Ear Wick Placement in Pediatric Patients
Place a compressed cellulose wick in the ear canal when severe edema prevents topical medication delivery or when most of the tympanic membrane cannot be visualized, then moisten it with an aqueous solution before applying the first dose of medication. 1
Indications for Wick Placement
- Use a wick specifically when ear canal edema obstructs medication entry or prevents adequate visualization of the tympanic membrane 1
- The wick facilitates drug delivery by expanding when exposed to moisture, which simultaneously reduces ear canal edema 1
- While many treatment studies uniformly use wicks, there are no randomized trials proving their efficacy, so their benefit is questioned by some clinicians for uncomplicated cases 1
- Following first principles: if anatomy (narrow or edematous canal) makes delivery of topical medicine problematic, use of a wick is prudent 1
Proper Wick Selection and Placement Technique
- Preferentially use compressed cellulose material because it expands when exposed to moisture, which enhances drug delivery and reduces canal edema 1
- Ribbon gauze can serve as an alternative if compressed cellulose is unavailable 1
- Never use a simple cotton ball as the wick material, since cotton can fragment and be retained in the ear canal 1
Medication Application to the Wick
- Once the dry wick is placed, moisten and expand it with an aqueous solution (water, saline, or aluminum acetate) before the first application of an otic suspension or nonaqueous viscous medication to ensure better penetration 1
- Aqueous solutions can be applied directly to expand a dry wick without pre-moistening 1
- After placing drops, perform tragal pumping (pressing the tragus in and out several times) to help medication enter through the wick 2
Duration and Removal
- A wick is unnecessary once ear canal edema subsides, which typically occurs within 24 hours to a few days of topical therapy 1
- The wick may fall out spontaneously, be removed by the patient if instructed, or be removed by a clinician at a scheduled follow-up visit 1
Important Clinical Caveats
- If adequate aural toilet or wick placement is not possible or practical due to severe external auditory canal edema, consider adding systemic antibiotics 1
- The ear canal should be cleared of inflammatory debris, obstructing cerumen, or foreign objects before wick placement 1
- For patients with risk factors such as diabetes or immunocompromised state, atraumatic cleaning with aural suctioning under microscopic guidance may be required rather than lavage 1
Context for Tympanostomy Tubes
Note that this question asks about wick use after myringotomy for persistent OME, but the American Academy of Otolaryngology-Head and Neck Surgery recommends against tympanostomy tube insertion in children with OME of less than 3 months' duration 1. The wick technique described above applies primarily to acute otitis externa or acute tympanostomy tube otorrhea scenarios where canal edema prevents medication delivery.