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
Received September 6, 2013; revised October 5, 2013; accepted November 2, 2013
Copyright © 2013 Stanley B. Amutta et al. This is an open access article distributed under the Creative Commons Attribution Li-
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-
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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
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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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