Eustachian Tube Catheter

The Eustachian catheter is a long, thin metal instrument mainly used to test Eustachian tube patency but with a few other uses as well.

It is actually a curved, metal cannula, measuring about 5 inches in length. Its tip is curved gently downwards. The other end bears a small metal ring in the direction of the curve. This ring serves as a guide to the direction of the curve once the tip is inserted into the nose.

Uses:

• Eustachian tube catheterization
• Nasal foreign body removal – The Eustachian catheter is sometimes used for removal of foreign bodies from the nose. It is a sturdy instrument whose curved tip can be used to nudge and maneuver foreign bodies lodged in the nasal cavity.

How Eustachian tube catheterization is done

This procedure is more than a century old and was earlier routinely done to check patency of the Eustachian tube.

• The tip of the catheter is inserted into the nose and passed along the floor of the nasal cavity till it touches the posterior pharyngeal wall. The tip is now in the nasopharynx.
• It is then rotated 90° medially and drawn forward till it meets resistance. The tip is now touching the posterior free end of the nasal septum.
• At this point, the tip is rotated 180° laterally so that it enters the opening of the Eustachian tube in the lateral wall.
• A Politzer bag is attached to the other end of the catheter. Air pushed from it can be heard rushing into the ear if the Eustachian tube is patent.

The medial and lateral rotations that appear to complicate the procedure were actually designed to avoid the tubal elevation located behind the tubal opening since the tip cannot be seen once inserted into the nose. The original procedure was a blind one, with only the metal ring to indicate the direction of the catheter’s tip. But the procedure can also be done under endoscopic guidance.

The important thing to remember is that the method only tests patency of the Eustachian tube and does not reflect on its function.

Other methods to test Eustachian tube patency

• Seigelization (or pneumatic otoscopy)
• Valsalva maneuver
• Politzerisation
• Toynbee’s test

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Jobson-Horne Ear Probe

This is a commonly used OPD instrument and is also called the wax hook or ring curette.

Uses:

Ear wax removal

Removal of foreign body from the ear

Removal of otomycotic debris or discharge from the external auditory canal

Probing of aural polyp or other mass in the ear canal

Probing of nasal masses and checking their sensitivity to touch

If you look closely, you will find that one end of the probe is shaped like a ring. This end may be used to hook out wax or foreign bodies from the ear canal.

The other end of the instrument is sharp and serrated. An ear wick can be fashioned out of this end by rolling cotton on to it and used to mop ear discharge.

More Information:

• If wax in the ear canal is impacted, it is better to first soften it with wax-softening or dissolving agents and then attempt to remove it.
• Wax in the ear canal can also be removed by syringing using an aural syringe or by using suction apparatus under microscopic visualization.

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Tuning Forks

In ENT, tuning forks are used to clinically test hearing and identify the type of hearing loss.

The parts of a tuning fork are:

• Base plate or footplate
• Shaft
• Prongs that vibrate producing sound

If you look at the shaft or the footplate closely, you will find it carries a number - this is the frequency at which the tuning fork vibrates and is denoted in Hertz (Hz). The commonly used tuning forks to test hearing are 256 Hz, 512 Hz and 1024 Hz. These frequencies correspond to the speech frequencies. Tuning forks of lower frequencies (like 128 Hz) produce vibrations that are felt more than they are heard, while those of higher frequencies produce more overtones.

More information:

• Tests done with these tuning forks include Rinne's, Weber's and the absolute bone conduction test.
• Other tests, not routinely performed, are the Bing's test, Stenger's, Gelle's and Chimani Moos test.
• If you have to perform these tests with a single tuning fork, pick the 512 Hz.
• To set the tuning fork into vibration, always strike it against a firm but yielding surface like your elbow
   and not hard surfaces like table tops.

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Aural Syringe

This instrument is the metallic aural syringe, an instrument used for syringing of the ear, an OPD procedure.


Indications for ear syringing:

• Wax removal
• Foreign body removal
• Removal of otomycotic debris

The syringe has a nozzle for insertion into the external auditory canal. Water at body temperature is loaded into the syringe. The syringe is held by inserting fingers into the rings at the back. The third ring is on the piston that forces the water out when pushed.


More Information:

• Syringing should be avoided in case of perforated tympanic membrane.
• Aural syringing can result in complications like trauma to the external auditory canal and perforation of the tympanic membrane.
• Other methods of wax and foreign body removal include manual removal using the Jobson-Horne wax hook, suction and removal under microscope.

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