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EAR IRRIGATION .pptx
- 1. MRS.SARASWATHY.S,M.Sc(N) ASSOCIATE PROFESSOR INNURSING MEDICAL SURGICAL NURSING
- 2. An earirrigation is the washing of the external auditory canal with a stream of liquid. PURPOSE: To remove the ear wax To remove the foreign bodies To cleanse the ear in case of purulent discharges caused in the middle infection. For antiseptic affect. To apply heat. To evaluate vestibular functions. E.g: by thermal caloric test.
- 3. Cerumen impactionirritates the ear canal with itching, pain, chronic cough, or decreased hearing. Another indication of impactions is an inability to visualize the tympanic membrane due to cerumen when inspection of the tympanic membrane is needed. Ear irrigation can also be used for caloric stimulation. This method is discussed in a different topic.
- 4. There area few contraindications to performing irrigation of the ear including lack of patient consent. These contraindications are a patient's inability to sit upright, a patent tympanostomy tube, a patient who is unwilling or unable to sit still, foreign body present in the ear canal, perforated tympanic membrane, an opening into the mastoid, and severe swimmer's ear (otitis externa). Also, a history of middle ear disease, ear surgery, inner ear problems (especially vertigo), or radiation in the area is an additional reason to choose another method for cerumen dis- impaction.
- 6. Face Shield(universal precautions) To safely perform ear irrigation, one should use an otoscope. You will need your cerumenolytic of choice. The water you will use for irrigation must be warmed before use. You can either use a thirty milliliter to a 60-mm syringe with a 16 or 18 gauge intravenous (IV) catheter attached (with the needle removed) or a pulsating water device (such as a WaterPik) to irrigate the impacted cerumen out of the ear. You will also need an ear irrigation basin or emesis basin to catch the water and pieces of cerumen as it leaves the ear.
- 7. Due tothe availability of syringes and IV catheters when compared to pulsating water devices, the syringe and IV catheter method is more common. A cerumen spoon or alligator forceps can be used to remove loose cerumen pieces following the ear irrigation procedure.
- 9. An assistantcan help by holding traction on the pinna. This straightens the ear canal, allowing for more efficient and effective cerumen removal.
- 10. Some providersmay choose to soften the wax before irrigation. Multiple agents may be used including mineral oil, 1% sodium docusate solutions, and carbamyl peroxide solutions. Warm the solutions and the water that will be used during the irrigation to near body temperature to prevent dizziness..
- 11. Cold solutionsput in the ear are likely to have an uncomfortable effect on the patient, and it may make them dizzy or nauseous If using an IV catheter and syringe, ensure the needle is removed from the IV catheter.
- 12. Ask thepatient to sit upright. Place your cerumenolytic of choice in the external auditory canal and leave it in the ear for fifteen to thirty minutes before initiating irrigation. Draw up the warm water into the syringe and attach the IV catheter to the end of the syringe. Place the IV catheter into the external ear canal, no further than the cartilage/bone junction. The cartilaginous portion usually makes up the outer two-thirds of the external auditory canal.
- 13. Hold theemesis or ear irrigation basin tightly to the skin below the ear, in an attempt to catch the water during irrigation. This will help keep the patient from getting wet. Direct the IV catheter superiorly and posteriorly in the ear canal so that the water will separate the cerumen from the tympanic membrane. Do not direct the water stream directly at the tympanic membrane, because this can cause perforation of the tympanic membrane.
- 14. Following irrigation,you can remove any loose pieces of wax with a cerumen scoop or alligator forceps, being careful not to damage the external auditory canal and the tympanic membrane. To dry the remaining moisture in the external auditory canal, apply several drops of isopropanol. This step is especially contraindicated if the tympanic membrane is ruptured.
- 17. Topical steroidcontaining suspension drops, such as ciprofloxacin/hydrocortisone drops, may be soothing to the external auditory canal. Some providers will prescribe these for a few days following the ear irrigation procedure. Many providers prescribe antibiotic drops (example: fluoroquinolones) to patients at high risk for severe infections, such as diabetic patients. These drops are usually prescribed for several days following the ear irrigation procedure to prevent the complication of otitis externa.
- 18. Before yourdoctor performs an ear irrigation, they will want to look inside your ear to ensure that your symptoms are the result of excess wax buildup or foreign materials and not something more serious. Your doctor may diagnose excess earwax by inserting an instrument called an otoscope into the opening of your ear. The otoscope shines a light into your ear and magnifies the image.
- 19. If waxbuildup is the issue, your doctor will perform the irrigation in their office using a syringe-like tool. This tool will be used to insert water or a water and saline mixture into the ear to flush out the wax. You may feel slight discomfort from the water in your ear or from holding your ear in place.
- 20. For at-homeirrigation, you will need to purchase the items to safely clean wax from your ears. The most common method is to use a dropper to insert baby oil, mineral oil, or specialized medication into the ear to soften the wax.
- 21. Put severaldrops in your ear two to three times daily over a period of a few days. Once the wax is softened, use the syringe filled with water (room temperature or slightly warmer) or a water and saline mixture to flush out the wax.
- 22. Irrigation ofthe ear can lead to otitis externa, vertigo, perforation of the tympanic membrane, and middle ear damage if the tympanic membrane is perforated. These complications are less common with the syringe and IV catheter technique than when compared to the pulsating water device technique. Using a cerumen spoon to remove remaining wax can cause damage to the skin covering the external auditory canal.
- 23. Symptoms ofcomplications include sudden pain, ringing in the ears, loss of the ability to hear, nausea, and dizziness. If a patient experiences any of these symptoms, the provider should immediately stop and examine the ear canal and tympanic membrane with an otoscope. If the tympanic membrane is ruptured, prescribe the patient oral antibiotics to treat otitis media prophylactically. Refer the patient to an otolaryngologist for specialty consult.