Ear Wax Removal
My child went to the Pediatrician for a high fever. The Pediatrician was checking the ears and said he couldn't see bcuz of wax. He used something to scrape or dig some very hard wax out and the ear was bleeding. Not to mention the fact he said there was an ear infection. Is this standard procedure? Then he said just give Tylenol for the pain and use a tissue to stop the bleeding and prescribed antibiotics for the ear infection.
Unfortunately, it is very difficult to see into a child’s ear because the canal is so small and because they tend to move during the examination. To complicate matters, wax blocks the view of the ear drum. The only way to be certain that a child has a middle ear infection is to visualize and ascertain the mobility of the tympanic membrane(ear drum). (1)
Many times this is a catch 22 situation, because if the wax is not removed, a child could have an undiagnosed middle ear infection. If the wax is removed, it can be uncomfortable for the child and the procedure can sometimes cause a scrape on the inside of the ear canal.
Although it is not the norm, a scrape inside the ear canal during cerumen (wax) removal unfortunately sometimes does occur. If the curette used to remove the wax rubs against the side of the ear canal during the procedure, a scrape and subsequent bleeding can occur. (2) The tiniest scrape can cause a lot of bleeding and can usually appear a lot worse than what it is. The good thing is that the bleeding should stop within a couple of minutes and the scratch heals within a few days.
Children with a lot of wax or hard wax are at the risk of having their canal scratched during cerumen removal. In order to prevent this from happening, it is a good idea to keep the ears clear from excessive wax build up. This is especially important in a child with a history of recurrent ear infections because of the liklihood of subsequent visits requiring visualiation of the ear drum.
To keep the ears free from wax build up a hydrogen peroxide and water mixture can be instilled into a child’s affected ear.(2) Equal parts of hydrogen peroxide and water can be measured and poured into a small medicine cup. Four to five dropperfuls of the solution should be instilled into the affected ear twice per day. The child should be lying down on their side when the drops are instilled.(2)
The child needs to remain still for approximately 30 minutes after the drops are instilled so that the drops won’t roll out onto the cheek. Providing the child with a book or a favorite television show may help pass the time. For very young children or for children who move a lot you may need to instill the drops when the child is sleeping. It is a good idea to wait until the child is asleep for at least 30 minutes before trying to instill the drops.
If a parent prefers to use the hydrogen peroxide solution already prepared, Debrox can be purchased. Debrox comes with in its own dropper bottle and can be found over the counter.
The drops should to be instilled for 4 to 5 nights in a row and used on a monthly basis for children with chronic problems. Many parents report discontinuing the drops when they didn’t see any wax come out of the ear, thinking that the drops didn’t work. Just because wax doesn't come out of the canal, does not mean that the drops are not working. The purpose of instilling the hydrogen peroxide solution is to soften the wax so that it can more easily be removed. (2) In most cases, you will not see any wax come out of the ear.
In some cases wax may come out of the ear canal and stick to the outer ear. When this occurs, care should be taken when removing it. If a Q-tip is put into the ear canal and twisted this can cause the wax to be pushed back further which can worsen the condition.(2) In addition, inserting a Q-tip into the ear canal runs the risk of an injury such as a perforated ear drum. Instead, wax on the outer ear should be gently wiped away and the Q-tip should only be used on the external ear.(2)
Parents can also bring the drops to the Doctor’s office and if it is found that the child’s wax is obstructing the view of the ear drum, the drops can be instilled 15 minutes prior to the wax removal. (2) For children with impacted cerumen or excessive wax build up, irrigation or evacuation may be needed.
Ear irrigation can be quite messy and can frighten the child.(2) The irrigation of the ear is a very simple procedure and can be carried out in the Pediatrician's office. A spray bottle filled with warm water and hydrogen peroxide is squirted into the ear using a special adapter. In some cases a Water Pik may be used. (2) The water squirted into the child’s ear loosens and removes the wax build up. This procedure is not recommended if a perforated ear drum is suspected.(2)
Older children and adults have reported that this procedure feels uncomfortable, but is not painful. I have also had older children tell me that their ear felt much better when the wax was removed. Very young children many times have a different response. I found that young children tend to cry and resist the procedure. When I asked if they preferred the irrigation bottle or the manual scraping, most of them prefer to have their ear wax manually removed with a curette.
Some children with chronic build up of extensive amounts of wax need to see an Otolaryngologist and have their ears evacuated. This is not the norm but may be necessary in children with excessive amount of wax that cannot be removed by other means. Children with myringotomy tubes in their ears should not have any drops or medication instilled into the ear without approval of the specialist who inserted the ear tubes.
It must be upsetting to see your child’s ear bleed after it is examined for an ear infection. Unfortunately, this is one of the risks of removing wax from the ear canal. The good thing is that your daughter’s ear infection was discovered and antibiotic therapy was initiated which will hasten the resolution of her symptoms. Her ear canal will heal and she should be back to herself soon.
(1)Carlson L. What’s New in the Guideline? Therapeutic Spotlight. 2004. June:11-13.
(2)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 706-707.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice About Treating Sick Children