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Boyle Davis Mouth Gag

This instrument is part of the tonsillectomy set.

Mouth gags are used to keep the patient’s mouth open during oral surgery, leaving
both hands of the surgeon free to operate.

The Boyle Davis mouth gag consists of the Davis gag, a frame that serves to hold the
mouth open and the Boyle tongue depressor to hold the tongue down. The tongue
depressor comes in several sizes, from pediatric to adult. The instrument is
assembled by sliding the tongue blade into the frame. The mouth gag is held in
position using the Draffin bipod stand.

This is a picture of the Draffin's bipod stand. These two rods are used to hold the
mouth gag.

Uses

Used in oral and oropharyngeal surgeries.

Adenoidectomy
Tonsillectomy
UPPP and other procedures on the soft palate
Procedures on the hard palate like cyst or tumour excision

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It cannot be used to perform procedures on the tongue as it is completely held

down by the tongue blade.
This instrument can cause injury to the lips and teeth. Care must be taken while
applying the mouth gag to avoid getting the lips caught in it.
Opening the mouth excessively with the gag can cause dislocation of the
temporomandibular joint.

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Posted 16th January by Ent Guide

Labels: throat instruments, ENT OT instruments, tonsillectomy instruments

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Killian’s Nasal Gouge

This instrument is part of the septoplasty set.

The Killian’s nasal gouge is bayonet shaped – that is, its shaft is bent so that the tip
lies on a higher plane than the handle. This feature ensures that the hand holding the
instrument does not obstruct vision and the surgeon can visualize the tip of the
instrument inside the nasal cavity.

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The tip of the instrument is V-shaped and very sharp. This feature helps remove spurs
and sharp projections during septal surgeries.

This is a mallet (or hammer) used along with the gouge.

Uses

The instrument is used in septoplasty to remove spurs. It is especially useful to

remove a deviated maxillary crest.

The wedge-shaped tip is placed at the beginning of the spur or bony projection in the
septum. With the instrument in place, its handle is tapped gently with the mallet as the
gouge cuts through the bony projection which is then removed with nasal dressing
forceps.

More information

Spurs are horizontal projections in the septum often formed at bony cartilaginous
junctions that may cause nasal obstruction.
The maxillary crest lies at the floor of the nasal cavity. It is sometimes deviated
resulting in a large spur near the floor of the nasal cavity.
Another type of gouge in ENT is the mastoid gouge. Before the introduction of the
surgical drill, the mastoid gouge and hammer were used to perform
mastoidectomy.

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Posted 12th January by Ent Guide

Labels: septoplasty instruments, ENT OT instruments, nose instruments

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Killian’s Nasal Speculum

This is one variety of nasal speculum and is used for both nasal examination and
surgery.

It comes in several sizes, from small to long-bladed. A screw in the handle can be
tightened to hold the blades of the speculum in the open position. This gives the
speculum its self-retaining feature, very useful during septal surgery.

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Unlike the Thudichum’s nasal speculum, this instrument is much easier to handle. The
blades are attached to handles which can be used to open and close the speculum.

Uses

The Killian’s nasal speculum is used in:

Anterior rhinoscopy
Anterior nasal packing
Septoplasty
Polypectomy
Nasal foreign body, rhinolith removal
Turbinate reduction surgeries

The speculum is particularly helpful in septoplasty. When the mucoperichondrial flap is

being raised, the blades of the speculum can be used to lift the flap to provide access
and vision. Later, when the mucoperiosteum has been elevated on both sides, the
instrument can be positioned within the flaps with the blades on either side of the bony
septum. The self-retaining feature of the instrument helps free both hands for bone
removal.

More information

In septoplasty, the mucoperichondrial flap is only raised on one side of the septal
cartilage, whereas in SMR it is raised on both sides of the septum.
Tearing the mucoperichondrial flaps in corresponding places on both sides of the
septum can result in a septal perforation postoperatively.
A septal hematoma occurs when blood collects between the septal cartilage and
its mucoperichondrium.

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Posted 10th January by Ent Guide

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Tonsillectomy Instruments – Dissection Tonsillectomy

Set

The dissection method of tonsillectomy requires the use of several instruments. Here
is a comprehensive list of instruments in the tonsillectomy set. Read the individual
posts for photos, complete descriptions and the uses of each instrument.

