Ears

[nagmeriendaak]

How do you all irrigate ears? Where I work, LTC., we put 2 gtts. of dss in the occluded ear twice a day for 2 days, then irrigate. My problem is Im seldom able to get the cerumen out. What am I doing wrong? What size syringe should I use? What solution? How forceful do I irrigate? And any tips would help. Thank you.

PS, I see some nurses sticking a curette in the ear to dig the wax out. I wont do this, it seems dangerous, especially with an Alzheimer patient who may not hold still and end up with a ruptured ear drum, am I to cautious? Do you recommend this Practice?

[Whispera, MSN, RN]

I've had my own ears irrigated to remove impacted cerumen. A 50cc syringe with rather hot water was used. The water was forced in with LOTS of force, over and over until the cerumen loosened. One ear's cerumen came out on its own. The other ear's had to be plucked out with tweezers, after it softened some.

I can't see someone in LTC holding still for this procedure! It's uncomfy!!

[stidget99]

At a state institution that I used to work at we would do.........

DSS for 4 days f/b irrigation w/ a waterpik.

I once spent several weeks irrigating a co-worker's ears out because she was taking a trip in an airplane. She was very sensitive but we finally got her ears clean as a whistle.

[kaiteeb61]

when i worked in family practice, i used to dread seeing my doctor sneek around the corner and while she teasingly grins, say, 'bilateral, have fun!'

the trick for me would be to squeeze a couple drops of cerumenex or like-product in the ear canal, have the patient lay on the opposite side for 5 mins. then, cut the tip off of an IV cath and put it on the end of a 50cc syringe, that way you can get right in there. fill a basin with equal parts warm water and hydrogen peroxide. put an emesis basin at the side of the ear for the drainage, and to verify what was dislodged. pull the earlobe up and back, then push the fluid with quite a bit of force. always warn the patient of what to expect, ask them to notify you of any dizziness or pain.

i try to avoid using the curette, as it is very easy to cause harm or further impact the cerumen. and often, the inside of an elderly patient's ear can be 'flaky' and you end up trying to remove something that is actually a part of them. tearing the skin, causing sensitivity, etc. i was usually very successful with this method and you'd be amazed at what comes out sometimes! (i.e. pencil lead, corn kernal)

for patients that made no progress with this, i would have them apply the drops before bedtime for two nights, then return for another flush. hope this helps!

[underwatergirl]

Peroxide and/or DSS is what I find to work the greatest...we have curved 10cc syringes that work great, alot of the Techs use the IV tubing cut down, I like a little more force.

Sometimes, it doesn't always work, the earwax loosens but is too stubborn...then an order for eardrops and a recheck in 1-2 wks is in order. We have this happen with some pt.'s...one we irrigated for over an hour of soaking and irrigation, I know crazy PA. We ended up getting a cotton swab(q-tip) out of one ear but the other just wouldn't loosen up...so he did the eardrops and came back and then it came out with irrigation.

Hope it helps,

Annette

[VickyRN, MSN, DNP, RN]

Liquid docusate sodium can also be used in an ear irrigation to loosen and dissolve ear wax. However, you will need a physician order to use this product in this manner...