Cerumen Impaction: Procedure

00:01 He wanted to position the patient sitting upright with head tilted 50 to 30 degrees toward the opposite shoulder. Straighten the ear canal gently by pulling the pinna up and back in adults, and down and back in children.

00:17 For manual removal, use a cerumen spoon or a curette under the direct visualization.

00:24 That means you're going to be using your otoscope to actually see what you're going to be removing.

00:30 Enter the canal only as far as you can clearly visualize.

00:34 Remove wax with a gentle scooping motion and toward the external canal.

00:39 For irrigation, use warm solution to the body temperature.

00:43 Use 20 to 50 cc syringe or bottle with a flexible plastic tip which we have here, or a commercial irrigation.

00:53 You want to provide a direct stream along the canal wall, not directly at the tympanic membrane, and allow the water to flow out naturally.

01:03 Between attempts, you want to reexamine with the otoscope to assess progress and ensure no trauma has occurred. Stop if patient experiences pain or extreme vertigo, as we discussed earlier, they may have a little vertigo before even starting the procedure. After removal, examine the tympanic membrane to confirm complete visualization and assess for any abnormalities.

01:29 Now we're going to perform the procedure.

01:31 We have Brandon in front of me.

01:33 How are you doing today? Great. Thank you.

01:35 Good. Um, you came in today because you were having a little bit of hearing loss.

01:40 And so I need to look in actually, your ear canals, both ear canals, and see what's going on.

01:46 I f it's what I suspect, which is ear impaction with cerumen, then we're going to need to irrigate that out so you can hear better again.

01:54 It's a painless procedure.

01:56 It really should not cause any pain or discomfort.

01:59 It may feel a little funny, but we're using warm water.

02:02 You let me know that if you have any pain at any point, whether I'm using the Otoscope or the irrigation kit.

02:08 Is that okay? Yes.

02:09 All right, let's begin. Now I have my otoscope and I'm going to look in your ear canal.

02:15 You're going to feel me pulling up on your ear.

02:17 But this gives me better visual to be able to look at your ear canal.

02:27 And I can see that you have cerumen in your ear canal.

02:30 So we're going to need to irrigate that and see if we can get that clear.

02:34 Is that okay with you? Yep.

02:36 All right. I'm going to leave my tip on my otoscope because I'll be using it again.

02:42 After I do a little bit of irrigation.

02:43 I'm going to look in. His earwax appeared moist, so I don't think I'll have any difficulties being able to remove the earwax.

02:51 However, if it was hardened, I would want to use a clay tablet and let it sit for 15 to 20 minutes to see if it gets soften.

02:59 Brandon, I'm going to need a little help from you. Okay.

03:02 I'm going to need you to kind of tilt your head over to the side.

03:06 And if you wouldn't mind holding this ear dish while I irrigate your ear.

03:11 Remember that you want to put the tip away from the tympanic membrane, but in the ear canal, as you're washing, you're going to gently press in and begin to squirt. I'm sure that feels a little weird.

03:27 And I'm sorry. Okay, now that we've done a little bit, let me now see how much we have removed and see if we need need of further irrigation.

03:37 So I'm going to grab my otoscope again and we're going to look back in the ear canal.

03:49 The earwax now has been removed, so I think we're in good shape.

03:54 Brandon, how does that feel? Can you hear better out of your ear? I can.

03:59 I'm so glad that that's working better for you.

04:02 Now, let's try a little whisper test to see if you can hear.

04:05 Okay, I'm going to have you take your right hand and occlude your ear for me.

04:10 And I'm going to go behind you, and I'm going to whisper a word, and I want you to tell me what I said. Okay? "Peanut butter" What word did I say? Peanut butter.

04:23 Yes. Great. Well, I think we've resolved your problem.

04:27 Thank you for coming in today.

04:29 Thank you.