Boyle Davis mouth gag – This instrument gives access to the tonsils and keeps the
mouth open during surgery.

Scalpel – This is used to make the incision on the medial edge of the anterior pillar. A
no.15 blade or the sickle-shaped no.12 blade may be used. Some surgeons also use
the tooth on toothed forceps to make the incision.

Denis Browne tonsil holding forceps – These forceps are used to grasp and hold
the tonsils during surgery.

Gwynne Evans tonsillar dissector – This instrument is used to dissect the tonsil
from its bed.

Eve’s tonsillar snare – This instrument is used to cut and crush the pedicle of the
tonsil in order to remove the last of its attachments.

Waugh’s toothed forceps – This pair of long forceps is used while packing the
tonsillar fossa.

Birkett’s tonsillar first artery forceps – These forceps are used to catch bleeders in
the tonsillar fossa after tonsillectomy.

Wilson’s or Negus second artery forceps – These forceps are used while applying
ligatures to bleeding points in the tonsillar fossa after tonsillectomy.

Mollison’s anterior pillar retractor – This instrument is used to retract the anterior
pillar to examine the tonsillar fossa for bleeders after the removal of the tonsils.

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Read the individual posts for complete details about each instrument.

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Posted 10th January by Ent Guide

Labels: throat instruments, ENT OT instruments, tonsillectomy instruments

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Tonsillar Second Artery Forceps

This instrument is used while applying ligatures to bleeding points in the tonsillar fossa
following tonsillectomy.

Identification

This instrument is the Negus second artery forceps. Notice how its tip is curved like a
hook.

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This is another variety of the same instrument – this is the Wilson second artery
forceps.

Both its shaft and tip are bent at obtuse angles.

How the instrument is used

When a bleeding spot is observed in the tonsillar fossa following tonsillectomy, it is

first caught using the tip of a first artery forceps. The bent tip of the second artery
forceps is then applied below the tip of the first artery so that some of the surrounding
tissue can be held as well. The ligature is then applied below the second artery.

More information

Ligatures applied in the tonsillar fossa don’t have to be removed, they slough away by
salivary action.

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Posted 7th January by Ent Guide

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Birkett’s Tonsillar First Artery Forceps

This instrument is part of the tonsillectomy set and is used while applying ligatures to
control bleeding.

Identification

The tonsillar first artery forceps are long, straight artery forceps with a ratchet for
locking.

How the first artery forceps are used

Following tonsillectomy, the fossa is inspected for bleeding points. The tip of the first
artery forceps is used to ‘catch’ the bleeder. The second artery forceps are then used
before applying ligatures to the bleeding point to stop hemorrhage.

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It can also be used to remove clots present in the fossa.

More information

The other method to stop bleeding from the tonsillar fossa is to use
electrocautery.
While applying ligatures, the first artery is used along with the anterior pillar
retractor and the second artery forceps.
Clots present in the tonsillar fossa can prevent hemostasis by coming in the way
of muscular contraction and should be removed.

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Posted 7th January by Ent Guide

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Mollison’s Anterior Pillar Retractor

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The anterior pillar retractor is used in tonsillectomy operations.

Identification

This is a long and thin instrument one end of which is flattened out like a blade. The
other end is wide and its edge is curved.

This is end may be hooked around the edge of the anterior pillar to pull it laterally after
tonsillectomy.

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The tonsillar dissector is a similar looking instrument in the tonsillectomy set. To

differentiate the two, closely observe the ends. One end of the dissector is serrated
like a comb.

How to use the pillar retractor

The curved edge is hooked around the free edge of the anterior pillar to retract it
laterally. This gives a very good view of the entire tonsillar fossa which can be
inspected for remnants and bleeding points after the removal of tonsils.

More information

Reactionary bleeding is hemorrhage that occurs in the postoperative period

within 24 hours.
It usually occurs due to slipping of ligatures.

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Posted 6th January by Ent Guide

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JAN Gwynne Evans Tonsillar Dissector

This instrument is used in the dissection method of tonsillectomy.

The tonsillar dissector is a long and thin instrument that is used to separate the tonsil
from its bed in the dissection method of tonsillectomy. While one end is flattened out
like a blade, the other end is serrated.

