Preparation

• Gloves
• Goggles
• Waterproof pad
• Otoscope
• Irrigating solution (water or sterile saline)
• Irrigating syringe
  • 60mL luer lock syringe and 16-gauge IV catheter
• Emesis basin
• Cotton-tipped applicator
• Cotton balls
• Waterproof pad

Procedure Steps

Step 1: Inspect aural canal and tympanic membrane

Do not perform irrigation in the presence of tympanic perforation, tubes in the ear, or an active ear infection.

Determine the purpose of the irrigation and rule out tympanic membrane rupture.

Insert the otoscope into the aural canal to observe the tympanic membrane, to look for foreign body, or cerumen impaction.

Step 2: Explain the procedure to the patient

Obtain informed patient consent. Ensure to advise the patient that this procedure can make them feel slightly dizzy and if they were to experience this, they must let you know immediately and the procedure is to be stopped. Explanation facilitates cooperation and provides reassurance for the patient.

Step 3: Set up equipment, wash hands, position patient

This procedure is non-sterile.

Have the patient sit up or lie with the head tilted toward the side of the affected ear. Gravity facilitates the irrigating solution to flow from the ear to the basin. Have the patient support a basin under the ear to receive the irrigating solution.

Protect the patient with a moisture proof pad.

Step 4: Clean the pinna and meatus at aural canal

Use the irrigating solution and cotton tipped applicator to clean as necessary. Materials lodged on the pinna and the meatus may be washed into the ear.

Step 5: Fill the irrigating syringe with solution

Warm irrigating solution to 37°C (98.6ºF) to prevent discomfort and dizziness.

Step 6: Straighten the aural canal

Straightening the aural canal aids in allowing solution to reach all areas easily.

Adults: pull the pinna up and back

Children: pull the pinna down and back

Step 7: Irrigate with steady, slow stream

Place the tip of the catheter at the opening of the canal, ensuring not to insert it past the lateral one third of the ear canal.  Do not occlude the auditory canal with the irrigating nozzle.

Direct a steady, slow stream of solution against the roof of the aural canal to reduce risk of injury to the tympanic membrane. Use only sufficient force to remove secretions. Forceful instillation of the solution can rupture the tympanic membrane.

Allow solution to flow out freely.  Continuous in and out flow of the irrigating solution helps prevent pressure in the canal. Continue irrigating the canal until the cerumen is removed or the patient expresses dizziness or discomfort.

Step 8: Absorb excess solution

Place a cotton ball loosely in the auditory meatus and have the patient tilt their head toward or lie on the side of the affected ear on a towel or absorbent pad to absorb residual moisture.

Step 9: Reassess aural canal

Insert the otoscope into the aural canal to assess the tympanic membrane for resolution of the condition.

Video

Aftercare

Advise the patient to monitor for side effects:

• Vertigo
• Difficulty hearing
• Signs of ear infection such as pain, fever, or drainage

Patient Education

Follow-up

Advise the patient to follow-up if the symptoms recur.

Key Takeaways

• Aural canal irrigation should not take place if there is a known ear infection, tubes present in the tympanic membrane, or suspicion of a tympanic membrane perforation.
• Forceful installation of the irrigating solution can rupture the tympanic membrane.