Those of us who do clinic each week often have to answer the question for our patients, “Are Q-Tips really that bad?”
This week’s Hearing International discussion investigates that question. The current thought is that most attempts to clean the ears by us
ing cotton swabs only result in pushing the wax further into the ear canal. Wax is not formed in the deep part of the ear canal near the eardrum, but in the outer part of the canal near the external opening. When a doctor sees wax pushed up against the eardrum, he or she knows that it is often because the 
individual has been probing his or her ear with such things as Q-Tips, bobby pins or twisted napkin corners. Such objects become ramrods to push the wax deeper into the ear and can lead to problems.
Of course, the skin of the ear canal and the eardrum is very fragile and its thin structure is easily injured. Physicians note that the ear canal is more prone to infection after it has been stripped clean of the “good,” coating-type wax. So is “Don’t use cotton swabs” an “overstated” recommendation? Is it possible that a routine gentle cleaning of the ear with cotton swabs could be OK or does that lead to problems as well? This is the core of our discussion!
Where did The Q-Tip Come From?
Born in Warsaw, Leo Gerstenzang (1892-1973) emigrated to Chicago in 1912 from Poland. Feeling a need to assist those less fortunate he returned to Poland in 1918 and represented the America Jewish Joint Distribution Committee, a Jewish 
humanitarian assistance organization. Upon his return from Poland, he became a US citizen in 1919.
In 1923, Louis Armstrong had just recorded his first album with King Oliver’s band Blue Chimes, and Leo was now married with an infant child. He often 
watched his beautiful young wife, Zuita, clean their baby’s ears with toothpicks with the tips wrapped in wads of cotton during bath time.
As she cleaned the ears and other hard-to-reach areas, Leo had a vision that this could be a useful product to other mothers. But, he also saw, one slip-up on Mom’s part would mean a nasty little wound for the Gerstenzang baby. Leo designed a better device, which he called a “Baby Gay” (yes, really!).
This was the start of the Leo Gerstenzang Infant Novelty Company, which sold the hand-manufactured cotton swabs by hand. As his business grew, Leo and the family moved to New York City and he invented an automatic manufacturing method to make his invention more viable. By the time Bobby Jones wins the 30th US Open in 1926, 
he had changed the name from Baby Gays to Q-Tips, with the Q standing for “quality”.
Of course, over time, the sticks of cotton were no longer being used just to clean baby ears, but were also employed in many other areas, such as for removing makeup and nail polish, applying ointments, and, later, for cleaning audio heads in cassette recorders, cleaning model railways and simply for crafts and many other uses.
Due to the ever-increasing demand, Gerstenzang moved the manufacturing facility to Long Island, New York in 1948 and later teamed up with famous makeup artists to demonstrate the Q-Tip’s usefulness in applying and removing make up. Today, Q-tips are made by Unilever. Available worldwide, they come in many different types for specific uses.
Why Can’t I use Q-Tips to Clean My Ear?
The main controversy over the use of cotton swabs is that physicians and other health professionals do not recommend their use for cleaning the ear. Yet, people everywhere still use these tools for ear cleaning. If truth be told, most people have at least 
tried cleaning their ears with cotton swabs. Maybe it’s after the shower, and you just want to dry the canal, or there is a bunch of gunk in the canal and you just want to get it out! But, in the view of the medical community, there is no controversy: Using cotton swabs in the ear canal has no medial benefits and poses definite medical risks.
Cerumen is a naturally occurring, normally extruded product of the cerumenous glands mixing their secretion with the sebum glands and dead epithelial cells within the external auditory canal. Nussinovitch et al. (2004) found that the use of cotton-tipped applicators to clean the ear canal was a leading cause of otitis externa in children. Attempting to remove cerumen from the ear canal can also lead to cerumen impaction, which may result in total blockage of the canal, which is often painful. This condition can cause pain, tinnitus, and sometimes dizziness; removing it often requires medical attention. Additionally, physicians cite the use of Q-Tips as a common cause of perforated eardrums that may require surgical intervention. The American Association of Family Physicians, among other physician groups, recommends that cotton swabs never be placed in the ear canal.
OK… So How Should I Clean My Ears?
The first thing is NOT to use the cotton swabs. Even if they are used cautiously they remove the wax coating of the ear canal that repels water and gathers dirt and debris as the skin of the ear canal migrates. A wax blockage typically responds well to home treatments such as placing a few drops of mineral oil, baby oil, glycerin, or other commercial drops made to soften earwax. For more stubborn blockages, the use of detergent drops such as hydrogen peroxide or carbamide peroxide may aid in the removal of the wax. The use of water and/or these preparations should not be used more than once every few weeks as it can cause c
racking in the ear canal and alcohol should never be used in the ear canal. Irrigation is often used for cleaning the ear canal as well and can be performed at home with a small “bulb syringe” or a professional apparatus at the physician’s office. But wherever this procedure is conducted, the water should be body temperature, as too cold or too hot can cause a temporary dizziness. American Academy of Otolaryngology Head/Neck Surgery (ACO) states that irrigations are most effective when water, saline, or wax-dissolving drops are put in the ear canal 15 to 30 minutes before the irrigation. ACO also cautions that irrigation should not be conducted on diabetics, or on people with a perforated eardrum or tubes in the eardrum, or for individuals with a weakened immune system from disease. Manual wax removal can be performed by an otolaryngologist (ENT) or other physician or by a trained audiologist using suction, instruments, and a microscope to magnify and visualize the ear canal. If the patient’s ear canal is narrow or there are tubes in the eardrum or a perforation, then manual removal method is preferred. Additionally, those who are diabetic or immune-compromised should see a professional for manual removal. (Click on the photo to the left to view a video featuring Dr. Michael Seidman, an otolaryngologist, from Henry Ford Hospital in Detroit discussing the proper methods of wax removal).