Uses
Tonsillectomy – The flat end is used for sharp dissection while the serrated end is
used to release the connective tissue holding the tonsil to its bed.
The serrated end is also useful in other surgeries like the removal of cysts when
connective tissue has to be separated from the cyst wall.
The instrument is also useful in separating periosteum from bone in some
surgeries.

Differentiating it from other instruments:

The Freer’s elevator

This is a long, thin instrument used in septal surgeries. Both its ends are flattened out
like blades. Also, it is smaller and thinner compared to the tonsil dissector.

Pillar retractor

This is an instrument that looks very similar to the tonsillar dissector. Unlike the

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a hook. Read more about the anterior pillar retractor to learn how to identify it and to
look at pictures.

More information:

Other instruments that can be used for tonsillar dissection are Waugh’s toothed
forceps and sharp dissecting scissors.
It is important to carry out dissection in the exact plane between the tonsil and its
bed – digging either into the fossa or the tonsil can cause a lot of bleeding.

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Posted 6th January by Ent Guide

Labels: throat instruments, ENT OT instruments, tonsillectomy instruments

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Denis Browne Tonsil Holding Forceps

This instrument is used in tonsillectomy operations.

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grasped gently and then pulled medially. This step helps hold the tonsil away from its
bed to facilitate dissection and prevent injury to structures in the bed of the tonsil.

Identifying the instrument

Tonsil holding forceps are long and sturdy with the shaft bent at an angle to the
handle. The tips are cup-shaped with holes.

The instrument is very similar to the Luc’s forceps used in septal surgeries. To
differentiate the two, examine the tips of the forceps. The edges of the tips are
smooth in tonsil holding forceps, their job is to just hold tissue, whereas the edges of
the tips are sharper in the case of Luc’s forceps because they have to do some
cutting.

Also, the cup-shaped tip of the upper arm fits into the tip of the lower arm in the case
of tonsil holding forceps.

Additional information

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The bed of the tonsil is made of the superior constrictor muscle which is
separated from the tonsil by connective tissue that forms the plane of dissection
in tonsillectomy.
The carotid artery is located about 2.5cm deep to the bed of the tonsil.

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Posted 5th January by Ent Guide

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St Clair Thomson Adenoid Curette

The adenoid curette is used in adenoidectomy operations.

The instrument has a strong handle, a shaft and a curette at the tip. The curette itself
is a curved, square window that allows for the tissue to engage in it.

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An adenoid curette with cage comes with a detachable guard that has teeth to hold
the removed tissue.

How the adenoid curette is used

For the adenoidectomy operation, the patient lies supine in the neutral position. The
mouth is held open with a mouth gag. The curette is held at the handle like a dagger.
The curette is then introduced into the oral cavity, all the way above and behind the
soft palate. The adenoid tissue is caught in the curette and removed with a smooth,
shaving movement.

Adenoidectomy was earlier performed as a blind procedure. A nasal endoscope can

now be used to visualize the procedure.

More information

Endoscopic adenoidectomy achieves better results and lesser complications as

the procedure is performed under visualization.
Endoscopic adenoidectomy can be performed using endoscopic instruments
and/or microdebrider.
Hypertrophied adenoids cause nasal obstruction, nasal discharge and predispose
to ear conditions like otitis media and otitis media with effusion.

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Posted 5th January by Ent Guide

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JAN Eve’s Tonsillar Snare

This instrument is part of the tonsillectomy set and is used in the step of removing the
dissected tonsil from its final attachment to the fossa.
Identification of the instrument

This is an easy instrument to identify. It consists of a long, thin, hollow tube with a
stainless steel wire loop at one end and three large rings at the other. These three
rings allow the instrument to be operated using three fingers.

How the tonsillar snare is used

The instrument is held by inserting the forefinger and the middle finger into two rings
on either side of the snare. The thumb is placed in the single ring at the back. This ring
is actually located at the end of the plunger. Pulling the plunger with the thumb draws
out the wire loop while it can be pulled back in by pressing the plunger with the thumb.

