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[Tripping]

Empezamos con la Busqueda de bibliografia y de evidencia cientifica sobre el Lavado de Oido




En cuiden hay mas bien poco:

Número Registro   311191
Autor Artículo   [Sin autor especificado]
Título   Lavado de oídos
Revista   Oiñarri
Fecha de Publicación   1999 jun
Año/Volumen/Páginas   19:21-22
Tipo de Documento   Protocolo y pautas de actuación
Palabras Clave   Oído/ Higiene/ Lavado de oídos

y encima no está online. Seguire buscando en cuiden, pero casi mejor me paso a Medline. Otros buscar en otras bases de datos. Aunque me parece que un tema asi, al ser tecnca, vendra mejor en libros de Técnicas de Enfermería.

[Lilita]

Ahí va otro: El uso del agua oxigenada como diluyente de tapones óticos de cerumen versus aceite de oliva versus cerumenolíticos comerciales  http://es.geocities.com/carlosgerena/reseviden02
Nos da una idea de como hacer las busquedas...

[Tripping]

en ENFISPO tampoco hay nada. me paso directamente al Medline

[Lilita]

  Este esta en Ingles http://icarus.med.utoronto.ca/carr/manual/cerumen.html

1. Ceruminolytics

A variety of substances are available:

    * Bicarbonate solution
          o There is experimental evidence that a 10% aqueous solution of bicarbonate dissolves cerumen most effectively
    * Olive oil
    * Glycerine
    * Off the shelf preparations: Cerumenol, Cerumenex etc.
          o These work well when used prior to ear syringing, but are more expensive
          o Local reactions to these solutions are possible

¿Alguien ha usado bicarbonato al 10% para los tapones de cerumen? Yo es la primera vez que lo veo 

[Tripping]

interesante...

[Tripping]

 

incluso podriamos hacer un estudio de casos y controles:
prescripción facultativa: gotas oticas (casos)
prescripcion enfermera: aceite de oliva (controles)

en un mes (agosto) en un centro de salud...

[Tripping]

 :baby:mirar la base de datos en MBE CATS

www.mbe.i2000.com
del hospital de Donostia
hay algunos estudios de EBE (8) 

[Tripping]

 
Estudios EBE del Hospital de Donostia: CATS

  LA PROTECCIÓN OCLUSIVA (ESCUDO DE ESPONJA CON BETADINE) DE LA CONEXIÓN (SISTEMA/CATÉTER) DE LAS VÍAS VENOSAS CENTRALES PARA NPO DISMINUYE EL RIESGO DE SEPSIS 

      LA DESINFECCIÓN DE LAS MANOS O EL USO DE GUANTES DISMINUYE LAS COMPLICACIONES DE LA INSERCIÓN DE CATÉTERES VENOSOS PERIFÉRICOS 

      LA DEAMBULACION PRECOZ EN LA TVP AGUDA NO AUMENTA EL RIESGO DE EMBOLIA PULMONAR 

      LA NUTRICIÓN ENTERAL (NE) CONTINUA CON REPOSO NOCTURNO NO PARECE MEJORAR LA TOLERANCIA DIGESTIVA FRENTE A LA NE EN BOLUS EN PACIENTES GERIÁTRICOS HOSPITALIZADOS 

      EN LAS ULCERAS VENOSAS Y UPP LAS CURAS HÚMEDAS PARECEN SER IGUAL DE EFICACES A LAS TRADICIONALES Y ADEMÁS AHORRAN TIEMPO DE ENFERMERÍA Y Nº DE CURAS 

      EL USO DE DIFERENTES TIPOS DE APÓSITOS NO PARECE INFLUIR EN EL RIESGO DE INFECCIÓN DEL CATÉTER VENOSOS CENTRAL 

[Lilita]

Y la wikipedia... http://en.wikipedia.org/wiki/Earwax

Cerumenolysis

It is usually necessary to soften wax before its removal. This process is referred to as cerumenolysis, and is achieved using a solution known as a cerumenolytic agent which is introduced into the ear canal. The most common home-remedy for this purpose is olive oil [16]. Other commercially available and common cerumenolytics include:

    * [under multiple brand names] Carbamide peroxide (6.5%) and glycerine
    * Sodium bicarbonate B.P.C. (sodium bicarbonate and glycerine)
    * Various organic liquids (glycerol, almond oil, mineral oil, baby oil)
    * Cerumol (arachis oil, turpentine and dichlorobenzene)
    * Cerumenex (Triethanolamine, polypeptides and oleate-condensate)
    * Exterol (urea, hydrogen peroxide and glycerine)
    * Docusate, an active ingredient found in laxatives

