ear, nose, and throat disorders
How To Remove Cerumen Manually and With Irrigation
Step by Step Description of Cerumen Removal
Consider doing a pre-procedure screening bedside hearing assessment. Advise the patient not to move the head, to minimize any trauma that could result from a sudden movement while an instrument is in the ear canal. During an examination of the canal or cerumen removal, gently pull (or have an assistant pull) the pinna up and backward (for adults) or down and backward (for children), to straighten the canal as needed. Patients may experience some discomfort, but you must stop the procedure if the procedure becomes painful and reexamine the ear for signs of injury. Soft cerumen is removed effectively using irrigation and/or spoonlike instruments, or curettes. Hard cerumen is more easily removed with cerumen loops and small ear hook instruments. Suction removal is useful for very soft cerumen and small cerumen fragments but not for a large, hard, or impacted cerumen plug. Irrigation is done only if there are no risk factors for perforation. Instill a cerumenolytic and allow it to work for 15 to 30 minutes. Fill the syringe with irrigation solution. Insert the irrigation tubing only about 0.5 cm into the canal and not beyond the hair-bearing skin that defines the cartilage-bone (of the skull) junction. Have an assistant or the patient hold the emesis basin snugly under the ear to catch the irrigant. Direct a moderate-pressure stream of water around the cerumen or superiorly; the cerumen can then be propelled out by the water accumulating behind it. You may need to make multiple attempts. If you can see the tympanic membrane and it is intact with some retained irrigant, you can instill a few drops of isopropyl alcohol after irrigation to hasten water evaporation. If there are no risk factors for perforation, consider instilling a cerumenolytic and allowing it to work for 15 to 30 minutes. Use instruments under direct visualization; insert them through the procedure head of the otoscope and speculum. Remove cerumen using suction or a curette (for soft cerumen) or a loop or hook (for firm cerumen). If needed, extract cerumen using an alligator forceps. 