BACKGROUND OF THE INVENTION
Among the most common examinations conducted by a doctor, particularly in pediatric practice, is examination of the ears, nose and throat of the patient. A variety of illuminated otoscopes are used for examination of the ear. Typically, these have a generally cone-shaped speculum that is inserted into the ear canal. Illumination of the interior of the ear is provided and in some cases magnifying lenses may be included in the otoscope. The conventional otoscope has a circular ring into which a speculum is threaded and, typically, the doctor does no more than wipe off the speculum between one patient and the next. The same or a similar speculum may also be used in the nose, although such examination is less commonly conducted.
When it is desired to view the lower throat, an angled mirror is inserted deep into the mouth and typically touches against the soft palate or other portion of the back of the throat. This touching frequently causes the patient to gag or become nauseated and it has become customary for the examining physician to apply a topical anaesthetic to this region. Typically, this is sprayed onto the surfaces and in the matter of minutes, the region is numbed and the gage reflex suppressed.
The instruments for examining and treating the ear, nose and throat of the patient are in need of substantial improvement for ease of manipulation, increased visibility for examination, economy of construction and a disposability to reduce cross-contamination.
BRIEF SUMMARY OF THE INVENTION
There is, therefore, provided in practice of this invention an improved ear, nose and throat examining instrument having an elongated handle with a non-round speculum support tang extending laterally therefrom at one end. A fiber optic bundle extends through the handle for conducting light from a remote light source to the end of the tang. A variety of transparent specula for the ear, nose, mouth and lower throat fit onto the support tang for examination of these cavities.
These and other features and advantages of the present invention will be appreciated as the same becomes better understood by reference to the following detailed description of presently preferred embodiments when considered in connection with the accompanying drawings wherein:
FIG. 1 illustrates in perspective an improved ear, nose and throat examining instrument constructed according to principles of this invention;
FIG. 2 illustrates in rear view a typical inexpensive ear speculum for the examining instrument;
FIG. 3 illustrates in end view the speculum support tang of the instrument;
FIG. 4 illustrates in cross-section the end of the tang of FIG. 3 along line 4--4;
FIG. 5 illustrates in cross-section the instrument as used for examination and treatment of a person's ear;
FIG. 6 illustrates in rear view an improved ear speculum which is also seen in cross-section in FIG. 5;
FIG. 7 illustrates a collection vial for the improved ear speculum of FIG. 6;
FIG. 8 illustrates the examining instrument fitted with a tongue depressor;
FIG. 9 illustrates in side view the examining instrument fitted with a laryngoscope; and
FIG. 10 is a perspective view of the improved laryngoscope of FIG. 9;
FIG. 11 illustrates an alternative collection vial;
FIG. 1 illustrates in perspective an improved ear, nose and throat (ENT) examining instrument constructed according to principles of this invention. Portions of the instrument can also be seen in FIGS. 5, 8 and 9. The ENT instrument has an elongated handle 20 that conveniently has a generally rectangular cross-section. A slide 21 fits into a T-slot 22 extending along the length of the handle. A thumb knob 23 on the slide permits it to be moved up and down easily during use of the instrument. The slide is held in position by a detent spring 24 after it has been adjusted. A magnifying lens 26 is mounted on the upper end of the slide so that when it is in its elevated position opposite the tang, it can be used for magnifying an area within an ear, for example, for close examination. Similarly, the slide can be retracted so that the lens is out of the field of view of the physician and to permit access by surgical instruments, for example.
A speculum support tang 27 extends laterally from the handle at its upper end. The tang is preferably integral with the handle and extends therefrom at an angle of about 105° to 120° rather than at a right angle. This turns out to be a very convenient angle for most examinations and permits the instrument to be manipulated in such a way that specula mounted on the tang are not easily dislodged. As better seen in FIG. 3, the tang has a somewhat flattened curved cross-section adjacent its forward end. The forward end of the tang is not circular so that a speculum mounted thereon will not rotate. In addition, the end of the tang is preferably tapered with a locking or self-holding taper so that a speculum pressed on is not easily dislodged. The speculum can be pushed off with the thumb after use and discarded.
