hi everybody this is rhys barber from
audiology associates thanks very much
for watching our ear wax removal compilation video
today
two patients in this compilation
second one's quite an interesting one
which you guys have asked me a lot about
so stay tuned for that one as well
but the first one here you can see we've
got some very light material here
at the entrance to the canal quite
hard as well so this looks to me as if
it's a hardened up
ear wax maybe a little bit of dry skin
looking at the side of it as well it's
got this nice sheen to it
but you can see it's a tough old plug
here so we've got the standard size
zoellner tube on here so the wider the
suction tubes and we're just holding
onto this top section
trying to work this out now when you get
these bigger harder plugs like
this they don't always come away easily
and so we're going to drop in with the
jobson horn just behind the top section
you can see how this top section is a
little bit softer
than the front end here so we're just
going to pull this down and
as we pull this forward you can see that
softer material folds forwards
and then you've got this harder under
layer here which is
a little bit of dry skin running
underneath this plug of ear wax
surrounding it and running underneath it
what we're going to do is carry on
with the jobson horn here we're just
going to see if we can drop behind this
top section
and pull this whole thing forwards but
it's such a tough layer underneath
that's all we're doing is
unfolding it out to the ear canal rather
than actually pulling the entire plug
out
we're just going to keep going back
over the top now there we are we've got
a good grip on the rear section out
comes that plug
let's see if we can pick this up they
don't always want to be picked up with a
jobson horne very easily
we've got a good grip in there now and
you can see as we're lifting this up
that piece of dry skin
is still going in further into the canal
so we've had to switch now to the
crocodile
forceps just to pull this last section
of skin
there we go we took that plug and the
connecting layer of skin away there
you can see the eardrum there is looking
nice and healthy but we've got this
section around the front end here just
needs a little bit of tidying up getting
rid of a few of these bits and bobs
so we're just going to start taking some
of these pieces away here
easier to do that with the jobson horn
on these harder bits of skin
just because if they were slightly
bigger you could hold on to them with a
suction tube
but because they're a little bit smaller
the suction tube isn't really going to
get a good grip there
so it's easier to go around with the
jobson horn just to tidy this up
a little bit of looser ear wax there
it's more very soft almost an
oily consistency coming away
i'm just using the bits of the jobson
horn here
just passing very gently along the skin
on the outer part of the ear canal
obviously we don't want to push too hard
against the skin because that can then
cause a little bit of
discomfort for the patient but eardrum
they're looking lovely and healthy
smooth
pearlescent good light reflex there
absolutely fab
this is the the patient's second ear
here and you can see that we've got this
long
dry flap of skin right at the entrance
to the canal
because it was easier for us to use
the jobson Horne straightaway last time
we're going to go straight in here
you'll see how this folds down and this
is a bit easier to explain when you see
these patients who've got these
plugs
you can see as we folded that piece of
skin
outwards it had actually folded back on
itself and into the ear canal trapping a
plug of ear wax behind
so there is quite a hard plug just
behind that which i'm working on now
very gently bringing this down the canal
i'm hoping it's going to take this front
section of skin which it is there with
it
there you go you can see that big plug
that was hiding behind that
that layer of skin this patient
actually didn't experience
any issues with this ear it wasn't when
we took a look that we could see it but
you can see that long
dry flap of skin going further in here
now rather than just keep pulling at
that with the
the crocodile forceps when you get these
long very dry strips
i prefer then to go over and
use the jobson horn just to nip it off
at source there and bring it out
sometimes when you're using the
crocodile forceps when you pull it's
like a lift imagine pull of skin
next to your nail
it can pull all the way down the canal
which can be quite uncomfortable so
sometimes it's better just to
drop behind it and bring
it forwards with the jobson horn just to
take that piece away there
you can see now just the same thing
as last ear we just
got a bit of tidying up to do around the
edges here
there we are just doing that bits and
pieces or while we're just tidying up
this one tonight's the night that
mr b senior is doing his 30-ton
challenge so i'm recording this in the
daytime and i'll be up at the gym then
later on trying to record the video
tonight so you'll probably see that
sometime next week i'd imagine
it's going to take me a bit of time to
edit that in but there we are you can
see
now we've got this lovely shiny
