NAME OF THE PROCEDURE: EAR

IRRIGATION
DEFINITION:
An ear irrigation is the washing of the external auditory canal with a
stream of liquid.

PURPOSES:
• To remove the ear wax
• To remove the foreign bodies
• To cleanse the ear in case of purulent discharge caused by the
middle ear infection.
• For antiseptic effect
• To apply heat
• To evaluate vestibular functions (e.g. bithermal caloric test)

SOLUTIONS USED:
• Boric acid 2-4%
• Sodium bicarbonate solution 1%
• Normal saline
• Hydrogen peroxide 2%
• Sterile water

INDICATIONS:
• History of mucous discharge
• Perforations
• Previous ear surgery
• Patient with cleft palate
 • History of middle ear infection
• Has evidence of otitis externa

CONTRAINDICATIONS:
• Tinnitus
• Healed perforation
• Dizziness

SCIENTIFIC PRINCIPLES:
The employer must ensure the following:
• That all staff has access to a policy on ear care.
• Appropriate training is available to staff in order to carry out these
procedures.
• All staff who carry out ear irrigation need to be competent and
accountable for what they do and attend theoretical and practical
training in ear care which includes recognition of ear problems.
• To have a system in place to ensure the availability of safe and
appropriate equipment. Equipment needs annual maintenance
checks.
• Staff need to ensure the safe use of equipment provided according
to the policy.

PREPARATION OF THE UNIT:

• Explain the procedure to the patient to win his confidence and
cooperation.
• Unless contraindicated make the patient to sit on a chair with a
back support.
• Leaning against the back of the chair.
 • If the patient condition does not allow for a sitting position have the
patient lying on his back with the head turned slightly to the sight to
be irrigated.
• Place the mackintosh and towel under the head to protect the
bedding and he garments.
• Place the kidney tray under the ear to be irrigated. Ask the patient
to adjust the position of the kidney tray against the neck to receive
the return flow.
• Arrange to provide enough light for the procedure.
• Arrange the articles conveniently in the patient’s unit.
• If the patient is a child or uncooperative, restrict the movements.

PREPROCEDURE ASSESSMENT OF THE

PATIENT:
• Check the name, bed name and other identification of the patient.
• Check the diagnosis and purpose of the ear irrigation.
• Check the doctor’s orders and the specific instructions regarding the
type of solutions to be used and the movement of the patient.
• Assess the patient’s abilities and limitations.
• Assess the patient mental state to follow the instructions.
• Ascertain whether the impaction is due to hygroscopic substance
which attracts and observes moisture in such case, the ear irrigation
should not be carried out because the substance will observe, water
and swell and produce intense pain.
• Examine the ear for any perforation of the tympanic membrane by
using an otoscope.
• Check whether one or both ears are to be irrigated.
• Check the articles available in the patient’s unit.
PREPARATION OF THE ARTICLES:

S. NO. ARTICLES RATIONALE

1. Prescribed sterile To instill into the ear after the ear
irrigation solution irrigation
2. Irrigation set To insert water or a water and a saline
mixture into the ear to flush out the wax
3. Waterproof pad
4. Emesis basin To receive the waste
5. Cotton tipped To clean the external auditory canal an to
applicators remove any discharge
6. Clean gloves To handle sterile supplies
7. Cotton balls

8. Spot light and To visualize the ear cavity

head mirror
9 Sterile gauze To plug the ear at the end of the
piece procedure to absorb the infection left in
the auditory canal
10. Sterile jug with
extra fluid

STEPS OF THE PROCEDURE:

