Sure, yes, I knew that the ear is an erogenous zone. But never did I expect that a quick, news-you-can-use post about the dangers of sticking Q-tips into that zone would draw an outpouring of "Noooooo! Q-tipping is one of life's great ecstasies!"
Nor did I know that Q-tip use is apparently a frequent issue of spousal disagreement, as e-mailed responses like this suggest: "Sending this to the habitual Q-tip abuser in my home," and "My husband LOVES q-tips, he uses them far more often than I'm sure any doctor would say is healthy."
That quick post — Why You Really, Truly, Should Not Put Q-Tips Into Your Ears — has enjoyed regular resurgences onto the WBUR.org top 10 since it went up in November, to the point that it seemed worthwhile to revisit the theme, draw some lessons, and seek a reality check on some of the claims in the comments.
I spoke with Dr. Steven D. Rauch, professor of Otology (ears) and Laryngology (throats) at Harvard Medical School and associate chief for education and academic affairs of the Otolaryngology department at the Mass. Eye and Ear Infirmary. But before I get to his sage comments on Q-tips, here's the main pearl he shared:
"Q-tips aside, If someone develops new onset of a blocked feeling in the ear — like the feeling of water in the ear when you get out of the shower — most of the time it's harmless and it goes away in minutes or hours. But if you develop an acutely blocked ear and it does not clear that day, it should be checked. It could be sudden deafness, which strikes one person in 5,000 every year — so about 500 people in Metro Boston a year — and is an emergency because there's a short time window in which to treat it, within a couple of weeks. After that, it's untreatable."
"If your ear blocks up suddenly or you realize that one ear is blocked, here's the test you should perform: Hum. Just hmmmmmmmmmmm. And if you hear your voice louder in the blocked ear, the bad ear, there’s nothing to worry about. But if you hear it louder in the good, unblocked ear, that's bad. That's when we worry you have sudden deafness."
Nobody knows exactly what causes this sudden deafness, Dr. Rauch said, but it's nerve damage that is potentially reversible if treated with steroids within two to four weeks. Often, he said, patients wait to see if the symptoms improve, and try to clean out their ears, and try cold medications, and by the time a specialist sees the ear it's three months out and too late to treat. So remember, he said, "that little humming test is the simplest, low-tech thing to do, but if you're not sure, have an ear, nose and throat specialist look at your ear."
End of public service message. Now for Q-tips. Dr. Rauch, lightly edited:
"The topics that came up in the post's comments range across the whole gamut of all the things anybody ever says about ear wax. Back in the 19th century and early 20th century, there were a lot of medical papers on ear wax. All the indications were that it kills bacteria and moisturizes the ear canal and protects it from particulate debris, so it's good for you. People who don't make enough ear wax are miserable because their ears are itchy and dry all the time.
By and large, ears are self-cleaning. If you leave your ears alone, they’ll leave you alone.
The ear canal is only about an inch long from the external world to the drum, and the wax forms only at the outer edge. The skin of the ear canal migrates outward like a conveyor belt and pushes the wax out, so by and large, ears are self-cleaning. If you leave your ears alone, they’ll leave you alone. In some cases, because of the shape of the canal or the consistency of the wax, you need someone to clean it, but routinely, that's not the case, and you're thwarting the normal conveyor belt mechanics when you plow the stuff down into the deep part of the canal.
There was some discussion in the comments about touching your ear drum, but that is unlikely, because the distance to it is three times the length of the Q-tip cotton ball, and it's intensely painful to touch. No one can tolerate that. When we're cleaning an ear and accidentally touch the drum, the patient goes right through the roof. So no one commenting on the pleasurable aspects of Q-tips is going that deep — it would be intensely painful.
So let’s talk first about all these pleasure responses. I was amazed by the flood of responses from people defending the exquisite pleasure of ear-cleaning...
That shouldn't be a surprise. The ear is an erogenous zone. That's not news.
Well, but it didn't sound like they were talking about sexual pleasure...
