section name header

Information

Editors

EBMG

Irrigation of the External Auditory Canal

Essentials

  • Before irrigation the ear should be examined.
  • Find out if there is a known perforation of the tympanic membrane. If there is, and the ear is dry, irrigation causes a risk of otitis media.
  • After irrigation, the external auditory canal should be checked, cleaned if necessary and dried by suction.

Indications

  • Infections
  • Foreign body extraction
    • It is often more practical to remove a solid foreign body by forceps, ear hook or suction than irrigation.
  • Removal of earwax Ear Wax
    • In association with ear symptoms, when the earwax prevents assessment and cannot be easily removed by other means
    • Removal of the earwax is not indicated if the patient is asymptomatic and the ear can be examined.
    • Earwax can most often easily be removed without irrigation, by suction, cotton swab or forceps.
    • Irrigation of the external auditory canal softens the earwax effectively and facilitates its removal but is rarely sufficient to remove it.

Procedure

  • Irrigation fluid
    • The irrigation fluid must be at body temperature.
      • Otherwise, irrigation will cause a caloric reaction in the vestibular organ in the inner ear, leading to rotatory vertigo, nystagmus and sometimes nausea.
    • Physiological saline is the safest choice; sterile water can also be used.
    • When irrigation is done because of an infection, an ethanol and saline rinse (50% ethanol - 50% saline) can also be used if the tympanic membrane is known to be intact.
      • Ethanol in the middle ear will cause burning and may cause facial nerve or inner ear dysfunction.
  • Irrigation equipment
    • Irrigation tip (or 16-18G i.v. cannula), syringe (max. 20 ml), kidney bowl, approx. 2-mm suction tip
  • Performance
    • Ask the patient or an assistant to hold a kidney bowl underneath the ear.
    • Support the irrigation tip against the outer orifice of the external auditory canal, and direct the fluid obliquely towards the back wall of the auditory canal.
    • Introduce the irrigation fluid slowly into the auditory canal.
      • Do not irrigate against pressure.
  • Inspection of the external auditory canal after rinsing
    • Use suction to remove any moisture remaining in the auditory canal especially if the indication is infection.
    • Use suction, forceps or the like to remove any material remaining in the auditory canal after rinsing. Check the ear.
    • Neglect of subsequent cleaning or removal of moisture will create favourable conditions for inflammation in the external auditory canal.
    • When the indication for irrigation is a plug of earwax and there is no reason to suspect anything else abnormal, a nurse trained for irrigation can perform the irrigation. After the irrigation, cotton wool is placed at the mouth of the external auditory canal and the patient is instructed to lie down with the irrigated side down (towel underneath).