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Discussion

Ifants and Checking Tympanic Membrane

New NP in family practice. I've noticed that about 60 to 70 percent of infants I see I am unable to full visualize their TM due to earwax. If I'm concerned about otitis media or they have a fever, I usually irrigate it if they are over 1. For the first time I asked a nurse if they could lightly irrigate an ear for 9 month year old and they acted surprise I was asking for such a young age?? Is it not recommended for infants or should I be attempting to use a currette manually if they are under 1? What do you all do in your practice? 

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    One of my concerns is not being very experienced with manual removal, I would be weary of injuring the TM in an infant. Especially since their canals are so small.

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    and we claim that NP are on par with MD LOL

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    I've never claimed that and most NPs I know don't. It's something I've struggled with so I was asking for advice to provide better patient care. In the area I work, if I wasn't here some pediatric patients wouldn't be able to be seen for a week for an acute visit until a week out or have to go to the ER. Most if my clinical experience was with adults 

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    No irrigation for children less than 1 and I don't recommend manual attempts unless your skills are great.  I would seek guidance from your mentor or coworker.  Can also call any ENT office for advice or recommendations.  At times if I am concerned for otitis media and unable to visualize TM on an infant I will treat empirically.  I wouldn't make that a common practice but it is an option you still have.

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