hi everybody this is Rhys Barber from
audiology associates thank you very much
for watching out you ear wax removal video
today we just got one patient who came
through on Monday this week very very
narrow area ear canals for this patient so
we're actually going to use what they
call a fine end now a few people have
mentioned that they don't really get the
size of these different different tools
so what I've got here this is a finance
if I try and hold this up to the camera
so I hope that weighs probably easier so
this actually fits onto the end of a
standard size on the tube the diameter
at the top is really certainly see I can
put my finger sort of just so you can
get a rough idea
there you go of the size so I've
measured this myselves 1/16 of an inch
wide from outside edge to outside edge
so just over a millimeter so we're gonna
be using this one quite a bit that's
going to give you some frame of
reference as to how narrow this ear
ear canal was for this patient the other
thing we're gonna use today is the
Jobson horn though this is an oval table
some horn okay you can get them in round
or oval this is the oval we obviously
better shape at the end there you can
see that it's got a very firm hand light
very soft slight bend on the end there
so we're able to to get over the top and
to bring that ear wax out so I talked to you
about there being a slight Bend on the
end of the job sternal and that's what I
was referring to so without further ado
it will pop on to today's video so
basically this really lovely lady to
come through feeling really blocked up
on one side you can put lots of lots of
different home remedies in there to try
and get rid of this but you can see the
entrance to the cards are very fine and
now that is actually a fine end there so
you can see just how narrow this ear
ear canal was so you're talking that is 1/16
of an inch just over a millimeter so
it's very very narrow so what we're
having to do here is to hold ear canal
up when we use in the endoscope or the
side of the endoscope top to actually
hold the air come up and so we can get
in side the ear canal we're just very slowly
working our way down you do see a lot
with these very narrow ear canals like this
because the ear wax just can't migrate
however you imagine it strained to get
out or a really narrow space it can't
get over very well so the ear wax does tend
to sit
there and dry out and become really
really sticky and just really kind of
hold in place there but you can actually
see as we're suctioning this in but lots
of little bits of sort of dead skin and
debris coming away on here as well so
we're just slowly guiding the stone it's
always a painstaking procedure when you
try it
suction somebody with a very very narrow
ear canal like this one because you were
just trying to to lift and peel down the
ear canal all the way down just to try and
get get some relief for this patient you
can see the skin layers actually just
separate and with the dead skins coming
away off the top layer there see as you
stretch you get this this thin Tour
spider webby film just underneath way
it's slowly peeling down there you go
just try to get a hold of this harder
piece one disadvantage of using the fine
and it's great when you've got very very
narrow ear canals like this but you don't
get a tremendous amount of suction grip
because you're you would think you'll be
the opposite way because you're forcing
that that sort of AI feel to a much
narrower tube you'd think you got a lot
more suction
but what tests happen is it blocks very
easily and very quickly especially if
you have sticky ear wax which we've just
encountered here you can see it's coming
away the sticky ear wax just gets in the end
and blocked it very very fast so we've
got rid of that outer skin layer but you
can see that all this soft mushy a
sticky has have a ear wax sitting behind it
so it's very slowly bringing this out
always really conscious with with
patients with narrow ear canals that you
try not to touch the ear canal walls at all
because I think they are quite
uncomfortable if you if you press
against and don't forget it's very thin
skin in there with nerve endings just
below the surface yeah you can see you
just start the chip away at the bottom
now try into just just try to lift up as
much of this good as we can it's not
like using the standard size to where
you could to lift a lot and get a good
grip on that to pull it forwards you
just slowly chipping all
we add the ear wax with this type of tube
it's a little here actually in there
that's just going across the tube there
as well you can see that kind of slight
pinkness to the skin this last section
of ear wax here very very deep so sitting
you're really close to the edge or very
difficult to get to there we are we're
just trying to pull down on it just
trying to roll it forwards if we can we
haven't got a great deal of kind of if
you imagine side-to-side movement in
here so the best one we can do is that
up-and-down movement but we got just to
try and kind of bend this forward and
bring it out and thank you for everyone
as well who said they would like to see
this particular type of format continue
yep that's great I'll carry on with that
well I know some people mention they had
a few difficulties with some of the
audio so I've changed mics so if you
could just let me know if that's any
better for you guys it sounded better on
the playback well they did a quick test
earlier but it's it just just to make
