PATIENT______________________ DATE_____________

1. Make sure that the correct ear receives the drops. In many cases, only one ear needs to be flushed.

You need to insert drops into: RIGHT LEFT BOTH

2. The drops should be inserted daily, once a day, and should begin:

______ONE DAY BEFORE FLUSHING

______TWO DAYS BEFORE FLUSHING

______THREE DAYS BEFORE FLUSHING

Your ear flushing is scheduled for Day:___ Date:___ Time:___

______We will contact you with your scheduled date and time.

Once you begin using the drops, stop wearing your hearing aids in the ears receiving the drops.

3. Only FDA approved drops should be used. They are those that contain 6.5% Carbamide Peroxide. If the following conditions exist, then eardrops should not be used, and you should see a medical doctor for removal of the wax:

• Ear drainage or discharge
• Ear pain
• Dizziness of unknown origin
• Ear rash or skin irritation
• Perforation of the eardrum (hole)
• Recent ear surgery

4. Tilt your head to the side; usually lying down is helpful. Have someone drop 10 drops from the bottle into your ear canal. It is best if the bottle does not touch the skin directly. Have the person who is inserting the drops take a very small piece of cotton ball and seal up the opening of the ear canal. This way you can sit up, and the drops will not drain out of your ears.

If you are putting the drops into your own ears, you will not be able to tell when you have dropped 10 drops. So instead of dropping the drops directly into your ear canal, put the 10 drops into a small paper cup and then drain the drops from the cup into your ear canal. Remember to seal up the ear with cotton before you pick up your head or the drops will drain out. Throw away the cup after you use it for eardrops, because it is not safe to use for drinking.

5. Keep the cotton in your ear for an hour and then remove it and throw it away.

6. Do this for as many days as marked on page one of this Instruction Sheet.

7. If any portion of this instruction is not clear, please call the office before you begin this treatment: 216-921-6556.

For persons who do not wear hearing aids, small amounts of ear wax are no problem. If the ear actually gets plugged with wax, this can be the beginning of larger ear problems and the wax should be removed. For persons who do wear hearing aids, even small amounts of ear wax are a problem. The most common cause of hearing aid malfunction is wax clogging the sound tube that carries the sound into the ear. Once this happens, the hearing aid stops working until it is properly cleaned.