Tag Archives: ENT
Welch Allyn is the leading manufacturer of otoscopes and ophthalmoscopes, however the quality is also reflected in their higher prices. While many medical students want to purchase top name-brand equipment, and indeed this should be the case for such instruments as stethoscopes, this strategy is not always needed for diagnostic kits. Here’s the usual scenario: second year medical students from AMSA or some other group organize a “money-saving fundraiser” (let’s ignore that blatant oxymoron) and only highlight larger, more expensive, name-brand companies. Often times there are even incentives to purchase the more expensive $500-$800 diagnostic sets to “save” on smaller instruments such as tuning forks or reflex hammers.
As mentioned in the Compare Welch Allyn series, it is incredibly important to talk to senior medical students at your school to ascertain the actual usage of instruments. This cannot be accurately assessed from manufacturer representatives, or even the second year medical students running the instrument sales. If third and fourth year students carry their diagnostic sets with them at all times, a Welch Allyn set may be more beneficial. If such diagnostic kits are used in a small handful of learning sessions that teach physical exam techniques during first and second years and are never utilized throughout the rest of medical school, we recommend the following.
The company Med School Supply (completely unrelated to this site despite the similar name) sells full-sized otoscope and ophthalmoscope sets for around $100. Their standard model works just fine, although their LED otoscope set is actually more highly recommended due to the brighter, better lighting it produces. You can clearly see the difference between their fiberoptic LED bulb and an older Welch Allyn halogen bulb in the top image of this article, and read more about the differences in the article How to Pick the Best Light Source.
Both kits work with standard otoscope tips, which means there is no reliance on this company for tips after purchasing one of their models. Like the Standard Otoscope in the Welch Allyn description, Med School Supply otoscopes use a groove system to hold tips internally. The ophthalmoscope uses the same halogen bulb for both kits, and is a solid basic model, without the bells and whistles as its WA counterpart. Unlike Welch Allyn, there is no built in rechargeable option for the handle. These models take two C batteries, and that will last the entirety of medical school for the average user.
It is important to note that this company does not have the same quality control standards as Welch Allyn, so it is possible for them to sell and ship a set with a suboptimal component. Nonetheless, they have a full lifetime warranty on all of their products, so any piece will be replaced free of charge with free return shipping at any point during your use of the instrument. For the $400 difference between this and the Welch Allyn version, some find this compensated downside to be more than tolerable.
This is the sixth and final part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic set (otoscope and ophthalmoscope).
By now, you should have reviewed the other five articles in the series, and noted your preferences:
Compare Welch Allyn Series: How to Pick the Best Battery and Handle
Compare Welch Allyn Series: How to Pick the Best Case
Compare Welch Allyn Series: How to Pick the Best Light Source
Compare Welch Allyn Series: How to Pick the Best Otoscope
Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope
Trade-offs of Pricing and Usage
It is important to remember that many medical schools only require use of personal diagnostic sets while learning how to perform a physical exam during preclinical years. Many rotations will either not require use of these instruments, or provide them to medical students and staff if needed. You should contact senior medical students at your school to ascertain the usage of these instruments when considering the price. For minimal use, you may want to consider purchasing from another manufacturer entirely. It is also a common mistake for incoming med students to assume these instruments will be used after med school. Specialties that use these instruments have more expensive versions or wall mounted models, and many specialties won’t need them at all.
Selecting Your Model
Most retailers do not carry all diagnostic kit combinations of the above Welch Allyn components. Most local companies will carry about 4 of the 75 total diagnostic kits manufactured by Welch Allyn, and that is actually sufficient for the large majority of med students. It is not uncommon for retailers to highlight the more expensive components, such as the PanOptic ophthalmoscope, and to list all other options by their model number. This can be a rather confusing selection process, which can be remedied below.
The following application is designed to assist in putting it all together and selecting the Welch Allyn diagnostic kit that is best suited for your needs and desires based on the results of the above articles. You may input your selections and the application will output the specific model number for your use with retailers. It will also output a list of the closest matches to your selection, in case your first choice is not carried by your retailer.
Please click one of the following from each category:
Recommended Diagnostic Kit Model Number:
This is the fourth part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit otoscope heads.
Unlike prior posts in this series that assist medical students in deciding on which type of products to purchase, this one will focus more on the variability normally encountered by medical students when they first hit the clinic. Most retailers offer only one option for otoscopes in their diagnostic kit even though Welch Allyn manufactures two varieties, so purchasing decisions are not really an issue. However med students still need to know how to use all the historically popular versions and accessories, and what to avoid if buying an older model. As with ophthalmoscope heads, all of the below otoscopes are the 3.5 volt version, which refers to the standard power handles, and are in contrast to miniature “pocket sized” versions of these instruments.
First, let’s review the older pneumatic otoscopes, seen right. The thing to take away from the discussion of this type of scope is that you should not buy one. The general concept is the same as all the other otoscopes, without the shiny distracting bells and whistles you’ll never use. However the big difference between this and the next Welch Allyn otoscope type is the tip. Notice how the base of the tip is rather wide? It is essentially the diameter of the barrel of the scope itself. There is no inherent problem with such tips, as they work perfectly well if you can actually find them, but the chances of coming across one in hospitals and clinics is rather low unless that clinic is specifically using this type of otoscope. So, if you happen to come across one in clinic, you now know to shove the wide-base tip into the wide barrel of the otoscope. However you are also aware that buying one of these most likely comes with providing your own lifetime supply of tips.
Next, let’s look at one of the latest Welch Allyn models to become obsolete for absolutely no reason: the standard diagnostic otoscope. This is the model you are most likely to come across in clinics and hospitals, because they are generally a solid and reliable means of assessing ears. You will also come across other otoscope makers that produce similar looking scopes (to be reviewed in future posts). If you do want to save money by buying an older used diagnostic kit, this is the otoscope head to get.
