hi everybody my name is Rhys Barber I'm
the audiologist here at audiology
associates we upload new ear wax removal
videos every Monday Wednesday and Friday
at 9 p.m. UK time so please consider
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[Music]
hi everybody this is Rhys barber from
audiology associates thank you very much
watching our new actual video today
we've got two patients in this
compilation so first patients come
through with very soft your ear wax or
lovely opening your ear canals here very
sticky and soft ear wax so we're just using
the standard sizes on the tube just
going into the ear canal lifting the ear wax
from the the base of the ear canal at the
moment - and sticking it from the ear canal
walls which is going to help us to
remove it a bit later you can see that
the ear wax is stretching and then pulling
away from the ear canal water working from
the left side to the right side now you
go slowly coming away working back up to
the right side working our way all the
way around this piece of ear wax just to
allow us to really get behind and get
some traction to get in this out there
we are nice big chunk just came away so
now we've got this this softer section
now we're just moving this forwards
manoeuvring it out to the ear canal you
can see a nice big nice big lump there
so it's broken away from a much deeper
section here so you can see that the ear wax
on the right side comes a bit further
towards the camera so we're going to
take that piece away first because
that's going to anchor some of the rest
of this in place here we just working
the leading edge of this ear wax here just
moving it across on the right to the
left hand side trying to turn and spin
the ear wax so that we get a much more flat
surface to work on so we get a much
better microsuction grip you can see using
the wiggle there just to get that out
but it hadn't quite got the grip so we
had it broken away there you can see
it's quite big it's struggling to get
out of the ear canal there we go
and here we are it's a lovely looking
your drum there
so we're just working this is the other
side no so the same patient but the
second ear very similar story on this
side so you can see there's much very
soft sticky type of ear wax in this side as
well so we're gonna use the same
technique is on the other side we're
gonna lift first of all from the base of
the ear canal
if you imagine gravity is always gonna
pull the ear wax down to the lowest point so
we spend a lot of our time up right so
you're gonna find that a lot of the ear wax
ends up sitting at the base of the ear canal
so usually really get stuck there so I
always find it easier to remove from
that section usually that section first
and then you can see now we've got a
good gauge point as to where the ear canal
walls I could we've uncovered it at the
base so we can start working our way
around the outside edge now there we are
just slowly working our way around
detaching the sticky most solid pieces
of ear wax around the outside edge first
yeah you can see how this dried up
section here there we go is starting to
come away stick with this one guys the
next one it was a really difficult one
to do so it's well with a watch it goes
on a bit though so you might want to
pause and make yourself a quick cuppa so
what you can see here is this bigger
chunk just starting to come away now so
we're imagine to get this out just push
in the here's a side there's the eardrum
looking lovely and shiny or looking nice
and healthy there's that little bit of
sticky ear wax there to the left-hand side
we'll just get rid of that there you go
and then we are again looking all
looking good so this is what we removed
you can see that the the difference in
colour this kind of ready brown coloured
ear wax tends to be a more stickier slightly
hardened up type so this next patient
came through we have a lot of difficulty
here in this particular area where our
clinics are based where the waiting time
to get ear wax removed from the ear is
quite long especially because a lot of
the GP surgeries have actually stopped
stopped microsuctioning so this lady was
having areas cleaned out quite regularly
by the local hospital at the ear nose
and throat department by the consultant
but
has had her appointment canceled quite a
few times so she was having this done
roughly about every six months but it's
been 18 months it since been done the
reason that she was going through there
is because we've got very narrow ear
ear canals now the difficulty we have today
is obviously instead of having six month
worth of ear wax to take away we now have
three times as much as we normally would
so this lady's ear canal is very narrow
at the entrance and then widens out
quite a bit just as you get about a
third quarter to a third of the way in
which is what you can see here now when
we first started using the microsuction tube
we started with the standard size zoellner
tube and try to get that into the ear
and it was too big what happens then is
it sits on the outer part of the ear canal
collapses the ear canal down in front of the
such the force of the microsuction which is
uncomfortable for the patient and
doesn't allow us to get in there very
well so we're having to use the ENT fine
end now you can see you know from the
videos you've seen so far how small
these fine ends are they are very very
small and we can just about get that
into the ear canal with a little bit of
room to manoeuvre the difficulty we're
having here is that we've got this
really large hardened up piece of ear wax
that's sitting in the wider section of
the ear canal and we can only use the fine
end to get this out which is which is
kind of worst case scenario for us as
far as ear wax was concerned so what we're
having to do is hold on to this hard
lump bring it towards the front of the
ear canal and train wedge it in that
entrance so that we can start breaking
little pieces off it so that we can fit
this over to the ear canal okay now the
difficult you have with the fine end is
