hi everybody this is Rhys barber from audiology associates thank you very much
for watching our video today we have a bilateral ear wax removal and skin removal
for you this is quite an interesting case this chaps come through with
reduced hearing on both sides what you can see here is us removing what looks
like skin debris so I think we're looking at keratosis obturans on this
side which is a overproduction of skin in the ear canal what what that does
there's a pressure on the ear canal wall and can block the ear canal up if you want to
know a little bit more information we did a video explaining this a few weeks
back so I'll try and put a link on here to that video for you as well but
looking at what we're removing here is lots of layers and layers and layers of
dry skin you can see it's quite wet to the left-hand side of the screen there
next to theear ear canal wall that's where the skin started putting a bit of pressure I
think on the on the ear canal so we're starting at a little bit degradation of
the skin underneath so you can see it's quite tough stuff it's really kind of
thickened up hardened up skin it's almost like a leathery consistency to it
so we're just going to try and free this up you can see the layers there one two
three layers running up and down that skin there so you can see where the
skins overlapped on itself quite a few times having a bit of difficulty getting
a really good we can get a good grip on it but it's just tearing and shearing as
we as we take a good grip on it so we're just gonna use the Jobson horn now to go
in and try and loosen this up a little bit this is quite a long video that goes
on for about 12 minutes thereabouts so if I do go quite in places I'm just
resting my voice halfway through what we have here is the skin is starting to
break down so as we're taking it away that jobs and
I was really pulling through the center of it which is going to leave lots of
little bits hanging around either side so we're just going to tidy up with
those on or a minute you see the white skin there around the outside edge
that's where the the late the top layer of skin in the ear canal wall has
started to degrade because this has been in here for so long
this gentleman has a bit of a fear of coming along to medical professionals
which is why he's taking this long to get to us you can see it just starting
to pull away now in in slightly bigger pieces looking at how much is coming
away I don't think this ear canals going to look particularly pretty by the time
we finish because there's obviously going to be a lot of dead skin and and
that's a white fluffy skin in there as well just taking the pieces away that we
couldn't get out with the Jobson so back to the crocodile forceps
lots of people mention in the comments how frustrating it is when you get a
grip and little bits break off as equally as frustrating for us
professionals I promise you so we're just using that Jobson horn now to try
and break some of this deeper skin debris you can see it gets almost crumbly in
places so we're just gonna tidy up a little bit with us all now
well we're doing a bit of tidying that if if anyone's not subscribed to the
channel already if you don't mind doing so you can get a subscription you'll see
a notification and every time we post a new video we do it twice a week now
Tuesdays on Fridays you can see just how tough this skin material is you know
that the zoellner can get a grip on it but it just can't pull it apart it's
really really difficult there you go nice bigger pieces coming away now you
can see this still a lot more in here can you see the whiteness to the base of
the ear canal there where it's been putting so much pressure on that ear canal that this
is actually starting to degrade now it's very difficult to remove that whites
sluffy skin you could see at the bottom because in some cases it can put it can
actually degrade through to the bone underneath so we don't really want to
take all that away because we're going to cause more problems by doing it so
we'll tidy up in there but we'll let that skin regenerate them and more
likely this gentle come back then and maybe a month or so also we'll check him
over
still coming away
just see that the striations in the skin the long strips of skin that start
coming away so this has been building for for quite some time
you can see some redness there at the base underneath this bit of ear wax where
this has been aggravating that skin underneath so like I said it's it's not
going to look probably look the cleanest when we finish but we'll certainly get
rid of all of this harder material that's in here by taking this away then
it will allow their ear canal natural skin migration processes to carry on as
they should do which will help all the skin to repair itself you know in a
month's time this this year can I will look a lot healthier than it does right
now it's always difficult when you're undoing potentially years worth of
neglect if you like this is not due to poor hygiene its this is just one of
those conditions that just can spontaneously develop in some people so
it's not that this patient has poor kind of personal hygiene it's just that ear wax
just accumulates in some people unfortunately there you go you can see
that it's time to get to some of the deeper harder bits we're just getting
our first view of the eardrum there so this is backed right up to the eardrum
getting all these pieces away you can see this is actually been pressing on
the drum so I think if this patient had left this go on a little bit longer it
would have caused a lot more issues in here you can see all that old dead skin
coming awake there's the eardrum you can see where all this has been pressing on
there so we're just very gently stir a little bit of tidying up around the
eardrum around the outside edge you can see just how aggravated and there's a
lot are all dead skin left in there the white stuff you can see we'll just tidy
it a little bit but you can I'm gonna leave a lot of this here because as we
start to lift this you'll see just how sluffy all that skin material is become
there can you see as we're lifting it now this is going to become quite
uncomfortable for that patient so I'm only gonna do as much as the patient
will tolerate because don't forget patients are not anaesthetised for this so
in the majority of cases suction it doesn't cause any issues as far as
paying or or kind of it's it's it's quite a comfortable process to sit
through but what we don't want to do is cause cause a discomfort for our patient
so we'll do as much as we can and he's didn't finish he sat through a lot
already so just gonna get some of that the older and hard of it to this stuff
away
this bits hanging on for dear life so we're just gonna pop that bit out using
the crocodile force just helps me to get a better grip that's all here we go
you can see the layers peeling away look in the ear canal you can see how red the
skin underneath is there as well so this patient probably ought to keep their
ears dry for about 24 hours just to stop any risk of infection
you can see how oh well this is holding on to the skin underneath we don't want
to go too crazy we're taking this away and we're gonna call it a day there this
is oh this is the other side now now patients been complaining the reduce
hearing on this side as well now we can see the ear wax this we just put a little
bit of olive oil inks it's quite a hardened up piece of ear wax so we just want
to maneuver this out just trying to get a grip on it with the standard size on
the tube you can see we can't really get a very good grip so we're gonna use the
Jobson horn just very slowly working our way behind it and see just how tough
this piece of ear wax is I'm gonna put a lot of pressure there to guide this out
the idea with the jobson Horne is to kind of get into the center and bring
it forwards this one's rolling which is okay if
you've got quite a short piece of ear wax if you've got a long piece also that could
be quite uncomfortable but there we go it's rolling down the ear canal
out he pops
right so I'm expecting to see an eardrum but unfortunately there isn't one there so
this is actually almost a false fundus it's basically it's a it's a it's a
layer of thickened skin that's formed in the ear canal now this you can't get rid
of with suction this has to be done surgically you can see a lot of blood
vessels running through there if you go popping that then you're going to cause
problems as far as bleeding's concerned so this has to be done in a hospital
environment can't be done in and out patients and if you just put a bit of
gentle pressure you'll see this give there you can see it's quite thickened
up layer of skin now thinner pieces you can take away but that's so thick that
it's actually caused a second layer which is blocked the ear canal up so the
eardrum is behind that somewhere but at the moment we can't get rid of that so
this is what we removed obviously the first piece you can see here that was
what we removed from the second ear everything else that you can see all
came out of the first ear to see was a fair fair bit there these are all the
tools we use Jobson horn standard size zoellner and the crocodile forceps and
there we are so as always guys if you did enjoy the video then please if you
don't mind liking sharing subscribing that would be great and which post new
videos look out for those on Tuesdays and Fridays as always take care
everybody