Community Health Manual
Procedure
Birth to school entry
School aged children
6.4
Ear health
6.4.4
Technique for tissue spearing
Aim
Tissue spearing is one of a range of techniques used to clean and dry the ear canal.
It may be used to remove pus, exudate or other debris from the ear canal, to dry the
canal after ear irrigation is performed, and prior to instillation of drops.
It is noted that Australian ear health publications sometimes use the term ‘tissue
spearing’ interchangeably with ‘dry mopping’. Dry mopping is a different procedure,
and is not routinely undertaken within WA community health services.
Key points

To be performed only by staff with appropriate training.

Otoscopy should always be conducted first, and in the event of any pain
during the procedure.1

Cleaning of the ear canal using tissue spears should be conducted in
preference to ear irrigation where the child is experiencing pain, there is
history of recent trauma, where ear discharge is due to acute otitis media
(AOM), or where perforation is evident or suspected.1

Community Health staff should follow the organisation’s overarching infection
prevention and management policies and perform hand hygiene in
accordance with WA Health guidelines at all appropriate stages of the
procedure.

Parent/carer support and involvement with the procedure should be
encouraged where possible.
Equipment

Otoscope

Disposable otoscope tips- the largest size that will comfortably fit in the ear
canal

Tissues
Continued over page.
Date Issued: 2007
Date Reviewed: June 2013
Next Review: June 2016
NSQHS Standards:
1.7, 1.8
6 Procedures
6.4 Ear health
6.4.4 Tissue spearing
Page 1 of 5
Community Health Manual
Procedure
Birth to school entry
School aged children
Procedure
Steps
Additional information
Process for making a tissue spear:
o Twist a square of tissue or toilet paper spirally into a ‘rat’s tail’ using the
thumb and forefinger of both hands. Continue to twist until tight. If tissue
spear is too fat, it will be difficult to insert properly.
o Break off or cut the tip, which may become floppy, and also the remaining
tissue from other end so that it doesn’t impede procedure. 2
1. Explain the procedure to the
parent/carer and the child. Allow
sufficient time for discussion of
parent concerns.
Encourage parent/carer support and
involvement with the procedure where
possible.
Obtain verbal consent to proceed.
2. Position the child in a comfortable,
supported sitting position, preferably
on the parent/carer’s lap for younger
children, with the head turned to one
side.
Parent/carer should be encouraged to
assist with this where possible.
3. Pull the back of the pinna gently
away from the head to straighten the
ear canal. For older children, pull
pinna back and up. For infants, pull
pinna back and down.
This will straighten the ear canal and
promote good visibility.
Babies and toddlers must be held firmly
to prevent unexpected movement. This
may include wrapping. Ask the
parent/carer to hold the child’s head
firmly against their chest and use their
other arm to secure the child’s arms and
body to stop any sudden movement.
The least affected ear should be
examined first.
4. Inspect the ear canal using the It is important to brace the hand holding
otoscope.
the instrument against the child’s head to
prevent ear trauma in the event of a
sudden movement. 3
Continued over page.
Date Issued: 2007
Date Reviewed: June 2013
Next Review: June 2016
NSQHS Standards:
1.7, 1.8
6 Procedures
6.4 Ear health
6.4.4 Tissue spearing
Page 2 of 5
Community Health Manual
Procedure
Birth to school entry
School aged children
Steps
Additional information
5. Gently push the tissue spear into
the ear canal:
If tissue spear is too fat or too floppy, it
may be difficult to insert.
o Carefully rotate the spear
while inserting it
If the spear is not inserted far enough, it
may not reach the middle ear and so
ineffective cleansing will result.
o Insert to about 2 - 3 cm, or
until the child blinks, coughs
or cries.
6. Leave the tissue spear in place for
3-5 minutes to enable absorption of
exudate or pus.
Make additional spears while waiting.
This is also a good opportunity to teach
children / parents how to make the
spears correctly.
Pus will adhere to the spear when
removed.
7. Remove the spear slowly and
discard.
8. Repeat the process with a new
tissue spear until the tissue is dry
when it emerges from the ear canal.
9. Where bilateral tissue spearing is
indicated, then spearing both ears
concurrently where possible may
save time and promote compliance.
10. Re-inspect the ear using the
otoscope with a clean tip.
The tympanic membrane may look pink,
as blood vessels may be dilated.
11. Instil ear drops as indicated/
prescribed.
Refer to procedure 6.4.3 within this
manual for guidelines on installation of
ear drops.
Wait for at least 2-5 minutes following
instillation of ear drops prior to
repositioning child to other side.
Continued over page.
Date Issued: 2007
Date Reviewed: June 2013
Next Review: June 2016
NSQHS Standards:
1.7, 1.8
6 Procedures
6.4 Ear health
6.4.4 Tissue spearing
Page 3 of 5
Community Health Manual
Procedure
Birth to school entry
School aged children
Steps
Additional information
12. Provide opportunistic ear health
education for parents/carers and the
child.
Parents/ carers should be encouraged to
keep the outer ear clean to avoid
contamination of the child’s face which
may potentiate additional infection.
13. Where a child has a chronically
discharging ear (Chronic Suppurative
Otitis Media) the parent/carer may be
taught to perform tissue spearing
several times a day, before instilling
ear drops.
This should be continued until the
ear has been dry for at least 3 days.
Referral pathway
Discuss any concerns with the parent / carer and seek verbal consent for referral to
a medical practitioner using the CHS 663- Referral from Community Health form.
Related policies, procedures and guidelines
Staff should also refer to any service specific policies where applicable.
Section 1.11 Infection Control
3.7.3 Hearing (Including management of common ear problems)
6.3.1 Otoscopic examination
6.4.1 Irrigation ear toilet
6.4.3 Instillation of ear drops
Continued over page.
Date Issued: 2007
Date Reviewed: June 2013
Next Review: June 2016
NSQHS Standards:
1.7, 1.8
6 Procedures
6.4 Ear health
6.4.4 Tissue spearing
Page 4 of 5
Community Health Manual
Procedure
Birth to school entry
School aged children
Useful resources
Edwards K. Tissue spears: do it right! [DVD] [Internet] Darwin, NT: Community
Paediatrician Centre for Disease Control Northern Territory; 2008.
Bestic J. CARPA Standard Treatment Manual. 5th ed. Alice Springs, NT, Australia:
Centre for Remote Health; 2010.
Coates H, Vijayasekaran S, Mackendrick A, Leidwinger L. Aboriginal Ear Health
Manual. Perth, WA; 2008.
Policy Owner
Portfolio
Director - Statewide Policy Unit.
Birth to School Entry
References
1. World Health Organization. Primary ear and hearing care training resource.
Switzerland: WHO Press; 2006
2. Edwards K. Tissue spears: do it right! [DVD] [Internet] Darwin, NT: Community
Paediatrician Centre for Disease Control Northern Territory; 2008. [cited 2013
February 15].
3. Bestic J. CARPA Standard Treatment Manual. 5th ed. Alice Springs, NT,
Australia: Centre for Remote Health; 2010.
Date Issued: 2007
Date Reviewed: June 2013
Next Review: June 2016
NSQHS Standards:
1.7, 1.8
6 Procedures
6.4 Ear health
6.4.4 Tissue spearing
Page 5 of 5