that it when it does start breaking
pieces off only a tiny piece breaks away
it means that end blocks so we have to
keep unblocking the tube so we have to
keep going in out in out of the ear all
the time the other thing that happens is
you can't put too much pressure on it
from the front because it pushes the ear wax
further in wish there's any other cause
your problem so you have to hold onto it
try and bring it back to the front
wedge it so you've got enough force to
break this
off so when you take all that into
account you can see where this lady was
having to go to the ear nose and throat
specialist to get this done because a
lot of them have obviously quite
specialised tools to do this we have
certain specialised tools and I was
confident that we could get this out
this is the Jobson horn okay so you can
see the end here and just how small this
ear canal is because that's the end of the
Jobson horn which is your a couple of
MIL at the most of what wide I can't
even put it into the ear canal sideways
I have to go in straight so we can't use
the Jobson horn and it's no not big
enough to allow us to get the standard
size on the tubing here at the moment so
we're still cracking on with this fine
end and you can see just how difficult
this is this ear wax is rock solid so what
I'm trained but it is brittle so all I'm
trying to do is just break little pieces
away and we're making this ever so small
you ever saw ever so much smaller every
time we take a piece away until we can
try and get it small enough to fit out
this ear canal this lady was an absolute
star she did so well she was so nervous
about going anywhere to have this done
other than the nose and throat
specialist you know we reassured her we
would be as gentle as we possibly could
and we would get it out but yeah you can
see she sat through quite a bit we're
constantly in allowed to the ear with
this at the moment
working on the bottom here we've broken
some pieces off so we've made this piece
a little bit smaller so what we're going
to do now is try and turn this I'm
trying to find a narrow edge if we can
to try and manoeuvre it towards the outer
part of the ear canal so I'm trying to
turn but it's such an awkward shape and
such a narrow ear canal it's not turning
we can't wiggle it out because we can't
get a good enough microsuction grip using the
fine end so I'm just sort of pushing
into the ear wax a little bit against the
ear canal wall now I always say to you know
every time we do this video we try and
avoid the ear canal wall as much as we can
in this case we don't really have much
of an option we have to work close to
this ear canal wall so when you're doing a
procedure like this you always check in
with the patient make sure they're happy
make sure they you know they feel ok
they're comfortable you know constantly
reassuring if they forget in comfortable
wheel that we'll take a break for a bit
but this lady was just wandered this out
it was causing so many problems with her
hearing so uncomfortable an area that
she just wanted to get rid of it you can
see we've managed to turn it now from
the right to the left we're just
spinning this ear wax a little bit just
guiding it around now I'm working on
that section there that the smoother
section because sometimes you get a
slightly softer bits of ear wax when you
turn it so the front end might be really
brittle but he might get softer pieces
behind unfortunately in this case it was
just brittle all the way around and
there was just no no gap there was just
hardly any movement to this so it was a
real painstaking procedure to take this
away so to give that right-hand side a
bit of a rest I'm trying to move the ear wax
now across to the left-hand side you can
see just try it you can see there's a
little bit of movement to it it's trying
to turn it trying to bring it from the
right to the left and it guide it into
the entrance you can see with the camera
there but it's just getting wedged which
means the back end of this ear wax is
probably larger than the front end so I
wasn't trained to manoeuvre it at the
front section the back sections
restricting our the amount of movement
we have and we've got a point there now
okay so this is the standard size tube
now going in I'm holding the ear canal open
using the endoscope or the sides of the
endoscope and then trying to get a grip
and trying to hold on sometimes with the
wider end we can break larger pieces off
that will just get sucked straight into
the machine but even with a wider end
it's not breaking anything so because
we've got that slight point I'm going to
use the crocodile forceps you can see
there's barely enough room to get the
crop
or something either side of this ear wax and
what you tend to find is as you can see
there because it's not because it's
narrow and then widens at the back end
when you try and push the forceps out
the side to get the good grip the ends
of the forceps inadvertently touch the
wider section of the back and push it
further in so then you've got to work
really hard then to get it back to the
front of the ear canal again so what I've
decided to do is just kind of mash up
the front end of this ear wax break it down
a little bit and then we'll go in and
remove that so because it is quite hard
the forceps are good at kind of breaking
hard or ear wax down this allows me then to
use the microsuction to break some more
pieces away which is hopefully gonna
make it small enough to work its way out
you can see we got a nice flat section
there now working on any looser parts I
can see you can see just trying to break
this chunk away there just try to turn
it again we're moving it down from the
right to the left and then pulling it
down from the top as well we've got a
bit of a Ledge here so I'm hoping this
is gonna snap off which is just starting
to there so that gets another chunk off
off this ear wax
still turning it still training manoeuvre
it around you can see it's just moving
it's wobbling back and forth started to
move deeper into the ear canal now so we've
