hi everybody my name is Rhys Barber I’m the audiologist here at audiology associates we upload new ear wax removal videos every Monday Wednesday and Friday at 9 p.m. UK time so please consider subscribing hi everybody this is Rhys barber from audiology associates thank you very much watching our video today really interesting case came through to
Ebbw Vale clinic today patient has a fungal infection which is in the process of getting treated so has some drops to treat this but really struggling with their hearing and the itching sensation that’s in this ear canal at the moment what you can see here is we’ve got this very light-colored mushy material now that’s actually debris from the fungal infection itself but you’ll also see that there are some white pieces in there that look like remnants from using a q-tip we saw this very thin fine fibrous layers now that’s actually the spores coming from the infection itself so with fungal infections the classic kind of appearance you get is this mushy layer on top with a thick under layer that’s that’s a mixture kind of dead skin and hardened up infected material so what we’re trying to do here is use the sock use the suction tube sorry just to suck down and pull away this material from the ear canal wall you can see that it’s all coming away here can’t quite see the eardrum yet but you’ll get a good look as we lift this piece away from the see there that flap that appears and it peels away quite nicely the analogy I usually used to describe the texture this if if you ever had that the skin on a custard or a gravy something like that you get a skin on the top it feels that kind of consistency on the top here so you can sometimes lift and peel this down the ear canal unfortunately for this patient what’s happened is it’s built at really deep in the ear canal so not only is it covered the ear canal walls but it’s gone as that thick layer up and over the ear drum as well so really restricting the movement to the ear drum and really dampening that sound so patients having quite a few problems with their hearing on this one side at the moment apart for him being really itchy and annoying as well so if you can see we’re starting to peel those layers away there getting our first glimpse of those kind of those layers you can see with that the the spores on the top followed by the ends Luthor not that more thinner mushy Eliran and the thicker layer at the bottom so you can see that quite clearly there as there as it’s coming away from the ear canal walls just trying to find a grip on an edge here the weakened peel but it’s as you can see it’s just tearing and slicing apart as we’re getting a grip on it now where we have to be careful here is because we have a layer built up of the ear drum we can’t just go digging into that because you could end up you know pushing the the tooth through the eardrum itself so what we’ve got to try and find is a weak edge to this section that flows over the year drum though sometimes if you work back from where it starts away from where we’re trying to work on is obviously the year drum we’re working back away from that to try and find an edge that we can peel down that will continuously go and take this off the drum itself but as you can see it’s not really too compliant and because of the aggravation to the skin in the ear canal the ear canals are quite pink they’re aggravated they’re puffy which means that you don’t have a lot of room so when you are doing a peel like this normally it you kind of peel it across on one side to the opposing ear canal wall you have got a little bit more room but this one there’s not a lot of room you don’t have a lot of space to carry that peel out Jess trying to lift off that right ear canal wall because I think that’s where we’re going to get the most movement here aiming for the top now just see if we can peel downwards because obviously we’ve got more space top to bottom and we have left to right and we can see we’re getting a little bit of movement to that layer there can you see it’s just peeling down but unfortunately it’s just peeling away in smaller pieces at the moment I want a really good really good piece to come away it’s a good analogy if you have a strip wallpaper when you take that away you know sometimes you get these really frustrating little bits that come away and suddenly you’ll get this one piece it’ll take almost the whole sheet off that’s what you’re looking for is one piece to try and get a good grip I would just starting to get a bit of movement to that right side then it started to peel up there a little bit more while we’re doing this we’re constantly checking in with a patient making sure they’re feeling okay are they all right for us to convey in any discomfort so it’s you’re always checking in to make sure they’re all right especially with a deep deep peel like this now because we’re not be able to get from the side I’ve aimed for us a loose PC I can see moving at the bottom so I’m gonna let the holder suction on there let the grip build and you can see it’s actually sucked a hole through there now so this is like a layer that’s built up just in front of the eardrum so it means I’ve got a bit of room to play with at the bottom here trying to get a grip strong enough to pull this away because you’ve got to think this is one continuous layer that’s gone from one ear canal wall across the eardrum to the opposing ear canal wall so as much tension as we’re putting on the front to pull those side pieces are holding it in but I can’t get enough of a grip on the side pieces to detach those first so where I’m to kind of work backwards on this one just trying to pull down from the top there you can see it’s starting let’s start the peeler where you can see it peeling from the skin underneath there see that coming wait oh great now we’ve loosened it now it’s come away from the drum you can see it’s loose it’s moving back and forth you can see how thick that is but it’s still held to the bottom left of the top right of the ear canal one continuous piece so I’m gonna aim for this center section try and hold it and pull because it’s not coming away so it’s trained strip away the one corner really holding in there you can see just how tightly that’s holding in there I can see that there’s also a piece now that goes down into the valley wheels talk about just in front of the ear drum so that piece is gonna be really firmly held in there if we’re lucky it’ll take the valley piece out as well as that bottom section but it’s just not quite peeling the way I want it to always difficult to get to this top right corner and just because of the angles in here and the width of the ear canal where a little bit higher let’s see if we hold the suction tube on there let the suction tube grip can we pull oh we’ve got a bit of movement it’s pulling forwards but it’s not really pulling out sorry I should have said we’ve switched to the fine end so we can get it do more delicate work in here sorry I meant to say that earlier just get a bit carried away with the narration you can see now that we’re just trying to aim for a flatter section of that thick debris trying to hold the suction tube on there to get a good grip trying to flip any bits we possibly can here you can see the movement and how much of this is attached to the ear canal walls which is why it’s really just not budging with the with it with the amount of suction we’re going here at the moment got a good grip there I’m trying to tease it out from our right side to try and get this out although these can be one of the most frustrating ones to do because you are doing a lot of very fine movements very tiring on the