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PubMed1996

[History of the ear speculum. Images from the history of otorhinolaryngology, highlighted by instruments from the collection of the German Medical History Museum in Ingolstadt].

BACKGROUND. Inspection of or interventions in the external ear canal and the nostrils pose similar technical problems. This is the reason why early instruments devised for otoscopy and rhinoscopy were based on an identical principle. They were shaped like a pair of tongs, comparable to nasal specula of today. A similar type of instrument had been developed earlier by barber surgeons for inspecting narrow wound cavities. TONG-SHAPED SPECULA. The first description and illustration of an aural and nasal speculum was provided by Guy de Chauliac in Montpellier, France in 1363. Sophisticated models were presented by Fabricius Hildanus in Germany in 1646 and J.J. Perret in Paris in 1772, who offered them in his illustrated catalogue of surgical instruments at fixed prices. W. Kramer (1836) in Berlin improved this tong-shaped instrument and devised the ear speculum named after him that was generally favored during the first half of the 19th century. Further variations of this type were presented by Lincke and Schmalz (1846) in Germany. FUNNEL-SHAPED SPECULA. Ignaz Gruber in Vienna in 1838 devised the first tunnel-shaped ear specula made of metal. They had a simple conical shape, were not divided into separate jaws, and could not be spread. Gruber himself did not publish his invention, but he demonstrated his ear specula to W. R. Wilde from Dublin, who had paid a visit to his office in Vienna. Wilde reported on this in 1844, and subsequently systematically refined Gruber's specula. A. v. Tröltsch from Würzburg (Germany) had seen these instruments at Wilde's office and it was Wilde himself and v. Tröltsch who helped this type of ear speculum to gain acceptance on an international scale. A different type of bottle-shaped ear speculum was first used by Schmalz (1846) and Erhard (1859) in Germany, but it was only developed into a commercially available instrument by Josef Gruber in Vienna in 1870. The ear specula most in use today were first presented by A. Hartmann in Berlin in 1881. SUPPLEMENTARY INVENTIONS. An important supplementary invention was the pneumatic ear speculum by E. Siegle in Stuttgart (Germany) in 1864. It permitted not only inspecting the tympanic membrane but also examining its compliance and response to variations in air pressure in the ear canal. The importance of this instrument was recognized at once and has remained undisputed to this day. J. Bruton, an English military surgeon, presented his otoscope in 1862. It was the first device to incorporate interchangeable ear specula, illumination by a perforated mirror, and a magnifying lens into one handy instrument. It is the precursor of the modern diagnostic sets comprised of a battery-handle, various specula, and accessories for otoscopy, rhinoscopy, and ophthalmoscopy which started to come into use in the late twenties of this century. This historical development of the ear specula is described and illustrated in detail.

Endoscopy↗
PubMed2004

Does speculum examination have a role in assessing bleeding in early pregnancy?

OBJECTIVES: To assess to what extent a speculum examination after a bimanual examination influences the accuracy of diagnosis and subsequent management of women with bleeding in early pregnancy in an accident and emergency (A&E) department. METHOD: A prospective study over a five month period included women presenting to A&E with vaginal bleeding at <20/40. Exclusion criteria were haemodynamic instability or known cervical carcinoma. The clinician recorded a diagnosis and management plan on a standard questionnaire after bimanual examination and after subsequent speculum examination. RESULTS: 236 women were included in the study. Of these, a total of three (1.3%) had a change of management plan and 10 (4.2%) patients had a change of diagnosis after speculum examination. CONCLUSION: The results suggest that speculum examination contributes to a minority of management decisions. The need for speculum examination should be assessed on a case by case basis depending on whether the findings on bimanual are conclusive.

Abortion, Spontaneous↗
PubMed2006

The role of speculum and bimanual examinations when evaluating attendees at a sexually transmitted diseases clinic.

