Nasal Speculum

Nasal speculum is a medical tool used by the ENT physicians to examine the anterior part of the nose. Nasal speculum helps in enlarging the sinus area so that the exposed area can be clearly observed. - Dr. Varsha Sharma Kapila

Nasal speculum Picture Courtesy: http://rhinitis.hawkelibrary.com

A speculum is a medical instrument used by physicians to explore cavities within the body for easy visualization & access. There are various different kinds of speculums used to penetrate the body cavities. Each type of speculum is designed to enter a specific orifice. Based on the use of the speculum, types of speculum are categorized as vaginal, rectal, aural, oral, & nasal. This article highlights regarding the types & uses of the nasal speculum.

Nasal speculum is a medical tool used by the ENT physicians to examine the anterior part of the nose. This diagnostic nasal equipment helps in widening the opening of a nostril so that the inside of the nose can be clearly & easily visible by the physician. It helps the physician in diagnosing and performing certain procedures. Use of nasal speculum produces space between the mucosa and the cartilage within the nasal cavity. Nasal speculum helps in enlarging the sinus area so that the exposed area can be clearly observed. Thus, it enables easy access by the physician to certain sinus areas. Nasal speculum is the best tool in resolving discomfort in the nose.

Nasal Speculum is available in various types & sizes which are made up of high-quality stainless steel or plastic. The stainless-steel nasal speculum is a non-disposable medical tool which has to be appropriately sterilized before each use, while the plastic nasal speculums are disposable& single-use.

Use of Nasal Speculum

Nasal speculum is used in certain nasal operations, especially minor operations. Nasal specula are further useful in

 Diagnosis.
 Surgical techniques &
 Removal of foreign bodies stuck in the nose.

Parts

The nasal speculum is composed of two parts – handle & cone. The handles of nasal speculum resemble typical pliers or scissors. The tip of this device is coneshaped. The cone portion of the nasal speculum varies in sizes. The size to be used depends on the age of the patient. There are different sizes available for children & adults. The nasal speculum is hinged so that when the handles of the nasal speculum are squeezed together the blades spread laterally exposing the sinuses, enabling easy examination by the physician.

Types of Nasal Speculum

There are several different types of nasal specula available. Some of them are as follows:

Killian’s Nasal Speculum

This variety of nasal speculum is a self-retaining nasal speculum which is used in the nasal examination & nasal surgeries. It is available in various sizes ranging from small to long-bladed. This type of nasal speculum is much easier to handle.

Killian’s nasal speculum has a set screw locking mechanism. The screw in the handle is tightened to hold the blades of the speculum in the open position, thereby freeing the hands of the physician. It has a single spring plier handle and the blades are attached to the handles.

Indications

The Killian’s nasal speculum is used in:

 Septoplasty.
 Anterior rhinoscopy.
 Polypectomy.
 Turbinate reduction surgeries.
 Anterior nasal packing &
 Nasal foreign body removal.

Voltolini Nasal Speculum

This self-retaining nasal speculum is used to view the nasal cavity for diagnostic and therapeutic nasal procedures. It is used in anterior rhinoscopy for foreign body removal and nasal packing. To accommodate a huge variety of patient types, the Voltolini nasal speculum is available in three varying types.

Voltolini nasal speculum has two long curved blades which are designed to form a duck-billed cone, which aids in deeper inspections of the nasal cavity. The handle has an adjustable screw which is adjusted to alter the distance between the blades so that the blades are approximated and inserted into the nasal cavity. The blades are opened after insertion. The self-retaining feature provides freedom to the physician to simultaneously perform other steps of the procedure with ease.

Cottle Nasal Speculum

Cottle Nasal Speculum helps in providing internal visualization of the nasal valve. This speculum is designed for endoscopic nasal procedures. The very thin, narrow & tapering blades of Cottle Nasal Speculum are used for retracting the nasal walls thus, allowing visualization of the narrow nasal passage. Cottle Nasal Speculum features a screw which enables it to be self-retaining. It is angled at the shaft to offer enhanced visual access to the physician.

Indications

The Cottle Nasal Speculum is commonly used in:

 Rhinoplasty.
 Other plastic surgeries &
 Deviated septum repair.

Thudichum Nasal Speculum

The Thudichum nasal speculum has two nasal flanges. The size of these flanges varies depending on the age of the patient. These two flanges are inserted into the nostril to widen the nasal cavity, permitting an enhanced view of the structures inside the nose. Thudichum nasal speculum is routinely used in the outpatient department to examine the nose.

Indications

This type of speculum is commonly indicated in:

 Septal surgeries.
 Extraction of foreign bodies &
 Preoperatively, for nasal packing.

How to use the Thudichum’s nasal speculum?

Initially, the instrument has to be held at its bend with the thumb and index finger.

Then, the middle and ring fingers of the physician are to be placed on either side of the limbs of the speculum. As these fingers are moved close to each other the flanges of the speculum come close together. The instrument in this position has to be inserted into the nostril. Move the middle and ring fingers apart which will widen the flanges of the speculum thus, opening up the nasal cavity.

Vienna Nasal Speculum

Vienna Nasal Speculum is also used to widen the nasal cavity by retracting the nasal tissue for optimal visualization of the nasal cavity for examination. It has a plier spring-handle and the blades vary in sizes for adults, child and infants.

Few other types of nasal speculum are Bechman, Halle-Tieck, Hardy Bivalve, Hartmann, Martin, etc. All the nasal speculums are specifically designed & have different indications for use.

Apart from these traditional nasal speculums, the ENT physicians further use fibre optic nasal speculums which help in enhancing the visualization in the operative space. Fibre optic nasal speculums offer consistent & longlasting illumination which helps the physician to clearly view the narrowed nasal passage. Few more innovations in nasal speculum can be expected in the near future.