hi everybody this is Rhys barber from
audiology associates apologies for not
putting a video up last night i was a
bit under the weather so i
put it up tonight instead um we've got
two patients in this compilation
both of which we use jobson horns for
for the majority of the ear wax removal so
you can see this first patient has this
very
sticky type ear wax it's very soft
around the edges but does
still have a little bit of a little bit
of rigidity in in the centre of the ear wax
there which is why it's
bending and moving slightly so we've got
the standard size zoellner tube in here
first
trying to see if we can detach it from
the ear canal walls before we before we
get the main bulk of this out
but as you can see it's mostly just kind
of moving and stretching and
just moving from side to side really
just managed to break that front end off
there
just going to try and lift this bottom
of the ear wax here just see if how free
moving it is it does look like it's
moving quite freely
there you go you can see as we get a
grip on the top it's really wiggling
back and forth
but it's very very wedged in here
i'm trying to draw it forwards with the
suction tube at the moment
hopefully then if we can draw it
forwards far enough we'll just have
enough of a gap at the top to get the
jobson horn through there as well
there we go so there's the jobson horn
go here you can see the gap we were
trying to create by bringing it forward
you've created that little gap between
the
the attic of the um the the ear canal
there and the
ball of ear wax itself so just pulling this
foot you can see it
that little bit harder darker material
at the back end of the ear wax there
as we draw this forwards
there we are you can see it the change
in colour look at that much
lighter tight ear wax at the entrance of the
ear canal
and as we get much deeper in that older
darker harder ear wax it's oxidised a lot
more giving that much darker appearance
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you can see it just starting to come
away there so we've got that whole
section out
there's the eardrum there and that's the
piece of ear wax we removed
so you can see just how how solid that
piece of ear wax was there it just wasn't
wanted to to budge very easily in
there
so this is the second patient the
compilation we did both ears on this
patient
you can see initially here the first
one has this very dark type ear wax in there
as
well so we're just going to try and use
the standard size on the tube here just
to hold
that ear canal you can see a very very
narrow entrance to the ear canal wall
it's a ear canal itself not ear canal
wall
and then we're holding that back now
using the
standard size on the tube just trying to
get some sort of grip
you can see it's really hard but can you
see the gap to the top right hand corner
there
so that's what we're going to aim for
with the jobson horn
and thank you for watching the top 10 as
well while i was away on holiday last
week
i just took a break from work for a week
didn't really go anywhere but
there was some really positive comments
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you ask
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issues with you know trolls and
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it it's a it's a pleasure to go on
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so we're struggling you can see we've
got a little bit of olive oil being
released here which is
just what's blurring the camera slightly
there
we have to work quite close to this ear wax
because we're using the side of the
endoscope to hold the ear canal open
and just trying to get behind it then
with the jobson horn just going over the
top
there you go we got behind it as we pull
now that whole trunk there you go
op it out it comes in one piece
and we just pick it up there you can see
there with the the standard size on the
tube
looking behind that then there's the
eardrum
looking nice and healthy it's all
looking good in there this second year
there was a a lot a lot more ear wax in
this one
um we've got some really thick
thick type ear wax here
not very easy to get out with the jobson
hall explain why
in a second but as you kind of go in
here what you'll see is as we push down
on the ear wax
you can see it's there's not enough hold
in the ear wax together to get that really
good
grip and that really good kind of
pull we would normally get
on on a large chunk of ear wax if anything
what's happening is it's just
breaking the surface down so what you
end up with then is is causing this kind
of furrow this
divot right in the centre of the ear wax so
this kind of channel that you've grooved
out then with the jobson horn
and what that effectively does it pushes
the ear wax to the ear canal wall so
when you've got this kind of more sticky
type ear wax like this
you do end up getting a lot of it stuck
to those ear canal walls which makes it a
little bit more difficult because
remember we talk about how sensitive the
ear canal walls are
and obviously we don't want to cause any
discomfort for the patient
so if you have to kind of really dig
into that and press against the ear canal
wall it means it it can be uncomfortable
when you use the jobson horn then
you'll see what i mean about that groove
you can just about there i go better
view there see how it's
the cutout the ear wax is still stuck to
those walls there but you get that deep
deep groove in the centre
um i was playing with my son the other
day we were using play
play-doh and that is i think that
play-doh in the us
but it's the um it's the same kind of
consistency now imagine you've got
play-doh
inside a tub and it's all stuck to the
kind of you're trying to get it out
you know if you if you kind of pull the
