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
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