ENT INSTRUMENTS

Instrument Diagram Parts Use

Ear Instruments
Myringotomy - (incising the tympanic
• Bayonet/lance-shaped sharp blade
membrane to drain fluid in otitis media
1. Myringotome • Fine angled shaft
with effusion or pus in acute otitis
• Flat finger handle
media)

• Curved prongs/blades with 4x4 sharp Mastoidectomy - to retract soft

2. Mollison’s mastoid teeth tissues and periosteal flaps after
retractor • Ratchet locking mechanism incision; self-retaining and provides
• Finger rings local haemostasis

3. Jansen’s self-
• Two blunted/pronged blades Mastoidectomy - to hold back soft
retaining mastoid
• Threaded thumb-screw mechanism tissue flaps away from the bony field
retractor

• Two lateral blades (for skin/flaps)

Endaural approach in ear and
4. Lempert’s • Third central blade with holes (for
mastoid surgery to expose the deep
endaural retractor temporalis muscle)
auditory canal and mastoid antrum
• Body with fixing screw mechanism

5. Lempert’s Spread open the external ear canal

• Curved expanding blades
endaural when making an endaural incision or
• Spring-action handles
speculum administering local injections

• Curved bevelled cutting edge Remove cortical bone during mastoid

6. Mastoid gouge • Sturdy solid shaft surgery (historically with a mallet;
• Flat impact head largely replaced by surgical drills)

Curetting bony septa, granulations,

7. Lempert’s curette • Oval cup-like scoop end
and cholesteatoma debris in
(scoop) • Sturdy handle
mastoidectomy
• Double-ended instrument Mastoid surgery to explore hidden air
8. MacEwen’s
• Curved blunt probe (cell seeker) on one cell tracts with the seeker end and
curette and cell
end scrape away bony septa with the
seeker
• Small sharp scoop/curette on the other curette end
Elevate the periosteum from the
9. Farabeuf’s
• Flat/slightly curved bevelled blade mastoid cortex during flap creation in
periosteal
• Solid heavy handle mastoidectomy
elevator
Nose Instruments
 Proof puncture (antral lavage) by
10. Lichtwitz
• Sharp-pointed solid trocar piercing the lateral nasal wall into the
trocar and
• Hollow outer metal cannula maxillary sinus through the inferior
cannula
meatus

11. Tilley’s
harpoon

12. Tilley’s antral

burr

Irrigating or douching the maxillary

13. Rose’s sinus • Curved blunt tubular tip
sinus through a pre-existing naso -
douching cannula • Directional indicator hooks on the hub
antral window

Caldwell-Luc surgery,
• Oval ring-shaped cup jaws SMR/Septoplasty (to remove bone
14. Luc’s forceps
• Thin shaft without box-lock or ratchet and cartilage), polypectomy, and for
taking tissue biopsies

• Metal barrel/cannula
15. Nasal snare Engage and avulse nasal polyps at
• Thin wire loop (30 SWG)
(Krause’s) their pedicle during nasal polypectomy
• Sliding finger-ring ratchet mechanism

16. St. Clair

Thomson’s nasal
speculum

17. Killian’s long- SMR and septoplasty operations to

• Two long thin blades
bladed nasal retract mucoperiosteal flaps and
• Spring handles with set adjusting screw
speculum inspect the nasal septum

Inserting anterior nasal packs, ear

18. Tilley’s • Angled bayonet serrated jaws dressings, and extracting foreign
dressing forceps • Box joint bodies from the nasal cavity or ear
canal

19. Hartmann’s • Angled bayonet serrated jaws Placing nasal packs, ear wicks, and
dressing forceps • Screw joint removing debris or foreign bodies
20. Wilde’s • Angled bayonet serrated jaws
dressing forceps • Spring bow

∘ revolving/swivelling blade tip SMR operations to cleanly excise

21. Ballenger • 360 strips of septal cartilage in one
swivel knife • Forked shaft and long handle continuous movement

22. Killian’s nasal

gouge (bayonet-
shaped)

23. Freer’s • Double-ended tips (one sharp flat Elevate mucoperichondrial and
double-ended elevator, one curved blunt elevator) mucoperiosteal flaps from the nasal
elevator • Central octagonal handle septum during septoplasty or SMR.