The wire loop is first threaded over the Denis Browne tonsil holding forceps. The
dissected tonsil is then held with the forceps and the wire loop moved over it until it
surrounds the pedicle of the tonsil. The thumb is then pressed down to draw back the
loop. The pedicle of the tonsil is both cut and crushed by this movement. Cutting and
crushing the pedicle rather than just cutting it helps reduce hemorrhage.

More information:

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anymore.
In the absence of a tonsillar snare, the pedicle can be clamped with long, curved
artery forceps, cut and tied with silk.
After the tonsil is snared out, the raw tonsillar fossa is immediately packed with
gauze to achieve hemostasis.

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Posted 5th January by Ent Guide

Labels: throat instruments, ENT OT instruments, tonsillectomy instruments

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Eustachian Tube Catheter

The Eustachian catheter is a long, thin metal instrument mainly used to test
Eustachian tube patency but with a few other uses as well.

It is actually a curved, metal cannula, measuring about 5 inches in length. Its tip is
curved gently downwards. The other end bears a small metal ring in the direction of
the curve. This ring serves as a guide to the direction of the curve once the tip is
inserted into the nose.

Uses:

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tip can be used to nudge and maneuver foreign bodies lodged in the nasal cavity.

How Eustachian tube catheterization is done

This procedure is more than a century old and was earlier routinely done to check
patency of the Eustachian tube.

The tip of the catheter is inserted into the nose and passed along the floor of the
nasal cavity till it touches the posterior pharyngeal wall. The tip is now in the
nasopharynx.
It is then rotated 90° medially and drawn forward till it meets resistance. The tip is
now touching the posterior free end of the nasal septum.
At this point, the tip is rotated 180° laterally so that it enters the opening of the
Eustachian tube in the lateral wall.
A Politzer bag is attached to the other end of the catheter. Air pushed from it can
be heard rushing into the ear if the Eustachian tube is patent.

The medial and lateral rotations that appear to complicate the procedure were actually
designed to avoid the tubal elevation located behind the tubal opening since the tip
cannot be seen once inserted into the nose. The original procedure was a blind one,
with only the metal ring to indicate the direction of the catheter’s tip. But the
procedure can also be done under endoscopic guidance.

The important thing to remember is that the method only tests patency of the
Eustachian tube and does not reflect on its function.

Other methods to test Eustachian tube patency

Seigelization (or pneumatic otoscopy)

Valsalva maneuver
Politzerisation
Toynbee’s test

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Posted 23rd December 2011 by Ent Guide

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JUL Trousseau’s Tracheal Dilator

This instrument is a part of the tracheostomy set. It should be available not only in the
OR but also in the emergency/casualty.

Uses of the tracheal dilator

It is basically used to widen the tracheal opening while inserting a tracheostomy tube
Peroperatively during tracheostomy
During a tube change
It is especially useful should the tube accidentally come off in the early post op period,
when the track is still not well formed.

Identifying the instrument

It looks like a pair of regular artery forceps except that

Its tip is bent at almost right angles to the rest of the instrument
There is no lock or clasp
The tip is smooth and rounded unlike the sharp, dissecting tip of the artery
forceps

Note how the tip of the dilator is bent at right angles to the rest of the body. This helps
reach the tracheal opening located at a depth in the neck.

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Notice how bringing your fingers together actually opens the tracheal dilator. The
instrument has a spring action to keep it closed; the prongs will remain open only as
long as you hold them apart.

How to use the tracheal dilator

The instrument is held by inserting your thumb and index fingers into the rings
provided. When using regular artery or Allis forceps, if you bring your thumb and index
fingers together, the prongs of the instrument also move inwards and close. But with
the tracheal dilator, when you bring your two fingers together, the prongs at the tip of
the instrument move away from each other.

So hold the instrument, insert the tip into the tracheal stoma and bring your fingers
together. This will help you widen the tracheal opening so you can slide in the
tracheostomy tube.

More information

Stay sutures may be placed on either side of the tracheal opening. Pulling on
these sutures will help to hold open the stoma and to pull it up to the level of the
skin, facilitating tube insertion or change.
Structures to be divided before the trachea can be reached:
Skin
Subcutaneous tissue
Strap muscles
Isthmus of the thyroid
Pretracheal fascia
How to prevent accidental displacement of the tracheotomy tube before the track
is formed
Correct placement of the tube
Firmly securing the tube – the tube may even be secured with sutures

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Freer’s Elevator

This instrument is an important part of the septoplasty set.

