Poor evidence that Q-tips are harmful

I'm here to clarify how many (but not all) of us use medical research: the "pyramid of evidence."

The idea is that I rely upon the best available evidence, which (roughly in order) is: meta-analysis, randomized controlled trials and other prospective data, retrospective analyses, expert consensus, and (finally) clinical experience.

This is rough because there are good critiques of meta-analyses as a tool, the available data may be a bad fit for that patient, research biases, etc. A big one is that many questions don't have a big commercial upside, so nobody will ever fund a good prospective blinded trial. Which takes us to the last point: absence of evidence is not evidence of absence. Just because all the of the studies about Q-Tips are low quality doesn't mean a better study would find something different. We don't know the answer to that, and that would be a big assumption to make.

So, sometimes the best available evidence is not statistically ironclad. It falls on us to use a reasonable approach about how hard a line to take. Some do a better job than others.

That was long and rambling, but hopefully it helps to clarify some misconceptions. As an applied science, we have to go with the data we've got, which is almost always not an ideal fit for the patient in front of us.

You sit in a chair or lay down on a table (my preference) and someone who does this all day long, puts a bright light near your ear and uses a razor to cut off the hair on the outsides of your ears (if you have any) and then uses a bunch of different tools [0] to extract out all the ear wax and anything else in there. I always come out feeling like my hearing is more 'clear'.

They literally touch your eardrum and the feeling is somewhere on the edge of uncomfortable, but oh so good at the same time. At the end, they use a very fuzzy q-tip and it makes this wonderful noise and feeling.

Of course, I've heard horror stories about this not going well. Punctured eardrums, infections, etc... but the fact is that literally millions of people every day get this service in Vietnam. You see people all over getting it in shops. You also learn quickly that if you don't like something, move your head away and they stop immediately.

If you get this often enough, you should purchase your own set of 'tools' (about $4-6) that you carry with you and have them sanitize them each time before use. I went to a whole bunch of different people and eventually found a few places that I liked a lot. For the most part the service is the same all over, but everyone has their own unique different technique too.

[0] https://chamsoccothe.com/uploads/images/san-pham/lay-ray-tai...

For example, a doctor prescribed two medications (A, B) to take twice per day. Yet there is an alternate medication (C) for one of them (B) that can be given 3 times per day, which reduces blood level fluctuations resulting in better symptom management. She told me that they don't usually prescribe that one because they don't trust the parents of their patients to correctly administer one drug only twice per day (A) when giving the other drug (C) 3 times (they are worried about overdoses of the twice daily medication A).

Regardless of whether future evidence may demonstrate that salt is bad for you, or that q-tips are bad for you, this sort of thing seems to be the medical field's version of the urban legend. Everybody believes X because they heard someone else -- maybe a professor at school -- stating it, but ultimately it has little scientific basis, and it takes years to root it out. I wonder how often this happens, and what can be done to counter it.

Cerumen will thinly coat the ear canal to protect it. When you mess with that flow, you create little build-ups, kind of like road traffic. This accumulates and create the equivalent of a traffic jam.

This is also why Q-tips users swear by them: they are creating the issue that requires the Q-tips in the first place.

Worth noting that not all humans have the same kind of cerumen. There is wet cerumen (dominant, 50%) and dry cerumen (20%). It depends on your genetic. If you are asian, chances are that your cerumen will be harder and require scooping out. Again, this is done with a little spoon by a third-party or by using one carefully (they also come with cameras and flashlights). You remove the build-up with accuracy, you don't just jam cotton in there and randomly scrape at your ear canal.

> There are two distinct genetically determined types of earwax: the wet type, which is dominant, and the dry type, which is recessive. While East Asians, Southeast Asians and Native Americans are more likely to have the dry type of cerumen (gray and flaky), African and European people are more likely to have the wet type (honey-brown, dark orange to dark-brown and moist).

https://en.wikipedia.org/wiki/Earwax

So, the effectiveness of any tool is going to be wildly different for a 'wet' type vs a 'dry' type. And, the ability to be "impacted" will vary as well.

But when I see people use them in both ears simultaneously, I cringe. Better hope you don't have a seizure or sneeze while doing that.

I got one after I had to have a doctor unblock my ear. I use it once a month or so and haven't had any problems since.

Dietary cholesterol is not bad for you. At all.

Saturated fat is not bad for you. At all.

Sugar is all kinds of bad. The more they look, the worse it gets. Particularly fructose and sucrose. (Glucose is fine.)

Meat still causes heart trouble, but it's not the saturated fat at fault. After all these decades, we still don't know what is. Nobody was looking, because "sat fat!"

Works much better than a qtip in my experience.

Obviously make sure you are alone and in a place where you won't be startled or jostled or otherwise put yourself in a situation where you jam the bobby pin into your ear drum.

The amount of junk that gets built up in your ears is pretty impressive.

the have the perfect shape, to remove the wax,

been using it for years. make sure you brush the Wooden Coffee Stirrers against something like your jeans or shirt, to unsharpen the edges.

The common parroted advice is not to use slow cookers for this because they don't get hot enough to destroy toxins in some bean varieties - this seems to be based on slow cookers not reaching above 80C though, when I'd say most slow cookers get much hotter than this.

> cotton tipped swabs (that’s the generic term for Q-tip)

Pretty sure it's actually "cotton buds". That's what they are called outside America.

This warning always struck me as exaggerated caution, like telling kids to never ever touch a pair of scissors, just to avoid the possible risk of them running with scissors, which has a possible risk of them tripping onto scissors.

The left/right ear differences may have to do with the majority of people being right handed. If you are using a Q-tip on your own ear, you have to use the same sided hand to clean the ear. Thus, you probably do a better job with your right ear than with your left ear, if, like most people, you are right handed.

I wouldn't exactly call it "basically no evidence" as he says in the article, the correlation is very strong and the mechanism seems plausible.

> Disclaimer: I am not a doctor; even if I’m 100% right in my argument and you are 100% convinced by it, you shouldn’t listen to me over actual doctors; it’s a bad habit that might actually kill you.

At least in the U.S., with for-profit medicine, you cannot and should not trust doctors. There is a financial motivation that is misaligned with trying to help you; they (and their employers) have very twisted incentives to try to get you to do procedures that are at best unnecessary and expensive, but at worst potentially damaging to your health.

I've seen and dealt with it enough times in my life, and came to the frustrating conclusion that you really just have to look out for yourself. Don't rely on doctors unless you know them personally.

Not that it's super related to this Q-Tip thing. I just had to take issue with this, because I hear it so often, and it is really just a lazy cover-your-ass line.

Maybe the advice is a white lie—e.g. to protect PPE supply in the case of masks—or maybe it has a certain delicious counter-intuitiveness that makes the speaker feel wise, which means it gets repeated more frequently over time, thus crowding out competing ideas. Or maybe it's an attitude on the part of doctors of "common people can't be trusted to do it correctly," so they default to the standard advice of "don't."