Available Online at http://www.journalajst.

com
ASIAN JOURNAL OF
SCIENCE AND TECHNOLOGY

Asian Journal of Science and Technology

ISSN: 0976-3376 Vol. 09, Issue, 04, pp.7892-7896, April, 2018

RESEARCH ARTICLE
PATTERNS OF SELF EAR CLEANING AMONG OTORHINOLARYNGOLOGY PATIENTS IN
DEVELOPING COUNTRY
1Adegbiji, W.A., *2Olajide, T.G. and 3Nwawolo, C.C.
1 ENT Department, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
2 ENT Department, Federal Teaching Hospital, IdoEkiti, Nigeria
3 ENT Department, Lagos University Teaching Hospital, Lagos, Nigeria

ARTICLE INFO ABSTRACT

Article History: Aims and objectives: Self ear cleaning is a common bad health practice among many
Received 17th January, 2018 patients despite associated complications. This study aimed at determining the prevalence,
Received in revised form sociodemographic, clinical presentation, associated complications and management of self
19th February, 2018
Accepted 26th March, 2018
ear cleaning among patients in a tertiary hospital in sub Sahara Africa.
Published online 30th April, 2018 Materials and methods: This is a prospective hospital based study of patients with history
of self ear cleaning. The study was carried out over a period 6 months between June and
Key words: November, 2017. Informed consent was obtained from patients. Pretested interviewers
External ear canal, assisted questionnaire was administered to obtain data. Data obtained were collated and
Ear cleaning, statistically analyzed by using SPSS version 16.
Ekiti, Otology. Results: The prevalence of self ear cleaning was 93.4%. There were 47.9% males with male
to female ratio of 1:1. Common reasons for self ear cleaning were 35.1% personal hygiene,
21.8% dirty/earwax and 11.8% itching. Both ears were most commonly cleaned among the
patients in 46.9%. Right ear in 31.8% was commoner than left ear in 21.3%.
Commonest object used in ear cleaning was cotton bud in 44.5%. Other objects were finger,
feather and key in 24.6%, 15.6% and 14.7% respectively.
Common clinical presentation were dirty/earwax in 35.1%, otalgia in 29.4%, hearing loss in
27.5% and itching in 24.2%.
Long time (chronic) ear cleaning accounted for 63.5% while short time (acute) ear cleaning
accounted for 36.5%. Frequency of ear cleaning in these patients were daily in 49.3%,
weekly in 17.1%, monthly in 13.3% and occasional in 20.4%.Major diagnosis was 34.6%
personal hygiene, 22.7% allergy and 18.5% earwax impaction.
No complications were recorded in 39.3%. Common complications were external auditory
canal injury in 28.9%, impacted foreign body in 25.6% and traumatic perforated tympanic
membrane in 6.2%. All patients had health education. Other treatment was
conservative/medical treatment in 71.1% and foreign body removal in 17.5%.
Conclusion: Ear cleaning was higher among the patients. Majority of the patients believed it
is beneficial. This is associated with available complications.
Copyright © 2018, Adegbiji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION Insertions of different object into the ear are common not only
in adults but also common in pediatric population either by
Self ear cleaning is when an object is inserted into the external children themselves or by their parents. A large number of
ear canal with the aim of removing deposits. This habit is a patients report to their family doctors and
common practice worldwide (Afolabi et al., 2009; Lee et al., otorhinolaryngologists with otological complaint and urge to
2005 and Hobson and Lavy, 2005). Common reasons given for scratch their external ear canal with different available object.
self ear cleaning were earwax, itching, foreign body, irritation, The practice of self ear cleaning has widely been condemned
ear blockage, hearing impairment, ear pain and ear discharge. worldwide. This is subsequent to associated complication
Others people see this habit as part of personal hygiene so it is which includes ear trauma, impacted ear wax, infection, and
mandatory and normal (Olajide et al., 2015). impacted foreign body (Raman, 1997). Insertion of objects
inside the ears is unnecessary and potentially dangerous to the
*Corresponding author: Olajide, TG.,
ENT Department, Federal Teaching Hospital, IdoEkiti, Nigeria.
user (Olajide et al., 2015).
7893 Asian Journal of Science and Technology, Vol. 09, Issue, 04, pp.7892-7896, April, 2018

