Disclaimer: I am not a doctor; even if I’m 100% right in my argument and you are 100% convinced by it, you shouldn’t listen to me over actual doctors; it’s a bad habit that might actually kill you.
(Why doesn't substack let me link words rather than paste whole urls?)
(Also, linking to the cache because of the wapo paywall, but the post is still up afaict.)
It doesn't really add much to the evidence conversation, but the history is interesting/entertaining. It does mention a study but the link is broken and it sounds associational rather than RCT anyway.
I struggled with this a bit writing the post, because I don't want to discourage people from taking medical advice for obvious reasons. And I think I could definitely be wrong here, mostly because I don't think anecdotal evidence is worthless, especially when it's overwhelming - and it is overwhelming from what I can tell. But it is weird when you run into pockets of things that "we know" that we don't know nearly as well as it seems like we should.
If I hope anything in particular comes from this, it would be that better studies were done on the subject.
I work in prototype engineering and spend a lot of time very carefully understanding very very complicated things at a microsecond time scale to find bugs and fix complex system interactions. I also see an amazing number of things stick around just because they work well enough and aren't the highest value place to spend the man-hours to improve. I think something very similar can be said about any complex thing -- if you don't want to spend time understanding it, you are better off deferring to someone who presumably has, but if you want to spend the time (all potential pitfalls and misassociations and reverse causations potentially included) that presumption is rebuttable. Including in things like diet, given the low quality of the associational evidence used in the field as a whole.
Doctors are good at memorization. You get through medical school by being good at memorization. Doctors are not scientists (the vast, vast majority of them anyway). In this light, it's entirely unsurprising that doctors as a group thoughtlessly repeat "Q-tips: bad. New Porsche: good."
I produce a lot of earwax. If I don't use cotton swabs, my ears are impacted in less than two months to the point that I can't hear a thing. I have never experienced impacted ears with any sort of regular qtip usage.
Seems like a survey study asking questions like these would be pretty straight-forward to run. Someone could make tenure overturning this big anti-qtip conspiracy 😉
I have unusually formed ear canals, father and grandfather are the same. They are narrower than average, narrow even more in the middle of the canal, and slope down. Using a Q-Tip to clean the inner ear will, and has, produced exactly the impacted wax described here. Additionally I have the gene that gives me dry earwax which is very common in people of east Asian ancestry.
If you enjoy cleaning your ears, of feel you need to do a very thorough job, consider that there are purpose build tools for doing this far superior to Q-Tips that aren't terribly expensive and a normal part of the toiletries items in homes in Asia. Amazon will have many kits.
While I am currently multi-tasking (NBA playoffs and Steph Curry managing 50 points in a Game 7 at age 35 -- geez, fun, even if not a sports fan) your writing is entertaining and the previous post has little correlation to the next in this case. Cotton-Tipped Swabs. Wow, it is sorta funny IMO. Stories like this are fun and lighthearted. What's the point of this (and lots of topics full of false insight and just enough uncertainty that leads normally sensible people to embrace an idea without much context)? Recency bias and the failure to evaluate all of the evidence available (even if not indexed on Google Scholar). The ABSURDITY that a creature with perhaps a 2 million year track record and the evolutionary prowess of tens of millions of years of prior mammal and primate evolution is somehow dependent on the usefulness of putting a soft-tipped stick into their ear to accomplish some task tied to its survival is absurd and asinine on its face. Probably not a bad idea to defer to someone who has experience and insight rather than silly stuff on the Web based on opinion. Silly but fun. Your writing is FUN and I am going to keep at it. Because I am planning my regular post tomorrow and then a farewell for now on Wednesday makes me happy to have found your little corner of the Internet.
Pro-tip: use Qtips with as small a diameter head as you can find, and roll them in vaseline before putting them in your ear. The smaller tip will push less material down the ear, instead allowing an angle to grab and move material. The vaseline will lubricate the tip and prevent scratching and tearing the skin.
