From Big Medical Encyclopedia

OTORHINOLARYNGOLOGICAL TOOLS — the special tools intended for diagnostic and operative measures on an ear, a nose and its adnexal bosoms in a throat and a throat. Nek-ry tools apply also at interventions on a trachea, bronchial tubes and a gullet.

In O.'s creation and. many domestic and foreign otorhinolaryngologists took part. The majority of tools is developed in the second half of 19 century and in 20 century. Their creation and improvement happened to development otorhinolaryngology (see). So, F. Hofmann in 1841 designed a frontal mirror, Garcia (M. of Garcia) — guttural mirrors, G. Killian — nasal mirrors, A. Polittser — cylinders for blowing off of ears, F. Betsoljd together with Edelmann (M. Th. Edelmann) — a special set of tuning forks, B. Bryunings — tools for direct survey of a throat, a trachea, bronchial tubes and a gullet, including nippers for extraction of foreign bodys, V. I. Voyachek — probes, saws, chisels and other tools for ear operations, G. G. Kulikovsky — simplified diafanoskop, a needle for a puncture of a Highmore's bosom, a palate suturing needle, L. T. Levin — a number of tools for ear operations, for opening of a labyrinth, etc.

In the USSR the St. 300 names separate otorinolaringol are issued. tools, and also special sets, napr, the big otorhinolaryngological surgical exit set which is turning on 67 tools, etc. Nek-ry types otorinolaringol. tools and the main areas of their use are given in the table.

On range of application of O. and. is divided into several groups.

General-purpose instruments

General-purpose instruments for diagnosis and treatment of the majority of otorinolaringolognchesky diseases. The frontal mirror (a frontal mirror) — a concave spherical mirror belongs to tools of this group, a cut concentrates and reflects the rays of light getting on it from a light source and sends them to depth of the inspected body — a nose, a throat, a throat, an ear. In the center of a mirror there is an opening, through a cut examine. The mirror is movably strengthened on a dense tape made of cloth or a rigid plastic rim (fig. 4). At ENT organs operations the nalobny lighter (fig. 1) allowing to create illumination of a surgery field to dia can be used. 20 mm, at distance of 230 mm to 2000 lx.

For various manipulations in an ear, a nose and in a drink use the special bayonet shaped auriscalpiums bent on an edge with spoon-shaped sponges, teeth or cutting (see. Tweezers ). For spraying in cavities of an ear, a nose, a throat of liquid pharmaceuticals as with to lay down. the purpose, and for surface anesthesia use a hand sprayer of liquid drugs (fig. 3), and for administration of powdery medicines — a poroshkovduvatel — the inflator (fig. 2). For washing of outside acoustical pass for the purpose of removal of foreign bodys and cerumen impactions use an irrigation syringe of cavities (Chanée's syringe) with a capacity of 100 — 150 ml (see. Syringes ).

Tools for survey, holding conservative medical actions and ear operations

Ear speculums (ear mirror) apply nickelized and plastic (fig. 5, 6) to survey of outside acoustical pass, a tympanic membrane, sometimes a medial wall of a drum cavity. Internal diameter (it is provided in the table) a narrow part of a metal funnel 1 mm less outer diameter, and a plastic funnel — on 2 mm. A pneumatic ear speculum (see. Zigle funnel ) the hl is applied. obr. for definition of mobility of a tympanic membrane and acoustical stones. Cannulas for washing of an attic (fig. 15) use at conservative treatment of an attic disease, and also for identification of a cholesteatoma.

For a research of hearing use tuning forks (fig. 13) publishing tones with a frequency of fluctuations 128, 512, 1024, 2048 Hz lasting sounding from 60 to 30 sec. (see. Audiometriya ). For the purpose of temporary switching off of one ear from the acoustical act at suspicion of unilateral deafness apply a noise apparatus (see. Barani graggers ).

Ear catheters metal and polymeric (fig. 16) are intended for bougieurage and blowing off of ears at acute and hron, inflammations of a middle ear as with to lay down. the purpose, and for definition of passability of an acoustical pipe. Catheters and a cannula to blowing off of ears (fig. 14) are applied in combination with a rubber bulb of Polittser (see. Ear inflation ). Ear manometers or indicators of barofunction of an ear across Svetlakov use for a research of passability of acoustical pipes (see. Manometriya ear ), and for a toilet of an ear — ear probes with a navivka, and also acute and bellied probes of Voyachek (fig. 11, 12).

At operations on a mastoid apply nippers nippers to a mastoid according to Jansen (fig. 23), nippers nippers bone direct and curved (fig. 24), a ranorasshiritel of outside acoustical pass, an endoauralny ranorasshiritel (fig. 20). For without-molotkovoy trepanation use Voyachek's chisels — zhelobovaty (fig. 21), flat (fig. 22), big and small ear acute spoons and Voyachek's pricker. Apply the hollowed chisels with the corrugated or square handle (fig. 7) bent on the Yew zhelobovaty (fig. 9) and flat (fig. 8), an ear bilateral acute spoon, etc. to the same operations. With a research objective of a condition of bone walls of supratympanic space apply an attic probe (fig. 10).

