Q-tips are still causing pediatric ear injuries

Between 1990 and 2010, more than 260,000 children were treated in emergency departments (EDs) for ear injuries related to use of cotton-tip applicators (CTAs), according to data from the National Electronic Injury Surveillance System.

Almost three-quarters of the injuries were associated with ear cleaning, with small proportions among younger children that were tied to playing, tripping, or falling. Patients themselves wielded the CTA in more than three-quarters of the injuries, with the likelihood of a parent handling the CTA decreasing as the child’s age increased. The most common reason for an ED visit was bleeding in children aged 3 years and younger, and foreign body sensation in children aged 8 to 17 years. The most common diagnosis was the presence of a foreign body (29.7%), followed by tympanic membrane perforation (25.3%) and soft tissue injury (23.1%). Foreign body was the most common diagnosis in children aged 8 to 17 years, whereas tympanic membrane perforation was most common in those aged younger than 8 years, in whom more than two-thirds of overall injuries were seen. Almost all patients were treated and released.

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The good news? These CTA-related injuries decreased significantly-by 26%-from 2001 through 2010 (Ameem ZS, et al. J Pediatr. 2017;186:124-130).

Thoughts from Dr Burke

More than 12,000 kids a year have CTA ear injuries severe enough to generate an ED visit, proving that warnings to avoid putting CTAs in the ear canal are based on more than just urban legends of bad outcomes. That’s why we’ve all heard the advice to “put nothing smaller than an elbow in your ear.” Maybe it’s time for a study on running with pencils?