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Ear Flush (Deep) 1094.e1

Ear Flush (Deep) Client Education
Sheet
VetBooks.ir

• Ear loops and curettes
Difficulty level: ♦
damaging the tympanum.
• Bulb syringe remove debris while minimizing the risk of
Overview and Goal • Otoscope with surgical head • The red rubber feeding tube is cut to a length
Deep ear flushing will remove debris, exudate, • Cotton swabs of approximately 8 inches. The catheter tip
bacterial toxins, and hair from the ear canal to • Culture swabs end of the feeding tube is cut off to fit on the
allow examination of the ear canal, tympanic • Alligator forceps 5- or 10-mL syringe. The syringe is then used
membrane, and middle ear and to allow effec- • Rigid video endoscopic units have been to flush the deep canal with flush solution
tive topical therapy. Flushing also may remove developed specifically for veterinary medicine after passing the tube through the cone. If
otic foreign bodies and provides an opportunity that allow visualization deep in the horizontal the tympanic membrane is perforated or
to sample deep in the canal for bacterial or ear canal. They have flushing and suction ruptured, the middle ear can be flushed
fungal culture. abilities. When available, these units are using the same tube and technique. Procedures and Techniques
very useful for ear flushing and ear canal • Inflammatory polyps may be grasped using
Indications examination. alligator forceps through the cone and gently
• Chronic otitis externa, especially where tugged to break loose. Otic tumors may be
retained exudate prevents visualization of Anticipated Time biopsied similarly.
tympanic membrane 30-60 minutes
• Acute or chronic otitis where there is signifi- Postprocedure
cant ear canal swelling preventing epithelial Preparation: Important • Monitor patient during anesthetic recovery.
migration and self-cleaning Checkpoints • Selection of medication, whether topical
• Ear cytology results that demonstrate a • Advise owner that there is a very slight risk of or systemic, will depend on results of ear
degenerative neutrophil response vestibular signs or deafness after ear flushing. cytology and appearance of ear canal. Avoid
• Removal of debris to allow visualization of These side effects are uncommon and may potential ototoxic medications if tympanic
tumors or inflammatory polyps (especially be transient, but they do occur. membrane is not intact.
in cats) • This procedure is commonly done on a • Send polyps or biopsies of masses for
wet table because a lot of liquid is used to histopathology.
Contraindications effectively flush the ear canal.
• Chronic otitis externa if the ear canal is so Alternatives and Their
swollen and calcified from chronic inflam- Possible Complications and Relative Merits
mation that it is entirely occluded; such cases Common Errors to Avoid • Rigid video endoscopes with irrigating
are considered end-stage and total ear canal • Vestibular signs or deafness (rare) and suction abilities are excellent tools for
ablation is likely the only option. • Aspiration of contaminated fluid in the ear flushing, and there are units marketed
• Any health condition that precludes general absence of an intact tympanum due to fluid specifically for that purpose. The initial
anesthesia leaking through the eustachian tube to the expense may be justified if the utility of
pharynx. Endotracheal intubation is essential. this equipment encourages the clinician to
Equipment, Anesthesia perform more ear flushes.
• General anesthesia with endotracheal Procedure • Daily ear cleaning by the client at home by
intubation is required. Animals with otitis • The animal is anesthetized. If collection of filling the ear canal with a cleanser, massag-
are extremely sensitive, and sedation is not cytologic samples were prevented in the ing, and letting the patient shake out the
adequate for ear flushing. awake animal due to pain, they can be fluid can be helpful in treating otitis but
• Cotton balls collected now. is inferior to flushing under anesthesia and
• Exam gloves • Debris is cleaned from the ear pinna using does not allow the clinician the opportunity
• Ear cleansing solution flush solution and cotton balls (less abrasive to examine a clean ear canal and visualize
○ Ceruminolytic agents (many surfactants, to inflamed tissue than gauze). the tympanum and middle ear.
wax emulsifiers, foaming humectants, and • The bulb syringe is used to irrigate, flush, and
detergents are available). It is essential that suction the vertical portion of the ear canal. Pearls
these agents be rinsed from the ear canal Cotton swabs may be used to remove debris • Ear flushing in pets with chronic otic disease
after removal of debris because they are from the folds of the external orifice of the often is coupled with routine dental prophylaxis.
potentially ototoxic if left in the middle ear, with care taken to not pack debris into • Animals that have ear cytology results that
ear in patients that do not have intact the horizontal canal. Ear loops and curettes show toxic neutrophils must be flushed as
tympanic membranes. may also be used to remove this debris. part of effective therapy.
○ There are numerous commercial milder • The otoscope with surgical head is used to • Having an assistant gently pull on the ear
cleansing agents that may contain a visualize and flush the horizontal (deep) pinna to straighten the ear canal while the
mixture of ingredients and are designed canal. The largest ear cone that will fit in clinician holds the otoscope and syringe
to be left in the ear canal. These may the ear canal is selected and advanced into with attached feeding tube can improve
be irritating to inflamed epithelium and the horizontal canal. The ear curette is passed visualization of the horizontal canal.
should be rinsed from the canal in the through the cone and gently pulled along the
author’s opinion. epidermis to loosen debris. Passing the ear SUGGESTED READING
○ The author prefers saline as the only loop while touching the wall of the canal will Glaze MB. Diseases of the eyelids, claws, anal sacs,
ear-flushing solution. Saline is effective at help the clinician to ascertain the location and ears. In Miller WH, et al, editors: Muller and
removing debris and is gentle on inflamed and depth of the tip because one eye is used Kirk’s Small animal dermatology, ed 7, St. Louis,
ear canal tissues. for the technique and depth perception may Elsevier, 2013.
• 5- or 10-mL syringe be compromised. The loop is rolled over
• Red rubber feeding tube, 8 Fr debris and then pulled out of the canal to

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