I only use it on the outside…

When I ask parents on their initial visit with me if they use cotton swabs, this is frequently the response I get.  They insist that they only use cotton swabs on the outside of the ear and that they NEVER go into the ear canal.  I have even heard this and ended up pulling several cotton swab heads out of the ears. 

The reason people frequently use cotton swabs is to remove earwax, or cerumen.  Cerumen is normal in the appropriate amount.  It functions to protect the ear canal as a mechanical barrier and an anti-bacterial layer.  Normally, cerumen is worked naturally out of the ear canal with normal movements of the jaw and ear canal.

Occasionally, cerumen gets stuck in the ear canal.  This can cause problems on multiple levels.  The biggest concern is for resulting hearing loss.  A significant cerumen impaction can result in a 30-40 dB hearing loss.  Prolonged cerumen impactions can become severe enough to cause erosion of the ear canal.  A significant cerumen impaction can also allow water to get trapped in the ear canal.  This moist, dark environment is a perfect breeding ground for yeast, mold, and bacteria which can setup a significant infection of the ear canal, or otitis externa.

Cotton swabs frequently facilitate these deeper cerumen impactions as instead of removing the wax, they actually plunge the wax further down the ear canal.  Furthermore, they can cause microtrauma to the skin of the ear canal resulting in small injuries which can more easily become infected.

“But how do I clean my child’s ears?”  This is one of the more common questions I hear in the office.  The truth is, we should not have to do much to clean the ears; they are quite good at cleaning themselves.  Occasionally the cerumen will become too thick or dry to work out of the ear canal.  In these instances, using a drop or 2 of mineral oil in the ear canal once per week can soften the earwax and help get it out of the ear canal.  If this is not enough, your ear, nose and throat doctor can use specialized suctions and instruments to get the cerumen out SAFELY!

“What about over the counter remedies?”  There are numerous things sold over the counter that can be used to clean the ears.  Beyond mineral oil, I would not recommend any of these.  Ear candles, in particular are dangerous, with common injuries including burns and rupture of the eardrum.  In fact the FDA has expressed concerns over these as well.  However, there are no randomized studies of ear candles in the management cerumen impactions.  Other ear drops and remedies are not recommended unless used under the direct supervision of your doctor. 

So remember, nothing smaller than your elbow in your ear.  Cerumen impactions can cause significant issues for your child, so be aware of this as a source of hearing loss, ear pain, and infections.