An intense light source 28 illustrated only schematically in FIG. 1 is located remote from the handle. A conventional flexible fiber optic bundle 29 extends from the remote light source through the lower end of the handle and terminates adjacent the end of the tang 27 as seen in FIG. 3. By using a fiber optic bundle and a remote light source, an intense illunination can be provided from the end of the tang without making the instrument itself hot. In addition, the light source can be conveniently powered from an ordinary convenience outlet rather than requiring batteries or other portable power supply. Removal of batteries from the examining instrument makes it much lighter weight than present instruments.
As best seen in FIG. 4, a transparent plastic cover 31 is fitted on the end of the tang so as to cover the end of the fiber optic bundle. Shallow grooves 32 in the end of the tang retain the cover in place during use. However, if desired, the cover can be snapped off and replaced. The cover serves to protect the end of the fiber optic bundle from mechanical damage and contamination. It also permits the exchange of covers for a variety of functions. Thus, for example, the surface of the cover can be roughened to diffuse the light from the fiber optic bundle, if desired. Similarly, the cover can be non-planar for concentrating or spreading the light beam for more specific illumination. One can also remove the water clear transparent cover and replace it with a green tinted transparent cover for enhancing the contrast of blood vessels in the region being examined. Green light can, of course, be obtained by a filter in a light source.
About the most common attachment for the ENT instrument is an ear speculum 33 as illustrated in FIGS. 1 and 2. This ear speculum is in the form of a generally flaring cone similar in external shape to the conventional specula used with otoscopes. The larger end of the speculum is open. The smaller end may be open or it may be closed by a plane window since the speculum is made of transparent material.
A crescent-shaped socket 34 is formed on the inside surface of the speculum adjacent its larger open end. The socket 34 has an internal taper matching the taper on the tang 27 so that it is firmly retained when pressed onto the tang. To use the ENT instrument as an otoscope, it is necessary only to press an ear speculum onto the tang and conduct an examination in the normal manner using the light source for illumination and, if desired, the lens 26 for magnification.
Light from the fiber optic bundle 29 is projected from the end of the tang and passes through the transparent end of the socket 34. Some of the light projects through the open center portion of the speculum and some is conducted along the transparent plastic so as to be projected from the smaller end of the speculum. This latter is preferred when the small end of the speculum is closed so there is minimum reflection from the window at the end of the speculum. In such an embodiment, the transition between the end of the socket 34 and the balance of the ear speculum is gradual so that most of the light is transmitted along the length of the speculum until it reaches its smaller end. If desired, the interior surface larger end of the speculum can be darkened or made opaque to avoid an objectionable ring of illumination due to reflection internally within the speculum. If the inside is rendered opaque, a transparent window may be left at the end of the socket for transmitting light from the end of the tang.
One problem that sometimes occurs in examination (particularly of children) is that the person moves his head suddenly, which can cause painful or dangerous penetration of the speculum into the ear. The improved ENT instrument is therefore provided with a spring loaded "bumper" 36 below the tang. The bumper is typically a circular pad that can be rested against the next or jaw of the patient for limiting penetration of the speculum into the ear. As seen in FIG. 5, the bumper 36 is mounted on a slide 37 that is free to move along the length of the handle in a T-slot or the like. A detent spring 38 retains the slide in its selected vertical position along the length of the handle. The bumper 36 is mounted on a short shaft 39 fitted into a sleeve 41 on the slide. A spring 42 biases the bumper away from the handle. This gives some resilience to the bumper which may also be covered with foam rubber, if desired.
