Required instruments [Figure 66]
- Ear syringe
- Kidney dish
- Towel
- Cotton bud
- Cerumen loop
- Cerumen hook
- Otoscope + 6 mm speculum
Figure 66
Procedures
The external auditory meatus can be cleaned in various ways.
Ear syringing
- Fill the syringe with water that is at body temperature (water that is too hot or too cold can cause severe dizziness in a patient)
- Place a towel over the patient’s shoulder and ask them to firmly press a kidney dish against their neck, underneath the ear that is to be syringed.
- With your spare hand hold the upper ridge of the lobule and pull this in an anterosuperior direction [Figure 67].
Figure 67
- Squirt the contents of the syringe into the auditory meatus and aim the jet onto the posterior auditory meatal wall during this procedure. Never squirt directly in the direction of the tympanic membrane: as soon as sufficient cerumen has been removed, the water jet will hit the tympanic membrane with such force that there is a risk of perforation.
- Finally, carefully dry the outer part of the auditory meatus with a cotton bud [Figure 68].
Figure 68
Using a cerumen loop or hook
- If you wish to remove cerumen in this manner, youwill have to look through the otoscope during the procedure to properly see what you are doing and to avoid damaging the auditory meatal wall or the tympanic membrane.
- Slide the retractable lens of the otoscope far enough to the side to allow the hook or loop to be inserted past it [Figure 69].
Figure 69
- Attach a clean ear speculum to the head of the otoscope.
- Ask the patient to grasp the auricle with one hand and to pull it in a posterosuperior direction. Whilst looking through the partly retracted lens, insert the speculum into the auditory meatus [Figure 70].
Figure 70
- When you have a good view of the cerumen plug, slide the loop or hook past the lens through the speculum into the auditory meatus [Figure 71]. Soft cerumen can be removed efficiently with a cerumen loop. If the cerumen is impacted, it is better to use a cerumen hook. The hook should be placed horizontally underneath the hard cerumen. Once you are sufficiently far under the cerumen (careful: you will not be able to see the tympanic membrane, so do not move too far), turn the hook upwards and retract it.
Figure 71
For both the syringing and the cleaning technique using a cerumen loop or hook, it may be necessary to ‘pre-soak’ the cerumen plug. This can be done with standard baby oil. Specially-designed ear drops are also available for this, which have a slightly more powerful soaking effect on the cerumen than baby oil.