• Heavy parallel flat blades (rubber-

24. Walsham’s Disimpact and realign fractured nasal
covered or smooth)
forceps bones
• Sturdy long handles

Straighten and crush fractured or

25. Asch’s • Heavy parallel flat blades
displaced nasal septal cartilage and
septum forceps • Sturdy long handles
bone.

Throat Instruments
Opening the mouth and depressing the
tongue
Operations on the oral cavity (palate
• U-shaped metal frame with ratchet
26. Boyle-Davis surgery), oropharynx (tonsillectomy,
• Interchangeable flat Davis tongue
mouth gag surgery of soft palate,
blades with anaesthetic/ether tube slot
pharyngoplasty), and nasopharynx
(adenoidectomy, excision of
angiofibroma)

• Two rubber-padded serrated jaws Inserted laterally between molars to

27. Doyen’s
• Cross-action handles with ratchet lock keep the mouth forced open during
mouth gag
oral or pharyngeal procedures

• Cup-shaped ring jaws with inner teeth Firmly grasp and pull the tonsil
28. Jenning’s
• Long shaft with box lock and finger-ring medially during dissection
mouth gag
ratchet tonsillectomy
  Each pod has four rings.
 They can be assembled to vary the height at which the tongue blade of the Boyle-
29. Draffin’s
Davis mouth gag can be suspended
bipod
 The lower end of each pod can be placed in one of the several depressions in
Magauran’s plate

• Cup-shaped ring jaws with inner teeth

30. Tonsil holding Firmly grasp and pull the tonsil
• Long shaft with box lock and finger-ring
forceps (Denis medially during dissection
ratchet
Browne’s) tonsillectomy

31. Tonsil
dissection forceps Incision in mucous membrane and
-
with teeth dissection of tonsil
(Waugh’s)

32. Yankauer Suction in tonsillectomy and other oral

-
suction tube or oropharyngeal operations

Used to dissect the tonsil and the

33. Tonsil One end –
other
dissector and
anterior pillar To retract the anterior pillar to inspect
retractor Another end – the tonsillar fossa for any bleeding
point

Straight forceps Catch the bleeding point

34. Tonsil artery

forceps (straight
and curved) Replacement forceps before tying with
a ligature
Curved forceps
Smaller bleeding points are cauterised
- larger ones require ligation

Replacement forceps to ligate the

35. Negus artery • Long curved serrated jaws bleeding point
forceps • Ratchet finger-ring handles Clamp bleeding vessels deep in the
tonsillar fossa during tonsillectomy

36. Negus knot Carry the ligature knot deep up to the tip of artery forceps holding the vessel and
tier tie it
 • Heavy outer cannula
37. Eves’ tonsil Crush and sever the lower pole pedicle
• Internal wire loop mechanism
snare of the tonsil during tonsillectomy
• Finger rings with ratchet pull

Drainage of peritonsillar abscess

Number 11 blade covered
38. Peritonsillar Distal part is used to stab the abscess
with micropore plaster except at its tip
abscess forceps and then it is opened with an artery
forceps

• Fenestrated square/oval cutting blade

39. Beckmann Curetting and removing hypertrophied
• Angled shaft and heavy handle (with or
Adenoid Curette adenoid tissue from the nasopharynx
without attached wire cage)
40. St. Clair
Curette - shaves off the adenoid mass
Thompson’s
Guard - holds this tissue and prevents Adenoidectomy
adenoid curette
slipping
with guard

41. Leighton Tonsillotomy (Tonsillotomy cuts away

tonsillotome - projecting and obstructive part of
(Guillotine) tonsils) or tonsillectomy

Larynx and Trachea Instruments

Blunt tracheal hook - retract thyroid
isthmus upwards or downwards to
expose the trachea
42. Tracheal hook Sharp tracheal hook - lower border of
Tracheostomy
(blunt and sharp) cricoid cartilage to stabilize the trachea
and prevents its movements during
respiration when making incision in the
tracheal wall

Keep the tracheal edges open after

43. Tracheal Curved artery forceps can be easily used incision in the trachea so that
dilator in place of a tracheal dilator. tracheostomy tube can be
easily inserted

Single or a twin light carrier which can

Direct laryngoscopy (diagnostic or
44. Laryngoscope be connected to a cold-light source
therapeutic)
through a flexible cable

1. Laryngoscope
2. Chest support
45. Microlarynge 3. Suction tip and other instruments
al surgery 4. Fibreoptic cord
5. Various types of microlaryngeal instruments
6. Specimen bottle
Length of oesophagoscope and its lumen
46. Oesophagosc
vary with the age of the patient
ope (Negus – w/ Diagnostic or therapeutic
Handle - at the proximal end of
twin proximal oesophagoscopy
oesophagoscope, indicates the direction
lighting)
of the bevel at the distal end
 Opening - at the distal part of the tube
which help in ventilation of contralateral
47. Bronchoscope lung or side bronchi
Distal tip - also bevelled to facilitate its
passage between the cords

Proximal end –
A. Prism light deflector where fibreoptic cord is connected.
B. Main portal of the tube through which instruments like section tube or forceps
48. Fibreoptic for biopsy or forceps for foreign body removal or a telescope can be passed.
Bronchoscope C. For introducing flexible instruments like fine suction tube or flexible forceps or
for jet ventilation.
D. For connecting to any type of respirator for ventilation or assisted respiration,
any of the openings B, C or D can be closed with a suitable plug.

