hi everybody this is Rhys Barber from
audiology associates it's our first day
but actually work today so it's it's
been a really really busy day this is
actually real lunch break so we're doing
sort a quick video on my lunch break as
you can see I'm looking a little bit
different I've lost my beard
unfortunately obviously we're feeling a
good good fit with the face mask so it's
so it's going to be a clean-shaven me
for the foreseeable future until things
change I hope you guys are all doing
well both myself mrs. B our family are
all doing well on our side and although
staff it's actually quite nice to be
back in today so without further ado
this is a video of what our patients
that we saw this morning so I just pull
this up for you after pop we blasted on
so I can see so what we had lovely lady
came through this morning she's been
suffering since about February with ear wax
problems in both sides what you can see
here is we've got some very dry skin at
the entrance to the ear canal which were
just removing with a little bit of micro
suction there the ear wax behind it though
the lady has been using lots and lots of
different treatments to try and clear
this at home obviously because that we
didn't have any were open it was
difficult to get this done so the sodium
bicarbonate is gone in there this BSL
syringe ink it gone in there there's
been olive oil going in there
so basically everything but the kitchen
sink is gone in there so what we can see
those you've got some very very thick
very sticky almost a clay type ear wax you
know we talk about this kind of fudgy
consistency you get to act that's the
type of ear wax here no no was the easiest
to remove with micro suction just
because of the nature of the ear wax it
tends to block the suction quite a bit
and rather than sort of pulling harder
pieces away you move in this more
slightly more flexible ear wax back and
forth nice adhering and stick into the
ear canal walls so very very blocked up on
this side lady reporting a lot of
hearing issues a lot of pressure in the
ear as well not really reporting any
problems on the other side the other
side is also quite full of ear wax we're
going to do both ears today so we've
managed to clear the entrance now you
can see that we've got this you can see
the sticky nature to this ear wax we're
trying to position the suction tube on
the right side and pull the ear wax across
to the left detach it from the ear canal
wall you know you can see what I mean
about it being more flexible
it's not the easiest if you're talking
about having like a harder piece of ear wax
in there then what you tend to find is
you can hold on to that harder piece and
draw the whole thing down when you've
got this more flexible tape it's a lot
of sort of hovering just above to lift
the edges off the ear canal wall which is
what we're doing here
there's a slight pinch point in this
ear canal as well just beyond this next
section which is sort of holding it in
because obviously the ear wax can those here
to the sides a lot more effectively
there so it's just holding everything in
place it's not quite not quite moving
out as well as I'd like you to at the
moment
but it's it's just a case of keeping
chipping away at it for this type of for
this type of ear wax maybe I was starting to
get a little bit of mobile you can see
Jess did invent a little bit of wiggling
technique there just just to loosen it
off the top of the ear canal there we go you
can see as we draw it down where it
starts to stick again to the ear canal wall
as it's coming away so I'm just really
trying to wiggle wiggle and Bend this
around the corner now just to get this
out so we'll take this leading edge your
wigs it's gonna get stuck and try and
hold on just beyond that there we go
there we are it's GS pulled away so you
can you can see it's very very dark in
color now that the the the color of the
ear wax will usually dunno how old it is so
if you've had ear wax it's been in there for
quite a long time then the ear wax will
start to oxidize and become much much
darker in color so you get this very
deep dark brown almost black in color
which is what you can see here but when
it's now we've got to these deeper
sections these are the harder pieces you
can see we're actually able to draw out
the slightly thinner longer pieces of
ear wax now so I'm popped a little bit of
olive oil in here because this last
section is a little bit harder it's
gonna be wedged don't forget we talked
about that Valley
you've got your ear drum here and then
you see the little valley that just
falls just in front of it maneet can
harden into the shape of that so you've
got a very wide section there and it
narrows down so you're pulling on this
and this wider section is stopping it
from from
being out so that's what we're doing the
one just try that look for any looser
pieces around the outside edge I'm
working this around back in this is the
standard saison the 2 by the way we've
got in here you can see they start to
see the smoother edge that's a good
indication that's there we go as it
pulls down from the top-right corner you
see this little glimpse of blue behind
it that's the ear drum that's the outer
edge of the utamu so we know we've got
this deep section so now I'm going to
lift from the bottom and we're gonna
train tease this ear wax out to that little
Valley there there we go it start become
nice mist it up a little bit because the
olive oil I got to take a slippity
because it's about lechero sir and maybe
i said we can just grab that top section
of ear wax now just slowly pull this down
there we go it's out it's popping it's
really more than you know you're the
stuff next door they're all exist the
first ever all been back together since
since lockdown 2 it says it's quite nice
to see everybody so we're just pulling
that chunk of ear wax away there and you can
see that the piece behind it is actually
wedged on the outer part of the you can
I was a bit too wide to fit out but just
slowly rolling it moving it down the
ear canal that way and there we are we can
see the eardrum there it's a little tiny
piece of dry ear wax to that left hand ear canal
wall so we'll just take that away now
slowly working down with the standard
size on the tube very slowly just
pulling this away from the ear canal wall
there we go
lovely so we've got the eardrum patient
here a much much better on that so much
much better now this is actually the
other ear now the this lady wasn't
reporting any hearing issues at all on
this side now sometimes that kits you
tend to find if you get somebody comes
over ear wax in both ears one is completely
blocked up they can't hear very well
it's usually nine times at ten is the
other ear that causes you more problems
because the patient hasn't really
noticed if having the issues they've
really been treating that side but what
you can see here is you got this very
thick but soft outer edge layer okay now
this is what water and if the lady had
put any treatment in here this this is
what it would have come into calm
that with but we've got quite quite done
our a pinch point just beyond here so
we've got this ear wax which starts off in
