NURS 516 EMERGENCY NURSING CARE 1 PRACTICAL

EAR IRRIGATION
STUDENT NAME:
MS. NAWAL
COURSE COORDINATOR:
DR. DOLORES I. CABANSAG
EAR IRRIGATION
PURPOSE/INTRODUCTION/BACKGROUND OF
THE PROCEDURE
 INDICATIONS

1. To remove drainage, cerumen, or foreign

bodies from the external auditory canal
2. To irrigate the external auditory canal
with an antiseptic solution
3. To apply heat or cold to the external
auditory canal
CONTRAINDICATIONS
AND CAUTIONS 1. Irrigation is contraindicated
if the tympanic membrane
is perforated or potentially
not intact, (secondary to
injury, myringotomy tubes,
or surgery) or in the
presence of severe external
otitis
CONTRAINDICATIONS
AND CAUTIONS 2. Avoid extreme temperatures,
which may cause pain,
dizziness, nausea, and vomiting
3. If there is water-absorbent
material in the ear, such as
vegetable matter (e.g., beans),
do not irrigate, because the
material may swell and make
removal more difficult
CONTRAINDICATIONS
AND CAUTIONS
4. Be careful not to abrade the
ear canal with the irrigating
device.
5. Discontinue the procedure
and notify the physician if the
patient experiences pain,
vertigo, or nystagmus
CONTRAINDICATIONS 6. Use caution with elderly and
AND CAUTIONS immunocompromised patients
because irrigation may lead to
malignant otitis externa.
7. Do not attempt on an uncooperative
patient or child who cannot be still or
adequately restrained to perform the
procedure safely.
8. Referral to a specialist should be
considered if the affected ear is the
only hearing ear
STANDARD PROTOCOL
Perform Hand Hygiene
Don Appropriate PPE’s
Identify the patient correctly.
Explain the procedure to the patient
Prepare all the necessary equipments.
Position the patient properly.
EQUIPMENTS
Otologic ear syringe (metal ear syringe)
or 60-ml syringe with an 18- or 20-G
intravenous catheter sheath attached,
or a butterfly, with the needle and wings
removed, cut to leave approximately 1
in of tubing near the hub or Dental
irrigating device (such as a Water-Pik)
on low setting (A proper ear irrigating
syringe is preferred to extemporized
devices or a Water-Pik because it
supplies a large volume at low
pressure, rather than the high pressures
of other devices.)
Irrigant—warm water,
warm normal saline, or
half-strength hydrogen
peroxide
Basin to hold irrigant
Towels or waterproof pad
Emesis basin
Otoscope
Thermometer (optional)
Cotton balls or gauze
dressings
Cotton-tipped applicators
 PATIENT PREPARATION

1. Position the patient

with the head tilted
toward the affected ear.
2. Protect the patient's
clothing with towels or a
waterproof pad.
PROCEDURAL STEPS

1. Cleanse any discharge from

the outer ear with a cotton-
tipped applicator. Examine
both ears with an otoscope
before the procedure to
establish a baseline. To
examine the ear, pull the auricle
of the ear up and outward to
straighten the ear canal.
PROCEDURAL STEPS
2. If a ceruminolytic is used, it should be
instilled into affected ear(s) at least 10
minutes before attempting irrigation

3. Prepare the irrigation solution.

Common irrigation solutions include tap
water or a 1:1 solution of tap water and
hydrogen peroxide. The solution should
be at body temperature. If you drip some
of the solution onto your inner wrist, it
should be a comfortable temperature, or
you can check the temperature with a
thermometer.
PROCEDURAL STEPS

4. Draw up the irrigation solution

into the syringe and expel the air
from the syringe.

5. Ask the patient to hold the

emesis basin under the ear and
against the neck.

