hi everybody this is Rhys Barber but from
audiology associates thank you very much
for watching our video today you might
want to grab yourself a cup of coffee
for this one takes about seven and a
half minutes to get through this so we
have a ear ear ear ear wax extraction this patient has
come through and previous history is
they've had a master you ectomy so
they've removed part of the mastoid bone
which is the hard bone you can feel if
you touch behind you yeah so when you
look at this there's lots of very dry
skin and ear wax in here so this should be
removed every kind of six months these
they'd be cleaned out but this client
hasn't had the ears cleaned out to do
the various reasons for about two and a
half years there's a lot of stuff in
here that needs to come away when you
look at a patient with the master that
to me normally it ear canals when you look
into them will be cylindrical in shape
because it's completely encased in bone
when you remove some of that mastoid
bone from the certainly the sides and
normally the attic region so the top
portion of the ear canal then you widen the
ear canal out so you end up with these
recesses pocket spaces in there which in
some cases can be quite large so what we
have here is the bottom half of the
screen that what that piece there I'm
just working on now this is what's
blocking what would be the normal part
of the ear canal if you like and then
the top portion is all in this space
which is a much larger space you get
huge pieces of ear wax in here that are not
going to come out without quite a bit of
help so you can see just a tough and how
sticky some of this ear wax is it's dried up
it's old it's been in there for a few
years now claim is notice that they've
been struggling a little bit with their
hearing which would be reduced more than
likely due to the fact they webmaster
anyway but when you look at what's
coming out it's no reason and no
surprise we got this patients being I've
been struggling a little bit so very dry
chunks of ear wax it is going to take a
little bit of bitter removing this so so
you might hear me go quiet every so
often just to wear just as I'll let you
guys see what's going on there you go
dragging see there's a huge dry piece
that's just wobbling back and for and
they're using the the wiggle technique
is weak a little bit no but it's it's
only breaking little pieces away if
you're hearing you sound in the
background the audio I'm actually in
clinic doing this today so you might
hear something
bits and pieces going on the background
but maybe I'll just see little haze in
here as well so not only is it dry it's
hardened up this hard bits of skin
there's bits of here in there pretty
much all the things you really don't
want to see when in ear wax when you when
you take a look in there so I've broken
the majority of this down so when we go
back in and take a look now this will be
with the standard sort of sized ear
ear canal there so you can see the eardrum
there at the base of its Weir uncover
the agent but all of this is in that
pocket way that the bone has been
removed so you can see the some old old
skin here which is quite tough in nature
just pulling on that to try and break
that down a little bit there you go you
know the patient's not going to feel
anything doing this that's all gonna
feel so that's like so a tugging
sensation
lots of people will have asked in the
comments when they've seen extractions
like this why you know why did you go in
scrape it out why do you not use the
Jobson horn or various other tools to
remove this the longer short answer is
that I have no idea how deep this I've
never seen this mastoid cavity before I
don't know how deep it goes I don't know
you know when it starts to open out so
this is really tough stuff I could try
and go in here with the Jobson horn but
I've got no idea what I'm gonna be
poking into just behind this so I could
be doing damage to the skin and bearing
in mind this patients already a lot of
ENT history going on in here they've
already had a few operations on this the
last thing I want to be doing is causing
unnecessary damage or trauma in here so
I'm just often to use the section just
to try and break this down as much as I
can it's less traumatic we're working on
the outer part of the ear ear ear ear wax we're just
kind of pulling it through so you can
just see we're just starting to break it
down my goal here is to try and loosen
this big chunk because I'm not gonna get
all this out in one go but what I need
to do is break it ideally in about half
so you can see I'm working on the center
and with a split the top and bottom into
two pieces here trying to loosen this as
best I can but this ear wax is gonna
disappear up just past this point so I'm
not going to get this out because it's
really wedged in me so it's just a case
of breaking it piece by piece
it's so tough it's really difficult to
get get through
if we could see a little bit more at any
indication as to how far in this way and
then yeah you could try other jobs in
home but it's just not safe to do it at
the moment and you know patient safety
and comfort is that it's paramount doing
this we've got some very sensitive
ear canal here see it's just trying to work
this down trying to pull this down from
the space above getting a grip on some
of this you've got a little quite a big
piece of dry skin there we are get rid
of that you know just see what's going
on behind that just trade to find any
gap or any any give in this way so you
can see a starting to move we've broken
it in half and we're starting to move
this one section but it's not coming out
without a fight guys
just getting some grip on some skin
there we are just breaking that down
really train the move of this one member
we're looking at this at the moment it's
too dry and flaky to get a good grip on
it with with the crocodile forceps
that's my platter there we are you just
seem to start and get one piece out
there there we go just maneuvering away
there you go fuse the crocodile forceps
now we've broken a piece off so we're
just going to try and grip it with a
crocodile forceps but you'll see just
tears straight away so we're not gonna
get the really good grip on this so my
plan though is to maneuver this whack so
this bit I've broken off into the outer
part of the ear canal try and get a
bigger thicker chunk there so I can get
a better grip on it with the crocodile
for set so just tripping over this a
twiglet it's best they come forwards
there we go you just tried that maneuver
some of this down so now we can go in
and get a better grip on a thicker piece
yeah see wouldn't pull that it's broke
off just starting that we can see there
we've got the next section it's just
gonna get a grip much thicker section to
get hold off here we go oh I broke away
again okay last sections much much thick
a bit now there we go okay so you can
see just how large that was there was no
way I was going to come up with section
but we were just maneuvering it breaking
it down take a look in there
oh just a little bit of ear ear ear ear wax left here
this the eardrum behind it you can see
the scar we just have Messi all this is
at the top portion of the of the ear canal
they see lots of little sort of recesses
in here little hole up there just
maneuvering this piece of ear ear ear ear wax
it's not going to come out it's wedged
in this we're gonna use the forceps to
go in now just grab the edge of this
there we go and nobody comes here we are
there's dead skin on the back of that
there take your look in there again you
can see the ear drum little Tony Hawk
there are take this is what we removed
this is just what we took out of the
that's without what we ended up in the
tank which I'll show you in a second he
goes all the bits hovering around in the
bottom of the tank there the the liquid
is water basically we flush the microsuction
through a water well thank you very much
for watching again today please don't
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doing a really good job and as always
take care