12/19/2023 0 Comments Curette ear wax removalCare is taken to avoid friction against the tender canal walls. Although most procedure books demand that the procedure be done under direct vision using an operating head of the otoscope, I prefer to hold the curette in one hand and use the free hand to manipulate the auricle posteriorly and superiorly, to optimally straighten the ear canal.Īfter I believe that I have passed the earwax with the ring portion of the curette, I engage the circular ring of the curette at the inferior portion of the wax plug and very gently scoop the wax toward the external canal orifice. Many infants or struggling older children must have aural cleaning in a supine position with the arms and thighs restrained against the examining table.Īfter otoscopy shows me where the earwax has accumulated, the angled curette, which has been cleaned with isopropyl alcohol, is slowly introduced into the ear canal adjacent to the canal wall, taking care not to touch the canal wall itself. If the child/adolescent can remain still and the earwax is not tightly impacted or located more than one centimeter deep in the ear canal, skillful removal of the earwax can be performed in the sitting position. One day soon, I plan to start a comparison trial of metal vs. However, in the hand of a novice, compared with a metal curette, the flex-loop design or infant ear scoop may be less likely to scratch the canal wall. Although I have limited experience with the plastic disposable curettes, they seem inferior to a proper-designed metal curette because of their light weight and thickness of the ring. I much prefer using a metal aural curette such as Buck's angled (not straight), blunt (not sharp), size 1 German-made curette. Methods of earwax removalĮarwax can be removed by three methods: water pressure, suction and curettes. Ethnic Chinese, Korean, and Vietnamese children with Down syndrome often had dry, flaky, pale earwax which was more difficult to remove. 1 Buck's metal curette was noted in about 10% of children, and 6% of those children had enough bleeding to require insertion of a cotton wick, with or without instillation of coagulant solution such as phenylephrine, 0.5% or Monsel's solution, a ferric subsulfate that coagulates blood at bleeding sites. Only a few children in that study had excessive hard-inspissated earwax which required softening with ceruminolytic agents. One of three children 13-24 months old, and approximately 15% to 20% of older children, also need to have their ear canals cleaned. Seventy percent of infants 2 to 6 months old and 50% of infants 7 to 12 months old required removal of cerumen to clearly see the ossicular landmarks. In general, the younger the child, the greater the chance of having to remove cerumen and squamous debris in order to properly visualize the ossicular landmarks of the eardrum. In a previously published study, mechanical removal of the cerumen was necessary to visualize the eardrums of 29% of 279 children with unilateral acute otitis media. Few otolaryngologists use them in my area and, to my knowledge, there are no studies to compare their effectiveness with blunt, angled, Buck's or Shapleigh's metal aural curettes - the gold standard for the task. Disposable plastic aural curettes in four styles are now available (Bionix Safe Ear Curettes) and used by some pediatric residents and practicing pediatricians. Homemade curettes fashioned from nasopharyngeal swabs or metal paper clips and homemade aural irrigation attachments fashioned from butterfly needles and a 10 ml syringe appear to be the tools of the trade for these trainees. It is curious that medical students and pediatric residents, usually at the forefront of technical advances, often use rather primitive and ineffectual equipment for the task.
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