Operational Medicine 2001
Ear Wash (Irrigation)

Considerations:

1.  Ascertain if patient has a history of tympanic membrane perforation or other complications that would contraindicate ear irrigation.  If such history exists, consult with health care provider before proceeding.  

2.  For adults, pull auricle up and back to straighten auditory canal. For pediatric patients, pull auricle down and back to straighten auditory canal.

3.  Determine what is to be irrigated from ear.  If object absorbs water, then it may swell during procedure exacerbating symptoms or causing pain.

4.  Be prepared for patient to become dizzy, especially if cool water is used to irrigate.  This is a common side effect of ear irrigation.  

Before beginning:

1.  If not already available, begin warming solution to be used.  Use of cold water is uncomfortable to the patient and may even be painful due to spasms it can cause - especially in geriatric patients.  Solution should not be hot to the touch.

2.  Consider use of cerumenolytic solution to soften or loosen any suspected impaction.  Instillation at this point will allow time for solution to take effect while you prepare for irrigation.

3.  Set up protective toweling and/or basin to collect drainage water/solution.

4.  Other equipment to have at bedside includes:  

• cotton tipped applicators

• cotton balls

• ear syringe or irrigation bag

• ear pick (for debris removal)

• dry toweling.

5.  Place the patient in a position of comfort that has them either sitting or lying down and head tilted toward ear to be irrigated.

Procedure:

1.  Use a cotton tipped applicator or ear pick to remove any visible debris or discharge near auditory canal opening.

2.  Gently place tip of irrigation device at the opening of the auditory canal and gently direct stream of water against the sides of the auditory canal so as to allow the force of the irrigation solution to reflect behind the object and “push” it out.  Do not direct stream directly at the object as you may only drive it in deeper.  If an irrigation drainage bag is used, allow no more than a six inch (fifteen centimeter) elevation above the auditory canal.

3.  Dry external ear and place patient in a position of comfort with irrigated ear facing downward so as to allow any remaining irrigation solution to drain by gravity.

4.  Record procedure and results, including solution(s) used, length of procedure, and patient response.

Reference:  Nettina, Sandra M., (1996)  The lippincott manual of nursing practice (6^th ed.)  pp 464-465.  Lippincott:  Philadelphia. 

This section contributed by Patrick Myer RN, BSN, CEN, Emergency Medicine Department, Naval Medical Center, Portsmouth, Virginia

Approved for public release; Distribution is unlimited.

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Operational Medicine 2001
Health Care in Military Settings

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