May 15th, 2017

Cotton-tip swabs (or Q-tips) are useful for many things. Cleaning ear canals isn’t one of them. Fortunately most ears don’t need them because earwax is actually an important protector of the ear canal. Dirt, dust, and even bacteria that enter the ear canal get stuck in the sticky wax which works it’s way out, slowly but surely, to the opening of the ear canal, where a washcloth (or fingernail) will take care of it. As we learned on The PediaBlog back in 2012, the best advice is to leave the wax alone:

Cotton swabs especially tend to be problematic for two reasons. First, while a little wax will be seen on the tip of the swab after cleaning, more unseen wax is actually pushed further into the canal, potentially leading to an impaction of wax.  Second, older children and teens tend to use cotton swabs more aggressively than their parents and can cause considerable trauma to their ears.  A frequent cause of ear pain at this age is simply from frequent or vigorous swabbing, which, by friction, produces inflammation of the ear canal.  Usually no treatment is needed for that, but the pain results in a lot of visits to the doctor.


A lot of visits to the doctor, as we discovered in January:

Earwax (cerumen) isn’t a trivial issue. The American Academy of Otolaryngology – Head and Neck Surgery estimates that about 12 million Americans suffer from cerumen impaction (defined as “an accumulation of cerumen that causes symptoms or prevents a needed assessment of the ear canal, tympanic membrane, or audiovestibular system or both”). In 2012, $46.9 million was spent on 1.3 million office encounters to remove impacted wax by doctors and other health care providers.


Children are especially fond of jamming things into their little ear canals (and nostrils, too!) and every pediatrician can catalogue the treasures they’ve pulled out of one of these tiny orifices. A new study, published last week in Journal of Pediatrics, assesses the damage done to children’s ears. A. Pawlowski provides the details that reinforces the idea of just leaving earwax alone:

Despite years of warnings to avoid putting the product into the ear canal, more than 263,000 children in the U.S. had to be treated in emergency rooms for ear injuries related to cotton-tip applicators between 1990 and 2010(…) That amounts to about 34 injuries a day.


Here’s the scoop (pun intended):

> A quarter (25%) of the children who were seen in emergency departments during the 20-year study period had perforated ear drums. This painful condition can be very serious and lead to hearing loss. Another 23% damaged the skin and soft tissue of the ear canal.

> 67% of the injured children were under the age of 8, with most (40%) under the age of 3.

> The majority (77%) of children with injured ears hurt themselves while handling the cotton swabs; the rest were injured by others including parents (16%) and siblings (6%).


Pawlowski has three important reminders about earwax:

• Realize ear wax is normal. Ear wax that’s not causing symptoms or blocking the ear canal should be left alone.

• (Don’t) overclean your ears: it may irritate the ear canal and cause infection.

• Go to the doctor if you have hearing loss, a feeling of fullness in the ear or ear pain. An ear, nose and throat doctor can remove more stubborn excess wax.



(Google Images)


3 Responses to Leave Those Ears Alone

  1. If the best practice is to leave earwax be, how does a parent or other people avoid earwax buildup to the extent that it needs to be removed by a doctor?

    • Some people are genetically prone to produce either a lot of earwax or wax that is either very sticky or very dry, so avoidance of wax buildup can be a challenge. This special group of people need to receive special attention to their earwax, either by using regular over-the-counter preventative ear drops or receiving regular irrigation treatments or curettage in order to preserve hearing or to allow providers to assess the health of the external, middle, and internal ear. This can be challenging for any parent or provider charged with dealing with earwax in a kicking-and-screaming infant or young child. In any case, cotton swabs are more likely to push earwax deeper into the ear canal instead of extracting it, resulting in the eventual annoying (and sometimes painful) problem of impaction. Leave those ears alone and allow your pediatrician to help you manage earwax when it becomes problematic.

  2. Excessive ear wax is the “bane” of pediatric practice—-ear exams cannot be “faked”—there are consequences to both under-diagnosis and over-diagnosis of ear infections and other maladies. Removal can fray the nerves of all involved.
    A good project for an enterprising biomedical engineering student would be immediate obliteration of occluding ear wax without discomfort. Only then can the patient’s perception of the pediatrician as a otoscope-wielding troll be exterminated.


    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

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