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The things we put in our ears may or may not hurt us

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Dr. George Alexiades, of the New York Eye and Ear Infirmary, puts a picking device through an otoscope to loosen a wax plug before grabbing it with an "alligator," a kind of scissor clip. (John Wendle/Columbia News Servic)

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Dr. George Alexiades, of the New York Eye and Ear Infirmary, explains the workings of the inner ear. (John Wendle/Columbia News Servic)

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Dr. George Alexiades, of the New York Eye and Ear Infirmary, examines a patient through an otoscope. (John Wendle/Columbia News Servic)

Dr. George Alexiades stared intently through a silver and black otoscope into his patient’s ear. Flipping up the magnifying lens, he slid a scissor clip through the funnel and grabbed a bright golden gob. Giving a slight tug, he snagged a chunk of earwax the size of a pencil eraser.

“I’ve seen some weird stuff,” said Alexiades, who practices at the New York Eye and Ear Infirmary. “Lots of cockroaches; they like dark, warm places. They get in there, and they can’t turn around and they die.

“I’ve pulled hearing aid batteries out, beads from necklaces. The weirdest thing I’ve pulled out of a person’s ear was crack cocaine when I was a resident at Bellevue Hospital. I had to turn it over to the cops.”

The outer part of the human ear is largely skin and cartilage that is pierced and decorated for cosmetic and cultural reasons, but the middle and inner ears house vital sense organs that help humans hear and walk. Fluke ear injuries, even if they are accidentally self-imposed, are serious and costly medical matters. And they raise questions about what makes people put such random things into their ears.

Of all the things people put in their ears, among the most dangerous, Alexiades and other doctors say, is a small, innocuous object found in countless American homes: the cotton swab.

Alexiades said that during the last five years, he had treated two to four eardrum punctures a year that were caused by cotton swabs.

“It’s true,” he said. “Never put anything in your ear smaller than your elbow.”

Surprisingly, some people know better than to use swabs on their ears, but they do so anyway.

Meredith Harris, a blogger on Metafilter, a community Weblog, doesn’t just use them on occasion. She admits to a sort of ear-cleaning addiction, despite the various warnings on most swab boxes.

Q-tips boxes, for example, carry a clear admonition. “WARNING: Do not use swab in ear canal. Entering the ear canal could cause injury.”

Meredith wrote about her response to the warning in an e-mail message. Her words resembled the response a conflicted smoker might have to labels the surgeon general placed on cigarette packages.

“I cannot be the only person who knows this, but compulsively does it every morning anyway . . . can I?” she wrote. “I can't help myself.”

Americans aren’t the only eccentrics when it comes to sticking things into their ears.

Henok Fente, an Ethiopian living in New York, said his grandmother, who lives in Miami, still follows the traditional method of ear cleaning used in Addis Ababa, Ethiopia’s capital.

“She takes an iron rod and puts it gently into her ear,” Fente said. “She moves it around to loosen the wax. Then she takes a chicken feather, cuts the soft end to a point and sticks it into her ear. It’s good. It cleans everything out.”

The original Q-tip was created by Leo Gerstenzang in 1923 after he watched his wife wrap cotton batting around a toothpick to clean the ears of their infant son, according to the Useless Information Web site.

“Doctor, Explain Earwax,” a pamphlet from the Eye and Ear Infirmary, notes that earwax helps moisturize the skin in the ear and prevents the growth of bacteria. “The ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the ear canal and cause a blockage. Wax blockage is one of the most common causes of hearing loss.”

Of course, not all wounds to the ear are self-inflicted. The more serious ones can cause long-term disability and require costly medical procedures.

Dr. Barry Hirsch of the University of Pittsburgh Medical Center, described his experiences and offered insight into ear trauma in an e-mail interview.

Hirsch once treated a patient who had a thin tree branch pierce his eardrum. The man lost his hearing and was hospitalized for vertigo. He also treated a young child who put a wire necklace through the ear canal and hooked it onto one of the three ear bones in the middle ear.

“The gamut of damage from a traumatic injury can be a scratch in the ear canal to injury to the inner ear” that can cause hearing and balance problems, Hirsch said.

Small tears in the eardrum can heal on their own or with a little help by placing a patch over the perforation. This can be done in an office setting. Larger perforations that do not heal require a graft of the patient's tissue from behind the ear to be attached to the edges of the remaining eardrum.

Besides more serious dangers, problems can be caused by simply misusing a Q-tip--meaning cleaning your ear canal with it.

Despite all the risks, Harris the blogger isn’t willing to change her behavior. In fact, an unscientific poll she carried out found that everyone was a compulsive swab user at her workplace.

“A quick survey of some of my co-workers reveals that six out of six of them do indeed use Q-tips to clean their ear canals,” she wrote. “We're all apparently risk-taking fools.”

E-mail: jcw2136@columbia.edu