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 [Music] hi everybody this is Rhys barber from audiology associates thank you very much for watching our video today well a few patients come through recently with a mixture of a the dry skin issues or keratosis dr. and so we thought we’d do a compilation video so there are three patients in this video this first gentleman’s comes through you can see we’ve got a ring of dry skin with a little bit of ear wax it looks like sitting behind it so we’re using the standard size on the tube to get a grip on that dry skin first of all and just move it off the ear canal wall and then we’re going to use the crocodile forceps here just to get a grip on that skin show and pull it forwards a little bit and you can see it’s starting to pull much deeper skin forward so we go into that first section just working in the ear canal no entrance to the ear canal just to get this next piece it makes it a long ribbon of dry skin coming away just put in the next section forward so we’ll just grab that with a forceps now we get into that deeper section of ear wax that you’re going to just see it coming into the ear canal there we’ll just grab that and so you just broke a little piece away there using the suction now just to get a better grip on it and bring it out just a little bit further so this is the ear wax you can see here has been trapped behind that dry skin it’s actually a bit of dry skin in here as well so just an overproduction of skin in the ear ear canal basically here trapping a lot of this debris behind it there we are and a little bit at the entrance this will get rid of that you know that’s go on so I wanted to show you that we have got two pieces of ear wax here one actually on the drum but the second piece there is actually on the ear canal wall so I’ve got a coal strip and removing this piece off the drum the piece on the ear canal wall it’s going to come up with baths and showers and they’ll be quite uncomfortable to get it from that top section so we’re just going to concentrate on getting the piece that would be problematic as far as hearing is concerned so using the fine end here just to grab that they here we go and take that away and there we are drum itself looks good so this is the same patient over the second year so you can see much longer dry a piece of ear wax on this side and skin all mixed together so this piece you can see at the front of the camera there that’s that’s a piece of dry skin so we’re just going to touch on that with the suction tube just to try and get rid of that first of all you can see it’s quite angular is quite hard difficult to get a good grip on so we can use the crocodile forceps now again just to go and pinch maybe I’ll bring that out here we go and see all connected together with one long ribbon of dry skin a bit of ear wax at the end there you see one last flake of dry skin at the rear of the ear canal just in front of the ear drum here now what you’ll notice with this lots of people have talked about keratosis of drones and they talk about the overproduction of skin watch as we lift this piece of ear wax no see the bottom is free but the top is held and it’s held there okay so it’s actually attached to the to the very very top portion of the eardrum but only very loosely so we can take this away quite effectively if sometimes what you get with keratosis opto is an overproduction of skin is that you get the skin actually coming away from the drum but still quite firmly attached which you’re going to see in a video a bit later on in this compilation so that would be difficult to remove that skin because it’s because it’s still firmly attached to the ear drum you’ve seen us to appeals from your drones before but that’s loose debris on top of the ear drum but this is actually skin physically attached to the drum so by peeling something like that away if it’s very firmly attached she’s going to cause a few problems but you can see that that ear drum looks nice and healthy this is what we removed so you can see that in centimeters there and we’ll have it in inches there you go okay so second patient the compilation this gentleman has been coming through with really kind of blocked up ears you can feel there’s something in there moving around so we’ve got quite a large plug here so we just use the standard size on a tube just to grab this bit of skin here see if we can loosen it it’s actually quite firm so the skins actually toughened which does tend to happen a little bit with these our when skin detaches from the ear canal it hardens it goes kind of leathery for want of a better word really so it’s very difficult to get this out sometimes with suction so I’m just preparing it for using a different tool so just loosening it off the ear canal walls first of all here we are so we can go in there with a crocodile for SAP it’s quite a nice shape this one’s a bit of a dent in the middle so it allows us to get a good grip with a force out there you can see the whole thing starting to move just trying to get a more secure grip there we go and there it all comes out so it’s a skin plug there a little bit of loose ear wax then behind that skin plug so we’re just gonna lift this away just stuck at the entrance of the ear canal there we’re doing it up and down just to get it out okay now can you see this section at the bottom here no you can see this is attached to the actual drum there so if you go into it and we try to take this away we run the risk of peeling and actually rupturing part of the drum so I’m gonna leave that there I’m not gonna take that away so I want it off so you can see it does grow away from the drum and that’s what we need for it to do is grow away and detach but as it is at the moment it’s too firmly attached there to get rid of so we’ve got a mixture of skin and ear wax on this side as well see it looks quite hard and plug again bit of a gap above this one so I’m not so much of a hearing issue on this side but just because of the way it have formed on the other ear thought the best to remove this at the same time so crocodile forceps going in again see you’re unraveling long strips of skin again so we’re just going to do the same thing that I just grabbed there sometimes we’re lucky little peel away you know in a very long strip there is a video I think whether we got an 11 centimetre piece of skin that comes away I’ll try and pop a link up in the top right corner for that one for you but you can see it all just starting to move out to the ear canal now there we go another long strip you see as it’s pulling away it’s pulling it so everything’s attached to it it’s a little flap of dry skin here at the entrance to the ear canal so let’s get rid of that at the same time there you go it becomes much drier hard a bit of skin that look just bought another piece out with it so we’ll get rid of that out to the entrance as