Nov 10, 2023

Why are Q

This is Explainer, a column that answers questions we all have (or should have).

As someone who regularly “cleans” my ear canals with cotton swabs, a question hangs over me basically every day: How bad is it…really?

I know I am not supposed to stick cotton swabs in my ears. We all know this. It says so right there on the Q-tip packaging: “Do not insert swab into ear canal.”

The American Academy of Otolaryngology is similarly unambiguous on the issue, noting that sticking Q-tips or other objects in your ear “may cause a cut in your ear canal, poke a hole in your ear drum, or hurt the hearing bones, leading to hearing loss, dizziness, ringing, and other symptoms of ear injury.”

And yet, many people do stick Q-tips in their ears. The Washington Post once called the swabs “the most bizarre thing people buy,” given that they are often used for something you are expressly not supposed to use them for. Surveys done at doctor’s offices report that over half of patients stick Q-tips in their ears. And yet … we’re not all walking around with “hearing loss, dizziness, ringing, and other symptoms of ear injury.” (Are we?) Could digging around in our ears with Q-tips really be so bad?

According to one ear, nose, and throat doctor I found: No, it’s actually not. “I don’t agree that swabbing your ears regularly is dangerous and should be avoided,” said William Portnoy, who also specializes in plastic surgery and is based in Miami, noting that he cleans his ears with cotton swabs and has his whole life. “I’m, like, the pariah of the otolaryngology community,” he added.

Portnoy made his case in a 2016 review paper in the International Journal of Head and Neck Surgery titled “To Swab or Not to Swab.” The use of cotton-tipped swabs to clean ears is “ubiquitous,” he wrote. Out of 100 patients that he surveyed at his office, 77 percent used cotton swabs, and nearly half did so on a daily basis. Just four reported “complications” from ear cleaning: in three cases, impacted wax; and in one, an “unspecified injury.” While “most otolaryngologists have seen injuries caused by ear canal swabs,” he wrote, there’s no clear data on just how often such injuries—which really do sound harrowing!—occur. Perhaps what’s needed is education on how to safely use Q-tips, given that they are used so widely anyway.

One thing that Portnoy does see as a problem: people sticking Q-tips in their ears after wax has built up. “You don’t want to start swabbing if your ear is impacted with wax to begin with,” Portnoy said. That just pushes the wax farther down. Another is, obviously, the fact that you should not push the Q-tip so far that it touches the eardrum.

That said, “it’s actually fairly unusual for people to stick it that far,” agreed Seth Schwartz, an otolaryngologist in Seattle.

What’s more common with ear cleaning, he said, is that people damage the skin in the ear canal, leading to swimmer’s ear—which, despite the name, you can get without swimming—and symptoms like itching, pain, and even difficulty hearing. But Schwartz told me that he sees even this kind of damage most often when people use bobby pins or small spatulas to clean their ears. Q-tips may be comparatively less risky because they are soft. Though, as one doctor told former Slate writer Seth Stevenson, who admitted in these pages to cleaning his own ears with a paper clip (!), they can still cause micro-abrasions and lacerations.

Schwartz emphasized that the main issue with Q-tips is that you really don’t need to clean wax out of your ears yourself, with a Q-tip or anything else—so why risk the potential complications? Wax naturally makes its way out of the ear canal, “facilitated by movement of the jaw that occurs during chewing,” he wrote in an explainer for an ENT magazine. Any wax that you see on a Q-tip you have stuck into your ear is regular, healthy wax that did not need your assistance in being removed. If you want to clean your ears, do so by gently wiping a washcloth on the entrance of the canal to clear away any wax that has made its way out, Schwartz told me. If wax farther in truly is a problem, a professional can help extract it via “manual removal with direct visualization,” he explained—meaning that they scrape it out while also peering into your ear so as not to do any damage.

I sent Portnoy’s review paper to Schwartz. He agreed that the exact risks of Q-tipping one’s ears were unclear. Doctors do see a lot of issues from Q-tips—but then again, many, many more people may be Q-tipping. “It would be great to know those numbers so that people could make more informed decisions,” he wrote me via email.

But would knowing really change anything, anyway? “Knowing better and doing it anyway is part of what makes us human,” wrote Vanessa Hua in the New York Times magazine in a letter of recommendation for ear spoons, which she learned about from her grandmother, noting that they are common in Asian households. In Portnoy’s informal survey, most people swabbed for perceived hygienic purposes, but a third said they did so because it feels good. Which is to say, there is a purpose, even if it’s not medical. It’s clearly a compelling one. After our conversation, Portnoy sent me a comment that appeared beneath the Washington Post story that had called Q-tips a “bizarre” purchase: “IDGAF about this. I always have, and always will, clean my ears with q-tips!”