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Clinical Nursing Skills

14.2 Administering Ear Medications

Clinical Nursing Skills14.2 Administering Ear Medications

Learning Objectives

By the end of this section, you will be able to:

  • Identify different forms of ear medications
  • Recognize the purpose of performing ear irrigation
  • Describe procedural steps for ear medication administration

Ear (i.e., otic, auricle) medications are used for a variety of ear conditions (e.g., treating infections or inflammation, administering local anesthesia, softening cerumen (earwax) for removal, and facilitating removal of objects from the ear canal). The internal ear is sensitive to extreme temperatures; therefore, ear medications should always be administered at room temperature to reduce the risk of vertigo and cold sensitivity in the ear. The nurse must demonstrate competence in administering ear medications to ensure safe patient care.

Forms of Ear Instillations

Sterile technique should always be used for instilling medications in the ear. Sterile technique reduces the risk of infection if the eardrum is ruptured. In cases where a surgical opening was placed into the tympanic membrane, instillations may be used; however, caution must be taken to prevent debris from being introduced into the middle or inner ear. Medications administered via the ear come prepared as drops or medicated wicks.

Ear Drops

Liquid solutions that are injected into the ear canal are known as ear drops (Figure 14.8). Some ear drops are available over the counter, whereas others require a prescription. Ear drops are used to treat ear infections, ear pain, swimmer’s ear, and excessive earwax. Examples of ear drops include ciprofloxacin otic solution (Cetraxal) and ofloxacin otic solution (Floxin Otic). Ear drops should be administered at room temperature. Drops that are too warm or too cool may cause the patient discomfort, dizziness, vertigo, or nausea. Contraindications for ear drops include a ruptured eardrum, unless otherwise noted by the provider, because the opening in the eardrum may allow medication to pass into the middle ear.

A bottle of ear drops.
Figure 14.8 Ear drop packaging must be carefully observed because it is similar in appearance to eye drop and super glue packaging. (credit: Robyn Alvarez)

Medicated Ear Wicks

Small cellulose wicks (Otowick) used when the ear is severely swollen or infected are known as medicated ear wicks (Figure 14.9). The wick is placed in the ear canal, with the outer portion of the wick visible at the entrance of the ear canal. The medication is then applied to the end of the wick. When moistened, the wick expands to the size of the ear canal, dispersing the medication throughout the ear. Ear wicks may typically be removed within a few days, after the ear swelling has subsided.

An illustration showing an ear wick in the ear canal and medicine being applied.
Figure 14.9 The provider applies the medication directly to the ear wick. (credit: NIH/NIDCD, Public Domain)

Purpose of Performing Ear Irrigation

Washing out the ear with a continuous flow of liquid or medication, ear irrigation, may be warranted to remove foreign objects or wax buildup from the ear canal. Removing these unwanted substances helps minimize the risk of damage to the ear and hearing loss. Side effects of ear irrigations include dizziness, pain, nausea, and ringing in the ears. Ear irrigations should not be performed on patients with damaged eardrums, tubes in their ears, or an active infection in their ear canal. Risks of ear irrigation include ear infections, perforated eardrum, vertigo, and hearing loss.

Real RN Stories

Common Side Effects When Performing Ear Irrigation

Nurse: Eliza
Clinical setting: Outpatient family medical practice
Years in practice: 13
Facility location: Portland, Oregon

I had been working as an RN in a busy primary care clinic for several years, and ear irrigation was a common procedure that I frequently performed. One particular day, I had a patient who came in complaining of severe ear discomfort and hearing loss in the right ear. She mentioned she had tried over-the-counter earwax removal drops, but they didn’t seem to help. I gathered the necessary equipment, including an otoscope to examine the ear and warm water for the irrigation. I carefully examined her ear using the otoscope and confirmed the presence of a significant earwax blockage. As I began the irrigation, I positioned a kidney basin under the patient’s ear to catch the water and dislodged earwax, and then I used a bulb syringe to introduce the warm water gently into the ear canal, being cautious not to insert it too deeply. She described the sensation as a “strange” but not uncomfortable feeling as the warm water flowed into her ear.

Slowly but surely, small pieces of earwax started to emerge from the ear canal. After about five to ten minutes of irrigation, the patient starting to complain of being dizzy and lightheaded. I stopped the irrigation and assisted the patient in lying back on the exam table. While the patient was lying down, I looked in the ear canal to see if the eardrum had ruptured. Thankfully, it had not. After about five to ten minutes, I assisted the patient to a sitting position; however, the patient complained of continued dizziness. We were unable to continue the ear irrigation that day and a family member was called to drive the patient home. She came back a few weeks later to continue the procedure and we were able to successfully remove the rest of the wax then.

Ear Irrigation Solutions and Procedure

Before performing ear irrigation, the provider should assess the ear using an otoscope (Figure 14.10), a tool that shines light into the ear and helps to visualize objects or quantify the amount of wax in the ear. Typically, normal saline is used; although, a mixture of saline and hydrogen peroxide also may be used. A 60 mL needleless syringe typically is used to squirt the solution into the ear. A spray bottle with a soft angiocatheter also may be used. The solution should be at room temperature to reduce vertigo, dizziness, and discomfort for the patient.

