Earwash for wax plugs

The need for a procedure such as ear rinsing arises when excess protective wax – cerumen (earwax) – is not removed naturally, but accumulates in the ear canal.

Indications for the procedure

The main indications for ear irrigation may include complaints of discomfort, noise and ringing in the ears; itching in the external auditory canal; ear congestion and hearing loss; reflex cough. [ 1 ]

A child's ears may need to be washed if there is a foreign body in the ear canal (as evidenced by the child's anxiety and the appearance of a smell from the ear). [ 2 ], [ 3 ]

The safest way to have your ears washed is by an ENT (otolaryngologist).

As a rule, earwax needs to be flushed from the plug, that is, the wax plug is removed from the ear canal with a stream of warm water. This is not always possible the first time: when trying to clean the ears with so-called cotton swabs, the earwax moves deeper along the ear canal and can get clogged in the eardrum, which causes discomfort and hearing loss. [ 4 ], [ 5 ]

In addition, the accumulation of cerumen and dead skin cells in the external auditory canal makes it difficult to visualize the eardrum, so another purpose of ear irrigation is to perform otoscopy, that is, an examination of the ear for diagnostic purposes, or to perform a hearing test - audiometry. Removal of the earwax is also necessary for the introduction of appropriate medications into the ear. [ 6 ]

Preparation

Preparation for ear lavage consists of examination by an otolaryngologist, collection of the patient's medical history and complaints.

In outpatient settings, a syringe for ear irrigation is used - a Janet syringe designed for irrigation and aspiration (capacity 100-150 ml). [ 7 ]

There are also more modern methods of performing this procedure. For example, the Hygrotherm Plus Atmos device or electric device for washing ears (with a heating and water supply system), as well as a professional irrigator for washing ears of various models (Propulse HG, Chammed XCI7, Chammed CMEI 100, Charly Otopront). [ 8 ]

Technique earwashes

In case of sulfur plugs, the ears are washed with water (boiled or distilled), the optimal water temperature for washing the ear is +36-37°C. The saline solution for washing the ears should be the same temperature - a sterile 0.9% aqueous solution of sodium chloride.

Technique: the patient sits and holds a medical tray under the ear being washed (where the water or solution should flow); the doctor pulls the auricle to straighten the external auditory canal - up and back in adults, down and back in children; the tip of the Janet syringe is inserted into the external auditory canal (however, it should not go more than a third of its length, i.e. deeper than 7-8 mm from the external auditory opening); the stream of solution is directed upward - along the back wall of the ear canal. To ensure that all the liquid comes out, after its introduction is complete, the patient should tilt his head over the tray. The ear canal is dried with a gauze napkin. [ 9 ]

Otologists ask not to confuse rinsing with the introduction of antimicrobial or antiseptic drugs into the ear cavity in case of purulent otitis. Thus, rinsing the ears with Furacilin (0.02% solution) or using the antibacterial agent Dioxidine for rinsing the ear is pouring them through a cannula (a special tube) into the middle ear cavity and the tympanic cavity, which is inserted into the rupture of the eardrum or through a puncture made in it (paracentesis). In this case, the exudate or pus accumulated in the middle ear cavity is removed by aspiration. [ 10 ]

Do not rinse the ear with Miramistin: in cases of purulent otitis, gauze turundas soaked in this antiseptic are placed in the external auditory canal.

When sulfur plugs form, it is not advisable to rinse the ear with Chlorhexidine, which is a surface-active disinfectant. Chlorhexidine bigluconate dries out the skin in the ear canal, and if perforation of the tympanic membrane is not diagnosed, its entry into the middle ear cavity can lead to damage with hearing loss. [ 11 ]

Ear irrigation at home

At home, a bulb ear rinsing bulb is most often used - a regular rubber or PVC medical syringe (with a capacity of at least 50 ml). Also, rinsing of the ear canal can be done with a large syringe (20 ml) without a needle. The rinsing technique is similar to the technique of using a Janet syringe, described above.

