Before irrigation, the clinician should perform otoscopy and ensure that the tympanic membrane is intact and tympanostomy tubes are not present. Using an intravenous catheter attached to a 20 to 50 mL syringe, irrigate with lukewarm water by directing the stream at the posterosuperior wall of the external auditory canal.
Modified from: Fuerst RS. Removal of cerumen impaction. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2008.
