II. Indications

III. Contraindications

  1. Tympanic Membrane not intact
    1. Tympanostomy Tubes
    2. Tympanic Membrane Perforation
  2. Prior ear surgery or Radiation Therapy to area
  3. Severe Otitis Externa
  4. Sharp foreign objects in external canal
  5. Vertigo

IV. Precautions: Avoid forceful irrigation

  1. See Precautions in Manual Cerumen Removal
  2. Risk of Tympanic Membrane Rupture
  3. Risk of ossicle Trauma
  4. May further impact cerumen

V. Preparation

  1. Warm water (Body Temperature)
    1. Prevents Vertigo from caloric stimulation
  2. Additives
    1. Acetic Acid
      1. Prevents Pseudomonas overgrowth
      2. Add 1 part 5% acetic acid to 2 parts water
      3. Consider instilling after irrigation
    2. Detergent Effect
      1. Helps separate wax from ear canal
      2. Detergents
        1. Hydrogen Peroxide OR
        2. 1:750 benzalkonium chloride
      3. Dilute irrigant 1:1 with Hydrogen Peroxide
  3. Lavage apparatus
    1. Ear Bulb syringe or
    2. Syringe (20 to 50cc) with IV or butterfly tubing

VI. Technique

  1. Retract pinna upward and posteriorly
  2. Use moderate pressure (AVOID forceful irrigation)
  3. Direct fluid to superior canal or other opening in wax

VII. Efficacy

  1. Effective in 70% of cases

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