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
subscribing hi everybody this is Rhys
barber from audiology associates thank
you very much watching our video today
I'm sorry a little bit different this
time we've done fungal infection
recently and lots of people asked the
question about you know what was it like
when people come back and so I thought
what we do where the patient who came
through the clinic with an outer ear
infection so we've seen this patient on
three occasions this is the first time
I've seen this patient you can see we've
got a very swollen ear canal the ear canal
walls are really puffy they're also very
red aggravated inflamed very wet sticky
thick discharge in the ear as well
which is a mixture of the ear wax but also
infected debris as well in here so what
we're going to show over that over this
video is the three visits the patient
has so it'll give you an idea of the
progression of the treatment of the ear
infection so for this one the main job
today we know the patient's got an
infection so my main job here is just a
clear as much of this debris as we
possibly can so that when the patient is
using for an outer ear infection is
usually a topical treatment so when the
patient uses the spray to calm this skin
down and to treat this infection it
means that the spray itself can get to
the affected skin underneath so I'm just
taking away the sticky thicker debris
here you can see there's not a great
deal Iram to work in here that's
actually a fine end we have on the end
of the suction there so you can see that
it's not there's not a great deal of
space in there whatsoever so just trying
to work as gently as we can but
obviously if you could imagine ear canal
walls are sensitive any way if you
aggregate them and inflame them like
this they are ultra sensitive so it we
just try as best I can to avoid touching
those ear canal walls this is the patient's
second visit so this is ten days later
so the patients have treatment in here
now for ten days it looks very wet they
were using a spray treatment in here so
we've now got a mixture of the spray
treatment
the infected debris and these are liquid
more liquid ear wax so I can just try to
uncover the ear canal walls first of all so
we can get a look and see what the ear canal
walls are looking like now as we start
to clear you can see there's some
pinkness they're not looking quite as
red as it did in the last video so it is
starting to take an effect but what
you'll see now as we start stripping
this Way's you'll start to see lots of
dead skin as well where the top layer
see wares peeling away they've got this
whiter layer underneath
if you imagine the skin is wet
constantly then you're gonna get this
whiteness of you ever had your hands in
water for a long period of time you get
this kind of white layer to the top of
your skin that's similar to what we're
seeing here so we're just stripping this
away at the moment very gently we can
see the ear canal that some of the
swelling's gone down because this is the
standard size on the tube we have in in
in the ear canal at the moment so you can
see gives us a little bit more room am i
- I do have two bits of news fear for
everyone as well so I'm gonna wait till
a bit later on to tell you those two
things but we're just going to keep just
plugging at this a moment you can start
to see the eardrum now so we're going to
go in with a fine end just to get a
little bit deeper in because you'll be
working a little bit closer to the
eardrum so you can see we're lifting
this liquid debris off the base of the
ear canal here looking at the ear canal walls I
know this patients gonna have to come
back in and see us again what we do here
is if a patient comes through with this
type of problem with is an infection we
automatically follow them up following
their treatment now a lot of places done
we like - I'll explain why when you see
the last visit in for the patient it's
pretty easy to explain to be able to see
what we're talking about but what I want
you to bear in mind with this one seal
wet this debris is at the moment it's
covered the eardrum so we just try to
take some of this loose skin and debris
off the ear canal walls here so it's
completely covered the eardrum a little
very wet material you can see it's very
thick as we go a bit closer so you
starting to peel away there at the top
of the ear canal there we go what we're
going to want to try and do is uncover
this
a drum as much as I possibly can here
because I'll see the eardrum is skin so
it's going to get aggravated with this
infection as well so we want the
treatment to be able to get down to that
layer as well now when it's all blocked
up and thick with debris like this is
that the treatment can't get down to
where it needs to so you can see we're
just trying to clear a little bit off
you'll see a little bit of flexion there
to the eardrum so we're going to be
really careful here just taking as much
of this so you can see it it's thick we
can see the blue of the eardrum
underneath which is great it shows when
the eardrum hasn't been affected too
much I'm not going to really read
puffiness to the eardrum which you can
do with with some of these sort of saw
the outer ear infections the term find
out who your infections are take this
externa which just means any kind of
aggravation or irritation to the outer
part of the ear you can see we've got
still got some quite liquid thick debris
deeper in just take another way
I'll get first bit of news I am on leave
next week so there will be no videos
next week I'm sorry but I am then back
to normal the following week this is the
last visit so you can what we can see
now there's the eardrum so you can see
the swelling has gone down the skins
will come on normal but see all that
liquid debris we did have on the eardrum
is now hardened so it's formed a thick
plate also coating the ear canal walls now
this is the reason I like to have
patients back in now this patient was
explaining that they felt much better in
their ears
there was no irritation there now it
didn't feel as squelchy which is quite a
common term that people normally use
with it out through ear infection but
they did feel that here and was still
quite muffled now the reason for that is
that liquid debris that's been sitting
all over everything is now hardened up
so it's actually thickened and formed at
a very thin plate or layer over the ear
drum which is hardened itself so what
that means then is it's very difficult
to get the full range of movement to the
eardrum so this is why I like to follow
these patients back up it's because then
we can go back in and as you can see
here all of that infected debris all of
the treatment that's been going into
these ears is now dried into these much
harder pieces so we've introduced a
little bit of olive oil in here which is
going to help us to peel this off the
ear canal walls
so while you're just watching that the
second bit of news we have for you is we
have another audiologist starting in a
few more weeks time which is absolute
front it was super excited it means that
we it's going to free us up a little bit
to be able to concentrate a lot more on
things at YouTube now social media and
stuff of that so thank you everybody for
being so understanding and bearing with