Foreign bodys delete from an ear by means of a hook (fig. 1). In outside acoustical pass and on a tympanic membrane apply a knife (needle) to operation paracentetic lanceolated, a scalpel ear crescent with the cutting surface turned up or down (see. Knives surgical ). For removal of polyps and granulations from an ear use an ear polipny loop (fig. 19), bone punches polipny (fig. 25) and tampon (fig. 26), nippers for ear microoperations (across Bystrenin), an ear conchotome with a round opening, etc.

Nek-ry tools are completed in sets: e.g., a set of ear tools of Gartmann (fig. 18), tool kit for tympanoplasties (see), tool kit for ear microoperations (at an otosclerosis), tool kit for prosthetics of a stirrup.

Tools for diagnosis and treatment of diseases of a nose and its adnexal bosoms

use Nasal mirrors (fig. 30, 31, 32) for a front and average rinoskopiya. Various pharmaceuticals use the probe to greasing of a nose nasal with a navivka (fig. 33).

A septectomy of a nose and removal of the bent sites of a cartilage carry out a knife for a resection of a nasal partition (on Ballendzhera) (fig. 45). For separation of soft tissues from a bone or cartilaginous skeleton of a nasal partition the elevator bilateral (fig. 56), and for department of a nadkhryashchnitsa and a periosteum of a nasal partition — an elevator unilateral serves. For operations on a partition of a nose apply also a chisel with the corrugated handle angular 60 °, nippers to operation on a nasal partition (Bryunings's nippers, fig. 50), nasal nippers (Geymann's nippers) spoon with the oval ends (fig. 54).

At cosmetic operations use rasps with a direct and return notch (fig. 48), a saw a nasal straight line of Voyachek (fig. 47), a hook for procrastination of wings of a nose (fig. 41). Reposition of a fracture of nasal bones is made the elevators for endonasal reposition of bones of a nose right and left (fig. 57) offered by Yu. N. Volkov, and removal of foreign bodies hooks for removal of foreign bodys from a nose (fig. 42), removal of choanal polyps is made by a special hook (fig. 43).

Turbinotomy (see) usually carry out by means of horizontally curved scissors of Bekmann for a conchotomy (see. Scissors surgical ), conchotomes with the slotted opening (fig. 40) and the cutting polipny nasal loop, and removal of polyps — the tearing loop (fig. 46).

For a front tamponade of a nose tampon nasal (Gartmann's nippers, fig. 55), nippers apply nippers to packing of a throat and a throat small (fig. 53), etc.

At operations on a trellised labyrinth use direct and curved conchotomes with the round, oval, slotted opening, and with spoon-shaped sponges (fig. 37, 38, 39).

At endonasal opening of adnexal bosoms of a nose use a trocar-vykusyvatelem endonasal (fig. 49), a vykusyvatel endonasal direct (fig. 28) and bent (fig. 27, the area of a sku-syvaniye from 6 to 18 mm2). The puncture of a Highmore's bosom is made a needle (Kulikovsky), and also a hypodermic puncture needle and drainage of a Highmore's bosom (consists of a needle, the conductor, a nozzle and a plastic tube).

At extra nasal a Highmore's bosom operation apply nippers to adnexal bosom operations for adult (fig. 51) and children (fig. 52), a soft spoon for paranasal sinuses (fig. 44). After operation the Highmore's bosom is washed out by means of a cannula for washing of a Highmore's bosom (fig. 36). Cysts of a Highmore's bosom in some cases manage to be opened with tools for opening of cysts of a Highmore's bosom (fig. 35). Apply to raying of adnexal bosoms of a nose diafanoskop (fig. 29), providing illumination to 15 000 lx.

Tools for survey, conservative treatment of a throat, and also on it

make the Pushing off of language at survey of a throat for operations various pallets: the pallet for language bilateral with round openings (Bryunings's pallet, fig. 75), autoscopic spatulas for children and pallets with an electric lighting. For survey of a nasopharynx use nasopharyngeal (fig. 61) and guttural mirrors to dia. 12 mm of j connected by the handle for guttural and nasopharyngeal mirrors and vatoderzhatel (fig. 68).

For survey of a nasopharynx and carrying out various manipulations in the mouth of an acoustical pipe use a salpingomanipulyator (fig. 69).

