THE EAR CLINIC

GUIDELINES FOR MICROSUCTION AND IRRIGATION 

 AUTHORS: E.S.EVANS, A.MORGAN, G.DAVIES

RATIFIED: 06/24 REVIEW DATE : 06/26

INDEX

TRAINING

CONSENT AND DATA PROTECTION

MICROSUCTION

IRRIGATION

CRYOTHERAPY

EFFICACY, MAINTENANCE, STERILISATION OF EQUIPMENT

EQUALITY AND DIVERSITY

REFERENCES

TRAINING

At the Ear Clinic our Clinicians are trained to a high level of competency. Training, regular reading and updating of skills for continuing professional development is strictly adhered to. Our clinicians are all self-employed and therefore responsible for their own professional development.

All our Clinicians have professional fitting and treatment liability insurance.

CONSENT

It is a general legal and ethical principle that informed and valid consent, freely given by a person with the capacity to make that decision independently, must be obtained before commencing an examination or starting treatment. Consent is not a simple yes / no answer, it is informed, providing sufficient evidence-based information to enable the client or the parent / carer on behalf of a minor or person deemed lacking in capacity.

Informed consent is obtained prior to procedure. It is important to understand if there are underlying health conditions which may impact on the microsuction or irrigation process. For example, if the client is on anti-coagulant medication this would indicate that they are more prone to bleeding should any slight trauma of the ear canal occur. If they have a condition which means they are unable to keep their head still, the clinician needs to ascertain whether it is safe to proceed. To obtain the relevant information regarding the health of the client, they are asked to fill out our consent form (appendix 1). The consent form is discussed with the client and once they are aware of risks involved with treatments they are asked to sign.

Following consent being obtained a description of the process is given to the client using a model of the anatomical ear. The client is given an account of each process and is informed how the decision of which methods of treatment to use, or both is made. If the wax is close within reach, that is close to the opening of the ear canal, microsuction is the first treatment of choice. If the wax is further down the ear canal and closer to the tympanic membrane or potentially impacted, then warm, gentle irrigation is indicated. It may also be necessary for both methods to be used.

In handling a clients consent, personal / medical information the 7 principles of GDPR are adhered to: lawfulness, fairness and transparency; Purpose limitation; data minimisation; accuracy; storage limitations; integrity and confidentiality; accountability. In the event a paper consent is obtained for example if a home visit is done where data cannot be inputted directly into the power diary, as soon as is feasible when back in clinic that sensitive information is transferred directly into the computer and the paper copy shredded and disposed of in an appropriate manner.

MICROSUCTION

This is a safe, quick and effective procedure. Prior to treatment clients are warned that it will be noisy and may feel odd. Sometimes flaps of skin can cause ‘clareting’ when a whistling noise is heard as these flaps of skin are removed. Subsequently, like ear syringing clients may report tinnitus or increased tinnitus if they already experienced it before treatment. Also, the tinnitus may be abolished completely. There is a slight chance of bleeding due to grazing / scratching of the ear canal with the suction probe. Rubber bungs are used on the tips of the probes to lessen trauma. The caloric effect can also be experienced in microsuction due to the cooling effect of the suction probe. This may make the client feel dizzy but passes quickly when temperatures stabilise.

The use of speculae in the ear canal to aid microsuction I debatable as to the benefits, as it is the opinion of many practitioners that the speculum restricts the view, as it takes up space. Hence the practitioners view is restricted. Furthermore, the speculum can cause minor trauma to the skin of the ear canal if the ear canal is narrow.

IRRIGATION

Ear syringing (irrigation) is performed here at The Ear Clinic following careful training. An irrigator pump with a disposable jet tip has replaced the old-fashioned metal syringe. The irrigator has a regulated variable pressure, which is set according to the client being treated. As follows:

Bar 1 Child

Bar 2 Teenager

Bar 3 993 hpa Adult

Bar 4 1030 hpa Large adult

The water temperature must be between 36.5 and 37.8 degrees centigrade. The water is gently pulsed in, having been set to the correct pressure, a metal container being held under the ear, to collect the water dribbling out. The wax will either be loosened and can be prominent enough in the ear canal to be microsuctioned out or will fall out into the canister.

Side effects, risks and Disadvantages

Hard wax must be softened up for 3-4 days before procedure.

If the angle of the jet of water is slightly off, syringing can push the wax further up the ear canal.

