Ear Syringing

 

When to be cautious about Ear Syringing ?

A history of ear disease or insertion of grommets is not necessarily a contraindication to syringing. However it is not sufficient to assume that the drum is sound and capable of withstanding syringing because there have been no symptoms for years. The practitioner must be satisfied that the drum has healed soundly.
A good history and examination is necessary as in all good medicine.

Traumatic perforation of the drum is the commonest injury. There is good evidence that the pressure produced by syringing is insufficient to rupture a healthy drum but easily sufficient to rupture a drum which has been weakened. A weak segment may occur as a consequence of a healed perforation, recurrent infections, or previous grommets which may leave a thin scar.

Syringing may worsen otitis externa especially if the net result of the syringing is to give the debris trapped in the deep canal a good soaking and thereby exacerbate infection.

Very narrow ear canals are difficult to syringe, there being a risk that the nozzle of the syringe will fully seal the canal. Under these circumstances, it is not possible for injected water to drain and the consequence is very high pressure on the ear drum. Narrow ear canals occur in young children, Down's syndrome and some adults.

CONTRA-INDICATIONS

The presence of a perforation is a definite contra-indication. The Inner ear can be damaged severely if an ear with a perforation is syringed.

Retraction pocket or a cholesteatoma
are conditions in which syringing may precipitate a severe infection, even possibly acute mastoiditis.

Previous Tympanoplasty procedures.


Conditions which need to be carefully considered as relative contra-indications include:

• Previous injury from syringing
• A stated aversion to syringing.
• Previous or current history of middle ear disease.
• Previous history of ear surgery
• Severe otitis externa
• Occluding aural exostoses
• Very narrow ear canals
• Children under 12 years of age
• Foreign bodies, especially sharp objects and dried vegetable matter.
• If it is the only hearing ear
• Severe hearing loss
• Known inner ear disturbance especially if characterised by severe vertigo.
• Uncooperative patients
• Keratosis obturans
• History of radiation therapy which includes external or middle ear, skull base or mastoid.

 

EAR SYRINGING PROTOCOL

(© Whangarei Healthcare Ltd. 1999)
Reviewed and approved by ENT Specialists Mr J. St. C. Gathercole and Mr C. J. Seeley on 31 August 1999.


First

ALL PATIENTS SHOULD BE MEDICALLY ASSESSED TO EXCLUDE OTHER SIGNIFICANT CAUSES OF SYMPTOMS BEFORE PROCEEDING WITH EAR SYRINGING FOR WAX.
DO TAKE A CAREFUL OTOLOGIC HISTORY AND EXAMINE THE EAR CAREFULLY BEFORE RECOMMENDING SYRINGING

DO NOT SYRINGE EARS IN:

• ACUTE STAGES OF OTITIS MEDIA

• OTITIS EXTERNA WHERE THE CANAL IS SWOLLEN

• KNOWN INNER EAR DISTURBANCE especially if characterised by vertigo

• PAST HISTORY OF GROMMETS OR OTHER EAR SURGERY.

• WHEN A FOREIGN BODY IS PRESENT

• WHEN PERFORATION OF THE EARDRUM CANNOT BE EXCLUDED.

IN THESE CASES WAX SHOULD BE CLEARED WITH SUCTION, A HOOK, OR CURETTE UNDER DIRECT VISION BY APPROPRIATELY TRAINED PERSONNEL.

 

Technique:

Sit patient in comfortable position and explain procedure
Obtain standard battery powered otoscope. Use largest size speculum that will comfortably fit in patients ear canal. Carefully check ear canal and ear drum.
Assemble equipment. Check that equipment is clean and in good working order.
Use water at body temperature (excessively hot or cold water can precipitate vertigo and nausea).
Ask patient to hold appropriate receptacle under ear to collect water
Adults - gently pull pinna slightly upwards and backwards to straighten canal.
Children - gently pull pinna horizontally and backwards to straighten canal
Direct nozzle of syringe just inside the auditory meatus, angling slightly upwards and backwards
Gently direct water along roof of canal
Stop immediately if any pain, faintness or vertigo, and reassess
Dry external opening of ear carefully
Reassess ear canal and drum
Wax softener may be required if wax is difficult to clear. Instill and leave for 20 minutes or ask patient to return on another day.


Patient information.

Do not ever use cotton buds to clean ears. 

If any further problems return to the surgery