A cerumenolytic should be used 2-3 times daily for 3-5 days prior to the cerumen extraction [17]. Although most commercially available cerumenolytics available in the U.S. are identical, containing carbamide peroxide (6.5%) and glycerine [17], a 10% solution of sodium bicarbonate was found to be a more effective cerumenolytic than several commercially-available solutions (Cerumenex, Auralgan) and numerous organic liquids, including glycerine, olive oil, and alcohol [18]. Additionally, 1 mL of docusate was also found to be a more effective cerumenolytic than several commercially-available solutions (Cerumenex, Debrox) [1]. Docusate may be extracted from liquid preparations of laxatives, such as Colace.

Syringing

Once the cerumen has been softened, it may be removed from the ear canal by irrigation. Ear syringing techniques are described in great detail by Wilson & Roeser [17], and Blake et al. [19], 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. 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 water [19], normal saline [20], sodium bicarbonate solution [21], or a solution of water and vinegar to help prevent secondary infection [19].

Patients generally prefer the irrigation solution to be warmed to body temperature [20], as dizziness is a common side effect of syringing with fluids that are colder or warmer than body temperature . Sharp et al. [15] recommend 37ºC, while Blake et al. [19] recommend using water at 38ºC, one degree above body temperature, and stress that this should be checked with a thermometer.

   1. ^ Roeser, R.J., Ballachanda, B.B. (1997). " Physiology, Pathophysiology, and Anthropology/Epidemiology of Human Earcanal Secretions". J.Am.Acad.Audiol. 8 (6): 391-400. PubMed.
   2. ^ Alvord, L.S., Farmer, B.L. (1997). " Anatomy and orientation of the human external ear". J.Am.Acad.Audiol. 8 (6): 383-390. PubMed.
   3. ^ Overfield, T. (1985). Biologic Variation in Health and Illness: Race, Age, and Sex Differences. Menlo Park, CA, USA: Addison-Wesley Publishing. ISBN 0201128101.
   4. ^ Bass, E.J., Jackson, J.F. (1977). " Cerumen types in Eskimos". Am.J.Phys.Anthropol. 47 (2): 209-210. PubMed.
   5. ^ Yoshiura, K.I., et al. (29 January 2006). "A SNP in the ABCC11 gene is the determinant of human earwax type". Nat Genet.. DOI:10.1038/ng1733.
   6. ^ Alberti, P.W.R.M. (1964). " Epithelial migration on the tympanic membrane". J.Laryngol.Otol. 78: 808-830. PubMed.
   7. ^ Harvey, D.J. (1989). " Identification of long-chain fatty acids and alcohols from human cerumen by the use of picolinyl and nicotinate esters". Biomed.Environ.Mass.Spectrom. 18 (9): 719-723. PubMed.
   8. ^ Bortz, J.T., Wertz, P.W., Downing, D.T. (1990). " Composition of cerumen lipids". J.Am.Acad.Dermatol. 23 (5): 845-849. PubMed.
   9. ^ Perry, E.T., Nichols, A.C. (1956). " Studies on the growth of bacteria in the human ear canal". J.Invest.Dermatol. 27 (3): 165-170. PubMed.
  10. ^ Chai TJ, Chai TC. (1980). "Bactericidal activity of cerumen". Antimicrob Agents Chemother. 18 (4): 638-641. PubMed.
  11. ^ Stone, M., Fulghum, R.S. (1984). " Bactericidal activity of wet cerumen". Ann Otol Rhinol Laryngol. 93 (2): 183-186. PubMed.
  12. ^ Megarry, S., Pett, A., Scarlett, A., Teh, W., Zeigler, E., Canter, R.J. (1988). " The activity against yeasts of human cerumen". J.Laryngol.Otol. 102 (8): 671-672. PubMed.
  13. ^ Roland, P.S., Marple, B.F. (1997). " Disorders of the external auditory canal". J.Am.Acad.Audiol. 8 (6): 367-378. PubMed.
  14. ^ Oliveira, R.J. (1997). " The active earcanal". J Am Acad Audiol. 8 (6): 401-410. PubMed.
  15. ^ a b c d e f Sharp, J.F., Wilson, J.A., Ross, L., Barr-Hamilton, R.M. (1990). " Ear wax removal: A survey of current practice". Br.Med.J. 301 (6763): 1251-1253. PubMed.
  16. ^ Fraser J.G. (1970). " The efficacy of wax solvents, in vitro studies and clinical trial". J.Laryngol.Otol. 84 (10): 1055-1064. PubMed.
  17. ^ a b c Wilson, P.L., Roeser, R.J. (1997). " Cerumen management: professional issues and techniques". J.Am.Acad.Audiol. 8 (6): 421-430. PubMed.
  18. ^ Robinson, A.C., Hawke, M. (1989). " The efficacy of ceruminolytics: everything old is new again". J.Otolaryngol. 18 (6): 263-267. PubMed.
  19. ^ a b c d e Blake, P., Matthews, R., Hornibrook, J. (1998). " When not to syringe an ear". N.Z.Med.J. 111 (1077): 422-424. PubMed.
  20. ^ a b Ernst, A.A., Takakuwa, K.M., Letner, C., Weiss, S.J. (1999). " Warmed versus room temperature saline solution for ear irrigation: a randomised clinical trial". Ann.Emerg.Med. 34 (3): 347-350. PubMed.
  21. ^ a b Bull, P.D. (1985). Lecture notes on diseases of the ear nose and throat, 6th edition, Oxford: Blackwell Scientific Publications. ISBN 0632065060.
  22. ^ Grossan, M. (1998). " Cerumen removal – current challenges". Ear Nose Throat J. 77 (7): 541-548. PubMed.
  23. ^ Carroll, R.T. (2005). The Skeptic's Dictionary: ear candling (coning). Retrieved on 13 February 2006.
  24. ^ Adams, Cecil (1995). The Straight Dope: How do "ear candles" work?. Retrieved on 21 March 2006.
  25. ^ Commanding Officer of NOAA Ship MALCOLM BALDRIGE