There is accidental ear injury in the patients which were self Figure 1 showed the lateralization of self ear cleaning among
induced (Steele and Brennan, 2002 and Hobson and Lavy, the patients. Commonest object used in ear cleaning was cotton
2005). Associated complications of self ear cleaning are bud in 94 (44.5%). Other common object were finger, feather
traumatic laceration of ear canal, tympanic membrane and key in 52 (24.6%), 33 (15.6%) and 31 (14.7%)
perforation, impacted ear wax, otomycosis, otitis externa and respectively. Table 4 further illustrated common objects used
impaction of foreign body (Nussinovitch et al., 2004; McCarter for self ear cleaning among the patients. Common clinical
et al., 2007; Adegbiji et al., 2012 and Adegbiji et al., 2014). presentation were dirty/earwax in 74 (35.1%), otalgia in 62
Impacted cerumen is seen in about 2% to 6% of the general (29.4%), hearing loss in 58 (27.5%) and itching in 51 (24.2%).
population. Presentation of these complications includes Other clinical features were 37 (17.5%) personal hygiene and
bleeding, otalgia, hearing loss, tinnitus and vertigo (Amutta et 26 (12.3%) tinnitus. Table 5 demonstrated clinical features
al., 2013; Guest et al., 2004 and Neher et al., 2008). Little among the patients. Long time (chronic) ear cleaning was the
studies have been conducted on the practice of self ear cleaning commonest and accounted for 134 (63.5%) while short time
in developing country. This study aimed at determining the (acute) ear cleaning accounted for 77 (36.5%). Common short
prevalence, sociodemographic features, clinical presentation, time duration were (9-12) weeks in 39 (18.5%) and (5-8)
associated complications and management of self ear cleaning weeks in 22 (10.4%). Frequency of ear cleaning in these
among patients in a tertiary hospital in sub Sahara Africa. patients were daily in 104 (49.3%), weekly in 36 (17.1%),
monthly in 28 (13.3%) while occasional in 43 (20.4%). Figure
MATERIALS AND METHODS 2 illustrated the duration of self ear cleaning at presentation. In
this study, major diagnoses were 73 (34.6%) personal hygiene,
This was a prospective hospital based study of patients with 48 (22.7%) allergy and 39 (18.5%) earwax impaction. Other
history of self ear cleaning. The study was conducted in ear, diagnoses were noted in 20 (9.5%) otitis externa and 17 (8.1%)
nose and throat department of Ekiti state university teaching otitis media.
hospital, Ado Ekiti, Nigeria. The study was carried out over a
period 6 months between June and November, 2017. Aims and Table 6 showed the diagnosis among the patients. No
objective of the study were explained to the patients and complications were recorded in 83 (39.3%). Common
confidentiality assured. Informed consent was obtained. complication were external auditory canal injury in 61 (28.9%),
Consented patients were enrolled into the study. Data were impacted foreign body in 54 (25.6%) and traumatic perforated
collected with pretested interviewers assisted questionnaire. tympanic membrane in 13 (6.2%). No information on ear
The questionnaires contained information on cleaning was received in 76 (36.0%) while information was
sociodemographic features such as age, sex, religion and received in 98 (46.4%) family and in 37 (17.5%)
occupation. Other information obtained includes pattern of self neighborhood.
ear cleaning, frequency, type of object used, reasons for self-
Table 1. Age group distribution of the patients
ear cleaning, complications, danger and benefit of ear cleaning.
Detailed ear examination including otoscopy was carried out. Age group (year) Number Percentage (%)
The data obtained was collated and analyzed using SPSS 1-10 17 8.1
version 16.0. The data was expressed by frequency table, 11-20 9 4.3
percentage, pie charts and bar charts. Ethical clearance was 21-30 56 26.5
sought for and obtained from ethical committee of the 31-40 79 37.4
41-50 35 16.6
institution. 51-60 13 6.2
≥61 2 0.9
RESULTS Total 211 100.0

