PROCEDURE FOR AURAL TOILET

PROCEDURE NO: KEY WORDS Aural Toilet - Ear CRITERIA FOR PRACTICE This procedure is only to be carried out in primary care by a doctor, or nurse who has received the appropriate training. AREAS FOR USE General Practice, appropriate clinic and patients own home. AIM Aural toilet is used to clear the external auditory meatus of debris, discharge, soft wax or excess fluid following ear irrigation. OBJECTIVES Correctly treat otitis externa. Improve conduction of sound to the tympanic membrane. Remove debris to allow examination of the external auditory meatus and the tympanic membrane. Dry the meatus following irrigation to prevent risk of infection. EQUIPMENT Headlight or head mirror and lamp. Jobson Horne probe. Auriscope with halogen light source. Good quality 100% cotton wool cut into squares [postage stamp size] PRINCIPLES FOR PRACTICE

N82

1. Explain procedure to patient and gain verbal consent as per PCT Policy and
document. 2. Examine the ear, working from the pinna to the tympanic membrane. 3. Remove debris etc.. from the meatus by dry mopping. Use a Jobson Horne probe and a small piece of cotton wool, applied to its serrated end. Using direct vision sat at the same level as the patient, straighten the meatus by pulling the pinna gently but firmly backwards and upwards; clean the meatus with a gentle rotary action of the probe. 4. Replace the cotton wool as soon as it becomes soiled.
N82 Aural Toilet Ratified October 2005 Page 1 of 2

5. Re-examine the meatus, using the auriscope, intermittently during cleaning to check for any debris/discharge/crusts, which remain in the meatus at awkward angles. 6. If an infection is present treatment should follow patient group directives and referral guidelines or as dictated by the result of a swab culture and sensitivities following the failure of first line management. If the patient has repeated problems with the ear, an ENT surgeon should review the patient. 7. Give advice regarding ear care and any relevant information. 8. Document what was seen in both ears, the procedure carried out, the condition of the tympanic membrane and external auditory meatus and treatment given. Findings should be documented following the NMC guidelines on record keeping and accountability. If any abnormality is found a referral should be made to the ENT outpatient department following local policy. 9. Decontamination as per PCT Policy. IMPORTANT POINTS Patients who have mastoid cavities should be followed up in the ENT department unless the nurse or doctor has been specifically trained in this area. The frequency of cleaning required by the cavity will depend on the individual patient. If the cavity gets repeatedly infected the patient should be referred for further ENT opinion. ADDITIONAL INFORMATION AVAILABLE FROM The Guidance document in Ear Care available on the Primary Ear Care Centre website: www.earcarecentre.com and at www.entnursing.com Rodgers R. [2002] Continued education: preventative ear care. Nursing in Practice. March: 71-73. UKCC [1998] Guidelines for records and record keeping. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. London. NMC [2002]. Code of Professional conduct. Nursing and Midwifery Council. London.

Date Recommended at Nursing Procedures Working Group: Date Ratified at Clinical Governance Committee: Date of Review: Author: ACKNOWLEDGEMENTS:

7 July 2005 12 October 2005 2 years October 2007 Primary Ear Care Centre

This has been adapted from the Guidance Document in Ear Care produced by the Action on ENTSteering Board endorsed by the Royal College of General Practitioners, the Royal College of Nursing, The Primary Ear Care Centre and the Medical Devices Agency. Headlight or head mirror and lamp. Jobson Horne probe. Auriscope with halogen light source. Good quality 100% cotton wool cut into squares [postage stamp size]

N82 Aural Toilet Ratified October 2005

Page 2 of 2