Sociodemographic Characteristics and Prevalence of Self Ear Cleaning in Sokoto Metropolis

doi:10.4236/ijohns.2013.26057

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International Journal of Otolaryngology and Head & Neck Surgery, 2013, 2, 276-279

Published Online November 2013 (http://www.scirp.org/journal/ijohns)

http://dx.doi.org/10.4236/ijohns.2013.26057

Open Access IJOHNS

Sociodemographic Characteristics and Prevalence of Self

Ear Cleaning in Sokoto Metropolis

Stanley B. Amutta1*, Mufutau A. Yunusa2, Kufre R. Iseh1, Ayodele Obembe2, Enokela Egili3,

Daniel Aliyu1, Mohammed Abdullahi1

1ENT Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

2Psychiatry Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

3Family Medicine Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Email: *[email protected]

Received September 6, 2013; revised October 5, 2013; accepted November 2, 2013

cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Self ear cleaning with cotton buds and other objects is a common practice. Objective: To determine the

sociodemographic characteristics and the prevalence of self ear cleaning habit among patients attending a family medi-

cine clinic in a teaching hospital in Sokoto metropolis. Materials and Methods: This was a 4 weeks prospective study

carried out between May and June, 2013 at Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital

Sokoto. A structured self response questionnaire containing items on sociodemographic characteristics, frequency of

administering objects into the ear and complications of self ear cleaning was administered to the respondents after in-

stitutional research ethical clearance. The data were analysed using SPSS for windows version 16.0. P-value was con-

sidered significantly if less than 0.05. Results: A total of 200 subjects were included in this study, comprising of 93

(46.5%) males and 107 (53.5%) females. Their ages ranged from 18 - 57 years with the mean age being 30.29 years

(±8.70). Eighty percent (160) of the respondents practise self ear cleaning. Types of objects included writing objects

and cotton buds. For many of the subjects, the frequency of insertion was once daily and both ears were frequently

cleaned. Complications that have arisen due to the practice included otitis externa. Conclusion: Self ear cleaning was

prevalent in the subjects. Considering the complications that may arise, ear cleaning is better done by trained health

personnel.

Keywords: Ear; Cleaning; Self; Wax; Cotton Bud; Sokoto

1. Introduction

The habit of cleaning the external auditory canal (EAC)

with cotton buds and other objects is a common practice

[1,2]. Generally, it is done to clean ear wax considered as

dirt from the EAC [1,2]. However, this wax resulted

from combined secretions of the ceruminous and seba-

ceous glands and desquamated epithelium from the tym-

panic membrane and skin lining the external auditory

canal form the ear wax [1,3-7].

Accumulation of ear wax in the EAC is the most

common and routine otologic problem [4]. Ear wax ac-

cumulation obstructed the clinician from viewing the

tympanic membrane, caused ear discomfort, otalgia,

hearing loss, itching, tinn itus and increased infection risk

[4-6]. Rarely, unproductive cough may be the only clini-

cal presentation of impacted ear wax [8]. Some people

make a routine attempt to remove the ear wax using cot-

ton bud, and loose tip cotton swabs, feathers, stick and a

variety of other objects [1,2,4,9]. This act interferes with

the self cleansing function of the EAC and the wax

which is further pushed medially towards the tympanic

membra n e [2,4]. Moreover, ear wax habitual removal is a

risk factor for repeated trauma, inflammation and weakens

the EAC local defence against bacterial and fungal infec-

tion [1,2,9].

Previous studies have reported the habit of ear clean-

ing, objects used to clean the ears, and ho w frequent and

associated with complications [1,2,9]. In Sokoto, North-

Western Nigeria there is no study conducted on self ear

cleaning habit. The purpose of this study was to deter-

mine the sociodemographic characteristics of patients

who practice self ear cleaning habit and associated with

*Corresponding author.

S. B. AMUTTA ET AL. 277

complications in Sokoto metropolis, North-Western Ni-

geria.

2. Materials and Methods

This was a p rospective stud y which was carried ou t over

a 4 weeks period between May and June, 2013 at Us-

manu Danfodiyo University Teaching Hospital (UDUTH)

and Specialist Hospital Sokoto. Usmanu Danfodiyo

University Teaching Hospital and Specialist Hospital are

tertiary and secondary health institutions respectively.

These two institutions are located within Sokoto me-

tropolis. The subjects comprised of both patients and

healthy adults (staff and students) of these institutions.

However for subjects to be included into this study,

should not have ear problems or complaints, give consent

to participate in this stud y and should not be less than 18

years. Exclusion criteria were individuals less than 18

years of age, having ear problems/complaints and not

giving consent.