A total of 226 patients were seen in the department out of Table 2. Sociodemographic features of the patients(N = 211)
which 211 practices self ear cleaning. The prevalence of self
ear cleaning was 93.4%. The peaked age group was 31-40 Sociodemographic features Number Percentage (%)
years with prevalence of 79 (37.4%). Table 1 illustrated Age Sex
Male 101 47.9
group distribution of the patients. There were 101 (47.9%) Female 110 52.1
males and 110 (52.1%) females, the male to female ratio being Religion
1:1.About 17 (8.1%) practiced Islam while 194 (91.9%) were Christian 194 91.9
Christians. Common education level were post secondary in Muslim 17 8.1
Residential
102 (48.3%) and nil formal education in 58(27.5%). Majority Urban 117 55.5
of them were artisans, business, farming and student/apprentice Rural 94 44.5
37 (17.5%), 35 (16.6%), 31 (14.7%) and 29 (13.7%). Others Education level
were applicant in 28 (13.3%) and industrial workers in 27 Nil 58 27.5
Primary 9 4.3
(12.8%). Table 2 demonstrated Sociodemographic features of Secondary 42 19.9
the patients. Common reasons for self ear cleaning were 74 Post secondary 102 48.3
(35.1%) personal hygiene, 46 (21.8%) dirty/earwax and 25 Patients occupation
(11.8%) itching. Other indications includes ear blockage, Student/Apprentice 29 13.7
Applicant 28 13.3
hearing impairment and ear discharge which accounted for 22 Business 35 16.6
(10.4%),1 3 (6.2%) and 12 (5.7%) respectively. Table 3 Driver 24 11.4
showed Indications for self ear cleaning. In this study both ears Industrial worker 27 12.8
were most commonly cleaned among the patients in with 99 Farming 31 14.7
Artisans 37 17.5
(46.9%). The right ear in 67 (31.8%) was commoner than left
ear in 45 (21.3%).
7894 Asian Journal of Science and Technology, Vol. 09, Issue, 04, pp.7892-7896, April, 2018

Table 3. Indications for self ear cleaning Table 6. Diagnosis among the patients

Aetiology Number Percentage (%) Diagnosis Number Percentage (%)

Personal hygiene 74 35.1 Allergy 48 22.7
Dirty/earwax 46 21.8 Otitis media 17 8.1
Itching 25 11.8 Earwax impaction 39 18.5
Hearing impairment 13 6.2 Hearing impairment 14 6.6
Blockage 22 10.4 Personal hygiene 73 34.6
Ear discharge 12 5.7 Otitis externa 20 9.5
Water in the ear 11 5.2 Total 211 100.0
Irritation 8 3.8
Total 211 100 Table 7. Management of self ear cleaning among the patients

Management Number Percentage (%)

Complications
Nil 83 39.3
External auditory canal injury 61 28.9
Impacted foreign body 54 25.6
Traumatic perforated tympanic membrane 13 6.2
Information on ear cleaning
No information 76 36.0
Family 98 46.4
Neighbour 37 17.5
Health education 211 100
Conservative/medical treatment 150 71.1
Foreign body removal 37 17.5

All patients had health education. Other treatment offered were

conservative/medical treatment in 150 (71.1%) and foreign
Figure 1. Lateralization of the ear among patients body removal in 37 (17.5%). Table 7 showed management of
Table 4. Common objects used for self ear cleaning self ear cleaning among the patients.

Objects used Number Percentage (%) DISCUSSION

Cotton bud 94 44.5
Finger 52 24.6 There is high prevalence of ill health practice of self ear
Keys 31 14.7 cleaning among the patients attending our ENT center. The
Sticks 28 13.3
Toothpick 19 9.0
findings are consistent with others reports in the literature,
Biro cover 9 4.3 which report a very high prevalence of self ear cleaning (Lee et
Paper roll 26 12.3 al., 2005 and Olaosun, 2014). This high prevalence is alarming
Feathers 33 15.6 despite self ear cleaning was not prescribed to patients.
Others 24 11.4
Contrary record revealed lower prevalence in a study done
among health workers (Oladeji and Babatunde, 2015). The
Table 5. Clinical features among the patients
peaked age group of self ear cleaning was fourth decades of
Clinical features Number Percentage (%) life in this study. This is because of very high activities among
Otalgia 62 29.4 this age group. Contrarily, third decades were the peaked age
Personal hygiene 37 17.5 group in other study (Oladeji and Babatunde, 2015). There is
Hearing loss 58 27.5 female preponderance in this study. This may be as a result of
Tinnitus 26 12.3 high prevalence of personal hygiene among female over male.
Itching 51 24.2
Bleeding 19 9.0 Majority of the patients were urban dwellers compared to
Dirty/earwax 74 35.1 minority rural dwellers. This may be because the institution is
Ear discharge 17 8.1 in the state capital and presence of various barriers to health
care services (Adegbiji et al., 2017 and Adegbij et al., 2017).
Self ear cleaning was commonest among the post secondary in
this study and this is an indication of high level of bad health
practices. There was almost same level of prevalence of self
ear cleaning among all the occupation. This may be incidental
findings. Commonest reason why studied patients cleaned their
ear was personal hygiene to remove dirty or earwax. Earwax
was generally believed to be dirty and must be removed
regularly. This is done during bath, morning even at leisure
time like body bath and teeth brushing. Other reasons for self
ear cleaning were dirty/ earwax, itching and sense of ear
blockage or hearing impairment. Previous studies revealed
similar findings (Gadanya et al., 2016 and Ahmed et al., 2014).
Bilateral self ear cleaning were major finding in this study as in
previous study (Suresh and Shamim, 2008). Major indications
for self ear cleaning such as personal hygiene, dirty/earwax,
Figure 2. Duration of self ear cleaning at presentation itching, and water in the ear commonly occurred in both ear.
7895 Asian Journal of Science and Technology, Vol. 09, Issue, 04, pp.7892-7896, April, 2018

