hi everybody this is rhys barber from
audiology associates thank you very much
for watching our ear wax removal video
today
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so what you're going to see in our video
today is one patient that's come through
feeling very blocked up especially on
the right hand side and some irritation
on the left
now this patient does have a little bit
of ear nose and throat history
they had a perforation when they were
very young and that perforation was
uh surgically repaired which is known as
the tympanoplasty uh so that was carried
out on the right hand side but patients
days cancer feeling really blocked up
so without further ado we'll go straight
into the video so if i just click that
button there there we go
so what you can see here when we look
inside this here the first thing you'll
notice the ear wax is very dark so very old
the second thing you'll notice is that
the ear wax itself has a really deep
depression
right in the centre of it now that
depression is because this patient
has been using q-tips in their ear
ear canals
now what you can see has happened here
is the ear wax at some point was probably
quite uh soft and then when they've
pushed the q-tip into the centre of it
so if you imagine this is your ear wax the
q-tip goes in and the ear wax does that
around the q-tip
so it spread it and stuck it to all
ear canal walls
and caused this deep depression in the
centre which is
very very deep in the ear canal now the
difficulty we have here
is that when we're trying to remove this
type of ear wax if you held the suction tube
in the centre of the ear wax here
the sides which are dried onto the ear canal
walls are not are going to hold that in
so you won't get the suction grip
to be able to pull that out but what you
can see i'm doing here is just slowly
working around the outside edge
looking for any gap or any bit of
play if you like in the ear wax so we can
lift those edge pieces off the ear canal
first
and then very slow so peel those back so
we can take this centre section away
but as you can see it's really really
difficult to find a loose edge around
the outside edge of this ear wax
this patient's done such a good job of
pressing this against the ear canal
and allowing it to dry there that we've
had this really sort of hardened up
plate this is one continuous piece of
ear wax you can see here
uh that's just really firmly wedged into
that ear canal
so i'm using the fine end here trying to
stay just above the skin so using that
imagine this is the end of the fine end
here just working very very slowly
across the edge just trying to lift on
the edge there
and lift any pieces up like this there's
a lot of dry skin in here and i'm
probing
all around the outside edge to try and
find a weak spot
but it's just so firmly hardened up in
there
and even using the standard size on the
tube which as you can see here
because of that dome uh that sort of
depressed section in the centre here
when you're trying to get a suction grip
you you can't get the grip the air
escapes through the side
so you can't get that really good kind
of seal that you need
to be able to get the pressure to be
able to pull this through
it's a really really difficult one to do
this one so i'm opting to use the jobson
horn here
it's deep and this we've got to be
really careful i'm just trying to break
an edge if i can just nip a little bit
off the edge there
as we're doing you can see just coming
away there just at the bottom edge it
will help me to lift this section here
and just be able to get behind we've got
a kind of a blunter edge if you like
which is going to be probably a little
bit
thicker than this tapered edge we have
at the moment
but you can see even with the jobson
horn trying to find
an edge to work with that doesn't push
this depressed section
further in is proving difficult to do so
i'm just
nipping a couple of these little edges
off
and now i'm using the jobs none slightly
differently i'm trying to push against
that thin
edge of the ear wax and lift off the ear canal
to try and get a little bit of purchase
then with that with the suction
or with crocodile forceps if we're lucky
okay so back in with the uh the standard
size on the tube here
you can see that as we lift here
look at the difference that section
there look how wet that is now that's
that's usually a little bit
disconcerting because if you see this
sort of really dry ear wax like this and
this very
wet liquid type ear wax underneath that
would indicate to me that there
is uh fluid trapped behind this ear wax
okay now given this patient's history of
uh the eardrum appearing in tympanoplasty
you always wonder what's going on behind
you especially the q-tips being pushed
in that deep
so we might have to lift the corner off
now so we're just going to slow this
down in a second because we've got a
nice
leading edge to work with there we're
just going to very very gently hold on
to it here with the forceps and just
pull did you see that
whole thing slide away from that from
that section
you can see i was all held together one
big piece of ear wax here
it's very dry and brittle look at the
colour difference in the ear waxes coming out
there where the forceps are at the top
is really dark
much lighter material that shows me that
it's it's that kind of wetter
more sludgy sort of liquid ear wax behind so
there's got to be something going on
behind this
there we are that's all coming your way
so that whole section came out in one
you can see the colour difference a
little bit more clearly there as we kind
of focus in on it
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look what we can see now you can see
that we've got this very
very you get this remnants of it here on
the outside look how liquid that ear wax is
so this must be getting moisture from
somewhere there must be a discharge in
this here somewhere
that we're just going to take away this
section to the right hand side
ear canal is a little bit on the narrow side
so difficult i mean this is the fine end