us over the last few months it's gotten
crazy busy here which is which is
fantastic but it is does mean with
somebody else on board as well covering
some of the sections it's going to help
us to really concentrate and get more
content out there for you guys as well
so you can see we're starting to peel
this away and it's starting to come away
from the bottom the ear canal these are
these are one of my favorite ones to do
I love peels
they're the most demanding ones to do
but they are by far the most satisfying
ones I find will do this something
really nice about it takes a really
steady hand to do them but they're one
of my favorite ones to do so we're just
taking some more of this Deborah where
you can see as we're uncovering the skin
in the you can I'll see you have far
more healthy beige color we just got
this little bit of debris here at the
top of the ear canal now normally when I'm
doing a peel like this you normally pull
down as far as you can
this patient has a more difficult ear canal
to working because you can see rather
than it being a circular shape we're
more of an oval tilted on to its side so
you get a lot of kind of top right to
bottom left movement but not a great
deal up and down which means that when
you're peeling from the the roof of the
ear canal they're sort of like the attic
regions what we like to call that what
you end up with then is you don't have a
lot of space so we have to kind of peel
across or left them back across from
right from right from left to right them
back across and right to left so we're
using the crocodile forceps here just to
see if we can do a gentle peel down and
across there we are that's taken that
away cuz it's easier to pull that
backwards motion whereas the suction
wouldn't have held onto it as tight
enough first real to do that and now
we're lifting the bottom section is you
can see we're working
slowly down to the eardrum see how much
healthier that skin looks though there's
a slight pinkness there yes there is
this has been sat on top of it so it's
been not aggravating this such but you
know it hasn't got that kind of normal
beige appearance but you can see just
how hard and thick this is what I'm
trying to do here is I'm trying to look
for a flatter section of that like so
they can get a really good grip on but
I'm struggling a bit to get a really
good grip so what I'm really use is the
crocodile forceps again it's not the
easiest piece to get a grip on because
it's sideways on and we haven't got a
great deal of room to open the forceps
up in here you can't it's difficult to
get around to the front end of this ear wax
and debris sorry I should say so I'm
trying to pinch it in the middle if we
can to fold the top back in so we can
get it there we are now we've got the
grip I want to get this piece because
it's quite a large pieces you want to
get this out of the way there we go and
you can see we've got the beginnings now
of what's coming down onto the eardrum
so we're going to peel this across you
can see we've got more room if I peel
from top right to bottom left there you
go see it's starting to peel away now
and so that's the top section coming
away we need to get this set you could
see how Brown that eardrum looks there
it's completely caked and as we peel
this away you can see it's starting to
come away from the eardrum starting to
come away from the ear canal walls we're
getting that pinkish skin look there at
the top underneath flattening it out
trying to get a good grip on that back
section there
peeling across and out there we go now
when you take a look at the edge and can
you see the blue or color starting to
come through now you'll see I'm gonna
work on this flap this about halfway up
here you'll see that blue tinge coming
through now so we're starting to break
this away what I'm doing here it's such
a fine piece I can't press in two exits
on the eardrum so what I'm gonna have to
do is flick it out so that it's facing
directly towards the endoscope
and that means then if I can get it
pretty much straight on I can get the
crocodile forcep on it to take that away
there that or I'd flip back you
difficult with a suction because you'll
pull it so far and then it'll flip back
into place you've got it straight this
or what I'm looking at you'll see what I
mean by getting the crocodile four so
now it's pointed straight towards the
endoscope whereas straight down with the
forceps
we can get a good grip heeling away
there we go you can see that chunk so
that's taken it off the top of the
eardrum there now okay this is where it
gets really delicate you can see I'm
just taking the glue what we've got here
that this the Deborah's come with a very
thin layer coming away so we have to
press into the ear canal walnut this is
really sensitive so I always explain
what I'm going to do before you put in
the argh enough experience a bit of a
pinching scratching I'm trying to lift
here off that ear canal wall you'll see why
because if I can get a lift there see
that see that top section and bottom
section are connected together we can
get a good or just flip back in place we
can get a good movement there you can
see the olive oil working down behind it
now but look what's half this sheared
away and can you see that pieces flick
back so there is a trick for doing this
what I'm going to do is I'm going to use
the suction not the end of the suction
tube to lift it watch what happens here
you'll see it flick up with the suction
this you just on the lift from the ear canal
wall they got it so we're not touching
the ear canal wall at all we're using the
suction to bring that up towards the end
of the tube we can get a good grip on
the back end of this now really trying
to peel from left to right now across
here you can see where the olive oils
gone in it started with behind it start
this you go remember this is so thin
that it's quite common for it to shear
there now we've exposed that left-hand
side of that the drum I'm going to train
to the same trick now with the suction
at the bottom here to only lift it but I
think this is too far back we're not
going to get a good lift here we're
gonna have to push into the ear canal wall a
little bit always going to be very
careful can our walls can bleed if you
push too far into them here we go we've
got the lift we wanted just got a grip
on that edge
peeling across to the right side also
have showed me the microphone there we
go and then we're going to bring this
section back
now there we go good peel there from the
ear canal wall and you know the patient fair
play they sat through so much to go
through this Fillion Fitness to them but
by this by they they kind of we were
gonna try and take this last little
piece of we could away but patient had
enough for that point so this is what we
removed and this was just from the last
visit so this is all those skin peels
you can see quite a bit there was
coating that ear canal wall just after this
I'll show you the difference from when
they first came in we should pop up in a
second there we are so that's where look
like when they first came in and that
was out the the first visit and then
that's what they looked like by the time
you can see the difference there in the
ear canal you very much for watching our
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take care