Unilateral ear cleaning were less common as this may be due to Funding
unilateral otological pathology. Many patients claim it is
beneficial practice because it is done on ear disorders. There There was no financial support. It is a self sponsored research
are various object inserted into the external auditory canal for study.
ear cleaning, soothed or remove object from the canal. In this
study, commonest used object was cotton bud. This is readily Competing interests
available in the market, street and supermarket. It is cheap
because it is dispense in small quantity of ten to twenty pieces All the authors declare that there was no competing interests..
and without any warning sign on the containing polyethylene
bag. There should be law enforcing warning sign on cotton bud Acknowledgements
container in developing country. Other used object included
The authors are most grateful to Ekiti state university teaching
finger, feathers and key. This findings concurred with other
hospital and all the patients who participated in this study.
study (Hobson and Lavy, 2005).

Ear related symptoms experienced by patients in this study REFERENCES

includes dirty/earwax, otalgia, itching and hearing loss. These
are the trigger factor for self ear cleaning. Contrarily, itchiness Adegbiji, WA., Alabi, BS., Olajuyin, OA. and Nwawolo, CC.
and earache seemed to be the most common symptoms 2014. Earwax Impaction: Symptoms, Predisposing Factors
experienced leading to self ear cleaning in other studies and Perception among Nigerians. Journal of Family
(Ullauri et al., 2014 and Macknin et al., 1994). Patients cleaned Medicine and Primary Care, 3:379-82.
their external ear canal very often with varied period at Adegbiji, WA., Alabi, BS., Omokanye, HK., Fadeyi, A.,
presentation. Majority cleaned their ear for more than three Nwawolo, CC. and Akande, HJ. 2012. Clinico-mycological
months prior to the study and has become habitual or chronic profile of otomycosis in two tertiary health institutions in
ear cleaner. This bad health practice has become a regular Nigeria – a prospective study. Port Harcourt Medical
activity in the studied patients. This is done like regular bathing Journal, 6:258-263.
and teeth brushing. Moreover, on the frequency of ear cleaning Adegbiji, WA., Aremu, SK. and Lasisi AO. 2017. Patients
among the patients, about half of the patients cleaned their ear Barrier to Ear, Nose and Throat Surgical Care in Nigeria.
everyday while very few cleaned their ear weekly, monthly and American Scientific Research Journal for Engineering,
occasionally. This is similar to findings in other study (Hobson Technology, and Sciences (ASRJETS). 32(1):96-104.
and Lavy, 2005). Major diagnoses of ear cleaning in this study Adegbiji, WA., Olajide, GT., Aremu, SK. and Alabi, SB. 2017.
were personal hygiene, allergy, earwax impaction and hearing Barriers to Adenoid and Tonsil Surgeries in Ekiti, Nigeria.
loss. Impacted earwax was also a common reported American Journal of Medicine and Medical Sciences,
complication. 7(2):385-92.
Afolabi, AO., Kodiya, AM., Bakari, A. and Ahmad BM. 2009.
Causes of self ear cleaning must be diagnosis and appropriate Attitude of self ear cleaning in black Africans: Any benefit?
treated otherwise it may be difficult to stop self ear cleaning East Afr J Public Health., 6:43–6.
practice. Other diagnosis included various form of otitis Ahmed, S., Zaheer, SAI. and Shabeer, SMA. 2014. Association
externa and media. These findings were recorded in previous of dermatological conditions of external ear with the use of
studies (Afolabi et al., 2009; Olajide et al., 2015 and cotton buds. Indian J Med Res., 10:1-7.
Nussinovitch et al., 2004). No complication was recorded in a Amutta, SB., Yunusa, MA., Iseh, KR., Obembe, A., Egili, E.,
third of the patients. This may be because majority of the Aliyu, D. and Abdullahi, M. 2013. Sociodemographic
patients were adults. Commonly associated complications of Characteristics and Prevalence of Self Ear Cleaning in
self ear cleaning in this study were external auditory canal Sokoto Metropolis. International Journal of
injury and impacted foreign body. This finding is similar to Otolaryngology and Head & Neck Surgery, 2: 276-279.
previous studies (Sperling and Portnoy, 2016 and Smith et al., Gadanya, M., Abubakar, S., Ahmed, A. and Maje, AZ. 2016.
2012). No prior information on self ear cleaning among the Prevalence and attitude of self-ear cleaning with cotton
patients. This concurred with findings in other studies buds among doctors at Aminu Kano Teaching Hospital,
(Reynolds, 2004 and Kumar and Ahmed, 2008). Adequate Northwestern Nigeria. Nig J Surg Res.,16:2-17.
management of this bad health habit requires health education Guest, JF., Greener, MJ., Robinson, AC. and Smith, AF. 2004.
at all levels. Continuous medical education in the outpatient Impacted cerumen: composition, production, epidemiology
clinic is necessary. Individual patients were treated on the and management. QJM, 97(8):477-488
causes and associated complications by medical and Hobson, JC. and Lavy, JA. 2005. Use and abuse of cotton
conservative treatment. Other treatment offered included buds. J R Soc Med., 98:360–1.
foreign body removal. Hobson, JC. and Lavy, JA. 2005. Use and abuse of cotton
buds. J R Soc Med., 98(8):360–361.
Conclusion Kumar, S. and Ahmed, S. 2008. Use of cotton buds and its
complications. J Surg Pak., (International). 13:3.
Self ear cleaning was higher among the studied patients. Lee, LM., Govindaraju, R. and Hon, SK. 2005. Cotton bud and
Majority believed it is beneficial because there was no prior ear cleaning: A loose tip cotton bud? Med J Malaysi.,
information on self ear cleaning. Ear cleaning has been found 60:85–8.
to compromise the integrity of the ear canal. This is associated Macknin, ML., Talo, H. and Medendrop, SV. 1994. Effect of
with avoidable complications. Education and information about cotton-tipped swab use on ear-wax occlusion. Clin Pediatr.,
the danger must be disseminated as widely as possible across (Phila). 33:14–18.
all age groups. McCarter, DF., Courtney, AU. and Pollart, SM. 2007. Cerumen
impaction. Am Fam Physician., 75:1523–8.
7896 Asian Journal of Science and Technology, Vol. 09, Issue, 04, pp.7892-7896, April, 2018

