Ear irrigation

Definition

Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline. It is used to treat patients who complain of foreign body or cerumen (ear wax) impaction.

Purpose

The purpose of ear irrigation is to remove earwax that is obstructing the ear canal or to remove a foreign object lodged in the ear canal. Ear irrigation is most commonly performed on those who experience a wax buildup that has impaired hearing and irritated the outer ear canal. Ear irrigation is performed in the emergency department as a first-line treatment for a foreign object in the ear canal, because it is less invasive than using an instrument. If the object is a live insect, oil is inserted into the ear to kill the insect; then, the ear canal is irrigated to remove the dead insect. Some foreign objects may be removed from the ear using irrigation alone, but most require a combination of both irrigation and the use of instruments by the physician.

Precautions

The ear canal should be examined with an otoscope prior to ear irrigation. Ear irrigation is contraindicated if the eardrum is ruptured, because the procedure may force bacteria through the perforation into the inner ear. Ear irrigation is also contraindicated in patients with fever and ear pain , as these symptoms may indicate an inner ear infection . If a foreign object is made of vegetable matter (e.g., a bean or pea), irrigation is contraindicated because the water will cause the object to swell and complicate extraction of the object.

Description

Ear irrigation can be performed using a 50–60-cc syringe (20–30-cc syringe for children). Some nurses prefer to attach a large bore IV (intravenous) catheter (with the needle removed) to the syringe for easier direction of the fluid. Using this method, the fluid is aspirated into the syringe and squirted into the ear canal. Another method uses IV solution and tubing, with a disposable ear irrigation connector that fits onto and over the outer ear. When using this method, the IV is turned on and the fluid flows by gravity into the ear to create the irrigation. When using the IV method, the bag should be about 6 inches (15 cm) or less above the patient's head to create the proper fluid pressure.

After positioning the patient, the earlobe of the affected ear should be held back, and up (back and down for an infant). The tip of the irrigation syringe or catheter should be placed at the entrance to the ear. The tissue of the ear should not be touched. The ear canal should not be occluded, or the solution will not be able to run back out of the ear. Gently aiming the flow of the irrigation solution towards the upper aspect of the external ear canal, the nurse should syringe or run in the IV fluid at a slow, steady rate, allowing the fluid to escape out of the ear canal and into the basin. If using a dental pik apparatus, the lowest setting should be used. Exerting too much pressure can force the foreign object or the wax occlusion deeper into the ear canal. The return fluid should then be checked before the syringe is refilled—or after 100cc of fluid for an adult, and 30cc of fluid for a child. The nurse should investigate whether the wax or foreign object has been flushed from the ear. When the occlusion has been removed, 500cc of irrigation fluid should be used for an adult—100cc for a child, or as ordered by the physician. The procedure should be interrupted if the patient complains of pain or dizziness.

Preparation

The patient should be positioned with his or her head bent slightly forward and tilted toward the unaffected ear. His or her shoulder and neck should be covered with a water-resistant pad and a bath towel. The patient should be given kidney-shaped basin to hold under the affected ear. Children, the elderly, or patients who cannot sit up may be positioned on the back with the head tilted slightly toward the unaffected ear. Again, the shoulder should be covered and/or the pillow with a water resistant pad and a bath towel. If necessary, the nurse should obtain assistance to hold the basin under the ear during the ear irrigation.

The nurse should wash his or her hands and put on gloves. The normal saline or sterile water irrigation solution should be heated. This can be accomplished by placement of the solution bag (bottle) in hot water, or using a microwave. Then, the temperature of the solution should be checked before the irrigation is started. The solution should be body temperature or slightly warmer (98.6–100°F [37-37.8°C]). Cool irrigation solution is more likely to make the patient dizzy. If using an irrigation syringe, the cap should be removed, and the first 60 cc should be drawn into the syringe. If using an IV catheter, the needle should be removed and the plastic catheter attached to the syringe or the IV tubing. All air from the syringe and tubing must be removed. Further, when an ear irrigation kit is used, the pieces should be opened and assembled. The IV tubing must be primed and filled, and the irrigation apparatus should be connected. The patient should have a dry wash cloth on hand in case the irrigation fluid runs toward his or her face or eyes. The patient should be informed before the irrigation begins. The patient should be instructed to speak up if he or she experiences pain or discomfort.

Aftercare

The patient should tilt his or her head toward the affected ear for a few minutes. This will allow excess fluid to run out. The irrigation apparatus should be removed and the patient assisted with drying off. The outer ear should be wiped with cotton balls or cotton swabs. However, the swabs should not be placed into the ear canal. Irrigation fluid should be discarded into a hopper. Disposable equipment and gloves should be placed in a trash bag that can be sealed and discarded. Finally, the nurse should wash his or her hands once the procedure is completed.

Complications

Complications of an ear irrigation are rare, but may include trauma to the external ear canal, external ear infection, pain, nausea, or vertigo. Forceful irrigation with high pressure can rupture the eardrum and force bacteria into the inner ear.

Results

Proper ear irrigation will most often result in the removal of the impacted earwax. If the wax is not washed out with 500cc of irrigation fluid, ear drops containing peroxide will be prescribed by the physician; these are to be used for several days, to soften the earwax before further irrigation. If foreign bodies cannot be removed with ear irrigation, suction or instruments to remove the foreign object may be employed by the physician.

Health care team roles

Ear irrigations are performed by a registered nurse (R.N.) in the health care setting. The patient or family of the patient may be taught, by the physician or nurse, to do ear irrigations in the home setting if a patient has frequent problems with ear wax build-up.

Resources

BOOKS

"Ear Irrigation." In Nurse's Clinical Guide. PA: Springhouse Corporation, 2000.

OTHER

Bemis, Patricia R.N., C.E.N. "Ear, Nose, Throat and Dental Emergencies." Wild Iris Medical Education Online, August 2001. <http://www.nursingceu.com/NCEU/courses/14bemis/>.

"Foreign Body in Ear." Common Simple Emergencies. NCEMI Online, 2001. <http://www.ncemi.org/cse/cse0305.htm>.

Rudy, Susan F., MSN. "What Precautions Are Necessary When Irrigating the Ear Canals." Ask the Expert. Medscape Online, June 2000. <http://www.medscape.com/medscape/Nurses/AskExperts/2000/06/NP-ae24.html>.

"Temperature of Saline Solution for Ear Irrigation: Tips From Other Journals." American Family Physician Online, January 2000. <http://www.aafp.org/afp/20000101/tips/20.html>.

Mary Elizabeth Martelli, R.N., B.S.