BACKGROUND: With the advent of molecular techniques, self-collected specimens without a clinician's examination are often adequate to detect common genital infections. OBJECTIVE: To evaluate the additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic. METHODS: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented. RESULTS: 15 918 of 21 703 records were included: 12 073 were symptomatic (SYM; discharge, rash, abdominal pain, dysuria, genital irritation or odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years; 94% were black. 11.8% of SYM, 4.6% of CON and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically relevant abnormalities in 6.5% of SYM, 0.8% of CON and 0.6% of ASYM patients. CONCLUSION: Symptomatic women are most likely to benefit from speculum and bimanual examinations. However, their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.

Adolescent↗
PubMed2005

A disposable vaginal speculum for the chimpanzee (Pan troglodytes).

The unanticipated underutilization of chimpanzees (Pan troglodytes) by the National Institutes of Health (NIH) for current NIH-supported research has prompted the application of a variety of contraceptive forms. Among the many methods attempted, the intrauterine device (IUD) has been described as having an efficacy similar to that described for humans. In addition, the device is both a financially sound and practical solution to prevention of overpopulation, while minimizing disruption of normal cyclic hormonal fluctuations. However, variations in the size and shape of the sexual skin of the female chimpanzee and the depth of the vaginal vault have posed physical constraints on the use of instrumentation developed for humans for assisting with insertion of the device. In addition the literature is lacking in specific methodology for pelvic examination in chimpanzees. Previously, the University of Louisiana at Lafayette New Iberia Research Center used a 3-ml plastic syringe case as a vaginal speculum to accommodate requirements of an approved research protocol in African green monkeys (Chlorocebus aethiops). Similarly, a simple and effective disposable vaginal speculum was developed for the chimpanzee. The closed tip of a plastic syringe case of appropriate size (20 to 60 ml) was removed to provide an open tube; momentary heating smoothed the cut edge. This simple speculum allowed for sufficient visualization of the cervix for assessment and assistance in the insertion of the IUD. Variously sized speculums were prepared to accommodate differences in animal size. This simple and effective speculum was clean, disposable, and inexpensive.

Animals↗
PubMed1985

[The nasal speculum. Its historical development and remarks on the history of rhinoscopy].

The examination of the nose has been known to the ancient Egyptian medical doctors (Papyrus Ebers), and is exactly described by Hippocrates (460-377 B. C.). It has been performed in direct sunlight until the 13th century when candle light was recommended by Arnold de Villanova. However, G. C. Arranzi, in the 15th century, used a glass flask, filled with water, directing candle light through it into the patient's nose. The first endoscopic lamps appeared during the 18th century. The nasal speculum was first mentioned by Guy de Chauliac (13th century) and was illustrated for the first time by Arcolano (14th century). Fabricius Hildanus (1560-1634) constructed an aural speculum which was nearly identical to the nasal specula of today. It was developed further by Peret (18th century) and Wilhelm Kramer (1801-1875) to the type of nasal speculum which is still. Predecessors of the nasal speculum are specula which were in use for the examination of the vagina and the anus. The eldest specimens were found in Pompeji, the city that was destroyed in 76 A. D. These specula consisted of two or three blades which opened by pressure or by means of a crank. The prototype of these specula is a tubular speculum as described by the so-called Ayurvedic doctors of ancient Indian medicine (Ayurveda of Suşruta ca. 500 B. C.).

Endoscopes↗
PubMed2000

Transsphenoidal "cross court" approach using a slightly modified speculum to reach pituitary adenomas with lateral growth.

BACKGROUND: The purpose of this study was to evaluate the usefulness of an oblique "cross court" transsphenoidal approach using a speculum with slightly modified projections for pituitary adenomas showing lateral extension. METHOD: The projection of the speculum on the side of the cavernous lesion was shortened by 5 mm. The tip of the longer projection was placed in the sphenoid sinus, while the end of the shorter projection was placed on the concha sphenoidalis. An oblique transsphenoidal view was then easily obtained by opening the speculum. The contralateral nasal incisura had to be widened in some cases to achieve a more oblique view. FINDINGS: Twenty-eight patients diagnosed with pituitary adenoma showing lateral growth underwent adenomectomy under direct observation of the medial portion of the cavernous sinus using this approach. Postoperative normalization of hyperendocrinopathy or gross total removal of the tumour was achieved in the majority of patients. INTERPRETATION: An oblique transsphenoidal approach using this speculum and contralateral minor maxillary osteotomy afforded a direct view of the medial cavernous sinus, sufficient for the removal of adenomas showing minor to moderate lateral growth.