the ear canal cone of this shape and then
narrows to serve this shape and English
back out to that shape so you've got
this this kind of almost like a capital
I if you imagine so a wide narrow white
and that's what's causing the problem
here is is you're pulling on the front
section this ear wax to remove this and kind
of wiggle up and down but the rear
section of ear wax then is that a little bit
wider so that's holding holding this
front section in so it's a case of kind
of try to break away as much of this as
you can working on it wiggling a lot to
try and have his head a little bit of
dry skin in there which is what's coming
away now popped a little bit of olive
oil in now just to just to try and to
loosen this up a little bit it does help
it stops the stickiness you do sometimes
get you can see you get this kind of
very slight blurring to the edge of the
camera that's just with it as you as you
obviously you move into the ear canal with
the endoscope then when you've got the
suction in there as well the suction can
actually cause the oil to move slightly
and it can just coat the edge - it's a
kiss or so pulling that back out and
cleaned up a little backing again you
can see that pinch point now I was
talking about so you know that wider
section I got this thin section now in
the middle okay thin it is at the bottom
you can ask something's pinched down
into this kind of v-shaped valley anyway
but we're just trying to strip that
section away and you can see as you're
passing that you keep passing to that
same layer olive oil so it's just your
sort of blurring away there so we'll
take it back out and feed it off now in
a second what I'm trying to do here is
I'm trying to roll the ear wax so I'm trying
to roll that top section of really
sticky rice because you can get a good
grip on it but it tends to sort of move
and flex with the movement of the
suction tube so I'm trying to hold on to
this top section draw all those really
close they come drew all this back down
med there we go okay I'm so used to
doing these voiceovers without you be
able to see I keep forgetting there's a
camera there so keep them ads of what
the cameras okay but yeah we're trained
it's going to draw
they're sectioned I've tried pulling the
top didn't really move trim pull-up now
from the bottom so I'm trying to unstick
it on the other side of this this little
Valley
we just got gaps just appeared at the
top of the ear wax you're kind of it was a
blink in your missing moment just have
just a few seconds ago so you can see
you've got some dry skin lifting off the
ear canal wall there we've got the movement
I can see when we hold onto it see and
the whole thing starts to move with this
type of ear wax if you've got just a grip on
one section you haven't got the whole
thing moving that one section will move
up and down but when you get this this
more pronounced movement to the whole
piece of ear wax you know you've got a good
grip you know you've detached it from
the ear canal wall so now we're rolling it
down it's on its way there just hold
onto this top section just drawing it
forwards and again they go a piece broke
away there let's go back in now it's all
still staying quite mobile that olive
oil is left a layer on the skin you see
so as the ear wax touches against the skin
it's going to touch against the olive
oil so it's going to stop it from
adhering to that skin again so we keep
it moving we don't move it and stick it
against the opposing ear canal wall it's on
its way it's starting to come down the
turn down through that little pinch
point now here we are just cleaning away
the sides just to try and get a good bit
of movement I can see there's a little
gap at the top so I know we've worked it
down away from the ear drum now if we
can just move it forwards I don't think
I'm gonna be able to get out of the
pinch point using the suction but like
you know what I want to do now if we're
gonna use a different tool in here so if
we're gonna use the Jobson horn what I
want to do is get this ear wax draw it
forwards into the pinch and wedge it the
reason being if I make it to mobile and
we go in with something like a Jobson
horn as I try and pass the jobs in horn
member that's got a curved into it as I
train pass the Jobson horn over the top
it may well push against the ear wax and the
ear wax will roll back into that space again
so you can see here it's quite is
getting quite wedged I'd like to move it
forward just a little bit more you can
see
a small section at the bottom which
shows me the ear wax is turning it's
flicking upwards because the small
sections been against the ear canal walls
see the difference you got Bob Lee
section on the front that small section
on the back so it managed to lift it up
right and pull it forwards towards that
the camera there and we got that rayon
wedge it which is what we've done there
so and see if we can pull it forwards
well there we go sometimes you're
lacking it will come away obviously I've
just done this so I know it doesn't
cover way but it's it's GS kind of
rolling it so we are we've got a good
grip now we can see the rear of that
whack so we're going to go over the jobs
and on into that little gap get right
behind there you go tilt which is going
to get put the the the bend in behind it
and draw down there we go we go to the
other section now we're going to need to
put it bound yet the right hand side to
pull it around the corner and there we
are you can see out really thick thick
dark ear wax there you can see just how deep
that ear wax we've gone it was right up
against the eardrum so this is what we
remove we've got the two rulers over
this is it months ago didn't look too -
maybe - a 1/16 of an inch
five centimeters there as well so you
can see it was it just you can look at
how dark that is the the the piece at
the two inch mark there or the zero
Centipede amok it's almost black in
color and you can see the colour
gradiation as it as you move across the
ruler there it goes from that sort of
really dark kind of ebony color into
this this kind of more nutty brown color
and then you've got like at a darker
section as well so all the different
ages of ear wax you can see all in that one
ear so let's go back to let's go back
to Beyonce this back off so you can see
me go and so yeah it's a really
interesting case you know I think over
the next couple of weeks and probably
over the next couple months we're going
to see a lot more these cases where
people have had a lot of difficulty
trying to get their ear wax out which means
that we're going to see a lot more
impacted ear waxes and a lot more cases that
have gone on slightly longer the rule of
light so I know people have been really
suffering but it's yeah we are back open
now we are getting patients coming
through we're super SuperDuper busy and
most alike so insert so it's really good
I hope you enjoyed the video if you did
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guys and I shall see you again on
Wednesday we're going to try to keep the
videos coming we are really busy I'm
trying to keep on top of everything at
the moment so so we shall see you soon