The cotton buds or also popularly known as Q-tips became quite a rage after its invention in 1923 by Leo Gerstenzang. 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 first instances of medical concern over the use of cotton buds were in 1972 with reports of tympanic membrane perforation, otitis externa and cerumen (ear wax) impaction. In spite of doctors warning against the use of these unostentatious, seemingly harmless contraptions which is nothing less than a nightmare for the ear, it is still being used commonly by most people. Even the manufacturers have put words of warning against the use of cotton buds in the ear canal.
The ear though seemingly unpresuming is actually rather complicated as we go deeper within it. The ear is divided into three parts namely the external or outer ear, the middle ear and the inner ear. The outer ear has an ear canal which is not straight but is inclined and ends at the tympanic membrane or what is popularly referred to as the ear drum.
Wax is produced by the hair-bearing skin of the ear canal. The ceruminous glands are modified sweat glands that open into the root canal of the hair follicles and produce a watery, white secretion that slowly darkens, turning semi-solid and sticky as it dries. These glands respond to many stimuli such as drugs, fever and emotion which, along with direct mechanical stimulation, can all produce an increase or altered secretion. The sebaceous glands produce an oily material (sebum) which is usually excreted into the root canals of the hair follicles. Wax is a combination of dead skin cells, sebum and cerumen formed by glands in the base of the hair.
Human earwax is a Mendelian trait consisting of wet and dry forms. Dry wax, lacking cerumen, is yellowish or grey and brittle, while wet wax is brownish and sticky. The wet phenotype is dominant over the dry type, and is frequently seen in populations of European and African origins. East Asians show the dry phenotype and there are intermediate frequencies among the Native American and Inuit of Asian ancestry. The wax has certain antibacterial properties as well, which protects the ear to some extent. Most external canals are self-cleaning, the wax moves towards the outer part of the canal by a migratory process and with the help of jaw movements.Therefore putting anything in the ear canal can disturb this harmony and lead to impaction of wax. Moreover one cannot see one's own ear canal not even in the mirror making it even more hazardous to clean one's ear by one's own self. There is every chance that you may:
• Injure the ear drum which is only 2.4cm away from the outer ear canal opening.
• Damage the skin of the ear canal causing bacteria to enter the wound and resulting in infection of the ear canal.
• The cotton swab itself can introduce infection into a preexisting perforation in the ear drum.
• And there have been cases where the cotton sometimes is left behind in the ear canal posing as a foreign body in the ear and later causing infection.
Needless to say, after this, the question still remains, I am sure in most minds as to how then should one keep one's ear clean. It's simple, provided we just take a few steps towards ear care such as:
• See that the ear remains dry always.
• Do not direct the shower to the ears.
• Pat the ear dry after a shower or a swim with a clean cloth or tissue and gently blow dry at the lowest setting possible if water has gone inside.
• Show your nearest physician or ENT specialist if you feel your ear is blocked.
• If an insect goes inside your ear, don't try to remove it with buds or any other instrument on your own as it will just cause more damage making further intervention even more difficult. If it's a tiny ant, try showing light to the ear; most of the time the insect comes out attracted to the light. If it is a flying insect and still alive in the ear put oil or clean water into the ear to drown the insect and then show the ENT doctor as soon as possible.
• Do not use any drops without having your ears checked up.
• And most importantly refrain from using cotton buds. They do more harm than good. The only use left for them is in the application of any ointment or to remove make up.
Dr Nisha Krishna, MBBS, MS in ENT at Al Raffah Polyclinic, Amerat