ENT INSTRUMENTS
Dr Harish M O
EXAM PATTERN
Theory 100 marks
Clinicals 80 marks (2cases)
Theory internal assessment 25 marks
Clinical internal assessment 25 marks
Viva voce 20 marks
Total 250 marks
OPD INSTRUMENTS
Bull’s lamp
Head mirror
Thudicum’s nasal speculum
Vienna’s nasal speculum
Killian’s self retaining nasal speculum
Aural speculum
Tilley’s forceps
Hartman’s forceps
Gardiner Brown tuning fork
Jobson Horne probe
Tongue depressor
Indirect laryngoscopy mirror
Posterior rhinoscopy mirror
BULL’S EYE LAMP
Semi-mobile Indirect illumination
lamp; focal length ~45 cm
70-100 W bulb, Convex lens
Pt & doctor on adjustable stools
Place behind lt ear of pt, at Same
level
Light source is reflected from mirror
onto pt - in level with the pts left ear.
Mirror over the right eye, close the left
eye, adjust the mirror to look through
hole at the pt’s nose.
Adjust light and mirror until maximum
amount of light is reflected onto pt.
Reflected light will be brightest and
sharpest when the examiner and
patient are focal length apart
HEAD MIRROR
Mirror:
Concave. Hole in center.
Diameter – 9 cm
Cental aperture – 2 cm
Focal length of 25 cm (maximum
illumination )
Lever with 2 ball and socket joints
The 2 joints at right angles to each
other.
Adjustable Plastic Head bands.
OTOSCOPE
Held like a pen
Speculum, handle and a magnifying
attachment (1.5-2 x).
Appropriate size speculum
Right hand - right ear examination
Start by examining better ear
Little finger extended— against
patient's cheek.
TUNING FORK
Used for clinical hearing evaluation
Parts – prongs, shoulder, stem & base
Strike at distal 1/3 & proximal 2/3rd over a
bony prominence or elbow.
Clinically 256, 512 & 1024hz tuning forks
are used to asses type and degree of HL
512 is MC used matches speech
frequency
Tuning fork tests
NASAL SPECULUM
Thudicum’s Nasal speculum
Vienna’s nasal speculum
Killian’s self retaining nasal
speculum
How to hold the speculum
Different sized prongs
Uses
USES
Diagnostic
Anterior rhinoscopy – examine littles area, septum,
lateral wall, F-B, rhinolith, nasal mass
Therapeutic
F-B removal, anterior nasal packing, cauterisation,
application of medicines, antral puncture
Nasal surgeries – infiltration, septoplasty, SMR,
turbinoplasty
TILLEY’S DRESSING FORCEPS.
Used for nasal packing, ear
dressing, removal of foreign
bodies from the nose. It has a
box joint.
HARTMANN’S DRESSING
FORCEPS.
Similar to above forceps. It has
a screw joint.
The jaw is serrated and
grooved.
AURAL SPECULUM
Different types
Preferably black coloured
Held in non dominating hand
Inserted by rotating motion
Uses
OPD – examn of deep EAC, features of TM; removal of f/
b, wax, otomycosis
OT – infiltration of LA, Myringotomy +/- grommet
insertion, aural polypectomy, F/b removal
LACKS TONGUE DEPRESSOR
2 plates at Rt angle – one straight (for
tongue) & other curved (to hold)
Uses
OPD – examn of oral cavity, Opx,
retraction of cheeks & lips, elicit Irwin-
moore sign, to test gag reflex,
posterior rhinoscopy, take throat swab,
intra oral injections, cold spatula test.
OT – take Bx; excision of cyst,
papilloma; FOM Sx, check post nasal
bleeding, drainage of quinsy, removal
of f/b throat, tonsillectomy under LA
JOBSON – HORNE PROBE/CURETTE
2 ends – ring end and cotton carrier end.
Ring end – used to remove wax, f/b & granulations.
Also used to palpate aural mass.
Cotton carrier end – cotton is wrapped – used for
aural toilet (dry mop), chemical cautery (granulations,
margins of small perforations) & trace sinus track.
Posterior rhinoscopy
mirror
Indirect laryngoscopy
mirror
TONSILLECTOMY
INSTRUMENTS
Boyle Davis mouth gag
Draffin’s bipod
Dennis Brown Tonsil holding forceps
Waugh’s tonsil dissection forceps
Gwynne Evans Tonsil Dissector
Hurd Tonsil dissector (Blunt) with Pillar retractor
Eve’s Tonsillar snare
Yankauer suction tube
Boyle – Davis mouth gag
Draffin’s bipod
Magaurans plate
Uses –tonsillectomy, adenoidectomy,
styloid process excision,
uvulopalatopharyngoplasty, cleft
palate repair, benign parapharyngeal
tumor excision.
Denis BrowneTonsil holding forceps.
Used for holding the tonsil during
tonsillectomy by dissection method.
Waugh’s tonsil dissection forceps – Plain and toothed
Gwynne Evans Tonsil Dissector, Double Ended -
Serrated End & Blunt End
• Hurd Tonsil dissector (Blunt) with Pillar retractor
Yankauer suction tube. Used for suction in
tonsillectomy and other oral or oropharyngeal
operations.
