Instilling Medications into the Ear

• To treat inflammation and infection and soften cerumen for easy removal.

• Solution must be at room temperature to avoid vertigo or nausea.
• Do not force solution into ear.
• Do not occlude ear canal with dropper; pressure can rise during instillation causing injury to ear drum.

Special Considerations

• Pediatric patients may require a second person (preferably a caretaker) to assist by holding the child in a position as to avoid causing damage to the ear during administration of ear drops.

Relevant Nursing Diagnoses

• Possible disturbed sensory perception (hearing) related to infection or disease process

• Patient states there is no discomfort or pain during procedure
• Patient reports that pain is relieved or eliminated
• Affected ear shows no evidence of wax buildup, redness, swelling, or drainage
• Patient shows improvement in hearing acuity

• Medication Administration Record (MAR) (See Procedure 5.1. Administering Oral Medications)
• Medication to be administered
• Clean gloves
• Small basin of warm water
• Soap
• Washcloth
• Small, dry towel

• Review physician's order for correct drug name, number of drops to instill, time of administration, and ear (right, A.D.; left A.S.; both A.U.). Compare the label on the medication container with the MAR, and check the expiration.
• Ensures drug will be administered accurately and safely.
• Wash hands, observe appropriate infection control technique, and organize the patient's supplies at bedside.
• Reduces transmission of microorganisms. Ensures an efficient, methodical procedure.
• Check patient's identification by asking patient's name and checking it against ID bracelet. Explain procedure and purpose of medication, and close room curtain or door for patient privacy.
• Ensures that the right patient receives the right medication. Decreases anxiety, and promotes patient cooperation.
• Don gloves and wash ear if excess wax or drainage is observed.
• Reduces the risk for exposure to ear secretions. Cerumen and drainage can harbor microorganisms and inhibit the distribution of medication.
• Position patient in a side-lying, sitting, or high Fowler's position with affected ear facing up (if in a sitting position, patient will have to tilt head toward the opposite side).
• Helps to channel medication into ear canal.
• Gently pull the auricle of the ear up and back using the nondominant hand (in children younger than 3 years old, pull the auricle down and back).
• This technique straightens the ear canal for proper channeling of medication.

  See Fig. 5.5A (1) Method for Instilling Ear Medications in an Adult

  See Fig. 5.5A (2) Method for Instilling Ear Medications in a Child

• Instill drops as ordered holding the dropper about ½ inch above ear canal.
• Accidental injury of eardrum is prevented; medication is delivered; and contamination of remaining solution in bottle is reduced.
• Request that patient remain in position for 5–10 minutes. Use gentle massage or pressure to tragus of ear.
• Allows complete distribution and absorption. Helps to move medication toward the inside of ear.
• Remove gloves, dispose of dirty supplies in the appropriate receptacle, and wash hands.
• Maintains a neat and clean environment for the patient. Reduces transmission of microorganisms to others.

Evaluation and Follow-Up Activities

• Assess patient's comfort level during procedure
• Assess amount, color, character, and odor of drainage if indicated
• Assess patient's pain level using a pain scale; determine if pain medication is indicated

Key Points for Reporting and Recording

• Medication name and time administered.
• Patient's tolerance to procedure.
• Amount, color, character, and odor of drainage if indicated.
• Swelling or redness in ear canal.
• Type of test used to assess patient's auditory acuity.
• Irrigation solution used.