How is ear irrigation performed?

Ear Irrigation Procedure

Ear irrigation is an effective method for removing cerumen impaction when performed with proper technique, but should not be used in patients with tympanic membrane perforation, history of ear surgery, or anatomical abnormalities of the ear canal. 1

Patient Assessment Before Irrigation

• Contraindications - Do NOT perform ear irrigation in patients with:

  • History of tympanic membrane perforation 1, 2
  • Previous ear surgery 1, 2
  • Patent pressure-equalizing tubes 2
  • Anatomical abnormalities of the ear canal (congenital malformations, osteomas, exostoses, scar tissue) 1, 2
  • History of ear trauma 2
  • Inability to visualize the tympanic membrane (unless history confirms intact membrane) 1

• Special Considerations:

  • Diabetes - Use extra caution due to higher risk of malignant otitis externa 1, 2
  • If a small portion of the tympanic membrane is visible and mobile with pneumatic otoscopy, it is likely safe to proceed 1

Irrigation Technique

1. Pre-irrigation preparation:

   • Use cerumenolytic agents 15 minutes before irrigation to soften wax (reduces water volume needed) 1
   • Water should be at body temperature to prevent caloric effects and vertigo 1

2. Equipment options:

   • Manual syringe (metal or plastic) - most common method 1
   • Electronic irrigator with controlled pressure 1
   • Soft rubber bulb ear syringe for self-administration 3, 4

3. Proper technique:

   • Position the patient with head tilted to the side being irrigated 3
   • Direct water stream at the canal wall, NOT directly at the tympanic membrane 1, 2
   • Use appropriate pressure - low settings if using electronic devices 1
   • Typically requires between 500-1000ml of fluid for effective irrigation 5

4. Post-irrigation care:

   • Ensure ear canal is completely dry after the procedure 2
   • Consider reacidifying the ear canal with vinegar or acetic acid drops 1, 2
   • For diabetic patients, provide instructions to report otorrhea or otalgia promptly 1

Potential Complications

• Pain (most common) 1
• Injury to ear canal with or without bleeding 1
• Acute otitis externa 1
• Tympanic membrane perforation (0.2% of cases) 1, 5
• Vertigo (0.2% of cases) 1, 5
• Tinnitus 1
• Otitis media 1

Efficacy and Outcomes

• Success rate of cerumen removal is high when performed correctly 6
• Hearing improvement of 5-10 dB can be expected in most cases 1
• Up to 34% of patients may experience an average of 10 dB improvement 1
• Significant complications requiring specialist referral occur in approximately 1 in 1000 irrigations 1

Self-irrigation Option

For appropriate patients without contraindications, self-irrigation using a bulb syringe can be effective:

• Reduces subsequent clinic visits for ear irrigation 4
• Instructions: Tilt head sideways, place 5-10 drops in ear, keep head tilted for several minutes 3
• Can be used twice daily for up to 4 days 3
• After treatment, gently flush with warm water using a soft rubber bulb ear syringe 3

Important Caveats

• After three unsuccessful attempts at irrigation despite using cerumenolytics, consider alternative methods of cerumen removal 5
• Proper training and technique are essential for minimizing complications 2
• Manual removal under direct visualization is preferable in high-risk patients 2