Ear-Rational Behavior: A Survey Study of Q-tip (Cotton Swab) Habits and Health Perceptions

Q-tips (quality-tips) and cotton swabs have long-standing warnings about their use in the external auditory canal. Despite these warnings, cotton swabs are widely used for these purposes. This study aims to investigate the prevalence, motivations, perceptions of safety, and complications associated with the use of cotton swabs in adults who are engaged on social media.

A cross-sectional survey was conducted from March to April 2025 using Google Forms (Google, Mountain View, CA, US), distributed via Instagram (Meta Platforms, Inc., Menlo Park, CA, US). Adults aged 18 years or older were eligible, and surveys that were not completed were excluded. The survey consisted of 17-item questions that explored the use of Q-tips.

Of 257 respondents, 229 completed the survey (85.2%, number (n) = 195 aged 18-29 years; 61.1%, n = 140 held a bachelor's degree). Nearly all participants (95.6%, n = 219) reported using cotton swabs for ear care, primarily to remove cerumen (60.3%, n = 138), with 14.4% (n = 33) reporting daily use. Although 92.6% (n = 212) were aware that medical professionals discourage the use of cotton swabs, 38.4% (n = 88) intended to continue using them, and 38.9% (n = 89) intended to use them occasionally; only 14.4% (n = 33) intended to discontinue their use. Complications were reported by 31.9% (n = 73) of users, most commonly ear discomfort (21.4%, n = 49), cerumen impaction (10.5%, n = 24), and hearing loss (9.2%, n = 21). A small proportion of these individuals sought medical care (8.8%, n = 6). The mean perceived safety score among participants was 3.0 (neutral) on a five-point scale.

The use of Q-tips remains nearly universal in this young, highly educated, and socially media-engaged population, despite widespread awareness of professional warnings. Nearly one-third of users reported complications, yet most planned to continue using the product. These findings underscore a persistent gap between knowledge and behavior, highlighting the need for targeted public health campaigns that not only discourage cotton swab use but also promote safe, practical alternatives for ear care. Social media may be a valuable platform for such interventions.