Common ENT instruments and what they are for
- Topic
A short guide, in words, to the ENT instruments you will see in clinic, in the emergency room and in theatre.
What it is
ENT examines narrow, dark cavities, so most instruments either bring light and magnification (head light, otoscope, endoscopes, microscope) or open a path (specula, tongue depressors, mouth gags) or remove something (forceps, hooks, suction). Knowing what each one is and when it is used is a classic topic of practical exams and helps when assisting in clinic or theatre. This page describes the instruments in words, grouped by ear, nose, throat and larynx, airway and theatre. Brand names are not used; eponyms are kept because they are how instruments are usually called.
Key facts
- Head mirror: a concave mirror with a central hole worn on the forehead; it reflects light from a lamp beside the patient into the cavity and leaves both hands free; headlights do the same with their own light.
- Aural speculum: a funnel inserted into the outer canal while the pinna is pulled up and back in adults (straight back or down in infants).
- Ear irrigator: delivers a stream of water at body temperature along the canal roof to wash out wax; not used with a perforation, grommet or previous ear surgery.
- Crocodile forceps: fine forceps that open only at the tip; for soft or irregular foreign bodies. Round objects are removed with a hook passed behind them, never grasped.
- Tilley forceps: angled (bayonet-type) forceps used to place nasal packing layer by layer and remove nasal foreign bodies.
- Posterior nasal balloon or catheter: inflated in the nasopharynx to control posterior epistaxis; the patient is admitted and monitored.
- Rigid endoscopes (Hopkins rod) give bright, magnified views of the nose, nasopharynx and larynx; the flexible nasolaryngoscope passes through the nose to see the pharynx and moving vocal folds in the awake patient.
- Boyle-Davis mouth gag: holds the mouth open and the tongue down during tonsillectomy and adenoidectomy.
- Rigid bronchoscope: a hollow tube through which the patient can be ventilated; the instrument of choice to remove inhaled foreign bodies in children.
- Tracheostomy obturator: a blunt guide placed inside the tube to insert it; keep it at the bedside together with a spare tube one size smaller.
Structure
- Light and vision: head mirror or headlight, otoscope, operating microscope, rigid endoscopes (0, 30 and 70 degrees), flexible nasolaryngoscope.
- Ear: aural specula, pneumatic otoscope and Siegle speculum, tuning forks, wax curettes and hooks, Jobson-Horne probe, crocodile (alligator) forceps, suction tips, ear irrigator, myringotomy knife, ventilation tubes.
- Nose: Thudichum speculum, Killian speculum, posterior rhinoscopy mirror, Tilley (angled) dressing forceps, nasal packs and expandable tampons, posterior balloon catheter, Freer elevator.
- Throat and larynx: tongue depressor, laryngeal mirror, mouth gag (Boyle-Davis), tonsil holding forceps and dissector, adenoid curette, direct laryngoscope, rigid bronchoscope and oesophagoscope.
- Airway: tracheostomy tubes (cuffed and uncuffed, fenestrated, inner cannula, metal or plastic), obturator, tracheal dilator, tracheal hook, cricothyroidotomy set, suction catheters.
Instrument, what it is and what it is used for
| Instrument | What it is | Used for |
|---|---|---|
| Otoscope | Handheld light with magnifying lens and speculum | Examining the canal and eardrum; pneumatic version tests mobility |
| Tuning fork | Metal fork that vibrates at a fixed pitch (512 Hz) | Rinne and Weber tests |
| Jobson-Horne probe | Thin probe with a ring curette and a cotton-carrier tip | Wax removal, cleaning and drying the ear |
| Crocodile (alligator) forceps | Fine forceps that open only at the tip | Grasping soft foreign bodies, debris, packs |
| Thudichum nasal speculum | Short two-bladed spring speculum | Anterior rhinoscopy |
| Tilley forceps | Angled dressing forceps | Placing anterior nasal packing, removing foreign bodies |
| Posterior nasal balloon | Catheter with an inflatable balloon | Posterior epistaxis |
| Laryngeal mirror | Small angled mirror on a long handle | Indirect laryngoscopy and posterior rhinoscopy |
| Flexible nasolaryngoscope | Thin flexible endoscope passed through the nose | Seeing the nasopharynx, larynx and vocal fold movement awake |
| Rigid endoscope | Rod-lens telescope (0, 30, 70 degrees) | Nasal endoscopy, sinus surgery, laryngeal view |
| Direct laryngoscope | Rigid hollow blade-tube used under anaesthesia | Biopsy and surgery of the larynx, intubation |
| Tracheostomy tube | Curved tube with flange, ± cuff and inner cannula | Long-term airway, ventilation, toilet of secretions |
In clinical practice
- Blind attempts with the wrong instrument push foreign bodies deeper and injure the canal or eardrum.
- Using a forceps on a round bead or seed: it slips and goes deeper; use a hook or suction instead.
- Not warming the laryngeal mirror: it fogs and the larynx cannot be seen.
- A tracheostomy patient without a spare tube and obturator at the bedside is at risk if the tube blocks or falls out.
Next step / Initial management
- Before any instrument: good light, a cooperative (or sedated) patient and a clear view; examine first, then instrument under vision.
- First-line use: wax and soft foreign bodies with curette, hook, suction or irrigation when the eardrum is intact; anterior epistaxis packing with Tilley forceps after pressure and cautery fail.
- Refer routinely to ENT when the view is not adequate or removal needs a microscope or endoscope; refer the same day if a foreign body cannot be removed in one or two gentle attempts, if it is a button battery or a live insect causing injury, or if the eardrum is damaged.
- Tracheostomy patients: keep suction, a spare tube one size smaller and the obturator at the bedside; a blocked or displaced tube is an emergency for the ENT or airway team.
Test yourself
Think of the answer, then tap the question to see it.
Which instrument lets you check eardrum mobility and perform a fistula test?
A pneumatic otoscope or Siegle speculum, which changes pressure in the sealed ear canal while you look at the eardrum.
A child has a round plastic bead in the ear canal. Why not use crocodile forceps?
The bead slips and is pushed deeper; a hook passed behind it, suction or irrigation (if the drum is intact and it is not organic) is better.
Which instrument is used to place layered anterior nasal packing?
Tilley (angled dressing) forceps, with a nasal speculum to open the nostril.
Which instrument is preferred to remove an inhaled peanut from a toddler's bronchus, and why?
A rigid bronchoscope under general anaesthesia: it allows ventilation through the tube while the foreign body is grasped.
Connections
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Otoscopy (StatPearls Publishing (NCBI Bookshelf), 2025); Rinne Test (StatPearls Publishing (NCBI Bookshelf), 2026); Ear Irrigation (StatPearls Publishing (NCBI Bookshelf), 2026); Ear Foreign Body Removal (StatPearls Publishing (NCBI Bookshelf), 2025); Flexible Nasopharyngoscopy (StatPearls Publishing (NCBI Bookshelf), 2023); Direct Laryngoscopy (StatPearls Publishing (NCBI Bookshelf), 2023); Anterior Epistaxis Nasal Pack (StatPearls Publishing (NCBI Bookshelf), 2023); Tracheostomy (StatPearls Publishing (NCBI Bookshelf), 2025).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.