1,707 - Ear Wax & Dead Skin Removed from Monomeric Eardrum

[00:00:00]Hi everyone, this is Neil Writer here, consultant aiologist and director of Cleoax. Thank you for joining me in my latest video using the eyeoscope endoscope and this is the second year of um a recent video that I uploaded. I think it was my last video actually of a patient whose right ear I previously showed and in that particular procedure they had some wax but they also had a thick blanket of skin lining the medial ear canal. the inner section, the bony portion and also on the eardrum. And it's very similar um in this their left ear. I think this left ear is a bit narrower as well. And there may also be some otomicosis involvement. Um there's a few fungal spores um on the layer of skin. Now with this here, um so just put some oil just to help kind of soften, get a grip. So because there's a few hairs there, some of the oil kind of coats the hair. We did kind of mop it up a little bit. But so I've just come out going to wipe the lens of the endoscope kind of re-enter trying to get a different angle. Now in this ear they the patient previously suffered from a perforation posteriorly and they have what we call a monomeic eardrum. So the eardrum is three ply thick. You've got the outer epidermal layer of skin that lines the um the which forms the outer layer most superficial layer of the eardrum that is visible to us. You've then got a mucosal skin layer um which forms the inner most membrane of the eardrum and then in between those sandwich in between you've got a fibrous connective tissue layer. And when you suffer from a perforation, uh obviously all three layers are perforated. And if your perforation heals, it's normally the outer layer, the epidermal layer, and the innermost layer made of mucosal skin cells that heal. Meaning the middle fibrous connective tissue layer doesn't heal.

[00:02:03]And we call that a monomeic eardrum. is paradoxibly termed um instead of instead of being three ply thick, it's two ply thick because it's one layer miss and they call it monomeic.

[00:02:16]And that region of the drum for that reason is very delicate. So when we peel all the skin away, you'll see there's a little flap of skin just in the region where they had this perforation previously many years ago where it has healed. So we left that. So I did I went on there with the suction and if it just came away brilliant. But it was it was attached to that thinning of the eardrum. So it's not worth risking trying to remove that because if that's and we obviously put we did put some drops in there to kind of loosen it. But if that section of skin if we extract it and it's still strongly adeared to the monomeic section of the eardrum you could potentially perforate the eardrum.

[00:02:57]So sometimes you doing less is more. um you risk causing more trauma issues if you try and get a little less speck out.

[00:03:07]If it comes away, brilliant. If not, we just leave it. Um so, you will see that.

[00:03:11]So, that's a spoiler alert. So, we're kind of halfway here. In this section, the wax is a bit clay, so it there's lots of kind of merate skin if you like, and it gives it this clay consistency.

[00:03:24]It can be very hard to vacuum, but some bits are really dry as well. So, superiorly here where I am now, it's dark. Wax is darker. It's a bit drier now. I think I've created an opening so patient could hear a bit better. And we're just going to remove this occlusion.

[00:03:42]So just going kind of more posterly to the back section of the ear canal.

[00:03:47]Probably halfway. Now here it's really really dry. So I wasn't getting a grip with the back with the suction tip. So just going the opposite direction anterly. Quite a bendy ear canal as well. this side.

[00:04:03]And sometimes wax can be a bit dry that's more medially located u because you have less you the outer third of the ear canal you have natural oils and sweats being secreted. So you have um um sebaceous um glands secretreting an oily lipid um substance similar to what's secreted on our scalp. And then you have a a protein and lipid rich sweat. Different to the sweat we have in our brow when it's hot. This is more of an emotional sweat. Similar to the sweat that we also secrete under our armpits and kind of inner groin region.

[00:04:47]It's the same glands there. They're what we call apocryine glands. And in the ear they're modified and so we call them ceramunus glands.

[00:04:57]And um yeah, so the normal sweat that we u produce is from errine um glands and they produce a kind of a a salty uh watery um sweat and that's more involved in heat regulation. So you get um droplets of uh water and salt for example in your brow if it's a hot day and it helps to release heat. So heat helps to evaporate um that kind of uh droplet. Um so it just it's a mechanism for the body to release heat. So it's used to kind of evaporate um that sweat droplet.

[00:05:44]Um whereas the sweat produced by the apocrine glands and the modified apocrine glands in the ear. They also um they have uh I think I forgot the number so I don't quite I think it's 13 peptides so chains of amino acids which are antimicrobial.

[00:06:05]So they're known to help fight various bacter pathogenic bacteria and fungi.

[00:06:11]And it's more of an emotional sweat. So it could be emotions both ways. It could be sad or happy emotions.

