Just How Bad Is My Q-Tip Habit?

Ah, friends. They're like family but cooler. Fully customizable. Fall and one of them will be right there to pick you back up. But as great as friends can be, they also do a lot of really stupid stuff. Stuff that blows your mind. Like, sometimes it seems crazy that you even hang out with people who make such crappy decisions. Stuff that, were it to get out, would be mortifying for anyone with even a shred of self-respect. Lucky for your friends, they've got you to ask their deepest, darkest questions for them. And lucky for you, we started this column to answer those most embarrassing of queries. The scenario: On Tuesday, the American Academy of Otolaryngology issued updated recommendations doubling down on the idea that most people should just leave their earwax alone. Stay out of it, they basically said, and if you have problems, come to us, your friendly local ear, nose and throat doctors.

The issue: Your friend knows the old saying about elbows and ears, yet he cannot resist the full-body tingle that comes along with a good Q-tipping. And since he hasn't had any trouble in a decade or so of swabbing his ear canal, he has no plans to stop now.

The worst that could happen: Our bodies make earwax to stop harmful things like dust or water from getting to the sensitive eardrum. Though you might not notice it, jaw movements push earwax little by little from the inner canal to the outside, where it typically flakes away, though that might not happen for people who produce too much wax or have skin conditions that make the skin on the inner ear too dry.

Though you might think you're taking wax out of your ears with Q-tips, what you're really doing is jamming it down towards your eardrum and compressing it. Over time, that can cause a medical condition called cerumen impaction, in which so much wax builds up it can cause muffled hearing, a feeling of fullness or stuffiness in the ears, tinnitus, or even vertigo. Aggressive swabbing can also cause tiny cuts in the delicate skin inside the ear, which can cause itchiness or get infected. On rare occasions, overzealous Q-tippers have even ruptured their eardrums.

The guidelines note that 10 percent of children, 5 percent of adults, and 33 percent of elderly people seek medical care for earwax-related issues. "If [patients] are having symptoms related to earwax, there's a high chance that the Q-tips are perpetuating that," says Benjamin Tweel, a professor of Otolaryngology-Head and Neck Surgery at Icahn School of Medicine at Mount Sinai. He estimates that Q-tips are probably involved in about one fifth of ear problems in general.

Harold Pillsbury, the chair of the ear, nose, and throat department at the University of North Carolina School of Medicine, estimates that about a quarter of his patients come in because they have mismanaged Q-tips. One 2012 study that categorized 1,540 cases of perforated eardrums found that 3.5 percent of perforated eardrums were caused by cotton swabs. That's not a ton, but it's enough to know that it happens.

Still, there are worse things you can do to your ears than stick Q-tips in them. Candling, in which you hold a candle above the ear to (theoretically) melt the wax out, is one of them. "I've seen patients who burned up the whole side of their head, it's absurd," Pillsbury says. "It's like a grease fire down your ear canal."

What will probably happen: Lucky for you (as a person who likes to have friends who can hear you when you're talking), if your friend's Q-tip use hasn't caused a problem for him yet, he's probably fine, says Erich Voigt, an otolaryngologist at New York University's Langone Medical Center. Some doctors, in fact, haven't seen many problems at all—Tim Hain, an otoneurologist and emeritus professor at Northwestern University School of Medicine, sees Q-tip users all the time and doesn't see much damage other than some bruised eardrums.

Most doctors, though, agree with the guidelines. If it's hygiene you're worried about, just use a finger with a tissue to clean the outside bowl of the ear around the entrance to the inner canal. You can also flush out your ears with soap and water while you're in the shower, being sure to dry them carefully once you're done to prevent infection. Physicians usually check patients' ears during an annual checkup, so if you do happen to be an earwax overproducer, the doctor may recommend using over-the-counter drops, rubbing alcohol, or baby oil that can soften it so that it comes out more easily on its own. If you're experiencing symptoms that indicate the earwax might already be impacted, you can book an appointment with an ear, nose, and throat specialist, who may use tools like a cerumen loop or forceps to pull the wax out.

What you should tell your friend: Something along the lines of, Go ahead, dumbass, but be careful while you do it and don't get crazy. Ear doctors all have stories about the objects they have pulled out of the ears of patients who put them there with the intention of cleaning them, including but not limited to: pen caps, bobby pins, paperclips, an allen wrench, and keys. Specialists frequently pull out broken-off heads of cotton swabs, too. "A few times I've gotten embarrassed patients who put something in their ear to clean it and couldn't get it out and then said that they didn't know how this happened. Like, 'Oh I don't know how that bead got in there,'" Tweel says."If a person absolutely has to use a Q-tip, I would just tell them to be careful," Voigt says, "I hope you don't harm yourself or cause damage."