Ear Irrigation

Introduction:
The ear naturally secretes wax to protect and lubricate the ear as well as to keep
debris out and hinder bacterial growth. Under normal conditions, the body
keeps the amount of earwax in the ears under control. Cerumen accumulation
is normal and does not require treatment unless it is symptomatic. Too much
earwax or hardened earwax can cause a blockage in the ear, resulting in
earaches, ringing in the ears, or temporary hearing loss. Wax is usually
described as impacted if it obscures visualization of the tympanic membrane
and is associated with symptoms.

Some common terms associated with ear irrigation:

Cerumen. Otherwise known as "earwax," cerumcn is a normal substance
found in the ear canal.

Cerumen impaction. An impaction is the result of buildup that prevents

assessment of the ear canal or causes other symptoms.

Cerumen obstruction. This is a buildup of cerumen that totally blocks

the ear canal.

Definition of ear irrigation:

Ear irrigation is a routine procedure used to remove excess earwax, or

cerumen, and foreign materials from the ear. Ear wax irrigation can be done by
doctor or at home using an irrigation kit that includes a bulb syringe.

Common symptoms from too much earwax or hardened earwax

include:

1. Temporary or conductive hearing loss,

2. Ear pain & Itching.
3. Dizziness, tinnitus or reflex cough.
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Indications for ear irrigation:
• Clean the external auditory canal.
• Soften and remove impacted ear wax (cerumen).
• Dislodge foreign bodies.
• Administer antiseptics or medication.
Contraindications for ear irrigation:
1. Presence of foreign matter that swells in the ear. The foreign
matter may be peas, corn, bcans,... etc. These foreign matters
vvm increase in size as they come in contact with water.

2. The punctured eardrum. Irrigation will cause additional

middle ear infection and can cany debris or discharge to the
middle ear from the external auditory canal.

3. A continued bulge in the eardrum indicates possible pus or

fluid in the middle ear.

Risks of ear irrigation:

Ear infection: An Otitis external is a common complication. This is an
inflammation of the ear canal that could be caused by infection. It can be
painful. Another potential complication is otitis media, which is inflammation
of the middle ear that could also be caused by infection. Ear infections are one
of the most common complications of ear irrigations.

1. Perforated ear drum: Perforated eardrums are another potential

complication of ear irrigation. In some cases, ear irrigation will
press against the wax and make it more compacted. This makes

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 it harder to remove and may put more pressure on the eardrum,
increasing risk of perforation. In some cases, fluid becomes
trapped in the ear canal and causes an increase in pressure that
can rupture the eardrum.

In rare cases, additional complications can occur: These include:

1. Vertigo, which is the sensation of the room spinning in circles

around and loss of balance, (typically temporary).
2. Deafness, which can be temporary or permanent.

Common side effects of ear irrigation include:

• Temporary dizziness,

• Ear canal discomfort or pain,

• Tinnitus, or

• Ringing in the ears.

Precautions to safely syHnge ear wax:

I. Patients should be educated about the ear's self-cleaning mechanism

and discouraged from using anything to remove wax from the
ear canal.
2. Patients should first be encouraged to use eardrops to soften wax
and facilitate self-cleaning for symptomatic wax accumulation.

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3. Irrigation, or ear syringing, should be performed only after taking
a full history, doing an ear examination and explaining the
potential complications to the patient.

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 4. Gentle irrigation of the ear canal can be performed with a large
syringe (20 ml with rounded nozzle) and warm water.

5. The tip of the syringe should not pass the outer one-third ofthe ear
canal (approximately 8 mm).

6. Cease immediately if the patient experiences pain or if bleeding

occurs.

7. Mechanical jet irrigators are available and some allow better

control of water pressure and direction of spray

8. After syringing, examine the external canal and Ompanic

membrane. Document the patient's consent, procedure, and preand
post-examination findings.

Types of solution used:

1. Natural oils: Olive oil, baby oil, and mineral oil are all commonly
used as an alternative remedy for medical ear irrigation. Put a few
drops of oil in the affected ear canal, which will soften the wax.
These oils are typically nonirritating. After the oil has soaked for a
few minutes, the patient can lie with the affected ear face down on
a soft cloth to let it drain out.

2. Salt water: Salt water can also be used as eardrops to soften and
remove earwax. Let the salt water sit in the ear for three to five
minutes before placing the ear facedown to let the saline solution
drain. Clean the ear and any wax in the outer ear canal with a soft
cloth.

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3. Mixtures and solutions: Both hydrogen peroxide and a mixture of
vinegar and rubbing alcohol are alternative remedies that can

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 be used to remove earwax. They can soften earwax. They're
generally regarded as safe and effective, as long as the eardrum
is fully intact, though some patients may find them irritating.

Preparation
a. Equipment.
• Prescribed irrigating solution (warmed to 370C)
• Irrigation set (container and irrigating or bulb syringe)
• Waterproof pad
• Emesis basin
• Cotton-tipped applicators
• Disposable gloves
• Cotton balls
• Medication Administration Record (MAR)
• Hear Earwax Remover Kit, Includes: Ear Drops to Soften Ear
Wax, Wash Basin, 3 Soft Disposable Tips, Irrigation
System to Clean Outer Ear

b. Solutions:
Tap water.

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Normal saline.
Hydrogen peroxide and water.

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 Bicarbonate of soda and water.
Prescribed medication—mix solution, if required.
Oil (used to make the foreign matter slippery and easy to
expel).

Alcohol (used for vegetable matter, shrinks matter, and the

matter is easily expelled).

