Ear pediatricEar irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.1 Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.2 In this trick of the trade, we present a low cost and effective way of  “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.

Trick of the Trade:

Syringe and angiocatheter ear irrigation setup

Equipment needed:

  1. 14 or 16 gauge cannula (needle removed and tip trimmed)
  2. 20 mL syringe
  3. Body temperature saline

 

ear irrigation 3

 

Steps: Remove the IV needle and cut the cannula tip to remove shorten angiocatheter length. Prepare a bottle or basin of saline at a physiological temperature. Connect the syringe to the cannula and irrigate as needed. Attempt to irrigate in all directions if trying to dislodge cerumen or foreign bodies. 

 

IMG_0553

 

Tips

  1. Consider using a kidney-shaped small emesis basin to catch the fluid as it drips out of the ear.
  2. It is important to have water slightly warm (at body temperature) as cool water causes vertigo/nystagmus, nausea, and possibly vomiting. This can be seen in this video as utilized in the caloric reflex test.3 (Remember COWS from med school? Cold/opposite, warm/same.)
  3. Pro tip: Also works well as a low cost water gun. Temperature of liquid in this scenario is provider-dependent.

Safety

This set up for irrigation has been evaluated in the literature. Kumar et al looked at the pressures generated using this technique in vitro and found it appropriate for use in patients without increased risk of tympanic membrane perforation.4 The pressures generated do not exceed the pressure needed to cause perforation.

Expert Peer Review

See the EPR below by Dr. Jonathan Bronner with his 3 additional clinical tips.

1.
Memel D, Langley C, Watkins C, Laue B, Birchall M, Bachmann M. Effectiveness of ear syringing in general practice: a randomised controlled trial and patients’ experiences. Br J Gen Pract. 2002;52(484):906-911. [PubMed]
2.
Jones I, Moulton C. Use of an electric ear syringe in the emergency department. J Accid Emerg Med. 1998;15(5):327-328. [PubMed]
3.
Chris N. Oculocephalic and oculovestibular reflexes. Life in the Fast Lane. http://lifeinthefastlane.com/ccc/oculocephalic-and-oculovestibular-reflexes/. Published 2008. Accessed August 10, 2016.
4.
Kumar S, Kumar M, Lesser T, Banhegyi G. Foreign bodies in the ear: a simple technique for removal analysed in vitro. Emerg Med J. 2005;22(4):266-268. [PubMed]
Chris Belcher

Chris Belcher

EM Resident
Department of Emergency Medicine
Captain, United States Air Force Reserve
Chris Belcher

@seebelcher236

Board certified EM physician. Kentuckian transplant to Texas. Dabble in the running. Air Force and ALiEM AIR keep me busy. WildcatEM alum.
Chris Belcher

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Jacob Avila, MD RDMS

Jacob Avila, MD RDMS

Clinical instructor and Ultrasound fellow
Department of Emergency Medicine
University of Kentucky
Jacob Avila, MD RDMS

@ultrasoundMD

https://t.co/gFS9UMjaJv. University of Ky, Lexington. Ultrasound technologist, Battlestar Galactica. Views are my own.