ENT INSTRUMENTS

By Trishan
 CONTENTS
ORAL CAVITY
EAR NOSE & THROAT
Lack’s
Laryngeal
Aural Tilley’s Forceps Tongue
Tuning Fork Mirror
Speculum Depressor

Thudicum’s Anterior Tonsillar Dissector Cum

Siegel’s Nasal Speculum Anterior Pillar Retractor
Wilde’s
Pneumatic
Forceps
Speculum
Saint Clair Thompson’s Luc’s Boyle-Davis
Nasal Speculum Forceps Mouth Gag
Jobson-Horne Probe
With Ring Curette
Killian’s Self-retaining Denis Browne’s
Mollison’s Self-retaining Nasal Speculum Tonsil Holding Forceps
Hemostatic Three Prong
Mastoid Retractor
Posterior Nasal Fuller’s Bivalve
Hartmann’s Forceps Space (PNS) Mirror Tracheostomy Tube
 TUNING FORK
• Made up of Stainless Steel.
• To perform tuning fork tests.
• Used frequencies : 256Hz, 512Hz, 1024Hz.
• Why 512Hz is mostly used?
Ans : More vibration in lower frequencies like 256Hz
produce sense of bone vibration and may result in false
positive tests.
Higher frequencies like 1024Hz have a shorter decay
time, so they are not routinely preferred
• Commonly performed tests : Weber Test, Rinne Test, ABC
(Absolute Bone Conduction) Test.
 AURAL SPECULUM
• Used for visual examination of
external auditory canal, tympanic
membrane etc.
 SIEGEL’S PNEUMATIC
• It has three parts : SPECULUM
a. A pneumatic bulb with a one-way
valve that can pump air inside the
ear.
b. A speculum adapter with a
slanting convex lens for
magnification.
c. A set of 3-4 of speculums of
varying size to snugly fit into the
EAC.
• It is used for :
i. To check mobility of TM.
ii. Fistula test.
iii. To push medicine inside the
middle ear by blowing air.
 WILDE’S FORCEPS
• Also known as Wilde’s
Dressing Forceps.
• Used for packing the EAC in
cases like Otitis Externa.
• Can be used for nasal
packing, grabbing the soft
tissues etc.
• Two ends are serrated.
 JOBSON-HORNE PROBE
WITH RING CURETTE
• It has two parts :
• The ring curette is used to remove wax
from external auditory canal.
(Sometimes it can be used to remove
other foreign bodies from ear or nose).

• The serrated end is ideal for attachment

of a cotton wisp by rolling over, and it
can be used in Probe test for nasal or
aural polyps.
• Can also be used as a cotton swab for
mopping, aural toileting etc.
 MOLLISON’S SELF-RETAINING
HEMOSTATIC THREE PRONG
MASTOID RETRACTOR
• Used in Mastoidectomy for,

a. Retraction of soft tissues

after incision, and

b. Elevation of flaps.
 HARTMANN’S FORCEPS
• Also known as Hartmann Alligator
Forceps or Hartmann Foreign
Body Forceps.
• Used to remove foreign bodies
from external auditory canal.
• Used to insert medicated ear
wicks/packs in EAC. Screw Joint

• Difference from Tilley’s Forceps :

i. Screw joint (Tilley has box-joint)
ii. Its jaw is serrated and grooved.
(Tilley has serrated end but no
such groove).
Serrated and
Grooved Jaw
 TILLEY’S FORCEPS
• Also known as Tilley’s Nasal Dressing
Forceps or Tilley’s Packing Forceps.

• Used in nasal packing and removal

of foreign bodies/crusts from nose.
• Rarely, it can be used for ear
dressing, packing the ear/mastoid
cavity during mastoidectomy or Box Joint
removal of fish-bones from throat.

• Difference from Hartmann’s Forceps :

i. Box joint (Hartmann has a
screw-joint).
ii. Smooth serrated jaw.(Hartmann
has a groove before the serration). Smooth Jaw
 HARTMANN’S FORCEPS V/S TILLEY'S FORCEPS
Tilley’s Hartmann’s

Hartmann’s screw-joint and groove before

serration

Tilley’s box-joint and smooth serrated jaw

 THUDICUM’S ANTERIOR
NASAL SPECULUM
• Used for anterior rhinoscopy.
• Structures seen in Anterior rhinoscopy :
i. Nasal Passage :- Narrow (in DNS, any growth/polyp) or
wide (in atrophic rhinitis or concave side of DNS)
ii. Septum :- Check for Deviation or spur, ulcer,
perforation, swelling (hematoma), growth.
iii. Floor of Nose :- Swelling, ulcer, granulations.
iv. Roof :- look for crusts, ulcer, swelling.
v. Lateral Wall :- Color of mucosa (congested in
inflammations; pale in allergy); size of the turbinates
(enlarged in hypertrophic rhinitis; rudimentary in
atrophic rhinitis);
 SAINT CLAIR THOMPSON’S
NASAL SPECULUM
• Also known as Saint Clair Thompson’s
Long Bladed Nasal Speculum.