eardrum there you can see the flaps of
skin on there the larger piece of white
so we've got four centimeters i'm gonna
do this quickly there's four centimeters
and just over an inch and a half there
as well some big plugs
that piece of skin on the left hand side
so now at the top of the screen there
sorry yes to the right-hand side on the
top of the screen sorry because it's
reversed on my camera
you'll see that was the piece of
skin we could see just at the
entrance to the canal there on the on
the second ear
okay this patient really interesting
this lady
a lovely lovely lady came through having
a few issues came in for a hearing test
with a bit too much ear wax in there for us
to do the test
no real history of any ear
issues no surgery nothing untoward going
on there so
we just think this is going to be a
straightforward removal so you can see
we've got this layer of ear wax all
around the outside edge
very thin gap we can't see the eardrum
though so it needs to come away before
we can test this patient
so we've got the standard size zoellner
tube in here
just so gently taking this way lady was
very nervous never had any ear wax removal
done before bless her so
we went nice and gently with this one
and we're clearing all this
dry
skin ear wax around the outside edge here
taking that away there and then just
behind it you'll see we've got this
another piece of ear wax which is
sloped up at the back so we still can't
see the eardrum there
but we've got this very narrow
section at the front and very high
section at the back
usually a little bit more awkward to
remove these just because
it's difficult to get a good grip and
because when it slopes right up at the
back here
it's difficult to get the jobson horn or
any tool behind it to bring it down
so we've got to try and lift it from the
base of the canal here and just lift so
we get enough
ear wax coming off the bottom so we can get
a good grip so i've popped a little bit
of olive oil in here just to help that
along
and we're just going to take this little
bit of dry skin sometimes this will be
attached to the top of that block and
when you pull that away
it will actually move that block of ear wax
forwards as well
but there we are you can see this long
strip of dry skin they're coming away
there we go you can see just how long
that strip is as well so we're
holding on to it luckily there's a lot
there so it's not clarineting here which
is that high pitched squeal you get
we're holding on to we're drawing it
forwards and going back
grabbing a bit more drawing it forwards
just to try and pull that little bit of
dry skin away and now we're gonna see if
we can lift this whole plug up
from the base
there we go it's just starting to lift
if we can get a good grip underneath we
can take the whole thing away then
now we're starting to get
that nicer smoother edge
underneath
we can get a good grip on bit
of wiggling going on there no turbo
wiggling today guys but just a little
bit of normal wiggling going on
we're just going to work this down
the canal and out it pops
you can see a little bit of dry skin
underneath as well very smooth underside
where it's dried into the shape of the
base of the canal there as well
so we're just going to grab that bit
more wiggling and out comes that
layer of dry skin underneath right i
want you to take a look at the eardrum
have a look at that the
patient didn't even know they had this
but this to me looks like a healed
perforation you can just see it there
now the reason i think it's healed is
when you take a good look at this out of
this magnified section you can see it
looks like there's another layer of skin
behind it
this is the perforation now
a lot of the time patients may not even
know they have these small perforations
a lot of time they will heal back
together
but you can see it never heals back
the way it normally looks and sometimes
you get a gray patch
in this case the skin has become a
little bit
thinner when it's formed again so you
end up with this slightly more mobile
bit of skin
in the pars tensa which is that bottom
section of the eardrum
and then if you get any change
in pressure then that becomes almost
a little pocket so it withdraws
into the middle ear space
a little bit further the patient really
hadn't noticed they had a perforation
didn't know they'd ever perforated the
eardrum
no history of ear infections or anything
so we can't quite pin down why it was
there
a really interesting one so
i know a lot of you guys have asked
about perforations do they heal back up
what do they look like
that's standard you like to be a
gray or white patch on the eardrum which
is tympanosclerosis or scarring
thickening
or it'll be very thin like that one was
and you get that drawn in
section so quite an interesting one
for you guys to see
i totally forgot to look at the
measurements so
it is an inch and a half
four centimeters i think i can just work
that out well guys i hope you enjoyed
that video as much as i do voicing over
hope you find that second patient quite
interesting as well
as always guys take care of your ears
take care of yourselves and take care
one another and i shall see you again
real soon all the best guys bye