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JNT-Book-May-Aug The Journal of Nursing Trendz IndianJournals.com Vol. 9, Issue 2, May - August 2018, pp-36-39 DOI: 10.5958/2249-3190.2018.00032.9 TECHNOLOGY AT FINGER TIPS: ENT INSTRUMENTS. Kavitha M., Reader MMM College of Nursing, Chennai. Introduction introduced into the mouth and gently slide under the 1. Head Mirror. uvula. The mirror is tilted to get good view of the larynx. The patient is asked to say “eee”. The Description: It consists mobility of the vocal cord can be tested. This of a circular concave mirror, instrument has a handle, shaft and a plain mirror at an with a small hole in the angle. The focal length of this mirror is at infinity. The middle, and is attached to a mirror is available in various sizes ranging from 8 mm head band. The mirror is to 30 mm. worn over the physician's Uses: to visualize base of the tongue, epiglottis, eye of choice, with the pharyngoepiglottic folds, vocal cords, pyriform fossa, concave mirror surface tracheal rings and other parts of the larynx. facing outwards and the hole directly over the physician's eye, providing 3. Heath Mallet illumination like a ring light. The focal length is 8''. D e s c r i p t i o n : T h i s Diameter of the concave mirror is 4”. In use, the instrument appears like a patient sits and faces the physician. A bright lamp is hammer and is used along with positioned adjacent to the patient's head, pointing a gouge, chisel or osteotome. toward the physician's face and hence towards the The gouge is to be hit by a head mirror. The light from the lamp reflects off the mallet with movement at the mirror, along the line of sight of the user, with the light wrist during septal surgery. being somewhat concentrated by the curvature of the Uses: This instrument is mirror. When used properly, the head mirror thus part of the tonsillectomy set. Mouth gags are used to provides excellent shadow-free illumination. keep the patient's mouth open during oral surgery, 2. Indirect Laryngoscope. leaving both hands of the surgeon free to operate. It is D e s c r i p t i o n : T h e also used during mastoidectomy to open up the mirror used is plane mirror mastoid antrum. with a long handle. It is held 4. Tilley antral harpoon. like a pen in the dominant Description: It is an instrument used to hand with the mirror make an opening in the medial wall of the pointing downwards. The maxillary antrum. It is held like a dagger in mirror is warmed with a one hand and the index and thumb of the spirit lamp, the temperature other hand are used for an adequate fulcrum. is tested on the back of the It has one antegrade pointing tip and three hand. This is done to prevent retrograde pointing tips. While the fogging of the mirror. The patient is asked to protrude instrument is removed, a piece of bone could come the tongue and it is held with gauze. The mirror is out thereby enlarging the antrostome. The Journal of Nursing Trendz Volume 9 / Issue 2 / May - August 2018 36 Uses: Intranasal antrosotmy, removal of chip of 8. Alligator/ crocodile forceps. bone. Description: This 5. Eve's tonsillar snare. instrument is available Description: The a s s t r a i g h t ( A ) , snare has a stainless steel downturned (B) or wire which is usually 3 upturned (C) forceps. i n c h e s l o n g w i t h a A l s o k n o w n a s thickness of 28 gauge. It is crocodile forceps. used to snare the lower Variation: If tip has cups, teeth or scissors then pole of the tonsil after they are known as Wullstein cupped/toothed dissection. The lower pole is crushed on snaring and alligator forceps and micro-ear scissors respectively. thromboplastin is released which is a powerful Uses: to hold fascia, foam gel, cotton ossicles vasoconstrictor. etc during surgery. It also used to take biopsies Uses: To crush and cut the lower pedicle of the through an endoscope and removal of foreign body, tonsil. oral packing, nasal packing etc. 6. Doyen mouth gag. 9. Janson bone nibbler. Description: It is a self- Description: It is used to nibble retaining mouth gag used to bone pieces and fragments during open the mouth by anchoring maxillectomy, lateral rhinotomy and on the teeth. Caldwell-Luc operation. Uses: To keep mouth open for intra oral surgery 10. Heymann turbinectomy forceps. when retraction of tongue is not required. In Description: This unconscious patients to open the mouth and prevent instrument is bent obtusely airway obstruction at the centre and has 7. Tonsillar Dissector. narrow blades with blunt D e s c r i p t i o n : T h e tip and works in the tonsillar dissector is a long and vertical plane. thin instrument that