Between 1990 and 2010, an estimated 260,000 children visited U.S. emergency rooms with cotton-tip applicator injuries, according to an article published in Pediatrics earlier this month.
Parents could read this news and reasonably decide that ear-cleaning presents risks worth taking. Out of the over 260,000 injuries over two decades, only an estimated 588 (.2%) actually led to a hospital admission, suggesting that an overwhelming majority of Q-tip related injuries are not serious.
But parents could also read this news and decide never to buy Q-tips again. The researchers suggested that some of the most serious consequences of such injuries, like tympanic membrane perforation, are not always detectable immediately after injury. Because such injuries are completely preventable if parents leave kids' ears alone, they may want to tolerate a little waxy buildup.
But the far more interesting story about Q-tips is not that they may be dangerous. It's what our continued use of them says about our ability to absorb and implement scientific research.
One of the more interesting pieces of data in the Pediatrics article is how children get injured. The majority of estimated injuries happened during ear cleaning (73%), but also while playing with cotton swabs (9.7%), by falling/running into/tripping on them (9.3%), by being bumped or pushed into them (1.9%), or even by laying down or rolling over onto them (1.2%).
The authors do not speculate about these other causes of injury. We could just conclude that kids get themselves into an amazing array of situations. If you can turn around for five seconds only to find a four-year-old atop your refrigerator, you can probably also blink and find a kid who rolled on top of a Q-tip. But here's another hypothesis: we all know that we're not supposed to be using Q-tips, so when we're asked about Q-tip use, we lie.
The May 2017 Pediatrics study was not the first to describe Q-tip related injuries. Other researchers did that over 40 years ago. And it's not like those studies went unnoticed. Popular parenting books advise parents to leave their kids' ears alone. Go-to parenting websites such as Parents, BabyCenter, and the Mayo Clinic all warn readers against Q-tips. But we don't even need to read any of those warnings, because all boxes of cotton swabs, whether brand name or not, include a warning not to use the swabs for ear cleaning, as they have since the 1970s.
We've read before how cerumen (earwax) performs important functions and we're not supposed to be digging or scratching it out of our ear canals. But we've also been led to believe that earwax is gross. We see the sides of our children's heads more often than our own. We fear that someone else who happens to catch a glimpse of wax in our children's ears will think that they are dirty and that we are lazy or inattentive. And so we reach for the Q-tip.
This concern for hygiene and appearances seems to block any rational argument against Q-tip use. Roberto A. Ferdman, writing for the Washington Post last year, wrote about exactly this contradiction: "Q-tips are one of the only, if not the only, major consumer products whose main purpose is precisely the one the manufacturer explicitly warns against."
The comments section of Ferdman's article is full defiant readers, insisting that their ears are dirty and need cleaning. Commenter Zoe Stephens asserts "IDGAF about this. I always have, and always will, clean my ears with q-tips! Waxxy [sic] ears are gross. They feel gross. I can feel it when I scratch my ears or use earbud headphones. I am NOT gonna walk around with ear wax flakes on my shoulders, either. Nope nope nope."
ResponsibilityUS laments that the author didn't provide an alternative for ear cleaning: "What an irresponsible absurdity - An entire article is against using Q-Tips to clean the ears and, yet, any appropriate alternative is never mentioned. Yuck."
Space1999, after determining to go ahead and keep using Q-tips, notes that "This kind of issue reminds me that being right about something is not enough to change human behavior."
I'd like to say that in light of this evidence I'll repurpose all my Q-tips for toddler paint mixing, but in all actuality I know I'm likely to fall into the same trap as Zoe Stephens, ResponsibilityUS, and Space1999. So perhaps the real reason Q-tips are sending kids to the emergency room in 2017 is not that parents are sufficiently unaware of their dangers, but that in a battle between certain self-disgust and potential-but-unlikely danger, we'll choose danger every time.