May cause tinnitus.

May perforate the ear drum.

An undiagnosed perforated ear drum may not be seen due to the amount of wax {therefore accurate history taking and consent prior to procedure}. This will cause water, bacteria, wax and dead skin cells to be flushed into the middle ear. This could lead to a painful infection.

Not recommended following ear surgery.

Not to be performed when there is a known previous perforation, due to the risk of re perforation.

Under no circumstances to be performed on individuals with a left palate, foreign object in the ear canal or a mastoid cavity following mastoidectomy.

AFTERCARE

Following either procedure, the client is talked through the aftercare leaflet. It is important they understand to keep their ears dry for a minimum of two days post procedure and well protected from foreign agents as moisture can act as a breeding ground for infection. The aftercare leaflet highlights the possible complications and what to do should these occur. Also important to stress to clients how they can care for their ears going forwards and the need for regular ear checkups to optimise ear health.

CRYOTHERAPY

At our clinic bases where cryotherapy treatment is offered as a service, the practitioner has received specific training to qualify them to offer this treatment. They also hold a separate liability insurance.

There are several cryotherapy contraindications. This list is talked through prior to treatment, ensuring client safety.

A thorough and valid consent is obtained prior to treatment and as at present this is a paper copy, it is kept in a locked cabinet in clinic. Safety standards are high and in the instance of an unknown lesion, the client is asked to seek medical advice prior to treatment.

EFFICACY, MAINTENANCE, STERILISATION OF EQUIPMENT

All medical devices used in our clinics are kite marked and approved safe for specific designed use. Each medical device is completely sanitized down at the end of each clinic, as per manufacturers instructions, which are kept with that piece of equipment. At the end of each client, the single use parts (i.e. probes) are disposed of or are put into sterilising fluid (i.e. otoscope speculae} and sterilised part put ready for next use.

Described maintenance of equipment is done, as per manufacturers instructions. Before each clinic commences all apparatus is tested to ensure safe for use and in good working order. If there is any doubt as to the safety/ efficacy of a piece of equipment it is not used, is sent for testing /repair and a replacement used.

EQUALITY AND DIVERSITY

Healthcare Practitioners should adapt their communication skills to the hearing needs of the person with hearing loss. This will help to ensure that the person understands the need for treatment, either microsuction / irrigation or both. For clients with additional needs related to disability, impairment or sensory loss, information should be as set out in NHS England Accessible information standard. Careful consideration to be made in the event of a minor or client deemed to be lacking in capacity or a client without full grasp of the English language, to ensure a full understanding of the procedure.

At The Ear Clinic we fully encourage parents and carers to be involved in treatments, to ease the process and obtain a successful outcome.

REFERENCES

After Care/ ear wax removal {2021} Retrieved 6 June 2021, from https://www.waxout.co.uk/aftercare/

Medical Devices: Information for users and patients. 21/11/23 Medicines and Healthcare products. Regulatory Agency.Gov.co.UK

Principles of Consent; RCN 11/9/23   Act 2018

Appendix 1

THE EAR CLINIC CONSENT FORM

 Name:

Address: Email:

Tel: D.O.B.

Have you ever had earwax removal before?

Have you had problems with Microsuction

Severe dizziness

Keeping your head still

Sensitivity to noise

Have you had problems with Irrigation

Middle ear infection

Outer ear infection/pain

Cleft palate

Perforated ear drum not healed

Discharge within last year

Ear surgery

Precautions to Ear Irrigation Previously perforated ear drum

Prominent tinnitus

Impaired immune system

Balance problems

Anticoagulants

Radiotherapy of head / neck

Other information Previous head injury

Allergies

Hepatitis / HIV

Hearing Aid wearer

Previous ENT history

 Risk of treatment Perforated ear drum; highly unlikely

Trauma to ear canal; possible but usually minor

 Post treatment You will be more vulnerable to infection

Tinnitus; rare should settle within a few days

 Aftercare Keep ears dry for 48hrs

Use olive oil spray once a week

If pain develops contact your GP

 If the answer is yes to any of the above, please give more information below.

 I have read the above consent to having microsuction and /or warm water irrigation. If I wish to stop the procedure at any time, I will inform the specialist clearly that I wish them to stop.

 Signed…………………………………. Date…………………………….

 The Ear Clinic Chester Bromwich Redditch