arms they’re also the most satisfying ones to do so it’s always nice when you do manage to get these these bits out even the game for that bottom I’m looking I’m just trying to weaken it around the edges at the moment oh there we go we’ve got a peel on that bottom section so we took a chunk away there but it didn’t take the top right piece away as well so we’re going to need to get rid of that but now we’ve detached the bottom left I’m hoping that the top right will will come away a little bit more easily trained I’ve just had to back away a little bit to get the angle with the suction tube okay same for a different spot just trying to get a grip hold on they’re pulling from the side now we’re getting some movement you can see it starting to come away from the corner of the drum and the corner of the ear canal they’re aiming for that flatter section holding on to it gently teasing this out every time there you go now it’s come away from that bottom section there so we’re slowly breaking away all the adhesions around the side let’s see if we can get this top section down in a way now I’ve got a good grip there now let’s see if we can hold on to that grip it’s moving there it comes there you go so you can see that whole top section just came away then there we are so we’ve exposed you can see now you can start to see the ear drum behind looking very red very aggravated in there from this infection like I said the gentleman is having some treatment for this but because he just wasn’t hearing very well we thought we’d try and give him a bit of relief while that while that medications kicking in it also means that the medication could actually get down to the skin and really help to clear this up a little bit more now I can see I’ve got a bottom section now in this valley we’ve got this this this sort of lighter material that has this fuzzy top to it and that’s just a little bit of fungal infection this is really annoying but the skin that keeps getting in the way so I’m just going to get rid of that because it’s obscuring my view all the time but watch what happens as we lift that see as we lift we’re getting a poll now further into the ear canal so we’re going to run with this we’re going to take this all the way down as we lift it watch what happens here as we lift that’s the edge of what’s down in the valley and cover in the bottom of the eardrum so look how big this is where we start lifting it up that is a huge piece of fungal infection skin really thick thick layer so we’re going to switch now we’re going to put the standard saison or in here just because that that thin end of fine end is not going to hold on to that tight enough and if we can suck a lot of this into the end of the suction tube we really good really take it out the bottom of that Valley making circular movements moving around pulling left to right up down loosening this from that Valley there we go starting to come away there it goes all sucked into the salt into the suction tube okay so we’ve got rid of it now you can still see there’s a layer at the bottom of the eardrum it’s a discolored layer a brownish tinge to it so we’re gonna aim for that section next now this we’ve got to be really careful here we’ve got an aggravated inflamed eardrum this is going to be sensitive for the patient to remove this we’ve asked the patient is it okay if we carry on they’re happy for us to do so on the provider that if they’re uncomfortable will stop so they’ve put up with a lot already I’m just going to clear some of this because I need to get a good view in there I’m just going to clear some of these bits of dead skin away from the outer part of the ear canal first they tend to Fleck up in front of the camera because we’re working in that bottom section there you are starting to peel other weight gives me a task catch my breath as well yeah okay so we can see this bottom section here you’ve got a really kind of fuzzy layer sitting on top of the eat of the brown material there let’s take these pieces away to give us the best view we can look how pink and aggravated that skin is under there you know this is these are long-standing infections that flare up every so often so you can see it’s really really aggravated I don’t want to introduce anything wet in here either so because with a fungal infection you’re looking at being wet moist environments are gonna really flare this up so I put olive oil in there it’s just gonna cause more problems so we’re going in dry so you can see well we’ve got this bottom layer now we’re just trying to peel down and across the bottom of the eardrum here okay there we’ve got a grip let’s see if we can tease this across we’re working down in that valley so very small space here don’t forget what you’re looking here is if you look at the tip of your little finger this is going to be about this that size so this is that the kind of you’re talking with in the bottom third of that so it gives you an appreciation for how small a space you’re working in here okay how many of you looked at the tip of your finger that so what you can see that you’ve got down in the basement we’re just down to peel it away from the ear canal walls I can start to see some of the skin underneath we’ve got this piece here to the right hand side the same for the flatter section a good grip watch what happens now as we pull this dead skin all peels away from the ear drum it’s all coming away really nicely there let’s have a good look at that again then when we go back in now we can actually start to see the hammer bone now we can see the features of the ear drum this is started look more like ear drum skin we’ve got this piece now to the right-hand side which I would really love to be able to get rid of if we can let’s see if we can peel that we’re just gonna aim for a larger section of it see if we can get a good grip it’s in a corner it’s behind the lump it’s in the valley it’s really difficult to get to trying to hold on to a flatter piece of it there don’t forget we can’t just drag across the skin we’ve actually got to peel it away as we’re coming away whilst avoiding the ear canal wall and the ear drum there we go just pulling away and the cord just lost the grip away into the left-hand side there we go it’s peeling you can see it coming away I just want to get rid of this infection debris there we go perfect right okay I’ve exposed the majority of the ear drum here there’s a little patch to the right-hand side but I think this patients done really well today in to sit through all of this they did really really well so we’re gonna take that away there we are I’m gonna call it a day there so what we’ve said to this patient is carry on with the drops you can see there’s a couple little bits there we can actually see part of the ear drum there but looking row red and aggravated patients gonna go away carry on with the drops and come back in a couple of weeks so we’ll look at the video then see what – see what happens this is what we involved looks really unimpressive I know but it was just such a difficult one to do a really interesting case I want to share with you guys there’s the obligatory tank shot you can see what ended up in there thanks very much watching our video today if you did enjoy the video then please like if you not subscribe to idea you’d like to do so you can click the subscribe button here if you’d like to check out some more videos there also up there now if you want to follow us you can do on Facebook Twitter Instagram and also check our website if you want to know a little bit more about us as always guys until the next time take care


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