Uses of the Freer’s elevator:

Elevation of mucoperichondrial/mucoperiosteal flaps in septoplasty or SMR

Separation of the septal cartilage from bone during septoplasty
To perform uncinectomy during endoscopic sinus surgery
For mucoperiosteal flap elevation in endonasal DCR

Identifying the septal elevator

This is a thin and long instrument with small flattened blades at either end. Most
elevators are straight at one end and slightly curved at the other.

This is a close up of one end of the septal elevator.

Differentiating it from the tonsillar dissector

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The tonsillar dissector is slightly longer and stouter than the septal elevator.
It has a blade on one end that is similar to the ones on the Freer’s elevator, but
slightly larger.
But the other end is bent and serrated with a comb like appearance.

How to use the Freer’s elevator

The straight end may be used for elevation of flaps. The curved end may be used in
septoplasty to separate the quadrilateral cartilage from bone and elevate the
mucoperiosteal flap on the opposite side.

The curved end may also be used to make an incision at the attachment of the
uncinate process to the lateral wall of the nose during uncinectomy. (This is one
method of performing uncinectomy, there are several others.) Both ends of the
instrument are usually sharp, a feature that helps flap elevation and sharp dissection.

If you look closely at the blade, you will find that one surface is flat and the other is
gently curved. During flap elevation in septoplasty, make sure the flat surface and the
sharp end rest on the cartilage or bone, while the smooth, curved side faces the flap.
This will help you apply pressure on the septum without tearing the flap.
More information:

The elevator is used even in endoscopic septoplasty.

Modifications of the elevator with provision for suction are available. Bleeding during
flap elevation is common and this instrument helps provide a clear field.
This instrument is also handy in any procedure that involves dissecting soft tissue off
cartilage or bone.

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Lack's Tongue Depressor

This is a very commonly used OPD instrument.

It has two blades at right angles to each other. One of them is slightly wider than the
other and is completely flat. This is the part of the tongue depressor that is inserted
into the oral cavity. The other blade is narrower and has a slight curve at its free end,
like a handle. This is the part of the instrument that is held in your hand.

Uses of the tongue depressor:

Examination of the oral cavity – vestibule, buccal mucosa, gums, floor of the mouth
Examination of the oropharynx and posterior pharyngeal wall
Used in posterior rhinoscopy, along with the postnasal mirror
For the ‘cold spatula test’ – to assess (approximately) the nasal airway/ patency in
the OPD
To perform minor procedures in the oral cavity
To take a throat swab or a swab from the tonsil

How to use the tongue depressor:

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and repeat the same on the other side.

Then place the blade flatly on the dorsum of the tongue and press it down – this will
allow you to examine the palate, tonsillar pillars, the tonsils and the posterior
pharyngeal wall.
Take care to depress only the anterior two-thirds of the tongue with this instrument.
Touching the posterior third of the tongue will elicit the gag reflex.

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Posted 13th June 2011 by Ent Guide

Labels: throat instruments, ENT OPD instruments

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Tilley's Nasal Dressing Forceps

This nasal instrument has important functions in both the OPD and the operating room.
It is also called the packing forceps or dressing forceps. No nasal surgery set is
complete without these forceps.

Uses of the nasal dressing forceps:

To perform anterior nasal packing

To remove foreign bodies, crusts or packs from the nose

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Identifying the nasal packing forceps:

Like most nasal instruments, these forceps are bent at an angle so the hand grasping
the instrument doesn't obstruct the vision of the examiner. The blades are long and
thin so they can be easily inserted into the nasal cavities.

Differentiating nasal and aural forceps:

Both instruments are very similar to look at. The difference is in the tip. Aural forceps
have tips that are triangular while the tip of the nasal forceps is straight and serrated.
The serrations give grip to the instrument and help grasp the various objects
mentioned above.

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Posted 23rd May 2011 by Ent Guide

Labels: ENT OPD instruments, ENT OT instruments, nose instruments, forceps

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Nasal Foreign Body Hook

This is an instrument used in the outpatient to remove foreign bodies from the nose.

