You may have heard the warning never to put anything smaller than your elbow in your ear or shuddered at the story of a friend’s friend who ruptured her eardrum with a cotton swab.

While eardrum puncture injuries are “quite unusual”, they can be severe, said Dr Seth Schwartz, an ENT (ear, nose and throat) doctor at Virginia Mason Franciscan Health in Seattle in the US. And when they happen, cotton swabs are often to blame.

Here’s why you should stop sticking cotton-tipped dowels in your ears, and how you should think about cleaning them instead.

Cotton swabs

The first thing to understand is that earwax isn’t an enemy that must be eliminated, said Dr Alexandra Quimby, an ENT doctor at Upstate University Hospital in New York, US.

This tacky, sometimes crumbly substance — made up of oily skin secretions, sweat and dead skin cells — protects the delicate inner ear by trapping irritants like dirt, dust, bacteria and fungi, and by regulating moisture.

Earwax also helps clear away the dead skin cells that shed from the inner ear, Dr Schwartz said. As you shower, or when you move your jaw while speaking or chewing, your earwax carries those dead skin cells from deep inside your ear canal to the outer ear, where they will eventually be pushed out.

If you try to remove earwax with cotton swabs, you risk irritating your delicate inner ear skin, said Dr Hae-Ok Ana Kim, a doctor who specialises in treating inner ear disorders at Columbia University Irving Medical Center in New York City in the US.

Cotton swab fibres, while appearing “nice and fuzzy”, she said, are “actually quite abrasive”. And that can cause your ear to produce more wax to protect the now-vulnerable skin.

Cotton swabs can also push earwax deeper into your ear canal, where it
can cause a build-up, Dr Kim said, leading to symptoms like itching, pain, feelings of fullness or dizziness. If it becomes bad enough, it might cause muffled hearing, too.

An estimated 5 per cent of US adults experience built-up, or impacted, ear wax every year, though it can be more common in older adults or those who wear hearing aids. Kim said that people with skin conditions like eczema or psoriasis might also have a greater risk of impaction, as could people with small or differently shaped ear canals.

If you think you may have a blockage, go to a doctor who can safely remove it, said Dr Tiffany Peng Hwa, an ENT doctor at the Perelman School of Medicine at Pennslyvania University, US.

Other strategies

The best way to keep your ears clean and healthy is to leave your earwax alone, experts say. But if you absolutely can’t resist the urge to poke around in there — and it’s understandable; the ear is lined with nerve endings that, when stimulated, can be extremely pleasurable — experts have tips on how to clean them safely.

Use a washcloth. Dr Quimby recommended wiping the outer ear (called the pinna) with a moist washcloth, just as you would wipe other parts of your body. “Clean the outer part you can get to, but nothing deeper,” she said.

Try ear drops. To help your ear with its natural self-cleaning process, Dr Schwartz recommended over-the-counter ear drops. These tend to be best for those with naturally drier earwax, he said, since they work by softening the wax, making it easier to clear.

Some people find drops ineffective — or as effective as using drops of water — but because they’re generally safe, experts recommend ear drops over swabs.

Avoid DIY tools. Beyond cotton swabs, experts warn against using any homemade or store-bought tools that allow you to scrape, pick or scoop the wax from your ear. They can be as simple as paper clips, or they may be tiny curettes, brushes or camera-tipped picks that you can buy in drugstores or online. These tools are as dangerous as cotton swabs, Dr Schwartz said.

He also advised against ear candling, which involves placing the unlit end of
a hollow candle in the ear canal and lighting the other end. This is supposed to create suction that pulls the earwax out. But “candles are both ineffective and dangerous,” Dr Schwartz said. They can lead to burns; and the visible leftover wax, which some people might consider as proof that the technique worked, is really just wax from the candle, not earwax.

If you can’t resist cotton swabs, use them responsibly. Still, some people feel the urge to use cotton swabs despite their risks, Dr Hwa said. “If you’re using them to sop up a little moisture right around the opening of your ear, that’s probably fine,” she said.

But it shouldn’t go any deeper than that. And if your ears hurt, itch or feel clogged, go to a doctor who can diagnose a blockage and remove it safely. That’s “the least risky approach”, Dr Hwa said.

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