Healthcare professional irrigating a patient's ear

Step-by-Step Guide to Ear Irrigation

Learn the procedures, steps, risks, and requirements for performing ear irrigation.

Healthcare professional irrigating a patient's ear

Our bodies produce ear wax, clinically known as cerumen, to clean and protect the ear. Wax works in concert with the tiny hairs in the ears to trap dust and other foreign particles that could damage the deeper structures in the ear, such as the eardrum.

Most of the time, our ears are self-cleaning, and the earwax naturally works its way out of the ear. But sometimes that doesn’t happen and the earwax builds. This can create problems with a person’s hearing, lead to ear infections, and cause other problems.

Medical professionals, typically nurses, perform a procedure known as ear irrigation to flush excess ear wax from a patient’s ear. Ear irrigation is one of a nurse’s typical duties.

In this blog, let’s learn how to perform ear irrigation proficiently.

What is Ear Irrigation?

Ear irrigation is a relatively simple procedure. The external ear canal is flushed with sterile saline or hydrogen peroxide solution. Ear irrigation is necessary for patients who complain of a buildup in their ears. This may be impacting their hearing or causing infections and other problems.

What is the Purpose of Ear Irrigation?

The goal of ear irrigation is to soften and remove impacted cerumen or to dislodge a foreign object. A buildup of ear wax can become impacted or completely block the ear canal.

How Long Does it Take to Perform Ear Irrigation?

Ear irrigation happens in your physician’s office. Nurses often perform the procedure. It is a simple process that typically only takes 15-20 minutes for most patients.

Who Performs Ear Irrigation?

A variety of medical professionals can perform ear irrigation. Audiologists may perform it with hearing patients. Medical assistants can perform the procedure if they have specific training. Doctors in all settings can also perform ear irrigation.

Nurses usually do these procedures in any medical setting where the patient has a problem requiring ear irrigation.

What Are the Training Requirements to Perform Ear Irrigation?

No specific certification or testing criteria are required before a nurse can perform ear irrigation. But because there is a slight risk involved with the procedure, some healthcare facilities and systems have created educational modules for their nurses and medical assistants to complete before performing the procedure.

Because education on the anatomy of the ear is part of the training of all nurses, this gives them the information necessary to avoid potential problems such as damaging the eardrum.

Although not a specific section on the NCLEX-RN exam, there is often a question about ear irrigation. Click here if you’d like to know more about the NCLEX-RN exam.

What Equipment is Needed to Perform Ear Irrigation?

These are not complicated procedures requiring few supplies. Here’s the equipment used for ear irrigation:

  • Irrigating solution (typically sterile saline or a hydrogen peroxide mix solution) warmed to 98.6 F or slightly warmer
  • Bulb or irrigating syringe
  • Emesis basin to catch the outflow
  • Cotton-tipped applicators
  • Cotton balls
  • Waterproof pad or towel for the patient’s shoulder

What is the Procedure for Performing Ear Irrigation?

Medical professional irrigating a patient's ear

Sometimes the nurse or doctor looks inside the ear with an otoscope during ear irrigation. This is not necessary during the procedure, although the nurse may want to look to see the progress.

Here are the steps you’ll follow:

  1. Explain what’s going to happen to the patient. For example, patients can be concerned about placing something in their ear and may not be ready for the pressure of the syringed solution.
  2. Gather your equipment.
  3. Wash your hands thoroughly.
  4. Have the patient sit up or lie with their head tilted toward the side of the affected ear.
  5. Place the moisture pad or towel on the patient’s shoulder.
  6. Give the patient the emesis basin and have them hold it directly under the ear. Once the solution goes into the ear, gravity will bring it back out (hopefully with some ear wax).
  7. Clean the outer ear as necessary with some of the saline or hydrogen peroxide solution.
  8. Fill the bulb syringe or irrigating syringe with solution, or if using an irrigating container, allow air to be flushed from the tubing.
  9. You’ll want to straighten the ear canal for the best access. For an infant, do this by pulling the outer ear (pinna) down and back. For older children and adults, pull the pinna up and back.
  10. Direct a steady, slow stream of irrigation solution against the roof of the auditory canal, using only sufficient force to remove secretions. Be careful not to block the auditory canal with the irrigating nozzle, as this would create a pressure buildup within the ear. The syringed solution must be able to exit the ear while injecting it.
  11. At this point, ask the patient if they had any pain during the irrigation.
  12. Injecting the solution a few times to fully clear the wax will likely be necessary.
  13. When satisfied with the removal, place a cotton ball loosely in the auditory meatus. Have the patient lie on their side over the towel or absorbent pad to allow the liquid to finish exiting the ear.
  14. Document the date and type of irrigation. Also note the volume and the appearance of the wax removed from the ear.

Is There Any Recovery After Having Ear Irrigation?

There isn’t any recovery necessary after ear irrigation. However, because cerumen protects the inner ear, removal can make the ear more susceptible to potential infection. The ear will produce new wax, which is a continuous function, but it will take about five days. Over that period, instruct the patient not to allow water into their ears (such as through swimming).

Are There Any Potential Risks or Complications with Ear Irrigation?

The only potential risks involve the eardrum, which can be perforated. These are the risks with ear irrigation:

  • Middle ear damage
  • Perforation of the eardrum
  • Dizziness
  • Otitis externa (swimmer’s ear)

Should Anyone Not Have Ear Irrigation?

Some patients are not candidates for ear irrigation because they have a higher risk of eardrum perforation and damage. This includes patients who have had severe otitis externa. Patients with these conditions in their history should not have irrigation:

  • Ear damage due to sharp metal objects in the ear
  • Eardrum surgery
  • Middle ear disease
  • Radiation therapy to the ear

Tips in wood block letters next to a lightbulb

Pro Tips for Ear Irrigation

For a nurse in training, these are simple procedures to master. But there are a few things to consider for attaining proficiency:

  • Be sure the blockage is cerumen. Infants can stuff things such as corn kernels or peas into their ears. The food will swell if you rinse with these items in the ear.
  • If a patient has signs of an ear infection, any earwax removal needs to wait.
  • Avoid “dropping” or squirting solution directly onto the ear drum.
  • Never use more than 500 ml of solution in a single session.
  • Be sure you have adequately heated the solution to 98.6 F or slightly warmer.
  • It may be helpful for patients with hardened ear wax to insert 2-4 drops of warm water into the ear first. The patient should lie on their side to hold in the water and allow the warmth to soften the wax.
  • If a patient has had numerous ear irrigations, discuss with the doctor whether this procedure is a good idea. Frequent irrigation can signal the body to produce more ear wax.
  • Be careful not to inject the solution with too much force, as this can rupture the eardrum.

Are You Ready to Make the Move into a Nursing Career?

Ear irrigation is a common duty of most nurses. It is a seemingly trivial matter, but wax buildup can create issues with hearing and recurrent infection. Irrigation is a valuable skill to master.

Are you interested in working with people and making a difference in their lives? That’s the daily job of a nurse.

Plus, the career outlook is excellent. There is a projected need for more new nurses over the next decade.

Brookline College has three outstanding nursing programs in Arizona and New Mexico to help you move into nursing. From accelerated programs to various tuition assistance options, we want to get talented people like you to become nurses. Learn about our nursing programs today.