Nasal foreign bodies are common in children and in mentally retarded or disturbed
individuals. The usual foreign bodies seen are small objects like beads, seeds, chalk

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Children often present with a history of unilateral, foul-smelling and/or blood stained
nasal discharge. Anterior rhinoscopy may reveal the foreign body, covered with
slough or discharge. Long standing foreign bodies in the nose sometimes get covered
by deposits of salts and slough and become rhinoliths.

How is the foreign body removed

It is important to pass the tip of the instrument over and beyond where the object is
lodged in the nose so that it can be hooked and drawn forward along the floor of the
nasal cavity.

If you look closely, you will find that one end of the foreign body hook is shaped like a
ring.

The other end is a curette, shaped like a spoon.

Differentiating it from the Jobson Horne wax hook:

The Jobson Horne wax hook is a similar looking instrument used to remove wax and
foreign bodies from the ear. Here's how to tell the nasal foreign body hook and the
wax hook apart.
The nasal hook is shorter and stouter than the ear hook.

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case of the wax hook.

Other methods of removing nasal foreign bodies:

Earlier, an instrument called the Eustachian catheter, one end of which is slightly
bent, was used to hook out the foreign body.
Using the endoscope and endoscopic instruments.
In very small and uncooperative children, the foreign body is better removed
under general anesthesia.

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Posted 22nd May 2011 by Ent Guide

Labels: foreign body removal, ENT OPD instruments, nose instruments

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Jobson-Horne Ear Probe

This is a commonly used OPD instrument and is also called the wax hook or ring
curette.

Uses:

Ear wax removal

Removal of foreign body from the ear

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If you look closely, you will find that one end of the probe is shaped like a ring. This
end may be used to hook out wax or foreign bodies from the ear canal.

The other end of the instrument is sharp and serrated. An ear wick can be fashioned
out of this end by rolling cotton on to it and used to mop ear discharge.

More Information:

If wax in the ear canal is impacted, it is better to first soften it with wax-softening
or dissolving agents and then attempt to remove it.
Wax in the ear canal can also be removed by syringing using an aural syringe or
by using suction apparatus under microscopic visualization.

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Posted 21st May 2011 by Ent Guide

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Indirect Laryngoscopy Mirror

This mirror is used to examine the larynx in the outpatient using a procedure called
indirect laryngoscopy.

How indirect laryngoscopy is done:

The indirect laryngoscopy mirror is warmed to avoid fogging on it.

The patient is asked to protrude his/her tongue which is then held with a piece of
guaze.
The patient is directed to breathe through his/her mouth.
The warmed indirect laryngoscopy mirror is then introduced into the oral cavity
with the mirror facing downwards. (Check its temperature by touching the back of
your hand with it, it should not be hot.)
The mirror is brought to rest against the uvula but do not touch the posterior
pharyngeal wall to avoid setting off the gag reflex.
Once the laryngeal inlet is visualized, the patient is asked to say ‘eee’ to check
the movement of the vocal cords.

Structures seen on indirect laryngoscopy (in order):

Base of the tongue (posterior one-third of the tongue)

Vallecula
Median and lateral glossoepiglottic folds
Epiglottis
Pharyngoepiglottic folds
Aryepiglottic folds
Arytenoids
False vocal cords

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Indications for indirect laryngoscopy:

Examination of the larynx in cases of change in voice

Examination for dysphagia
To look for vocal cord mobility prior to thyroid surgery
To look for the primary in cases of neck metastases

The shaft of the indirect laryngoscopy mirror is straight, a feature which helps
differentiate it from the posterior rhinoscopy mirror which has a bent shaft.

More information:

The mirror is available in 5 sizes, the smallest is 1 and the largest 5.

Indirect laryngoscopy was first performed by Manuel Garcia, a singer.
Using flexible fibreoptic laryngoscopy is another method of examining the larynx in
the OPD.(Read examination of the larynx to learn what other methods can be
used to visualize the larynx.)

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Posted 20th May 2011 by Ent Guide

Labels: throat instruments, laryngoscopy, mirrors in ENT, ENT OPD instruments

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MAY Nasal Speculum - Thudichum's

The Thudichum’s nasal speculum is an instrument routinely used in the outpatient to

examine the nose.