Outer tube - made of two blades, which

when pressed together, can be easily
introduced into the tracheostomy
49. Fuller’s
opening
tracheostomy Tracheostomy
Inner tube – longer; has a hole in the
tube
centre so that patient can still have a
chance to breathe from the larynx even
when tube is blocked at its outer end

Three parts: outer tube, inner tube and an obturator

50. Jackson’s
 Outer tube is not split
tracheostomy
 Inner tube can be fixed to the shield of the outer tube by a lock
tube
 Obturator helps in the introduction of tube into the trachea

Used when there is danger of

aspiration of pharyngeal secretions as
51. Cuffed Cuff is inflated; it prevents aspiration of in unconscious patient
tracheostomy pharyngeal secretions into the trachea & or when patient is put on a respirator
tube air – leak Cuff should be deflated every 2 h for 5
min to prevent ischaemia and damage
to the trachea and cartilage necrosis
 52. Cuffed Suction tube - reaches
suction - aid above the cuff; helps to suck out Accumulated pharyngeal secretions do
tracheostomy pharyngeal secretion collected above the not get aspirated into the trachea
tube cuff

Used where face mask is ineffective

and intubation of the larynx difficult
To intubate the patient with
Device with a tube and a laryngeal mask endotracheal tube (less than 6 mm
which fits over the inner diameter) directly or to first pass
supraglottic region. a stylet and then rail-road
53. Laryngeal
Size of mask is selected according to the endotracheal tube.
mask airway
weight of the patient To pass flexible bronchoscope for
(LMA)
The cuff of mask is first deflated and fibreoptic assessment of airway and
positioned over the larynx and later then pass the stylet.
inflated Contraindicated – in obstruction in
the area of glottis and subglottis, and
cannot be used in patients with
trismus

A) Motor. (B) Curved hand piece. (C)

54. Mastoid drill Straight hand piece. (D) Different types
of burrs

SIZE OF TRACHEOSTOMY TUBE AND BRONCHOSCOPE ACCORDING TO AGE

Inner diameter of Size of bronchoscope
Age
tracheostomy tube (mm) tube (mm)
Preterm-1 month 2.5 - 3.0 2.5
1-6 months 3.5 3.0
6-18 months 4 3.5
18 months to 3 years 4.5 4.0
3-6 years 5 4.5
6-9 years 5.5 5
9-12 years 6 6
12-14 years 7 6

Tracheostomy Tubes for Adults

Types Features
Uncuffed and cuffed tubes
Double cuff tube Cuff can be inflated alternately to prevent pressure necrosis at one site.
 Single or multiple holes are situated at the upper curvature - help in speech production or in weaning from tracheostomy
Fenestrated tube
 Fenestrated tube is used in children for decannulation
 Extra length tracheostomy tubes are used when pre - tracheal tissues are thick or swollen or to by-pass a growth or stenosis in trachea.
Adjustable flange long tube
 Flange in these cases is movable and fixed at a desired place according to the thickness of tissues of the neck.
 Single lumen tube No inner cannula
 Inner cannula inside an outer cannula
Double lumen tube
 Easier to remove, clean and replace the inner cannula, keeping outer cannula in place for breathing
Suction-aid tracheostomy
Small tube ending above the cuff to suck out pharyngeal secretion and prevent their aspiration
tubes
 Valve is fitted at the outer end of tracheostomy tube
Tracheostomy with speaking  Allows ingress of air when breathing in but closes when breathing out
valve  Air finds its way to vocal cords to produce sound
 Long-term treatment of bilateral abductor paralysis or laryngeal stenosis

Classification of tubes according to the material they are made of

1. Silver - An alloy of silver, copper and phosphorus, e.g. Fuller, Negus or Jackson’s tube.
2. PVC (polyvinyl chloride) - They are disposable, single use tubes and thermolabile, and thus adjust to tracheal lumen.
3. Silicone - Bacteria and secretions do not adhere to the tube and there is minimum of crusting.
4. Siliconized PVC - It has the properties of both PVC and silicon, i.e. it is thermolabile and adjusts to tracheal wall while silicon prevents crusting.
5. Silastic - It is soft and non - irritating, and minimizes crusting.
6. Armoured tubes - They are plastic tubes reinforced by a spiral or rings of stainless steel. They are not easily kinked.

How to select size of endotracheal tube in a child (for size of tracheostomy tube in a child

How to select size of tube in adults - FG (French Gauge) = outer diameter × π (π = 3.14 or approx 3)