Trick of the Trade: Ear Irrigation in the Emergency Department
Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.1 Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.2 In this trick of the trade, we present a low cost and effective way of “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.
Trick of the Trade:
Syringe and angiocatheter ear irrigation setup
- 14 or 16 gauge cannula (needle removed and tip trimmed)
- 20 mL syringe
- Body temperature saline
Steps: Remove the IV needle and cut the cannula tip to remove shorten angiocatheter length. Prepare a bottle or basin of saline at a physiological temperature. Connect the syringe to the cannula and irrigate as needed. Attempt to irrigate in all directions if trying to dislodge cerumen or foreign bodies.
- Consider using a kidney-shaped small emesis basin to catch the fluid as it drips out of the ear.
- It is important to have water slightly warm (at body temperature) as cool water causes vertigo/nystagmus, nausea, and possibly vomiting. This can be seen in this video as utilized in the caloric reflex test.3 (Remember COWS from med school? Cold/opposite, warm/same.)
- Pro tip: Also works well as a low cost water gun. Temperature of liquid in this scenario is provider-dependent.
This set up for irrigation has been evaluated in the literature. Kumar et al looked at the pressures generated using this technique in vitro and found it appropriate for use in patients without increased risk of tympanic membrane perforation.4 The pressures generated do not exceed the pressure needed to cause perforation.
Expert Peer Review
See the EPR below by Dr. Jonathan Bronner with his 3 additional clinical tips.
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