I guess I'm one of the "bad ENTs". I use Q-tips about twice a week, and I tell
my patients, "You probably don't need to use Q-tips, but if you are going to
anyway, here's how to do it." Then I give them the rules:

* Make sure you are alone, and that no one can "surprise" you. Many Q-tip
injuries occur when another person bumps your arm while you are using the
Q-tip.

* Make sure you are focused on what you are doing, and don't get distracted. I
have seen two patients in the last year who perforated their TMs by putting a
phone up to their ear... while the Q-tip was still in place! Seems they forgot
it was there.

* Do not do it too often, as it can irritate the skin and "over-remove" wax
(yes, I tell them about the protective effects of wax) and can provoke itching
(I explain the itch-scratch syndrome to them.) Do not do it too rarely, as you
can pack wax down and cause a complete impaction.

* Hold the Q-tip just behind the cotton tip. That way, your fingers act as a
"back-stop" to prevent over-penetration.

In my opinion, there's nothing worse than a hypocrite; so if I am going to
tell my patients not to use Q-tips, I've either got to stop using them myself,
or tolerate being a hypocrite.

Doug Hoffman MD