HEALTH
April 16 2019, 12:01am, The Times
Put the cotton buds down! How to clean your ears without them
We have ignored doctors’ warnings for too long. Here are the do’s and don’ts for ears Simon Crompton
Cleaning with a bud is more likely to push wax into your ear than remove it.
The embattled cotton bud, newly shamed as a source of ocean plastic, is at the centre of a strange but true health scare. The British Medical Journal has reported the curious case of a 31-year-old man from Coventry who developed a potentially fatal infection inside the skull as a result of getting a cotton bud tip stuck in his ear.
He collapsed and was rushed to hospital after pain in and discharge from his left ear, violent headaches and a sudden inability to remember names. CT scans revealed a serious infection called necrotising otitis externa in the bone around the inner ear and the lining of the skull. Surgery revealed the cause: cotton wool encased in a hard ball of wax. Surgeons believed it could have been there for five years.
This might be dismissed as a one-off had it not been followed immediately by an almost identical story reported in Australia last month. Jasmine Small, 38, suffered permanent hearing loss after an undiagnosed infection, which was eventually found to be caused by a loose strand of cotton from an ear bud in her ear canal. Her symptoms included hearing problems, pain, and a brown discharge and blood from her ear.
We shouldn’t put cotton buds in our ears. We know we shouldn’t; doctors have warned us about it since the 1970s. But we still do it. According to research by YouGov, 62 per cent of us use cotton buds for ear cleaning, even though there are “Never insert into the inner ear” warnings on products. But who reads the small print? And surely it’s OK to go into the ear canal just a little bit — it’s poking right down that’s problematic, isn’t it? Actually, no.
The fact is that most of us aren’t looking after our ears properly, whether because of ignorance, habit or things our mothers told us. Often we’re doing more harm than good.
Here are some do’s and don’ts.
Don’t clear wax with a cotton bud
The possibility of cotton strands causing a serious infection in your skull is remote. Doctors are more worried about two other risks. First, overenthusiastic delving or a slip of the hand can lead to the bud piercing the ear drum, which can cause temporary hearing loss.
Second, cleaning with a bud is more likely to push wax into your ear than remove it, making it more likely to become impacted and stuck. The result is hearing problems, but impacted wax also leads to the ear canal becoming irritated, inflamed and infected, particularly if water gets trapped behind it.
An American study in 2017 found that a quarter of a million under-18s went to A&E with cotton bud injuries between 1990 and 2010 — three-quarters of them related to ear cleaning.
Why do we continue to put cotton buds in our ears? One theory is simply that it feels nice. “Cleaning the ears with cotton buds can feel very satisfying,” says Roger Henderson, a GP and author.
Don’t put anything in your ears
With the possible exception of earphones, earplugs, and occasional drops and sprays (see below), you shouldn’t put anything in your ears. “The general rule is nothing smaller than your elbow,” says Roger Wareing, a consultant ear, nose and throat surgeon at St Bartholomew’s and the Royal London hospitals. “Some people I’ve treated have managed to dig a hole through their skin into the bone of the ear canal,” he says. Wareing points out that there is another problem with ear cleaning, beyond eardrums and earwax: skin. Even gentle rubbing in the ear canal with something as soft as cotton wool can erode the protective upper layers of the skin lining it. It leaves the tissue more likely to become infected or irritated, troublesome and itchy. If it’s itchy, you’re more likely to poke it with a bud, which makes the problem worse.
Don’t syringe your ears
Wax normally works its way out of your ears naturally, but sometimes people overproduce wax and sometimes it doesn’t move out as quickly as it should, so it builds up in the ear canal. This causes discomfort and hearing problems. The answer used to be syringing, getting a doctor or nurse to squirt water into the ear to shift the wax. The National Institute for Health and Care Excellence, the NHS watchdog, advises against the technique because research has indicated it to be ineffective and “potentially harmful”.
The problem, Wareing says, is that the procedure is largely guesswork. Doctors and nurses can’t see into the ear while they’re syringing and can’t accurately control the water flow. Home syringing kits also have risks, but there are alternatives such as microsuction (see below), where doctors can see into the ear as the procedure is performed.
Don’t have your head in the water for too long
Some people’s ears retain water more than others and it can get trapped behind wax. The problem is that lengthy exposure to water makes the skin in your ears soft, like soggy hands when you’ve been in the bath too long. In this state it’s not as protective, which means bacteria is more likely to take hold. This can also happen if you stay in the pool or the sea all day. “Infection is most likely to get in if you traumatise the skin with a cotton bud while it’s soggy,” Wareing says. Products such as Swim Ear and Ear Calm, which dry your ear canal when it’s wet, can help, he says. “Surfers have traditionally made their own ear drops out of lemon juice and vinegar to dry the ear and keep bacteria from growing.”
Do leave your ears alone if possible
Ears don’t usually need cleaning. We may instinctively have an aversion to earwax, but it’s wonderful stuff, containing an antibacterial enzyme called lysozyme. As it is propelled in a circular and outward direction by the skin cells beneath, migrating towards to the outer ear, it catches and carries away dead cells and pollutants, so that the ear canal stays clear and clean.
Do get wax build-up cleared professionally
Syringing may be out, but there has been a boom in NHS and private practitioners using new technologies for wax removal. They include manual removal, electronic irrigation (a carefully controlled form of syringing) and microsuction (an ear microscope with a powerful sucker). Wherever you go, make sure the doctor, nurse or audiologist who treats you has training and experience in the procedure.
Do use a cloth to clean the outer ear
“Wiping your ears with a cloth or towel is fine,” Wareing says. “There’s normally no need for any products.”
Do use olive oil if you need to. If your ears are susceptible to wax build-up, you can keep on top of it by using drops of olive oil or a product such as Otex to soften the wax and give it a helping hand in finding its own way out. Drops of olive oil help to soften wax
HOW TO KEEP YOUR EARS IN SHAPE
What do I do if I have a spot in my ear? If it’s a pimple or a small scab, leave it to sort itself out. Larger painful lumps may be infections and using an antibacterial product such as Ear Calm spray may help.
What helps earache? Sometimes our ears ache after being out in a cold wind because the bone around the inner ear is covered by only the thinnest layer of skin, and easily gets chilled and irritated. NHS guidance suggests easing earache with painkillers, or putting a warm or cold flannel over the ear.
Do ear candles work? Inserting these hollow candles into the ear canal and lighting them is supposed to draw wax out, but research suggests they are ineffective and potentially harmful. A 2018 study found that a 16-year boy who regularly used ear candles experienced pain, reduced hearing and candle debris stuck in his ear.
Are headphones bad for ears? They are part of our lives, but they may contribute to ear infections or wax accumulation in those who are prone to them, Wareing says. “Most people are fine, but I often recommend over-ear rather than in-ear headphones.”
What about ear plugs? For most people who want to blot out the sound of noisy neighbours, wearing foam earplugs shouldn’t cause a problem, Wareing says. However, if you have a tendency for wax build-up or if you’ve had ear infections before, regular use could make these more likely.
What do I do about itchy ears?
Itchy ears may be related to dermatitis or even an allergy, for example to the plastic in your headphones. Wareing recommends a mild hydrocortisone cream, available from pharmacists.
