Aural syringing

Aural syringing:

This procedure helps in

1. Removal of wax from the ear

2. Clean up the external auditory canal fungus

3. To remove non hygroscopic ear foreign bodies

The capacity of aural syringe is about 120 ml or 4 ounces. Aural syringes are commonly manufactured as metal syringes which can be sterilized and reused. Plastic disposable aural syringes are also available.

Temperature of water used for syringing should be of body temperature. It should neither be too hot nor too cold. Temperatures lesser / greater than that of body temperature would stimulate the labyrinth causing giddiness.

While syrining the nozzle of the syringe must be directed towards the roof of the external auditory canal and should not be directed towards the posterior canal wall because it could stimulate vagus nerve which innervates the posterior canal wall. Stimulation of vagus nerve could cause giddiness and fainting of the patient.

Precautions to be taken before aural syringing:

Full clinical history should be obtained from the patient which include:

H/O

Pain in the ear or surrounding area

Hearing deficit

Dizziness

Ear problems during childhood

Tinnitus

Allergies / itching / discharge

Any other ENT problems

Any previous history of ear syringing and its effect on the patient

Procedure:

The patient should be comfortably seated in front of the examiner.

The procedure should be explained in detail to the patient.

If the patient is a child then its confidence should be won by allowing the child to handle the syringe prior to use

The patient should be properly draped with water proof sheets to avoid dress from becoming wet.

The patient should have used cerumen softeners adequately

The pinna should be inspected for lesions / discharge

The auricle should be moved up and down to check for presence of tenderness

Press behind and around the ear to check for tenderness

The syringe should be filled with warm water which is at body temperature (37 degrees centigrade)

Check to ensure that the nozzle is tightly secured

If using propulse air should be expelled from the tubing

Instruct the patient (if able) to hold the kidney tray under the ear. This will enable the patient to take his / her attention away from the procedure. If the patient is not able to do it then assistance can be sought for.

Straighten the ear canal while controlling the water jet. The nozzle should be aimed upwards and backwards. Water should stream along the roof of the meatus and flow out along the floor of the external meatus.

Lowest effective pressure should initially be used (pilot syringing). If the patient is comfortable then pressure can be increased

The external canal and the kidney tray should periodically be inspected during the entire process.

It is advisable not to use more than two aural syringes full of water in a single procedure. The procedure should not last for not more than 2 minutes.

After wax and debris has been removed the ear canal is mopped dry using cotton wisps.

The procedure should be stopped if the patient has discomfort or pain

The patient's ear should be checked before sending home.

Contraindications for aural syringing:

1. Ear drum perforation

2. Recent history of middle ear infection

3. In the presence of otitis externa

4. In the presence of hygroscopic foreign bodies