What is the procedure for ear irrigation to remove a foreign object?

Procedure for Ear Irrigation to Remove a Foreign Object

Ear irrigation is an effective and commonly used method for removing foreign objects from the ear canal when performed correctly. The recommended procedure for ear irrigation to remove a foreign object involves using warm water at body temperature directed at the ear canal wall rather than directly at the tympanic membrane, after confirming there is no contraindication such as tympanic membrane perforation. 1

Pre-Irrigation Assessment

• Obtain detailed history to identify contraindications:

  • Previous ear surgery
  • Known tympanic membrane perforation
  • History of ear pain, discharge, or bleeding
  • Presence of tympanostomy tubes
  • Diabetes (higher risk of malignant otitis externa)

• If possible, visualize the tympanic membrane:

  • If a small portion is visible and mobile with pneumatic otoscopy, it's safe to proceed
  • If completely obstructed, rely on history to rule out contraindications 1

Contraindications to Ear Irrigation

• Non-intact tympanic membrane
• Previous ear surgery
• Anatomical abnormalities (congenital malformations, osteomas, exostoses, scar tissue)
• Uncontrolled diabetes (higher risk of malignant otitis externa)
• History of ear surgery 1

Irrigation Procedure

1. Position the patient with the affected ear tilted slightly downward to allow drainage
2. Use water at body temperature (37°C) to prevent caloric vertigo
3. Direct water stream along the superior wall of the ear canal, NOT directly at the tympanic membrane
4. Use moderate pressure - enough to be effective but not excessive
5. Allow water to exit freely from the ear canal
6. Continue irrigation until the foreign object is removed
7. Dry the ear canal thoroughly after the procedure 1, 2

Equipment Options

• Manual syringe irrigation (most common in general practice)
• Electronic irrigator
• Metal or plastic syringe with specialized ear irrigation tip 1

Post-Irrigation Care

• Thoroughly dry the ear canal
• Consider reacidifying the ear canal with vinegar or acetic acid drops to prevent infection
• Avoid alcohol-containing solutions unless certain the tympanic membrane is intact
• Instruct patients to report development of pain or drainage promptly 1

Alternative Methods if Irrigation Fails

If irrigation is unsuccessful or contraindicated, manual removal may be necessary:

• Manual removal using appropriate instrumentation:

  • Metal or plastic curette loop/spoon
  • Alligator or cup forceps
  • Right-angled hook
  • Angulated suction tips
  • Jobson-Horne probe 1

• For tightly wedged smooth round objects, specialized techniques may be required 3

Potential Complications

Complications from ear irrigation occur in approximately 1 in 1000 procedures requiring specialist referral:

• Pain (most common)
• Tympanic membrane perforation (0.2%)
• Vertigo (0.2%)
• Otitis externa
• Otitis media
• Tinnitus 1

Outcomes Assessment

• Assess the ear canal at the conclusion of treatment
• Document resolution of the foreign body
• If symptoms persist despite removal, evaluate for alternative diagnoses
• If the foreign body cannot be removed, consider referral to a specialist 1

Special Considerations

• For diabetic patients, use extra caution and instruct to report otorrhea or otalgia promptly
• For children, ensure proper positioning and cooperation
• If the foreign body is organic material (like a bean), irrigation may cause swelling, making removal more difficult 1, 3

Remember that ear irrigation is generally safe and effective when performed correctly, but should only be attempted when there are no contraindications and by clinicians trained in the procedure.