• Use an electronic ear irrigator. This should have a variable pressure control so that irrigation can begin at the minimum pressure.
• Prepare equipment as per local guidelines and manufacturer's instructions. This will include a fresh speculum and jet tip for each person. Protect the person's clothing with a towel or waterproof covering. Ask the person to hold the water receiver under their affected ear.
• Ensure that the person is sitting comfortably and that you are sitting at the same level. Use a good light source, preferably with a head lamp or head mirror, throughout the procedure.
• Ensure that the temperature of water used for irrigation is around body temperature.
• Pull the pinna upwards and outwards (downwards and backwards in children) to straighten the ear canal.
• Angle the jet tip so that the flow of the water is along the top of the posterior wall. Compare the perimeter of the canal to a clock face: for the left ear direct the fluid towards 1 o'clock, and for the right ear direct the fluid towards 11 o'clock.
• Inspect the ear canal periodically with the auriscope and monitor the solution running into the receiver to determine whether wax is coming out.
• If the person complains of dizziness or pain, stop the procedure.
• In general, use no more than 500 mL of water per ear in any one irrigating procedure.
• Following irrigation, examine the ear with an auriscope to check that the wax has been removed and the tympanic membrane is intact. Look for old healed perforations. Inspect the canal for otitis externa. Follow local protocols regarding dry mopping.
• Seek immediate advice from an Ear Nose and Throat specialist if severe pain, deafness, or vertigo occur during or after irrigation, or if a perforation is seen following the procedure.

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