sure it's also okay for you very slow
you can see it it's difficult to get
that duct pulling sensation especially
when you get these problems with this
skin involved as well because the skin
is tough it doesn't it doesn't break
away like the ear wax does so as you're
trying to pull it you can't kind of
stretching it and normally if you've
seen our videos before we don't like a
the ear canal peel we lift quite high
into the ear canal to get the peel but you
just so restricted in your movement here
with this with this ear canal trying to
lift look from the bottom can you see
we're just just getting a little bit of
movement no to the ear wax with the whole
thing just starts to move now you know
then you've loosened it starting to come
away or it's almost there we're just
gonna turn pull this down is frustrating
little bits of breaking off the top
which is blocking the suction but it's
very slowly coming down just gotta clear
the suction tube you do find that
obviously using the define and you have
to clear quite a bit
there we are you just see it starting
now we're getting that roll it's just
starting to go there we go now we stop
and see a bit more movement there's a
light at the end of the tunnel no guys
it's almost there so we just got out
we're just rolling it over and they lift
him from the bottom again you can see
what I mean about it being really sticky
and we've actually blocked the suction
again now so we have to so you have to
repeat and they come out and clear
through this bits the skin they're just
getting sucked in there we go there we
go so we start to move now we've got to
lay out to partly I hope that bit curbs
us great it's gonna give us a bit more
room in there and fortunately there is
more ear wax behind we just don't see the
tip of a hammer bone there though just
at the top of that just at the top of
the ear canal can see just how narrow that
entrance is these patients would
normally be coming through on a regular
basis you'd see them probably every
every usually every two or three months
if you've got very narrow ear canals like
this just because of the nature of the
ear wax and the size of the ear canal they tend
to block up very quickly so if I suspend
that ear wax down so it's kind of turned
through 90 degrees but we've got a very
thin leading edge if you see so we've
already got the thin end in there and
the thin leading edge of this ear wax means
it's really difficult to get a a really
pronounced grip on it and you can see
it's just collapsing breaking away it's
all that tangling and peeling which is
gonna be a nightmare to try in that try
and pull out I'm trying my best together
if we can kind of get it forward
slightly to a slightly wider part of the
ear canal then we can use the Jobson
hole in that to get over the top and
bring it forward but when you're in a
very narrow part of the ear canal you saw
just a second ago and I showed you the
jobs numbered because of the shape of it
sometimes it's difficult especially
narrow ear canals to get that I'm going to
need to pass over the top of the ear wax to
pull it down still trying to roll it but
you can see what's happening is the ear wax
is just too sin
- greeting and then sticking to the
ear canal walls over Saves we're trying to
pull it I'm searching for any harder
slightly more solid pieces of wire so we
can get a good grip on you conceal as we
lifted it from the bottom that we saw a
little bit we're coming away okay so
Jobson horn to the rescue you can see
it's coming over the top we've managed
to get just over the top of it pull down
behind it and draw it through and out of
the ear canal you know you can see a little
bit more with Jobson hornet and lures
kind of wet tape swipes the ball why so
more easy to disintegrate if you like
you tend to find something that will
kind of smear it to the ear canal wall so I
tend to go in with the Jobson horn then
go back in with a suction tidy up a
little bit and then we can go back in
with the Jobson horn again if we need to
but we've minds you know we've broken
that front section the way that thinner
piece oh and come away quite nicely you
can see it really struggling again the
endoscope and there we are there's the
eardrum now so this is what we're more
so you can see it's not tremendous much
what's critical is for goes off-script
5/8 of an inch
he just or one of the half centimeters
there as well so you can see very very
small pieces but when you look at that
in comparison to the size of the ear
ear canal it makes it also it makes a
massive difference for these patients
when they when they kind of really
getting really blocked up with a sticky
sticky affirmative of ear wax so yet so I
hope you enjoyed seeing the tools we use
if that's something you'd like to see
more often so if I give you a rundown of
the tools were going to use and show you
that before we start let me know because
obviously you guys drive what we do on
this channel and you're really good at
it so if you tell me what you want to
see pop it into the comment section
below I am reading them I promise we're
just so busy at the moment I'm
struggling to keep on top of responding
to every one but let me know what you'd
like to see whether you want to see the
tools again next time or maybe you want
to see the endoscope we can show you
that if you want to see that next time
as well yes
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okay guys stay safe and I shall see you
on Wednesday
no Friday