Journal Logo


Beware the cotton-tipped applicator

Rensink, Michael; Martin, Robert

Author Information
doi: 10.1097/01.HJ.0000295757.16387.fc
  • Free
Michael Rensink
Robert L. Martin

You've heard the old saying, “Never put anything smaller than your elbow in your ear.” We should all heed this sage advice, because many people injure their ears with swabs.

Recently Judy, an intelligent middle-aged woman, came in for a follow-up visit. She said, “I've been cleaning my ears with Q-Tips for many years and I never dreamt I would hurt them. But I slipped 2 weeks ago and pushed a Q-Tip into my eardrum. Now I can't hear well in that ear.”

Judy had lacerated her tympanic membrane and created a sizable conductive hearing loss, a condition like that shown in Figure 1. The perforation in her ear has now closed, but she still has a greater than 20-dB conductive loss. She may also have damaged the ossicles. Time will tell.

Figure 1
Figure 1:
A traumatic perforation of the tympanic membrane.

Judy has lots of company. Otolaryngologists see hundreds of ears that have been severely damaged by cotton-tipped applicators and are adamantly opposed to their use in this manner. The injuries that so often result from misuse of these applicators frequently cause considerable pain and anxiety to patients, since the tissue in the ear canal and the eardrum is very sensitive. Moreover, people are scared by the sight of blood coming out of the ear.

The photographs in Figures 1 and 2 were published in the June 1995 Hearing Journal with permission from Michael Hawke, MD, who took them. Figure 1 shows a traumatic perforation, Figure 2 a hematoma.

Figure 2
Figure 2:
A hematoma in the ear canal.

Traumatic damage from “swabs” can occur in many different ways: When people are using a swab, they may be bumped, they may cough or slip, they may put too much pressure on the swab, or the cotton fibers can get entangled in tissue and tear healthy tissue when the applicator is removed, causing trauma and bleeding.

Putting excessive pressure on the end of the cotton swab can drive it against the tender skin in the ear canal. This ruptures the small blood vessels, causing bleeding and a hematoma, like the one in Figure 2. A mass of clotted blood is seen on the surface of the skin.

This type of ear trauma can lead to a severe ear infection, because the ear canal has an abundance of bacteria and fungus. The trauma breaks down the natural barrier, the outer layer of the skin, giving the bacteria an opportunity to invade the tissue.


When asked why they use cotton-tipped applicators to clean their ears, patients are likely to say something like, “I have to. I can't stand it when my ears are dirty.”

And herein lies the rub. The fact is, swabs do a very poor job of cleaning the ear! Patients get just enough “wax” on the swab to make them think they are cleaning their ears. But, in fact, they are pushing most of the wax deep in the ear canal, impacting the ear, creating an unhealthy condition, and leading to an eventual visit to the doctor.

Patients should read the warning label printed on each package that says, “Not for use in the ear canal!” The makers of these swabs understand they are dangerous if used in the ear canal. However, many patients ignore this warning and use them in the ear canal anyway.

When told, “Don't use these in your ears,” patients always ask, “But how should I clean my ears?”

In replying, it is important to tell patients that most ears are self-cleaning and need no intervention. The phrase “You have to wash your ears” came from mothers who wanted their children to wash the dirt off their external ears, not out of the ear canal.


There are two safe ways to clean your ears if they really need it. The most effective way is to let an ENT physician clean your ears every 3 to 6 months.

The medical value of having an ENT clean ears that have a history of problems should not be underestimated. One the most powerful principles in medicine is the act of cleaning. Dead skin (desquamatized keratin) accumulates in ears and can attract moisture and serve as a breeding ground for bacteria and fungus. These can cause irritation and itching. Clean, healthy ear tissue does not itch.

The other way is to do it yourself. The U.S. Food and Drug Administration (FDA) has approved only one substance for the removal of wax (cerumen) from ears. The technical name for this compound is carbamide peroxide, and it is found in all the over-the-counter earwax-removal products. This thick liquid is put into the ear canal with a dropper and then the ear is rinsed to remove the peroxide and any wax.

Because this product is thick and heavy, people often find it difficult to get it into the canal where it can dissolve the wax. It can also occasionally cause irritations in the ear. Patients often say they have used the carbamide peroxide prior to coming into the office. However, a quick look in the ear often makes it obvious that the product never reached the wax.


We often see patients like Judy, who have used cotton-tipped swabs for years without incident. But then, one day, they accidentally cause trauma to their ears. “Never put anything smaller than your elbow in your ear” is good advice and should be followed. But bad habits are hard to break. So, the first step is to make everyone aware that using cotton-tipped swabs in the ear is dangerous!

Copyright © 2007 Wolters Kluwer Health, Inc. All rights reserved.