While we’re on the subject of shockingly thin evidence bases in medicine, I want to mention that pretty much all of dentistry appears to be a cash transfer program from random citizens to boat vendors.
For years I have been using hydrogen peroxide to remove earwax. I first insert a small amount of hydrogen peroxide into the ear canal (head on side) and wait for popping sounds indicating wax is being softened. Then a cotton tip can be gently inserted while being slowly rotated and finally removed. I'm guessing that using hydrogen peroxide to soften any ear wax allows the cotton tip to be used as a mop.
I don't have any good evidence they are actively good for you, sadly. The closest I can get is the bit in the article about handedness, i.e. that it's as likely it helps as hurts.
With that said, you are a presumably adult person - this seems like a pretty minor risk to take in pursuit of the joy that only comes from a freshly q-tipped ear.
Well, I had the bad thing with Q-Tips (as they are called here in Germany, too). I was 19. Pushed to deep, I guess. Did not learn well from mom. Really painful. The doc told me a) that would pass b) to never use them again. I did as told. 3 decades without did no harm. - But, yeah, I agree it is probably bias. Billions get used. The docs see those cases, where things went wrong. - And they make more money cleaning them for you :)
After having my ears cleaned throughout my childhood by my mother (who is right-handed but faced me) with name brand Q-Tips, I was accepted to an Ivy League college. While attending that Ivy League college, I stopped cleaning my ears with Q-Tips of any brand. After my Wisefool year, I was out of state and had to go to a doctor to have a big-a-- rock of earwax removed from my RIGHT ear when it suddenly ceased receiving sound waves.
The doctor did not ask or mention Q-Tips because of the "don't ask, don't tell" policy surrounding them at the time. She did advise me to allow my ears to fill with water in the shower to assist in cleaning them (the inside, too) but never advised using swimmer's ear drops afterwards. This tell-tale missing link raised my suspicions.
After this traumatic experience, I became a committed user of Q-Tips after showering and have never had a rock in my right or left ear since. (My right ear is Caucasian and my left ear does not identify with any race, color, religion, or gender.)
From my exhaustive survey of myself, my first conclusion is that Q-Tip use during childhood increases intelligence and academic performance. My second conclusion is that once an individual achieves success in academics or any field, they should maintain the same habits as before, such as having their mother clean their ears weekly. This will guarantee their continued success and their mother's pride. My third conclusion is that a person should never leave their home town without a full check up of their ears.
The statistical significance of my findings is > 3.141592.....%
Long time Qtip user (and for both my sons, neither of which ever had ear infections or impacted earwax) because they clean and do feel good! Keep up the good work, I need positive reinforcement and totally agree with you!
Things like cancer are life-threatening, and therefore, more prestigious to work on. By "more prestigious" I mean more doctors want to develop/improve treatments, and more agencies (public and otherwise) will fund them to do this. While getting cerumen out of our own ears has a non-zero benefit to our well-being, in a world of limited resources to dedicate to medical research, focusing first on cancer is not inappropriate. For this reason, medicine is better at things which are more often fatal and more often acute than things which are chronic and not fatal, and especially things which are more about having an okay life vs a great life. For getting out ear wax, it's just something that feels good, so it falls squarely into the last category. So I do applaud your round-up of evidence (or lack thereof), and for the foreseeable future for things in that category it will be non-medical professionals or medical people working in their off-hours doing this. The question of why there's a near-unanimous consensus making it seem like using a Q-tip is a fatal mistake is a different one - where the medical establishment does have any opinion on questions in this category, there will be a tendency for it to be an overly strict one, which is some combination of legitimately taking a conservative approach in the absence of evidence, as well as guild protection.
I'm reminded a bit of this lovely piece in the washington post about the history of q-tips: https://webcache.googleusercontent.com/search?q=cache:PYqYTFDb_V8J:https://www.washingtonpost.com/news/wonk/wp/2016/01/20/we-have-a-q-tips-problem/+&cd=1&hl=en&ct=clnk&gl=us
(Why doesn't substack let me link words rather than paste whole urls?)
