Ear vectis with cerumen spud
This instrument has a ring vectis on one end and a blunt curette on the other. This is used to
Remove wax from external ear
To remove foreign body from the ear
To remove foreign body from the nose
Thuduchim’s nasal speculum
Thudichum’s nasal speculum is commonly used to visualize the nasal cavity. It is usually held in the non dominant hand leaving the dominant hand free for manipulation. This 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 intra nasal structures.
This instrument was designed and developed by John Louis William Thudichum a German born physician and Biochemist who settled down in London. His main contribution is towards the development of neurochemistry.
Uses of Thudichum’s speculum:
In anterior rhinoscopy
Foreign body removal from the nose
Peroperative nasal packing
In septal surgeries to make incision
The instrument is held in the non dominant hand at its bend with the thumb and index finger. The middle and ring fingers are placed on either side of the limbs of the speculum. When the fingers are brought close to each other then the flanges of the speculum also come close together. The instrument is ideally inserted in a closed position. When the middle and ring fingers are held apart the flanges will go apart widening the nasal cavity. It is not possible to examine the vestibule of the nose using this speculum. It can be done just by lifting up the tip of the nose.
John Louis William Thudichum
Aural syringe
Simpson’s Aural syringe
Reiner Alexander aural syringe. This is more or less similar to Simpson’s syringe but for the presence of shield. This shield just behind the nozzle prevents water from the patient’s ear soiling the doctor. This shield will redirect water from the ear to the kidney tray held underneath the ear.
Aural syringing:
This procedure helps in
- Removal of wax from the ear
- Clean up the external auditory canal fungus
- To remove non hygroscopic ear foreign bodies
The capacity of aural syringe is about 120 ml or 4 ounces. Aural sryinges are commonly manufactured as metal syringes which can be sterilized and reused. Plastic disposable aural syringes are also available.
Temperature of water used for syringing should be of body temperature. It should neither be too hot nor too cold. Temperatures lesser / greater than that of body temperature would stimulate the labyrith causing giddiness.
While syrining the nozzle of the syringe must be directed towards the roof of the external auditory canal and should not be directed towards the posterior canal wall because it could stimulate vagus nerve which innervates the posterior canal wall. Stimulation of vagus nerve could cause giddiness and fainting of the patient.
Precautions to be taken before aural syringing:
Full clinical history should be obtained from the patient which include:
H/O
Pain in the ear or surrounding area
Hearing deficit
Dizziness
Ear problems during childhood
Tinnitus
Allergies / itching / discharge
Any other ENT problems
Any previous history of ear syrining and its effect on the patient
Procedure:
The patient should be comfortably seated in front of the examiner.
The procedure should be explained in detail to the patient.
If the patient is a child then its confidence should be won by allowing the child to handle the syringe prior to use
The patient should be properly draped with water proof sheets to avoid dress from becoming wet.
The patient should have used cerumen softeners adequately
The pinna should be inspected for lesions / discharge
The auricle should be moved up and down to check for presence of tenderness
Press behind and around the ear to check for tenderness
The syringe should be filled with warm water which is at body temperature (37 degrees centigrade)
Check to ensure that the nozzle is tightly secured
If using propulse air should be expelled from the tubing
Instruct the patient (if able) to hold the kidney tray under the ear. This will enable the patient to take his / her attention away from the procedure. If the patient is not able to do it then assistance can be sought for.
Straighten the ear canal while controlling the water jet. The nozzle should be aimed upwards and backwards. Water should stream along the roof of the meatus and flow out along the floor of the external meatus.
Lowest effective pressure should initially be used (pilot syringing). If the patient is comfortable then pressure can be increased
The external canal and the kidney tray should periodically be inspected during the entire process.
It is advisable not to use more than two aural syringes full of water in a single procedure. The procedure should not last for not more than 2 minutes.
After wax and debris has been removed the ear canal is mopped dry using cotton wisps.
The procedure should be stopped if the patient has discomfort or pain
The patient’s ear should be checked before sending home.
Contraindications for aural syringing: - Ear drum perforation
- Recent history of middle ear infection
- In the presence of otitis externa
- In the presence of hygroscopic foreign bodies