EN4.9 | Wax Removal Technique — Summary & Reflection

KEY TAKEAWAYS

Wax removal is indicated when cerumen impaction causes hearing loss, otalgia, tinnitus, or obstructs TM examination. Pre-procedure assessment is mandatory: ask about TM perforation, ear surgery, only-hearing ear, active otitis, cleft palate — any of these contraindicate syringing (use microsuction). Cerumenolytic preparation: olive oil or 5% sodium bicarbonate drops 3–5 days before syringing. Syringing technique: warm water at 37°C (cold or hot water → caloric vertigo); pinna pulled posterosuperiorly; nozzle directed at posterosuperior EAC wall, NOT at TM. Microsuction: gold standard; no water, no caloric risk, safe in perforated ears and post-surgery ears. Post-procedure: inspect TM, dry the canal (prevent post-syringing OE), document findings. Complications: caloric vertigo (wrong water temperature), TM perforation (inadequate pre-procedure check or wrong jet direction), post-syringing OE (residual water). Only-hearing ear and post-mastoidectomy ear: ENT specialist referral mandatory. Never force syringing against hard impacted wax — prescribe further softening and return.

REFLECT

The hook described a GP who syringed without asking about surgical history or using properly warmed water, causing a TM perforation and caloric dizziness. Both errors were preventable with a two-minute pre-procedure assessment. Reflect on the following: in a busy primary care clinic with a large waiting room, what are the realistic pressures that lead a clinician to skip the history check and go straight to the procedure? What habit or system — a printed checklist on the syringing tray, a mandatory verbal check-list before picking up the syringe — would reliably prevent these errors regardless of time pressure? Write two to three sentences in your reflective journal about the relationship between procedural shortcuts and patient harm.