Although ear micro suction is usually our preferred method of ear wax removal, we have been using the Bionix OtoClear SprayWash irrigation technique at Liverpool Hearing Centre for over 3 years on what must be thousands of patients. We believe that it is 100% safe when used by a professional who has the ability to make experienced clinical judgments about how to proceed with every individual case.
When not to use a water method
In our opinion, water methods should be avoided, when possible. They can introduce infection or at least provide a conduit, you can't see what's happening in the canal, the warmth of the water can bring the blood to the surface and immediate impression taking (for moulds and hearing aids) after irrigation is rarely advised.
Also, any method of irrigation and syringing is contraindicated for patients whose eardrum may be perforated, where grommet tubes are present or suspected, or an active infection is present or suspected.
When it's a good idea to irrigate
So there are lots of good reasons not to but there are times when it does become good clinical judgement to put the suction tube down and turn to the trusty irrigator. The 2 main reasons are as follows:
1. The ear wax is beyond the second bend of the canal. Airflow noise for the patient increases significantly the closer you get to the eardrum with the suction tube and the risks of tinnitus and hearing loss will likely increase.
2. The ear wax is extremely viscous. This can be naturally occurring but the prevalence increases in patients who have been using ear wax softeners such as olive oil, hydrogen peroxide and sodium bicarbonate. Often there can be a thin coating all around the canal walls and tympanic membrane that makes it difficult for the practitioner to get their bearings and safely micro suction.
Why use OtoClear instead of electronic ear irrigation?
The number one main reason is simply convenience. You can make the switch from ear micro suction to water irrigation in a minute. There's even a temperature gauge on the bottle to make filling at the right temp a breeze.
Also, the exit portals of the OtoClear Tip are designed to direct drainage into the ear basin, reducing clean up time. This design also eliminates splash back onto the operator.
Reasons why OtoClear is Safe
Fluid will not directly impact the eardrum - At the tip there are three holes, which direct the fluid towards the ear canal walls, virtually eliminating the risk of damage to the eardrum.
The OtoClear Tip does not occlude the ear canal - It has special exit portals through which effluent is discharged from the ear canal. This prevents potential build-up of pressure in the ear
canal.
The tips cannot be over-inserted - The unique flared design of the OtoClear Tip ensures that it cannot be over-inserted in the ear.
The pressure is extremely controllable using a gentle action on the squeeze handle. A gentle, turbulent flow is usually enough for the removal of loose or liquid wax. Stubborn hard wax is
often best removed with microsuction or with a dry tool instrument such as a Jobson horn or a cerumen ear hook.
The kit comes with a collection basin and 20 tips included.
And yes, we're well aware that it's a glorified garden spray but the cleverly designed device is half the cost of traditional ear irrigators, while also being safer and more comfortable for your patients ears.
In the interest of full disclosure, we also have an electronic pulse irrigator at Liverpool Hearing Centre which is a fantastic device when we need it but the Bionix Spraywash is used far more often (daily) to mainly finish off the final third of the canal in a gentle and safe way.
