ENT INSTRUMENTS

Instruments in the Throat

Boyle Davis Mouth gag with tongue
blade
 Indications:

1. Tonsillectomy
2. Adenoidectomy
3. Surgery of the hard and soft palate
Doughty Tongue Blade

 Accommodate the ETT without compromising the air

flow and keep tube away from dissection plane
Draffin Bipods Plate

 Anchor and fixture of Boyls Davis

mouth gag for numerous oropharyngeal
operations
Magauren Plate

 Stabilize the Draffin Bipods stand on the patient tabel

St. Clair Thompson adenoid curette
with cage
 Used for blind adenoidectomy
 Cage used for preventing excised tissue from falling into
throat
Beckmann Adenoid Curette without
Cage
 Remove the adenoid tissue remnant after adenoidectomy

 Removal tubal tonsils without injury of Eustachian tube

opening
Adneoid Through Cut Forceps

 Remove the adenoid remnant

Dennis Browne Tonsil Holding Forceps

 Used to pull the tonsil medially during dissection

 Differ from Luc Forceps:

1. The edges of the jaw is smooth and not injury the tissue
2. Upper jaw is smaller than lower jaw
3. Tip has box mechanism
St. Claire Thompson Adenoid tag
forceps
 Remove adenoid tags in the adenoid ped after
Adenoidectomy

 Remove postnasal pack

Muck Forceps

 Hold and traction of the tonsil medially during dissection

 Specially for atrophic and fibrotic tonsil

 Gwynne Evan Tonsiller Dissector

 Used for dissection of tonsils from the bed

 2 ends :
 Blunt end: smooth dissection of tonsil and obtain the
proper plain
 Serrated End: to cut the tissues connecting to tonsils
from upper pole, pillars and tonsiller bed till reaching the
lower pole
Mollison Tonsiller Dissector and Pillar
retractor
 Blunt end used for atraumatic dissection and retractor
used to elevate anterior pillar during dissection
 Eve Tonsiller Snare

 Snare the lower pole after dissection ,,,, crushing and

thromboplastin released
 Birkett gently curved first artery
forceps
 Used to catch bleeding points in the tonsiller fossa after
dissection
 Negus Second Artery Forceps

 Used after (birkett 1st artery forceps) for ligation of the

bleeding points in the tosiller fossa
 Negus knot tie and ligature pusher

Used to push the ligature knot

over Negus artery forceps
 Waugh Tenaculum Foceps

Used for dissection ,,, single

tooth to incise the anterior
piller
 Yankauer Suction Tube

Used for suction in all

oropharyngeal surgeries and
neck surgeries
 Irwin Moore Tonsiller piller Suturing
needle
Used with needle to suture ant.
And post. pillars
 Lac Tongue Depressor

Examination of Oral and oropharynx

Cold spatula test (assess nasal
obstruction
Test gag reflex
Retract lip and cheek to examine
gingiva
Oral Cavity procedure (injection of
steroids, biopsy)
 St. Claire Thompson Quinsy Forceps

Used to drain Quinsy ,,, enter

with forceps closed then open
to drain
 Doyne Mouth Gag

Glossectomy
Softpalate and floor of mouth
surgeries
Tongue tie release
Dental Surgeries
Caldwell luc procedure
To get airway in unconscious patient
Instruments in the Ear
 Jobson-Horne ear probe with ring
curette
2 ends (serrated probe & ring)
Removal of wax
Removal of FB
Removal of Granulation
Probing polyp in nose or ear
Probe act as cotton swab to clean
or give medications
 Ear Vectis with Cerumen spud

Removal of wax and foreign

bodies
 Hartmann Aural Forceps

Has serrated end (spade like)

Removal of wax or foreign
body
Delivering dressing and
medication into ear canal
 Tilley Aural Forceps

With serrated end

Packing or unpacking of ear and
nose
Removal of FB (ear, nose)
Removal of crusts
Delivery of medicated gauze
inside the ear canal
 Troeletsch Aural Forceps

