Delivering an Ear and Hearing Care Consultation: Jess's Case Study.

0:01: Firstly, set your pressure to maximum on your suction unit to replace your canister with the serres canister.
0:11: First press the big blue button at the top of your unit and then unscrew the filter.
0:18: Ensure you have a filter that is compatible with your serres unit.
0:27: Always ensure your liner bag is secure within the unit.
0:38: Screw on the compatible filter and then attach the unit to the suction machine, secure the tubing to the top of your filter, and then attach your suction hose to the white adapter on top of the liner.
1:09: Ensure everything is secure.
1:19: In order to clean your suction hose, remove it from the adapter and flush water through one end of the tube by holding it under a running tap to replace your liner; remove the liner out of the holder; remove the adapter and replace it with the lid by unclipping the lid from the side and popping it on top.

0:03: We are about to delve into the process of performing otoscopy on children of various ages. 0:10: In this interactive video, we will guide you through the essential steps including preparation and what questions you need to ask prior to your procedure.
0:20: Positioning and the actual procedure for oscopy on different age groups.
0:25: We share valuable hints and tips to enhance your proficiency in this regard.
0:30: It's crucial, especially when dealing with the pediatric population, to remain adaptable but ensure you are safe at all times, as this flexibility often leads to better outcomes.
0:44: As you engage with this interactive video, take your time to explore a range of hints and tips. 0:50: Additionally, please remember to refer to the provided one page handouts for each age group. 0:57: These materials serve as a valuable resource for ensuring that your preparation, positioning, and procedure align correctly when delivering ear care. 1:07: This diligence is essential to guarantee your competence, safety and effectiveness in providing optimal ear care within your respective communities.
1:23: This interactive video will focus on two main developmental age groups, ages 6 to 7 and 7+. 1:31: Within each age group, you will see that you may need to tweak your approach with the child to get the best outcome.
1:42: When delving into the preparation, positioning, and procedure specifics for each age group, it is crucial to understand the mandatory questions to ask before examining a child's ear. 1:54: Depending on the child's age, you may direct these inquiries to their parents or significant others.
2:00: However, consistently asking these questions is integral and is an essential component of the informed consent process.
2:12: As we all know, the case history is important to identify what you are potentially going to see in and around the ear.
2:20: Hence, asking ear-related questions is essential.
2:23: The main questions which you need to ask, either directed to the child depending on their age or their guardian, are the following.
2:32: Is the child experiencing any ear-related symptoms including discomfort, pain, or discharge?
2:39: For younger children, a sign of this may be the child tugging at their ear.
2:45: If yes, you need to follow up by asking whether this is currently being treated or was it treated in the past and by who?
2:53: Also, if you have obtained a yes response to this question, you need to ensure you change the specular per year to avoid any cross-contamination and follow national or local infection control and waste disposal policies.
3:10: Another question to ask is if the child has ever had a hole in their ear drums known as a perforation.
3:17: If the parents say yes, ask them if they've been reviewed by ENT in the past, or are they currently under ENT?
3:25: And if so, are they waiting for a surgery or waiting for a follow-up appointment?
3:31: Even though the child may have a perforation in the ear, it does not stop you from performing atoscopy.
3:40: The last question to ask is, have they ever had any ear surgery?
3:44: If the parents respond yes to this question, it's worth asking if they know the name of the surgery the child has had.
3:53: Typically for children, this tends to be grommets or T tube insertions.
3:58: Ask when this happened and if they are still under ENT.
4:03: Again, if they respond yes to this question, it does not stop you from having a look in their ears to evaluate the situation.
4:11: However, if any action is required and they are still under the care of ENT, it is best to advise the parents to contact the ENT team for a further follow-up.
4:27: Moving on, in the next few slides, we will discuss the preparation, seating, and the otoscopy procedure when examining a child between ages 6 to 7.
4:43: For entertainment, engaged a child with simple games like building blocks, puzzles, or children's shows on a phone.
4:51: 6 to 7 year olds tend to be more receptive to sitting independently in a chair.
4:57: Most importantly, even for this age group throughout the appointment, shower the child with lots of praise and animated expressions, as these gestures can go a long way in building a positive experience with this age group.
5:19: As we said, between these ages, they are more receptive to sitting independently in a chair, but if the child is feeling nervous, they may prefer to sit on their parents' lap.
5:30: They may even prefer to stand.
5:32: Always be flexible whilst being safe.
5:35: This is key when performing atoscopy on children in these age ranges.
5:40: It's crucial not to use any form of restraint, even if it's light with this age group.
5:46: If there is a sense that restraint might be necessary due to distress, do not proceed and recommend that the child be seen by their GP. 5:59: Now it is time to perform the procedure. 6:02: When you are ready, use a 2.5 millimeter specular rather than a 4 millimeter specular, as children's ears are narrower than adults.
6:11: Introduce the otoscope in a positive manner using language like Wow, look at this amazing torch.
