skin in your ear canal, or mess with the hairs in your ear canal (which can eventually stop growing back if you mess with them too much iirc). They also remove the protective layer of wax in your ears. With that said, I used qtips every day for most of my life and never had a problem until recently (which I'll explain in a minute). This is why I suggest every two or three days.
Your ears do naturally drain by themselves, but this process may leave you with waxy ears which are disgusting when combined with iems. Plus if your ears have a bunch of (healthy) wax in them and you go deep-inserting your er4's with tri-flanges you could get a plug way in there which trust me is not cool.
Debrox or similar ear cleaning kits are the poor man's ear lavage. If you have a chunk of wax stuck in your ear it will not be easy to get out with debrox, but I have done it before. It will take several times to get it out while a doctor's ear lavage should take care of it right away since they use syringes that are much stronger than the weak little 'bulb' the debrox comes with.
My doctor did say some people who have waxy ears use diluted H2O2 in the same way you use the debrox. Just keep it in the shower and use it every once in a while. Peroxide is cheap and you don't want to waste your money on debrox. He said they use it every few days or every week just to keep the wax from building up. If you find the need to do that I'd suggest getting the debrox or store brand equivalent with the bulb included once just so you have the bulb to rinse your ears out with.
No one mentioned yet, debrox is NOT hydrogen peroxide. It contains a different peroxide that does basically the same thing. Just FYI.
Also worth noting, use warm water to flush your ears out after the debrox/peroxide. Cold or hot water won't hurt you but it might make you dizzy. TBH its not really a big deal, just don't use really hot water or ice cold water.
Getting your ears cleaned by a doctor shouldn't be painful if they do an ear lavage. I remember it hurting a little once but that's because they were rinsing my ear harder than normal.
Now here's my story. One ear began to really itch all the time. Naturally i'd rub it. After a while it plugged up with wax which I eventually got taken out by the doctors (ear lavage FTW! ). To make a long story short, the nurse practitioner I was going to didn't know what the problem was so the ear would start itching again after a week or so and the plug would eventually come back and I'd go back to get it flushed out again. Every time it was infected and I'd use antibiotic eardrops (expensive, so don't let it get that far). As soon as I'd stop using the antibiotic eardrops the itching would start to come back and eventually the infection/plug would come back. Eventually I went to a doctor who suggested I stop using qtips. After a few more lavages, using debrox all the time, and really waxy ears for a while, the infection and the plugs went away. Here's why it happened, at the time I was taking two showers a day and using qtips both times. I was also using them much deeper in my ear than I should've been, and was using them much more forcefully than I should've been. Not only that I was using my klipsch custom 3's with the biflanges deep inserted for hours a day. All that gave me an ear canal infection, not to be confused with the more common infection of the eardrum.
Now I occasionally use debrox and almost never use my iems. I stopped using qtips completely. Once or twice recently I used them lightly to pull out some wax. I don't use the biflanges anymore and only shallow insert the single flanges. When I do use the iems they come out pretty waxy which is why I wear headphones when I can.
Hope this helps you .