is used to Uses: a. Partial or separate the tonsil from its bed in the dissection total turbinectomy. b. Cut the cartilage in septal method of tonsillectomy. While one end is flattened surgeries. out like a blade, the other end is serrated. The handle is 11. Jenkin mastoid gouge. round and corrugated to provide a firm grip. This permits increased traction if necessary. Description: A gouge is an instrument with a curved rounded tip Uses: Tonsillectomy: The flat end is used for that has smooth beveling. It cuts bone sharp dissection while the serrated end is used to in a circular pattern. It is held at an release the connective tissue holding the tonsil to its acute angle to the bone for cutting it bed. and a mallet is used for hitting on it. The serrated end is also useful in other surgeries The gouge has been replaced by the like the removal of cysts when connective tissue has electrical drill in the present day. to be separated from the cyst wall. Uses: a. Remove hard bone during The instrument is also useful in separating mastoidectomy. b. Caldwell-Luc operation. c. periosteum from bone in some surgeries. Excision of exostosis in external auditory canal. The Journal of Nursing Trendz Volume 9 / Issue 2 / May - August 2018 37 12. Lempert mastoid curette. Uses: The Killian's nasal speculum is used in: Description: Anterior rhinoscopy. Uses: To curette chunks of bone from Anterior nasal packing. mastoid and ear canal during ear surgeries Septoplasty. like tympanoplasty, mastoid exploration or Polypectomy. stapedotomy. Removal of granulation tissue Nasal foreign body, rhinolith removal. and cholesteatoma. Turbinate reduction surgeries. 13. Aural speculum. b) Thudichum's nasal speculum: The Description: There are instrument has two flanges several types of aural that can be inserted into the speculum. nostril during anterior a. Holmgren adjustable rhinoscopy. The flanges aural speculum: This is a self- widen to open up the nasal retaining adjustable aural speculum with a screw. cavity, offering a better Used for examination of ear and ear surgeries. view of the structures b. Hartmann aural speculum: This is a funnel inside the nose. shaped speculum that has no slit on the body. The Uses of the Thudichum's nasal speculum: broader end is thickened for better grip. In anterior rhinoscopy. c. Rosen aural speculum: This is an aural Foreign body removal from the nose. speculum with an incomplete slit on its body. The slit Nasal packing, antral wash. is useful for injections on the external canal wall with the speculum in place. In septal surgeries. d. Shea aural speculum: This aural speculum 15. Posterior rhinoscopy mirror. resembles Hartmann aural speculum. However, the This instrument has a bayonet shaped handle narrow end of this speculum is beveled. (Which differentiate from e. Tumarkin aural speculum: This aural indirect laryngoscopy speculum has a complete split on its body to facilitate mirror), so that the intra-aural injections into the external canal. examiner's hand does not block his vision. The mirror Uses: Examination of the external ear canal and is available in sizes of 0 to 5 tympanic membrane. Removal of wax, foreign body, and should be of an appropriate size to pass behind otomycosis or ear discharge. Transcanal injections. beyound soft palate and reflect sufficient light for the During operative procedures like myringotomy, structures to be seen. This is a plain mirror and does myringoplasty, stapedotomy, stapedectomy. not magnify the image. 14. Self-retaining nasal speculum. Uses: to examine naso pharynx and posterior a) Killian's Nasal Speculum: A screw in the part of the nose. handle can be tightened to hold 16. Jobson-Horne Ear Probe. the blades of the speculum in the open position. This gives Description: This instrument is used the speculum its self-retaining to remove wax and foreign bodies from the feature, very useful during ear. One end of this instrument has a ring septal surgery. vectis while the other end has a blunt curette. The Journal of Nursing Trendz Volume 9 / Issue 2 / May - August 2018 38 Uses: Ear wax removal, removal of foreign 20. St. Clair Thomson Adenoid Curette. body from the ear, removal of discharge from the Description: The external auditory canal, probing of aural polyp or instrument has a strong other mass in the ear canal, probing of nasal masses handle, a shaft and a and checking their sensitivity to touch. curette at the tip. The curette itself is a curved, square 17. Myringotome. window that allows for the tissue to engage in it. D e s c r i p t i o n : T h e Uses: adenoidectomy.
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