well here we go right now when we take a look at this eardrum you can see the same things happened here this is one long strip of skin here but it’s attached top and bottom to the drum so if we try and take that piece away it’s just gonna rupture top and bottom or you’ll run the risk of it tearing through those very thin layers of skin so I’d rather leave it let it grow away from the drum detach and now we can take it away safely so so last patient now you can see the white fluffy blobs there in the center of the screen now this gentleman just give you a bit of backstory is absolutely petrified of having his ears cleaned out he’s had it at some really bad experiences with various different practitioners over the years very very nervous gentleman very unwilling to have suction done so he has had tools used before to remove these skin layers just to give you some idea of how quickly this is built up this gentleman came to see us three months ago so just give you some idea of how quickly this buildup the white fluffy bits you can see I was unsure whether that was actually a fungal infection or whether it was acute abuse but the gentleman did reassure me he’s been using q-tips a lot to try and clean as ears so I promised that we would only use suction as a last resort to help with this gentleman but what we can see is this is this is classic keratosis table 2 and so layer upon layer of thickened overproduced skin in the ear canal I’m having to use the crocodile forceps because when I’m using the Jobson horn it’s just clicking over the top it’s just flicking this back and forth it’s not really getting the grip I need because if you imagine this is one big bore of skin that’s wrapped around itself and can sometimes still be physically attached to the ear canal wall so as I’m trained about pressure on it and move it forwards I’m trying to do that without causing the patient any distress because obviously they are very very nervous so I don’t to go scraping along ear canal walls with this gent if I can help it so I’m just trying to use the crocodile forceps as much as I possibly can just just to train clear this out so trying to get under under a leading edge at the moment to try and get a good grip normally we’d use a variety different tools to go in here suction everything else to tidy manoeuvre and then use the crocodile forceps or Jobson horn to remove it the rest of the way but because we’re limited in what the patient will tolerate and with the patient’s wishes I just means that we’re going to be struggling a little bit so we’re going to use the same tour repeatedly then so what has effectively happened as the skins been over produced then gentlemen’s complicate the things a little bit by using cotton buds or what he’s done then is pushed a lot of this and compacted it together which is a little bit more problematic for us because obviously we want this to the right towards the outer part of the ear canal if possible and for normally you’d be able to unravel it with longer strips so because it’s been compacted and compressed together it’s formed this really hard and tough skin layer up in here which we’re just trying to break through whilst also being very conscious of the ear canal walls really so a little bit more fiddly to carry out can be done but a little bit more fiddly there we go so just peeling little pieces away at the moment you can see it lifts in these bigger flaps look there you go that’s what it should be coming out like these long peels but as you can see where it’s being compressed together we’re getting a leading edge but as we’re pulling it it’s G tearing through unfortunately estancia bit of white in there now so what I think has happened is this gent has compacted the ear wax who actually left old skin I should say but left some of the cotton bud behind in there which is what this white fluffy stuff you can see we’ve got a better view of it now we cleaned the camera off a little bit at the bottom of the screen just below the forceps that white section there is actually part of there you go there’s actually part of the cotton bud that’s been left in here so not only do we have very hardened up skin we’ve also got debris in here as well that note and foreign objects need to come away so not the easiest of not the easiest of removals because you’re just trying to get a grip on some of this cotton fluff see Oh tough this is it just bends and breaks away it’s very difficult normally we wouldn’t use the crocodile forceps to do the entire removal we’d we’d switch a bit but you know I really want to use the suction and other tools as little as they possibly can you can see that debris in there as well this is actually one film here that that debris is sitting on top of so one big piece of like a plate of ear wax underneath all that just using the edge of the crocodile for soap but very gently lift there we go see as we’re lifting it it’s flicking back down again it’s not easier so after a little bit of persuasion the patient allowed me to use suction just to try and tidy some of this up and just to start peeling some bit away from the ear canal walls she’s gonna make it easier to use the other tools in here so we’ve lifted that flap from the side just trying to really loosen the edges we stand a better chance if we can detach this from the ear canal walls we stand a much better chance of getting this out in in one piece if possible which is what we’re using the suction to do at the moment so back in with a crocodile forceps now you can see we’ve got that leading edge there just gently pulling this away from the deeper section you can see how we’ve loosened it like it’s starting to move as one piece aiming to get behind obviously we are very close to the drum here so just trying to be as gentle as we possibly can very frustrating extraction to do this one because you you can see the pieces you can see how they move but they don’t want to come away in one piece and I’m trying to keep this last piece in one section if I can because I’m not going to be able to clear the eardrum because it’s patients where you nervous they there you go so what you can see here there’s a flap up to the right hand side there there’s a little piece at the bottom of the eardrum now I can clear this top piece here quite effectively and we should be able peel some of this dead skin away from the drum normally I would go in and clean the drum afterwards but because this patient is very nervous about having suction done I don’t want to be going in there and poking around near the eardrum so we’re just going to let that last it’d come away of its own accord but this is what we removed just from one year so you can see all this is built up in the last three months so very fast producing skin you very much for snow video today if you did enjoy the video then please like if you not 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