Washing ears from sulfur plugs

The need for a procedure such as washing the ears arises when the excess of a protective wax substance - cerument (earwax) - is not excreted naturally, but accumulates in the ear canal.

Indications for the procedure

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

A child may need to flush his ears if there is a foreign body in the ear canal (as evidenced by the child's anxiety and ear odor). [2], [3]

The safest way to wash your ears is with an ENT  doctor - an otolaryngologist .

As a rule, rinsing of the ear from the plug is required, that is, the sulfur plug is removed   from the ear canal with a stream of warm water. It is not always possible to do this the first time: when trying to clean the ears with so-called cotton swabs, the earwax moves deeper along the ear canal and can clog into 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 tympanic membrane, so another purpose of ear washing is to conduct an  otoscopy , that is, to examine the ear for diagnostic purposes, or to conduct a hearing test -  audiometry . Removal of the wax plug is also necessary to inject appropriate medications into the ear. [6]

Preparation

Preparation for washing the ears consists in their examination by an otolaryngologist, taking anamnesis and patient complaints.

On an outpatient basis, a syringe is used to wash the ears - Janet's syringe (100-150 ml) designed for washing and aspiration. [7]

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

Technique ear washing

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

Technique: the patient sits and holds a medical tray under the ear to be washed (where water or solution should drain); the doctor pulls the auricle to straighten the external auditory canal - up and back in adults, down and back in children; the tip of Janet's syringe is inserted into the external auditory canal (while it should not pass more than a third of its length, that is, deeper than 7-8 mm from the external auditory opening); the stream of solution is directed upwards - along the back wall of the auditory canal. In order for all the liquid to escape, after completing its introduction, the patient must tilt his head over the tray. The ear canal is dried with a gauze napkin. [9]

Doctors-otiatrists ask not to confuse washing with the introduction of antimicrobial or antiseptic drugs into the ear cavity for purulent otitis media. So, washing the ears with Furacilin (0.02% solution) or the use of the antibacterial agent Dioxidin for washing the ear is their infusion through a cannula (special tube) into the middle ear cavity and the tympanic cavity, which is inserted into the tympanic membrane 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 media, gauze turundas soaked with this antiseptic are placed in the external auditory canal.

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

Ear washing at home

At home, a pear for washing ears is most often used - an ordinary rubber or PVC medical syringe (with a capacity of at least 50 ml). It is also possible to flush the ear canal with a large syringe (20 ml) without a needle. The flushing technique is similar to the Janet syringe technique described above.

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

Drops for washing the ears, for example, Aqua Maris Oto (with sea water) or the combined Remo-Wax drops, related to cerumenolytic agents, which are injected directly into the ear - once or twice a day, help soften dry earwax and facilitate its removal from the ear canal. Day for three to five days. And only after that, the ears are rinsed with saline or warm boiled water.

It should be borne in mind that Remo-Wax drops contain benzocaine anesthetic; antimicrobial chlorobutol; turpentine (with a local irritant effect); and paradichlorobenzene (which is a pesticide). This remedy may 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 oil for washing ears: almond, olive, petroleum jelly, which is used in the same way as cerumenolytic drops.

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

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

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

At home, washing the ear with soda will help remove earwax: dissolve a quarter of a teaspoon of baking soda in warm water (no more than one tablespoon). 5-6 drops are instilled into each ear, after 20-30 minutes, the ear canals are wiped, removing the dissolved sulfur.

Contraindications to the procedure

Experts note such contraindications for ear washing as:

• perforation of the tympanic membrane , including not diagnosed (in the presence of discharge from the ear of a serous or mucous nature);
• earache;
• middle ear infection - otitis media (including recurrent), otitis externa;
• ear surgery within the previous 12 months;
• vertigo (dizziness), which can be a symptom of middle ear disease with perforation of the tympanic membrane;
• edema of the external auditory canal;
• fistula of the external auditory canal;
• one-sided deafness (the only hearing ear cannot be washed);
• inflammation of the mastoid process of the temporal bone (mastoiditis) or undergoing surgery on the mastoid process.

The fact that washing the ear for otitis media is contraindicated does not mean that it is impossible to carry out therapeutic procedures using antiseptics and local antibiotics 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 media.

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

Consequences after the procedure

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

ENT doctors do not deny that there are negative consequences and complications after washing the ears, 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, tinnitus, hearing loss, dizziness, then this may also indicate a violation of the integrity of the tympanic membrane;
• external otitis media - inflammation of the ear canal due to its injury;
• otitis media - if the ear hurts after washing.

If the tinnitus persists, and the ear pain becomes worse, 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 carried out ear washing from sulfur plugs, which did not entail complications, guarantees good patient reviews. 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 rinses. For example, there are complaints that the Dolphin preparation got into the ear when rinsing, which caused its congestion and pain. This means that the procedure was performed incorrectly, and the fluid could enter the middle ear cavity through the Eustachian tube.