Ear Irrigation

It is vitally important that providers have unobscured view of the tympanic membrane in order to diagnose Otitis Media, Serous Otitis Media, or Otitis Externa. Additionally, impacted cerumen may be uncomfortable for patients, and in some situations may reduce hearing acuity.  So, it has become routine practice for physicians to remove cerumen during an office visit.

Many of us have developed our favorite techniques for removing cerumen. In the video above I share mine. Basic principles include using a ceruminolytic to soften wax. My preferred agent is sodium docusate liquid. ($12 or so for a big bottle on Amazon)  I saturate cotton balls with the liquid and put them in the ears for 15 minutes.  By using cotton balls, one can soften the cerumen in both ears at the same time. One then can use a syringe or an ear wash system such as the Elephant Ear Washer System ($26 on Amazon) that uses soft plastic catheters ($16 for a bag of 20).   The catheter is pushed gently through the wax before irrigation begins, so the cerumen is push out of the canal and not toward the tympanic membrane. Often the cerumen is extruded as a solid plug. 

The irrigation solution is room temperature water mixed 4 to 1 with hydrogen peroxide. I use an ear basin to catch cerumen and place chucks on the patient’s shoulder to prevent accidents. 

Contraindications to irrigation include the presence or history of a perforated tympanic membrane (or ear tubes),  previous pain on irrigation, previous surgery to the middle ear , or the presence of a discharge.

If you use a curette exercise caution. I prefer the EasiEar curettes which are metal, but flexible. These cost $69 for 25 from splashcap.com



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