Ear irrigation

When cleaning ear canal, the best quality is ensured when it is performed by medical specialist experienced in ear surgery using observation microscope and aspirator. In addition to cleaning, the ear surgeon is also competent to assess any anomalies of the auditory meatus and middle ear, need for surgical intervention and related risks.

Unfortunately, getting an urgent appointment with ear surgeon may be costly and is rather unlikely under regular health insurance services. A visit to the emergency room usually ends by getting a prescription for ear drops and recommendation to see family physician or medical specialist in a few next days. Waste of time and waste of money! According to common knowledge, making an appointment with a medical specialist through health insurance services reminds of a triple jump:  family physician, waiting time, medical specialist. All that for having someone inject warm water in your ear! Does this really require MD degree or perhaps the skills of a sauna man or firefighter would be enough?

I will teach you how to get rid of cerumen at home! 

If you have ever (even as a baby) suffered from suppurative otitis media, it is recommended to check the condition of eardrums before starting ear irrigation. Normal eardrum is invulnerable when using handheld shower head or 20ml syringe. Scars of eardrum due to otitis media, however, may sometimes be torn during irrigation (even when performed at doctor’s surgery). Perforation of eardrum during irrigation is safe for inner ear and usually does not cause inflammatory complications. People with “perforated eardrums” are not that rare. It does not significantly affect their quality of life. In case of regular earwax, the preferred irrigation procedure uses handheld shower head with massage function.

That allows directing into the ear large amount of water at proper pressure and at the body temperature. Procedure is performed while taking the shower. One of three jets is targeted at the auditory meatus at the distance of 1-3 cm. Shower must not be placed too close to the ear. Fortunately, this is impossible due to different shape of earlobe and showerhead.

Jet should be directed a bit forward and upward, corresponding to the direction of the auditory meatus. When performing irrigation correctly, you will feel that the water reaches deep in the ear “just like previous times at the doctor”. After successful irrigation, water should easily exit from the ear when tilting your head and the “ear unblocks”. First irrigation might not always work. In several occasions, cerumen has hardened and resists the water jet. In that case, the ear remains blocked and squelches. Place a swab or earplug in the auditory meatus and wait for a couple of hours. During that time, the water that was left in the ear will soften cerumen and the next irrigation is usually successful. In case of narrow auditory meatus, lacking skills and hard cerumen, several irrigations might be required. I recommend performing irrigation on a holiday or in the afternoon. If the procedure is unsuccessful and you lose patience, it is always possible to pay a visit to the medical institution. Medical staff will most likely be grateful deep down, because pre-soaked earwax is much easier to remove than rock-hard cerumen! The only serious complication is the tear of inflammation scars of eardrum, which is unlikely and does not involve severe consequences. It is also possible to treat eardrum scars surgically. Should you suffer any damage when following these instructions, I am ready to diagnose and treat them. However, the handheld showerheads with massage function are not always available.

For instance, when you are in Egypt, or at Kalev SPA, the irrigation can be performed by using 20ml plastic syringe. This is what I prefer at my surgery. It uses less water than bigger syringe and the jet is more efficient. Besides mobility, the syringe also allows using treatment solutions, e.g. in case of dermatitis of auditory meatus. Twenty ml syringe has a shape that prevents mechanical and barotrauma in adults, i.e. it is “fool proof”. Using other injectors at home is not safe and thus not permitted! End of the syringe (where needle is attached to) is located off the centre at one end of the cylinder. The end is placed in auditory meatus and is directed to the front (towards nose). The “pouch” at the end of the cylinder sits on the concha, i.e. on the rearward recess in the earlobe, which prevents it reaching too deep in the auditory meatus. Irrigation may be performed “at full speed”, without fear of excess water pressure and possible damage. Rather, problems may be caused by too weak water jet, which requires more repetitions of irrigation procedure to “unblock ear”. Suitable irrigation solution is 1% saline (5g or one heaped teaspoon of salt per half litre of water). Besides water, appropriate solutions include herbal infusions made of herbs that are usually used in skin care products (chamomile, calendula, etc.). In case of inflammation, you may use black tea with tannic properties.  Also, vinegar can be added to the solution, the solution should taste less acidic than lemon juice. Upon suppuration, you can add potassium permanganate, until the solution achieves transparent light purple colour. Ear irrigation has huge advantages over using swab: no trauma, solid contents are softened and made easily removable, water reaches the spots where swab cannot reach.

Aqueous solutions flush microbial toxins, allergens and chemicals from the epidermis. Correct salinity and acidity inhibit microbial growth and calm the skin. However, ear irrigation must create a situation, where, by the end of the procedure, water is drained from the ear, leaving it clean and dry. Sometimes tilting your head is enough to dry the ear. Slightly more complicated, but safe method for removing water from the ear is using twisted cotton “thread” or “rat tail”. Pouring max 60-70% alcohol solution in the ear binds water and quickens the drying process. Alcohol is not suitable in case of acute inflammation, because it hurts! Ears can also be dried by using smaller enema pump. Both blowing and suction are effective. The tip of the enema pump must not enter auditory meatus too tightly. If no other means are available, it is possible to use toothpick with pointy tip broken off (because it is much thinner than “usual earpick”) and a thin layer of cotton coiled on the narrow end to cover sharp end. Thin cotton layer should continue along the toothpick, because it ensures better absorption and prevents cotton from being stuck in the ear. When drying ear with toothpick, avoid any accidental impact against hand. Sit so that the ear is directed towards the corner of the room. Make sure there are no children or animals around. If the cotton detaches and remains in the ear, it can usually be removed by irrigation and/or thin crochet hook. If you have had recurrent problems with cerumen, pay a visit to an ear surgeon. In case of auditory meatus anomalies, the problems can be eliminated by surgical procedure and there are instances where this is worth consideration.

Start using eardrops (Cerustop, Vaxol, etc.) on a regular basis. It is particularly good to oil your ears before

visiting a SPA or diving in the Mediterranean Sea. Chlorine and soap water procedures should always end

with ear irrigation.

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