FIGS. 5 and 6 illustrate in transverse cross-section and end view, respectively, an improved ear speculum for mounting on the ENT instrument. As illustrated in FIG. 5, the improved speculum is mounted on the ENT instrument and inserted into the canal of an ear. The improved ear speculum has a flaring generally coneshaped exterior similar to a conventional ear speculum. A curved female socket 44 permits the speculum to be mounted on the ENT instrument in the same manner as the previously described speculum 33. A plane transparent window 46 is provided at the small end of the speculum so that it is closed.
When the speculum is inserted into an ear canal, the interior of the canal is isolated since the exterior of the speculum generally fits tightly enough into the ear canal to effectively close it. An upper channel or duct 47 generally opposite from the socket 44 is open at both the larger and smaller ends of the speculum. A lower channel or duct 48 is adjacent the socket 44 and also provides fluid communication with the region beyond the small end of the speculum. The upper channel 47 is used for addition of fluid into the ear canal for cleansing or medication. Any convenient syringe may be used for putting fluid into the upper channel 47. The lower channel 48 permits the fluid to be drained from the ear and the window 46 prevents the fluid from entering the viewing portion of the speculum.
A collection vial 49 as illustrated in FIG. 7 may be mounted on the handle by a spring clip 51. An L-shaped receiving funnel 52 guides fluid from the lower passage 48 in the speculum into the vial so as to maintain cleanliness of the examining instrument. If desired, as illustrated in FIG. 11, a collection vial 49' may be mounted on a slide 37' for moving along the handle like the slide 37 for the bumper illustrated in FIG. 5.
FIG. 8 illustrates the ENT instrument in side view with a tongue depressor mounted on the tang. The tongue depressor is a flattened blade of transparent plastic having a size and shape generally similar to a conventional wooden tongue depressor. The tongue depressor has a tapered socket 66 that fits onto the tang 27 of the ENT instrument. Light from the fiber optics within the tang is therefore transmitted along the length of the tongue depressor for illuminating the interior of the mouth. If desired, the upper surface of the tongue depressor can be slightly roughened or provided with transverse ridges for providing diffuse illumination throughout the mouth.
FIGS. 9 and 10 illustrate an attachement to the ENT instrument of particular utility for viewing deep into a person's throat. This attachment 76 converts the instrument into a laryngoscope. The laryngoscope attachment comprises an elongated member having a socket 77 at one end thereof for mounting on the tang 27 of the ENT instrument. It is generally found desirable to extend the socket 77 in the form of an elongated passage 78 open at its opposite end for optimum light transmission. A mirror 79 is mounted on the end of the attachment 76 opposite the end of the passage 78. The mirror 79 is set at an angle to the length so that light from the fiber optics within the tang is projected through the passage 78 and reflected at an angle so that it may, for example, illuminate the larynx.
As mentioned above, one problem with a laryngoscope is that the end may engage the soft palate or other portion of the rear of the throat and cause a gagging reaction. A topical anaesthetic is often administered to this region for suppressing the gag reaction. The attachment provided herein is also provided with a small passage 81 extending along its length. The passage communicates with a chamber 82 behind the mirror 79. A plurality of fine orifices 83 on the angled face of the laryngoscope communicate with the chamber 82. Anaesthetic in the form of an aerosol mist or the like is passed through the passage 81 along the length of the attachemnt and emerges from the orifices 83 so as to spray against those portions of the throat against which the attachment may engage. This provides localized anaesthesia to these areas and suppresses the gag reaction. A minimum quantity of anaesthetic is thus applied only to the areas when it is needed. The physician then simply views along the length of the attachment for examining those areas reflected in the mirror 79. Such areas are, of course, illuminated by the light from the fiber optics in the tang which is also reflected from the mirror 79.
It will also be noted that after viewing the larynx, the entire ENT instrument may be turned upside down and the nasopharynx and eustachian tubes may be examined.
Although limited embodiments and attachments for an ENT instrument have been described and illustrated herein, many modifications and variations will be apparent to one skilled in the art. It is therefore to be understood that within the scope of the appended claims, the invention may be practiced otherwise than as specifically described.