Pack and unpack spaces and

cavities
Both ear and nose
 Lucae Curved Aural Forceps

Bayonet Shaped aural forceps

The bayonet shaped ensure
unobstructed field during the
procedure
 Hartmann Tuning Fork
Parts( 2 prongs, shoulder, stem & base)
Different frequencies (128,256,512,1024)
512 Hz is common used:

1. Present in the mid-speech frequency range

2. Overtones are minimal.
3. Sound is more auditory than Tactile.
4. Tone Decay is optimal

Uses:

1. Detect type of hearing loss.

2. Make an approximate of the HL degree
 Siegel Pneumatic Speculum with bulb

Parts:

1. Rubber bulb
2. Rubber Tube
3. Aural Speculum
4. Eye piece with oblique convex lens

Uses:

1. Testing mobility of TM (Siegelization)

2. Fistula Test
3. Examiantion of the EAX and TM
 Simpson Aural Syringe
Uses:

1. Removal of wax
2. Removal of Non-hygroscopic foreign body ear

Contraindications:

1. TM perforation
2. CSF Otorrhea
3. Otitis externa
4. Large Hygroscopic Foreign body
5. Thinned or atrophied TM

Complications:

1. TM Perforation
2. Injury to EAC
3. Vasovagal attack
4. Vertigo due to stimulation of the labyrinth
 Barany Noise Box

Produce noise to the non-tested ear

(masking) during the tuning fork
test
 Aural Speculum
Uses:

1. Examination of EAC & TM

2. Removal of FB
3. Operative Procedure (Myringotomy, Myringoplasty,
Stapedotomy)
4. Transcanal injections

Types:

1. Hartmann: broad end to easily grip

2. Holmgren self-retaining: ear surgeries.
3. Rosen: split to facilitate canal injections
4. Tumarkin: Split for ear canal injections
5. Shea
 Politzer Myringotome

Used to make antero-inferior incision

in the tympanic memberane
For Acute otitis media
(circumferential) or Otitis media with
effusion (Radial)
 Ventilation Tubes A

Mechanism of Extrusion: the centrifugal peripheral migration of

the external tympanic memberane push the tube to peripheral before
extrusion B

Types:

A. Sheehy grommet: fibroplastic with identical flanges ,, short term

grommet. C

B. Goode T tube: long-term ventilation tube ,, soft flanges facilitate

removal
C. Shepard Grommet:fibroplastic with small inner flange for short
term use
D
D. Shah Grommet: shoehorn type in facilitate insertion in small
incisions and resist extrusion.
 Grommet Introducer
Materials used in grommet:
1. Fluoroplastic: non-sticky surface that reduce
adhesions on the tube. Rigid material and
easily introduced. Provide biocompatibility.

2. Silicone: soft material that is easy to

manipulate. It has proven biocompatibility.
Can be compressed easily to aid insertion
while it still retains its shape
 Micromotor Unit for Drilling

Parts (Console, wire, footswitch &

micromotor)
Uses:

1. Drilling mastoid and ear canal

2. Driling choanel atresia and DCR
3. Mandibulectomy
4. Caldwell-luc operation
A. Micromotor drill straight
handpiece: to anchor the burr for
drilling
B. Contrangle Handpiece: angled to
avoid obstruction of the operating
field
 Verhoeven ear microsuction tip

For suction during operation under

the microscope
Safe to be used beside vital structure

Microsuction Tip Adaptor

 Farabeuf Mastoid Periosteal Elevator
Parts: (handle, neck, thumb rest and broad tip)

Uses:

1. Elevate periosteum over mastoid bone

during mastoidectomy
2. Elevate soft tissue during Caldwell-luc
procedure
3. Elevate periosteum and soft tissue during
maxillectomy
 Mollison Self-retaining Retractor

To retract tissue and fascia from the

surgical field and assist in hemostasis
Uses:

1. Mastoidectomy & Tympanoplasty

2. Tracheostomy & Laryngofissure
A. Plester Mastoid Retractor: separate for right &
left ear ,,, 3 identical prongs with middle tall one
to push EAC skin anteriorly

B. Weitlander Prolonged Mast. Retractor: 3X4

prongs with long arm

C. Mahadevaiah mastoid retractor: retractor with

conical shaped blade to be inserted inside EAC
and anchor skin to avoid slipping. Used in
transcanal & Endaural
 Lempert endaural speculum

