Cis Self-Study Lesson Plan: Otolaryngological Instrumentation

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Otolaryngological Instrumentation

CIS LEARNING OBJECTIVES:

1. Provide a brief history of otolaryngology


2. Explain the primary ENT specializations
3. Describe some commonly used otolaryngological instruments

CIS Self-Study Otolaryngology (pronounced oto-lar-n-gol-o-gy) refers to the diagnosis, evaluation and
management of head and neck diseases. The primary focus is on ears, nose and throat,

Lesson Plan
so the discipline is commonly referred to as ENT. Specialties within ENT require numerous
instruments for the variety of target organs and applicable surgeries they address. The ears,
nose and mouth are natural orifices (openings), and some interventions are conducted
CRCSTLESSON NO. CIS 217
(Instrument Continuing Education-ICE)
through them. This often requires illumination, magnification, and special retracting and
holding devices to allow the surgeon to safely reach the target organ. Also, surgical sites are
small and access to them may require instruments designed with an angle at their handle or
Lesson Author
edge.
Yaffa Raz, RN, BA
Central Service Sterile Department Manager ENT surgery utilizes both modern surgical techniques (including endoscopic) and traditional
Lady Davis Carmel Medical Center surgical techniques. Knowledge about frequently-used ENT instruments will help Certified
Haifa,Israel Instrument Specialist (CIS) technicians understand why these devices require special care.

Historical Background considered the father of laryngology. He


Instrument Continuing Education (ICE)
developed the total laryngectomy, which is
lessons provide members with ongoing
education in the complex and ever-changing Some procedures used in present-day the complete removal of the larynx. Shortly
area of surgical instrument care and handling. otolaryngology, including the tracheotomy thereafter, Dr. Joseph O’Dwyer performed
These lessons are designed for CIS technicians, to create an opening in the trachea the first intubation (insertion of a flexible
but can be of value to any CRCST technician (windpipe), date to 3600 B.C.; However, tube into the body) of the larynx. Later
who works with surgical instrumentation.
ENT surgery owes its development to development of the bronchoscope and
You can use these lessons as an in-service surgeons and researchers who have esophgoscope allowed doctors to remove
with your staff, or visit www.iahcsmm.org incorporated technology into techniques, objects in the trachea and develop other
for online grading at a nominal fee.
instruments and surgical materials (many treatments for patients.
Each lesson plan graded online with a passing of which bear their names).
score of 70% or higher is worth two points Restoration of facial expression for
(2 contact hours). You can use these points The medical specialty of otolaryngology patients with facial nerve paralysis began
toward either your re-certification of CRCST
(12 points) or CIS (6 points).
expanded in the early 1800s when a metal in the 1920s, and Dr. Julius Lempert
wire, developed by Dr. Phillip Physick, was began fenestration operations (surgical
Mailed submissions to IAHCSMM will not be worn around a patient’s tonsil until it procedures to restore hearing loss from
graded and will not be granted a point value
fell off. During the mid-1800s, Dr. Ernst osteosclerosis, or advanced hardening of
(paper/pencil grading of the ICE Lesson Plans
is not available through IAHCSMM or Purdue Krackowiczer developed the laryngoscope bone) in the late 1930s. This procedure
University; IAHCSMM accepts only online to visualize a patient’s larynx (voice box). resolved some hearing problems and was
subscriptions). This led to the development of laryngology, later refined as modern stapedectomy
which enabled otolaryngology to (surgery of the middle ear).
provide a more accurate diagnosis of
several diseases. By the 1980s, cochlear implants (insertions
of small electronic devices to provide a
Dr. Solis-Cohen, a surgeon during the sense of sound) became commonplace
American Civil War (1861-1865), is and today physicians are increasingly
IAHCSMM
CIS Self-Study Lesson Plan

