The ear is a self-cleaning organ and a cotton bud has no business being inside the ear canal, writes Aznim Ruhana Md Yusup
OVER the years we have come to associate cotton buds almost wholly as a tool used to clean the ears. While it’s okay to use around the earlobe, these plastic rods with cotton wads on each end should never be used to clean the insides.
The misunderstanding is two-fold, one being that the ear requires cleaning and that a cotton bud is designed for this purpose.
But neither is true. The ear is capable of cleaning itself and the small print on most cotton bud packages states that it should not be inserted into the ear canal.
The original cotton bud was invented in 1923 by a Polish American named Leo Gerstenzang, whose eureka moment apparently came when he saw his wife apply cotton wads to toothpicks to reach hard-to-clean areas on their baby.
Nowadays, the cotton bud is marketed as an all-purpose cleaning or gel application tool. But most people still use it to remove earwax. It’s a difficult habit to break, not only because we feel that it’s a hygienic thing to do but also because we feel good doing it.
NERVE HERDER
According to Dr Shailendra Sivalingam from Sunway Medical Centre, there are nerve endings inside the ear canal (or auditory canal) that makes rubbing it enjoyable. This nerve originates from the brain and is linked to the heart and digestive system.
“So when you’re cleaning the ear, the pleasurable sensation that you get is a result of that neural connection,” says the consultant ear, nose and throat surgeon. “Some people cough. That’s because they’re irritating the nerve and it triggers a cough.”
Dr Shailendra’s suggestion is not to put anything smaller than the little finger inside the ear. So if your pinkie can’t fit in there, nothing else should.
“If you go to some stores, you see all kinds of things being advertised to clean your ears,” he continues. “There’s a thin metal rod being sold, there’s also a device with a light at the end and it looks so high-tech people think they should use it. But it’s a misconception.”
“Leave your ears alone, the ear cleans itself. It will continue to clean itself unless we disturb the process.”
HARM REDUCTION
Inserting a cotton bud inside your ear may feel nice, but then it becomes itchy, and so you rub a bit more. This continuous rubbing action damages the ear canal’s skin, causing inflammation and even injury or infection.
And not much of the earwax is cleaned out. The ear canal is wider at the opening but there’s a narrow point somewhere near the middle before it widens up again. So a lot of the wax will get pushed back beyond this narrow point, collecting at the eardrum with nowhere to go.
“That’s when they see us,” says Dr Shailendra. “They say ‘my ear is blocked up’ and they can’t hear or ‘I’m having ear pain’ because the wax touched the eardrum and that causes pain. Some patients complain of tinnitus, that’s a high pitch whine or buzzing noise in the ear, which is a result of the wax in contact with the eardrum.”
Earwax also absorbs water so some patients would come in complaining of blocked ears after swimming.
The impacted earwax is removed in the clinic using a suction device and Dr Shailendra sees two or three such cases every day. But some people are predisposed to having harder, drier earwax (as opposed to softer earwax) so they require medication first to soften out the wax.
But the thing about earwax is that it’s not dirty or unnecessary. It’s a substance naturally secreted by the ceruminous gland under the ear canal and traps dirt, debris and dead skin cells. It also has anti-bacterial and anti-viral properties, so it protects the ears from infection.
IN ONE’S EAR
Left to its own devices, the ear wax will come outside on its own over the course of a day or a week. It’s more difficult for drier wax but it will come out eventually, assures Dr Shailendra.
“The jaw joint is located right underneath the ear canal so the movement of the jaw joint helps to propel the wax out slowly. You can’t feel it because it happens as you speak or chew food. When you shower and dry yourself afterwards, you’re actually cleaning it out.”
You can’t have too much ear wax because it’s constantly being extruded. But having too little ear wax may be the result of an infection. “As long as there’s infection in the ear you’re not going to see wax. Once you see ear wax developing you know the ear has repaired itself and is on its way to recovery,” he says.
An infection is treated with antibiotic drops, with the infected area cleaned using a microscope at the clinic. “You can’t buy an ointment from a pharmacy because you may not be using the right one. Often without realising, it is a fungal infection and what pharmacies usually sell is for bacterial infection.”
“If it’s an injury, leave the ear alone,” he adds. “Don’t put anything inside. For a significant injury, we give the patient a course of oral antibiotics or antibiotic ointments to apply into the ear, and that usually heals within a week or two.”
DRUMROLL PLEASE
With persistence and force, cotton buds can cause perforation or a hole on the ear drum that will take weeks to heal. Meantime, there will be hearing problems with a noticeable difference between left and right hearing.
Water can pass through this hole and into the middle ear, causing an infection. To avoid this, Dr Shailendra advises patients to wear foam or silicone ear plugs to stop water from entering when they shower.
A more serious concern is that bones behind the eardrum may dislocate if the drum is pushed hard enough. Called ossicles, the three bones — incus, malleus and stapes — transmit sound from the outer ear to the inner ear.
“A hole in the eardrum will eventually heal if you give it enough time,” says Dr Shailendra. “But if you’ve got injuries to those little bones, that won’t heal and you’re left with significant amount of hearing loss which needs surgery to correct.”
“So it’s very dangerous. And we have seen a few of those,” he adds.
HOW WE HEAR
Sound waves are collected at the auricle — the visible portion of the outer ear — and are channelled into the auditory canal (ear canal) where they are amplified. The waves then travel towards the eardrum, which vibrates.
The vibration sets the ossicles in motion, further amplifying the sound.
The wave continues to the cochlea, which is part of the inner ear.
The cochlea transforms sound into nerve impulses that travel to the brain. The brain interprets these signals and this is how we hear.
Adapted from HopkinsMedicine.org and WebMD.com