• Used in nasal surgeries like Septoplasty

or Submucosal Resection.
 KILLIAN’S SELF-RETAINING
NASAL SPECULUM

• Also known as Killian’s Long

Bladed Nasal Speculum.

• Used in SMR or Septoplasty

operation to keep the
mucoperiosteal flaps away.
 POSTERIOR NASAL
SPACE (PNS) MIRROR
• Patient sits in front of the examiner,
opens his mouth and breathes quietly.
• Tongue is depressed with a tongue
depressor and PNS Mirror is introduced,
which has been warmed and tested on
the back of the hand.
• The mirror is held like a pen and carried
behind soft palate, without touching the
posterior third of the tongue to avoid
gag reflex.
• Light is focused on the mirror to
illuminate the structures.
 STRUCTURES SEEN IN
POSTERIOR RHINOSCOPY
❖ Choana (posterior nares or internal
nostrils), posterior end of turbinates,
posterior border of nasal septum.

❖ Opening of Eustachian tube, Torus

tubarius, Fossa of Rosenmuller.

❖ Adenoids, roof and posterior wall of

nasopharynx.

❖ Upper surface of soft palate and

uvula.
 INDIRECT LARYNGOSCOPY (IL)
MIRROR OR LARYNGEAL MIRROR
• Used in Indirect Laryngoscopy.

• Procedure :
a. Patient is seated opposite the examiner, he should sit
erect with his head and chest leaning slightly
towards the examiner.
b. He is asked to protrude his tongue which is wrapped
in a gauze piece, and held by examiner between
the thumb and middle finger. Index finger is used to
keep the upper lip or moustache out of the way.
Gauze piece is used to get a firm grip and to protect
the tongue against lower incisors.
c. Laryngeal mirror which is warmed and tested on the
back of the hand is inserted into the mouth and held
firmly against the uvula and soft palate. Light is
focused on the laryngeal mirror and patient is asked
to breathe quietly.
STRUCTURES SEEN IN INDIRECT LARYNGOSCOPY
I. OROPHARYNX : Base of the tongue,
Valleculae, Medial and Lateral
glossoepiglottic folds.
II. LARYNGOPHARYNX : Pyriform fossa in both
sides, postcricoid region, posterior wall of
laryngopharynx.
III. LARYNX : Epiglottis, aryepiglottic folds,
arytenoids, cuneiform and corniculate
cartilage, ventricular bands, ventricles, true
cords, anterior commissure, posterior
commissure, subglottis, rings of trachea.

❑To check movements of the cords,

➢ Patient is asked to take deep inspiration : for
abduction of cords.
➢ Patient is asked to say ‘Aaa’ : for adduction of
cords.
➢ Patient is asked to say ‘Eee’ : for adduction and
tension.
 LACK’S TONGUE
DEPRESSOR
• Flat end is used to
depress the tongue in
examination of oral
cavity and various
procedures like
posterior rhinoscopy.
• Used in Cold Spatula
Test to check nasal
patency.

• The bent end is used

to retract the cheeks
while examining the
oral cavity, to inspect
the gingivobuccal
sulcus.
 TONSILLAR DISSECTOR CUM
ANTERIOR PILLAR RETRACTOR

• The blunt end is used for initial

non-traumatic dissection of the
tonsils.

• The retracted lip end is used to

retract the anterior pillar to
inspect the tonsillar fossa to look
for any bleeding point or tags of
tonsillar tissue left behind.
 LUC’S FORCEPS
• Used in Caldwell-Luc operation to remove
thickened antral mucosa.

• Used in SMR operation for excision of septal

cartilage or bone.

• Used to take biopsy sample from tumors in

nose or throat.

• Previously used in polypectomy to grasp

and avulse polyps (not done nowadays).
BOYLE’S DAVIS’
BOYLE-DAVIS
MOUTH GAG
• The tongue depressing part is
Boyle’s and the mouth
opening part is Davis’ (D-
shaped, D for Davis).

• Used for opening the mouth

and depressing the tongue in
various surgeries,
a. Surgeries of oral cavity
(palate surgeries)
b. Oropharynx (tonsillectomy,
pharyngoplasty)
c. Nasopharynx
(adenoidectomy, excision of
angiofibroma).
 DENIS BROWNE’S
TONSIL HOLDING FORCEPS

• Used for holding the tonsil

during tonsillectomy by
dissection method.
 FULLER’S BIVALVE
TRACHEOSTOMY TUBE
• It consists of an outer tube and an
inner tube, the inner tube being
slightly longer.

• Outer tube is made of two blades,

which when pressed together can
easily be introduced in the
tracheostomy opening.

• Inner tube has a hole in the centre so

that the patients can still have a
chance to breathe from the larynx
even when the tube is blocked at the
outer end.