performing numerous types of ENT • Laryngology – Treatment of diseases narrow instruments used for grasping,
surgeries to help their patients. of the throat and larynx. cutting, or dissecting tissue can be passed
down the scope onto the larynx. Their
Primary ENT Specializations Adeno-tonsillectomies (removal of tips must be very small (usually only 1 or
adenoids and/or tonsils) and 2 mm) since vocal cord structures are also
There are four primary ENT specializations: tracheostomies (surgery on the larynx tiny. A long suction tube is also needed
to create an alternative airway in for interventions carried out with these
• Otology – Treatment of ear infection, the throat for patients experiencing instruments.
disease and damage to improve hearing difficulty breathing) are two common
and balance. Some interventions interventions. Other common otolaryngological
involve conditions deep in the middle instruments, while small-scaled and
and inner ear, and require delicate • Head and neck surgeries – These delicate, are similar to those used for
instruments. Bony and soft tissues procedures focus on cysts, glands other types of surgeries. These include
may be involved, and instruments (including the lymph, salivary, thyroid forceps, cutting instruments and other
may look similar to their orthopedic and parathyroid), and head and neck surgical devices.
counterparts (examples: mallets, drills cancers.
and bone hooks), but on a smaller scale. Forceps grasp tissue and may be straight
Note: instruments for these surgeries are or angled with a direction: right, left, up,
In addition to cochlear implants usually small- and medium- sized basic or down. There are several frequently-
mentioned above, common middle devices, such as forceps, scissors and used types:
ear surgeries include tympanoplasties dissecting tools.
(repairs of the eardrum or middle • Cup forceps use two opposing small
ear bones), stapedectomies (surgical Common Otolaryngological and round- or oval-shaped cups at the
removal of the stapes required by Instruments end of the shaft to grasp tissue and
otosclerosis), and mastoidectomies have a sharp cutting edge with very
(removal of bone from the mastoid Some ENT instruments are used to access limited cutting surface. They may be
process). Note: the mastoid process is natural orifices. For example, mouth straight or curved up or to the sides
behind the ear canal and contains air gags keep the mouth wide open, so the with cup dimensions from 0.5 mm to
cells that drain into the middle ear. Its surgeon can reach the larynx. They are 5-6mm.
removal may be necessary because of typically used with a tongue depressor
disease, or if an infected skin cyst is and are self-retained. Ear speculums • Alligator forceps have two long and
present. enable access to external ear, and they flat metal projections that oppose each
may be round or slightly oval, and come other and can grasp tissue. They can
• Rhinology – Treatment of sinus and in a variety of sizes. Many are ebonized be up, down, right, or left depending
nasal disorders, including allergies, to (blackened) to reduce light reflection from upon the direction in which the action
relieve pain, ease breathing and improve the microscope. Nasal speculums have end is bent. They may also be smooth,
nasal function. short blades that allow surgeons to view serrated or teethed.
the nasal septum and pathologies of the
Two common interventions are nostrils, and long blades for use during • Crimpers are used to secure a
septoplasties (corrections of the nasal surgeries. Their openings are controlled prosthesis (replacement part for the
septum to enable clear breathing and with a fixating screw. body) by pressing a metal arm to a
prevent obstruction) and functional tissue. The most common type is the
endoscopic sinus surgeries (minimally- Laryngoscopes are usually L-shaped McGee Stapes Crimpers.
invasive procedures for serious cases instruments with a handle. The narrow
of inflamed, infected and blocked part is inserted into the larynx , and the Cutting instruments for ENT surgery are
sinuses). surgery is performed through it. Long and sharp, and tip protectors are typically
IAHCSMM
CIS Self-Study Lesson Plan

