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Warm Water Ear Lavage
Aka: Warm Water Ear Lavage, Ear Lavage, Ear Irrigation
- Indications
- Cerumen Impaction
- Contraindications
- Tympanic Membrane not intact
- Tympanostomy Tubes
- Tympanic Membrane Perforation
- Prior ear surgery or Radiation Therapy to area
- Severe Otitis Externa
- Sharp foreign objects in external canal
- Vertigo
- Precautions: Avoid forceful irrigation
- See Precautions in Manual Cerumen Removal
- Risk of Tympanic Membrane Rupture
- Risk of ossicle Trauma
- May further impact cerumen
- Preparation
- 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
- Lavage apparatus
- Ear Bulb syringe or
- Syringe (20 to 50cc) with IV or butterfly tubing
- Technique
- Retract pinna upward and posteriorly
- Use moderate pressure (AVOID forceful irrigation)
- Direct fluid to superior canal or other opening in wax
- Efficacy
- Effective in 70% of cases
- References
- Malaty (2018) Am Fam Physician 98(8): 525-9 [PubMed]