INSTRUMENTS USED IN EAR EXAMINATION

Dr. Aparaajita Mundra

Assistant Professor
Department of E.N.T.
MGMMC and M.Y.H.,Indore
Bull’s Eye Lamp
• This consists of a metal box
within which a bulb is kept.
• The light rays come out
through a central opening in
the box.
• The lamp is placed 30 cm
behind the left ear of the
patient. The lamp is adjusted
to focus the rays on the head
mirror.
• It is also used for
examination of throat
(Indirect Laryngoscopy) and
nose(Anterior rhinoscopy).
 Head Mirror
• It consists of a plastic headband to
which an adjustable concave mirror
with a central hole is attached.
• The diameter of the mirror is 9 cm
while that of the central aperture is
2 cm and the focal length of the
mirror is approximately 18 cm.
• When parallel rays of light from the
Bull’s lamp impinge on the
concave mirror,the light rays
converge at the focal point of the
mirror.
• Used to focus light from the bull’s
lamp.
 Jobson-Horne ear probe with ring curette
It has two ends. One end has a serrated probe and the other
end has a ring.

Uses:
a. Removal of wax
b. Removal of foreign body in the ear and nose
c. Removal of granulations in the ear
d. The probe end is used to probe polyp in the nose
and ear
e. The probe end can act as a cotton swab carrier
and can clean the ear or apply medication.
Tuning forks:
• Parts:
a. Two prongs 256 Hz
b. Shoulder
c. Stem
d. Base 512 Hz
e.Footplate

It is available in various frequencies- 256 Hz, 512 Hz,

1024 Hz.

1024 Hz
Common Types:

Hartmann’s Tuning fork Gardiner’s Tuning Fork

Tuning Fork Tests

Rinne’s Test: In this test, Air conduction

of the ear is compared with its bone
conduction. A vibrating tuning fork is placed
on the patient’s mastoid and when he stops
hearing, it is bought beside the meatus. If he
still hears, AC is more than BC. Alternatively,
the patient is asked to compare the loudness of
sound heard through air and bone conduction.
Rinne test is called positive when AC is longer
or louder than BC. It is seen in normal persons
or those having sensorineural deafness. A
negative Rinne (BC>AC) is seen in conductive
deafness. A negative Rinne ondicates a
minimum air-bone gap of 15-20 dB.
 Weber’s Test
In the Weber test a vibrating tuning fork, is placed in the middle of the forehead,
above the upper lip under the nose over the teeth, or on top of the head equidistant
from the patient’s ears on top of thin skin in contact with the bone. The patient is
asked to report in which ear the sound is heard louder.
A normal Weber test has a patient reporting the sound heard equally in both sides.
In an affected patient, if the defective ear hears the Weber tuning fork louder, the
finding indicates a conductive hearing loss in the defective ear. Also in the affected
patient, if the normal ear hears the tuning fork sound better, there is sensorineural
hearing loss on the other (defective)
 Absolute Bone Conduction(ABC) Test

In this test, patient’s bone conduction is

compared with that of the examiner
(assuming that he/she has a normal
hearing).
EAC is occluded by pressing the tragus
inwards, to prevent amient noise entering
through AC route.
Inference:
• Normal- Bone conduction of patient is
equal to examiner.
• In SNHL- ABC is reduced as compared
to examiner
 OTOSCOPE:
• It is a hand-held battery
operated instrument.
• It has a convex lens which gives
a magnification of two times.
• It has a fiberoptic light
conveyance system for delivery
of light to the aural speculum.
USES:
• To visualize the external auditory
canal.
• To visualize the tympanic membrane
and the middle ear through the
tympanic perforation.
Aural Speculums

• This is an instrument used to examine the

external ear canal and the tympanic
membrane.
• The speculum is gently inserted into the
ear canal after pulling the pinna
backwards, laterally and upwards in
adults.
• The speculum is inserted up to the
cartilaginous meatus without touching
the bony canal as it is very sensitive and
can be painful.
Uses:
a. Examination of the external ear canal and tympanic
membrane
b. Removal of wax, foreign body, otomycosis or ear discharge
c. In operative procedures like myringotomy, myringoplasty,
stapedotomy, stapedectomy
d. For transcanal injections.
There are several types of aural speculum.

1.Holmgren adjustable aural speculum

This is a self-retaining adjustable aural speculum with a screw. Used for examination of ear
and ear surgeries.
2.Hartmann aural speculum
This is a funnel shaped speculum that has no slit on the body. The broader end is thickened for
better grip.
3. Rosen aural speculum
• This is an aural speculum with an incomplete slit on its body. The slit is useful for
injections on the external canal wall with the speculum in place.
4.Shea aural speculum
This aural speculum resembles Hartmann aural speculum. However, the narrow end of this
speculum is beveled.
5.Tumarkin aural speculum
• This aural speculum has a complete split on its body to facilitate intra-aural injections into
the external canal.
 Siegel Pneumatic Speculum with bulb
• Parts:
a. Rubber bulb
b. Rubber tube
c. Aural speculum
d. Eye piece with an oblique convex lens.
• Uses:
a. Siegelization
b. Fistula test
c. Examination of external ear canal and tympanic
membrane.
d. Instillation of medications.
Adult rigid otoendoscope
• This is a short rigid telescope
usually of 10 cm length and
varying diameters—1.9, 2.7, 3.4
millimeters. It is available in 0, 30,
45, 70 degree angles. It has to be
connected to a fiberoptic light
source
for illumination.
• Used to examine the external
auditory canal, tympanic
membrane and middle ear. The
findings can be recorded through a
camera.
 Operating microscope
The operating microscope is used routinely
for all ear surgeries as well as
microlaryngeal surgeries.
Parts of a basic model:
1. Optical system
a. Binocular assembly
a. Magnification changer
b. Objective lens
2. Illumination
3. Stand
 Eustachian tube catheter
• It is a metallic catheter with a curved
proximal end and a ring at its base. The
opening of its curved proximal end is at its
tip. This instrument is usually 12 to 15 cm
long. Ring on the proximal end indicates the
direction of the tip of the catheter.
• Uses:
a. To test the patency of Eustachian tube
b. To inflate the middle ear
c. To instill medications in the middle ear
d. To remove foreign bodies from the nose
e. As a suction cannula.
Endaural Speculum

• It is an aural speculum
that is curved and used for
making canal incisions
and endaural surgeries.
 Mollison’s Self-retaining Hemostatic
Mastoid Retractor
• This self retaining retractor is used
commonly in mastoid surgeries.
1. To Harvest temporalis fascia graft.
2. To expose the mastoid cortex and hold
the soft tissue apart.
• Advantages:
1. Allows the surgeon to have both hands
free.
2. Retracts the soft tissue away from the
surgical field
3. Has a hemostatic effect because it
firmly holds the soft tissue and skin
apart. This pressure keeps the area blood
free.
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