Used for injection of the Ear canal

skin and making incisions (endaural
surgeries)
 Lempert mastoid suction tube

Differentsizes
Has a thumb rest with vent to control
power of suction
A. Cutting Burr: burr tips with groove and
sipes on its body. Fewer sipes more bone
removed. Cutting by side not tip. Made
up of steel, titanium or tungsten carbide

B. Diamond polishing burr:

used over delicate structure (VII or
sigmoid sinus)
Polishing surface after using cutting burr.
Stop bleeding from bony surfaces by
clogging the vessels with bony dusts.
 House graft press forceps

Press and shape the graft (cartilage,

vein graft or fascia) before using it in
surgeries
A. Lempert Mastoid Curette: remove
bone EAC and also removing
granulations and cholesteatoma
B. MacEwen cell seeker & Curette:
probe to direct antrum and curette to
remove bone
C. House Ear Microcurette: removal
of bone (small fragments) beside the
vital structure (VII and Ossicles
 Micro ear Pick (Stright, curved)
(Cowthorne)
USES:

1. Clear granulation tissue and

tympanosclerosis
2. Freshening of edges during tympanoplasty
3. Stapedotomy
4. Myringotomy and grommet insertion
5. Facial nerve decompression
6. Spread of graft during tympanoplasty
 Paperella Duckbill Micro ear elevator

Uses:

1. Removal of granulation tissue

2. Elevation of tympanomeatel flap
during tympanoplasty
3. Remove bone covering facial nerve
during VII decompression
 Micro ear Sickle knife

1. Freshening of edges of TM
2. Dislocation of Incudostapedial joint during
Stapedotomy
3. Skeletonization of handle of Malleus
4. Incision of VII sheath during decompression
 Plester Flag Knife

Used in making horizontal incision in

the EAC and elevation of
tympanomeatel flap during
tympanoplasty
 Rosen Micro Ear Round Knife

Incision and elevation of

Tympanomeatel flap
Freshening of the edges
Break middle ear adhesions especially
between malleus and promontory
Clear granulation tissue and
cholesteatoma
 Alligator Forceps

Hold and transfer graft materials.

Hold grommet, Teflon piston, PORP
and TORP
Hold and transfer gel foam to inside the
middle ear
 Wullstein Cubbed Forceps

Remove granulation tissue,

cholesteatoma and tympanosclerotic
patches
Taking biopsy from middle ear
Hold & transfer ossicles
 Straight Micro Ear Scissors

Cut stapedius and tensor tympani

tendon
Cut adhesions in the middle ear
Freshening of edges in the tympanic
memberane
 Stapedectomy piston measuring rod
(Three markers)
Measure distance from underlying
foot of stapes to midpoint of incus
Three spikes from lower end (3 ¼- 3
½-3 ¾)
 Stapes Piston measuring jig

Used to cut the exact length of piston

after measuring distance using the rod
(footplate of stapes to mid-point of
incus)
 Stapedectomy Perforator bur straight

Make and accurate perforation into

the footplate of stapes
 Ossicular Implant (Ossiculoplasty)
Natural: Bone or Cartliage (Allo or autograft)
Biomaterials used for TORP/PORP:

1. Hydroxyapatite: dense variety resemble normal bone, resist

degradation and provide good sound conduction. Can be reshaped.
2. Titanium: light weight material, biocompatible.
3. Platinum: non-corrosive, biocompatible and non-magnetic
4. Fluroplastic (Teflon): excellent sound conduction, non-sticky (no
adhesions), biocompatible
5. Gold: Malleable and biocopmatible
 Partial Ossicular Replacement Prothesis
(PORP)
A. Teflon: thick shaft on the stapes
head and head on the graft.

