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. Consider pretreatment with Cerumenolytic (e.g. Debrox) before procedure
  2. Warm water (Body Temperature)
    1. Prevents Vertigo from caloric stimulation
  3. 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
  4. Lavage apparatus
    1. Ear Bulb syringe or
    2. Syringe (50 to 60 ml) with IV or butterfly tubing (or other disposable catheter tip)

VI. Technique

  1. Prevent the patient from getting wet
    1. Have patient change into gown if possible
    2. Place absorbent towels or pads over a basin (patient or assistant holds in place)
    3. May also use suction catheter lodged in the padding
  2. Retract pinna upward and posteriorly
  3. Use moderate pressure (AVOID forceful irrigation)
  4. Direct fluid to superior canal or other opening in cerumen
  5. Repeat irrigation until most of cerumen is removed
  6. Reevaluate the ear canal for Trauma (including to the Tympanic Membrane)

VII. Efficacy

  1. Effective in 70% of cases

VIII. Complications

  1. Tympanic Membrane Rupture
  2. Ear canal injury
  3. Contact Dermatitis to Cerumen Softening Agents
  4. Otitis Externa
    1. HIgher risk in Diabetes Mellitus
    2. Consider prophylaxis for a few days after Ear Irrigation (if intact Tympanic Membrane)
      1. Prepare a 1:1 mix of acetic acid-Alcohol drops (see Ear Canal Acidification)
      2. Topical Antibiotics drops

IX. References

  1. Warrington (2023) Crit Dec Emerg Med 37(12): 16-7
  2. Malaty (2018) Am Fam Physician 98(8): 525-9 [PubMed]

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