hi everybody this is rhys barber from
audiology associates thanks very much
for watching our ear wax removal video
today
this was a really interesting case i
thought you guys would enjoy this one
basically this patient came through a
few weeks ago while i was
on annual leave and Peter
the other audiologist here saw this
patient and managed to clear one ear but
the other ear he
struggled a little bit with this
ear wax really wouldn't come out so this
lady's been oiling this
for the last couple of weeks come
back in to see me on friday
and we had a look at this ear wax again now
what you can see here is we've got this
really tough exterior part of this ear wax
so we've got the standard sized zoellner
tube in here so if you're new to the
channel this is
the wider of the suction tubes that we
use and we've just popped that on top of
this ear wax but you'll see we've got this
really dry it almost looks quite crumbly
this this surface texture to this ear wax
here so i can get a grip here but
because there's lots of little
bobbles
on the top little knobbliest and bobbles on the
top of the surface here
it's difficult to get a really good
secure suction grip
which means when we're trying to hold on
to it and pull it forwards it keeps
losing suction so we can't quite drag it
forwards enough
so what i'm doing here is just trying to
look for any way i can get a bit of
purchase on this ear wax so anyway we can
get this good suction grip
now you'll see there's a little bit of
dry skin here to the entrance to
the canal
and that will become a little bit
more important a bit later on
i won't spoil anything i won't give you
any spoilers today so you can see that
we're just trying to pull this top
section of the ear wax down
and we're just struggling a little
bit here to
to pull that down so we're just going to
use the crocodile forceps now we've
created a ledge almost at the top here
we've got a grip but as we pull this
back you'll see that it is
quite brittle the surface here
so it's just breaking little bits away
we've got this little gap let's
try the jobson horn
so we're just popping over the top and
we're just
gently pulling down on this ear wax now what
i'm doing when i pull down is i'm
creating a gap between the the
roof of the ear canal
and the top of the ear wax so we somewhere
we can get the the jobson horn in
but what i can see is as i pull down on
this front section when you look a bit
further back
it connects to the roof of the canal
which would indicate to me that we've
got a little bit of dry skin that would
normally be holding this piece of ear wax in
which would certainly be consistent with
a dry piece of ear wax from the outside
that's hardened around a little bit of
skin which would also be one of the
reasons that as we're pulling this
it's not really working its way out very
well so you can see we've got a few of
those little dry pieces starting to come
where you can see these
lifts of dry skin coming off the side of
the canal wall there
and we're just working our way down
alternating between tools
now we know that this ear wax is quite
brittle although certainly the surface
of this blockage here is quite brittle
what we're doing with the
crocodile forceps i'm trying to draw this
down maybe not so much get the whole
thing out because i think we're not
going to get enough of a grip without it
sheering away
but just to draw it forwards enough so
we can use other tools to get behind it
so you can see i'm switching from the
forceps
to the jobson horne then back to
suction just to try and reposition this
ear wax
to get a better chance of getting
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that's my plug done for the day so you
can see with this plug here
when we take a look above we have got
that gap at the top
that little bit of skin still holding it
in there so we're going to switch back
to the forceps now
very slowly trying to draw this down
there we are you'll see with the forcep
you've got
jaws and the ear wax at the
moment is at this angle
so what we're trying to do is get above
the top there and clamp on but
unfortunately to get the top jaw over
the bottom jaw hits the ear wax and it just
tends to push it further back
so you've got to be really careful just
to nip the edge as you draw this down
and when you nip the edge because it is
a little bit more crumbly that's what's
shearing away all the time
so i've got the suction tube on this now
very slowly wiggling this down
the canal
you can see that little gap see the
white material at the top there that's
the skin material
this is what's happening with the jobson
horn unfortunately at the moment we've
got the top of the ear wax here
the jobson Horne going in but it's
just clipping against that little bit of
attachment to the top of the canal which
is effectively if you've even
got it's just pushing the ear wax further in
every time i try and go over the top of
it
and if you just pull it at the front
it's just flicking off the front of the
ear wax
so you can see how this would have been
a tough one to do and why you were
having to switch
tools quite quite regularly here
we've got the standard size zoellner
tubing here again
and we're just trying to
see if we can secure any grip
here but as you can see there's little
bit to the surface
that when you get a grip on you just
lift away from the rest of the blockage
here
but a really really tough one to do this
lady was
an absolute trooper she was 98
years of age this lady were absolute
diamond she sat through the whole thing
really well bless us she did so
well
so you can see now we're just trying to
pull down from the top trying to loosen
any piece of this ear wax here so we can get
a good old grip on it and you can see
it's just
starting to tease apart a little
bit there
so when we tease one of the little
sections off we'll go back in with the
forceps
see if we can grab that section and draw
it forwards it just moved a little bit
further
down the canal but not tremendous amount
so
back in now with the suction let's see
if we can loosen another section off
this ear wax
it is always more difficult when you get
a plug that's
perfectly formed to the shape of the
canal usually there's enough of a gap
to get a tool behind it and draw it
through
when you look at this other tools we
have
obviously available to us today then
we're looking at you know the saint
bart's hook well
it's not going to get over to get behind
the jobson home we know he's pushing it
further in
the crocodile forceps isn't quite
