Procedures on Ear Irrigation

Clearing the ear canal of cerumen or ear wax using normal saline or a medicated ear wash solution is usually performed by a licensed nurse in an emergency room or in the doctor's office.  This procedure is indicated for individuals who have impacted cerumen with hearing loss or ear canal irritation due to accumulation of cerumen.

1. Do not perform procedure unless you are a clinically trained and certified RN, LVN or other health care professional.


2. Introduce yourself and identify your professional role.


3. Gather brief history, verify onset of symptoms and conditions of ear impaction.


4. Verify no contraindications exist:
   
   
   
   
   • Vegetable matter foreign object--pea, bean, etc.
   
   
   • NO fever, pain in ear.  This is indication of an inner ear infection, irrigation of cerumen is contraindicated.
   
   
   • Punctured eardrum.  Irrigation can cause inner ear infection.
   
   
   
   


5. Explain to patient about the procedure.


6. Gather all necessary equipment.
   
   
   
   
   • Chux
   
   
   • Otoscope
   
   
   • Normal Saline or prescribed medicated ear irrigation solution, preheated to 98.6
   
   
   • Irrigation bulb syringe
   
   
   • Emesis basin
   
   
   • Cotton tipped applicator
   
   
   • Cerumen ear cleaning tool
   
   
   
   


7. Wash hands before proceeding


8. Explain to patient what you are doing every step of the procedure.


9. Gently between thumb and index finger, firmly pull top of the ear up and back to open ear canal.


10. Using otoscope, view inside of ear, verify there is not object inside ear and the degree of cerumen impaction.


11. Have patient hold the emesis basin under the ear, secure against the neck.


12. Fill irrigation bulb syringe with saline or ear irrigation solution.


13. Pull top of the ear up and back. 


14. Have patient tilt heat away from you slightly still holding emesis basin against neck under the ear to be flushed.


15. Squeeze fluid in an upward direction to the upper part of the ear canal to flow behind the mass of cerumen. 


16. Allow the solution to flow outward unobstructed.  Note cerumen or other matter flowing with the liquid. Repeat 15-16.


17. Using a cerumen ear removal tool, carefully remove remaining cerumen careful to not push it against the tympanic membrane. Repeat 15-16.


18. Using the otoscope, verify ear canal is clear of debris.


19. Wash hands. Clean ear with cotton balls.


20. Allow the patient to say down on treated side with cotton balls on ear to catch drainage.


21. Notate patient response, appearance of drainage and condition of ear.