you can see here so it gives you some
appreciation as to how big that ear canal is
but as you're kind of there did you see
that liquid coming away there from the
base of the eardrum then
that's where the discharge is coming
from now
based on this lady's history of
perforation to the eardrum and an
eardrum repair
i think what we have here looking at
this liquid that's coming away
is discharged from the middle ear space
so i think we've got another perforation
here
and you can see that white circular
section deeper into the bottom
left hand corner of the ear canal there
that's the bottom of the eardrum
as we suction here we're just coming a
little bit closer
look at the liquid that gets discharged
there we are
there you go so you can see we've got
this
perforation it just looks like a recess
but if it wasn't as wet that but that is
a perforation to the bottom of the
eardrum there
so what's happening is that the fluid
that we produce in the middle ear space
uh is actually discharging through that
hole in the eardrum
and has been soaking the back of this
ear wax which has caused this really kind of
slushy consistency there
um so this patient it's an
unclear as to whether by using the q-tip
they've actually re-perforated the
eardrum
or whether this is just something that
opened up again that no one's really
spotted before
i'm not sure what i've just played the
same bit twice i may have done i
apologise if i did sorry
but you can see there that that hole the
steeper i think i did i think i went
back and re-edited it the same bit twice
sorry
um but you can get a second look at it
anyway so you can see you've got that
hole just at the base there we're just
going to tidy up this little bit of uh
this will look kind of wet
uh skin material here with this
discharge that comes out of the ear it's
not infection it's just like a
very thin watery discharge but it can
cause some irritation in the ear canal as
this dries up because a lot of itching
and and the ear canal can feel quite
irritated as well
just tidying up around the outside edge
now
there we are okay so just zoom this out
so you can actually see that
wetness you can see the hole there a
little bit more clearly when you kind of
zoom it in there
um so yeah this patient does have
another discharging perforation
so we've advised them to go back to the
gp they need to go back and see the
ear nose and throat consultant
especially if it's discharging like this
a lot
whether they would look at repairing it
again with the scar tissue i'm not so
sure
what you can see here this is the
secondary but look how the ear wax is as
looped it's it's kind of spiralled down
the ear canal
this is the twisting action you see of
the uh
q-tip going in here it's actually spread
it and twisted it around
so it's very dry so i'm going to
concentrate on this top section because
this is the closest to the outer part of
the ear canal
pull this down which is what we're doing
here look how stretchy this is it's
pulling that dry
dead skin with it underneath as well
there where it's all dried onto the
ear canal
now if we can get a grip on this section
we'll use the crocodile forceps again
i'm hoping it's going to take the whole
thing out in one big cork screw so
as we pull this down now you'll see it
just peeling away from the left side
that rear section that's so closest to
the eardrum they're
coming away nicely now there we are you
can actually see the loop the curve of
it there as we take it out of the ear
ear canal as well
one dry hard piece
uh we see the eardrum there as well
looks a bit retracted you can see where
it's actually
you can see the hammer bone there quite
prominently and you've got that sort of
uh
section to the right hand side of the
eardrum there which has a little bit
more flexibility to it
has actually been drawn in just a little
bit more we'll take another look at that
eardrum now so you can get a good look
at it
here we are we were talking about the
tympanoplasty and whether that would be
another option for this patient that
would be the
nose and throat surgeons um call really
on that one
they always weigh up you know the risk
of leaving more scar tissue behind
against how well behaved that is
how much of an effect that is having on
the hearing as well
so have another good look at this
eardrum so you can see there the hammer
bone you can see
everything pulled quite tight around
that you can really clearly make that
out there
and then you've got this section here to
the right hand side where you've got
that
more more flexible part of the eardrum
and it's drawn into the space behind so
yeah quite retracted on that side
so this is what we removed so the piece
on the left hand side there
uh so up to about three quarters of a
centimeter uh
that piece there is is the uh first
section we took away from the first year
and then the second piece then the piece
to the right hand side is that corkscrew
effect piece that we had taken away from
the right uh from the
um from the second year as well lovely
so let's go back to
my view there we are so what you can see
from that is
you can see why we advocate not using
q-tips
okay when you see things like that where
you've got this real
uh indentation into the ear wax you can
sometimes push that ear wax further and you
can cause more problems by using the
q-tip it dries the ear wax out it compresses
it against the ear canal wall
and in this case it had pushed it very
very deep uh you know
in extreme cases i'm not saying this
happens all the time but in extreme
cases
you can end up perfect in your eardrum
in in some instances as well
well i hope you guys found that
interesting uh it's uh Wednesday today
so i shall see you again on
Friday uh drop some questions if you've
got questions by always drop them in the
comments section below i'm still trying
to keep up with the comments i apologise
if i miss any
uh but drop me a comment into this one
as well and i'll reply to as many as i
possibly can
as always guys take care of yourselves
take care of one another and look after
yourselves i shall see you on Friday