Cotton-tip swabs send dozens of kids to the ER every day

(Reuters Health) - Almost three dozen children end up in U.S. hospital emergency departments every day thanks to injuries that result from using cotton-tipped swabs to clean their ears, according to a new study.

The highest rate of emergency department visits for ear injuries from cotton swabs was in children up to age 3, the researchers found.

“It highlights the misconception that adults and children need to clean the ear canal in the home setting,” said senior author Dr. Kris Jatana, a pediatric ear, nose and throat surgeon at Nationwide Children’s Hospital in Columbus, Ohio. “While cotton-tipped applicators may seem harmless, there are certainly a lot of potential risks to using them to clean the ears.”

Jatana and colleagues write in the Journal of Pediatrics that cotton-tipped swabs were created in the 1920s to clean babies’ ears, but reports of ear injuries eventually came to light.

“The injuries can range from minor to severe,” Jatana told Reuters Health.

The researchers analyzed data from the National Electronic Injury Surveillance System, which contains nationally representative data from U.S. emergency departments, to assess the extent of ear injuries in children due to cotton-tipped swabs.

They estimate that overall, 263,338 children under age 18 were seen at U.S. emergency departments between 1990 and 2010 for ear injuries tied to the use of these products.

The yearly number of visits for this reason rose from 9,794 in 1990 to 17,449 in 2001, but then declined to 12,911 in 2010.

About 40 percent of emergency visits were due to a feeling of something stuck in the children’s ears. About 35 percent of visits were due to bleeding, and about 17 percent were due to ear pain.

After examination, about 30 percent of children were diagnosed with a foreign body in their ears. A quarter of children were diagnosed with broken eardrums, technically known as tympanic membrane perforations. About 23 percent were diagnosed with soft tissue injuries to the ear.

Almost all the children were treated in the emergency department and released without needing to be hospitalized, the researchers found.

About 40 percent of injuries occurred among children up to age 3, and about 67 percent occurred among those under age 8.

In nearly two-thirds of the cases, the researchers had information on where the injury occurred - and almost all happened at home.

When they were able to document the cause of the injury, the majority were due to cleaning.

“We’ve learned over the years that it’s not a safe practice to insert this product into ears,” said Jatana.

Even ear, nose and throat doctors wouldn’t use cotton-tipped swabs to clean out earwax, said Dr. Cuneyt Alper, a pediatric ear, nose and throat specialist at the Children’s Hospital of Pittsburgh of UPMC.

“We use different instruments ourselves,” said Alper, who was not involved with the new research.

Serious injuries to the ear canal or the eardrum are rare, according to Dr. Alyssa Hackett, a pediatric ear, nose and throat specialist with New York Eye and Ear Infirmary of Mount Sinai in New York.

“More commonly, the wax is pushed deep into the ear canal instead of removed by the cotton swab which can cause a temporary hearing loss similar to the feeling of having an ear plug in the ear,” said Hackett, who also wasn’t involved with the new research.

She added in an email to Reuters Health that ear wax deep in a child’s ear can be difficult and painful for a doctor to remove. It may also make diagnosing an ear infection difficult or impossible.

Instead, Alper recommends using a cotton ball to remove visible wax from the entrance to a child’s ear.

Parents should “go after the wax that they see,” he told Reuters health. “Ear canals are self cleaning - typically - unless the wax is pushed in.”

Jatana said using soapy water and a washcloth at bath time should also do a satisfactory job.

SOURCE: The Journal of Pediatrics, online May 1, 2017.