The Awareness Among Parents About Cotton Earbud (Q-tips) Use in Children in the Jazan Region, Saudi Arabia: A Cross-Sectional Study

Abstract

Background and objective The waxy substance secreted in the ear canal of mammals, including humans, is known as ear wax; it is also known by the medical term cerumen. It protects against germs, fungi, and water, helps with cleansing and lubrication, hydrates, and protects the skin of the human ear canal. The purpose of using cotton earbuds (Q-tips) is to clean the ear auricle (external part), relieve itching, and remove any excess water among other things; however, many people have been mistakenly using them for cleaning deeper spots in the ear, leading to some serious complications. Cotton earbud misuse has been documented to be the most common cause of accidental penetrating trauma of the eardrum among children. In this study, we aimed to determine the level of awareness of parents about the use of Q-tips among children and its consequences in the Jazan region, Saudi Arabia. Methods  This was a cross-sectional study involving 391 participants conducted from February 2023 to April 2023 in the Jazan region. While all parents in the Jazan region were eligible to be included in the study, only those who responded to our survey questionnaire were recruited. Since our research focused on parents, participants who were aged less than 18 years and those who had never married were excluded. A validated questionnaire tested for reliability was used in the study. The association between the level of awareness about Q-tips use and the sociodemographic characteristics of the parents was evaluated using the chi-squared test. A p-value ≤0.05 was considered statistically significant. Results Out of the 391 individuals included in the survey, two-thirds (67.5%) were male and 32.5% were female, and most of them were married (89.8%). Regarding the knowledge of cotton bud use among the participants, we found that 12.3% agreed and 34% strongly agreed that cotton buds should be used to clean the ears. Furthermore, 74.9% of the participants knew that cotton buds could cause ear infections, 80.8% knew that cotton buds could cause eardrum perforation, and 79.3% knew that cotton buds could push ear wax deeper into the ear. We found that 152 (57.6%) of the male and 91 (71.7%) of the female participants used cotton buds on their own (p=0.011). Moreover, 176 (66.7%) of the male participants thought that cotton buds can damage their child's ear while 69 (54.3%) of the female participants thought the same (p=0.048). When the participants were asked if they thought that the use of cotton buds caused complications, 155 (58.7%) of the males and 55 (43.3%) of the females said yes (p=0.015). Conclusions The parents in the Jazan region had a relatively good level of knowledge about ear cleaning using cotton buds among children. Nevertheless, we found a poor level of awareness about using cotton buds as the primary tool for cleaning the ears. Of note, 62.7% of the respondents knew that cotton buds could damage the ear, and 55% of the respondents thought that the use of cotton buds causes complications. However, 62.1% of the respondents still reported using it, and 50.1% of the respondents erroneously believed that it is beneficial to clean the ears with cotton buds. Otolaryngologists have always warned the public regarding the use of Q-tips and the complications they can cause. However, people are still ignorant as well as careless about these facts.