Cerumen Impaction: Introduction and Supplies

00:01 Hello, my name is Glenna and I'm a family nurse practitioner, and one of the skills that I feel like I have done a thousand times as a family nurse practitioner is ear irrigation. As an advanced practice provider student, you may not get the chance to see or practice this skill.

00:17 In this video, I'm going to share my tips and tricks to make this comfortable for you and the patient. Depending on your practice, it might be something you do all the time or delegate to a licensed provider in your supervision.

00:31 There are some things that you can do right and wrong about this skill, so it's important to know your anatomy and learn the steps.

00:40 Patients may need this procedure for a variety of reasons.

00:44 They may ask specifically, knowing is an issue for them.

00:49 You do a regular exam and you see cerumen in the ear canal.

00:54 That's blocking your visibility to be able to see the tympanic membrane, or they report to you that their loss of hearing over time.

01:02 And this actually triggers the exam and the visit for today.

01:06 Before I talk you through the steps and show you a removal, let's begin by reviewing the inner and outer anatomical structures of the ear.

01:15 I think it is important to do this because when you perform an ear flush and don't get anything back, there has to be a reason why.

01:23 First, let's think about where the cerumen develops and where it builds up.

01:28 So typically you're going to see cerumen in the ear canal.

01:32 And this is okay to have it there.

01:34 That's where it's supposed to be.

01:35 However we don't want it impacted or so severe that you cannot see through to the tympanic membrane. Signs and symptoms your patients may report to you may be ringing in the ear.

01:47 They may complain of hearing loss or sometimes even dizziness.

01:53 As with any procedure, there are supplies and steps to know.

01:56 I will talk you through the steps and then show you the procedure itself.

02:00 As always, I will give you some insights along the way.

02:06 Patient consent. Before doing anything to someone, we always want to explain what we're going to be doing before we do it, and we want to tell them what the final goal is.

02:17 We're going to explain that we're going to be flushing out the ear, that this should not cause any harm to them or pain, but they should be able to hear better or not have the dizziness or ringing in the ear.

02:30 I want to remind you again that this procedure should not hurt.

02:34 So emphasize this to the patient to let you know if they have any pain while you're doing this procedure. While this is considered a minimally invasive procedure, it typically only requires verbal consent and not a separate written consent form.

02:49 However, you want to follow the policies of your institution.

02:54 You want to perform an otoscope examination to confirm impaction and visualize the ear canal.

03:01 You want to examine both ears to compare the anatomy and determine if you have bilateral impaction. Some reasons why you would not want to remove or possibly refer to an ear, nose and throat doctor: if they have a history of tympanic perforation or surgery, and stable diabetes and active infection in the patient who is immune compromised, or if they currently have otitis externa or media.

03:30 And also if you're dealing with children, if they have tubes in the ears, you would not want to perform this because the procedure can take some time.

03:40 If you have an exam table that you can lay back or allow the patient to lay on their side, this is preferred. But most of the time your patients are going to sit upright on your exam table. If you have the time and opportunity, you may want to apply some pre -softening drops.

03:56 And you may say to yourself, what is that? You can use a c olace capsule and squirt a little bit in each ear and put a cotton ball in after it.

04:08 Here is a list of supplies I generally use.

04:11 Gloves, face mask or goggles, gown if irrigation plan, 50 cc syringe with flexible plastic tip.

04:21 I want to let you know there are several supplies you could use for this ear irrigation.

04:27 You could use the syringe.

04:28 You could also use an apparatus like we're going to use today, which is going to just have a trigger mechanism.

04:34 There is also commercial ear irrigation as well.

04:38 You want a basin or this one is actually specially made for the ear to fit within for the water to flow into as well. You want to make sure that water is body temperature.

04:50 You also want to make sure you have the cotton balls, the gauze, ear wax softening drops which we have already talked about.

04:58 And you also want to use 50% water and 50% hydrogen peroxide.

05:04 And you also want to make sure that you have a curette available as well.