Neher, A., Nagl, M. and Scholtz, AW. 2008. Otitis externa: Reynolds, T. 2004. Ear, nose and throat problems in accident
Etiology, diagnostic and therapy. HNO, 56: 1067–1079. and emergency. Natl Inst Health., 18:47-53.
Nussinovitch, M., Rimon, A., Volovitz, B., Raveh, E., Prais. D. Smith, M., Darrat, I. and Seidman, M. 2012. Otologic
and Amir, J. 2004. Cotton-tip applicators as a leading complications of cotton swab use: one institution’s
source of otitis externa. Int J Pediatr Otorhinolaryngol., experience. Laryngoscope, 122:409-11.
68:433–5.9. Sperling, NM. and Portnoy, WM. 2016. To swab or not to
Oladeji, SM., Babatunde, OT. and Adenekan, AK. 2015. Self- swab: appropriate medical advice regarding self ear
ear cleaning among health workers in Nigeria. J Dental cleaning. Int J Head Neck Surg., 7:1-4.
Med Sci., 14:122-6. Steele, BD. and Brennan, PO. 2002. A prospective survey of
Olajide, TG., Usman, AM. and Eletta, AP. 2015. Knowledge, patients with presumed accidental ear injury presenting to a
Attitude and Awareness of Hazards Associated with Use of paediatric accident and emergency department. Emerg Med
Cotton Bud in a Nigerian Community International Journal J., 19(3):226–228.
of Otolaryngology and Head & Neck Surgery, 4:248-253. Suresh, K. and Shamim, A. 2008. Use of cotton buds and its
Olaosun, OA. 2014. Self-ear-cleaning among educated young complications. J Surg Pak., 13:137-8.
adults in Nigeria. J Fam Med Primary Care, 3:17-21. Ullauri, A., Smith, A. and Espinel, C. 2014. WHO ear and
Raman, R. 1997. Should cotton buds be banned? Trop Doct., hearing disorders: Ecuador National Study 2008-2009.
27(4):250. Hindawi Publishing Corporation, Conference papers in
Science,

*******