A structured self response questionnaire was adminis-

tered to the respondents after institutional research ethi-

cal clearance was obtained for the study and informed

consent. A sample of loose tip cotton bud was shown to

the respondents during the response to the questionnaire

[2], and they were asked if they will replace the tight

cotton bud available in the market with the loose tip cot-

ton bud. Inclusion criteria were being adult and having

given consent to participate in the study.

The data obtained was analyzed using SPSS for win-

dows version 16.0. P-value was considered significant if

it was less than 0.05.

3. Results

A total of 200 subjects participated in this study. The

mean age of the respondents was 30.29 years (±8.70

years). Ninety three (46.5%) were males and 107 (53.5%)

were fema le, the ratio bei ng 1:1.2.

From Table 1, the respondents were mostly young

people with those in the 21 - 30 years age group com-

prising more than half of them (58.5%). One hundred and

thirty nine subjects were Muslims while 61 were Chris-

tians and more than 60% of them received tertiary educa-

tion. Majority of them were civil servants (42.0%) and

students (42.5%) while Hausa/Fulani ethnic group con-

stituted were 114 (57.0%).

In Table 2, one hundred and sixty (80%) of the re-

spondents practise self ear cleaning while 39 (19.5%) do

not clean their ears. The frequency of cleaning per day in

the subjects were as follows: those who cleaned once

daily were 77 (48.1%), twice 25 (15.6%), thrice 7 (4.4%),

four times 1 (0.6%), five times 2 (1.3%) and more than

five times 48 (30%). Cotton bud was the most common

object used by the subjects to clean their ears with 146

Table 1. The age distribution of the subjects.

Age range Number (%)

18 - 20 16 (8.0)

21 - 30 117 (58.5)

31 - 40 42 (21.0)

41 - 50 17 (8.5)

51 - 60 8 (4.0)

Total 200 (100.0)

Gender

Male 93 (46.5)

Female 107 (53.5)

Religion

Islam 139 (69.5)

Christianity 61 (30.5)

Education

Primary 15 (7.5)

Secondary 33 (16.5)

Tertiary 124 (62.0)

Postgraduate 28 (14.0)

Occupation

Civil service 84 (42.0)

Housewife 7 (3.5)

Missionary 1 (0.5)

Self employed 13 (6.5)

Student 85 (42.5)

Teacher 10 (5.0)

(91.2%), followed by biro cover/tip 6 (3.7%) and other

objects were 8 (5.0%) comprising feather 3 (1.9%),

broom stick 2 (1.3%), finger 2 (1.3%) and match stick 1

(0.6%). Removal of dirt 65 (40.6%) was the most com-

mon reason for self ear cleaning among the subjects, fol-

lowed by itchy ears 48 (30%), ear wax 25 (15.6%). The

other reasons included ear blockage 22 (13.8%), water in

the ear 10 (6.2%) and prevention of infection 6 (3.8%).

Both ears were most common frequently cleaned among

the subjects with 89 (55.6%), right ear 47 (29.4%) and

left ear 24 (15%). Only 13 (8.1%) respondents accepted

to replace the cotton bud with a loose tip cotton bud.

Forty (25%) of the 160 respondents involved in the

self ear cleaning had some complications while 120

(75%) had no complications. The most common compli-

cation was otitis externa 17 (10.6%), followed by re-

tained object in the EAC 11 (6.9%), pain 10 (6.3%) and

bleeding fr om EAC 2 (1.2% ).

4. Discussion

This prospective cross sectional study was aimed to de-

termine the sociodemographic characteristics, the preva-

Open Access IJOHNS

S. B. AMUTTA ET AL.

278

Table 2. Self ear cleaning among the subjects.

Self ear cleaning

Yes 160 (80.0)

No 39 (19.5)

Frequency per day

1 77 (48.1)

2 25 (15.6)

3 7 (4.4)

4 1 (0.6)

5 2 (1.3)

>5 48 (30)

Objects used

Cotton bud 146 (91.2)

Biro cover/tip 6 (3.8)

Other objects 8 (5)

Reason for using objects into the ear

Dirt 65 (40.6)

Itchy ears 48 (30)

Wax 25 (15.6)

Other reasons 22 (13.8)

Ear frequently clean

Both 89 (55.6)

Right 47 (29.4)

Left 24 (15)

Complications

Nil 120 (75)

Otitis externa 17 (10.6)

Lodge object in the EAC 11 (6.9)

Pain 10 (6.3)

Other complications 2 (1.2)

lence of practising self ear cleaning and previous history

of complications from the habit. Of the subjects 80% of

them indulged in self ear cleaning. In addition, majority

cleaned their ears once daily and both ears were fre-

quently cleaned. Cotton bud was the preferred object for

cleaning the ears among the subjects and the most com-

mon complication enco untered was otitis externa.

