II. Indications
III. Contraindications
- Tympanic Membrane not intact
- Prior ear surgery or Radiation Therapy to area
- Severe Otitis Externa
- Sharp foreign objects in external canal
- Vertigo
IV. Precautions: Avoid forceful irrigation
- See Precautions in Manual Cerumen Removal
- Risk of Tympanic Membrane Rupture
- Risk of ossicle Trauma
- May further impact cerumen
V. Preparation
- Consider pretreatment with Cerumenolytic (e.g. Debrox) before procedure
- Warm water (Body Temperature)
- Prevents Vertigo from caloric stimulation
- Additives
- Acetic Acid
- Prevents Pseudomonas overgrowth
- Add 1 part 5% acetic acid to 2 parts water
- Consider instilling after irrigation
- Detergent Effect
- Helps separate wax from ear canal
- Detergents
- Hydrogen Peroxide OR
- 1:750 benzalkonium chloride
- Dilute irrigant 1:1 with Hydrogen Peroxide
- Acetic Acid
- Lavage apparatus
- Ear Bulb syringe or
- Syringe (50 to 60 ml) with IV or butterfly tubing (or other disposable catheter tip)
VI. Technique
- Prevent the patient from getting wet
- Have patient change into gown if possible
- Place absorbent towels or pads over a basin (patient or assistant holds in place)
- May also use suction catheter lodged in the padding
- Retract pinna upward and posteriorly
- Use moderate pressure (AVOID forceful irrigation)
- Direct fluid to superior canal or other opening in cerumen
- Repeat irrigation until most of cerumen is removed
- Reevaluate the ear canal for Trauma (including to the Tympanic Membrane)
VII. Efficacy
- Effective in 70% of cases
VIII. Complications
- Tympanic Membrane Rupture
- Ear canal injury
- Contact Dermatitis to Cerumen Softening Agents
-
Otitis Externa
- HIgher risk in Diabetes Mellitus
- Consider prophylaxis for a few days after Ear Irrigation (if intact Tympanic Membrane)
- Prepare a 1:1 mix of acetic acid-Alcohol drops (see Ear Canal Acidification)
- Topical Antibiotics drops
IX. References
- Warrington (2023) Crit Dec Emerg Med 37(12): 16-7
- Malaty (2018) Am Fam Physician 98(8): 525-9 [PubMed]