What is the recommended solution for flushing drainage in outpatient management of otitis media?

Recommended Solutions for Flushing Drainage in Outpatient Management of Otitis Media

For cleaning ear drainage in outpatient management of otitis media, hydrogen peroxide or warm water are the recommended solutions for flushing drainage. 1

Cleaning Methods for Ear Drainage

Primary Cleaning Solutions

• Hydrogen peroxide: Recommended for removing dried drainage at the ear canal opening 1
• Warm water: Alternative solution for cleaning drainage 1

Application Methods

1. Cotton-tipped swab method: Dip in hydrogen peroxide or warm water and use to clean the opening of the ear canal 1
2. Cotton ball method: Use to absorb drainage 1
3. Infant nasal aspirator: Can be used for gentle suction of drainage 1

Proper Drainage Management Protocol

For Patients with Tympanostomy Tubes

When drainage occurs through tympanostomy tubes:

1. Do not worry - drainage indicates the tube is functioning properly 1
2. Clean visible drainage from the ear canal opening using:
   • Cotton-tipped swab dipped in hydrogen peroxide or warm water
   • Cotton ball to absorb drainage
   • Gentle suction with infant nasal aspirator 1
3. Apply prescribed antibiotic ear drops after cleaning 1

Proper Drop Administration Technique

• Have someone else administer the drops when possible 1, 2
• Position with affected ear upward 1, 2
• Fill ear canal with prescribed drops 1
• Remain in position for 3-5 minutes (use a timer) 1, 2
• Use gentle to-and-fro movement of the ear or press the tragus (small piece of cartilage in front of the ear) to help drops enter 1, 2

Important Precautions

Do Not Use

• Ear candles: No proven benefit and can cause harm including hearing loss 1
• Playdoh or silly putty: Can become trapped in the ear canal requiring surgical removal 1
• Tap water irrigation: Especially in immunocompromised patients due to risk of necrotizing external otitis 2

Water Precautions During Active Drainage

• Prevent water entry during bathing by using cotton saturated with Vaseline to cover the ear canal opening 1
• Avoid swimming until drainage stops 1

When to Call the Doctor

• If the tube cannot be visualized by the primary doctor 1
• If drainage persists despite appropriate treatment 1
• If drops become painful or unexpected symptoms develop 1

Follow-up Care

• Routine follow-up every 4-6 months is important to ensure tubes are in place 1
• All children need follow-up regardless of how well they appear to be doing 1

By following these recommendations for cleaning ear drainage, patients can effectively manage otitis media with drainage at home while minimizing complications and promoting healing.