SHORT ARTICLE
USE OF COTTON BUDS AND ITS
COMPLICATIONS
SURESH KUMAR, SHAMIM AHMED
ABSTRACT
Objective To evaluate the complications and effects produced by use of cotton bud tip in the ear for cleaning.
Study design Descriptive study
Place & This study was conducted from July 2005 to January 2007 at ENT Department, Sir Syed Medical
Duration of College & Hospital Karachi.
study
Patients and All patients having history of use of cotton buds were included. A thorough examination with aural
Methods speculum and auroscope was done. Few were examined with the help of microscope. Aural toilet
was done by sucking out pus and with dry moping. Hearing assessment done primarily with
tuning fork with 512 HZ frequency. Pure tone audiometry used in selected cases.
Results Out of 100 patients 58 were males and 42 females with the mean age of 38.5 years (range from
7 years to 73 years). The most common complication / effect was unspecified itching in the ear
in 34 cases, followed by otitis externa in 23, otomycosis in 15, trauma in the external auditory
canal in 9, impacted wax medially leading to decreased hearing in 6, cotton tip foreign body in
5, boil in 4 and traumatic tympanic membrane perforation in 4 cases.
Conclusions Use of cotton buds tip and match sick can lead to lot of complications including trauma to external
auditory canal and tympanic membrane which can lead to perforation resulting in deafness. It
should be avoided for the purpose of cleaning ears.
Key words Tympanic membrane perforation, Otitis externa, Cotton bud use.
INTRODUCTION: practice.1 Cotton tips for cleaning out the auditory canal are
Cotton buds are commonly used to clean the ears, remove readily available from drug stores and super markets. They
wax, in case of itching in the ear, aural toilet in discharging supposedly represent a safe means of cleaning the ear and
ears and some time as a habit. Cotton bud tips are used not nose. Insertion of cotton tips is not only unnecessary but also
only by adults but are also commonly used in pediatric potentially dangerous.
population either by children themselves or by parents. Ear
injuries caused by cotton buds are commonly seen in ENT Excess cerumen (earwax) in the external auditory canal is
associated with symptoms of earache, fullness in the ears,
Correspondence and diminished hearing. These symptoms, and tinnitus, are
Dr. Suresh Kumar commonly associated with whiplash injury. It is possible that
Department of ENT, Liaquat University of Health Sciences , a significant number of acute onset auditory symptoms
Jamshoro reported in whiplash patients have a benign cause. 2
drsureshadvani@[Link]
Journal of Surgery Pakistan (International) 13 (3) July - September 2008 137
Use Of Cotton Buds and Its Complications
The most common foreign bodies in children are beads, Nussinovitch M et al did survey to find out the leading causes
cotton tips, insects and paper while in adults cotton tips, of otitis externa. They identified many risk factors but the
insects, cotton wool and silicone ear plugs found commonly. use of a cotton-tip to clean the ear was assessed to be the
Adults were more likely to have associated otitis externa at leading cause.8 In our study we found this to be the second
the time of presentation.3 In one study the cotton tip swabs most common complication in cotton bud users. In our study
were the major cause of ear injury and hearing loss.4 The there were five cases of foreign body in the form of cotton
purpose of the present paper is to evaluate the complications tip in adults, while in children no case of cotton tip foreign
/ effects produced by the use of insertion of foreign body in body seen in this study.
the ear in the form of cotton tips for cleaning.
REFERENCES:
PATIENTS AND METHODS: 1. Hobson JC, Lavy JA. Use abuse of cotton buds, J
This observational study was conducted at the department R Soc Med 2005;98:630-1.
of ENT at Sir Syed Medical College & Hospital Karachi from 2. Ferrari R. Auditory symptoms in whiplash patients
July 2005 to January 2007. Patients with history of use of Could ear wax occlusion be a benign cause? Aust
cotton buds were selected and evaluated through detailed Fam Physician. 2006;35:367-8.
history and examination with aural speculum, auroscope and
under microscope in selected cases. Hearing assessment 3. Ryan C, Ghosh A, Smith WB, O'Leary S. Presentation
was done with tuning fork of 512 HZ frequency and pure and management of aural foreign bodies in two
tone audiometry done in selected cases. Clinical features Australian emergency departments Emerg Med
like itching, discharge, pain, bleeding and deafness, decreased Australia 2006;18:372-8.
hearing in ear after use of cotton bud were asked. On
examination signs of trauma in external auditory canal and 4. Karvitz H, Neyhus AL, Dale DO, Laker HI, Gomberg
status of tympanic membrane, presence of pus and wax RM, Korach A. The cotton tip swab: major cause of
were noted. Suctioning and dry mopping, where required, ear injury and hearing loss. Clin Pediatr 1974;13:965-
were done. 70.
RESULTS: 5. Macknin ML, Talo H, Medendrop SV. Effect of cotton-
Out of 100 patients 58 were males and 42 females. Mean tipped swab use on earwax occlusion. Clin Pediatr
age was 38.5 years and range from 07 years to 73 years. 1994;33:14-8.
The common complications / effects were unspecified itching
in the ear in 34, otitis externa in 23, otomycosis in 15, trauma 6. Reiss M, Reiss G, Pausch NC. Some view points
/ injury to the external auditory canal in 9, impacted wax on ear cleaning. 2000;89:1154-6.
medially resulting in decreased hearing in 6 and cotton tip
foreign body 5. Four patients developed boil and traumatic 7. Sim DW. Wax plugs and cotton buds. J Lrayngol
tympanic membrane perforation occurred in four cases. Over Otol 1988;102:575.
all 22% patients developed decreased hearing.
8. Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais
DISCUSSION: D, Amir J. Cotton-tip applicators as a leading cause
Cotton buds tip are frequently used in our population for ear of otitis externa. Int J Pediatr Otorhinolaryngol
cleaning in cases of chronic discharging ears. Many people 2004;68: 433-5.
use it as a habit after taking shower, or cleaning the ears for
wax or due to itching in the ear. Few studies have been
published on this subject. Cotton-tipped swabs are mainly
used for clearing wax.5. Cotton bud use can give rise to
cerumen accumulation and some dangerous complications.
It is absolutely unnecessary and may be a dangerous
practice.6 Study by Sim D on three hundred and ten patients
who used cotton buds for aural toilet, the incidence of visually
occlusive wax plugs in the external auditory canals was not
significantly different between users and non-users of cotton
buds. 7
In present study there were six cases in whom wax was
impacted and pushed medially lead to decreased hearing
after the use of cotton bud, but there was no perforation.
138 Journal of Surgery Pakistan (International) 13 (3) July - September 2008