Extent of cotton-bud use in ears

The use of cotton buds inside ears has widely been condemned worldwide by otolaryngologists. This is due to well documented complications including trauma, impacted ear wax, infection, and retention of the cotton bud.1 The most common mode of accidental penetrating ear injury in children is cotton-bud induced.2 Trends in cotton-bud usage have been studied previously, but have only focused on ear, nose, and throat (ENT) patients.3 In recent times, manufacturers have heeded the advice of the otolaryngologist and have consequently relayed warnings to the public. We conducted a survey to investigate the extent of ‘Q-tip’ cotton bud public use in ears and the awareness of associated complications.

Between January and August 2009, confidential questionnaires were given to patients at three primary care centres in the south east of England. The response rate was 80% (239/300). Ages ranged from 17 to 87 years, with a mean of 41.1 years. There were 144 (60%) female and 95 (40%) male responders. An alarming 68% admitted using cotton buds in their ears, with 76% of users using them at least weekly, if not more frequently. The primary reason (96%) given for using cotton buds was to remove earwax.

It is evident that there is a public perception that the ear requires regular cleaning. However, our knowledge dictates that earwax is produced in the outer part of the canal and migrates out with the epithelium towards the pinna. Other reasons included relieving an itch and drying the ear. Our survey showed that cotton-bud users were aware of 52% of the potential complications, whereas non cotton-bud users were aware of 59% of potential complications. There was no significant association between awareness of complications and cotton-bud use (χ² = 2.23, df = 3, P = 0.53).

Despite manufacturers' warnings, use of cotton buds inside ears seems to be common. Our survey was carried out in the south east of England, as a result there may be a population bias. Further research into both adult and paediatric populations country-wide is warranted. One previous study did attempt to evaluate cotton-bud use and awareness of complications.3 As responders were ENT-clinic attendees, the study was limited by a biased sample. However, similar levels of cotton-bud use and awareness of complications were found.

Awareness of cotton-bud related complications is an important public health issue. We recommend that public awareness of cotton-bud related complications and the notion of the ‘self-cleaning’ ear needs to be raised. A small proportion of patients do suffer from regular ear wax impaction. Safer methods of aural toileting that include syringing and microsuction may also need promoting. With the above information, the public can make an informed choice of whether or not to use cotton buds. One method of promoting awareness may be to distribute leaflets in primary care centres. This may reduce cotton-bud related complications in the community.

• © British Journal of General Practice 2011