It depends on the environment and location of t he computer.
As a computer service engineer for over 35 years, keeping the inside of a computer is very important to me. Of course my experience is more related to the commercial mini-computer and main-frame types. They had many fans and required an air conditioned environment. Most of the machines back in those days had scheduled downtime just for cleaning, replacing defective fans and light bulbs on the display boards, etc.
With the Personal Computer, some of this depends on what you have and where you have it. Many people in recent years have the tower type case, and is ideal for placing on the floor next to the computer desk. It's also ideal for collecting dust since dust settles to the floor, and that's where the airflow sucks it into the computer. Many times I have opened a computer that is 6 months and older and find dust and cobwebs inside.
As for opening the case, some are easier than others. It depends on the manufacturer, and you may even find a label that indicates not to open the case because "there are no user servicable parts inside" or may even void a warrenty if you do. Some cases have have simple latches, some have several screws that have to be removed, and some have hidden locks that prevent the average consumer from gaining easy access to the inside.
Generally speaking, I've used a vacuum cleaner with an exhaust port and a narrow nozzle to blow the dust out of the case, instead of vacuuming it out. You could always buy a can of compressed air, which is also good for cleaning those keyboards!
It's also a good idea to occasionally check that the fans are actually working, and have not frozen up over time. Most simple computers will have at least one that pulls air thru the power supply to keep it cool, and a second one directly over the CPU chip. Additional fans may be in the front of the case, and sometimes on specialized video adapters, etc.
Checking the power supply fan can be done by checking for airflow at the back of the case when it's turned on. Newer computers actually have sensors on the fans and can be checked by utilities that will tell the internal temperature and fan speeds. Many will even shut down the computer if there is a slowdown or failure of a fan or temperature increase
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