Background: The use of cotton swabs (Q-tips) for ear cleaning is a widespread practice among parents, often perceived as a convenient method for removing earwax in children. However, this habit is associated with various health risks, including ear canal trauma, infections, and tympanic membrane perforation. Objective: This study aimed to assess the prevalence of cotton swab use among parents in the western region of Saudi Arabia, evaluate their awareness of potential health risks, and explore factors influencing ear hygiene practices in children. Methods: A cross-sectional study was conducted between July and August 2024 involving 705 randomly selected parents residing in the western region of Saudi Arabia. Individuals under 18 years or never married were excluded. Data were collected using a validated Arabic-language online questionnaire covering demographics, knowledge, attitudes, and practices regarding cotton swab use. Statistical analysis was conducted using SPSS version 23.0, with chi-square and Fisher’s exact tests applied for categorical data, and significance set at p < 0.05. Results: Among participants, 66.2% were female, and 72% held a university degree. Overall, 28.3% reported using cotton swabs to clean their children’s ears, mainly to remove earwax (30.2%). Despite 72% acknowledging associated risks, only 58.5% had received prior health education, most commonly from ENT specialists. Complications were noted by 13% of respondents, with ear pain being the most frequent (61%). Conclusion: Cotton swab use among parents remains common despite moderate awareness of associated risks. Increased public health education is recommended to encourage safer ear hygiene practices and reduce preventable ear-related complications in children.