How a house­hold sta­ple be­came the source of doc­tor’s of­fice swab sto­ries

Q-tips may be the only ma­jor con­sumer prod­uct whose main use is pre­cisely the one the man­u­fac­turer ex­plic­itly warns against

Toronto Star - - IN­SIGHT - ROBERTO A. FER­D­MAN

Years ago, my mother com­plained about a ter­ri­ble ear­ache. The pain was un­bear­able. And it wouldn’t go away. For a week, she walked around with a de­bil­i­tat­ing ring­ing in her head.

Even­tu­ally, she re­called to me the other day, the dis­com­fort led her to a doc­tor, who care­fully pushed an oto­scope into her ear. Within sec­onds, he pulled it out and looked her in the face.

“Have you been putting Q-tips in your ears?” he asked with a dis­ap­prov­ing tone.

Like so many oth­ers, my mother had been us­ing Q-tips to clean her ears. But in do­ing so she was also mess­ing with a nat­u­ral process. Her ear was hurt­ing be­cause she had an ear in­fec­tion, and there’s a de­cent chance her rou­tinely us­ing Q-tips had helped cause it.

“Prom­ise me some­thing,” the doc­tor told her. “Prom­ise me you’ll never put an­other Q-tip in­side of your ear.”

Q-tips are one of the most per­plex­ing things for sale in North Amer­ica. Plenty of con­sumer prod­ucts are widely used in ways other than their core func­tion — books for lev­el­ling ta­bles, news­pa­pers for keep­ing fires aflame, soda wa­ter for re­mov­ing stains, cof­fee ta­bles for rest­ing legs — but th­ese cot­ton swabs are dis­tinct.

Q-tips are one of the few ma­jor con­sumer prod­ucts, if not the only, whose main pur­pose is pre­cisely the one the man­u­fac­turer ex­plic­itly warns against.

The lit­tle padded sticks have long been mar­keted as house­hold sta­ples, pitched for var­i­ous kinds of beauty up­keep, arts and crafts, home-clean­ing and baby care. And, for years, they’ve car­ried an ex­plicit cau­tion — ev­ery box of Q-tips comes with this caveat: “do not in­sert in­side the ear canal.” But ev­ery­one — es­pe­cially those who look into peo­ple’s ears for a liv­ing — know that many, if not most, flat out ig­nore the warn­ing.

“Peo­ple come in with cot­ton swab-re­lated prob­lems all the time,” said Den­nis Fitzger­ald, an oto­laryn­gol­o­gist in Wash­ing­ton. “Any ear, nose and throat doc­tor in the world will tell you they see th­ese all the time.

“Peo­ple say they only use them to put makeup on, but we know what else they’re us­ing them for,” he added. “They’re putting them in­side their ears.”

While Q-tips were never sold for use deep in­side the ear, it took around half a cen­tury for man­u­fac­tur­ers to ex­plic­itly warn against it.

The ver­sa­tile house­hold sta­ple was the brain­child of a man named Leo Ger­sten­zang, who thought to wrap cot­ton tightly around a stick af­ter watch­ing his wife preen their young child. She was us­ing a tooth­pick with a cot­ton ball on the end to care­fully ap­ply var­i­ous things to the baby, a clever but eas­ily im­proved trick.

In 1923, Ger­sten­zang in­tro­duced Baby Gays, the first san­i­tized cot­ton swabs. They were sim­i­lar to those sold to­day, save for a few key dif­fer­ences. They were made of wood in­stead of plas­tic or pa­per; they were sin­gle-, not dou­ble-sided; they were meant to be used for baby care, rather than ev­ery­thing un­der the sun; and, most im­por­tant, the mak­ers didn’t dis­cour­age putting them in­side of ears.

“Ev­ery mother will be glad to know about Q-tips Baby Gays (the Q stands for ‘qual­ity’), san­i­tary boric tipped swabs for the eyes, nos­trils, ears, gums, and many other uses,” a 1927 print ad­ver­tise­ment read.

In the years that fol­lowed, many things changed, in­clud­ing the name, which was short­ened to just Q-tips; the ma­te­rial, which shifted to pa­per; and the mar­ket­ing, which broad­ened to in­clude all sorts of other house­hold uses. But one thing didn’t: the ab­sence of a warn­ing.

It wasn’t un­til some time in the 1970s that boxes be­gan to cau­tion against stick­ing the things in­side of ears.

To­day, the warn­ings are even more ex­plicit. They say, rather un­am­bigu­ously, “Do not in­sert swab into ear canal.”

What ex­actly prompted the change is un­clear. There is no record of a pub­li­cized case around that time in which a Q-tip was blamed for dam­age to some­one’s ears. Nor does Unilever, which now owns the brand, at­tribute the shift to any­thing in par­tic­u­lar.

“The brand has been around nearly 100 years, so there’s been a few it­er­a­tions in pack­ag­ing,” said Carolyn Stan­ton, a compa ny spokes­woman. “The ear­lier boxes were in­tended for baby care, so it wasn’t rel­e­vant at the time.”

