We've all heard that you shouldn't clean your ears with cotton swabs. In fact, you may have even noticed a warning label on the box explicitly saying: "Do not insert inside the ear canal."
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But that advice is largely not being followed. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) estimates that a whopping 90 percent of people use cotton-tipped applicators to wipe out earwax.
We get it. If you've got a glob of gnarly gunk in there, it's tempting to scoop it out. And what could really go wrong? Sure, there are horror stories about puncturing your eardrum — but that's probably only if you're going at it like a jackhammer, right?
Well, it turns out mishaps are more common than you may think. Here's the real deal on what can go wrong when cotton swab meets ear.
How Wax Protects Your Ears
Turns out, wax is your ears' BFF. According to the AAO-HNS, cerumen (aka earwax) is composed of natural ear canal secretions mixed with hair and dead skin.
"It starts out as an oily, amber-yellow liquid," says neurotologist Elina Kari, MD, assistant professor of surgery at UC San Diego Health. "As it accumulates and ages inside the ear canal, it can turn brown or black."
It might look nasty, but this sticky substance plays an important role in maintaining aural wellbeing.
"Cerumen is relatively acidic in order to maintain your ear's microbiome, an ecosystem of healthy bacteria," Dr. Kari says. "It ensures a proper balance of microorganisms and prevents overgrowth of bacteria or fungus, which can lead to painful ear canal infections that require medical attention."
In fact, an August 2019 study in the Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery found that human earwax has antibacterial and antifungal properties.
It's also an essential emollient. "Cerumen keeps the ear canal moist," Dr. Kari says. "If you remove the wax from your ears, they can become dry and itchy."
All together now: Three cheers for earwax!
5 Scary Things That Can Happen if You Stick a Cotton Swab in Your Ear
Here's why the old saying holds true: You should never put anything smaller than your elbow in your ear.
1. You Could Scratch Your Ear
Rubbing cotton around in there can create tiny scrapes, called micro-abrasions.
"As a result, you are at a higher risk of developing ear infections, where you get excruciating pain, swelling and pus," Dr. Kari says.
2. The Wax Could Get Impacted
"Cleaning devices just shove the wax in further," Dr. Kari says, pointing out that we only produce wax on the outer third of our ear canal, not on the inner part next to our eardrum.
The canal is made to push wax out naturally, and if you thrust it in too deep using a cleaning device, it will become impacted. As a result, it will take longer to come out on its own and you may even need to have a doctor help you get it out.
In the meantime, you will experience intermittent or constant hearing loss in one or both ears; it'll feel like you're wearing an earplug.
"In some cases, you can get an ear infection from having impacted wax sit there for too long," Dr. Kari says.
3. You Might Puncture Your Eardrum
If you dig too deeply, you might rupture the eardrum.
"This leads to a loss of hearing and increased risk of infection," Dr. Kari says. "Usually the traumatic perforations will heal, but it will take several months."
A February 2018 study in JAMA Otolaryngology Head Neck Surgery found that 66 percent of people admitted to the emergency room for eardrum trauma had injured themselves by inserting instruments (usually cotton-tipped applicators) into their ears.
And a May 2017 study in The Journal of Pediatrics determined that 263,000 children were sent to the ER for ear damage related to cotton swab use between the years of 1990 and 2010. That's an average of 34 kids each day.
4. You Could Become Deaf
Beyond the eardrum lies the otic capsule, the wall of the inner ear. Penetrating this area leads to irreparable damage.
"If you violate the inner ear, you will be permanently deaf in most cases," Dr. Kari says. "You will also experience dizziness that can leave you with lasting imbalance."
5. You Might Dislocate Your Ear Bones
"When you perforate the eardrum, you can dislocate the little bones that transmit the sounds to the inner ear," Dr. Kari says. "This won't heal on its own — it requires surgery to repair."
Do You Even Need to Clean Your Ears?
Probably not. Per the AAO-HNS, excess wax passes out of the ear canal automatically, carrying dirt, dust and other particles of debris along with it. The movement of your jaw when you chew or talk facilitates the migration of cerumen. Once it reaches the ear opening, it dries up and flakes off.
"You should not be cleaning your own ears unless you've been directed to do so by a doctor," Dr. Kari says.
That said, some folks churn out a slew of sludge that does need to be professionally removed.