(Also, linking to the cache because of the wapo paywall, but the post is still up afaict.)
It doesn't really add much to the evidence conversation, but the history is interesting/entertaining. It does mention a study but the link is broken and it sounds associational rather than RCT anyway.
Thank you! I'm obviously interested in the subject and I haven't seen this before.
Spot on. Usually doctors are right, but obviously they aren't always right. Don't trust experts, but be more willing to defer to them.
I struggled with this a bit writing the post, because I don't want to discourage people from taking medical advice for obvious reasons. And I think I could definitely be wrong here, mostly because I don't think anecdotal evidence is worthless, especially when it's overwhelming - and it is overwhelming from what I can tell. But it is weird when you run into pockets of things that "we know" that we don't know nearly as well as it seems like we should.
If I hope anything in particular comes from this, it would be that better studies were done on the subject.
I work in prototype engineering and spend a lot of time very carefully understanding very very complicated things at a microsecond time scale to find bugs and fix complex system interactions. I also see an amazing number of things stick around just because they work well enough and aren't the highest value place to spend the man-hours to improve. I think something very similar can be said about any complex thing -- if you don't want to spend time understanding it, you are better off deferring to someone who presumably has, but if you want to spend the time (all potential pitfalls and misassociations and reverse causations potentially included) that presumption is rebuttable. Including in things like diet, given the low quality of the associational evidence used in the field as a whole.
Doctors are good at memorization. You get through medical school by being good at memorization. Doctors are not scientists (the vast, vast majority of them anyway). In this light, it's entirely unsurprising that doctors as a group thoughtlessly repeat "Q-tips: bad. New Porsche: good."
Null hypothesis papers not getting published, or at least somehow recorded, is the worst mistake of the modern scientific process.
Agreed! It's still important information!
I produce a lot of earwax. If I don't use cotton swabs, my ears are impacted in less than two months to the point that I can't hear a thing. I have never experienced impacted ears with any sort of regular qtip usage.
Seems like a survey study asking questions like these would be pretty straight-forward to run. Someone could make tenure overturning this big anti-qtip conspiracy 😉
We are the children of the occluded eardrum revolution!
I have unusually formed ear canals, father and grandfather are the same. They are narrower than average, narrow even more in the middle of the canal, and slope down. Using a Q-Tip to clean the inner ear will, and has, produced exactly the impacted wax described here. Additionally I have the gene that gives me dry earwax which is very common in people of east Asian ancestry.
If you enjoy cleaning your ears, of feel you need to do a very thorough job, consider that there are purpose build tools for doing this far superior to Q-Tips that aren't terribly expensive and a normal part of the toiletries items in homes in Asia. Amazon will have many kits.
While I am currently multi-tasking (NBA playoffs and Steph Curry managing 50 points in a Game 7 at age 35 -- geez, fun, even if not a sports fan) your writing is entertaining and the previous post has little correlation to the next in this case. Cotton-Tipped Swabs. Wow, it is sorta funny IMO. Stories like this are fun and lighthearted. What's the point of this (and lots of topics full of false insight and just enough uncertainty that leads normally sensible people to embrace an idea without much context)? Recency bias and the failure to evaluate all of the evidence available (even if not indexed on Google Scholar). The ABSURDITY that a creature with perhaps a 2 million year track record and the evolutionary prowess of tens of millions of years of prior mammal and primate evolution is somehow dependent on the usefulness of putting a soft-tipped stick into their ear to accomplish some task tied to its survival is absurd and asinine on its face. Probably not a bad idea to defer to someone who has experience and insight rather than silly stuff on the Web based on opinion. Silly but fun. Your writing is FUN and I am going to keep at it. Because I am planning my regular post tomorrow and then a farewell for now on Wednesday makes me happy to have found your little corner of the Internet.
Pro-tip: use Qtips with as small a diameter head as you can find, and roll them in vaseline before putting them in your ear. The smaller tip will push less material down the ear, instead allowing an angle to grab and move material. The vaseline will lubricate the tip and prevent scratching and tearing the skin.