Adenoma↗
PubMed1981

[A new disposable, self-retaining, single-bladed vaginal speculum (author's transl)].

A new, disposable vaginal speculum has been tested clinically. It consists of a thin, elastic plastic sheet which, rolled into the shape of a narrow tube, can be introduced into the vagina. Due to its inherent elasticity, it unfolds and allows examination of the cervix uteri. Of 507 patients investigated using this disposable speculum, cervical examination could be performed in 96%. In a comparative group of 138 patients using the usual metal speculum of Cusco, cervical examination was possible in 100%. The plastic speculum, developed for use in cancer screening tests, is suitable for routine vaginal examination after a little practice in the introduction technique.

Colposcopes↗
PubMed1996

Higher pregnancy rates with a simple method for fallopian tube sperm perfusion, using the cervical clamp double nut bivalve speculum in the treatment of unexplained infertility: a prospective randomized study.

The object of this study was to evaluate the efficacy of the newly developed cervical clamp double nut bivalve (DNB) speculum used for Fallopian tube sperm perfusion (FSP) with 4 ml of the inseminate, in comparison with standard intrauterine insemination (IUI) using a volume of 0.5 ml of the inseminate. Couples with unexplained infertility (n = 104), undergoing 202 cycles, were enrolled in this study. Cycles were assigned randomly to either IUI (group A, n = 92) or FSP + DNB speculum (group B, n = 110). Ovarian stimulation was achieved using three different ovarian stimulation protocols in both groups. The age and follicular development of the patients were similar in both groups. The serum hormonal measurements and the endometrial thickness was also similar on the day of human chorionic gonadotrophin (HCG) administration. The mean (+/-SD) number of motile spermatozoa inseminated was 44.83 +/- 16.57 x 10(6) in group A and 42.68 +/- 13.44 x 10(6) in group B. In group A (IUI). 11 clinical pregnancies (presence of gestational sac with heart beats) occurred (11.95% per cycle). In group B (FSP + DNB speculum) 29 clinical pregnancies occurred (26.36% per cycle). These differences were statistically significant (P < 0.001). The results of this study for the treatment of unexplained infertility indicate that this simple, well tolerated, inexpensive method of using the DNB speculum for FSP is more successful than standard IUI.

Adult↗
PubMed1996

[Corneal distortion induced by speculum--studies with computer-assisted corneal topography].

The corneal distortion induced by the presence of an eyelid speculum was analysed by the Videokeratoscope-Eyesys Corneal Analysis System (EYESYS), with a Barraquer type speculum (B group) in 22 normal eyes and with a Kratz-Barraquer type speculum in 38 normal eyes (KB group). The following differences were evaluated in the 2 groups: intraocular pressure (IOP), refractive power, change in astigmatism of the Cravy method, and corneal refractive power before and after the specula were put in the interpalpebral fissure. Significant differences were found in the IOP in the KB group, in spherical equivalent in the B and KB groups, and in corneal refractive power in the B groups. Then the 38 eyes of the KB group were divided into two groups by the average level of proptosis and the average difference of IOP, and the corneal refractive power of the two groups was compared by statistical analysis. Significant difference was found in the direction of 0 degree/ 180 degrees in the group with higher than average proptosis and in the direction of 90 degrees/ 270 degrees in the group with higher than average difference in IOP. Multiple regression analysis suggested that higher grades of proptosis were related with steeper vertical meridians and that wider palpebral fissures were associated with steeper horizontal meridians. Multiple regression also showed that the speculum did not cause corneal distortion with the proper relation between level of proptosis and width of the palpebral fissure.

Adult↗
PubMed1982

An adjustable self-supporting eyelid speculum.

I have modified a Maumenee-Park eyelid speculum to permit eyelid retraction in the direct plane of action of the lids and to avoid pressure on the globe from the speculum weight. A ball-joint at the end of the blade allows the blade to adjust with the eyelid. Increased angulation of the sidearm places the blade perpendicular to the eyelid. An adjustable rod at the screw end removes the weight of the speculum and secures the device.