required. They are designed to cut soft tissue, and care is required to protect instruments and use a magnifying device to
tissue, cartilage and bones. Common types their delicate tips. examine them. Thorough cleaning requires
include: placement on special racks inside washer
• Elevators that are sharp or blunt, and decontaminators to avoid water pressure
• Micro-scissors that are straight, curved available in different angles and sizes. damage and to expose their entire surface
or angled. These are extremely delicate They are used to raise up and retract to the cleaning phase. Manual pre-cleaning
and must be protected to avoid tissues and separate mucosa (a mucus- is sometimes required for instruments with
damage. secreting membrane) from cartilage. lumens, those used to cut bone tissue, and
Some elevators are double-sided, and for other difficult-to-clean devices.
• Sickle knives are spear-shaped and are each side may have a different size and
used to cut small pieces of tissue. shape. Two commonly-used elevators Assembly of ENT instruments requires
are the periosteal and Freer models. specialized knowledge and experience.
• Swivel knives use a pulling action that CIS technicians typically learn about these
revolves the blade through l80 degrees Suction tubes are used to remove blood devices during an advanced stage of their
to cut nasal cartilage tangentially during and other fluids during ENT surgery. orientation program. Many instruments
withdrawal. Commonly-used types include the Baron, have surgical tips that can barely be
Fraizer, Ferguson, and needle suctions. seen and require magnifying devices for
• Other knives include the Rosen and Suction tubes have a finger cut-off hole inspection and assembly. Fortunately,
Austin models, and others with different that allows surgeons to control suction manufacturer’s catalogs and digital
shapes, angles and sizes, according to pressure. This is important to assure that data with multi-dimensional instrument
their intended use. the tissues of delicate ENT organs are not illustrations are useful learning tools.
damaged. Some suctions have separate
There are a wide variety of other ENT ports for suction and water irrigation.
surgical devices, such as:
Interestingly, three different systems are CIS Self-Study Lesson Plans
• Snares: lumen- (circular or round) used to express the size (lumen diameter)
shaped metal wires fixed to a device and of suctions. The French system uses larger Lesson Author
used to remove tonsils and nasal polyps. numbers as tube size increases. In contrast, Yaffa Raz, RN, BA
numbers in the gauge system decrease Central Service Sterile Department
• Curettes used in adenoidectomy to cut as tube size increases. Note: needles are
Manager
the adenoids. usually described in the gauge system.
Lady Davis Carmel Medical Center
The third system describes tube size in
• Cutting burrs, diamond- or carbide- millimeters. Fortunately, conversion tables Haifa, Israel
coated in varying sizes, used to cut are available to understand and compare Technical Editor
bones. They are attached to a power lumen sizes. Carla McDermott, RN, ACE, CRCST
drill that usually has an attached line Educator
to allow fluid to cool the bone while Suctions are usually supplied with a metal South Florida Baptist Hospital,
the surgeon drills into it. If burrs are wire used to remove debris from the lumen Lakeland, FL
reusable, care is needed to ensure that during surgery and to check the lumen
Series Writer/Editor
all bone residue and debris are removed, during reprocessing. Care is required
Jack D. Ninemeier, Ph.D.
and a magnifying light is helpful for this during and after surgery to prevent mucus
purpose. and blood from drying in the suction Michigan State University
cannulae (tubes). East Lansing, MI
• Wire brushes sometimes used to IAHCSMM is looking for volunteers to write or
remove bone dust from cutting burrs Some Final Thoughts contribute information for our CIS Self-Study
and other instruments during surgery. Lessons. Doing so is a great way to contribute to your
own professional development, to your association,
ENT instruments are delicate and must and to your Central Sterile Supply peers.
• Picks with straight or angled tips that be carefully reprocessed. Holding Our team will provide guidelines and help you
can be sharp or blunt and of various devices, racks, tip protectors, and special with the lesson to assure it will be an enjoyable
lengths. They are used to probe organs, containers will help provide safe delivery. process. For more information, please contact
Elizabeth Berrios (elizabeth@iahcsmm.org).
measure canal lengths and perforate CIS technicians should disassemble the
CHL

CIS Self-Study Lesson Plan Quiz


(Instrument Continuing Education-ICE)
Lesson No. CIS 217: Otolaryngological Instrumentation
CIS Questions (circle correct answer):

1. The larynx is commonly called the: 6. Which ENT specialty includes surgical 12. Which of the following is spear-shaped
a. inner ear interventions that can help to ease a and used to cut small pieces of tissue?
b. voice box patient’s breathing? a. Micro-scissors
CRCST
c. wind pipe a. Otology b. Sickle knife
d. nostril b. Laryngology c. Swivel knife
c. Head and neck injuries d. Osten knife
d. Rhinology
2. Which of the following is the surgical e. “B” and “D” above
procedure to restore hearing loss? 13. Which of the following is used to
a. Septoplasty 7. The insertion of a small electronic device remove bone dust from cutting burrs
b. Tracheotomy to provide a sense of sound for the during surgery?
c. Stapedectomy patient is achieved by a ________ implant. a. Wire brushes
d. Adeno-tonsillectomy a. cochlear b. Picks
b. intubation c. Currettes
d. Cutting burrs
3. The focus of ______ is on the treatment 8. Ear speculums can be:
of sinus and nasal disorders. a. round
a. laryngology b. slightly oval 14. In which system do numbers measuring
b. otology c. elliptical lumen diameter of suctions decrease as
d. “A” and “B” above tube size increases?
c. otolaryngology
e. All the above a. French system
d. rhinology
b. Gauge system
9. The tip size of instruments used
4. Which ENT specialization addresses the with laryngoscopes is usually:
thyroid and parathyroid glands? a. One or two mm 15. Magnifying devices typically ________
necessary to examine ENT instruments
a. Head and neck surgeries b. Two or three mm
during processing.
b. Laryngology c. Four or five mm
a. are
c. Rhinology d. Larger than five mm
b. are not
d. Otology
10. Alligator forceps may be:
a. smooth
5. Removal of the mastoid process is an b. serrated
intervention in which type of ENT c. teethed
specialization? Sponsored by:
d. all the above
a. Otology
b. Rhinology 11. Which is the most common type
c. Laryngology of crimpers?
d. Head and neck surgeries a. Rosen
b. Beosten
c. McGee Stapes
d. Freer
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