hi everybody my name is Rhys Barber I'm the audiologist here at audiology associates we upload new earwax 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 for watching our new axe removal video today this gentleman's come through he's quite a regular patient of ours he's asking through about three months ago he suffers a lot with dry skin issues in the ear canal a kind of borderline keratosis objects and we have started cleaned up quite regularly so he's coming for both ears to be cleaned out today you can see that this skin has really dried up you talking this is only 12 weeks since his last microsuction so you can see how quickly this buildup which happens quite a lot with skin so we're using the Jobson horn here just to manoeuvre some of this dry skin towards the outer part of the ear canal and break it down with dry skin issues like this it tends to be that it's too tough a lot of the time to remove by microsuction certainly the older bits around the edge can be quite difficult to remove so that's the reason we're using the Jobson horn on here at the moment you can see we're just working this block of skin down the ear canal we did do a video on keratosis operon so I'll pop a link up to the top right corner for you so you can take a look at that and that just explains that the reasoning behind it but what we have here is layer upon layer of skin that's four overlapped and formed one over the top of the other so you get these kind of striations of skin in here though sometimes it'll form in a solid block which means that you can take it out in one big chunk we've got a video showing that earlier on this year but this was actually formed in layers and you can see as we're lifting this up now we get a grip on this outer section discovery to that piece first you can see how dry some of these pieces are just working our way around the edge what you'll see in a second I'm going to show you the striations oh I can show you the overlapping skin there watch now as we microsuction tip peel apart so you got layer upon layer of skin like this overlapping one that this drying up so it's really toughening and because it's layer upon layer it's almost like an overlap so you really binds together quite well so I'm just using the crocodile forceps now just on this section just remove those two layers of skin there which will help us to get behind it except the one that they're flicking up in front of the microsuction let's try and work on this next section now you can see it's slowly working the way down and we've had a few people ask us recently or comment on some really old videos from the first few we did we didn't add voiceovers onto them whether we would go back and voice them over I've looked into it I can't find any way of adding a voice over to an existing video so if you'd like us to do that what I'll have to do is take those videos down and then re-upload them but with a voice over on that probably would mean you wouldn't get any new videos for about a week because there's quite a few out there – voiceover so I'm gonna put a poll up if you guys want us to do that then click in the poll in the top right hand corner of the screen and that way then it lets me know whether you want me to do that for you or not if you do click yes and if you don't know okay so we just take in some more of these pieces awaiting see you slowly working our way down this ear canal lots and lots of very dry skin pieces coming away you can see just how much it accumulate and don't forget this is this is only 12 weeks so it's not a great deal of time for all this to be building up but as you can imagine skin is produced all the time in the ear canal I think what we've hit here is a little bit of earwax that's caught in the middle of all that skin as well so we're just going to need to get through this layer to train remove the remainder so you can see it peeling away so the skins actually held in by lots of pieces of drive actually rather there's what that dry skin I'm sorry there you go so you can see that piece coming away there it's left a bit of a gap at the top now which allows us to move some of this earwax over to the other side you can see just how tough this is it's breaking away with breaking away in tiny little pieces the reason I'm using the microsuction at the moment it's because we were about halfway down the ear canal okay so to use the Jobson he need to use two jobs not to break this apart a little bit something like a st.