B. Titanium
 Total Ossicular Replacement Prosthesis
(TORP)
A. Teflon: Prothesis has a head placed
over the graft and thin shaft placed
on the footplate of stapes

B. Titanium:
 Stapes Piston
A. Fisch Titanium Stapes Piston: available in
various sizes used in stapedotomy

B. Causse Teflon Stapes Piston: loop of piston

made of fluoroplastic (Teflon) with variable
size of diameter (0.4-0.8mm). Length
adjusted using measuring rod and jig.
 Frenzels Nystagmus Spectacles

Used to detect nystagmus in the

patient

Prevent visual fixation of the

image.
Behind the Ear (BTE) Hearing Aid

Receiver in the canal

 In The Ear HA (ITE)

Fills
the concha
More cosmetic
For mild to moderate HL
 In the Canal HA (ITC)

Inside the ear canal not

projecting into the concha
For mild to moderate HL
 Completely in the Canal HA (CIC)

Completely inserted inside the

canal with small antenna
projecting outside for easily
removal
 Contralateral Routing of Signal HA
(CROS)
Microphone sitting in the deaf
ear and the sound transmitted
to receiver in the better ear
For Unilateral Profound HL
 Bone Anchored Hearing Aid (BAHA)

Indications:

1. External ear malformation (Microtia/canal atresia)

2. Chronic discharging ear
3. Conductive hearing loss not improved on
conventional HA

Parts:

1. Screw
2. Abutment (Titanium)
3. Ear level sound processor
 Middle Ear Implant (Vibrant Sound
Bridge)
Semi-implantable device
Internal surgically implanted part (Vibrating
Ossicular Prothesis VORP) under the skin and
external audio processor.
VORP contain receiving coil, conductor link &
Transducer.
Floating transducer coupled to long process of Incus
For serviceable hearing patient with problem in
conduction of sounds
Audiometry
Tympanometry
Otoacoustic Emission
 ABR Electrodes
Non-inverting electrode(high forehead): that picks
up wave (III-V) ,,,

Inverting electrode ipsilateral ear lobe to detect wave

I

Ground electrode on lower forehead or cheek or

shoulder

The distance between electrode wires and transducers

to avoid possible stimulus artifact on ABR Waves
 EcoG (Electrocochleography)
The recording device was the
Vivo Sonic Integrity and TIPtrode
electrodes were inserted in the external
auditory meatus.
 -ve electrode: in the stimulated ear
 +ve Electrode: in opposite ear
 Ground Electrode: Forehead
 Vestibular Evoked Myogenic Potential
(VEMP)
Reference (-ve) electrode: on ipsilateral top of
SCM to detect myogenic potential

Active (+ve) electrode: on Sternum

Ground Electrode: on Forehead

The patient instructed to move the head opposite

to direction of sound stimuli to contract SCM
Instruments in the Nose
 Thudicum Nasal Speculum

Diagnostic: Ant. Rhinoscopy

Therapeutic: Removal of Foreign

body
 St. Clair Thompson nasal speculum

Longer blade to visualize more

Used in Surgeries:
1. Septoplasty
2. Polypectomy
3. Removal of Deep FB
 Nasal Speculum

Kilian Nasal Speculum

Pilcher Nasal Speculum

 St. Clair Thompson Posterior
rhinoscopy mirror
To examine the postnasal space after
adenoidectomy to ensure removal of
adenoid remenants
 Freer Double ended Mucoperichondrial
elevator
Elevate mucoperichondrial flap in septal
surgeries
Displacement of inf. Turbinate during
Antrostomy
Uncinectomy
Elevation of mucoperiosteal flap in ear
surgeries
Elevation of mucosa in Caldwell-luc surgery
 Septal Aspirating Elevator (Suction
Elevator)
Suction of blood during elevation of
flap in septal suregery
Howarth nasal septal elevator
 Nasal Gauge

Killian Bayonet shaped nasal Gauage ,,

usage:
1. Removal of maxillary crest
2. Opening of Canine fossa in Caldwell-luc
procedure

TilleyNasl Gauage (V-shaped for better

anchoring of maxillary crest
Heath Mallet
 Splints
Internal Nasal Splint

Septal Internal nasal splint with

airway

Septal Button
 Rigid Endoscopes

0 degree : Green

30 degree : Red

45 degree: Black

70 degree : Yellow

 Tilley Lichtwitz Antral Trocar and
Cannula
 Tip of the cannula is carfully passed underneath inf. Turbinate and penetrate
2 cm behind the ant. End of inf. Turb.
 Indications:
1. Diagnostic: obtain fluid for microbiology
2. Therapuetic: to remove secretions in acute infection