The best practice is to follow your physician’s or audiologist’s direction.
References:
American Academy of Otolaryngology/HeadNeck Surgery (ACO) (2012). Earwax and care. Retrieved November 19, 2014: https://www.entnet.org/?q=node/1254
Medicine.net (2014). Is it OK to use Q-tips. Retrieved November 18, 2014: https://www.medicinenet.com/ear_wax/page3.htm#is_it_ok_to_use_q-tips
Nussinovitch, Moshe; et al. (2004). Cotton-tip applicators as a leading cause of otitis externa. International Journal of Pediatric Otorhinolaryngology 68 (4): 433–435. Retrieved November 18, 2014: https://www.schneider.org.il/_Uploads/dbsAttachedFiles/Cottontipapplicators.pdf
Hain, T. (2012). Earwax. American Hearing Research Foundation. Retrieved November 19, 2014: https://american-hearing.org/disorders/ear-wax/
Images:
Edwards, P. How q-tips began as boric tipped baby gays. TriviaHappy:). Retrieved November 19, 2014: https://triviahappy.com/articles/how-q-tips-began-as-boric-tipped-baby-gays
Das, Asha (2013). Tips to clean your baby’s ears safely. Bold Sky Limitless Living. Retrieved November 19, 2014: https://www.boldsky.com/pregnancy-parenting/baby/2013/tips-clean-baby-ears-safely-037036.html
Hain, T. (2012). Earwax. American Hearing Research Foundation. Northwestern University. Retrieved November 19, 2014: https://american-hearing.org/disorders/ear-wax/
funonthenet.in (2014). Things most of us don’t know about our ears: The mystery of wax’s true purpose. Retrieved November 18, 2014: https://www.funonthenet.in/forums/index.php?topic=257977.0
Klien, S.,] (2014). This will make you never, ever want to clean our ears again. HuffingtonPost Healthy Living. Retrieved November 19, 2014: https://www.huffingtonpost.com/2014/07/21/dont-clean-ear-qtip_n_5600401.html
Q-Tips (2014). Retrieved November 19, 2014): https://www.qtips.com/
Peoples.RU (no date). Leo Gerstenzang. Retrieved November 19, 2014: https://www.peoples.ru/undertake/founder/leo_gerstenzang/gerstenzang_2.shtml
Positive Med Miami (2014). 10 Clever ways to use Q-Tips. Retrieved November 19, 2014: https://positivemed.com/2014/09/27/10-clever-ways-use-q-tips/
Video:
Seidman, M. (2013). Cleaning your ears safely. Henry ford Hospital. Retrieved November 19, 2014: https://www.youtube.com/watch?v=a1BJQOHAs-M
Hogwash! The primary danger from Q-Tips are careless people. People stick a Q-Tip in their ear and leave it there because it feels good. Accidents are bound to happen when they are left in the ear. Other people, in the middle of cleaning their ears, try to also do something else and end up hitting he Q-Tip. Instruction about proper use will mitigate this danger for most people.
My family and my clients have not suffered ear infections despite a daily regimen of Q-Tip use after a shower.
Yes, cerumen is a natural part of bodily function and it should coat the skin making the oil sticky to capture dirt. But just like snot, if it builds up, it blocks and causes endless problems – particularly to hearing aid wearers. Unfortunately, we can’t “blow our ears.”
An original brand Q-Tip used cautiously and regularly is the best way to prevent build up of wax. Before starting use of Q-Tips, the ear canal should be evaluated by a professional to ensure that it is clear of any solid wax that could be pushed deeper.
Turning your ear to the shower head is terrible advice. I have had clients who ruptured their eardrums doing that. Introducing alcohol based products to soften wax and then flush it out, should be done rarely as it dries out the skin. If there is a perforation, then it should not be done at all.
Thanks for your comments on this post Phil. As a valued visitor to HHTM, comments are how things get modified to sometimes reflect a more accurate picture. I did modify the post somewhat according to your comments, but the rest of the “hogwash” are recommendations paraphrased from the American Academy of Family Practice and the American Academy of Otolaryngology/Head Neck surgery.
Thanks for the information! I’ve grown up being told that it’s a good idea to use Q-Tips to clean my ears. I didn’t know that it’s a bad idea to have cotton swabs placed in the ear because it can cause otitis externa. I’ll take your advice and start using mineral oil to get rid of blockages in my ear from now on.
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