[Lilita]

Impacted cerumen: composition, production, epidemiology and management http://qjmed.oxfordjournals.org/cgi/content/full/97/8/477#SEC6 

The most effective products available to facilitate ear syringing
En este hay un interesante estudio sobre soluciones para instilar en el oido...

Enfermerva el enlace a MBE cats no funciona

[Lilita]

Protocolo lavado oidos http://www.enferurg.com/tecnicas/lavadooidos.htm

[Tripping]

:baby:mirar la base de datos en MBE CATS

www.mbe.i2000.com
del hospital de Donostia
hay algunos estudios de EBE (8) 

perdón:
www.mbe.i2000.es
comprobada...

[Lilita]

Articulo de enfermería sobre cuidados del oido... MUY BUENO...

http://www.entnursing.com/earcare.htm

Guidance on the use of syringes in the ear



The metal syringe is obsolescent for use in the ear canal. The syringe design is inherently dangerous. Combined with the danger of the syringe itself and the pressure of water it creates within the ear canal, there is the difficulty of disinfecting the syringe after each use. The Medical Devices Agency (MDA) also has reservations about the use of the metal syringe for wax removal. There are issues around the poor manufacture of some syringes allowing them to break and cause injury during use and the pressure of water that can be exerted manually on the tympanic membrane.[/b]

Electronic irrigators such as the "Propulse" and the "Otoscillo" allow irrigation of the ear canal rather then wax removal under pressure. The MDA issued Safety Notice SN 9807 in February 1998 that advised users that the original Propulse electronic irrigator required an isolation transformer for electrical safety. Subsequently, the manufacturer designed and marketed the Propulse II to replace the original Propulse. This guidance document recommends that practitioners use an electronic ear irrigator rather than the manual syringe and refer to the procedure as ear irrigation.

The Propulse II irrigator has a pressure variable control of minimum-maximum, allowing the flow of water to be easily controlled by commencing irrigation on the minimum setting. For patient safety, Propulse has limited the maximum pressure available; this limit is stated in the user instructions. The propulse II irrigator has specific disinfecting guidelines issued with approval from infection control committees.

The only other equivalent device available on the British market is the German ear irrigator called the Mulimed-Otoscillo irrigating jet machine. The numbers one to six denotes the pressure control but, as the manufacturer does not state a maximum limit, it is difficult to assess the maximum pressure developed by the irrigator. There is no evidence promoting this machine as an ear irrigator and there is no documentation about the safe pressure exerted by the machine. A further failing is that the design of the irrigator tip does not offer the preferred direction against the posterior ear canal wall. The manufacturers of the Mulimed-Otoscillo do not recommend a specific solution to disinfect the irrigating machine. This has the danger of users using inappropriate solutions and the machine harbouring infection.

