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Principles of care

Assessment

Before proceeding with any form of invasive ear care, it is important to undertake careful examination of the ear, taking note of any discharge, redness or swelling, and the amount and texture of any ear wax present, as this will give an indication of the general health of the ear. A small amount of wax should be found in the ear canal. Its absence may be a sign of a dry skin condition, infection or excessive cleaning that has interfered with the normal wax production (Harkin 2008).

The nurse should discuss with the patient their current level of hearing and after the procedure they should ask the patient if there are any changes so as to monitor the effectiveness of the intervention.

Consideration should always be given to a patient’s hearing aids and assistance given to help clean these. Advice regarding the most appropriate method should be sought, preferably from the patient.

Patient education should be provided when required to help the patient maintain healthy ears, hearing and balance.

Irrigation of the inner ear is sometimes necessary to remove foreign bodies from inside the ear or to clear excessive build-up of ear wax (cerumen) (Harkin 2007).

Methods of ear wax softener use

Due to the invasive nature of ear irrigation, it is advised that the patient first tries using wax softeners such as olive oil, which may avoid the need for irrigation (Kraszewski 2008). A typical treatment regime for ear wax softening is 2–3 drops of olive oil into the ear over a 5-day period (Aung and Mulley 2002).

Methods of ear irrigation

An electric oral jet irrigator fitted with a special ear irrigator tip is recommended for ear irrigation as the water pressure can be controlled more precisely, along with the direction of the water (Aung and Mulley 2002). The water temperature should be 37°; if too hot or cold, it can cause dizziness or vertigo (Aung and Mulley 2002). The traditional method of irrigation uses a metal water-filled, hand-held syringe but due to the high risk of infection and trauma to the ear, this is no longer recommended practice (Harkin 2008).

Ear irrigation is an invasive procedure that requires good understanding of the anatomy and physiology of the ear and competence with the procedure (Kraszewski 2008). The procedure is undertaken to remove impacted wax which can cause:

some degree of hearing loss

earache

itchiness in the ear

reflex cough

dizziness

vertigo

tinnitus

hearing impairment, which can cause frustration, stress, social isolation, paranoia and depression.

(Aung and Mulley 2002, p.327)

Ear irrigation is not recommended in the following circumstances.

Perforated eardrums.

Middle ear infection in the previous 6 weeks.

Mucus discharge.

In situ grommet.

Cleft palate.

Acute otitis externa with pain and tenderness to the pinna.

History of ear surgery.

(Aung and Mulley 2002, Harkin 2007)

The potential adverse effects of this procedure are:

perforated eardrums

otitis externa

damage to the canal

pain

deafness

vertigo

tinnitus.

(Aung and Mulley 2002)

If irrigation is unsuccessful, further interventions may be necessary, possibly in the form of removal of the wax under direct vision using suction, forceps or probes (Aung and Mulley 2002).

Preprocedural considerations

Specific patient preparations

The patient and nurse should be sitting at the same height to examine the outer ear and pinna (Harkin 2008). Any alteration to the appearance of the ear must be reported to the doctor. Ask the patient to tilt the ear to be treated up to allow the ear drops to reach the middle and inner ears.

Position of light source

A good light source such as a bull’s eye lamp and head mirror or an operating lamp positioned above and behind the nurse is necessary prior to commencing ear care procedures to enable careful assessment of the ears and to avoid damage to the delicate structures (Alexander et al. 2007).

Mouth care

Definition

Mouth care is the care given to the oral mucosa, lips, teeth and gums in