For adults and children over 2.5 years old, you can use the ear rinsing solution A-Cerumen (A-Cerumen Neo) with surfactants, which is used twice, 1 ml each, for three days, followed by rinsing the external auditory canal with water or saline. [ 12 ]

Softening dry earwax and facilitating its removal from the ear canal are facilitated by ear rinsing drops, such as Aqua Maris Oto (with sea water) or combined drops Remo-Wax, which are cerumenolytic agents and are administered directly into the ear - once or twice a day for three to five days. And only after that, the ears are rinsed with a saline solution or warm boiled water.

It should be noted that Remo-Vax drops contain the anesthetic benzocaine; chlorbutol, which has an antimicrobial effect; turpentine (with a local irritant effect), and paradichlorobenzene (which is a pesticide). This product can cause a burning sensation in the ear canal, redness, swelling and pain in the ears, nausea, vomiting and dizziness.

It is much safer to soften earwax with natural ear washing oil: almond, olive, petroleum jelly, which is used in the same way as cerumenolytic drops.

By the way, a solution of hydrogen peroxide (3%), a solution of boric acid (2%) and a 15% solution of sodium bicarbonate (baking soda) can also soften earwax.

In the full sense of the word, it is not a washing of the ears with hydrogen peroxide, but the instillation with a pipette (three drops) of a mixture of hydrogen peroxide solution with boiled water (1:1), which is removed after five minutes by tilting the head in the opposite direction, and the auricle is blotted with a napkin. The other ear is treated in the same way. But frequent use of hydrogen peroxide can lead to irritation of the skin inside the ear.

Similarly, washing the ears with boric acid, read more - Boric acid and boric alcohol for otitis

At home, earwax can be removed by rinsing the ear with soda: dissolve a quarter teaspoon of baking soda in warm water (no more than one tablespoon). Put 5-6 drops in each ear, and after 20-30 minutes, wipe the ear canals, removing the dissolved wax.

Contraindications to the procedure

Experts note the following contraindications to ear rinsing:

• perforation of the eardrum, including undiagnosed (in the presence of serous or mucous discharge from the ear);
• ear pain;
• middle ear infection – otitis media (including recurrent), otitis externa;
• ear surgery within the previous 12 months;
• vertigo (dizziness), which may be a symptom of middle ear disease with perforation of the eardrum;
• swelling of the external auditory canal;
• fistula of the external auditory canal;
• unilateral deafness (the only hearing ear cannot be washed);
• inflammation of the mastoid process of the temporal bone (mastoiditis) or previous surgery on the mastoid process.

The fact that ear irrigation is contraindicated for otitis does not mean that it is impossible to carry out therapeutic procedures using antiseptics and local antibiotics, carried out on an outpatient basis for chronic purulent otitis media, which is accompanied by discharge from the ear (otorrhea) through a perforated eardrum, as well as in the case of external or diffuse otitis.

Details in the publication - How to treat acute and chronic purulent otitis

Consequences after the procedure

Many people experience unpleasant sensations after ear rinsing and temporary discomfort in the ears. Some patients complain that water remains after ear rinsing, and complaints of ear congestion after rinsing are possible.

ENT doctors do not deny that there are negative consequences and complications after ear washing, and they can manifest themselves:

• perforation of the eardrum with minor bleeding, that is, when blood appears after washing the ear; if after washing the ear there is tinnitus, hearing loss, dizziness, then this may also indicate a violation of the integrity of the eardrum;
• external otitis - inflammation of the ear canal due to injury;
• otitis media - if the ear hurts after washing.

If the tinnitus does not go away and the ear pain becomes stronger, you should immediately contact an otolaryngologist. It is in cases of the above complications that care and rehabilitation after the procedure may be required.

Professionally performed ear rinsing from earwax plugs, which did not entail complications, guarantees good feedback from patients. It is difficult to judge how this procedure is handled at home.

Some people begin to experience discomfort in their ears even when using various solutions and pharmacy liquid nasal lavage products. For example, there are complaints that the Dolphin preparation got into the ear during lavage, which caused congestion and pain. This means that the procedure was performed incorrectly, and the liquid could get into the middle ear cavity through the Eustachian tube.