From the Guidelines
Ear lavage can cause pain due to the introduction of fluid into the ear canal, which can trigger pain signals, and this is supported by recent clinical guidelines 1. The ear canal is lined with delicate skin and contains numerous nerve endings, making it highly sensitive to pressure, temperature changes, and manipulation. During lavage, the pressure against the eardrum and canal walls can cause discomfort, and if the water temperature is too hot or too cold, this thermal stimulation can also cause pain 1. Additionally, if there's inflammation or infection already present in the ear, the procedure can exacerbate pain by irritating these already sensitive tissues. The physical manipulation of the ear during the procedure, including pulling on the outer ear to straighten the canal, can stretch nerve-rich tissues and cause pain. In cases where impacted earwax has created pressure on the ear canal wall, the initial movement of this wax during lavage can temporarily increase pressure and discomfort before relief occurs. Some of the main complications reported after aural irrigation are pain, injury to the skin of the ear canal with hemorrhage, and acute otitis externa, with perforation and vertigo being less common but significant complications 1. To minimize pain during ear lavage, using body-temperature fluid, gentle technique, and proper positioning are essential, and the procedure should be avoided if there's a suspected eardrum perforation or active ear infection. It's also worth noting that the prevalence of cerumen impaction and the associated need for ear lavage is significant, with estimates suggesting that between 2% to 6% of the general population in the United Kingdom suffers from cerumen impaction at any given time, and the total annual cost for managing cerumen in the United States is substantial 1. Given the potential for pain and other complications, it's crucial to approach ear lavage with caution and careful consideration of the individual patient's situation, prioritizing their morbidity, mortality, and quality of life outcomes. Key factors to consider include the patient's overall health, the presence of any underlying conditions that may increase the risk of complications, and the availability of alternative treatments or preventive measures, as outlined in recent clinical practice guidelines 1.
From the Research
Causes of Pain in Ear Lavage
- Ear lavage can cause pain due to various reasons, including the introduction of bacteria into the ear canal, irritation of the ear canal skin, or damage to the tympanic membrane 2.
- The use of contaminated ear lavage instruments can lead to the transmission of bacteria, such as Pseudomonas aeruginosa, which can cause otitis externa and subsequent pain 2.
- The ear canal skin can be irritated by the lavage process itself, or by the use of certain topical agents, such as those containing alcohol or mild acids 3.
Role of Bacterial Infections
- Bacterial infections, such as those caused by Pseudomonas aeruginosa, Staphylococcus aureus, and faecal organisms, can contribute to the development of otitis externa and pain 4.
- The use of topical antibiotic/steroid drops or creams can help manage these infections and reduce pain 4.