Pre Procedure:
1- OTO SCOPE
The otoscope is an instrument used to view the external auditory canal. The
speculum is an attachment to the otoscope to inspect inside the external ear
canal.

2. Warm and test the solution.

1. Place the container of warm solution in a pan of warm water solution
(a little warmer than the normal body temperature).

2. Test the temperature of the solution by allowing a small amount of

the fluid to nin on the inner aspect of the wrist.

NOTE: Cold solutions are uncomfortable and may cause dizziness or nausea
as a result of stimulation of the equilibrium sensors in the semicircular canals.
3. Insert the Oto scope speculum into the external ear canal.
1. Assist the patient to assume the position, which allows a good view.
2. Tip the patient's head toward the opposite shoulder or ear to be
irrigated.

3. Straighten the external ear canal by gently pulling the auricle upward
and backward

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 Figure 3. Straightening the external ear canal

4. Turn on the oto scope light and insert the speculum just inside the
opening of the ear

Figure 4. Speculum inserted.

4. Observe the external ear canal and the tympanic membrane for
abnormalities.

• Check the external ear canal for redness, swelling, drainage, or foreign
bodies.

• Check the tympanic membrane for bulging, perforation, and color

change.

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 • Normally, a blue, yellow, amber, red, or pink eardrum indicates disease
of infection.
NOTE: eardrum is normally shiny and pearly. A hole or tear in the ear
should be reported to the supervisor. Straighten auditory canal by
pulling the inna u and back.
Rationale
Procedure:
To identify patient and prevent
Action medication errors.
Gather equipment; Check the patient•s medication
char for allergies. To prevent the spread of microor anisms.
This is the most reliable method.
Perform hand hygiene and wear gloves.

Check name and identification number on the Exp non ac •tates cooperation an
patient•s identification band and ask the patient to reassures tient
state his name Explain procedure to patient

Keep patient privacy

Place the patient in suitable position

(patient sit up or lie with head tilted
toward side of the affected ear).
Place a waterproof pad and ask the patient to
support basin under the ear to receive the imgating
solution
Clean Pinna and meatus of auditory canal with
moistened cotton-tipped applicators dipped in
warm tap water or the irrigating solution Fill bulb
syringe with warm solution. If an irrigating
container is used, prime the tubing.
To Protect the patient and bed
Priming the tubing allows air to escape
from the tubing. Air forced into the ear
canal is noisy and therefore unpleasant
for the patient. Allows solution to reach
all areas of the canal easil

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Direct a stea y, s ow stream o so ution against the Prevent Injury to t e tympanic
roof of the auditory canal using only enough membrane. Continuous in-and-out flow
force to remove secretions. of the irrigating solution helps to

(note) Do not occlude the auditory canal with the

irrigating nozzle. Use no more than 500cc of

irrigatin revent pressure in the canal.

solution unless ordered.
When irrigation is complete, place a cotton ball To absorb excess fluid and gravity
loosely in auditory meatus and have patient lie allows the solution in the canal to
on side of affected ear on a towel or ad escape from the ear.

Remove gloves, assist patient to a comfortable This ensures patient comfort.

osition
Perform hand hygiene. To prevent the spread of
microorganisms.
Document the administration of the irrigation. To ensure patient safety.

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Evaluate the patient's response to the procedure. The patient needs to be evaluated for
Return in 10 to 15 minutes and remove cotton therapeutic and adverse effects from the
ball and assess draina e. medication.

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Post procedure: REPORT AND RECORD PROCEDURE

• Date / Time of irrigation.

• Type and amount of solution used.

• Nature of return of flow.

Referrals to an ENT specialist should be made in the following

situations:

• Pain or bleeding on syringing

• Failure to remove cerumen after multiple attempts of syringing,

preceded by wax-softening drops

• Persistence of symptoms despite successful removal of cerumen.

• Chronic cerumen impaction.

• perforated tympanic membrane prior ear surgery cerumen

impaction in the only or better hearing ear.

• Abnormal tissue in the ear canal.

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 Ear Irrigation
Student name: Date:
Action Allotted Done Done Not
de com tend Incom ten done
Preparation:-My self
Check the patient's 1
medication chart for
aller •es.
wash hands 1
put on clean gloves
Preparing equipment:
a. Equipment. 1
• Prescribed irrigating
solution (warmed to 370 C)
•Irrigation set (container
and irrigating or bulb
syringe)
• Waterproof pad
• Emesis basin
• Cotton-tipped
applicators
• Disposable gloves
• Cotton balls
Medication
Administration Record

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 b. Solutions:
• Tap water.
Normal saline.

• Hydrogen peroxide and

water.

• Bicarbonate of soda and

water.

Prescribed medication—

mix solution, if required.

• Oil (used to make the

foreign matter slippery
and easy to expel).

• Alcohol (used for

vegetable, shrinks
matter, and the matter is
easily expelled).
Action Allotted Done Not
incom et done
Preparation:-Patient & environment
Identify the patient and ask 1 for his
name

Explain procedure to patient 1 & take

consent.
Keep patient privacy 1
Place the patient in suitable 1
position (patient sit up or lie with
head tilted toward side of the
affected ear).

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Place a waterproof pad and 1 ask the
patient to support basin under the ear
to receive the irrigating solution

Procedure
Clean pinna and meatus of
auditory canal with
moistened cotton-tipped
applicators dipped in warm
tap water or the irrigating
solution

Fill bulb syringe with warm 1

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Student signature: Instructor signature:

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