They said orgasmic. How much more erotic can you get than that? The fact is, some kinds of stimulation in the ear, for some people, is pleasurable, and that's just old news. But not everyone agrees on what kind of tactile stimulation feels good. Not everyone wants someone to nibble on their ear — but some people do. This is a topic that definitely does not come up in my office!
So basically what happens is that people find out it feels good and use Q-tips the wrong way, deep in the ear?
You could say that. It does say on the box not to put them into your ear, and when there were TV commercials they would only show Q-tips stroking the external ear. But it is shaped like something you're supposed to stick into your ear canal. It's an evocative shape. Plus, everyone's been doing it for a long time, and it's only once in an while that someone leaves the Q-tip in their ear and forgets and answers the phone...
Can you quantify the extent to which Q-tips are the bane of the existence of ENT specialists?
Oh, I don't know. Lots of people stick Q-tips in their ears. Some of them do harm by doing that. They either push the wax down deep where it can't clean itself out and they have to get professional care, or they traumatize the canal so that it bleeds or hurts, or they make little scratches and bacteria get in and cause infection.
So it's a well-known mechanism for causing ear trouble, but that's a numerator with no denominator. Say I see 50 people who have Q-tip issues, but I don't know how many out there use them and never have a problem. I don’t know whether it’s 50 out of 75, or 50 out of 5000 users. It's impossible to know how big the problem is.
And it's not a secret. It's not an unknown problem. Everybody in the medical profession, every primary care doctor and ENT specialist, knows this. I think a lot of the public knows it too, but the public does a lot of things that are not good. They ride bikes without helmets and don't put on seat belts and drink giant soft drinks.
Some commenters suggested using ear plugs to keep water out of your ears in the shower.
Well, why would you want to keep the water out of your ear? Water in the ears is harmless unless you have a hole in the ear drum.
The original article comments that if you have the feeling that water is not coming out of your ear, put a couple of drops of alcohol in and it breaks the surface tension. Lots of times people think they have water in their ear but they really don’t. They have wax in the ear or hearing loss or other congestion, and they're mistaking it for water.
The ear canal is only an inch long and the diameter of a yellow pencil. It's not a big volume and it's a physical impossibility for water to stay in there for days at a time. Even if you got water in it, it would dry up or run out in an hour or two. If you have an ear blocked for a big part of the day, something else is wrong. It's not water in your ear.
[See above for Dr. Rauch's warning about sudden deafness.]
Back to Q-tips. The original post connects Q-tip abuse to a form of vertigo, called BPPV, for Benign Paroxysmal Positional Vertigo.
BPPV is very common. Nine percent of the population gets it at least once in life, and 50 percent of those people have it as a relapsing illness. Fortunately, it is easily treated in the office by your ENT doctor or physical therapist. We have people walking into the emergency department 24/7 for this treatment.
A bit more on Q-tips: Lots of people use them after they bathe to dry the ear and maybe they think simultaneously to clean it. Also, people use it because ears itch. It's like sticking a coat hanger down the cast on your broken leg.
The opening of the ear canal is very prone to eczema and psoriasis, which is flaky, scaly dry skin and itches like crazy. So when people have chronic dermatitis it often affects the ear, and that's also very treatable, usually with some steroid ointment. Here's a little secret: If you tried moisturizing the skin with baby oil and it doesn't work, and topical cortisone doesn't work, hemorrhoid treatment works great. Besides lanolin, it also has a little anesthetic in it, which makes the itching stop.
Some commenters mentioned an Asian form of ear-cleaning, and differences in Asian ear wax...
Yes, back in the early 20th century when people were studying ear wax, there was a fair amount of comments on racial and ethnic differences in ear wax, the color and consistency. Nowadays that’s not really PC, and it hasn't been studied by modern science. It is certainly true that ear wax color and consistency is very variable and may be influenced by diet, hormones, climate, age, all kinds of biological and environmental factors. These days, we don't really focus on that as an important medical topic.
Readers, I really do think we've exhausted this topic. But your comments and questions are always welcome...
This program aired on June 25, 2013. The audio for this program is not available.