got to try and grab it again and bring
it back towards the front you can see
that wider back end there this type of
ear wax removal is always by far the most
difficult and unfortunately we're seeing
more and more patience with these kind
of problems coming through just because
the ear nose and throat departments
can't cope with the number of referrals
they get in so the waiting time you're
talking to have this done in the
hospital in most places in this area is
anywhere from three to six months so it
takes a long time so I've popped a
little bit of olive oil in here for two
reasons it's gonna help us together hold
onto this ear wax little bit better it's
gonna lubricate the ear canal walls gonna
make it more comfortable for the patient
and we got a better chance if we can get
a little bit of a grip of this sliding I
using your to slide out of the ear canal now
you can see we're bringing it back
around again trying to get it to that
front section of of the ear canal just
really giving this a wiggle up and down
you can see now I told you to go away
make yourself a cup o because it this
takes forever together this is just one
side luckily there was there was hardly
anything in the other side so but the
ear canal on the other side was a little bit
more a little bit wider so a little bit
more open now as we've pulled down from
the top now we can see a little bit of
dead skin this means that to me that
we're going to we're getting closer to
the end of this block of ear wax so now
we've put the oil in that we can spin it
a lot more effectively we're bringing
this top section down now so we are
getting some good movement now the
forceps are going to come into play
again here because I want to try and get
above and below that little section of
dry skin they I'm hoping we've got
enough of an angle to get that out but
unfortunately as we go in to do it we
can I can see I'm not gonna get a good
grip I'm just going to push this further
in so I'm just going to use that
fine end again now to spin we can see
we've got a slightly different shape now
to this ear wax still too big to fit at the
ear canal but more effective for getting a
grip on with the crocodile forceps so
I've just got a grip they're just gonna
Paul you can see it's brittle it's
breaking away it's not pulling out of
the ear canal yet back in with the forceps
again because you have inadvertently
just bumped it a little bit there so
it's moved again back in with the
microsuction tube again now clearing up any
looser bits of debris breaking away in
these any smaller pieces that have just
started to chip off the the main bulk of
the ear wax there you see you've got the
softer section now at the tops we're
just working that down yeah this is
actually a little bit of dry skin that's
been embedded in the back of this ear wax so
I'm just trying to get a good enough
grip on that to work this out and as we
start doing that you can see in quite
your in relations of the size of the
piece a quite a big piece of that ear wax
has come away see a lot more of this
skin debris that getting sucked into the
machine oh now we're starting to see
this plug breaking down it's starting to
loosen up a little bit now
using that dryer skin it's more flexible
it's bendy it's gonna get sucked into
the end of the microsuction tube really well
which is going to give us a slightly
better grip sometimes this will be a
ribbon that's running through the whack
so if you can break that away it
collapses the integrity of the of the
block of ear wax you can see that's what's
starting to happen there as we pull we
can see this back section he has become
very loose so if we can get this section
out okay so there we go so we're
pressing down into the ear wax there now as
you can see it's starting to come
forward so I'm using the fine end almost
a bit like microsuction and Jobson horn at
the same time so I'm getting into the
ear wax bring it forwards using the microsuction
to help get in behind it because the
jobs are not just too big we can use
this fine end like that just to bring
this forwards there so you can see now
we've broken a piece away which means
this is starting to come away a little
bit more effectively getting just behind
that ear wax bringing there you can see the
length of that ear wax the back end kicking
up as you bring the front end down there
we go brilliant so we've got that front
section away now so we've got this back
section here which is just a collection
of smaller pieces of ear wax still a bit on
the large side to be able to get out of
the ear canal you can see you really having
to work this wiggle it back and forth
that little bit of dry skin it's just
block the end of the section there so
I'm trying to get behind there now we've
got behind it we can bring it forwards
there you go so sometimes you have to be
a little bit adaptable for what you do
you can see we've got a collection of
harder bits at the base of the ear canal now
because the ear canal was so narrow it left
me with very little movement near the
eardrum so what I'm doing here I'm
trying to sort of guide it down I'm
gonna aim for this sort of bigger bits
that are close to the actual drum itself
so I can get to the bottom of the drum
quite well
I can't get to the Attic I just can't
get the angle to get up there so I'm
gonna take all these larger pieces away
the area it's all coming away now
got a bit stuck there we go and there we
are we can see we've got that harder
piece they're sitting in the centre of
the eardrums just when I grabbed that
this lady did so well she sat through so
much for this and there we go nearly
fell off there we are okay and there we
are so we can see the edge of me you can
see there's a little bit left in the top
right-hand corner I just couldn't get
the angle to get up there unfortunately
you would just wouldn't allow it and
rather than be work that close with not
much movement I'd rather leave it and
this is what we removed you very much
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