The Welch Allyn Ear Wash System is an American irrigator that attaches to a combined hot and cold water tap. There are problems in the United Kingdom with attachment to a number of taps found within the community and hospital setting. It is of comparable price to both the electronic irrigators but there may be the added cost of having the tap changed to a suitable model. The system can not be used in rooms where there is no access to water as in patients confined to a sitting room within a nursing home or community setting. It does limit the maximum amount of water pressure exerted in the ear and controls variation in the flow of water. If there is an increase/ decrease in the temperature of water the machine will stop the flow of water until it is altered. This machine has a suction system, which returns the discharge and debris away from the ear and can be used without the flow of water to remove the remaining moisture from the ear canal.

Joerrr, que modernas  ¿Quien ha visto estos aparatos electricos para instilaciones auditivas?

Estoy de acuerdo en que la jeringuilla metalica es obsoleta, peligrosa y ademas dificil de limpiar...

[Tripping]

yo por lo menos no lo he visto nunca.
No olvides de guardar donde has encontrado esta inforamción, ok?
si son webs normales, no nos vana valer mucho si pretendemos hacer análisis crítico de un artículo (que para mi es mas interesante).

[Lilita]

En España na de naa, pero en Inglaterra 

# Aung, T. and Mulley, G.P. (2002) Removal of ear wax: 10 minute consultation. British Medical Journal  325(7354), 27-28. [Full text]

# Bapat, U., Nia, J. and Bance, M. (2001) Severe audiovestibular loss following ear syringing for wax removal. Journal of Laryngology & Otology 115(5), 410-411. [Full text]

# Bird, S. (2003) Clinical practice: risk management. The potential pitfalls of ear syringing: minimising the risks. Australian Family Physician 32(3), 150-151.

# BNF 47 (2004) British National Formulary. 47th edn. London: British Medical Association and Royal Pharmaceutical Society of Great Britain.

# Browning, G. (2003) Wax in ear. Clinical Evidence 10(Dec), 490-497.

# Burton, M.J. and Doree, C.J. (2004) Ear drops for the removal of ear wax (Cochrane Review). The Cochrane Library. Issue 2. Chichester, UK: John Wiley & Sons, Ltd. www.nelh.nhs.uk/cochrane.asp [Accessed: 06/01/2004].

# Grossan, M. (2000) Safe, effective techniques for cerumen removal. Geriatrics 55(1), 80-86. [Full text]

# Hawke, M. (2002) Update on cerumen and ceruminolytics. Ear, Nose, & Throat Journal 81(8:Suppl 1), S1-S4.

# Lewis-Cullinan, C. and Janken, J.K. (1990) Effect of cerumen removal on the hearing ability of geriatric patients. Journal of Advanced Nursing 15(5), 594-600.

# Memel, D., Langley, C., Watkins, C. et al (2002) Effectiveness of ear syringing in general practice: a randomised controlled trial and patients' experiences. British Journal of General Practice 52(484), 906-911.

# Sharp, J.F., Wilson, J.A., Ross, L. and Barr-Hamlington, R.M. (1990) Ear wax removal: a survey of current practice. British Medical Journal 301(6763), 1251-1253.

# Somerville, G. (2002) The most effective products available to facilitate ear syringing. British Journal of Community Nursing 7(2), 94-101.

# Zivic, R.C. and King, S. (1993) Cerumen-impaction management for clients of all ages. Nurse Practitioner 18(3), 29-39.

[Tripping]

y te sorprendes de algo?
Recomiendo leerlos todos..... jejejejeje.... elegir el mejor y más actual

[Tripping]

propongo que las personas que estén interesadas en formar parte del grupo envien un CV breve para poder formar parte de el...
asi tendremos los seguros participantes... y no nadie qeu este aqui por estar ni q...

[Lilita]

http://www.prodigy.nhs.uk/earwax/view_whole_guidance

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1409960 An evaluation of a nurse-led ear care service in primary care: benefits and costs. Muy bueno ademas justifica la prescripcion enfermera.

http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116671 Removal of ear wax

http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1324923 The effectiveness of topical preparations for the treatment of earwax: a systematic review

[Lilita]

http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1324923 The effectiveness of topical preparations for the treatment of earwax: a systematic review
Este es el mejor articulo que he encontrado... 

Enfermeva, las referencias son de PUBmed y los de nursing estan publicados en el NHS e indexados en Cochrane...

[Tripping]

 
Ok, leere mañana este ultimo.
sigue así lil...
yo no doy más por hoy.
Mañana sigo... si por la noche estás por aui... nos vemos.

haber si los demás se van apuntando¡¡¡¡