Definition
An ear irrigation is the washing of the external auditory canal with a stream of liquid.
Purposes
- To remove the earwax.
- To remove foreign bodies (except hygroscopic substances).
- To cleanse the ear in case of purulent discharge caused by middle ear infection.
- For antiseptic effect.
- To apply heat.
- To evaluate vestibular functions (e.g., bithermal caloric test).
Contraindications
- Perforation or history of mucus discharge.
- Recent (last 6 weeks) middle ear infection.
- Discomfort during procedure.
- Otitis externa
Solutions Used
- Boric acid (2-4%).
- Sodium bicarbonate solution (1%).
- Normal saline.
- Hydrogen peroxide (2%).
- Sterile water.
Articles
- Prescribed sterile irrigating solution (warmed to 37°C)
- Irrigation set (container and irrigating bulb syringe).
- Wаtегрrооf раd.
- Emesis basin.
- Cotton tipped applicators.
- Clean gloves.
- Cotton balls.
- Spotlight and head mirror.
- Sterile gauze piece.
- Sterile jug with extra fluid.
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Explain the procedure to the patient and inform him how he has to cooperate. | Explanation facilitates cooperation and provides reassurance. |
| 2. | Bring equipment to the patient’s bedside. Check the physician’s order and protect the patient and bed linen with a moisture proof pad. | Provides for an organized approach to the task. |
| 3. | During procedure Wash hands. | Prevents spread of microorganisms. |
| 4. | Have the patient sit up or lie with the head tilted toward the side of the affected ear. Have the patient support the basin under the ear to receive the irrigating solution. | Gravity causes the irrigating solution to flow from the ear to the basin. |
| 5. | Clean the pinna and meatus at the auditory canal as necessary with moistened cotton-tipped applicators dipped in warm tap water or the irrigating solution. | Materials lodged on the pinna and at the meatus may be washed into the ear. |
| 6. | Ascertain whether impaction is due to foreign hygroscopic (attracts or absorbs moisture) body before proceeding. | If water contacts such a substance it may cause it to swell and produce intense pain. |
| 7. | Fill the bulb syringe with warm solution. If an irrigating container is used, allow air to escape from the tubing. | Air forced into the ear canal is noisy and therefore unpleasant for the patient. |
| 8. | Straighten the auditory canal by pulling the pinna up and back for an adult upward and back for a child over 3 years of age and down and back for an infant or child up to 3 years of age. | Straightening the ear canal helps to allow the solution to reach all areas of the ear canal. |
| 9. | Direct a steady, slow stream of solution against the roof of the auditory canal, using only sufficient force to remove secretions. Do not occlude the auditory canal with the irrigating nozzle. Allow the solution to flow out unimpeded. | Directing solution at the roof of the canal helps prevent injury to the tympanic membrane. Continuous in-and-out flow of the irrigating solution helps to prevent pressure in the canal. |
| 10. | When the irrigation is completed, place a cotton ball loosely in the auditory meatus and have the patient lie on the side of the affected ear on a towel or absorbent pad. | The cotton ball absorbs excess fluid, and gravity allows the remaining solution in the canal to escape from the ear. |
| 11. | Discard the irrigated fluid and swabs. Clean and replace reusable articles. | |
| 12. | After procedure Wash hands. | Prevents spread of microorganisms. |
| 13. | Record the irrigation, appearance of the drainage, and the patient’s response. | Acts as a communication between staff members. |
| 14. | Remove the cotton ball and assess drainage after 15 minutes. | Drainage or pain may indicate injury to the tympanic membrane. |
Special Considerations
- Irrigation solution should be at least at room temperature.
- An irrigating container with tubing and an ear tip may be used if the purpose of the irrigation is to apply heat to the area.
- If irrigation does not dislodge the wax, instill several drops of prescribed glycerin, carbamide peroxide or other solutions as directed, two or three times daily for 2-3 days which helps to soften and loosen impaction.
- Take special care not to irrigate an older adult’s ears with cool water because dizziness may occur.
- Inform that the ear canal may be vulnerable to an ear infection after irrigation.
- Instruct patient to prevent water entry at least for 4-5 days into the ear canal to keep it dry by using ear plugs when necessary.
- Instruct not to put any foreign objects (cotton buds) to clean the ear canal.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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