AFTER DROPS 9:28 (external ear looks less red, cracks in skin have healed)
Hi everyone it’s connor here from durham hearing specialists i hope you’re doing well and welcome to another video we’ve got a very interesting case here we’ve got two problems with this ear the first being this is a mild case of a titus externa so we’re examining the outer ear at the moment just here and you can see it’s quite red crusty there are some cracks in
The skin some fissures in the skin which the patient did report had been bleeding and was quite uncomfortable and unfortunately one of these fissures did actually start bleeding during the procedure but uh nothing too intense there’s not going to be tons of blood just a tiny little bit and um it was unavoidable unfortunately because i’m having to as i’m doing
The procedure i’m having to touch you know the year which is obviously very sore so um that’s the first problem the utilities externa the second is as you can see the the ear canal is full of wax and dead skin and which is unfortunately probably the the worst consistency to deal with because it’s not quite soft enough such that we can just kind of latch onto it
And draw it out but it’s not hard enough such that we can hook it out all in one big chunk so it’s it’s the type of wax that will have to really work on be patient with and throughout this procedure you’ll see me apply copious amounts of olive oil to try and make progress here but i really did need to make a lot of progress here because immediately after this
Consultation um the patient had pre-arranged an appointment with their doctor and the the doctor basically prescribed otomize which is a common treatment in the uk for for um the type of externa you can see that bleeding just there so the external ear looks very sore at the moment um and that’s that’s the point where it’s bleeding is the point where i really
Do need to just lift up the cartilage to actually gain access to the ear but um the patient didn’t didn’t find that particularly uncomfortable so i really needed to get rid of as much debris as possible to give the medicine a chance to actually get down in there and be as effective as possible and i mentioned that in the previous video actually if you if you’re
Interested in sort of ear infections or titus externa and and the relationship relationship between that and dead skin build up then um i’ll link the acute diffuse disqualmation video in the description box um so you can check that out so there’s that fissure there looking very sore um so again we’re going to just gently strip this away and and make progress very
Slowly but it just takes a bit of patience so this is the first half of the video the second half you’re going to see the same patient exactly the same ear but 10 days later after they’ve had the otomize and just here you can see this white debris on the right hand side i don’t think that’s anything nasty i don’t think that’s any fungal growth fungal growth i just
Think that’s desiccated skin so so just to explain a little bit about what otomy’s is it’s not something that i would prescribe as an audiologist it has to be prescribed by someone’s general practitioners a family doctor or an ent doctor someone of basically a physician of some kind and it has what well it has the holy trinity basically of ingredients it would
Seem to treat uh an ailment of this kind so um it contains a steroid which is dexamethasone and a steroid will basically reduce any inflammation um it will reduce any swelling edema edema is just a you know fluid collecting in tissue essentially which leads to swelling so um you’ve probably heard of pulmonary edema before where you get fluid in your lungs um or
You probably see edema quite often actually so it’s not uncommon in elderly patients with heart problems they have a swelling in their feet and their ankles and their legs and that’s simply because the heart is not pumping blood around their system quite as effectively so fluid pools in their in their legs so the dexamethasone will will deal with the inflammation
Um and then the theotomize has two ingredients to deal with foreign invaders so bacteria essentially that’s causing the infection um so the first is acetic acid otherwise known as vinegar and vinegar has been used for hundreds and hundreds of years to to deal with um disease and infection or as far back as ancient greece um and it’s been used classically for for
Cleansing wounds and things like that so even back then they knew that it was as a good good in the form of medicine and we’re still using it today in otomize so the acetic acid is very good at dealing with bacteria and funguses and in a way it’s it’s definitely a good thing to have because it can deal with biofilms so biofilms are essentially little colonies
Of bacteria that form and proliferate so um plaque on your teeth and obviously biofilms can form on dead skin inside the ear canal so that little white arrow that just appeared there that’s just showing you a little window that we’ve created through to the eardrum so we are making progress just very slowly so so acetic acid is is extremely useful and then the
Other ingredient is an antibiotic drug called neomycin and neomycin has a very interesting mechanism of action so it what it does is it actually goes inside the bacteria and stops that bacteria from producing proteins which it needs to you know do jobs and and you know function as a as an organism so and you can think of proteins like uh they’re sort of like
The the lego of the cell world i suppose so they’re made up proteins are made up of chunks of of amino acids so amino acids are just lots of of um that are joined together and then the body you you know builds these proteins using amino acids like you would build lego you would build like a car out of lego and the body will will basically build these amino acids
Together in different shapes and forms to make proteins and these proteins can be come in lots of different shapes and sizes and coils and spirals and folds and things like that and the cell can then use these proteins to do different jobs so um you know it can aid in giving the cell structure it can uh act as little transporters to transport uh molecules from
One part of the cell to the other so they’re very very important they’re like tools essentially for the body and for the cells and the neomycin goes into the bacteria and stops the bacteria from making those proteins properly and if the bacteria can’t do that then it’s not going to last very long and if the bacteria can’t do that then it’s not going to last very
Long essentially so that’s how it works um and the in this particular case the optimize was very effective um so you can see i’ve just applied a lot of olive oil here and what we’re dealing with at the moment is essentially just this huge chunk of wax caught in this recess just before the um just before the eardrum so it’s basically a very deep trench in this
