Ear Irrigation Guidelines

Ref CLIN-0074-v1

Status: Approved
Document type: Procedure
Contents
1 Introduction.......................................................................................................3
2 Scope .................................................................................................................3
3 Definition ...........................................................................................................3
4 Responsibility ...................................................................................................3
5 Assessment ......................................................................................................4
When procedure must not be carried out ............................................................ 4
6 Consent .............................................................................................................4
7 Procedure ..........................................................................................................4
Equipment ..........................................................................................................4
Cleaning the Propulse irrigator............................................................................ 6
8 Implementation .................................................................................................7
9 Audit ..................................................................................................................7
10 Related Documents ..........................................................................................7
11 Bibliography......................................................................................................7
12 Document control .............................................................................................8
Appendix 1 –Checklist Prior to Procedure ..................................................................... 9

Ref CLIN-0074-v1 Page 2 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
1 Introduction

This guideline applies to the procedure of ear irrigation in adult patients.

Wax or cerumen is a normal secretion of the ceruminous glands of the outer meatus.
It is only when there is an accumulation of wax that removal may be necessary, when other
methods of removal have failed i.e. ear drops.
A build up of wax is more likely to occur in older adults and people with learning disabilities,
hearing aid users or those who have a narrow external auditory meatus.
Inserting implements into the ear (cotton wool buds) can cause wax to become impacted.
Excessive wax should be removed before it becomes impacted, as this can give rise to tinnitus,
hearing loss, vertigo, pain and discharge.
Ear irrigation is performed to remove excess or impacted wax from the ear.
The procedure should only be performed when the wax becomes troublesome and is affecting
hearing or balance or prior to hearing aid assessments and fittings.

2 Scope

This clinical guideline applies to competent practitioners who have completed a validated course
on ear irrigation and hold a certificate.
The main aim of this document is to set standards in practice to ensure that all service users
receive safe and effective treatment from a practitioner who is competent at ear irrigation.
This procedure must not be performed by staff who have not received the appropriate training at a
recognised centre such as Rotherham Ear Care Centre.

3 Definition

Ear irrigation is the removal of wax from the ear using water via an electronic irrigator.

4 Responsibility

The Executive Director for Nursing and Governance has overall responsibility for ensuring this
guideline is implemented.
There is corporate responsibility for ensuring this guideline is supported by appropriate training,
guideline distribution and awareness and incorporation into the clinical governance agenda, in
terms of audit.

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Ear Irrigation Guidelines Last amended: 24 April 2020
There is an individual responsibility to adhere to professional codes of practice and ensure that
clinical knowledge and competence is maintained.

5 Assessment

Before irrigation is performed a detailed history including any symptoms, previous perforation of
the ear drum and ear surgery is needed.
The ear must be examined by the practitioner before any irrigation is attempted to confirm
presence of wax.
Prior to the procedure the patient must be prescribed olive oil or alternative drops for a minimum of
7 days prior to procedure. Drops for 10-14 days is preferable

When procedure must not be carried out

• If the patient has had mastoid surgery in the past then they must be referred to own GP/
doctor or ENT.
• If the patient has a history of tympanic perforation then the procedure must NOT be
performed.
• Ear infection within last 6 weeks.
• Patient has undergone any form of ear surgery in the last 18 months
• Patient has a history of mucous discharge in last year.

6 Consent

Valid consent is required from the service user. If a service user lacks capacity to consent. Please
refer to the policy for Mental Health Capacity Act 2005 CLIN/009/v1, or seek advice from the
Mental Health Act Team.

7 Procedure

Equipment
• Propulse II or III electronic irrigator
• Single use jet tip applicator
• Head mirror and light
• Otoscope with disposable speculum
• Tap water at 37 degrees
• Jobson Home probe

Ref CLIN-0074-v1 Page 4 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
• Noots trough metal or disposable
• Cotton wool
• Tissues and receivers for dirty swabs and instruments
• Towels and cape
• Goggles
• Disposable apron and gloves
• Waste bag

Step Action Rationale

1 Establish that procedure is required by Ensure that procedure is necessary
examination of both ears

2 Obtain consent Ensure consent if valid

3 Explain procedure to patient Ensure informed consent and

understanding and improve compliance
with procedure.

4 Wash hands thoroughly Reduces risk of infection transfer

5 Place protective cape/paper towel / towel on Protect patients clothing

patients shoulder under ear to be irrigated.

6 Ask the patient or member of staff to hold the To collect water and avoid spillage
receiver under the ear.

7 Apply headlight and switch on Aid vision of the ear and wax

8 Check the temperature of the water and fill To ensure correct temperature and
reservoir of the irrigator prevent injury or discomfort

9 Connect a new jet tip applicator to the tubing In accordance with Universal infection
of the machine until you hear a click. control and prevention precautions

10 Direct the irrigator tip into the receiver and
switch the machine on for 10-20 secs to
circulate the water through the system
Eliminates any cold water or trapped air.
Patient becomes accustomed to the
noise of the machine

11 Irrigation should never cause pain. If patient

complains of pain, stop immediately.

