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  • 1.  Ear Lavage

    Posted 07-03-2025 13:51

    Does anyone on here use tap water for ear lavage? or are you using sterile water to mix with hydrogen peroxide? Currently we are using tap water but looking for literature that specifies if tap water is safe. The argument that was brought up was what if someone has a ruptured ear drum. We are a network of FQHC clinics in rural areas where the water quality varies. I think this alone speaks to why we should use sterile water, but wondering if anyone has experience with this?



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    Torie Bonnet MSN RN NE-BC NPD-BC
    Associate Director of Nursing
    Piedmont Health
    Raleigh NC

    bonnett@piedmonthealth.org
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  • 2.  RE: Ear Lavage

    Posted 07-04-2025 18:16
    Hi Torie,
    I have always used warm tap water for ear lavage. I've never worked anywhere that has a policy on this, it's just "the way I was taught" (my least favorite reason to do something!) I do at least have an evidence-informed rationale:  cool or room temperature water can increase the risk of dizziness, and I don't have a way to warm up bottles of sterile water or saline in clinic. Additionally, I consider the fact that the tap water at my urban FQHC is the same water that gets in patients ears when they shower at home. 

    With regard to the concern about a ruptured ear drum, I would say that the patient must be assessed prior to the procedure. As an RN, I would defer ear lavage and consult a provider in the setting of significant pain (disproportionate to a simple wax impaction) or recent ear infection or trauma. I would also stop the procedure if the patient reports pain during irrigation.

    In 14 years as an FQHC nurse, I have never discovered a ruptured ear drum after performing an ear lavage. I did once have a patient who insisted I use (room temperature) bottled saline for her ear lavage; she's also the only person who's gotten so dizzy that I had to stop the procedure!

    Of course, your calculus might be different in an area with water quality issues. Would a filtration system on the taps be effective? If you do need to use something out of a bottle, I strongly encourage finding a way to warm it to body temperature.

    I am always interested in feedback if anyone has a guideline with a firmer evidence based!

    -Charlotte





  • 3.  RE: Ear Lavage

    Posted 07-07-2025 08:36

    Hello,

    We follow Lippincott procedures in our clinics.  In the cerumen impaction, removal procedure it indicates that ear lavage is contraindicated if the tympanic membrane is perforated, so I echo Charlotte in recommending there be an assessment of ear prior to initiating the procedure.  We also use tap water. The Lippincott procedure does not specify the type of water to use, but it does cite this resource - 

    Schwartz, S. R., et al. (2017). Clinical practice guideline (update): Earwax (cerumen impaction). Otolaryngology–Head and Neck Surgery, 156(Suppl. 1), S1–S29.

    In scanning the resource for the word "tap", it is mentioned as causing a higher incidence of malignant otitis externa in special populations.  However, in our clinics, we provide instructions post-lavage for "reacidifying" the ear as outlined in the clinical practice guideline cited above to reduce the risk of infection.  To my knowledge, we have had no safety events related to our procedure. 

    Happy to discuss further if needed.  Best,



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    Marsha Pike DNP, APRN, CNS
    Pediatric Clinical Nurse Specialist
    Mayo Clinic
    Rochester MN
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  • 4.  RE: Ear Lavage

    Posted 07-07-2025 09:41
      |   view attached

    Hello 

    UpToDate indicates that Saline or Tap water is effective.



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    Celina Carrillo MSN
    HCA
    Cedar Park TX
    (915) 740-2743
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    Attachment(s)

    pdf
    Cerumen - UpToDate.pdf   670 KB 1 version


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