The National Institute of Clinical Excellence have compiled the following list of circumstances in which they do not recommend ear syringing/irrigation:
Contraindications, cautions and warnings
- Do not use ear irrigation to remove wax for people with:
- A history of any previous problem with irrigation (pain, perforation, severe vertigo).
- Current perforation of the tympanic membrane.
- A history of perforation of the tympanic membrane in the last 12 months. Not all experts would agree with this — some would advise that any history of a perforation at any time, even one that has been surgically repaired, is a contraindication to irrigation because a healed perforation may have a thin area which would be more prone to re-perforation.
- Grommets in place.
- A history of any ear surgery (except extruded grommets within the last 18 months, with subsequent discharge from an Ear Nose and Throat department).
- A mucus discharge from the ear (which may indicate an undiagnosed perforation) within the past 12 months.
- A history of a middle ear infection in the previous 6 weeks.
- Cleft palate, whether repaired or not.
- Acute otitis externa with an oedematous ear canal and painful pinna.
- Presence of a foreign body, including vegetable matter, in the ear. Hygroscopic matter, such as peas or lentils, will expand on contact with water making removal more difficult.
- Hearing in only one ear if it is the ear to be treated, as there is a remote chance that irrigation could cause permanent deafness.
- Confusion or agitation, as they may be unable to sit still.
- Inability to cooperate, for example young children and some people with learning difficulties.
- Use ear irrigation with caution in people with:
- Vertigo, as this may indicate the presence of middle ear disease with perforation of the tympanic membrane.
- Recurrent otitis media with or without documented tympanic membrane perforation, as thin scars on the tympanic membrane can easily be perforated.
- An immunocompromised state, especially older people with diabetes, as there is an increased risk of infection from iatrogenic trauma to the external auditory canal in this group of people.
- Careful instrumentation should be employed in people who are taking anticoagulants due to increased bleeding risk.
- Warn people with a history of recurrent otitis externa or tinnitus that ear irrigation may aggravate their symptoms.
Dr Claudia Pastides
