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Cautionary tale: Cotton swab stuck in ear leads to skull infection

Based on the swab’s location and the man’s history of symptoms, the doctors say it had probably been in his ear for many years.

cotton swabs
Instead of removing earwax from our ears, cotton swabs are just as likely to push wax up against the eardrum, causing it to become impacted and muffling our hearing.
Photo by Sharon McCutcheon on Unsplash

Doctors have warned us that using cotton swabs to clean our ears is not a good idea. In fact, the swabs can do a lot of damage.

They can cut up our ear canals, rupture our eardrums and dislocate our hearing bones, leading to hearing loss and ringing in the ears (tinnitus). And instead of removing earwax from our ears, the swabs are just as likely to push wax up against the eardrum, causing it to become impacted and muffling our hearing.

Yet, that’s not all. In an account published last week in BMJ Case Reports, British doctors report on a rare but truly frightening outcome from using a cotton swab: a potentially fatal brain infection. In this instance, it resulted when the tip of a swab broke off and became lodged deep within a young man’s ear canal.

The case underscores “the dangers of cotton bud use,” write the doctors.

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Perplexing symptoms

The story involved a 31-year-old man who arrived at the emergency department of the doctors’ hospital in Coventry, England, after he had suddenly experienced several short seizures and collapsed.

The man told the doctors that he had been having pain and discharge in his left ear for about 10 days. He also said he’d been having severe headaches, nausea and vomiting, and had found himself struggling to recall people’s names.

Although the symptoms had become more acute in recent days, they were not completely new. The man had been experiencing pain and hearing loss in his left ear on and off for about five years, and his doctor had twice given him antibiotics to treat “a severe ear infection.”

The Coventry doctors ordered a computed tomography (CT) scan of the man’s brain. The scan showed the existence of a severe bacterial infection — one that had spread from the man’s left ear into the bone at the base of his skull.

The doctors diagnosed the infection as necrotizing otitis externa (NOE), a rare and potentially deadly complication of an ear infection. NOE is most often seen in older people with diabetes or some other illness that compromises the body’s immune system and thus leaves the skin inside the ear canal particularly susceptible to infection if scratched.

This is one of the reasons people with those illnesses are instructed never to use cotton swabs — or any other object that can cut the ear canal — to clean their ears.

In the young man’s case, the infection had spread from the bones of his skull to the lining of his brain (meninges). That would explain, say the doctors, his memory problems — and the seizures.

The doctors gave the man a general anesthesia so that his left ear could be closely examined. There, deep inside the canal, they found the tip of a cotton swab, enclosed by wax and surrounded by other debris.

Based on the swab’s location and the man’s history of symptoms, the doctors say it had probably been in his ear for many years.

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They removed the swab. The man spent almost a week in the hospital, where he received intravenous antibiotics. He took oral antibiotics for about another eight weeks. Fortunately, he experienced a complete recovery, and has had no lingering hearing or neurological problems.

“Most importantly, he is no longer using cotton buds to clean his ears!” the doctors write.

What to do about earwax

As otolaryngologists (doctors who specialize in the treatment of diseases and disorders of the ears, nose and throat) point out, most of us are wrongly informed about earwax.

“Cerumen, commonly called ‘earwax,’ is not really a ‘wax’ but a water-soluble mixture of secretions (produced in the outer third of the ear canal), plus hair and dead skin, that serves a protective function for the ear,” they explain. “Cerumen is a natural product that should not be routinely removed unless impacted.”

The substance moves out of the ear entirely on its own, helped by movements of the jaw, such as during chewing. Once it leaves the ear canal, it can be wiped away with a soft cloth.

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If you feel too much wax has built up in your ear canal, otolaryngologists recommend using mineral oil, baby oil, glycerin, or hydrogen peroxide to soften it. Their instructions are simple:

First, place about two to three drops of one of the above-mentioned liquids into your ear.

Then, wait one to two minutes before tilting your head to one side.

Using a washcloth, wash the external part of the ear as the earwax drains. Do not insert the cloth into the ear canal.

If this at-home remedy doesn’t work and you believe a build-up of earwax is impairing your hearing, make an appointment with an otolaryngologist for a professional — and safe — cleaning.

FMI:  An abstract of the account of how the British man contracted NOA after using a cotton swab is on the BMJ Case Reports website, but the full article is behind a paywall.