Why you should keep cotton buds out of your kids' ears

Keep cotton buds out of your kids' ears - that's the clear message from a new study of children's emergency room visits in the US for cotton-tip related injuries.

The research by Nationwide Children's Hospital, published in the Journal of Pediatrics, reported that between 1990 and 2010, approximately 263,338 children under the age of 18 were treated for ear-injuries sustained by cotton bud use - that works out to around 34 per day.

In cases where the circumstances leading to the injuries were documented:

* 73.2 per cent were associated with cleaning
* 9.7 per cent were associated with playing
* more than two-thirds of the injuries occurred in kids under eight years old
* and in children under the age of four, a parent handled the cotton bud in almost 80 per cent of ear cleaning-related injuries.

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The most common injuries were foreign body sensation (30 per cent), perforated ear drum (25 per cent), and soft tissue injury (23 per cent).

"Nearly all of the patients with CTA (cotton-tip applicator) related ear injuries were treated and released, but this does not imply that some of the injuries were not serious," the authors note. Rather, they explain, delayed treatment for such injuries can lead to numerous health concerns, including hearing loss and facial paralysis.

So why are so many children being injured?

"There is a misconception among the general public that the ear canal requires regular cleaning and that CTAs are good products for that purpose," the authors note. "Contrary to public belief, cerumen (earwax) is beneficial for the ear, and the ear has a natural mechanism for self-cleaning."

Although the rate of injury decreased by 25 per cent from 2001 to 2010, the authors highlight that more than 12,000 children still received treatment for CTA-related ear injuries in 2010.

The team acknowledge that while most CTA manufacturers now include warning labels on their packages, they do not appear to be mandatory. Even so, they argue, "it is insufficient to prevent injuries."

The authors also explain that cotton-tip applicators originally came about in 1923, after Leo Gerstenzang observed his wife use cotton on toothpicks to clean their bub's ears. The first medical concerns about their use, however, weren't published until 1972.

Speaking to The Washington Post last year, Barbara Kahn, a marketing teacher said, "They're trying to change how people think of the product, to build a brand that's separate from the original and inappropriate use, but that's really hard when everyone knows a product and thinks about it in a certain way," she said. "If people are telling others to use Q-tips for their ears, if that message is coming through virally through videos or some other media, or just moving from customer to customer, that's a very powerful thing they can't control.

"There's really no way to stop it short of taking the product off the market, which they're obviously not going to do."

Instead, the authors suggest that new mothers should be instructed to avoid using cotton buds in their newborn's ears when discharged from hospital. In addition, proper storage, away from the reach of children, may also help prevent further injuries to young kids.

"While the number of overall injuries from cotton tip applicators did decrease during the 21 years we looked at in our study, it is still unacceptably high," Dr Kris Jatana, the lead author, said in a statement.

"These products may seem harmless, but this study shows how important it is that they not be used to clean ears."