When my husband was 4-years-old, he decided to jump on his bed to a Peter Pan record — and clean his ears with a Q-tip at the same time. Yep, you guessed it. He fell and jammed that Q-tip into his eardrum. Now, 34 years later, he has a major conductive hearing loss in his left ear.

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, the sight of blood coming out of the ear scares people.

Traumatic damage form "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.

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.

Ears are self-cleaning and most need no intervention. In fact, wax is the cleaning agent.

How to do it right
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 of 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. A compound called carbamide peroxide 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.

Recently Judy, an intelligent middle-aged woman, went to her audiologist 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 two 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. While the perforation in her ear has closed, she still has a greater than 20-dB hearing loss. She may also have damaged the occicles in her middle ear. Only time will tell.

The bottom-line? Beware of Q-tips in the ear!

Parts of this article originally appeared in the Sept. 2007 Hearing Journal and are reprinted with permission.