Ear Canal Trauma – August 3, 2023

Ear Canal Trauma – August 3, 2023

A mother brings her 3-year-old child to the Emergency Department (ED) with the chief complaint of ear trauma. She states that while attempting to clean the child’s ears with a cotton swab after his evening bath, he jerked away and the swab “went in too deep” in the left ear. The child cried and was upset for several minutes. When he calmed down, Mom inspected the ear and noted blood coming from the canal. Out of fear that she may have permanently injured his ear, she brought him in for evaluation. In the ED, the child is calm and cooperative with the evaluation. His external ear appears atraumatic. The Wispr digital otoscope exam of his left ear is shown.

What action needs to be taken?

No further action needs to be taken. 

This child has an injury caused by a common mechanism with a household item. The Wispr exam demonstrates bleeding in the external auditory canal (EAC) with a small amount of bright blood pooling near the base of the tympanic membrane (TM, ear drum). The TM itself does not appear acutely injured as there is no obvious perforation, excoriation, or injection. Careful return instructions should include increasing pain, fever, or decreased hearing.

The innocuous-appearing cotton-tip applicator (cotton swab) accounts for thousands of ED visits each year, with 2/3 of the injuries occurring in children under 8 years of age. Most injuries are either TM perforations or, as in this case, external ear canal (EAC) abrasions. While there exists a myth that waxy ears equal dirty ears, this is contrary to the message put forth by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. Its list of do’s and don’ts for patients includes “Do know that ear wax is normal” and “Don’t put cotton swabs, hair pins, car keys, toothpicks, or other things in your ear.” In other words, while cerumen may be an annoyance to all those attempting to evaluate a young child’s TM, care ought to be taken to dispel the misconception that cleaning out the ear canal ought to be a routine part of bath time.

Here is a complete video of the exam:


Ameen ZS, Chounthirath T, Smith GA, Jatana KR. Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010. J Pediatr. 2017 Jul;186:124-130.