Ear flush

Stinky ears and lots of head scratching

Ear flushes are often relatively straightforward to do but can be very messy so best tip is to be prepared and have everything you need to hand. This can make your life a lot less stressful and the procedure much more enjoyable. Often ear flush patients will have painful ear infections and this can be a sensitive procedure for them. Some practices will do these under sedation, but it is difficult to get a thorough clean done unless the patient is anaesthetised so I would always suggest a general anaesthetic for these.

BASICS

IV cannula
ET tubes (+ Intubeaze for felines)
Otoscope (some practices have use of video otoscopes)
Spreulls Needle or large bore cannula/urinary catheter
20ml syringe
3-way-tap
Warmed saline solution
Ear cleaner (e.g. Otoclean)
Cotton wool
Active warming
Analgesia (paracetamol +/- rescue analgesia such as ketamine, NSAID as well but patients may have had a course of steroids in severe cases so avoid use of NSAIDs if patient is already on steroids)
IV fluids
Incontinence sheets/puppy pads

MAY BE NEEDED

Swabs for culture and sensitivity
Topical medications to be used once cleaned or mixed with irrigating solution such as Tris-EDTA for pseudomonas infections.

The procedure and nursing considerations

Ear flushes can get really messy and the patient can get cold with lots of water being used on the head and in the ears. Before starting, ensure you have plenty of heating aids around to keep the patient warm throughout and I like to have several incontinence pads to hand too. If your practice has a tub table, this is often a really good place to perform the ear flushes.

Remember to preoxygenate prior to intubation and, if you are performing an ear flush on a feline, make sure you wait the full 30-90 seconds for the Intubeaze to work prior to intubating. When tying the ET tube in place, tying around the lower jaw can be useful for ear flushes as it prevents accidental untying of the tube tie.

I like to place several inco sheets underneath the patient's head when setting up, as I can quickly move these out once each one becomes wet and there is a fresh sheet underneath to keep the head area clean and (relatively) dry. I often will cut a small hole in the middle of the sheet and pull the ear through this. That way the head can stay relatively dry throughout, and the ear is readily accessible for the vet.

During ear flushes, the patient will likely have hands resting on their heads and faces, so it is important to check and re-lubricate eyes throughout.

If swabs need to be taken, make sure to do these before starting any flushing or cleaning begins.

If the patient has a pseudomonas (or any other contagious) infection in their ear then make sure to follow your practice's barrier nursing guidelines for this, and be mindful of thorough cleaning of the areas the patient has been during their stay.

For the flushing part, if an irrigating machine is not available, I like to have a bag of warmed saline prepared on a drip stand, attached via a giving set to a 3-way-tap with a 20ml syringe on one part, and the spreulls needle on the other. This way, the vet is able to flush and draw back without having to repeatedly draw flush from the bag. It can also help to get a good, gentle pressure whilst irrigating without risk damaging the tympanic membrane.

Often the patients for ear flushes will have particularly painful and sensitive ears and can sometimes shake their head during the procedure, even when under GA. This can be due to cold irrigating saline, so I would always recomend warming the fluids gently before flushing with them. If it is a pain response, then paracetamol can be given if it hasn't been used already (10-20mg/kg slow IV) or, if very severe pain response is seen, a one off dose of ketamine can be used (0.5mg/kg IM or slow IV), but this isn't commonly required. Be mindful for signs of apnoea if giving ketamine.

If there is a particularly extensive waxy buildup within the ear, it can be useful to place some cerumenolytic cleaning agent such as Otoclean into the ear, wait for 5 minutes, and then perform the flush. This will help to break up the wax and make the procedure easier.

Be mindful to only use medications and cleaning agents in the ear that are not ototoxic. Cleaners such as chlorhexidine gluconate (Hibiscrub) can damage the ear and cause deafness so always be aware of what is being used in and around the ears.

On recovery watch for any signs of hearing loss, vesibular signs, Horners syndrome (feline especially), or facial nerve paralysis.

Disclaimer:

The information on this website is for reference and education, and any medications and doses should be prescribed by your veterinary surgeon before giving. All patients should be assessed individually and treated as such.