barts hook with this type of problem were just literally sticking it and plow through the middle of it you wouldn't gain anything by using the hot because of a few people a skier white where we don't use that too often it's this such a specific type of earwax or specific scenario where I would use the hook where it's most helpful the majority of the time you're using things that jobs and horn instruction tends to be a little bit more helpful for the majority of cases that we see so you can see we're pulling through the front end of this dry skin there we go you can see it's starting to peel down the ear canal a little bit breaking the way at the edges there we go start to come forward just pulling this down the ear canal away from the rear of the way from the rear of the ear canal there we all see the ear drum is you can see these layer upon layer of skin there so we'll just train microsuction this piece see if we can get a grip on it so we've got a good grip you can see just how tough that's held in there so I'm going up to use the crocodile forceps now because it looks like it's holding together let's take the front section away just gonna trying to get a better grip on the rear of this section now it's moved it outs like this you can get a grip behind that dryer P there we go now you can see you can see it's much easier to use the forceps to grip this and pull it out then to try and get behind it to drag it you can start to see the ear drum there now so lots more these dry pieces you can see that the pinkness to the skin in the ear canal there as well it's your dried out that skin is just taking layer upon layer away a minute here we go you can see that you can see the flaps the skin there whip that's getting sucked into the machine now so you can see the layers like as they're forming so this is where they're forming from they're much deeper in the ear canal lots of white skin layers there we go just trying to get a grip on this piece of earwax at the base but that bit of dry skin there all that skin layer is holding it in place I can't quite get the grip I need you can see it flicking around behind that white piece of skin just trying to get a good grip on it but it's quite an angular piece so not really able to get a really good grip of the microsuction it's gonna try and move some of this skin out of its way if possible but it's actually attached at the rear as well so crocodile forceps gonna be the best option we've got very gently yes we are sitting just in front of the ear drum so you can see just gauging the size just gonna grip on the edge there he comes so I hope that one pops what we'll see then is Xavier drum there you can see a layer of skin here to the left-hand side more skin behind it which is looks like it's still attached to the ear canal wall a little bit you can see that was just so attached to the drum there we've got a piece at the top left here just pulling that down I know you can see it working it down from the cat the attic region to the top of the ear canal wall you see the layers there look it's coming away in long strips now what I'm gonna do in a second we've never really done it before we're gonna zoom in on a particular portion away then you last about a second or two but as we pull this watch the zoomed in section you'll see it pull off the drum they do see out pulling down towards the camera so that actually came away from the drum so that's where all this starts so you can see it all beings are migrating from the drum down the ear canal wrapping over itself drying out the skin would normally start as this is here which is this very soft no wetter as such but this softer material softer skin and as it comes away from the ear canal and it dries out just with body heat and because it's detach from the ear canal wall into there harder tougher layers of skin you saw there we go a little bit more was the same clip again then sorry let's take a little look there we are so you can see the eardrum there obviously we're not expecting our eardrum to look perfect it had so much of that skin debris attached to it and around it but that will hopefully now know we take another way it's sauce fingers crossed that will regenerate normally we'll just have to see I'll see whether it's the patient normally comes through with kind of more ear wax issues than skin issues but you can see it obviously has built up quite nicely so it's the same patient second year now so we're just using the forceps just to clear some of this harder skin debris away first of all so cameras just misting up a little bit there it's just very warm in this gentleman's ear canal so it's just causing a little bit of a mystic in the room was a bit cold so the camera was just missing up a little bit so you can see we're just working this larger piece here it's quite stuck to the ear canal wall on the left-hand side so I just want to try and detach so you can see this the adhesion there with the skin layer underneath just trying to detach this from the dry skin underneath because that's what's holding this in place at the moment so just slowly working this down the ear canal just trying to get a grip on it you can see that that skin is really holding this in place so because we've got a large enough gap now it's far enough away from the eardrum this is where a st.

Bart took will come into effect so we can just pull it down here get rid of that and then we'll do the same then just on that bottom section you can see where me about pulling straight through sometimes when you use the hook on these kind of pieces of ear wax because it's such a thin end to it which it has to be to get behind this ear wax it just doesn't give enough traction you can see it just ripping straight through the middle of this all dry skin really so just slowly work in this down the ear canal out of the ear canal there we go just pulling it very slowly down maybe I can see it there and then let's just see just Rock just using the edge of that the same box okay just oh just a roll it basically down the ear canal let's go in with the Jobson horn which will give us a bit more traction to this ear wax because of the shape of the horn you've got this spoon end it just means you'll get a better grip on the ear wax and skin so as it's coming down there you go you can see the difference as you're pulling this with the Jobson you can see because it's got a slightly wider end to it you get a lot more coming out than you would with that with the same Bartok there you go and let's take a look you need a little bit of dry skin there to the left-hand side so I'll take that away now there you go so that's coming away nicely so if you know some people in the background I mean click today recording this so these next patients outside so just slowly working this down the ear canal just coming away there really nicely that's lovely that's coming away and so there we go let's get that section away as well perfect a little bit more there at the base of the ear canal so we just need a bit of microsuction just to clear this away a minute just lifting off the ear canal walls there we go it was a nice dry piece coming away there so from the base of the ear canal so that's coming away nicely all stuck in the ear canal wall maybe out and there we go we can see the eardrum now all nice and clear on this side so this is what we removed altogether so you can see it's quite the first sort of left-hand side of the ruler there was what we removed from the first year and you can see it comes all the way along so we're about five inches altogether you very much for 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 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.