Introduction:
Ear wax or cerumen is a naturally occurring substance produced in the external auditory canal (EAC). This region consists of pilosebaceous glands, hair follicles, and ceruminous and sebaceous glands. The ear wax is formed by the combination of dead cells and oily secretions of sebaceous glands and modified sweat from ceruminous glands. This modified sweat produced by the ceruminous gland has bactericidal and fungicidal properties, which help in lubrication and cleaning the external auditory canal. Therefore, ear wax is a protective barrier that traps foreign particles and prevents infections.
The ear wax usually gets removed with jaw movement during eating or other activities, but in some cases, the wax gets build-up and gets impacted, which troubles the patient. The ear wax impaction usually occurs when its extrusion is prevented due to hearing aids or continuous use of earplugs or earbuds for noise reduction or listening to music. According to various studies, approximately 5 percent of healthy adults, 10 percent of children, 57 percent of older adults, and 33 percent of people with mental retardation suffer from ear wax impaction. Therefore, various techniques are used to clean the ear canal or remove the ear wax build-up, one of which is ear irrigation.
What Is Ear Irrigation?
Ear irrigation is also known as ear lavage. In this procedure, excess ear wax that gets built up in the ear canal is removed by using liquid. The ear wax can be flushed out using the liquid or can be softened with ear drops so that it can be removed with the instrument. This procedure has to be done by a medical professional otherwise, the eardrum may get damaged. Before performing this procedure, the ear canal is thoroughly examined using an otoscope to check whether there is any perforation in the tympanic membrane (eardrum) and to assess the anatomic abnormalities in the ear.
Why Is Ear Irrigation Performed?
The human ear is designed to be self-cleaning by pushing the wax out with the movement of the jaw. However, in some people, the wax builds up and can block the ear canal, causing pain and discomfort. This is usually found in people who wear earplugs or earbuds, people with narrow ear canals, and older adults. Excessive ear wax may lead to the following symptoms which include -
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Coughing.
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Discharge from the ear.
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Dizziness (feeling light-headed or faint).
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Hearing loss.
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Itching.
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Ear pain or otalgia.
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Fullness in the ear.
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Tinnitus (ringing in the ear).
Therefore, ear irrigation is usually performed in case of ear wax impaction if the patient shows the following symptoms. Removing the impacted wax can help in immediate relief from these symptoms, and this procedure has to be done by professional medical personnel.
What Are the Contraindications of Ear Irrigation?
Ear irrigation includes a few contraindications, such as a lack of patient consent, and other contraindications include -
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The inability of the patient to sit upright.
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The patient is unwilling to sit still.
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Presence of foreign body in the ear canal.
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Perforated eardrum or tympanic membrane.
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Patient with a history of middle ear infection.
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History of ear surgery.
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Patient with inner ear problems such as vertigo (sensation spinning).
What Equipments Are Used in Ear Irrigation?
The first step of ear irrigation is to assess the canal using an otoscope. For irrigation, water is used, which should be warm before use. The equipment required for irrigation includes -
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Irrigating solution is warmed to 98.6 F before use.
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Irrigation set including container and irrigating, or bulb syringe.
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A shallow basin.
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Cotton-tipped applicator.
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Cotton balls.
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Waterproof pad.
For irrigation 60 mm syringe with a 16 to 18-gauge intravenous (IV) catheter can be used, or a pulsating water device. When the ear canal is flushed with the liquid, the ear irrigation basin will be needed to collect the debris as it leaves the ear. Syringes and IV catheters are easily available compared to pulsating water devices, therefore, they are most commonly used.
How Is Ear Irrigation Performed?
The following are some of the steps involved in the procedure of ear irrigation -
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Before starting the procedure, it is important to ensure whether any associated contraindications can harm the patient.
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After that, the procedure is explained to the patient, and the necessary equipment is gathered.
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The patient is instructed to either sit up or lie down with their head tilted, and the patient is told to hold the emesis basin (shallow basin with a kidney-shaped base) under the ear to collect the solution.
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The outer ear is cleaned with normal saline or irrigating solution.
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The bulb syringe is then filled with the solution, and the ear canal is straightened by pulling the outer ear or pinna in directions down and back for an infant and up and back in the case of adults.
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After that, the solution is injected into the ear canal with a steady and slow stream, and the solution coming out is collected in the basin.
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After that, the cotton ball is placed in the canal, and the patient is asked to lie down on the side of the affected ear and clean the ear using a towel or pad.
At last, the provider will check the canal with an otoscope to see whether all the wax is removed. If the wax is still there after ear irrigation, it can be removed using an instrument called a curette.
What Are the Risks and Possible Complications of Ear Irrigation?
Earwax irrigation is a simple and easy procedure that does not cause complications. However, with any procedure, some complications or risk factors are involved, and the same is in the case of ear irrigation, which includes -
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Bleeding.
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Dizziness.
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Perforated eardrum.
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Pain.
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Tinnitus or ringing in the ears.
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Swimmer’s ear (outer ear canal infection, which runs from the eardrum to the outside of the head).
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Temporary hearing loss.
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Water in the ear canal.
Conclusion:
Ear irrigation can be useful in case of wax build-up in the ear. As wax impaction may cause pain, fullness, itching, or imbalance sensation, all these symptoms can be easily resolved by this procedure. Ear irrigation is a simple and safe procedure and rarely involves any side effects.