centre you're just going to get these
kind of grooves coming in the centre but
the sides are going to hold it in
that's what's happening here so yeah
i've tried to steer away from food and
allergies this time so
if you imagine that trying to get that
out you've got this really kind of
sticky material stuck to the side so we
need to get rid of that now before we
can release the rest
so we're just trying to take one of
those sides away now the left hand side
see how that's coming away
there it goes we managed to take that
piece away there on the left
it's actually falling out the ear canal
there looks quite dry
and we're pulling you can see it's kind
of falling into the ear canal a little bit
there
there we are just swipe it out the way
there with the jobson horn we'll pick
that up after using this all in the tube
sometimes when the ear wax is sticking to
this you can't really get the jobs in
the morning
you can see the darker material step to
the right so it's that white material at
the back of the ear wax there
that's actually a bit of dead skin so
it's not the eardrum you can see there
but look how much of this is still
stacking look how dark that is it's that
kind of
really deep brown almost ebony in colour
so we're going to use the jobson horn
though to try and push into this
ear wax on the right side so you so use
the the the bent end of the drops and
hold it to get into that side there you
go
and pull that forwards now if there's
enough
consistency there it will drag the
other smack straight to the camera
we'll drag drag it all out but you
can see it's just broken the front end
off it there unfortunately
see how it's all really stuck so now
would be a good time we're not gonna we
just tried pulling that was just taking
the more chunks off
now what we don't want to do is get in
that deep that we have to use the jobson
horn
really deep in the ear canal so i'm going to
use the zoellner tube here now
to lift off the ear canal wall now you may
find that the ear wax on this
underside then the one that's been
closest to the ear canal wall is sometimes
really really dry and can be quite hard
so i'm going to just test it using the
crocodile forceps
you may notice like a little skin bump
there at the bottom it's not a pimple
it's just a
little raised section of skin almost a
bit like a skin tag if you like you can
see just at the entrance
as you get a grip on this though it
hasn't quite got
um the kind of solidity around the
outside to be able to hold on to it
but we have pushed it off the ear canal wall
there so let's try with the jobson horn
again
you can just about see the end we're
slowing this down now we're
digging into that ear wax there and then
we're going to use this backward pulling
motion then we're hoping it's going to
pull a lot of this
if we can get to that base layer the
layer that's closest to the ear canal wall
and just gently bring this forward just
scraped along the surface again
this type of ear wax is is quite frustrating
to remove because it's
it's so sticky but you don't get the
good grip you normally would
that looks good we've got a good grip
there look how it moves see the whole
side now moving forward look at that
pulling away
if we can keep just came away against
almost there
we've brought it forward it's starting
to move now so i think if we can get in
there one more time now
about two-thirds of the way down we can
get a good grip let's have a look
yep we're just starting to pull on the
front look at the whole bottom section
they're moving forwards can you see
now look at it all sliding along the
ear canal wall this whole thing is staying
together
really nicely that's the site that was
stuck to the right ear canal wall you can
see they're coming out
little haze on the entrance to the ear canal
it's just dropped we've pulled it
forward but we've actually got another
section to get behind
so we're going to push in just like the
ego just over the top again
draw that down there we are do you see
the white material underneath that was
the skin material the dry skin we could
see attached to the left hand ear canal wall
there
so there we go there's the eardrum there
you can see on to the left hand side all
that white material there
and you can see it if you look at the
three centimetres or in china quarter
you'll just see the the scattering point
on the screen you can't see it
just the um the skin material that's
attached around the outside edge of that
ear wax
i can't forget you guys can't see what i
can see so it's it's all around there so
that's
that block there between um
three quarters of an inch an inch and a
quarter inch and a half i'm sorry
that is all one block that was the last
piece we took away all the other pieces
the first one you can see to the right
hand side there which is
between up to a quarter three
eighths of an inch sorry that was what
came at the first year so the five to
six said to be the mark
and what came out then between sort of
two centimetres in four and a half
or from sort of about three quarters
of an inch two inch and a half there
that's what that was a large plug we
took out the second year but you've also
got all the other bits around that as
well
you can see all the tiny pieces that we
were taking away at the very beginning
um which were all coming away in tiny
little bits from the jobson horn
well i'll go back to the big screen
um i hope
you guys enjoyed that as much as i
enjoyed
the rating over the top of it we'll
go back to normal again though guys so
i'll post again on Wednesday and on
friday
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keep forgetting to say if you could like
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um but as always guys take care of
yourselves and one another
and i shall see you again on Wednesday