title: Removal of impacted cerumen in children using an aural irrigation system.
abstract: OBJECTIVE
  Impacted cerumen in the ear canal is a common problem that can cause discomfort or prevent assessment. Cerumen removal can have deleterious side effects if performed improperly. We created an aural irrigation system which is currently not available on the market to provide a continuous flow of water at a regulated pressure and temperature. The purposes of this study were to (1) evaluate the safety and efficacy of this aural irrigation system in children and (2) determine the success rate of cerumen disimpaction when used by an allied health professional.
  
  
  METHODS
  The following were evaluated in a nurse-run clinic: (1) referral patterns; (2) extent of canal occlusion; (3) cerumen consistency; (4) peak water pressure used; (5) patient discomfort; (6) efficacy of removal. Each ear was recorded as a separate event.
  
  
  RESULTS
  302 procedures were performed on 244 children (mean age 7.6 ± 4.1 years (range 0.5-18.3 years)). Patients were most commonly referred by an Otolaryngologist (63%), parent (17%), hearing aid provider (10%) or audiologist (9%). The most common reasons for referral were difficulty seeing the tympanic membrane (42%), fitting a hearing aid (20%) or performing an audiogram (11%). Prior to irrigation, 98% of canals were partially or fully occluded. After irrigation (mean peak pressure=488.21 ± 18.61 mm Hg (range 390-590 mm Hg), 92% of canals were completely free of cerumen (99% clear enough for evaluation or treatment). There was mild or no discomfort in 99% of patients and there were no incidences of trauma.
  
  
  CONCLUSIONS
  An aural irrigation system can be effective at clearing impacted cerumen from pediatric ear canals with minimal discomfort and no trauma and can be successfully employed in a completely nurse-run clinic.
authors.affiliation: Department of Otolaryngology, 6th Floor, Burton Wing, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. evan.propst@utoronto.ca
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Propst
authors.forename: Tomka
authors.initials: T
authors.lastname: George
authors.forename: Arif
authors.initials: A
authors.lastname: Janjua
authors.forename: Adrian
authors.initials: A
authors.lastname: James
authors.forename: Paolo
authors.initials: P
authors.lastname: Campisi
authors.forename: Vito
authors.initials: V
authors.lastname: Forte
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods; D002170:Canada; D002571:Cerumen; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004424:Ear Canal / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061214:Patient Safety; D018570:Risk Assessment; D007507:Therapeutic Irrigation / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014867:Water / Q000008:administration & dosage*
chemical_list: D014867:Water