Tissue Spearing to Remove Ear Drainage (Video)

When there is copious drainage from the ear due to infection or the ear canals are just wet, tissue spearing can be performed to remove as much of the drainage out of the ear canal as possible.

Once as much of the drainage is removed as possible, antibiotic ear drops can be placed if needed. Please note, tissue spears should NOT be used to attempt earwax removal. Tissue spears may exacerbate earwax impaction.

Tissue spearing as a formal maneuver appears to have originated in Australia. First mention of tissue spearing in the medical literature was in 2016 by Australian researchers at Flinders University.

The steps to tissue spearing are as follows:

1. Twist a square tissue or toilet paper spirally into a ‘rat’s tail’ using the thumb and forefinger of both hands. Continue to twist until tight. If the tissue spear is too fat, it will be difficult to insert into the ear canal.
2. Break off the tip (which may become floppy) and also the remaining tissue from the other end, so that it does not impede insertion of the tissue spear.
3. Gently push the tissue spear into the ear canal while pulling the ear back. Carefully rotate the spear while inserting it. Insert into the ear canal about 2 - 3 cm or until the child blinks, coughs or cries. If the spear is not inserted far enough, it may not reach the bottom of the ear canal and so ineffective cleansing will result.
4. Leave the tissue spear in place for 3-5 minutes to enable absorption of drainage. Make additional spears while waiting. This is also a good opportunity to teach children how to make their own spears correctly.
5. Should both ears suffer drainage, spearing both ears concurrently when possible will save time.
6. After 3-5 minutes, remove the spear slowly and discard. The pus will adhere to the spear when removed.
7. Repeat the process with a new tissue spear until the tissue is dry when it emerges from the ear canal.

Reference:
Do tissue spears used to clear ear canal pus improve hearing? A case series study of hearing in remote Australian Aboriginal children with chronic suppurative otitis media before and after dry mopping with tissue spears. J Laryngol Otol. 2016 Jan;130 Suppl 1:S11-5. doi: 10.1017/S0022215115003217. Epub 2015 Dec 21.