Eyelids↗
PubMed1992

Emergency percutaneous dilatational cricothyroidostomy: use of modified nasal speculum.

The authors devised a percutaneous dilatational method which they believe trained physicians and nonphysicians (emergency medical technicians and paramedics) can use with safety and speed. With one blade of a modified nasal speculum embedded in a tapered small pigtail-dilator catheter, the closed, flattened instrument is forced through the cricothyroid ligament, with a twisting motion, and then opened. Only the skin is incised 1 cm in length. Then a free flow of air via attached syringe is sought before any further penetration. This guarantees accurate and safe entry into the airway. The operator forces the J-tipped dilator and speculum inward as the needle is withdrawn. At the proper depth the speculum is opened transversely, and a cuffed tracheostomy tube with an internal diameter of 6 mm is inserted. The instrument is removed and immediate suctioning and active ventilation is possible. The authors developed the use of this instrument in trials on a mannequin and on 25 cadavers.

Cricoid Cartilage↗
PubMed2002

Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears.

OBJECTIVE: To test the hypothesis that lubrication of the vaginal introitus and external speculum does not adversely affect Papanicolaou interpretation. METHOD: One hundred eighty-two patients presenting for Papanicolaou smears as part of their visit were randomly assigned to have either only warm water or a water soluble lubricant to assist speculum insertion. Cytotechnicians and pathologists were blind to the cohort from which smears were obtained. RESULTS: Two unsatisfactory smears were found among 93 patients with the lubricant and two were found among 89 using only warm water. No significant difference was found using the t test for continuous variables and chi(2) for categoric variables. CONCLUSION: Use of a water soluble lubricant on the vaginal introitus and external speculum facilitates examination with no adverse effect on Papanicolaou smear interpretation.

Adult↗
PubMed2002

The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis.

OBJECTIVE: Nonlubricated plastic specula can adhere to the vaginal introitus and cause discomfort with pelvic examination. We wanted to see if application of water-soluble gel lubricant to the plastic vaginal speculum would change the unsatisfactory cervical cytology diagnosis rate. METHODS: Five public health family planning clinic sites were randomized to either water-soluble gel or water only as lubricant during speculum examination for cervical cytology collection. The pathologists were unaware of the assignment of lubricant use. The cumulative rates of cervical cytology diagnoses were calculated for 6 months before, 6 months during, and 6 months after the intervention. RESULTS: From July 1998 through December 1999, 8534 Papanicolaou smears were collected, with 1440 using gel lubrication from January 1999 through June 1999. Rates of unsatisfactory smears for lubricant use clinics were 1.4% during use of lubricant and 1.4% without use (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.6, 1.8). Rates of unsatisfactory smears for lubricant use versus nonlubricant use clinics during the gel intervention period were 1.4% versus 1.3% (OR 1.1; 95% CI 0.6, 2.0). There were no significant differences for the rates of atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or atypical glandular cells of undetermined significance within or between lubricant and nonlubricant clinics for each 6-month period. There were no cases of invasive cancer. CONCLUSION: The use of a small amount of water-soluble gel lubricant on the outer inferior blade of the plastic vaginal speculum does not change cervical cytology results in a young, reproductive-age population.

Female↗
PubMed1986

Ptosis following radial keratotomy. Performed using a rigid eyelid speculum.

Seven patients with acquired ptosis and normal levator function following anterior radial keratotomy are presented. Five of these patients then elected to undergo radial keratotomy of the opposite eye, and four had symmetrical lid fissures (mild bilateral ptosis) after bilateral surgery. Ptosis is a well-known complication of cataract extraction, but has not been reported following radial keratotomy. Unlike cataract extraction, radial keratotomy does not require anesthetic injections, bridle sutures, or conjunctival flaps. The rigid Knapp eyelid speculum used in these cases remains as the only apparent cause of eyelid trauma and subsequent ptosis. During radial keratotomy, the speculum was opened widely in order to provide good corneal exposure and avoid contact with the diamond knife. Contraction of the orbicularis oculi muscle against the rigid speculum may have traumatized the lid, resulting in a levator aponeurosis disinsertion and subsequent ptosis.

