Ear procedures

Dry mopping ears with tissue spears

Removes pus, dries middle ear. Allows topical medicines to reach inflamed surfaces, makes ear conditions much less favourable for bacteria

Attention

• If discharging ears — get child to blow nose before and during procedure
• Must push tissue spears well into ear canal, near eardrum — about 2.5cm 
• Don't worry about pushing spear in too far, tissue is soft and won't do any damage

What you need

• Toilet paper  — Figure 8.41
• Waste bin close by
• Ear drops — as needed under guideline or prescription

What you do

• Take piece of toilet tissue, hold in one hand and twist from corner — Figure 8.42
• Use thumb and first finger of both hands to twist until spear is tight — Figure 8.43
  
• Do not roll — rolled tissue is too thick and can’t be put far enough into ear canal

• Break off tip (too floppy to use) and other end of spear. Spear should be about as long as your thumb — Figure 8.44

• Straighten ear canal
• Push tissue spear into ear with slight twist — Figure 8.45
• Stop pushing when tissue stops going in
• OR child cries, coughs or blinks (about 2.5cm)
• If time leave spear in place for a few minutes to soak up pus
• Remove slowly, throw away. String of pus often connected to spear — Figure 8.46

• Do again with new spears until spear comes out dry. At first this may take some time but will get quicker as ear improves
• When ear is dry, put in ear drops
• Teach child’s carer and older children to make and use tissue spears
• Pus re-forms in middle ear cavity within hours, do
• At least 4 times a day to begin with
• Then twice a day for 1 week
• Then once a day for 1 month

Syringing ear

Used to remove softened wax, foreign bodies, pus/debris from ear canal

Attention

• Do not syringe ear if pain in ear or recent trauma
• Do not use forceps to remove foreign body — may damage eardrum
• Always look in ear before syringing. If any pain — stop and look again
• Soften wax with softeners before syringing
• If CSOM — syringe with diluted povidone-iodine 10%
• Can drown and float out insects with oil or tetracaine (amethocaine) 1% instead
• If foreign body doesn't come out — may need to see specialist

What you need

• Otoscope and earpieces
• Bluey
• Gloves
• Kidney dish or similar (eg ice cream container) to collect run off
• Ear syringe OR 20mL plastic sterile syringe +/- tubing from scalp vein needle
• 20–50mL fresh warm water (body temperature)
• Dilute povidone-iodine 10%, if needed — mix 5mL (one teaspoon) in 100mL of fresh warm water

What you do

• Look in person’s ear to find material to be removed
• Protect person’s clothing with bluey, ask them to hold kidney dish under ear — Figure 8.47

• Fill syringe with warm water or dilute povidone-iodine 10%. Make sure all air is removed
• Straighten ear canal then put tip of syringe or plastic tubing into ear canal
• Aim up and back so water will run along roof of ear canal
• Push water/povidone-iodine into ear with smooth, firm pressure on plunger. Water/povidone-iodine will spiral around canal, flush out foreign bodies
• Repeat until canal clean
• If one angle of ‘squirt’ doesn’t get object out — try another, but be gentle
• Dry mop ear when finished

After syringing, ear drum often looks pink, blood vessels dilated

Putting in ear drops

Attention

• Always clean pus and foreign bodies out of ear first, so drops can reach middle ear — dry mop or syringe
• Do not put tip of bottle into ear canal — keep end clean

What you need

• Ear drops
• Gloves

What you do

• Sit person in comfortable chair
• Ask them to tilt head away from you
• Straighten ear canal 
• Hold dropper just above ear canal, squeeze in right number of drops
• Pump or gently rub on skin flap in front of tragus (ear canal) to make drops run down into canal
• To help medicine stay in contact with ear canal, ask person to lie on their side or keep head tilted for 3–5 minutes. Can also put cotton ball in ear canal
• Do other ear, if needed

Putting in ear wick — to give drops 

Attention

• Always clean pus and foreign bodies out of ear first, so drops can reach middle ear — dry mop or syringe
• If ear very swollen ear wick may hurt when first put in

What you need

• Ear wick (eg Merocel Ear Wicks, Pope Otowick)
• Ear drops
• Gloves
• Alligator forceps or tweezers

What you do

• Lie or sit person comfortably
• Open ear wick packet — keep ear wick clean and inside packaging
• Pick up wick with forceps
• Straighten ear canal with your other hand, if needed
• Gently put wick into ear canal — leave end of the wick level with entrance to ear canal
• Ask person to tilt their head away from you, put drops on end of the wick
• Wick will swell up, fit more snugly and be comfortable
• Reapply drops as needed
• Change wick after 2 days — can be left in place for up to a week if drops are applied regularly
• May fall out itself if swelling goes down
• To remove — moisten wick with ear drops and gently pull out with forceps

Putting gauze wick into ear — to apply ointment

What you need

• Dressing pack
• Scissors
• Ribbon gauze — about 10cm
• Ointment to go on wick
• Gloves
• Clean probe or orange stick
• Ear-packing (angled) forceps

What you do

• Lie or sit person comfortably
• Lay out dressing pack and equipment
• Drape site with towels
• Cut about 10cm of ribbon gauze
• Put drops/ointment onto gauze, rub in with forceps
• Ask helper or person to straighten ear canal
• Pick up gauze at one end with dressing forceps and about 1cm in from other end with packing forceps
• With packing forceps, gently put gauze along line of canal as far as it will comfortably go
• Ask helper/person to let go of ear. Gently hold gauze in place with probe or orange stick so it doesn’t fall out — Figure 8.48

• Pick up gauze again with packing forceps — about 2cm further along. Push gauze gently into ear canal to lay against gauze already there
• Repeat until ear canal comfortably filled with gauze to level of canal opening
• Cut off any leftover gauze
• Leave 1–2 days then take out packing. Dry mop canal, repack if needed

If ear very tender and/or swollen

• Try putting nozzle of ointment tube straight onto 18G or 19G plastic IV cannula (without needle)
• OR Put ointment into 2mL syringe — connect to plastic cannula
• Looking with otoscope, guide cannula very gently to near eardrum, squeeze in ointment (this avoids air bubbles)
• After 2 days syringe with warm water
• Repeat if needed