S.NO. NURSING ACTION RATIONALE

1. Explain the procedure to the patient Explanation facilitates
and inform him how he has to cooperation and provides
cooperate reassurance
2. Bring equipment to the patient’s Provides for an organized
bedside. Check the physicians order, approach to the task
protect the patient and bedlinen with
a moisture proof pad
3. Wash hands Prevents spread of
microorganisms
4. Have the patient sit up or lie with the Gravity causes the irrigating
head tilt onward the side of the solution to flow from the ear
affected ear. Have the patient to the basin
support the basin under the ear to
receive the irrigating solution
5. Clean the pinna and meatus at the Materials lodged on the
auditory canal is necessary with pinna and at the meatus
moisten cotton tipped applicators may be washed into ear
dipped in warm tap water or the
irrigating solution
6. Ascertain whether impaction is due If water contracts such as
to foreign hygroscopic (attracts or substance it, may cause it to
absorbs moisture) body before swell and produce intense
proceeding pain
7. Fill the bulb syringe with warm Air forced into the ear is
solution, if an irrigating container noisy and therefore
used, allow air to escape from the unpleasant for the patient
tubing
8. Straighten the auditory canal by Straightening the ear canal
pulling the pinna up and back for an helps to allow the solution
adult, upward and back for a child to reach all areas of the ear
over 3 years of age and down an and canal
back for an infant or child up to 3
years of age
9. Direct a steady, slow stream of Directing solution at the
solution against the roof of the roof of the canal helps
auditory canal, using only sufficient prevent injury to the
force to remove secretions. Do not tympanic membrane.
occlude the auditory canal with the Continuous in and out flow
irrigating nozzle. Allow the solution to of the irrigating solution
flow out unimpeded. helps to prevent pressure in
the canal
10. When the irrigation I completed, The cotton ball absorbs
place a cotton ball loosely in the excess fluid and gravity
auditory meatus and have the patient allows the remaining
lie on the side of the affected ear on solution in the canal to
a towel or absorbent pad escape from the ear
11. Discard the irrigated fluids and
swabs. Clean and replace reusable
articles
12. Wash hands Prevents spread of
microorganisms
13. Record the irrigation, appearance of Acts as a communication
the drainage and the patient’s between staff members
response
14. Remove the cotton ball and assess Drainage or pain may
drainage after 15 minutes indicate injury to the
tympanic membrane

AFTERCARE OF THE ARTICLES:

• Remove the mackintosh and towel from under the head as to make
the patient comfortable.
• Collect all the articles used and take them to the utility room.
• Clean them first in cold water and then with warm soapy water.
Rinse them thoroughly, dry them and send for sterilization.
• Wash hands.
• Record the treatment, the type of solutions used, the effect of
treatment along with the date and time in nurses record.

POST PROCEDURE CARE:

• The ear canal may be vulnerable to an ear infection after irrigation.
This is caused by removal of all the wax, which has inherent
properties to protect the ear canal.
 • Until the ear produces more wax to protect the canal keep the
ear(s) that have been irrigated dry from entry of water for a
minimum of 4-5 days after the procedure.
• To keep the ears dry while washing the hair, showering, bathing or
swimming, insert ear plugs or cotton wool coated in petroleum jelly
into the outside of the ear canal to act as a protective seal.
• Consult with the physician in case there is pain, dizziness.
• It may be helpful to instill olive oil 2-3 times a week and wear ear
plugs.

DOCUMENTATION:
• Irrigation should be at least at room temperature.
• An irrigating container with tubing and an ear tip may be used if the
purpose of the irrigation is to apply heat to the area.
• If irrigation do not dislodge the ear wax, instill several drops of
prescribed glycerin, carbonite peroxide or other solutions as
directed, two or three times daily for 2-3 days which helps to soften
and loosen impaction.
• Take special care not to irrigate an older adult’s ears with cool
water because dizziness may occur.
 CHECKLIST

TOPIC: EAR IRRIGATION

Past history Rt ear comments Left ear comments
Yes/No Yes/No
Previous problem following
ear irrigation
Recent ear perforation
Previous ear surgery
e.g. mastoidectomy
discharge from the ear
Current or recent ear
infection
Catarrh or cold
Ear pain
Grommets
Cleft palate
Foreign body in situ
Use of olive oil
appropriately for a
minimum of 7 days