In a new study confirming the danger of "using anything smaller than your elbow in your ear," researchers have found that using Q-tips or other small instruments to clean your ears account for a disproportionate number of ED visits for traumatic eardrum perforations, Shereen Lehman writes for Reuters.

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Background

In an update released last year, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) said earwax is good for you, and using cotton swaps or other instruments in your ear can be harmful.

While medical professionals have long recommended earwax removal, AAO-HNSF in the guidelines detailed why earwax is good for you: It can prevent dirt, dust, and other small items from entering the ear, and efforts to remove it can result in cuts to the ear canal, perforated eardrums, or dislocated hearing bones.

Study details

For the latest study, published in JAMA Otolaryngology Head & Neck Surgery, the researchers assessed five years' worth of records from 100 EDs in the United States and identified more than 900 ear-related injuries. Overall, the incidents represented nearly 5,000 ED visits for tympanic membrane (eardrum) perforations when extrapolated to a national level, according to the researchers.

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The researchers distinguished between eardrum perforations stemming from a trauma of some kind—which is the type of perforation the study focused on—versus those stemming from infections.

Key findings

Of the identified cases, the researchers found that around 66% of patients treated for traumatic eardrum perforations had caused the injury by sticking an "instrument" in their ear.

"Ear canal instrumentation" accounted for 61% of those cases, with 45% involving cotton swabs, the researchers found. Aside from cotton swabs, other objects used included combs, hairpins, lollipop sticks, pencils, straws, toothpicks, and toys. According to Eric Carnoil, an otolaryngologist at the University of Toronto and the lead author on the study, water activity was also a significant cause of injuries.

Discussion

Carnoil said he and his colleagues believe that "the majority of these injuries were caused by patients trying to get their own ear wax out."

Noting that "earwax is made in the outer 1/3 of the ear canal, and it is water-soluble," Carnoil advised patients who want to remove earwax to simply use a washcloth after a shower. He added, "If you've taken away nothing else from this interview and the article, it is please, do not use Q-tips to clean your ears."

Separately, Hamid Djalilian—a professor of clinical otolaryngology at the University of California, Irvine, who was not involved in the study—said while the study was a helpful assessment of ear-related visits to EDs, it did not "capture all the patients who had this problem in the United States because it doesn't include patients who sought care in an outpatient setting such as an urgent care, primary care physician, or ear nose and throat specialist."

Moreover, he pointed out that ears are largely self-cleaning: "The dead skin of the ear canal along with the earwax gradually move outward and come out of the ear on their own," Djalilian said. As a result, he said, using a Q-tip or other instrument to get earwax out of your ear could have the opposite effect, pushing wax deeper into the ear canal. "A little bit of wax will stick to the Q-tip and make the user feel great about themselves that they accomplish something, but chances are approximately 5-10 times more wax was pushed in," he said.

Djalilian added that using instruments to clean your ears is the leading cause of ear canal infections, as the instruments scratch the skin within the ear canal, allowing bacteria to enter the skin (Lehman, Reuters, 12/28).

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