EAR WAX REMOVAL KERATOSIS OBTURANS AND SUB TOTAL PERFORATION – EP 101


hi everybody my name is Rhys Barber I’m
the audiologist here at audiology associates thank you very much watching
our video today if you’ve never come across one of our videos before or if
you haven’t looked at the channel before what we do here is post ear wax removal
videos we post new ones every Tuesday and every Friday so if you have any
questions about the video that you go to watch then pop them into the comment
section below and that way then the most popular questions we can answer at the
end of the week so enjoy the video and I shall see you at the end so we have a
bilateral ear wax removal for you today guys so in this first ear you can see that
we have some very dry ear wax really solid so I’ve put some olive oil in here which
just helps to loosen more than anything else this the ear wax from the ear canal
walls this is usually from cotton bud or q-tip use because you’ve got the center
section push much deeper than these pieces on the ear canal walls coming further
out so it’s where the head of the cotton bud the q-tips gone in so what we’re gonna
do first of all before we can take this ear wax aways we need to unstick the
majority this ear wax on the ear canal walls we’re just lifting it from the ear canal
which you can see we’re managing to do just here this is the standard size zoellner tube that we’re using here today no we’ve lifted it we use the crocodile
forceps just to get underneath and lift that ear wax up a little bit more I
apologize my voice sounds a little bit weird today I’ve still fought it with a
head cold unfortunately so we’re just getting a grip on this ear wax and just
pulling it towards us you can see the layers of skin underneath where this has
actually been sat on top and so the dead skin underneath doesn t able to come
away it’s held together with his which in this case is helping us because it
means we’re getting the whole thing out or the majority without in one one
larger piece there we go you see all the skin underneath it that
came away with it so when we’re looking now we can see the eardrums exposed we
have this whole dry skin section at the top so we’re gonna use the same process
just to remove that as well so still using the standard size zoellner tube to
start us off but be a little bit more gentle here because that back end of
the ear wax is actually quite close to the ear drum while we’re just watching this
bit just want to say a massive thank you to all the guys who came along on the
premiere the other night it went down really really well I just fantastic
session where you guys meal to answer some of your questions say hello to the
subscribers was really good so we’re definitely do another one of those
because it was received really well I think it’s coming away there nicely and
we’re just gonna work on the last piece on this side okay so we’ve pulled it
down at the center so we can get a good grip now with the forceps there you go
just twisting it into the right position to get a grip you can see it’s just
pulling away some of the hairs rather than gripping the main body of ear wax so
there you go nobody comes okay so you can see the eardrum there’s a little bit
of dry ear wax which we’re gonna take away now on the right hand side while we’re
doing this guys don’t forget if you’ve got any questions you want to ask us you
can pop them into the comment section below the most popular questions we get
during the week then I will put a video together answering those questions
probably the following week if that’s okay so don’t forget to pop any
questions you might have underneath you go is the eardrum took you’re nice and
healthy okay so this site you can see that’s very different this is more skin
tissue so this looks like keratosis obturans
this gentleman’s come through because we know he has a perforation on this side
he’s aware of each other for quite a long time it’s a well-behaved
perforation we’ve got all this excess dead skin that’s hanging around in here
so if you did wanna know a little bit more information about keratosis obturans
I’ll pop a link up in the top right-hand corner and also into the description
below so we’ve done a video on that already and you can see it’s starting to
come away and we’ve got a gap in the skin now so I’m going to switch from the
forceps to a Jobson horn I want to detach the skin from the top portion of
the ear canal here so just pull it down there you go you can see it all starting
to come away the skin that is are just a little bit too loose to get hold of
properly with the jobson so I put the crocodile forceps the Jobson
horn works really well on this type of material but the crocodile forceps will
just pull straight through the middle of it
so you can see the layer see the rippled layer of skin here that you can see
directly in front of the camera there so that’s what we’re trying to remove and
kind of pull this down the ear canal away from that perforation so I can’t see it
yet she’s just pulling through this softer material dragging it to the front
to take it out of the ear canal there we go let’s pulled that long strip of skin
that we could see earlier with it a little bit more behind there now
now with keratosis obturans which was explained in the video about it earlier
you can get some degradation of the skin underneath so actually degrades the skin
at the skin of the ear canal wall which is what’s happened here I’m starting to get
these whiter pieces coming away and that’s normally indication that it’s
degraded the skin underneath as we suction here you’ll see they use that
whiter skin just under the as on the tube is suctioning so it’s actually
start the piece actually start to eat through the layers of skin underneath so
you’ve gotta be really careful taking this away I don’t want to take too much
of it away because I want the skin to repair itself and looking at how deep
that goes we could keep taking that way taking now that way taking that way it’s
just gonna just gonna keep going deeper and deeper and eventually you will
probably hit bone so what I’d prefer to do is take as much
of this way as we can I’m just gonna start to see the the perforation there
you can just see the perforation past the zoellner tube take as much of this way
as we can but do leave some behind so the skin can start to repair itself we
don’t wanna leave this patient open to infection which they obviously would be
any way with the perforation they so see is quite delicate in here just trying to
slough away some of the top layer of dead skin I wanna go too deep with the
the Jobson because it can be quite uncomfortable for the patient especially
like this so there’s the subtotal perforation if you wanna know a little bit more
information about perforations then we’ve also got a video of perforated
eardrums as well which you can take a look at up or a link to that and top
right-hand corner description as well a subtotal
perforation means it’s a very large perforation as almost the whole of the
eardrums gone we’ll get a good look at the perforation in a second we’re just
still taking away some of this some of this debris obviously you if you follow
the channel for a while you know we’ve done it we’ve also done a section on
perforation recently but I was a much much smaller perforated eardrum so if
you want you can check that video out as well I’ll put a link to that in the
description and that will basically just tell you about the you can see the
different sizes of perforation and compare that one to this one you’ll see
this is a much much larger perf so the skin because it’s such a large
perforation the skin hasn’t been able to knit back together you can see the tip of the
hammer bones still visible which is the little white bobble just central screen
there now just the top of the skin that’s left of the eardrum through that
hole you can actually see the middle ear space as well so quite a lot going on
for this gentleman on this side okay so I’m not going to take much more way now
this is it so there you can see the white bubble to the top right corner of
the screen coming down a thats the actual hammer bone and then you have this middle ear
space you can see visible there then as well so this is what we removed I’ve got
the ear wax these two first one two three pieces they are from the first ear the
Ranger is from the second you’ve got the crocodile forceps standard size zoellner
tube ent fine and I’m Jobson on it almost got the full set there to see in
which you can get an idea of the sizes of those as well
you can see the skin layers we’ve got built up there as well thank you very
much for watching our video today if you did enjoy the video then please like if
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until the next time take care

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