12 Gently pull the pinna upwards and outwards Opens meatus for more clear view
to straighten the external auditory meatus

13 Inform the patient that you are about to start

procedure and advise them to say if they

Ref CLIN-0074-v1 Page 5 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
 experience pain or discomfort from the
procedure. Also to say if the feel unwell so
that the procedure can be stopped.

14 Imagining the ear is a clock face aim the tip

at 11am in the right ear and 1pm in the left
ear.

15 Throughout the procedure continue to Check for trauma and effectiveness of

examine the ear using the otoscope. Also the procedure.
inspect the water that is running into the
receiver

16 A maximum of 2 reservoirs of water to be To prevent any trauma to the ear

used during any one irrigation procedure.

17 Any excess wax that is clearly visible at the

entrance to the canal can be gently removed
using the Jobson Horne probe.

18 If wax has not been removed successfully at

the end of 2 reservoirs, advise patient that a
further course of ear drops required.

19 After removal of the wax, drop mop the Ensure dry and comfortable.
excess water from the meatus under direct
Prevent infection
vision using the Jobson Horne prone and
cotton wool.

20 Examine ear, both meatus and tympanic To check for perforation of the tympanic
membrane. membrane.

21 Results and any injury.

Refer to GP/Doctor if necessary.

22 Wash hands thoroughly

23 Give advice re future ear care Prevent reoccurrence

24 Document findings and procedure as per Adherence to Trust policy

trust policy.

Cleaning the Propulse irrigator

The machine must be cleaned each day before use.
• Make up a Chlorine solution 1000 ppm using Chlor-clean tablets and fill the water tank with
the solution.
• Run the machine for a few seconds to allow the solution to fill the pump and flexible tubing

Ref CLIN-0074-v1 Page 6 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
• Leave to stand for 10 minutes. Empty the water tank, then rinse the system thoroughly with
tap water before use.

At the end of the day or ear irrigating session, turn off the electrical supply
• Make up solution as above and repeat steps above.
• Dry thoroughly
• Always follow manufacturers guidelines and annual servicing of irrigator to be completed

8 Implementation

Managers and Heads of Service should ensure that only qualified staff who have been trained and
competent in this procedure perform ear irrigation.
This training is not available from the education department of the Trust but needs to be accessed
externally from institutions like Rotherham ear care centre.

9 Audit

The practitioner is responsible for maintaining their competence in the procedure and this should
be reviewed annually at appraisal.

10 Related Documents

• Medical Devices and Clinical Procedures Policy CORP/0008/v2

• Minimum standards for clinical record keeping CORP/0031/v5
• Physical healthcare assessments of patients, (admission, annual and ongoing ) CLIN/0052/v2
• Policy for consent to Examination or Treatment CLIN/0001/v3
• Standard (universal) infection prevention and control precautions IC/0002/v3.

11 Bibliography

Rotherham ear care centre (11.8.11) online http://www.earcarecentre.com/

Ref CLIN-0074-v1 Page 7 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
12 Document control

Date of approval: 7 December 2012

Next review date: 31 September 2020

This document replaces: N/A

Lead: Name Title

Lesley Chapman Nurse Consultant

Members of working party: Name Title

Lesley Chapman
Vanessa Omoni
Cheryl Watson

This document has been Name Title

agreed and accepted by:
(Director) Elizabeth Moody Director of Nursing and Governance

This document was approved Name of committee/group Date

by:
Quality Assurance 7 December 2012
Committee

An equality analysis was March 2012

completed on this document
on:

Change record

Version Date Amendment details Status

1 7 Dec 2012 New document Published

1 4 May 2016 Full review – no changes needed. Content published

transferred to new template. Review date
extended 3 years

1 08 Aug 2019 Extended till 31 October2019 to allow review of Published

doc

1 24 April 2020 Review date extended to 31 September 2020 Published

Ref CLIN-0074-v1 Page 8 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
Appendix 1 –Checklist Prior to Procedure

IMPORTANT INFORMATION FOR THE PATIENT TO READ AND INFORM THE NURSE
ABOUT, PRIOR TO HAVING THEIR EARS IRRIGATED

NB irrigation may cause slight discomfort but should never cause pain.
If the patient complains of pain stop immediately.

Name ................................................................................. D.O.B...........……

Past history Comments

Previous problem following ear

syringing/irrigation

Previous ear perforation

Any previous ear surgery e.g.

mastoidectomy

Discharge from the ear

Current or recent ear infection

Catarrh or cold

Pain in your ear

Ear infection within last 6 weeks

History of mucous discharge within last

year

Permanent or new deafness in either ear

Ref CLIN-0074-v1 Page 9 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020
Presence of unsoftened wax

Hearing aids worn or planned for hearing

aids

Foreign body in situ

Use of olive oil appropriately for a

minimum of 7 days

Tinnitus is not a reason to not irrigate the ears as it does not worsen tinnitus.

Ref CLIN-0074-v1 Page 10 of 10 Ratified date:7 December 2012

Ear Irrigation Guidelines Last amended: 24 April 2020