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Medical Files

Cotton-tip applicators can be ‘weapons of ear destruction’

/ 03:17 AM January 31, 2017

One of my embarrassing moments as a young doctor at the Manila Doctor’s Hospital decades ago, was when I consulted our ENT (ear, nose and throat) specialist, Dr. Felix Nolasco, for some aching pain in my left ear. After taking a quick look in my ear canal with his otoscope instrument, he asked me, “Are you using cotton-tipped applicators to clean your ears?”

“Of course I do, and I do that everyday after taking a bath,” I answered quickly, without an inkling that I was about to realize one of the greatest blunders I’ve been committing as a physician—that is, unwittingly exposing my ear canal to injury by enthusiastically wiping off ear wax, which is supposed to protect it, with cotton-tipped applicators (CTAs).


“I think I was absent when they taught us that in medical school,” I replied in jest, humbly accepting my ignorance.

But after that episode, I resolved to do penance by always asking all those who complain of earache, vertigo (dizziness), tinnitus (ringing sensation of the ear) and other ear symptoms if they use CTAs, and explaining to them the potential harm to the ear canal.


CTAs are very useful if used for the right reasons. As their name implies, it’s used to apply something, usually a medicated agent, to a part of the body—such as antibiotic ointment to a wound.

But cleaning the inner ear canals is not one of CTA’s intended uses.

In fact, some boxes of CTAs have a warning on the box not to use them inside the ears. We can safely use them in the outer parts of the ear, but not in the more scratch-prone, sensitive ear canal.

Unfortunately, if I were to judge from the feedback of our patients, the majority still think CTAs can be safely used to wipe off the ear wax in the ear canal.

I tell them, “Don’t push your luck too far. You may have gotten away with it up to this point, but there’ll be payback at some point.” And I’m not ashamed to admit it happened to me once before.

Ear spoons

Ear-canal cleaning has been practiced for centuries. It is well documented by historical relics—just look at the ivory and gold ear spoons in museums dating back to ancient civilizations.


Ear cleaning has been inculcated in us as part of good body hygiene. Ear wax is supposed to be a big “eeeew,” and should be regularly cleaned off, as we do the booger in our nose.

The truth is that ear wax is a protective mechanism for our ear canal. It is a normal, beneficial coating to the ear canal lining to help ward off dirt and germs that may cause infection.

Ear wax also will prevent water from getting into our ears when we take a bath, especially when we swim.

Enthusiastically digging into it with CTAs, as if we’re searching for precious metals, takes away the protective coating provided by the wax and exposes the ear canal to injury and subsequent infection.

Our ENT colleagues have even seen cases of some people puncturing their ear drums because they’ve pushed their CTAs deep inside. That can get really complicated, and may even require surgery to fix the damage.

We should never allow anyone else to poke into our ear drums except our ear-specialist doctors. They’ve trained long enough to know how to do it gently and properly, frequently with the aid of devices.

ENT specialists now have video otoscopes so you can even see the area inside your ear as they examine it, like experts carrying out an expedition inside a dark cave with their head lamps.

They’re experts, but they do it with such care, and with the aid of modern devices.

Just imagine what we’ve been doing all these years—poking CTAs blindly into the sensitive parts of our ear canal.

When we finally finish our reckless “digging,” we take out the CTA and even feel proud as we look at the wax-stained cotton tip. If only we realize the big folly we’re committing.

So, CTAs are useful, with a thousand and one uses in health care. But, as some doctors and health writers call them, they can also be modern “weapons of ear destruction.”

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TAGS: cotton buds, doctor, ear, ear wax, Health, infection, Lifestyle, nose, throat
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