[00:06:19]Um stress obviously uh was one of those as well. Um and you get that particular gland you get uh due to a genetic mutation um if you've got an active ABCC11 gene um they're more lipid soluble molecules um available in those cereamunous glands essentially and they make the wax a bit um bit wetter so it's less vis viscous and also more odorous because these lipid um soluble compounds they're either odorous in their nature or if they when they're secreted to the surface of the the ear canal um you have bacteria feeding on these lipid soluble molecules and they release an odorous pungent smell.

[00:07:14]So just trying to wrigle this piece out here. You can see the that layer of skin. We peeled it away beneath that.

[00:07:21]It's nice healthy ear canal. But it is cuz as I mentioned the skin is like double-sided sticky tape. So you've got this thick blanket of skin on the eardrum and medial ear canal and this wax. So it's stuck to the canal and eardrum and you got this wax also surrounded by the skin. So we just had to loosen that. So now I've removed this. You'll see this layer of skin in a moment. You can probably see it. the eardrum just doesn't look translucent.

[00:07:46]You've got a layer of skin and you'll see it a bit more when I remove this wax anterly.

[00:07:52]Just break away. So, I'm going to mop that up and then we're going to start the peeling process. We're going to start peeling the skin away. So, although the patient could hear better, it's not 100%. And if you look carefully at the eardrum in the distance, um 3:00 on screen, you'll see there's a little circle there and you'll have a better view there. Um, so that's where their previous uh perforation was, where it's healed. So just to the right of the suction tip in the distance where the eardrum is, you can see there's like a little circular patch there.

[00:08:22]So I'm just going to get a smaller suction tip, I think, so I can get a better suction grip. It's probably a 16 gauge here. We're just going to gently lift it off the canal wall. We got to be careful here because we're on the bony part. The bony part is very sensitive.

[00:08:36]Obviously the outer third of the ear canals consist of cartilage and a thick layer of skin which has three layers including a fatty tissue layer. The bony part of the ear canal it just has the outer epidermal layer of skin. So it's very thin 0.1 mm in thickness.

[00:08:55]So it's literally a wafer thin layer on bone. So compare it to your shin shin bone. If you knock your shin bone you can imagine how painful that is. It's very acute sharp pain. Similarly with the bony part of the ear. So I'm just trying to lift it. The oils help that we put in previously. So I'm just slowly going around the edges. It's going to go to the top.

[00:09:18]Just trying to peel it down from the roof of the ear canal and eardrum. You can see to the left of the suction tip.

[00:09:24]The skin is peeling down. Now I've got a feeling I'm going to just peel it a little bit more and then put some drops in so the drops can get kind of get in and behind the skin. I'm pretty sure I'm going to do that in a moment. Let's see.

[00:09:40]Just go the bottom of the ear canal first.

[00:09:44]It's very adearing. It's very adhesive.

[00:09:51]And this skin to the left of the suction tip, it's kind of tucked away in the anterior recess.

[00:10:00]I'm just going to try and peel this down. So, it's quite a thick layer of skin. Now the eardrum itself is about 0.1 0.2 mm in thickness and you've got this skin on top. So it's going to significantly increase the thickness of the eardrum which is making it less mobile because it's a narrow. So the anithmus is a term given u for narrowing. It's not only used in the medical field. It's also used in agriculture I believe as well and other kind of walks of life.

[00:10:30]and it essentially means a narrowing.

[00:10:32]Um, and in the ear canal we have two narrowings. We have one just in front of the eardrum about half a centimeter away just where we are here. You can see the bone on the left hand side. It kind of comes more in the midline and then it widens again towards the eardrum. Then we have a narrowing at the entrance of the ear canal between the first and second bend just where we entered through with the endoscope. Now, so I've just put some oil in. So, some of this oil is going to loosen the surface of the skin, but hopefully some of it's going to kind of seep in between in behind the skin.

[00:11:05]So, in behind the skin onto the eardrum just to kind of weaken this adusions.

[00:11:12]And then I'm going to peel downwards.

[00:11:22]Just trying to get a good grip. Just lost the grip there.

[00:11:33]There we going to try to go to the back surface if I can. But you see it's not a complete seal there. Now I've got more of a tighter seal. The suction tip I just lost it there. But it's making contact with more of the skin.

[00:11:47]There's more suction created.

[00:11:50]But when you approach dead skin like this with the suction, the skin starts flapping a little bit and that's what cause it to clarinet. So it's difficult to get a full seal sometimes. But as you can see, this is peeling away now. Oils work the treat. It's going to come off all the back part of the ear canal. And then when we reenter, you're going to see that flap of skin that I mentioned earlier just in that section there. Now we're going to approach it. If it comes away, brilliant. If not, we're just going to leave it. We don't want to cause any tr. If I start pulling at this and we perforate the eardrum, it's not good. So, it's not coming away without a fight. So, we're just going to leave it.

[00:12:23]I just frozen that for you. Well, I hope you enjoyed that video, guys. Take care.