I find many patients he cerumen accumulation in their ears. Is it a safe practice for nurse practitioners to irrigate the ear canals or should an ENT specialist perform the procedure? I find it difficult to determine whether the ear canal has been irritated from the impaction or by the irrigation. After irrigation, I use amoxicillin and antibiotic ear drops to prevent complications. Is this necessary or am I being too cautious?
Response from Susan F. Rudy, MSN, CS-FNP, CORLNIt is safe for nurse practitioners to irrigate the ear canals if the procedure is done safely! Cerumen removal is always safer and more comfortable if the cerumen is first softened. Ceruminolytic or antibiotic drops may be used depending on your suspicion of an underlying infection. Some important considerations for safe irrigation are the choice of irrigating device, and the temperature, pressure, direction, and contents of the irrigant.
The irrigating solution should be at body temperature to minimize the chance of vertigo. The irrigant should be aimed at the roof or side wall of the canal, not straight at the center, to minimize pressure against the tympanic membrane. When a dental irrigating device is used for ear irrigation, always use a soft nonobstructive tip and the lowest irrigating pressure setting.[1]
A 20- to 30-cc syringe should be used for a child, with slow, gentle pressure. For an adult, a 50- to 60-cc syringe may be used. A soft IV catheter attached to the syringe will further reduce the possibility of trauma.[2] Be sure there is unobstructed outflow of irrigant to prevent excessive pressure from building in the canal. When ailable, use sterile water, because tap water contents are variable. The intact skin may be superficially traumatized by the cerumen, the procedure, or both, creating potential risk for infection. Sterile water must be used for immunocompromised patients. Peroxide added to the irrigant may improve the chances for successful cerumen removal.[3]
An experienced practitioner should always examine the ear for complications after cerumen removal . Erythema of the canal is common after cerumen removal. One can never be sure whether the cerumen or the instrumentation (or both) has caused erythema. It is important to assess the degree of inflammation and manage accordingly. Erythema will generally resolve on its own, although some clinicians instill one dose of Cortisporin in the office before discharge. (Remember that 1% of patients are sensitive to the neomycin component of Cortisporin). With any superficial excoriation, it is common practice to use antibiotic drops for 3 to 5 days to prevent infection from developing.
In the event of a tympanic membrane perforation occurring after irrigation, refer the patient to an otolaryngology specialist. With the possible exception of the severely immunocompromised patient, the use of oral antibiotics is virtually never needed after cerumen removal.
Ear canal irrigation is contraindicated if there is a known or suspected tympanic membrane perforation (including a patent myringotomy tube), monomeric or dimeric tympanic membrane (a thin, weak area of the membrane where one or two layers he healed after perforation), the presence of vegetable matter such as a bean or a pea, the presence of a watch or hearing aid battery, evidence of purulent exudate filling the canal, or a history of ear surgery. Reasons for a referral to a specialist in otolaryngology include unsuccessful attempts at irrigation, abnormal ear anatomy, or a patient's inability to cooperate with the procedure.
ReferencesMedscape Nurses.聽2000;2(1)聽漏聽2000聽Medscape
Cite this: Susan F Rudy.聽What Precautions Are Necessary When Irrigating the Ear Canals?聽-聽Medscape聽-聽Jun聽01,聽2000.