Nowadays disposable plastic ones are available.
oEves’ tonsil snare. Used for tonsillectomy. After the tonsil
has been dissected till its lower pole, snare is passed round
the tonsil to engage the pedicle and then firmly closed. It
rushes and cuts the pedicle thereby minimizing bleeding.
EXPECTED QUESTIONS
All questions regarding tonsil
Anatomy, Acute & chronic tonsillitis – types & features
D/d of membrane over tonsil
Indications, contraindications & methods of
tonsillectomy
Complications of tonsillectomy
Peritonsillar abscess and management
ADENOIDECTOMY
St. Clair Thompson’s adenoid
curette with & without guard.
Used in adenoidectomy.
Curette shaves off the adenoid
mass while the guard holds the
tissue and prevents slipping.
With the advent and use of
debrider and coblation techniques,
use of the curette is declining.
FESS & NASAL INSTRUMENTS
00 Endoscope Gouge
700 Endoscope Mallet
Blakesley Forceps Walsham’s forceps
Backward biting forceps Asch’s forceps
Tilley’s forceps
Luc’s forceps
Vienna’s Speculum
Killian’s self retaining
speculum
Freer’s elevator
Turbinectomy scissors
Ballenger’s swivel knife
ENDOSCOPE/TELESCOPE
Rigid, different angles – colour coded(green, red, black &
yellow), has lens, eye piece & light carrier.
Adult – 4mm diameter, paediatric 2.7mm; 18cms
Diagnostic nasal endoscopy, laryngoscopy & otoscopy.
Endoscopic nasal surgery, endoscopic skull base surgery,
endoscopic ear surgeries.
Blakesley forceps
Straight, 45 upturned, 70
upturned.
Used in nasal surgeries,
biopsy forceps, foreign
body removal
Backbiting forceps
Used in uncinectomy
Luc’s forceps
Used in septoplasty, SMR,
biopsy, foreign body removal
Turbinectomy scissors
Used in turbinate resection,
conchabullosa excision,
septoplasty & SMR
Ballenger’s swivel knife
360 rotating blade
Used in shaving the
septum in SMR
FREER’S ELEVATOR
Double ended, available in various sizes
Usually one side sharp & other side blunt.
Used to elevate mucoperichondrial & mucoperiosteal
flap in septoplasty & SMR; uncinectomy, during
harvesting temporalis fascia graft, elevate periosteum of
EAC, reduction of fracture nasal bone, lateralise IT,
elevate mucosa during caldwell luc surgery.
KILLIAN’S NASAL GOUGE (BAYONET-
SHAPED).
Used for removal of septal spurs
or bony crests and ridges in SMR
operation.
FISHTAIL NASAL GOUGE
CHISEL – previously used for
mastoid surgeries.
MALLET
LICHTWITZ TROCAR AND CANNULA.
Used for proof puncture (antral
lavage).
Puncture is done in the inferior
meatus as this site is easily
accessible and safe.
TILLEY’S HARPOON.
Used for INA in the IM.
Its advantage lies in the removal
of the bony chips when the
instrument is withdrawn so that
they do not fall in the sinus cavity.
TILLEY’S ANTRAL BURR.
Used to enlarge and smoothen the
hole made by harpoon in INA.
WALSHAM’S & ASCH’S FORCEPS
Walsham’s forceps used to disimpact and reposition
fracture nasal bone
Asch’s forceps used to disimpact & reposition fracture
nasal septum
Difference - Walsham’s forceps is straight & asch’s
forceps is angulated.
EAR INSTRUMENTS
Mollison’s mastoid Lemperts endaural
retractor speculum
Jansen’s self-retaining Hartmann’s aural forceps
mastoid retractor Rosen’s knife
Lempert’s endaural Plester’s knife
retractor Gardiner Brown tuning
Farabeuf’s periosteal fork
elevator
Myringotome
House micro ear curette
MOLLISONS MASTOID RETRACTOR
Self retaining & haemostatic
Retracts skin & soft tissue
during ear surgeries
Uses – temporalis fascia graft
harvesting, mastoidectomy,
posterior canal retraction,
cochlear implantation
Other uses – laryngofissure,
borehole craniotomy, external
ethmoidectomy, tracheostomy
FARABEUF’S PERIOSTEAL ELEVATOR
Straight & curved
Used for elevation of
periosteum from the
mastoid cortex
MYRINGOTOME
Used for myringotomy
Pointed tip & 2 sharp edges
Indications of myringotomy
HOUSE MICRO EAR CURETTE
Used to remove bony edges in stapedotomy &
mastoidectomy
Rosen’s knife/round knife
Used to give curvilinear
incision 4-7mm lateral to
annulus
Plester’s knife/Flag knife
Used to give linear incision
at 6 ‘0’ clock & 12 ‘o’ clock
from annulus to rosen’s
incision
TRACHEOSTOMY TUBES
Portex
tracheostomy
tube
Double
lumen tube
Jackson’s
tracheostomy
tube
Armoured
tracheostomy
tube
RIGID ESOPHAGOSCOPE
Metal tube with markings
Handle, at the proximal end of oesophagoscope, indicates
the direction of the bevel at the distal end.
Proximal & distal illumination
Marking on scope indicates distance from the upper
incisors.
Technique of insertion
Indications – usually therapeutic – removal of f/b,
insertion of stent, dilatation of web/stenosis.
C/I & complications – cervical spondylosis, instability of
cervical spine, esophageal perforation.
