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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Tuesday, November 10, 2009

Never Use a Waterpic to Remove Earwax (And Don’t Let Your Doctor Do It Either)

There is an interesting posting on the Ear, Nose, and Throat message board from MollieMae01: Water Pick Injury:

“My 2 year old daughter was being checked for an ear infection (She is in good health and has never had any ear problems or infections before. We also had her ears tested a few months ago by a specialist and they were fine.) and the nurse used a water pick to clean the wax out for clear viewing. My usually quiet daughter screamed like we were torturing her and when the nurse removed the water pick from her ear canal a substantial amount of blood followed.”

During the California Gold Rush, huge amounts of rocks and dirt were removed from ancient bedrock by a technique called hydraulic mining (Placer Mining). Water was fired at high pressure to loosen compacted earth. As a matter of fact, my neighbor has an old hydraulic nozzle sitting in his yard as a display. Until this method was outlawed, millions of dollars of gold was extracted. Of course, the sludge clogged streams and rivers, causing devastating floods; the land was marred forever.

Hydraulic mining is not unlike the ear lavage. To safely extract impacted ear wax, it must first be softened, and then it needs to be washed out with a GENTLE stream of warm water. The key point here is “gentle”.

The Waterpic was hot in the 1970′s. Designed as an adjunct to dental hygiene, the Waterpic proved to be an effective tool, especially helpful for those with braces. It didn’t take long before people started finding other, non-dental uses. These were untested and unapproved uses not condoned or encouraged. We had one in our family practice that we used to irrigate wounds, and yes, irrigate ears that were impacted with wax. The most important lesson that we learned was adjusting the force of the pulsating stream. High settings had the potential of splash-backs. You really didn’t want to have contaminated water splash back in your eyes or mouth! If the high setting was used for cleaning out the ears, it could easily rupture the eardrum. I must say, that on the low setting, it seemed to be an effective irrigation tool as long as you were careful. The problem with this unapproved use was cleaning the instruments. Medical offices, as you know, are not the cleanest places on Earth. The Waterpic was primarily plastic, and plastic cannot be adequately sterilized between patients. In a busy medical office, you never knew what it was used for previously. After a short while, the Waterpic was permanently abandoned as an ear or wound irrigator. It probably ended up at Goodwill.

Speaking of unintended uses, Q-tips are not promoted as a tool to remove earwax, but yet, they are used for exactly that purpose. Some people – and you know who you are – are literally addicted to Q-tipping their ears every day after every shower. Many will go through their entire lives thinking earwax is dirt, or implies that you are an unclean person, and must be removed. Earwax is one of the most beneficial substances made by the body. It protects the delicate lining of the ear canal and it is antibacterial (prevents skin infections). It should NOT be removed, unless of course, it is deeply impacted. And, in most cases, earwax is deeply impacted BECAUSE people are using Q-tips to pack it in, just like loading a Civil War cannon.

Welch-Allyn, a respected manufacturer of fine medical tools and instruments, re-invented an ear irrigator several years ago for clinic use. It, too, had a pulsating stream, powered by the water pressure from our faucets. The clever design even created a vacuum to catch the extruded chunks of wax. Always a fan of new gadgets, I got one. After using it a few times, I found it cumbersome and messy. My old method actually worked better. It is now sitting in a box somewhere in our clinic. The special faucet adapter is still attached, but I doubt I will use it again. I guess that some clinicians really like it.

The trick in cleaning out the ears is really related to visualization. Unless you can actually see what you are trying to clean out, it is not wise to blindly dig in an ear, let alone try and wash it out with a stream of water. The rubber bulb syringe that comes with commercially-available ear-cleaning kits can work, but the stream is really a bit too large. I always have this fear that someone will fail to read the instructions and jam the bulb syringe in the ear and squeeze. This, of course, would be an automatic eardrum rupture. Since this is the same (or similar) bulb that parents use to suck snot out of their baby’s noses, they may think that can suck out earwax. You cannot. If you try and suck out earwax with a bulb syringe, you will simple suck out (and rupture) the eardrum.

Since you can’t really look inside your own ear, you will need a trusted friend or partner with a home otoscope. If you start inviting people over to your home, asking them to look in your ear to see if you have a wax impaction, you are going to lose a lot of friends. The Japanese – a culture that seems to be obsessed with clean ears – does have a fiberoptic video device for those who really want to peek inside their ears. I have never seen or used this home model video otoscope, but I suspect the resolution is not that good. Besides, there is always going to be an odd spatial orientation that you will need to overcome. I would love to be able to have a good video otoscope unit in my office so I can show patients their ears, but good ones are really cost-prohibitive. So, the bottom line: If you are going to be cleaning out your own, or anyone’s ears, you need to have an otoscope to look FIRST.

A painful, potentially-infected ear should never be washed out…by anyone. In a medical setting, we often have to remove cerumen (earwax) in order to adequately examine the eardrum, but we use a wire loop or cerumen spoon. This is NOT the same as Grandpa digging wax out of his ear with a bobby pin or paper clip. Medical providers learn how to do this, and they have the ability to actually see (with an otoscope) what they are doing. Anyone who blindly digs in their ears with homemade instruments is really a fool. It is only a matter of time before you rupture your eardrum. Q-tips are also Weapons of Ear Destruction, causing many of the unintentional ruptures that I see in the office.

If I do need to lavage an ear, I have several instruments that I use. There is the metal syringe that can be autoclaved, and of course, my homemade ear lavage unit made from a 20-50 ml syringe and a piece of IV tubing or intracath – items not available at the local Walmart. It is rea
lly not the tools, but the skill of the person using the tool. I am not bragging, but I have never met a wax impaction that I couldn’t beat. It may take me a while, and I may consider blasting from time to time, but in the end, I do get it out. Unlike ENT offices, I do not have an ear vacuum device. I could sure use one though, if my medical group would see fit to cough up the capital expenditure funds. Since my homemade unit costs less than a buck, they are less inclined to order one.

Unlike the old days, I would never use a Waterpic to wash out an ear. If your doctor has one, just say “No thank you.” If you see one at Goodwill, don’t buy it. If you have one at home and are tempted to use it, I hope I have changed your mind.

If you know what you are doing, have the right equipment, and common sense, ears can be safely lavaged out at home. Sometimes, it is best to leave the job to a medical professional.

Da…da…da…da. Da…da…da…da. Wax Man!

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Posted by: Rod Moser, PA, PhD at 8:01 am

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