J R Soc Med 2005;98:360-361
doi:10.1258/jrsm.98.8.360
© 2005 Royal Society of Medicine
Use and abuse of cotton buds
Jonathan C Hobson MA MRCS
Jeremy A Lavy FRCS
Royal National Throat Nose & Ear Hospital, 330 Gray's Inn Road,
London WC1X 8DA, UK
Correspondence to: Jonathan Hobson, 20 Claremont Grove, Manchester M20 2GL, UK
E-mail:
jchobson{at}doctors.org.uk
 |
SUMMARY
|
|---|
Ear injuries caused by cotton buds are commonly seen in ear,
nose and
throat (ENT) practice. We asked 1000 patients attending
an ENT referral clinic
whether they used cotton buds to clean
the ear canal. Of the 325 who
responded, 171 said they did.
The frequency of use was no higher in those with
ear complaints
than in those with nose and other complaints. 15–20% of
respondents
disagreed with the statements that cotton buds can cause
infections,
wax impaction or perforations. On the evidence of this survey,
manufacturers'
warnings need to be fortified.
|
INTRODUCTION
|
|---|
Cotton buds were developed in 1923 by Leo
Gerstenzang.
1 After
observing
his wife using wads of cotton on toothpicks to clean his baby's
ears,
he developed a cotton-tipped swab that he considered safer.
The product
was initially called Q-tips Baby Gays (Q for quality)
and Q-tips survive to
this day. The first instances of medical
concern over the use of cotton buds
were in 1972 with reports
of tympanic membrane perforation, otitis
externa
2 and cerumen
impaction.
3
Manufacturers
then advised against use of cotton buds in the external auditory
canal.
Nonetheless, cotton-bud-related injuries are a common reason
for
attendances at ear, nose and throat (ENT) referral
clinics.
4 We asked
patients attending an ENT clinic about the practice.
|
METHODS
|
|---|
All patients attending an ENT urgent referral clinic in two
months were
invited to complete an anonymous questionnaire (available
from authors). About
500 patients attended per month and 325
responded, with some questions
answered according to a 5-point
Likert scale—strongly disagree,
disagree, not sure/neutral,
agree, strongly agree. We also wrote to nine
manufacturers and
retailers of cotton buds inquiring about the wording of any
warnings
on packaging and how long such a warning had been present. For
the
two who did not reply, we made our own purchases.
|
RESULTS
|
|---|
325 patients, 173 male, answered the questionnaire, average
age 41 years
(range 9–92). In 232 patients the symptoms
were ear-related, in 40
nasal, in 31 throat and in 22 other.
171 (53%) respondents said they used
cotton buds to clean their
ears, and the frequency in those with ear symptoms
was about
the same in those with other complaints.
Table 1 lists reasons
for
cotton bud use. Likert scale responses to a series of statements
are
summarized in
Table 2.
Concerning the potential complications
of cotton bud use, the numbers
expressing ignorance ('strongly
disagree' or 'disagree')
were: 'can cause infections of the
ear' 64, 'can cause a
perforation of the eardrum' 51, 'can push
ear wax deeper into the
ear' 47. The warnings of nine companies
are shown in
Table 3.
|
DISCUSSION
|
|---|
Ear wax is a mixture of ceruminous gland secretions, squames
of epithelium,
dust and other foreign
debris.
5 It is
expelled
by epithelial migration from the tympanic membrane, aided by
movements
of the temporomandibular
joint.
6 This process
renders the ear
'self-cleaning'. Unwise efforts with a cotton bud
can produce
wax plug impaction, with resultant discomfort, deafness and
vertigo,
7 injury to
the external auditory canal or perforation of the
tympanic
membrane.
2,8
Otitis externa can likewise be caused
by overzealous use of cotton
buds.
9
The survey reported here is best regarded as qualitative. The response rate
was too low for quantitative validity, and we cannot tell whether the
behaviour of the ENT patients typified that of the wider population—or
whether, indeed, some of them had cotton-bud-induced disorders. What the
survey does indicate is that warnings against use in the ear canal are quite
widely discounted or ignored. Most cotton bud users, when asked why they did
it, merely said 'it seems like a good idea' or family and friends
use them. Fortunately, only a small number had been advised to do so by
medical professionals. We have to admit that a large number of people use
cotton buds without coming to harm and the actual risk remains to be
elucidated. Cotton bud manufacturers are explicit in their warnings against
use in the ear, but on the evidence of this survey these warnings need to be
stronger.
|
Acknowledgments
|
|---|
We thank Ellen Jones, Julio Rodriguez, Abdul Beebeejaun and
Veenawyn Seeram
for help in collating patient questionnaires
and Mr Henry Grant for
suggestions on the study design.
|
REFERENCES
|
|---|
- Q-tips, 2004
[www.qtips.com]
- Robertson MS. The misuse of cotton wool buds. N Z Med
J 1972;75:37
- Barton RT. Q-tip otalgia. JAMA1972; 220:1619
- Steele BD, Brennan PO. A prospective survey of patients with
presumed accidental ear injury presenting to a paediatric accident and
emergency department. Emerg Med J2002; 19:226
-8[Abstract/Free Full Text]
- Hanger HC, Mulley GP. Cerumen: its fascination and clinical
importance: a review. J R Soc Med1992; 85:347
-9
- Anonymous. Wax in the ear. BMJ1972; 4:623
-4
- Sim DW. Wax plugs and cotton buds. J Laryngol
Otol 1988;102:575
-6[Medline]
- Kravitz H, Neyhus AI, Dale DO, Laker HI, Gomberg RM, Korach A. The
cotton-tipped swab: a major cause of ear injury and hearing loss.
Clinical Pediatr1974; 13:965
-70
- Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais D, Amir J.
Cotton-tip applicators as a leading cause of otitis externa. Int J
Pediatr Otorhinolaryngol2004; 68:433
-5[Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
TOP
SUMMARY
INTRODUCTION