While we’re on the subject of shockingly thin evidence bases in medicine, I want to mention that pretty much all of dentistry appears to be a cash transfer program from random citizens to boat vendors.
For years I have been using hydrogen peroxide to remove earwax. I first insert a small amount of hydrogen peroxide into the ear canal (head on side) and wait for popping sounds indicating wax is being softened. Then a cotton tip can be gently inserted while being slowly rotated and finally removed. I'm guessing that using hydrogen peroxide to soften any ear wax allows the cotton tip to be used as a mop.
Man, I was so hoping you would find evidence that using Q-tips was actually good for us! It's so damn satisfying!
I don't have any good evidence they are actively good for you, sadly. The closest I can get is the bit in the article about handedness, i.e. that it's as likely it helps as hurts.
With that said, you are a presumably adult person - this seems like a pretty minor risk to take in pursuit of the joy that only comes from a freshly q-tipped ear.
Well, I had the bad thing with Q-Tips (as they are called here in Germany, too). I was 19. Pushed to deep, I guess. Did not learn well from mom. Really painful. The doc told me a) that would pass b) to never use them again. I did as told. 3 decades without did no harm. - But, yeah, I agree it is probably bias. Billions get used. The docs see those cases, where things went wrong. - And they make more money cleaning them for you :)
Reminds me of the research "proving" that masks don't work back at the beginning of 2020.
After having my ears cleaned throughout my childhood by my mother (who is right-handed but faced me) with name brand Q-Tips, I was accepted to an Ivy League college. While attending that Ivy League college, I stopped cleaning my ears with Q-Tips of any brand. After my Wisefool year, I was out of state and had to go to a doctor to have a big-a-- rock of earwax removed from my RIGHT ear when it suddenly ceased receiving sound waves.
The doctor did not ask or mention Q-Tips because of the "don't ask, don't tell" policy surrounding them at the time. She did advise me to allow my ears to fill with water in the shower to assist in cleaning them (the inside, too) but never advised using swimmer's ear drops afterwards. This tell-tale missing link raised my suspicions.
After this traumatic experience, I became a committed user of Q-Tips after showering and have never had a rock in my right or left ear since. (My right ear is Caucasian and my left ear does not identify with any race, color, religion, or gender.)
From my exhaustive survey of myself, my first conclusion is that Q-Tip use during childhood increases intelligence and academic performance. My second conclusion is that once an individual achieves success in academics or any field, they should maintain the same habits as before, such as having their mother clean their ears weekly. This will guarantee their continued success and their mother's pride. My third conclusion is that a person should never leave their home town without a full check up of their ears.
The statistical significance of my findings is > 3.141592.....%
My toast to RC?... Here's mud in your ear.
Long time Qtip user (and for both my sons, neither of which ever had ear infections or impacted earwax) because they clean and do feel good! Keep up the good work, I need positive reinforcement and totally agree with you!
Things like cancer are life-threatening, and therefore, more prestigious to work on. By "more prestigious" I mean more doctors want to develop/improve treatments, and more agencies (public and otherwise) will fund them to do this. While getting cerumen out of our own ears has a non-zero benefit to our well-being, in a world of limited resources to dedicate to medical research, focusing first on cancer is not inappropriate. For this reason, medicine is better at things which are more often fatal and more often acute than things which are chronic and not fatal, and especially things which are more about having an okay life vs a great life. For getting out ear wax, it's just something that feels good, so it falls squarely into the last category. So I do applaud your round-up of evidence (or lack thereof), and for the foreseeable future for things in that category it will be non-medical professionals or medical people working in their off-hours doing this. The question of why there's a near-unanimous consensus making it seem like using a Q-tip is a fatal mistake is a different one - where the medical establishment does have any opinion on questions in this category, there will be a tendency for it to be an overly strict one, which is some combination of legitimately taking a conservative approach in the absence of evidence, as well as guild protection.