What is an Ear Wick
An ear wick is a small, expandable device—preferably made of compressed cellulose—that is inserted into a swollen ear canal to facilitate delivery of topical antibiotic drops when severe edema prevents medication from reaching the infected tissue. 1, 2
Primary Function and Mechanism
The wick serves as a conduit for medication delivery when the ear canal is too swollen for drops to penetrate effectively. 1 When compressed cellulose material is exposed to moisture from the antibiotic drops, it expands to fill the narrowed canal space, simultaneously reducing edema while ensuring continuous drug contact with infected tissues throughout the canal length. 1, 2
Clinical Indications
The American Academy of Otolaryngology-Head and Neck Surgery recommends wick placement specifically when:
- Severe ear canal edema prevents topical drops from reaching the medial canal 2
- The tympanic membrane cannot be visualized due to canal narrowing or swelling 1, 2
- Debris obstruction cannot be adequately cleared by aural toilet alone 1
Material Selection and Placement
Compressed cellulose is the preferred material because it expands predictably when moistened, unlike cotton balls which can fragment and leave retained fibers in the canal. 1, 2 Ribbon gauze serves as an acceptable alternative. 1
The placement technique requires:
- Inserting the dry wick into the edematous canal first 2
- Priming with aqueous solution (water, saline, or aluminum acetate) before applying otic suspensions or viscous medications 1, 2
- Applying antibiotic drops directly to the wick 2-4 times daily 3
Research demonstrates that six drops are required to fully prime a wick before therapeutic penetration occurs, meaning the initial application should use this volume to ensure medication reaches the deep canal. 4
Expected Course and Patient Instructions
The wick typically falls out spontaneously within 3-7 days as canal edema resolves—this is a positive sign indicating treatment success. 3 Patients must not remove the wick themselves unless specifically instructed, as premature removal can compromise treatment and the tender canal remains vulnerable to trauma. 3
Critical patient instructions include:
- Continue applying drops for at least 7 days even if symptoms improve 2, 3
- Lie with affected ear upward for 3-5 minutes after each application 1, 3
- Use gentle tragal pumping (pressing in/out on the cartilage in front of the ear) to facilitate drop penetration 1
Safety Considerations for Special Populations
For diabetic or immunocompromised patients, avoid ear canal irrigation entirely before wick placement—use only atraumatic aural suctioning under microscopic guidance instead, as irrigation with tap water has been implicated as a contributing factor in malignant (necrotizing) otitis externa. 1, 2
When tympanic membrane perforation is known or suspected, prescribe only non-ototoxic fluoroquinolone drops (ofloxacin or ciprofloxacin), never aminoglycoside-containing preparations like neomycin, which cause permanent sensorineural hearing loss with middle ear exposure. 2, 5
When Wick Placement Fails
If severe edema prevents adequate wick placement or aural toilet, systemic antibiotics become necessary. 2 This also applies when infection extends beyond the ear canal, in diabetic or immunocompromised patients, or when topical therapy fails after 48-72 hours. 2, 5
Common Pitfalls
Never use simple cotton balls as wicks—the cotton fragments and becomes retained in the canal. 1 If the wick has not fallen out spontaneously after 7-10 days, the clinician must remove it during follow-up; do not assume spontaneous expulsion will always occur. 3 Research confirms that bacteria can penetrate through otowicks, but continuous application of antibacterial drops prevents this bacterial migration. 4
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