A photo of a provider using a device to examine a patient’s ear.
Figure 14.10 The healthcare provider is using an otoscope to assess the ear of an adult patient. (credit: “U.S. Naval Hospital Naples Offers Back to School Physicals, COVID-19 Vaccine” by Tia Nichole McMillen from DVIDS, Public Domain)

Instruct the patient to sit upright and place a towel over their shoulder on the affected side. Draw up the irrigant in the syringe. Hold the irrigation basin next to the ear to collect the irrigant as it runs out of the ear. Gently pull the ear upward and back to allow the irrigant to enter the ear more easily. If irrigating the ear of a pediatric patient, gently pull the ear downward and back. Place the syringe or catheter into the ear, pointing away from the tympanic membrane. Directing the irrigant toward the tympanic membrane may cause perforation. Slowly and gently instill the irrigant (Figure 14.11). Injecting the irrigant too rapidly increases the risk of trauma, bleeding, and pain. After the irrigation is complete, the provider may use a cerumen scoop to remove any remaining wax or particles left in the ear. Place a cotton ball loosely in the ear to absorb any excess irrigant and instruct the patient to lie on their side toward the affected ear to allow the irrigant to completely drain from the ear.

A photo of a provider using a syringe of liquid to irrigate a patient’s ear.
Figure 14.11 It is helpful to have the patient or another staff member hold the irrigation basin when performing an ear irrigation. (credit: “Ear Irrigation to Remove Cerumen Impaction” by National Library of Medicine, Public Domain)

Clinical Safety and Procedures (QSEN)

QSEN Competency: Irrigating a Patient’s Ear

See the competency checklist for Irrigating a Patient’s Ear. You can find the checklists on the Student resources tab of your book page on openstax.org.

Irrigation of the ear has the potential to cause several complications (e.g., otitis externa, vertigo, perforation of the tympanic membrane, middle ear damage). Signs of complications include sudden pain, ringing in the ears, hearing loss, nausea, and dizziness. If any of these symptoms present, stop the irrigation and examine the ear canal with an otoscope. Assess the ear canal for presence of a foreign body, edema, signs of infection, or injury (such as a ruptured eardrum).

Clinical Judgment Measurement Model

Prioritize Hypotheses: Recognizing Potential Complications during Ear Irrigations

The nurse is performing an ear irrigation on a patient. While performing the irrigation, the patient begins to complain of ear pain and dizziness. After recognizing cues of potential complications (e.g., sudden pain, ringing in the ears, hearing loss, nausea, dizziness), the nurse analyzes cues and stops the irrigation until a hypothesis is formed. The nurse considers factors that may result in the identified cues and formulates a hypothesis regarding potential causes: perforation of the tympanic membrane, middle ear damage, the irrigant may be too hot or too cold, or the irrigant may have been instilled too rapidly. The nurse uses an otoscope to assess the ear canal to further refine and prioritize the hypothesis. The nurse generates solutions upon which to take action. For instance, if the eardrum appears ruptured, the nurse should contact the healthcare provider and document the patient’s response and the action taken. If the ear canal appears within normal limits, the patient may need to lie down for a few minutes until the symptom resolves before continuing with the irrigation. The nurse should also assess the temperature of the irrigation solution to ensure that it is neither too hot nor too cold.]

Procedural Steps for Ear Medication Administration

When administering ear medications, it is important to confirm the rights of medication administration, including the number of drops to be administered and the ear in which the drops should be placed. Abbreviations used for ear instillations include right ear (AD), left ear (AS), and both ears (AU). Ensure the medication is labeled for otic use and check the expiration date.

Before administering ear medications, wash your hands and don gloves to prevent contamination. Instruct the patient to lie on the side opposite the affected ear. Using a warm wet washcloth, clean the external ear of any debris. Ensure the medication is at room temperature. Remove the medication cap and place it on a clean surface to prevent contamination of the inside of the cap or the dropper tip. Straighten the patient’s ear canal to prepare the ear for instillation. For an adult, pull the auricle up and back. For a pediatric patient, pull the auricle down and back (Figure 14.12). The ears of pediatric patients are shorter and have a more horizontal angle; hence, they require you to pull the auricle at a different angle.

(a) An illustration of a provider holding a child patient’s ear while administering ear medication. (b) An illustration of a provider holding an adult patient’s ear while administering ear medication.
Figure 14.12 When administering ear medications, (a) pull the auricle down and back for children or (b) up and back for adults. (attribution a and b: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Aim the bottle toward the side of the auditory canal and gently squeeze the bottle, using caution not to squeeze the medication directly onto the tympanic membrane. Release the auricle and massage the tragus (the small piece of thick, skin-covered cartilage in front of the meatus of the external ear immediately in front of the ear canal) to help move the medication toward the tympanic membrane. Instruct the patient to continue lying on their side for five minutes to allow the medication to continue flowing toward the inner ear. After five minutes, the patient may turn to the other side and repeat the ear drops in the other ear, according to the provider’s orders. Remove gloves and perform hand hygiene after administering ear medications and assess for common side effects (e.g., dizziness, nausea). Document administration of the medication as well as the patient’s tolerance of the medication and procedure.

Clinical Safety and Procedures (QSEN)

QSEN Competency: Instilling Eardrops

See the competency checklist for Instilling Eardrops. You can find the checklists on the Student resources tab of your book page on openstax.org.

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