 Complications:
 Contraindications:
1. Bleeding
2. Misplacement into cheek (swelling, pain &emphysema 1. Bleeding Disorders
2. Age below 3 years
3. Penetration orbital floor (proptosis & periorbital swelling) 3. Acute maxillary Sinusitis
4. Infection
5. Damage to NLD (epiphora)
6. Air embolism
 Killian Curved nasal suction tip

For maxillary sinus

 Microdebrider
Microdebrider Console
Microdebrider Handpiece
Microdebrider detachable blade and
its tip
 Nasal Endoscopic Sickle Knife

In uncinectomy

Opening of Concha Bullosa

Mucosal incision during endoscopic

DCR
 Sinus Ostium ballpoint probe

Locatemaxillary and sphenoid sinus

opening

Delineate and resect the Uncinate

process

Identify the consistency of nasal mass

 Forceps in FESS
Blackesley Weil straight cupped forceps

Blackesley Through cut forceps

Blackesley weil 45 upturned forceps

Nasal Endoscopic Scissors
Cut and resect any tissues,
conchoplasty, trimming of inf. Turb.

Ostrum Backbitting Forceps

Uncinectomy and widening MMA

TilleyHenckel forceps (larger tip and

markings on the upper surface
 Stammberger Mushroom punch forceps

Straightforceps to open anterior wall

of sphenoid sinus

Upward turned forceps for frontal

recess surgery
 Kerrison Rongeur

Removal of lacrimal bone in DCR

Opening of sphenoid sinus
Removal medial wall maxilla
Caldwell-luc procedure
 Balloon Sinuplasty
Sinus Balloon Catheter
Sinus Balloon inflation Catheter
Sinus Guide Catheter
Flexible Sinus Guide wire
Heymann Turbinectomy Scissors

Higginson Syringe
Capacity 50 ml
For (Antral wash and nasal douching)

Nasal probe for submucous diathermy

1. Shrink enlarged turbinate
2. Control bleeding point
3. Burn a stalk of a mass of rhinosporidiosis
Instruments in the Larynx – Trachea -
Oesophagux
 Bronchoscope
A: Proximal attachment (glass window,
Bridge & telescope)
B: Bridge (between bronchoscope &
Telescope)
C: Fiberoptic connection
D: Prismatic light deflector
E: Side attachment (injection cannula or
suction catheter)
F: Guide for suction catheter
G: Ventilation connection
Hopkins Optical Forceps for
Bronchoscope

Hopkins Optical telescope for

Brochoscope : length 30 cm and
diameter 4mm
1. Adult Oesophagoscope: Long rigid
hollow (40-45 cm) parts:
1. Handle
2. Eye piece (proximal end)
3. Body shaft
4. Light carrier
5. Distal opening
2. Hypopharyngoscope: similar to oes.
But shorter (29 cm) the distal end not
narrower than proximal like Oes.
 Laryngoscopes
Hollinger Anterior
Commissure scope
Macintosh Laryngoscope

Rigid Telarygopharyngoscope: 90
degree
Magill Forceps
 MLS
Kleinsasser Suspension Laryngoscope
for MLS

Kleinsasser Anterior
commissure
operating Laryngoscope

Riecker Chest piece and jack for MLS

 Pharyngeal Pouch

Weerda Diverticulosocpe

Pharyngeal pouch endoscopic stapler

 Tracheostomy Set
Cricoid Hook

Trousseau Tracheal Dilator

Singer Laryngectomy Tube : to
prevent stomal stenosis
 Voice Rehabilitation
Trocar and Cannula for secondary
TOP
Pharynx Protector for secondary TOP
Provox Voice Prosthesis
Provox Prosthesis Inserter
Speech Valves
General Instruments
1. Bulldog Clamp: Temporary ligation of
big vessels
2. Allis Forceps
3. Babcock Forceps : hold cysts & Glands
4. Kocher Forceps
5. Metzenbaum Dissection Scissors
1. Joll Thyroid Retractor

2. Kocher Thyroid Retractor

(especially upper pole)

3. Surgical Stapler