Ear Wash

• Indications:

1. Wax accumulation.

2. Otomycosis.

3. Foreign body in the external auditory canal: animate after it is killed or inanimate which does not swell with water.

4. Caloric test.

• Contraindications:

1. Impacted or large vegetable foreign body in the external auditory canal.

2. Tympanic membrane perforation (traumatic or dry).

3. Otitis externa.

4. A fistula between the middle and inner ears  labyrinthitis.

• Technique:

1. Use special syringe for ear wash.

2. Use warm sterile water at body temperature (37 C).

3. Pull the auricle by the left hand upwards and backwards to straighten the meatus.

4. Direct the nozzle upward and backward.

5. Be gentle and careful.

Figure 24: Ear wash.

• Complications:

1- Traumatic:

• Injury of the canal skin by the syringe due to sudden patient movement or by very hot water.

• Rupture of the tympanic membrane due to forcible jet of water directed toward the tympanic membrane . The patient feels sudden pain, hearing loss, tinnitus, slight bleeding from ear, and water in his throat.

2- Infective:

• Otitis externa, otomycosis due to use of unsterile water or syringe.

• Otitis media.

3- Reflex:

• Cough or syncope due to stimulation of the vagus nerve.

4- Vertigo and nystagmus:

• Due to caloric (thermal) stimulation of the inner ear by too cold or hot water.

5- Faulty technique ≫ impaction of the foreign body.

Category: ENT Notes