6. Stress the importance of

remaining still during the procedure.
PROCEDURAL STEPS 7. Pull the auricle of the ear up and backward
(Figure 164-1, A). Place the tip of the
irrigating syringe at the opening of the ear
canal. Do not occlude the opening of the ear
canal, because this can cause excessive
pressure, which could in turn lead to rupture
of the tympanic membrane. Direct the fluid
toward the posterior wall of the canal, not at
the tympanic membrane (Figure 164-2).
Visualize the perimeter of the canal as a
clock face. For the left ear, direct the fluid
toward 1 o’clock; for the right ear, direct the
fluid toward 11 o’clock (Parshall, 2005).

8. Irrigate slowly to prevent build-up of

pressure inside the canal. If a Water-Pik is
used, special care must be taken to avoid
excessive water pressure (Parshall, 2005).
PROCEDURAL STEPS
9. After each irrigation, inspect the
ear canal to assess the progress
being made, or check the irrigation
solution as it returns to the basin
for cerumen or foreign bodies. If the
irrigation is successful, the patient
will generally report a relief of
symptoms (Parshall, 2005).

10. Repeat the irrigation as needed,

allowing the patient to rest between
each irrigation if necessary.
PROCEDURAL STEPS 11. If irrigation is not successful,
ceruminolytic drops may be
prescribed for several days and the
patient referred for follow-up.
Irrigation may be reattempted if
cerumen impaction does not
spontaneously resolve.

12. After irrigation, dry the outer ear

with a cotton ball. The cotton ball
may be left loosely in place for 5 to
10 minutes to absorb any excess
moisture. Instillation of a drying
agent such as isopropyl alcohol may
be prescribed.
 AGE SPECIFIC
CONSIDERATION
The ear canal in a child is small.
Caution should be exercised to
avoid totally occluding the canal
during irrigation because excessive
pressure within the ear canal may
result.

To straighten the ear canal in a

child younger than age 3, pull the
ear down and outward
 AGE SPECIFIC
CONSIDERATION Place the child in the supine
position. If the child is
uncooperative and all other
appropriate control measures have
failed, a child restraint board may
be used to prevent movement.

Ill children may require ear irrigation

if cerumen prevents visualization
and assessment of the tympanic
membrane, because this is a key
component of the evaluation of a
febrile child.
 AGE SPECIFIC
CONSIDERATION
A dental irrigation device should be
used with caution in children
because the jet stream is forceful.
Use the lowest setting and aim
toward the posterior wall of the ear
canal. To decrease the child's fear,
explain the procedure and
demonstrate the device, allowing
the child to feel the water on his or
her hand and listen to the noise.
 AGE SPECIFIC
CONSIDERATION
Do not use cool irrigant because
dizziness or discomfort may result,
especially in an older patient.

Cerumen impaction is very

common in the elderly, but care
should be used as malignant otitis
externa may result.

Caution should be used in the

immunocompromised patient.
COMPLICATIONS

1. Vertigo, nausea, or pain during or after the procedure. Stop immediately if any of these
symptoms occur. Allow the patient to rest until the symptoms resolve and then restart. Be sure
gentle pressure is used. Aim at the posterior portion of the ear canal and use the proper irrigant
temperature to help prevent recurrence of symptoms.

2. Rupture of the tympanic membrane with possible middle ear injury

3. Loss of hearing

4. Trauma or injury to the ear canal

5. Otitis externa
DOCUMENTATION
 PATIENT EDUCATION

1. Report any pain, nausea, dizziness, or loss of hearing

as it occurs during the procedure.

2. Report any persistent pain, purulent drainage, vertigo,

or fever (Riviello, 2004).

3. Cleanse the outer ears daily with a washcloth, soap,

and water.
 PATIENT EDUCATION
4. Do not place objects in your ears, especially cotton applicators
that can impact cerumen. “Instrumentation” of the ear should only
be done with direct vision by a competent practitioner.

5. Patients with unrelieved impactions, who are to return after a

course of softening treatment, should be cautioned about a
possible increased risk when driving and or performing
hazardous tasks because of diminished hearing, attention, and
possible dysequilibrium until the problem is resolved.
REFERENCES

Proehl,J.A. Emergency Nursing Procedures. 2009. Saunders Elsevier. St. Louis,

Missouri 63146