Adenotomes (fig. 58) are intended for removal of adenoid growths (see. Almonds ). Apply also adenotomes with the receiver (fig. 59), in Krom there is a deleted almond that prevents its aspiration. The tonsillotomy is made a tonsillotome for cutting off of palatine tonsils (Mathieu's tonsillotome, fig. 70). For determination of depth, the direction and contents of lacunas of palatine tonsils use the bellied probe of Kulikovsky for almonds (fig. 62). At conservative treatment apropos hron, tonsillitis use Yurovetskaya's syringe to washing of lacunas of almonds (fig. 76). At a tonsilectomy for fixing of an almond fenestrated nippers are intended for almonds (fig. 72), a clip for a tonsilectomy (fig. 60), peritonsillar abscess forceps direct (fig. 73) and curved. The section of a mucous membrane of front handles is usually made a knife for operation in an oral cavity and a nose (fig. 64). Almonds allocate with various tools — a spoon raspatory (fig. 63), a tonsil elevator (fig. 77). Final otde-division them in the field of the lower pole is made by means of a lever tonsillotome of Tidinga — Bokhona (fig. 71), Yakhnin's tonsillotome or a loop for Bryunings's almonds. In case of bleeding palatal handles over a tampon a needle of Kulikovsky (fig. 34) sometimes sew; in some cases apply Mikulich's clip compressor. Removal of high-quality new growths from a nasopharynx and a biopsy is made fenestrated nippers for a nasopharynx (fig. 74). For removal of youthful angiofibromas use raspatories for nasopharyngeal fibromas of 5 types (fig. 66, 67) and the raspatory chisel (fig. 65).

Tools for survey and treatment of diseases of a throat

At indirect (mirror) laringoskopiya (see) use guttural mirrors (fig. 80). Use the guttural syringe (fig. 95) to administration of liquid medicines, and various pharmaceuticals make greasing of a throat by means of the probe with a navivka (fig. 83). If survey of a throat is interfered by the «curtailed», rigid epiglottis, it is fixed the holder of an epiglottis (fig. 79). Foreign bodys at an indirect laringoskopiya delete from a throat with nippers guttural for extraction of foreign bodys (fig. 96). Abscesses of a throat open with the hidden guttural knife on Tobolda (fig. 87). The direct laringoskopiya is made the laryngoscope with the direct one-piece corrugated blade (fig. 85), the universal laryngoscope (fig. 86), the laryngoscope with a fiber light guide and also which are available in various bronchoscopic sets blades on Bryuningsa, Mezrina, etc.

Samples for researches are taken direct and curved probes for capture of scraping (fig. 81, 82).

Removal of small high-quality new growths of a throat and pieces from a throat make by means of spoon-shaped guttural nippers (fig. 97). For the same purposes use the guttural vykusyvatel with a curved tube applied under control of an indirect laringoskopiya, or with a direct tube, applied at a direct laringoskopiya (fig. 78). Various tips — spoon-shaped, fenestrated, etc. are included in the package of a vykusyvatel. In some cases apply guttural polipny loops (fig. 88) to removal of the high-quality new growths from a throat having a thin leg.

For expansion of a gleam of a throat at hron, its cicatricial narrowings use guttural dilators (fig. 89). For the purpose of survey and holding various medical and diagnostic procedures in a trachea, bronchial tubes and a gullet (survey, bougieurage, removal of foreign bodys, capture of pieces for gistol, researches, washing and administration of medicines) various apply bronkhoezofagoskopa (see). Nek-rye from them are completed with nippers for extraction of buttons, pins and other foreign bodys.

During the performance of one of the most immediate surgeries — tracheostomies (see) along with all-surgical instruments (see. Surgical tools ) use tracheotomic sharp retractors (fig. 84), tracheotomic dilators (fig. 90, 91). Enter plastic or metal tracheotomic tubes (8 sizes) differing both on diameter, and on length (fig. 92) into a tracheostoma.

Tracheotomic tubes with obturators (fig. 93) and tracheotomic tubes with an opening on a bend (fig. 94) apply to accustom the patient to breathe through natural respiratory tracts.

Table. Some types of otorhinolaryngological tools and area of their main use (the name of tools and their appointment, in brackets number of the drawing is specified)

Note. Total length (L), weight (M); sizes of a working part: length (l), &shirinanbsp; (b),   volume (V), diameter (d). Outward of tools is given without observance of scale; the tools differing only in the size or number are shown in one drawing.

Otorhinolaryngological tools. General-purpose instruments

General-purpose instruments

Otorhinolaryngological tools. Tools for survey, holding conservative medical actions and ear operations

Tools for survey, holding conservative medical actions and ear operations

Otorhinolaryngological tools. Tools for diagnosis and treatment of diseases of a nose and its adnexal bosoms
Otorhinolaryngological tools. Tools for diagnosis and treatment of diseases of a nose and its adnexal bosoms

Tools for diagnosis and treatment of diseases of a nose and its adnexal bosoms

Tools for survey, conservative treatment of a throat, and also for operations on it
Tools for survey, conservative treatment of a throat, and also for operations on it

Tools for survey, conservative treatment of a throat, and also for operations on it

Tools for survey and treatment of diseases of a throat
Tools for survey and treatment of diseases of a throat

Tools for survey and treatment of diseases of a throat

Bibliography: Vulstein X. L. Slukhouluchshayushchiye of operation, the lane with it., M., 1972; The Multivolume guide to otorhinolaryngology, under the editorship of A. G. Likhachev, t. 1 — 4, M., 1960 — 1963; Pal-chun V. T. and Preobrazhensky Yu. B. Diseases of an ear, throat, nose, M., 1980; Preobrazhensky Yu. B., Chireshkin D. G. and Galperina N. S. Mikrolaringoskopiya and endo-laringialny microsurgery, M., 1980.

Yu. B. Preobrazhensky.