Self ear cleaning is a common practice. It is usually

done by most people to remove ear wax, which most

individual considered as dirt [1,2]. The prevalence of self

ear cleaning among the respondents in this study was

comparable to previous study in Kaduna, Nigeria [1].

The objects used by the respondents in this study for

self ear cleaning varied. The most common object used

was cotton bud in 91.2% of the respondents involved in

the habit. This is in agreement with numerous studies

[1,2,5,9]. Feathers, biro cover/tips, broom stick, match

sticks and finger were used by few members of the sub-

jects. An unprofessional attempt to clean the EAC is a

potential risk factor for ear trauma and otitis externa

[1-5,9]. Moreover, the risk is greater if done without di-

rect visualization of the EAC, and using wrong instru-

ments or objects not design for removing ear wax or for-

eign body from the ear.

The majority of the subjects in this study clean their

ears 1 - 5 times d aily. Th e break down o f the fr equ ency of

cleaning revealed 48.1% routinely clean their ears once

daily, while 21.9% clean 2 - 5 times every day and 30%

clean more than five times per day. The rate of cleaning

in this study is similar to other report [1,2]. The compli-

cation of self ear cleaning among the subjects in this

study was 25%. In contrast, Lee, et al. [2] reported from

2% in Malaysia. The larger sample size in this study may

be the possible explanation for this difference. The most

common complication encountered in this study was oti-

tis externa, followed by retained object in the EAC, pain

and bleeding from EAC and ear wax impaction. Similar

complications were reported in other studies [1-5 ,9,10].

In this study, the most common reason for self ear

cleaning was removal of dirt, followed by itchy ears and

ear wax. Itchy ears were the most common reason re-

ported by Afolabi et al. [1], while ear wax was the pre-

dominant reason in the study by Lee et al. [2]. Majority

of the respondents in this study considered ear wax as

dirt. Ear wax is not dirt, but natural product of the EAC

that prevents infection and foreign bodies from easily

entering the EAC [1-5]. Cleaning the EAC with cotton

bud and other objects is a behavioural factor that con-

tributes to impacted ear wax because the action opposes

the self cleansing property of the EAC, mechanical

trauma to the EAC wall, tympanic membrane perforation

and secondary infection [3-5,9]. The appropriate indica-

tions for ear wax removal include symptomatic ear wax

impaction and to view the tympanic membrane during

ear examination [3,4]. Furthermore, the ear wax removal

should be done by trained and skilled ENT Nurses, Gen-

eral Physicians and Otolaryngologists.

Itchy ears require complete evaluation by an oto-

laryngologist because fungal infection of the external

ears and allergic conditions such as allergic dermatitis

and allergic rhinosinusitis may be responsible. Self ear

cleaning because of blockage as practiced by 6.2% of the

respondents in this study is dangerous due to the risks

mentioned above. Moreover, middle ear lesion that leads

to fluid accumulation in the middle ear such as otitis me-

dia with effusion (OME) presents with sensation of ear

blockage and hearing impairment.

Ironically, 3.8% of the respondents indu lged in self ear

cleaning to prevent infection. Health education is indis-

pensable to stop the habit. Another 3.8% cleaned their

EAC to mop out water after bath, overall, only 8.1% of

the respondents agreed to replace the traditional tight

Open Access IJOHNS

S. B. AMUTTA ET AL.

Open Access IJOHNS

279

cotton bud with a loose tip cotton bud despite adequate

explanation that loose tip cotton bud is better because it

absorbs more water and less traumatic. Reason for the

choice of the tight cotton bud was due to its aesthetic

appearance. In contrast, 24% of the subject in the study

by Lee et al. [2] agreed to replace the conventional cot-

ton bud with loose tip cotton bud.

It is important that in the interpretation of the findings

in this study, some limitations present be considered.

This was a hospital based study hence extending the

findings to the community may be difficult. Also the

sampling was mainly convenient and the subjects were

relatively few. In spite of these, this report would appear

as a call to action on self ear cleaning among the Nige-

rian population living in Sokoto metropolis.

5. Conclusion

The present study suggested that self ear cleaning habit is

prevalent in Sokoto metropolis. The complications re-

ported in this study suggested that future study should be

community based on involving larger subjects.

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