6:18: Get them to hold the otoscope and encourage them to shine the torch on the back of their hand.
6:24: Ask the child, are you ready?
6:26: and lighten the mood by saying something like, how many potatoes will we find in your ear today?
6:33: Start with the non-problematic ear first.
6:36: Examine behind the ear, and then gently pull the pinna down and back.
6:42: Use a toy as a distraction and continue to brace over the cheek or head to safeguard from sudden movements.
6:50: Slowly enter the ear canal and keep the examination brief, as this is intended to be a rapid assessment focusing on identifying any signs of inflammation or discharge.
7:03: Then applaud and praise the child once you have finished examining the ear canal and ear drum.
7:13: Reflecting on the steps in the previous slide, please look at the video showing the steps in action to performing otoscopy on a 67-year-old. 7:25: I got it.
7:28: Whoa, look at this amazing camera that I was found down there.
7:33: And look at its amazing light.
7:35: How cool is that?
7:36: Do you wanna have a little look?
7:38: Yeah?
7:40: So this bit here is gonna have a little look inside your ear, OK?
7:44: And I've got another piece that's exactly the same.
7:48: So before we'll have a look in your ear, do you want to feel what that's like just to lend your finger there?
7:53: Yeah, so nice and comfortable.
7:55: So that won't hurt at all.
7:57: If it did, just let me know, OK?
8:00: So I'm gonna turn you forward, then I'm gonna have a little look in your rear.
8:05: While I'm doing that, because you're being such a good lad, why don't you play with this for me, yeah?
8:11: Yeah. So are you ready to get started?
8:13: Great, behind you here first.
8:17: And in your ear.
8:23: All done. Well done.
8:25: Excellent.
8:29: Our final section will discuss the preparation, seating, and otoscopy procedure when examining a child 7 years and above.
8:41: Most children aged 7 and above are compliant when they are provided instructions. 8:46: Therefore, it is preferable for them to sit in a stable chair.
8:50: If the child expresses reluctance, take a moment to gently ask the child why they are reluctant and answer any questions they may have and address their concerns.
9:02: This will help build trust.
9:04: An additional tip with the parent's consent suggests that the child may want to look at a puzzle, phone, or a tablet to create a positive distraction.
9:20: Children aged 7 and over are more receptive to sitting independently in a chair, but if the child is feeling nervous, they may prefer to sit on their parents' lap.
9:30: They may even prefer to stand.
9:32: So in the same way that you would adapt your technique when handling the aged 6 to 7 group, the same applies here.
9:40: Be flexible whilst being safe when performing atoscopy on children in this age range.
9:46: It's crucial not to use any form of restraint, even if it's light with this age group.
9:51: If there is a sense that restraint may be necessary due to distress, do not proceed and recommend that the child is seen by their GP. 10:03: Now it is time for the procedure.
10:05: When you are ready, again, use a 2.5 millimeter specular rather than a 4 millimeter specular, as children's ears are narrower than adults.
10:15: Again, begin by showing the child the otoscope and address them directly, saying something like, This is my torch, and it will allow me to take a quick look inside your ears.
10:26: I want you to know it doesn't hurt at all, but if it does, let me know straight away.
10:32: Get them to hold the otoscope and encourage them to shine the torch on the back of the hand.
10:37: Always perform otoscopy with the non-problematic ear first.
10:42: Examine behind the ear and then gently pull the pillar down and back.
10:47: You can also use a toy as a distraction and continue to brace over the cheek or head to safeguard from sudden movements.
10:55: Slowly enter the ear canal and examine the health of the ear canal and ear drum.
11:03: Reflecting on the steps in the previous slide, please watch this video showing the steps in action to performing atoscopy on children aged 7 and over.
11:15: I What I've got down here is my camera. 11:21: As you can see, it's got a light on the back there.
11:23: Do you want to have a little look?
11:25: What that's going to allow me to do is have a little look inside you here, OK?
11:29: I want you to know that shouldn't hurt at all. 11:32: If it did, just let me know and we can stop there, OK?
11:36: So I'm going to have a little look in your ear in just a second.
11:39: While I'm doing that, do you think you can try to finish this puzzle?
11:44: And do you think you can do it quicker than I can have a look inside your ear.
11:48: Yeah, so I'll sort you.
11:49: There you are.
11:50: I'm just going to turn you to face forward and I'm gonna have a little look in your ear.
11:54: Are you ready?
12:00: And you can start your puzzle.
12:07: Brilliant.
12:08: It would.
12:10: You did.
12:16: Thank you.
12:17: We hope this has been insightful and has offered valuable guidance and tips on performing otoscopy across various age groups of children. 12:26: To bolster your confidence, it is essential to familiarize yourself with the minimum guidelines for ear examinations.
12:33:This is outlined by the British Society of Audiology.
12:37: It ensures that your ear examinations are conducted safely and to the required standards.