But the im­pe­tus for the switch must have come, at least in part, from an un­der­stand ing that many peo­ple were mis­us­ing the cot­ton swabs. De­spite the cau­tion­ary la­bel that was added to pack­ag­ing, Q-tips were still — as they had been for decades — mar­keted as a tool for ear clean­ing.

In 1980, a com­mer­cial for the brand fea­tured Betty White, who en­cour­aged peo­ple to use them on eye­brows, lips and ears. “This is a Q-tips cot­ton swab,” she said. “They call it safe swab.

In 1990, a piece pub­lished in the Wash­ing ton Post joked that telling peo­ple to use the swabs on “the outer sur­faces of the ear with­out en­ter­ing the ear canal,” as Q-tips pack­ages do, was akin to ask­ing smok­ers to dan­gle cig­a­rettes from their lips with­out ever light­ing them.

The cig­a­rette anal­ogy is an apt one. We con­tinue to twist Q-tips in our ears thanks to a sim­ple truth: it feels great. Our ears are filled with sen­si­tive nerve end­ings, which send sig­nals to var­i­ous other parts of our bod­ies. Tick­ling their in­sides trig­gers all sorts of vis­ceral plea­sure.

But there’s more. Us­ing Q-tips leads to what der­ma­tol­o­gists re­fer to as the itch­scratch cy­cle, a self-per­pet­u­at­ing ad­dic­tion of sorts. The more you use them, the more your ears itch; and the more your ears itch, the more you use them.

Fitzger­ald, the oto­laryn­gol­o­gist, said he ap­pre­ci­ates the cig­a­rette anal­ogy, but in­sists there’s noth­ing funny about the temp­ta­tion to stick cot­ton swabs into your ears.

“Peo­ple have been led to think that it’s nor­mal to clean their ears — they think that ear­wax is dirty, that it’s gross or un­nec­es­sary,” he said. “But that’s not true at all.”

Fitzger­ald likens ear­wax to tears, which help lu­bri­cate and pro­tect our eye­balls. Wax, he says, does some­thing sim­i­lar for the ear canal, where the skin is thin and frag­ile and highly sus­cep­ti­ble to in­fec­tion.

“Your body pro­duces it (ear­wax) to pro- tect the ear canal,” said Fitzger­ald. “What you’re tak­ing out is sup­posed to be in there. There’s a nat­u­ral mi­gra­tion that car­ries the wax out when left alone.”

Even if our ears were meant to be cleaned, the truth is that Q-tips would still be a ter­ri­ble thing to use, he says. The shape, size and tex­ture of cot­ton swabs is such that in­sert­ing them into your ears tends to push wax in­wards, to­ward your ear drum, rather than woo it out.

“Push­ing wax in, as Q-tips tend to do, can in­duce hear­ing loss,” said Fitzger­ald. “They can also be in­serted too deeply and rup­ture the ear drum or dam­age the small mid­dle ear bones, both of which hap­pen more than you would think.”

For this rea­son, the Amer­i­can Academy of Oto­laryn­gol­ogy listed cot­ton swabs as an “in­ap­pro­pri­ate or harm­ful in­ter­ven­tion,” even when wax needs to be forcibly re­moved from the ear.

To­day, there is not a sin­gle ear on the of­fi­cial Q-tips web­site. There’s a woman us­ing the cot­ton swabs to ap­ply makeup to her lips, an­other us­ing them for nail pol­ish, a dog, a baby and a sparkling clean liv­ing room, among other things.

The va­ri­ety re­flects Q-tips’ busi­ness strat­egy, which in­creas­ingly has been driven by a de­sire to broaden the prod­uct’s ap­peal.

“The mar­ket­ing ex­panded to ‘all pur­pose’ use in the late 1990s and 2000s,” said Svet­lana Udus­li­vaia, the head of tis­sue and hy­giene at Euromon­i­tor, a mar­ket re­search firm.

The firm es­ti­mates $208.4 mil­lion (U.S.) in Amer­i­can Q-tips sales in 2014, up from $189.3 mil­lion in 2005.

“Peo­ple may use it for ear clean­ing, but we in­struct against it,” Stan­ton, the Unilever spokesper­son, said.

The prob­lem, of course, is that peo­ple do. Bar­bara Kahn, who teaches mar­ket­ing at the Whar­ton School of Busi­ness, said it’s par­tic­u­larly dif­fi­cult to change how peo­ple per­ceive Q-tips be­cause they are such a his­toric brand.

“They’re try­ing to change how peo­ple think of the prod­uct, to build a brand that’s sep­a­rate from the orig­i­nal and in­ap­pro­pri­ate use, but that’s re­ally hard when ev­ery­one knows a prod­uct and thinks about it in a cer­tain way,” she said.

“Peo­ple have been led to think that it’s nor­mal to clean their ears — they think that ear­wax is dirty, that it’s gross or un­nec­es­sary. But that’s not true at all.”

DEN­NIS FITZGER­ALD

OTO­LARYN­GOL­O­GIST

JONATHAN HAY­WARD/THE CANA­DIAN PRESS

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