Why having both hands free is essential for safe ear wax removal with Dr Jan Romout ENT
Ear Wax Removal: Clinical Insights with Dr Jan Rombout, Episode 5.
In Episode 5 of our clinical insights series, ENT Surgeon Dr Jan Rombout explores the importance of having both hands available during ear wax removal and microsuction, and how head-worn visualisation can support a coordinated approach to the procedure.
https://youtu.be/sekvvHEDKkE
Building on the previous episodes, this discussion brings together several important considerations: binocular vision, depth perception, ear canal access, anchoring and instrument control.
Why Are Both Hands Important During Ear Wax Removal?
Ear wax removal requires the clinician to coordinate visualisation, patient positioning and instrument handling within a relatively confined anatomical space.
Depending on the technique being used, one hand may be needed to position the external ear to help improve access to the canal, while the other controls the instrument used for the procedure.
Having both hands available can support this approach by allowing the clinician to manage positioning and instrumentation as separate but coordinated tasks.
For example, during microsuction, a clinician may need to:
- Gently position the external ear to help improve access to the ear canal.
- Maintain an appropriate point of support to help control instrument movement.
- Guide the microsuction instrument while observing the area being treated.
- Adjust hand position in response to the patient’s anatomy and movement.
These actions need to work together. The specific technique will depend on the clinician’s training, the patient’s anatomy and the clinical situation.
How Does Head-Worn Visualisation Help Keep Both Hands Free?
The type of visualisation equipment used can influence how a clinician approaches a procedure.
Traditional examination and visualisation systems differ in how they present the anatomy and how the clinician interacts with the patient and instruments. Some systems require the clinician to look through an instrument or at a separate screen, while head-worn systems position the visualisation optics on the clinician.
A head-worn system can allow the clinician to look directly at the area of interest while keeping both hands available for clinical tasks.
For ear wax removal, this can be particularly relevant when the clinician needs to coordinate ear positioning, anchoring and instrument handling.
Rather than treating visualisation and hand positioning as separate considerations, head-worn visualisation can help bring them together within the clinician’s working technique.
The benefits in practice depend on the individual device, the clinician’s technique and the clinical circumstances.
Why Binocular Vision and Depth Perception Matter
Keeping both hands free is only one part of the picture. The clinician also needs to interpret the anatomy and understand the spatial relationship between the instrument and the ear canal.
Binocular visualisation uses information from both eyes to provide stereoscopic vision and depth perception. This can help the clinician interpret spatial relationships while working within the ear canal.
In a procedure such as microsuction, the ability to coordinate what the clinician sees with how their hands move is an important consideration.
When visualisation is delivered through a head-worn binocular system, the clinician can look directly at the area being treated while retaining access to both hands for positioning and instrumentation.
This brings together two related elements of the procedure: seeing the anatomy and coordinating the hands that perform the work.
How Do Both Hands Work Together During Microsuction?
A coordinated approach may involve one hand helping to position the external ear and the other controlling the microsuction instrument.
Appropriate anchoring can provide a point of support for controlled movement, while visualisation helps the clinician interpret the instrument’s position relative to the ear canal.
The clinician must continually adapt to the patient’s anatomy, comfort and movement. Having both hands available does not remove the need for training or careful technique, but it can allow the clinician to manage the different tasks involved in the procedure.
The principles explored in this series can be considered together:
Position → Visualise → Anchor → Control
Each element contributes to the clinician’s overall approach. The sequence is a useful way to understand the relationship between access, visualisation and instrument handling, rather than a rigid protocol for every patient.
Technology that Supports a Hands-Free Approach
There are currently a number of technologies and devices available to the ear health medical segment, but Dr Rombout emphasises the importance of those allowing clinicians to work hands free without compromising accurate direct visualisation with depth perception. Microscopes and head-worn binocular visualisation systems, like the VorOtek o Scope, are designed for clinical applications including ENT and ear care.
They both offer converged binocular optics providing stereoscopic vision and depth perception, while integrated LED illumination supports visibility of the area being examined.
Because the VorOtek O Scope is worn on the clinician’s head, the clinician can look directly at the area of interest while keeping both hands available for tasks such as positioning the external ear, maintaining an appropriate point of support and controlling instruments.
This combination of head-worn visualisation and available hands is particularly relevant to clinicians performing procedures that require coordinated positioning and instrumentation.
Bringing the First Five Episodes Together
Throughout this clinical education series, ENT Surgeon Dr Jan Rombout has explored the practical considerations that influence ear wax removal technique. Each episode builds on the previous discussion, moving from the fundamentals of visualisation towards the coordination of the clinician’s hands and instruments.
Episode 1: Three Key Success Factors for Ear Wax Removal
The series began with three core considerations: vision, access and control. These provide a useful foundation for understanding the relationship between what the clinician sees, how they access the ear canal and how they manage instruments.
Episode 2: Why Binocular Vision and Depth Perception Matter
The second episode explored how binocular vision provides depth perception and helps clinicians interpret spatial relationships within the ear canal. Visualisation is not simply about seeing the anatomy; it is also about understanding its position in three-dimensional space.
Episode 3: Why Straightening the Ear Canal is Important
Episode 3 focused on ear canal positioning. Dr Jan discussed his approach to gently positioning the external ear to help establish access before introducing a speculum, where appropriate. The aim is to create a suitable pathway for visualisation and instrumentation while respecting the sensitive anatomy of the ear canal.
Episode 4: Why Anchoring to the Patient is Critical
The fourth episode examined anchoring and the role of an appropriate point of support in coordinating hand movements. Anchoring complements visualisation and access by helping the clinician manage instrument movement in a controlled manner.
Episode 5: Why Having Both Hands Free Matters
This episode brings those principles together. Head-worn visualisation can leave both hands available for positioning, anchoring and instrument handling, while binocular optics provide depth perception to support the clinician’s view of the working area.
Taken together, these discussions highlight the connection between vision, depth perception, access, anchoring and coordinated instrument control.
In the meantime you can follow these links for more information in relation to Direct Binocular Vision and Microsuction solutions for cerumen management.