Health Canada said Wednesday it will review a coroner's recommendation for stronger warning labels for cotton swabs, after a Montreal man died two days after piercing his eardrum with one.

All cotton swab manufacturers must have a notice on their outer label that warns consumers not to insert the swab into their ear canal, Health Canada said Wednesday in a statement.

In a report released Tuesday, Quebec coroner Dr. Jacques Ramsay suggested including pictograms on cotton swab packaging that showed a small ear with a red X painted over it.

"In light of the Quebec City coroner's report recommending a picture warning on the outer labels, Health Canada will be reviewing this recommendation and will take action, if necessary," agency spokeswoman Carole Saindon said.

Daniel St-Pierre, 43, died last March of meningitis-induced intracranial complications caused by a bacterial infection he developed after accidentally piercing his eardrum with a cotton swab two days earlier.

In his coroner's report, Ramsay said most consumers are not aware that even a single use of a cotton swab can cause fatal consequences, although on Wednesday he said he has only heard of four or five such cases.

"The infection starts in the inner ear, basically millimetres away from the brain. And that's one of the rare but possible complications that the infection could go one step further," Ramsay told CBC News.

Even in cases where cotton swabs do not cause an infection that leads to death, Ramsay said the innocuous-looking sticks can cause a range of problems for people who misuse them.

"If you talk to an ear, nose and throat specialist, they have tons of cases of perforated eardrums and some people with permanent hearing loss and vertigo, dizziness, symptoms like this," he said.

Ramsay suggested people use their pinky fingers instead of cotton swabs to clean the insides of their ears. His recommendation was echoed Wednesday by nose and throat specialist Jack Rothstein, who said people should never put anything "smaller than an elbow" in their ear.

Rothstein said he sees 10 to 15 cases a year of eardrums that have been broken by improper use of cotton swabs or hair pins.

"If a non-professional puts a [cotton swab] into the ear canal, this could accidentally be pushed into the ear drum and cause a hole in the ear drum," he said.

"And in fact, the ear is a self-cleaning organ, it does not require anything to be put into it in order to clean it, except if a professional has to do it in the office."

Health Canada did not indicate when their review of Ramsay's recommendations would be finished.

With files from the Canadian Press