Adult↗
PubMed1996

Comparison of Gram-stained smears prepared from blind vaginal swabs with those obtained at speculum examination for the assessment of vaginal flora.

OBJECTIVE: To determine whether Gram-stained smears obtained from blind vaginal swabs could be used reliably for the assessment of the vaginal flora. DESIGN: A prospective, blind comparative study. SETTING: The antenatal clinic of a district general hospital. PARTICIPANTS: Eighty-eight women examined and screened for the presence of bacterial vaginosis during their first antenatal clinic visit. Two smears were obtained for each woman, the first prepared from a vaginal swab taken blindly and the second at speculum examination. The smears were Gram-stained and classified according to the Nugent score: Grade 1 (normal), Grade 2 (intermediate), Grade 3 (bacterial vaginosis). RESULTS: Eight of the 88 pregnant women were identified as having bacterial vaginosis on the basis of the smear taken at speculum examination, and these were correctly identified as having bacterial vaginosis by smears prepared from the blindly taken swab. This gives the blind vaginal swab technique for detecting bacterial vaginosis a sensitivity and specificity of 100% when compared with swabbing at speculum examination. The flora of two women were graded as intermediate, and of 75 as normal by both techniques. Only in three cases was there a disparity between the two techniques, a difference that was not statistically significant (kappa = 0.8546, 95% CI 0.6945 to 1.0). CONCLUSIONS: Vaginal smears prepared from correctly taken blind vaginal swabs can be used to assess the vaginal flora and screen for bacterial vaginosis. This method could be used in epidemiological studies of bacterial vaginosis in the general population and for screening antenatal populations for abnormal vaginal flora.

Double-Blind Method↗
PubMedDate not supplied

Screening for retinopathy of prematurity: are a lid speculum and scleral indentation necessary?

We wanted to investigate the value of using a lid speculum and scleral indentation in performing binocular indirect ophthalmoscopy (BIO) in neonates at risk of retinopathy of prematurity (ROP). We performed a prospective masked comparison of BIO examinations using either a lid speculum and scleral indentation (SI) or no scleral indentation (NSI), in our neonatal intensive care unit. We did 57 consecutive BIO examinations of infants weighing less than 1500 g and/or having a gestational age of less than 32 weeks. With NSI, zone I ROP was reliably seen in 53 of 57 examinations; the superior, nasal, and temporal aspects of zone II were seen in 45 of 57 examinations; inferior zone II, in 22 of 57 examinations; and zone III in 1 of 57 examinations. SI facilitated complete peripheral fundus examination in all cases but had to be abandoned in two infants due to acute changes in oxygen saturation levels. Five infants developed threshold disease, and in two of them details of the active ROP ridge were missed with NSI. The gentle use of an eyelid speculum and globe rotation allows rapid and relatively atraumatic assessment of the peripheral fundus, even in babies who are being ventilated. Although threshold ROP may be diagnosed by observation of posterior retinal vessel dilation and tortuosity ("plus" disease), accurate grading of ROP is likely to require SI. In the absence of clearly developed "plus" disease, borderline or prethreshold disease may occasionally be missed using BIO with NSI. SI is necessary to examine the inferior midperipheral retinal vasculature (zone II) and the far peripheral temporal retina (zone III) and is associated with few complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Fundus Oculi↗
PubMed1978

Forces applied by nasal speculums during transsphenoidal operations.

The forces exerted by nasal speculums were measured during the transsphenoidal approach to the pituitary. The highest forces were found to occur at the beginning of surgery when the speculum had been spread to the desired opening (reaching 42 kg). This force decreases during surgery due to the time dependent motion of the biological structure distant from the applied pressure (relaxation). The amount of relaxation that occurred was measured but was found not to be high enough to indicate damage to the tissues adjacent to the speculum. It is also concluded that this type of instrument was underdesigned for its intended function.

Humans↗