Temporary Threshold Shift (TTS) Observed during Endoscopic Ear Suction - #369

This blocked ear wax removal extraction procedure is performed by UK pioneer and world-leading endoscopic ear wax removal specialist Mr Neel Raithatha (Consultant Audiologist) aka 'The Wax Whisperer’ at his clinic in Oadby, Leicester, UK.
Ear wax removal is necessary when ear wax build up becomes impacted. Symptoms causes by earwax blockage include: earache (otalgia), conductive hearing loss, blocked ear, vertigo, tinnitus, itchiness and irritation, occlusion etc.
The client is a regular who needs to attend almost every 4/5 months to have his ear wax removed. The right ear, in particular, can be problematic due to the consistency of his ear wax, which is quite loose and ‘gloopy’ making it difficult to suction. I began with his left ear, whereby I was able to suction the ear wax plug in a single attempt by carefully obtaining a suction grip and slowly teasing the ear wax out of the ear canal.
With the right ear, knowing his type of ear wax is difficult to remove, my main objective was to create a sound opening through the middle of the ear wax to his eardrum. This would alleviate him of his symptoms, which is the main purpose of ear wax removal. As I approached the eardrum, the ear wax simply wasn’t suctioning but instead blocking my suction probe. I therefore instilled some olive oil drops as I find this can sometimes ‘bind’ the ear wax together. If so, I can then obtain a suction grip and hopefully remove the ear wax in one go. Other types of drops can make the ear wax more molten and more difficult to remove off the eardrum.
I had to be extremely cautious as the client suffers from Otitis Externa, causing his ear canal walls to be slightly tender. This is why I resistant using a Jobson Horne to try and scoop the ear wax off the canal wall. Nonetheless, this ear wax was non-problematic and was not causing an obstruction towards the eardrum. I felt the client twitch slightly when I approached the bony portion of his ear canal (latter 1/3). This was because the ear wax was ‘hiding’ in the anterior recess, which is a widening of the ear canal wall adjacent to the front (anterior) aspect of the eardrum, hence the name. It is sometimes not possible to visualise the anterior recess with a microscope, but due to the field of view provided by an endoscope, I could see the ear wax hiding in there.
To make it more comfortable, I bent the Fine End so that it can curve around the bony canal wall. This enabled me to remove some more of the ear wax. However, I could see it was becoming slightly uncomfortable for the client, hence my decision not to continue. The remaining ear wax will now naturally migrate out of the ear given the occluding ear wax that was blocking the ear canal itself was extracted.
After the procedure, the client noticed a Temporary Threshold Shift (TTS) in his hearing due to the noise generated by the suction probe. After a minute or so, though, he felt the hearing in both ears to be more balanced. This can be one of the risks of suction, therefore it is important you try not to over-clean the ear when it is not necessary to do so.
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