"These people might have chronic inflammation of the ear, causing a lot of skin to build up over time and mix with the wax," Dr. Kari says. "This leads to repeated impaction, where their ears are clogged with wax."
In addition, dermatologic issues that lead to dry, scaly skin like eczema or psoriasis can create clumpy wax that's more likely to get stuck in your ear canal, according to Harvard Health Publishing.
Genetics also play a role. For example, you might have been born with particularly narrow ear canals that get blocked up more easily. And people of East Asian descent tend to have drier earwax, making it difficult for the crud to slide out.
Plus, because cerumen secretions become flakier as you age, older adults are prone to impacted wax. Hearing aids worsen the problem by pushing the wax deeper in.
"If you're naturally a heavy wax producer, your ears need to be cleaned by a doctor on a regular basis — typically every three to 12 months," Dr. Kari says.
The AAO-HNS recommends hearing aid-wearers have regular earwax inspections, too.
The Best Way to Clean Your Ears at Home
Even though scrubbing the insides of your ears clean isn't necessary, having a hunk of brownish-yellow goo sitting right there is pretty gross.
"To get rid of it safely, wrap a towel around your finger and wipe off your ear opening," Dr. Kari says. It might help to tilt your head to one side during your shower and let the warm water run over your ears to soften up the wax before wiping.
She concedes that you can use a cotton swab (although a towel is preferable) — just make sure the applicator never, ever enters the ear canal itself.
5 More Things You Should Never Do to Your Ears
While cotton swabs are the most common culprits for ear cleaning trauma, there are endless products out there claiming to slay wax. Listen up: You should steer clear.
"I've never seen anything good coming out of using a device to clean your ears," Dr. Kari says. "I wish that the market would stop creating these tools."
Here are a few offenders you might encounter:
1. Spiral Ear Cleaners
Although these silicone, corkscrew-like implements claim to safely extract earwax, Dr. Kari cautions people to skip them.
"They cause the same problems as cotton swabs, because you may be inserting them to varying degrees of depth," she says.
2. Ear Candling
Simply light a hollow candle and place the unlit end into your ear opening in order to draw out wax, according to this woo-woo practice. What could possibly go wrong?
"I feel very strongly that you shouldn't candle your ears," Dr. Kari says. "I have seen a lot of heat injuries resulting in burns to the ear canal from candling."
3. Ear Irrigation
This popular technique involves squirting a bulb syringe filled with water into your ear canal. It can be effective, but it should only be done by a doctor.
"If you do it for a prolonged period (more than 30 seconds), the temperature of the water can stimulate your inner ear, leading to dizziness," Dr. Kari says. "Plus, if you use too much force, you can push the wax further in, rather than flushing it out, and you risk rupturing your eardrum."
4. Earwax Softening Drops
"The drops often don't help the wax drain out or relieve any uncomfortable symptoms," Dr. Kari says. "All they do is turn a big plug of hard earwax into a slushy mess."
5. Ear Picks
"Oh, God, no," says Dr. Kari. We'll leave it at that.
Head to the ER ASAP if This Happens
Let’s say you wake up one day and can’t hear out of one ear. You might assume you’ve got some wax clogging things up. But when you head to your primary care doc or the urgent care clinic for a cleaning, they say you’re free of buildup and chalk it up to just a cold.
Do not brush it off.
“You should see an ENT right away — it could be a condition called sudden sensorineural hearing loss, or sudden deafness,” Dr. Kari says. “It can become permanent, but some people get better if they are treated quickly.”
One in 10,000 people will experience this condition, which is thought to be viral, although the cause is unknown.
So, How Bad Is It Really to Use a Cotton Swab in Your Ears?
As long as you don't insert it inside your ear canal, it's fine. But if you dig any deeper than the outer rim, you run the risk of doing way more harm than good.
"I have friends who tell me they use a cotton swab all the time," Dr. Kari says. "I just shake my head and tell them it's not a great idea."
- Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery: "Human cerumen and its antimicrobial properties: Study at a tertiary care teaching hospital of Eastern India"
- American Academy of Otolaryngology-Head and Neck Surgery: "AAO-HNSF Clinical Practice Guideline: Earwax Removal"
- Harvard Health Publishing: "Got an ear full? Here's some advice for ear wax removal."
- JAMA Otolaryngology Head Neck Surgery: "Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments"
- The Journal of Pediatrics: "Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010"
- AAO-HNS: "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.