Cotton swabs are sending about 34 children to the emergency room daily

That was the title of an article that appeared on the USA Today website on May 8, 2017. It came from a press release titled Study: Cotton Tip Applicators Injure Children at Surprising Rate which said: 

“Doctors have warned that using cotton tip applicators to clean your ears can lead to injury and infection, but a new study shows that a startling number of children suffer injuries after cotton tip applicators are inserted into their ears. The study by researchers at Nationwide Children’s Hospital found that more than a quarter of a million children were treated in U.S. emergency departments from 1990-2010 for cotton tip applicator-related ear injuries, that’s about 34 children every day.

‘Far too many children and parents believe that the ears should be cleaned at home, and that a cotton tip applicator is the tool to do that,’ said Kris Jatana, M.D., a pediatric otolaryngologist at Nationwide Children’s Hospital and lead author of the study. ‘And because this study only captured injuries that were treated in emergency departments, there were likely a lot more injuries to children who were treated by an ear, nose and throat specialist or a pediatrician.’

Of the children treated in emergency departments, more than two-thirds were under the age of eight, and 77 percent of patients were handling the cotton tip applicators themselves. Dr. Jatana says these products should be kept out of the reach of young children, and it’s important for parents to teach older children that cotton tip applicators should never be used in their ears.

‘The ear canals are self-cleaning, so not only is it unnecessary to clean children’s ear canals, but it puts them at serious risk of injury,’ said Dr. Jatana. ‘Cotton tip applicators can easily cause a perforation or hole in the eardrum or push wax deeper into the ear canal where it gets trapped. Injuries can cause infection, dizziness or irreversible hearing loss.’ ”

How could most injuries be prevented? Take those swabs away from children. Tell them if they want to get water out of their ears after a shower or bath, then they should just jump up and down. They’ll probably instead roll up a facial tissue, but won’t be able to push it hard enough to perforate an eardrum.

Where are the detailed results from that study? In an article that will appear in The Journal of Pediatrics by Zeenath S. Ameen, Thiphalak Chounthiarth, Gary A. Smith, and Kris R. Jatana titled Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010.

What is missing from that press release and article? A context for that 34-a-day number. Where does it fit in a bigger picture compared with other injuries?

For example, how does it compare with skateboarding? I found an article from April 8, 2016 at LiveScience by Sara G. Miller titled Not So Gnarly: Skateboarding Sends 176 Kids to the ER Every Day. That’s five times the number of cotton swab injuries. It reported on results from a 2016 magazine article in Injury Epidemiology by Lara B. McKenzie, E. Fletcher, N.G. Nelson, K. J. Roberts, and E. G. Klein titled Epidemiology of skateboarding-related injuries sustained by children and adolescents 5-19 years of age and treated in US emergency departments: 1990 to 2008. You can read the abstract here at PubMed. Curiously McKenzie, Nelson, and Roberts are with the Center for Injury Research and Policy in The Research Institute at Nationwide Children’s Hospital, as are Ameen, Chounthiarth and Smith – the first three authors of the article on cotton swabs.

How about other sports? I found a July 2016 report (Statistical Brief #207) by Audrey J. Weiss and Ann Eixhauser titled Sports-Related Emergency Department Visits and Hospital Inpatient Stays, 2013. It came from the Healthcare Cost and Utilization Project (HCUP). Table 2 listed the Top Five specific sports activities associated with emergency room visits (discharged) for both boys (2789 per day) and girls (1415 per day), and the overall total (4204). As shown above, for boys there were 458 injuries associated with American tackle football, followed by 379 for other unspecified sports activity, and 329 for bicycle riding. For girls there were 181 for school recess and summer camp, 139 for bicycle riding, and 132 for other unspecified sports activity. Running (111) and soccer (110) were almost the same and both more than 3 times that for cotton swabs.    

Table 1 listed the Top Ten specific sports activities associated with emergency room visits (discharged) for both children and adults. I have plotted them in the bar chart shown above, along with the cotton swab and skateboarding injuries. There were almost exactly twice as many (353 per day) soccer injuries as skateboarding injuries, but that was minor compared with the largest category - 1051 bicycle riding injuries. There were a total of 7,688 sports-related Emergency Department visits per day.