What should be done to help a teenager who injured their ear with a cotton‑swab (Q‑tip)?

Management of Q-Tip Ear Injury in a Teenager

Stop all self-manipulation immediately and seek professional medical evaluation to safely remove any retained cotton debris and assess for ear canal trauma or tympanic membrane perforation. 1

Immediate Actions

The teenager must stop inserting anything further into the ear, as continued manipulation risks pushing debris deeper, causing ear canal lacerations, eardrum perforation, or dislocation of hearing bones. 1

Critical Warning Signs Requiring Urgent Care

Seek immediate medical attention if any of the following develop:

• Ear pain 1
• Drainage or bleeding from the ear 1
• Sudden hearing loss 1
• Dizziness 1

Why Professional Removal Is Essential

Cotton swabs pose a unique hazard because cotton fibers can fragment and become retained in the ear canal. 2, 1 Self-attempts at removal will likely worsen the situation by:

• Pushing cotton deeper into the canal 1
• Causing trauma to the delicate ear canal lining 1
• Risking perforation of the tympanic membrane 1
• Potentially causing hearing loss or vestibular symptoms 1

What to Expect During Professional Evaluation

The clinician will perform the following steps:

Assessment Phase

• Determine if the tympanic membrane is intact or perforated 3
• Visualize the ear canal using an otoscope to identify retained cotton debris 2
• Check for signs of infection including pain, erythema, and tragal tenderness 3

Removal Technique

The provider will remove cotton debris using one of these methods under direct visualization:

• Gentle suction 2, 1
• Dry mopping with specialized instruments (cotton-tipped applicators used by professionals, not patients) 2, 1
• Gentle irrigation with body-temperature water or saline 2, 1

Important caveat: If the teenager has diabetes or is immunocompromised, inform the clinician immediately—these patients require special precautions and should avoid ear canal irrigation due to increased risk of necrotizing otitis externa. 2, 3, 1

If Infection Develops

Signs of Acute Otitis Externa

Watch for:

• Pain with ear manipulation 3
• Ear canal erythema 3
• Tragal tenderness 3
• Drainage from the ear 3

Treatment for Infection

If acute otitis externa develops:

• Topical fluoroquinolone ear drops (such as ofloxacin 0.3%) are first-line therapy 3
• Aural toilet must be performed before initiating drops to clear debris and allow drug delivery 2, 3
• Proper drop administration: Lie with affected ear upward, fill canal with drops, perform gentle tragal pumping, remain in position for 3-5 minutes 2

Prevention Going Forward

Never insert cotton swabs, bobby pins, car keys, toothpicks, or any object smaller than your elbow into the ear canal. 1 This simple rule prevents the majority of iatrogenic ear injuries in adolescents.

Why Q-Tips Should Never Enter the Ear Canal

• Cotton can fragment and become retained 2, 1
• Self-administration of ear cleaning is unnecessary—the ear is self-cleaning 2
• Risk of trauma far outweighs any perceived benefit 1

Follow-Up Considerations

Refer to otolaryngology if:

• Persistent or worsening symptoms despite appropriate treatment 3
• Recurrent episodes 3
• Hearing loss develops 3
• Persistent pain 3