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CLINICAL: BASIC CARE Zoë Rawles


BN RGN BSc Hons


Licensed trainer for Rotherham Primary Ear Care Training Centre


A guide to... ear irrigation


Although modern irrigation equipment has improved the safety of this procedure, it is still important that nurses are appropriately trained to avoid damaging the ear


E


ar irrigation may be useful to enable the patient to hear poperly again where there is a build up of wax in the ear canal. It is a skill that requires appropriate training as an incorrect technique can result in perforation or infection. It is important to be aware of the current best practice in ear irrigation. All nurses who are likely to be perform-


ing this procedure should attend appropriate study days and updates when possible. Before the modern irrigation equipment in use today became


available, ear syringing was performed using a traditional metal syringe. Water was directed at the tympanic membrane and the pressure was determined by the force with which the nurse pushed the plunger, so perforations were a common occurrence. Furthermore, the importance of drying the ear canal effectively following the procedure was not recognised. Consequently, the Medical Defence Union (MDU) settled litigation costs of £154,000


BOX 1. CONTRA-INDICATIONS8


Complications following the procedure in the past. History of middle ear infection within the last six weeks. Any ear surgery apart from grommets that have extruded 18 months previously. Acute otitis externa with pain or tenderness of the pinna. Cleft palate (repaired or not). Perforation or history of mucus discharge within the last year.


Special Precautions Dizziness. Tinnitus. Healed perforation.


for problems related to ear syringing between 1992 and 1997.1 The use of electronic irrigators that have been designed


specifically for the purpose has resulted in far fewer problems due to the lower pressures involved. However the risk of perforation and infection following the procedure still exists, particularly when an inappropriate technique is employed.


ASSESSMENT OF THE PATIENT Consider if the wax is actually obscuring the tympanic membrane (TM). Look in the unaffected ear first for comparison while sitting at the same level as the patient. Hold the auriscope like a pen in the right hand to examine the right ear, and in the left hand to examine the left ear. Keep the little finger on the cheek to steady the hand in case of sudden movement by the patient. Some nurses find it easier to use their right hand for both ears in which case the little finger will have to be held against the back of the head when looking in the left ear. Palpate the outer ear gently to identify if the patient has any pain.


Straighten out the ear canal by gently grasping the cartilaginous part of the pinna and pulling upwards and outwards (down and back for children). If the TM is visible it should be possible for the patient to use olive oil drops to soften the wax and facilitate the natural cleansing process without the need for irrigation. If the TM is completely obscured, check the consistency of the wax. If it is dark and hard, removal of the wax using a Jobson Horne Probe is an alternative option to irrigation, but only where the nurse is competent in the procedure and the wax is visible externally with a head light. Otherwise, advise the patient to instil olive oil drops at room temperature two to three times a day for three or four days before returning for further assessment and irrigation.2


necessary to perform irrigation prior to a hearing aid fitting to ensure an accurate mould, and occasionally a doctor might request irrigation to remove debris from an ear where there is a non-painful otitis externa in order to facilitate the efficacy of ear drops.


It may sometimes be


74 Nursing in Practice March/April 2012


www.nursinginpractice.com


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