Reference:
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 59, pp. 1935-1963)
Cerumen Impaction
Cerumen is a normal secretion of the cerumenous glands in the outer part of the meatus, producing ear wax. It is initially colorless and semi-liquid, but changes to pale yellow, golden yellow, to light brown, then finally black. During this change in color, the wax also hardens, and becomes denser. When enough cerumen builds up and hardens, it may block the ear canal and produce impaction, which can also cause otalgia, with or without hearing loss.
- Home Treatment: soften the wax in the ear with mineral oil, baby oil, glycerin, commercial drops, and detergent drops (e.g. 50% hydrogen peroxide, ceruminolytic agents [Carbamide peroxide] b.i.d/t.i.d). This can also be done 30 minutes before an irrigation.
- Irrigation: body-temperature water (cold water can cause vomiting), with the head upright, is instilled with a syringe (at the lowest pressure possible) against the ear canal wall next to the wax plug. Afterwards, tip the head to drain the water. Repeat several times as needed. Once the wax is removed, the ear should be dried thoroughly. Drying can be helped by a few drops of alcohol in the ear or a hair dryer set on low. Never irrigate the ear if integrity of the ear drum is questionable. This may lead to infection or acoustic trauma.
- If attempts to remove the wax plug is unsuccessful, consult a health care provider. They may repeat irrigation, suction the ear canal, or use a cerumen curette. Instrumentation may only be done by otolaryngologists and nurses with special training due to the risk of perforating the tympanum or excoriating the thin skin of the external auditory canal.
Foreign Bodies
Any number of small objects can be lodged into the ear canal e.g. peas, beans, pebbles, toys, beads, insects, etc. Manifestations may range from no symptoms to severe pain and hearing loss. Irrigation, suctioning, and instrumentation may be attempted, same as in Cerumen Impaction. Contraindication for irrigation is the same. Vegetable-type foreign bodies may swell with irrigation, and is therefore also contraindicated. Risks of perforation and excoriation suggest that removal of foreign bodies should not be done by unskilled individuals.
Any object that has been lodged in or penetrated through the ear canal.
- Calm down and reassure the patient.
- If the object is sticking out, gently remove it by hand or with tweezers. Get medical help to ensure that no remaining foreign bodies have been left inside the ear. Do not attempt to remove remnants if not clearly visible.
- Attempt to use gravity to remove the object. Never strike the head to try and get it out. Gently shake the head in the direction of the ground to try and dislodge the object.
- If the object remains inside, seek medical help.
If the foreign body is an insect e.g. ants, mosquitos, spiders, and cockroaches:
- Do not insert a finger or objects into the ear canal. The insect may sting or bite when aggravated.
- Point the ear canal up, and wait to see if the insect flies out or craws out.
- If the insect remains, attempt to pour mineral oil, olive oil, or baby oil into the ear. Pull the ear lobe gently (back, up for adults; back, down for children) to facilitate irrigation. The insect should suffocate and float out in the oil. Oil should only be used for insects, as other objects may absorb the oil and swell.