Mirage Propulse Ear Irrigator Mode D'emploi page 12

Contraindica�on to irriga�on
If the pa�ent has experienced any complica�ons from a
previous episode of irriga�on with water.
There has been evidence of a middle ear infec�on (���s
Media) in the last 2 months.
The pa�ent has undergone any form of ear surgery apart
from grommets, which are documented to be extruded
from the tympanic membrane for over 2 years and the
pa�ent is discharged from the ENT department.
There is a suspected or actual perfora�on present or there
is a history of mucous discharge from the ear in the last 2
years.
If the pa�ent has a cle� palate (regardless of whether it has
been repaired or not).
In the presence of acute o��s externa (pain, swollen ear
canal and tenderness of the pinna).
Profound hearing loss in one ear.
Cau�on when irriga�ng with water in the
following groups of pa�ents
Pa�ent is taking an��coagulants.
The pa�ent is diabe�c.
Tinnitus.
Ver�go.
Radiotherapy that has involved the ear canal.
Ra�onale
If the pa�ent did not tolerate a previous episode of irriga�on it
would be unwise to repeat the procedure in case the symptoms
are exacerbated.
The tympanic membrane may be vulnerable to damage due to the
adverse effect infected fluid may have on the ear drum.
There will be a weakness to the structure of the ear canal and
tympanic membrane a�er surgery. This does not include cosme�c
surgery to the pinna (for example repair of bat ears). If the
tympanic membrane is intact 2 years post grommet extrusion,
there should not be an increased risk of damage to the tympanic
membrane.
A mucous discharge would indicate a perfora�on and water entry
under pressure could cause infec�on or damage the delicate
middle ear structures.
A cle� palate indicates an underdeveloped facial skeleton and as
such the tympanic membrane and middle ear structures could be
more vulnerable to damage.
Although it is essen�al to thoroughly clean the infected ear canal,
when it is swollen debris should be removed by microsuc�on.
There is a risk associated with any interven�on and when a pa�ent
completely relies on one ear for hearing (as the other ear has a
profound hearing loss) any risk to this ear is unacceptable.
Ra�onale
The lining of the ear canal is delicate and there is a higher risk of
bleeding so ensure trauma to the ear canal is avoided.
The pH of wax in pa�ents who are diabe�c is a higher pH than
average, increasing their vulnerability to infec�on.
Although wax impac�on can cause �nnitus, trauma to the
tympanic membrane may exacerbate this.
This is also a symptom of wax impac�on but irriga�on can trigger
an episode so ensure appropriate water temperature and pa�ent
safety.
A radiated ear canal can develop bony necrosis so wax should be
removed before it becomes hard and trauma to the canal should
be avoided.
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