Usually, earwax can be safely removed by softening it with water, saline or commercial ear drops and then through gentle syringing or manual extraction with a device called a curette.
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The recurrent problem of wax in Errol's ears, a buildup that affected his hearing, required Dr. Higueros's attention: hydrogen peroxide to soften the impaction and then vigorous syringing over a white ceramic bowl into which the wax fell, in a way that Errol found stirring.
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Docusate sodium, when used with ear syringing, may help with earwax removal, particularly in the case of impaction. Sodium docusate is also used as a lubricant in the production of tablets and as an emulsifier in topical preparations and other suspensions.
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The author Bull advised physicians: "After removal of wax, inspect thoroughly to make sure none remains. This advice might seem superfluous, but is frequently ignored." This was confirmed by Sharp et al., who, in a survey of 320 general practitioners, found that only 68% of doctors inspected the ear canal after syringing to check that the wax was removed.
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There have been rare cases of air embolism being caused by air entering the bloodstream from the uterus or tears in female genitalia. The risk appears to be greater during pregnancy. Cases have been reported that resulted from attempts to perform an abortion by syringing. These appear to have been due to damage to the placenta allowing air to enter the bloodstream.
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While high, this is not surprising, as ear syringing is an extremely common procedure. Grossan suggested that approximately 150,000 ears are irrigated each week in the United States, and about 40,000 per week in the United Kingdom. Extrapolating from data obtained in Edinburgh, Sharp et al. place this figure much higher, estimating that approximately 7000 ears are syringed per 100,000 population per annum.
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Movement of the jaw helps the ears' natural cleaning process. The American Academy of Otolaryngology discourages earwax removal, unless the excess earwax is causing problems. While a number of methods of earwax removal are effective, their comparative merits have not been determined. A number of softeners are effective; however, if this is not sufficient, the most common method of cerumen removal is syringing with warm water.
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The irrigation solution flows out of the canal along its floor, taking wax and debris with it. The solution used to irrigate the ear canal is usually warm water, normal saline, sodium bicarbonate solution, or a solution of water and vinegar to help prevent secondary infection. Affected people generally prefer the irrigation solution to be warmed to body temperature, as dizziness is a common side effect of ear washing or syringing with fluids that are colder or warmer than body temperature.
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It is simply spread over a greater area and the plants require even closer care than before, for greater attention must be paid to watering, syringing, and ventilation, success at this stage being very largely dependent thereon. As the fruit attains size, it is usually lifted from the soil by a shingle or flat stone, to avoid loss from cracking, rot, etc. Uniform shape, color, netting, and ripening is secured by turning the fruit every few days. When the runners fairly occupy the inclosed area the frames are raised a few inches.
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As a doctor in Vienna, Bárány was syringing fluid into the external auditory canal of a patient to relieve the patient's dizzy spells. The patient experienced vertigo and nystagmus (involuntary eye movement) when Bárány injected fluid that was too cold. In response, Bárány warmed the fluid for the patient and the patient experienced nystagmus in the opposite direction. Bárány theorized that the endolymph was sinking when it was cool and rising when it was warm, and thus the direction of flow of the endolymph was providing the proprioceptive signal to the vestibular organ.
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As a result, failure to remove the wax from the canal made up approximately 30% of the complications associated with the procedure. Other complications included otitis externa (swimmer's ear), which involves inflammation or bacterial infection of the external acoustic meatus, as well as pain, vertigo, tinnitus, and perforation of the ear drum. Based on this study, a rate of major complications in 1/1000 ears syringed was suggested. Claims arising from ear syringing mishaps account for about 25% of the total claims received by New Zealand's Accident Compensation Corporation ENT Medical Misadventure Committee.
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Once the cerumen has been softened, it may be removed from the ear canal by irrigation, but the evidence on this practice is equivocal. This may be effectively accomplished with a spray type ear washer, commonly used in the medical setting or at home, with a bulb syringe. Ear syringing techniques are described in great detail by Wilson & Roeser and Blake et al. who advise pulling the external ear up and back, and aiming the nozzle of the syringe slightly upwards and backwards so that the water flows as a cascade along the roof of the canal.
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