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Cotton swabs in the ears: Are they safe?

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In a recent unscientific survey, eight out of 10 people reported that they routinely use Q-tips or other similar cotton swab products to clean, dry, massage or scratch their ear canals.
Despite widespread warnings against use of cotton swabs in the ear canal by manufacturers, media and health care professionals, it appears that this use continues unabated.
Many of you may be doing this on a daily basis without any problems (so far) and wondering why there is so much commotion about it. Below you will find answers to some commonly asked questions about cotton swabs.
1. Are cotton swabs good for removing wax from the ear canal?
The short answer is no.
The ear canal is a cylindrical passage about the size of a cotton swab or slightly larger. If you have a large amount of wax buildup, the cotton swab will fail to remove the wax and may also push it in more, impacting it against the eardrum. At this point, the wax is difficult to remove and can cause pain and discomfort.
A small layer of wax lining the ear canal is in fact necessary for normal function of the ear canal by forming a water-resistant barrier and keeping bacteria and other pathogens out. Removing it can make you more prone to infections.
2. If not cotton swabs, then what should I use to get excessive wax out of my ears?
Over-the-counter cerumen softeners such as carbamide peroxide drops can help soften up the wax to help it flow out naturally. If that does not work, your primary care physician or ear, nose and throat (ENT) doctor can help with safe removal of excessive wax.
3. Can I use cotton swabs to scratch an itchy ear or help dry the ears after a shower? If not, what alternatives are there?
You really shouldn’t need cotton swabs for this. Moist, itchy ear canals can improve if steps are taken to keep them dry. For example, avoid water exposure by using cotton balls covered with petroleum jelly when showering or use a blow dryer on a low setting to dry the ears.
Drops of 90/10 alcohol-vinegar solution can also help soothe an itching ear canal. Before you do this, be sure to have you ears examined by your primary care provider or an ENT specialist to rule out more serious issues such as infection.
4. I’ve been using cotton swabs for years. What’s the worst thing that could happen if I continue?
That’s like saying you’ve been driving without a seat belt for years. Accidents only need to happen once to make you regret a certain practice. Ear infections caused by fine scratches of the ear canal and penetration of bacteria is the most common problem with cotton swab use. I frequently see injuries and bleeding of the ear canal, trauma, tear of the eardrum or more severe injury to the bones of the ear, and even deafness associated with cotton swab use.
5. What if I’m careful and avoid going too deep into the ear canal?
You may trust yourself, but you can’t always trust your environment. Distractions or other people or animals in the vicinity pose the greatest danger. I have heard people trip on children, animals or get distracted by a phone call, causing injury and in some cases necessitating surgery to repair the damage.
Bottom line: be safe and do not go poking into the ear canal. Use drops when needed. If that does not work, talk to your doctor about further help.

Sepehr Oliaei, MD, is an otolaryngologist (ear, nose and throat specialist) at MultiCare ENT, Sinus & Allergy Specialists - Tacoma. To schedule an appointment or evaluation, call (253) 403-0065.

MultiCare Health System is a not-for-profit health care organization with more than 11,000 employees and a comprehensive network of services throughout Pierce, South King, Thurston and Kitsap counties.

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