The instrument has two flanges that can be inserted into the nostril during anterior
rhinoscopy. The flanges widen to open up the nasal cavity, offering a better view of
the structures inside the nose.

Uses of the Thudichum’s nasal speculum:

In anterior rhinoscopy
Foreign body removal from the nose
Peroperatively, for nasal packing
In septal surgeries (septoplasty and SMR) while making the incision

How to use the Thudicum’s nasal speculum:

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First, hold the instrument at its bend with your thumb and index finger.

Then, place your middle and ring fingers either side of the limbs of the speculum.
Bringing these fingers close to each other will also bring the flanges of the speculum
close together. Insert the instrument into the nostril in this position. Moving your
middle and ring fingers apart will widen the flanges of the speculum, opening up the
nasal cavity in the process.

More Information:
Insert the speculum fully closed into the nasal cavity, but keep the flanges slightly
open while drawing the speculum out to avoid pulling any vibrissae!
Practice using the Thudicum’s speculum during your clinical posting, the method
described above is the optimal way to best visualize the nasal cavity.
Structures seen on anterior rhinoscopy:

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Do not use the nasal speculum to examine the vestibule. Just lift up the tip of the
nose with your finger to look at the vestibule of the nose, using the speculum will
only obscure it from your vision.

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Posted 19th May 2011 by Ent Guide

Labels: nasal speculum, ENT OPD instruments, nose instruments

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Tuning Forks

In ENT, tuning forks are used to clinically test hearing and identify the type of hearing
loss.

The parts of a tuning fork are:

Base plate or footplate
Shaft
Prongs that vibrate producing sound

If you look at the shaft or the footplate closely, you will find it carries a number - this is
the frequency at which the tuning fork vibrates and is denoted in Hertz (Hz). The
commonly used tuning forks to test hearing are 256 Hz, 512 Hz and 1024 Hz. These
frequencies correspond to the speech frequencies. Tuning forks of lower frequencies
(like 128 Hz) produce vibrations that are felt more than they are heard, while those of

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Tests done with these tuning forks include Rinne's, Weber's and the absolute
bone conduction test.
Other tests, not routinely performed, are the Bing's test, Stenger's, Gelle's and
Chimani Moos test.
If you have to perform these tests with a single tuning fork, pick the 512 Hz.
To set the tuning fork into vibration, always strike it against a firm but yielding
surface like your elbow
and not hard surfaces like table tops.

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Posted 18th May 2011 by Ent Guide

Labels: tuning fork, ear instruments, ENT OPD instruments

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Aural Syringe

This instrument is the metallic aural syringe, an instrument used for syringing of the
ear, an OPD procedure.

Indications for ear syringing:

Wax removal
Foreign body removal
Removal of otomycotic debris

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rings at the back. The third ring is on the piston that forces the water out when
pushed.

More Information:
Syringing should be avoided in case of perforated tympanic membrane.
Aural syringing can result in complications like trauma to the external auditory
canal and perforation of the tympanic membrane.
Other methods of wax and foreign body removal include manual removal using the
Jobson-Horne wax hook, suction and removal under microscope.

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Posted 17th May 2011 by Ent Guide

Labels: ear instruments, wax removal, ENT OPD instruments

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Posterior Rhinoscopy Mirror

This instrument is the St. Clair Thompson post-nasal or posterior rhinoscopy mirror.

Uses:

Examination of the post nasal space by a procedure called posterior rhinoscopy, an

out-patient procedure.
The mirror is warmed and introduced into the oral cavity while the tongue is depressed
with a tongue depressor. The mirror is turned upwards in order to examine the post
nasal space.

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The shaft of the instrument is bent to achieve a bayonet shape, a feature that helps
differentiate it from the indirect laryngoscopy mirror. The mirror is available in 5 sizes.

More Information:
Posterior rhinoscopy is done to look for lesions in the post nasal space - for
example, adenoids, tumours of the nasopharynx, etc.
Diagnostic nasal endoscopy is the best method to examine this region.
In small children who may be uncooperative for posterior rhinoscopy or nasal
endoscopy, X-ray of the skull, lateral view, may be used to rule out adenoids.

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Posted 16th May 2011 by Ent Guide

Labels: mirrors in ENT, ENT OPD instruments, nose instruments

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