getting the grip without shoving it back
further
which is why we're still relying quite
heavily here on the the standard size
Zoellner tube
we've got a good grip there we're just
drawing this
down the canal you can see it moving
towards the entrance to the ear canal
there
now it's got stuck so i'm just seeing if
i can
roll it let's see if we can
pull this ear wax or
or work on an edge to spin it because
you'll have a smoother
side to the ear wax and top and bottom to
the ear wax where it's been resting against
the canal wall which is usually a good
place to
get a good grip so we've pulled it for
us watch what happens when we
put the jobson horn in there and try to
get above it to roll it forwards look
what happens
you see what i mean about it just
rolling back and if you try and take the
front it just smooths that front layer
off
really tough old difficult one to do
this one
i it's you know sometimes when you're
doing a ear wax removal that is a bit
tougher like this one sometimes you
have to sit down and think okay
all right i've tried that i've tried
that i've tried that i've tried that
what can we try next
but sometimes you just have to look
at things in a slightly different way
and maybe sometimes use a tool in a
slightly different way you would
normally use it
and that tends to make a difference in a
lot of these ear wax removals
so we can see now we've we've drawn it
back down it's
closer to the outside part of the ear
canal i'm trying to lift from all the
sides
trying to spin or break a bit off so i
could get a good grip of the
with the forceps there
a lot more olive oil got in again that's
gonna help if we do get it
moving again it'll help it to stop it
from sticking
it'll just slide across the skin
really well
we do get this plug out by the way i'll
give you that spoiler just so you don't
don't get a bit too frustrated
with it but it's
just starting
to move around the outside edges here
but you can see it just gets
so far and then wedges right on the
outside part of the ear canal
oh there's a little bit of movement
there you can just see it to that top
corner
that whiter material is that is the
section that's against the canal wall so
you can see how we're just
starting to loosen some edges here
back in with the forceps can we get a
grip
just got the grip on the bit we've
loosened but as we pull
something is holding this in this
something's got to be holding this back
by this point because you're getting a
good grip
you should have seen a little bit of
movement or you at least see it tipping
forwards with that forcep so something's
got to be holding on to this at the back
let's see if you can guess what that is
okay it shocked me actually i've
got to be honest
when i took it away i'm not going to
spoil it i promise i'm really trying
so hard not to give you spoilers so you
can see now you just got the edge here
we're trying to work this around
really trying to spin or move or or
loosen any part of this but it is just
solid it is just not budging you can see
what i'm doing here a very gentle kind
of wiggle
which is just holding on to that one
piece just don't draw it back but
it's not really budging so i've put the
fine end on now now i've done this a
couple of times before when you get this
hard bits like this
fine end i can get in above it and i can
pull
down using the side of the fine end
because it's much much thinner than the
jobson horn but you've also got that
suction working for you as well
i find that works really well you get a
really stuck piece like this so you can
see i'm working all the sides
drawing down with the fine end using the
suction using the side of the fine end
to try and
lever this out you see how
floppy the skin is in here as
well because it's collapsing down in
front of that suction very quickly
we've got a good grip there on the
outside there so i'm using the fact that
this plug is so hard against itself
using it along the side you can see it's
drawing down now it's starting to break
away it's starting to come forwards
there we are using the side you can see
a lot of whiter material at the top
which is skin material
but just by the way this bends and moves
this
looks more like skin than ear wax to me so
let's see if we can grab anything with
the forceps
there we are look at that starting to
come forwards a little bit there now
we've drawn that white section there
at the top let's see if we can get
another grip on this
let's try that leading edge now it's
starting there see that whiter material
down that one side
that's dead skin okay that's what's been
holding this in place
but look at this plug where we pull it
out now we're trying to pull this out
but it's it's just not budging that dead
skin is really holding this
in but have a good look at this plug
where we do work this out we're going to
pop the jobson horn in now
there we are get down the side of that
that softer white skin
look at that coming away now as we roll
this forwards
look at all that dead skin that's
accmulated behind that plug
all that white material is just this is
literally a plug
of dead wet skin you can see it moving
down now as we flick this over we've
actually turned it through 180 degrees
all that white sluffy material you can
see they're coming away that's
all dead skin
look at that plug coming away there and
we'll pick that up now if you can have a
look at it
the front end was that darker material
we'll have a good look at the eardrum
now
when you look at the eardrum you can
actually see the outline of the eardrum
there you can see where that white
dead material was sitting right in the
corner there and almost right down on
top of the eardrum and bless this poor
lady was really struggling
it's a centimeter and a half
just over half an
inch there that dark material you can
see to the left hand side
that was that harder material at the
surface but all that white material
stuck behind it that was just
one big skin plug that's all that was in
that ear
and that's why it was holding on so
tightly is because this dead skin was
still attached to the canal wall so as
hard as we were trying to draw it out
that skin was holding on to everything
in there whew
i think i need to sit down
i really hope you enjoyed that guys
as much i did voicing over i hope you
found that one interesting i was
thinking of you guys when that one came
out as well when i saw the patient
but as always guys take care of your
ears take care of yourselves
and take care of one another and i shall
see you again on wednesday
bye guys