Removal of impacted cerumen in children using an aural irrigation system

• Published in: International journal of pediatric otorhinolaryngology 2012-12, Vol.76 (12), p.1840-1843
• Main Authors: Propst, Evan J, George, Tomka, Janjua, Arif, James, Adrian, Campisi, Paolo, Forte, Vito
• Format: Article
• Language: English
• Subjects: Adolescent; Ambulatory Care - methods; Canada; Cerumen; Cerumin; Child; Child, Preschool; Cohort Studies; Debridement; Ear canal; Ear Canal - physiopathology; Female; Follow-Up Studies; Humans; Irrigation; Male; Otolaryngology; Patient Safety; Pediatrics; Pressure; Removal; Risk Assessment; Rupture; Safety; Therapeutic Irrigation - instrumentation; Therapeutic Irrigation - methods; Treatment Outcome; Tympanic membrane; Water; Water - administration & dosage
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2012.09.014

Abstract Objectives Impacted cerumen in the ear canal is a common problem that can cause discomfort or prevent assessment. Cerumen removal can have deleterious side effects if performed improperly. We created an aural irrigation system which is currently not available on the market to provide a continuous flow of water at a regulated pressure and temperature. The purposes of this study were to (1) evaluate the safety and efficacy of this aural irrigation system in children and (2) determine the success rate of cerumen disimpaction when used by an allied health professional. Methods The following were evaluated in a nurse-run clinic: (1) referral patterns; (2) extent of canal occlusion; (3) cerumen consistency; (4) peak water pressure used; (5) patient discomfort; (6) efficacy of removal. Each ear was recorded as a separate event. Results 302 procedures were performed on 244 children (mean age 7.6 ± 4.1 years (range 0.5–18.3 years)). Patients were most commonly referred by an Otolaryngologist (63%), parent (17%), hearing aid provider (10%) or audiologist (9%). The most common reasons for referral were difficulty seeing the tympanic membrane (42%), fitting a hearing aid (20%) or performing an audiogram (11%). Prior to irrigation, 98% of canals were partially or fully occluded. After irrigation (mean peak pressure = 488.21 ± 18.61 mmHg (range 390–590 mmHg), 92% of canals were completely free of cerumen (99% clear enough for evaluation or treatment). There was mild or no discomfort in 99% of patients and there were no incidences of trauma. Conclusions An aural irrigation system can be effective at clearing impacted cerumen from pediatric ear canals with minimal discomfort and no trauma and can be successfully employed in a completely nurse-run clinic.