Doctors have been warning for years to avoid using cotton swabs to clean ears.
A man who apparently lived with a cotton bud stuck in his ear for years before it led to a dangerous infection is highlighting the risk of cleaning ears with swabs.
Doctors recently described his ordeal in BMJ Case Reports, calling it the first known example of a lodged cotton swab leading to a necrotizing infection inside a person’s skull.
The mystery began when an ambulance rushed the 31-year-old unnamed man to a hospital in Coventry, England, after he suddenly experienced seizures and collapsed.
He’d been previously healthy, except for on-and-off pain and hearing loss in his left ear for the past five years that led his primary care doctor to prescribe antibiotics for a “severe ear infection.”
Four days before his collapse, the pain escalated to headaches on the left side of his head, plus nausea and vomiting. He’d also been more forgetful about names in recent days, he said afterwards.
Scans of his head revealed two abscesses — pockets of pus — between the surface of his brain and the protective membrane that surrounds it, the dura. His left ear canal was filled with “soft-tissue density material,” so doctors explored it while the man was under general anesthesia and found an impacted cotton bud.
He was diagnosed with necrotizing otitis externa, an infection that starts in the soft tissues of the ear canal and spreads to the surrounding bone. The condition is traditionally seen in elderly people with diabetes or a compromised immune system.
Doctors removed the cotton bud, cleaned his ear canal and treated the patient with antibiotics. All traces of the infection vanished after 10 weeks and the man remains well, without any lingering neurological problems or ear symptoms.
“Most importantly, he is no longer using cotton buds to clean his ears!” the authors wrote, adding the case “further reiterates the dangers of cotton bud use.”
STEP AWAY FROM THE Q-TIP
As a basic rule, don’t put anything smaller than your elbow in your ear, the group advised. Items like cotton swabs, hair pins and toothpicks can lead to a cut in the ear canal or a hole in the eardrum. They could dislocate the hearing bones, leading to hearing loss, dizziness and ringing in the ear.
It’s not ever necessary to clean within the ear canal, though it’s fine to wipe away ear wax from the outer portion of the ear with a tissue or wash cloth, said Dr. Seth Schwartz, an otologist at Virginia Mason Medical Center in Seattle, Washington. He helped write the AAO-HNSF’s best practices for the treatment of ear wax buildup and blockage.
“People think of wax as being unhealthy, like they don’t want wax in their ears,” said Schwartz. “But ear wax is actually a healthy part of the ear, it’s the natural substance that occurs from the body’s self-cleaning mechanism. The body is sweeping away dead skin and debris from the ear canal and it will migrate out.”
Despite years of warnings, cotton swabs send thousands of kids to the hospital each year, a 2017 report found. More than 263,000 children in the U.S. were treated in emergency rooms for ear injuries related to cotton-tip applicators between 1990 and 2010.
“There’s this misconception that people need to clean their ears in the home setting and that this is the product to do that with,” said Dr. Kris Jatana, senior author of the study and a pediatric ear, nose and throat specialist at Nationwide Children’s Hospital.
“The ears themselves are typically self-cleaning… It is risky to use cotton-tip applicators in the ear canal across all age groups, and certainly we are seeing way too many injuries as a result of this practice.”
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