Particular case it was very very deep trench and what you’re seeing here is sort of a an iceberg situation so this sort of very dark wax right in the back there obscuring most of the eardrum you can see that just the top bit of it but it was very difficult to get this last piece um primarily because it just wasn’t ready to come out and i i probably could have
Cajoled it a little bit more um but again it was very difficult to get access here partially due to the the swelling um but also just it’s in a very awkward position and um the last thing i wanted to do was just you know jab at it and be very rough because we are close to the eardrum we have to be mindful of that so at the moment i’m just sort of manipulating it
And touching it seeing if i can if i can loosen it up um but it’s just not happening so i’m using a fine end gauge at the moment which has a slight bend in it um which i do sometimes just to give me better access even though the access was very difficult in this year and thankfully the otomy’s not only worked to you know reduce inflammation and you know resolve
The infection but it also loosened this huge chunk of wax right up so i could actually leverage it out of this recess so it was uh you know good timing so i’m just seeing a little bit of movement here but it’s really not enough to um to give me any kind of opportunity here and you can see the eardrum just poking through there it’s the slightly gray skin right in
The center of the frame there that white debris on the left hand side is just desiccated skin just dead skin so nothing nothing negative there um again just trying from a different angle here but again it’s i’m really not going to get purchased on this you can see that there is oil there there is oil down there you can see it glistening um but uh and the machine
Is cranked up at this point uh around minus 500 millimeters of mercury so it’s you know fairly powerful my suction machine which i’ll show you in a future video but nothing is really working to uh to loosen this up so again i’ve just applied some more olive oil which is uh smearing up the endoscope quite beautifully i’m going to go in so here is 10 days later
So i didn’t realize it was coming this early so you can see the outer ear is looking much much better it’s not quite as red there’s some dry skin around but all those cracks in the skin have gone thanks to the otomize so we’ve now got some ordinary brown wax at the periphery and we’re just going to remove this just to give us better access and when you when
We actually go in and see that sort of gigantic log next to the eardrum what you’ll see is it looks a little bit more prominent a little bit more buoyant so i rather suspect that it absorbs some of those drops and it’s now in a position to come out obviously so there it is and we’re just going to remove a little bit more just to give us an opportunity to get a
Clear path in there there we go and again once as always i’ll uh i’ll lay all this out on the tissue so you can see the centimeter amount that we’ve removed and i’ll give you a shot of the tank as well i think it’s always very useful to see exactly what has been removed maybe i should start weighing it like neil that would be quite good quite useful so now we
Can see this very very dark oxidized wax i’m going in with a fine end just to see if i can loosen it up and already we can see we’ve got some movement here now as i mentioned before it’s a bit like we’re sort of getting an iceberg effect and what you can see really is only the top third of what we’re going to remove here so it really was quite a gigantic piece
I was not expecting such a huge amount but when everything’s cleared up you’ll see just how deep this recess actually goes so it’s loosening it up here and now we’re finally getting some movement and you’ll be able to see on the underbelly of this huge piece of wax you’ll see there’s white splodges again that’s desiccated skin dead skin and now we can finally
See just the gigantic plug in its own right really and you wouldn’t think that such a large amount of wax wax can be hidden in that recess so it’s understandable why the patient couldn’t hear very well so after the first consultation they felt that there was a little bit of improvement but not much and you can see why seeing as this was shoved up right against
The eardrum so at this point it’s it’s actually so large that i’m actually struggling to get it out of the ear canal so we’re going to have to switch back to a a regular suction probe here so again this is the fine end but it’s just not cutting it so i’ll go back in with a regular probe and i should be able to drag it out quite successfully here and this is
Just sort of peripheral wax ordinary brown wax this isn’t the plug and this plug will actually unfortunately break in two so it’s not going to be one huge glorious boulder like um like you’re probably expecting but uh still a fair amount here so i’m just wriggling it out to see if i can just get purchase on it so that’s the first bit that’s broken off and then
This here is the main bit it’s quite interesting to see the underside of it where all the dead skin is so there we have it and now let’s take a good look inside at the eardrum and we’ll be able to see it the eardrum is actually obscured by this sort of hill um which so you can understand why it was able to hide such a huge amount of wax so it’s that gray skin in
The background there we’ll just mop up and then get a better look and this sort of soft brown wax around the exterior that’s pretty good that’s pretty healthy given the fact that the patient has recently had the titus extern i don’t want to get rid of all of this i just want to clean up all those little bits of dead skin because that’s not good but ordinary soft
Brown wax is fine that will protect the patient from future infection and one final look at the eardrum and we can see here the aftermath of what we removed so we’re looking at about probably a centimeter centimeter and a half just from just pulling that out of the recess which is quite a large amount considering it’s such a you know such a small space and yet
It can conceal so much wax and the fine end there is just the one with the purple sleeve and here is the tank again not no huge chunks but again lots of just small flakes here that we’ve removed so there we go i hope you found this video interesting it’s always good to see a before and after and i just touched on the the information about the medicine and acetic
Acid i think that’s very interesting as well so if you have any questions please leave it down in the comment section below and i will try and get back to you thank you very much for watching like subscribe and i will see you on the next one
Transcribed from video
Infection and Ear Wax BEFORE AND AFTER Antibiotic Drops (9:28 Otomize) By Durham Hearing Specialists
