consider ear irrigation using an electronic irrigator, microsuction or another method of earwax removal (such as manual removal using a probe) for adults in primary or community ear care services if:
the practitioner (such as a community nurse or audiologist):
has training and expertise in using the method to remove earwax
is aware of any contraindications to the method
the correct equipment is available
do not offer adults manual syringing to remove earwax
when carrying out ear irrigation in adults:
use pre-treatment wax softeners, either immediately before ear irrigation or for up to 5 days beforehand
if irrigation is unsuccessful:
repeat use of wax softeners or
instil water into the ear canal 15 minutes before repeating ear irrigation
if irrigation is unsuccessful after the second attempt, refer the person to a specialist ear care service or an ear, nose and throat service for removal of earwax
contraindications include:
recent trauma
foreign bodies in the external auditory canal (2)
vertigo (2)
perforated ear drum
recent otitis externa
otitis media
previous middle ear/mastoid surgery (having miringotomy tube)
radiotherapy to the area (2)
only hearing ear (3)
in these cases the patient should not be syringed and should be referred for dewaxing under direct vision (3)
complications
a study examining ear syringing in UK general practice estimated that the rate of complications requiring specialist referral was about in 1/1000 ears syringed (3):
these complications included
perforation
canal lacerations
failure of wax removal
otitis externa
criteria for referal include (2):
persistant severe pain following attempted removal
if irrigating with water at body temperature causes vertigo
referal should also be considered when there is
oedema of ear canal, abnormal anatomy
history of tympanic membrane perforation,surgery, radiation
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