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Am Fam Physician. 2000;61(1):197-198

Ear irrigation is used to treat patients who have complaints such as foreign body or cerumen impaction. Normal saline solution is the most widely used irrigant because of availability, sterility, low cost and rare side effects. A previous study demonstrated that patients significantly preferred warmed solution for ocular irrigation, but no studies have demonstrated a similar preference with ear irrigation.

Ernst and associates compared the comfort level and side effects of warmed versus room-temperature saline solution for ear irrigation. Forty volunteers, mostly emergency department personnel in a single hospital setting, underwent ear irrigation with warmed and room temperature saline solutions in a single-blind, randomized, crossover study. The warmed solution was maintained at a temperature between 32.2°C (90°F) and 37.8°C (100°F). The ambient room temperature was 21.1°C (70°F). Subjects had opposite ears sequentially irrigated at approximately 3 mL per second with room temperature solution and warmed solution. Following each irrigation, patients rated the discomfort level using a standard 100 mm visual analog scale (VAS) with one end labeled “no discomfort” and the other end labeled “worst discomfort.” Patients were also asked four questions to further evaluate their sensations and preferences, and then an otoscopic examination was performed to check for irritation or damage (e.g., erythema).

VAS scores indicated a significant difference between the two solutions, with the warmed solution being favored. More patients found the warmed solution soothing, although a majority of patients found neither solution soothing. Dizziness was significantly more common in patients following irrigation with the room-temperature solution. No patient was noted to have nystagmus. All post-trial otoscopic examinations revealed findings within normal limits.

The authors conclude that warmed normal saline solution was more comfortable than room temperature saline solution when used in small amounts for irrigation in patients who did not have acute ear injury. Dizziness was the only side effect reported and was more frequent following irrigation with room temperature solution. Solutions for irrigation can be easily warmed in a microwave, but the temperature should be carefully checked before use. The authors noted that the study used only a small amount of irrigant, probably much less than might be used in cases of impaction or foreign body removal.

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