Unlike the previous otoscope, this model and the following one both use standard otoscope tips, but through different means. The covered end of the scope (under the black plastic tip) is conical metal, and has a groove cut into the top of it that helps lock in a bump of plastic on the inside of the tip. The common mistake med students make is just shoving the tip on without lining up bump with groove, which means the tip doesn’t actually make a secure connection with the otoscope and readily falls off during the examination. While it is especially hilarious to observe medical students accidentally detach the tip and find it dangling out of the patient’s ear (sometimes without their knowledge), this is generally a newbie move to avoid. You should be able to give a slight tug on the tip to ensure it is secure.
The other difference to note between this and its predecessor is the input for the insufflator bulb, which is an accessory used to push air into the ear and gauge movement of the tympanic membrane. You may never use an insufflator bulb throughout med school, and should not buy one. Pediatric offices that require their use will supply them. Nonetheless, Welch Allyn decided to change up the industry standard of having a tube attach onto an external plug (female port) to an extra piece of plastic that gets plugged into a hole in the side of the scope (male port). You can see the additional end piece in the image on the right. I’m sure they saw a minor rise in sales because of that change, but medical students should not purchase this accessory.
Lastly, we come to the unnecessary but unavoidable up-sell, the Welch Allyn Macroview Otoscope. Despite decades of doctors being able to visualize the ear canal perfectly well with standard otoscopes, Welch Allyn claims “this instrument is a significant advance in hand-held otoscopy…”
Their key selling points are that this otoscope doubles the field of view and increases magnification by 30% compared to other models. The former may be helpful, but otherwise you can simply move the scope if you want to view the tympanic membrane periphery. That’s how doctors have done it for decades. The increased magnification simply isn’t noticeable. Remember back when you last used a microscope? The lowest setting was the 10X lens, followed by the 40X lens. That’s 400% greater magnification. This offers a 30% increase, which would be like moving up to a 13X lens on your microscope. In the world of light otoscopy, it sounds like a big improvement, but this really isn’t doing much. This also comes with “the ability to adjust focus for variable ear canal length or farsighted eyes,” which is yet another issue doctors have never really had a big problem with historically.
The macroview otoscope also uses standard tips, but instead of holding onto them by a groove internal to the tip, they actually secure the tip externally. Ridges found near the tip base actually twist under the end of the otoscope head. This is actually a nice improvement, as it does a better job of securing the tips. Of note, you most likely should not need to purchase otoscope tips yourself, as clinics provide them. Be sure to always grab 10 or so extra for your case, just in case you run into a clinic which is not so courteous.
Another key difference in the Welch Allyn Macroview Otoscope is that its lens cannot be rotated or slid aside for direct access to the ear with a curette through the barrel of the otoscope. This is often used to remove ear wax under direct visualization. However, most attendings will not want medical students to be performing manual cerumen disimpaction, as there have been rare case reports of bones in the ear accidentally being removed during this process. Remember: never manually disimpact unless you can directly visualize some portion of the tympanic membrane!
Despite this article poking holes in the advertising of Welch Allyn, this is overall a great otoscope to have. It is reliable, sturdy, and a great tool to visualize the ear canal, which are all excellent qualities as it is most likely your only diagnostic kit option. Unlike differing ophthalmoscope designs that require different learning and skill sets to actually use, there is no difference in the physical use of any of the above otoscopes. That essentially means you can purchase and learn on the Welch Allyn Macroview Otoscope, and still know how to use any standard wall-mounted otoscope in an office or emergency department setting.
In summary, the direct comparison is as follows:
in New Kit
||$150||Large Base||yes||special order only|
|* prices are for the otoscope heads only. handles are sold separately.|
Prices are higher if you purchase components separately, so try to buy a value meal (a complete diagnostic kit sold as a single unit) unless you can find a really great deal. With that being said, the above three scopes were added to the price-check plugin as a reference.
Surgical Recall is one of those third year med student books that can be your secret phone-a-friend ace up your sleeve, and concurrently your downfall. There are a number of books you will encounter throughout medical school where the outcome of that class or clerkship is dependent on how the book is used. Just as you wouldn’t use Netter’s or Rohen’s to replace an anatomy text, Surgical Recall must be used properly.
As the title implies, Surgical Recall is your guide to all things pimping on surgery. Unless surgery is your first rotation, you should already be aware that the pimping starts on the very first day. Accordingly, you should ideally grab a copy of this during the weekend before your surgery clerkship starts and dig in quite a bit by time you hit the first day. This is the book that’s going to help you avoid looking like a total newbie, because common surgical etiquette and culture is not taught in preclinical classes. This is the book that’s going to tell you all the usual abbreviations, the names of all the different scissors you enounter, why you should NEVER touch the mayo tray (and what that is), and all of the common pimp questions you will commonly encounter.
Like other books in the Recall series, Surgical Recall uses a split page question and answer format that quizzes the reader on all the common things seen in surgery. The book does a good job in its use of pictures, especially on sections dedicated to surgical instruments and consumables. This is important as most third year med students don’t know what a JP drain is, what JP stands for, what they look like, and how they are different from other drains. You could responsively google “JP drain” right now, but you won’t know the names of all the other commonly used tools, which is why this book is helpful.
The latest edition (as seen above) has taken on a somewhat retro look. Perhaps market research has shown med students go for books that are already on fire to quell the need to later set them ablaze in frustration, or perhaps this just allows for the subsequent edition to look modernized in comparison. Nonetheless, we can’t judge a book by its cover, else the BRS series of books would have gone extinct long ago. The first section of Surgical Recall is going to touch on the big picture and background of surgery, including abbreviations, surgical signs, syndromes, cutting, suturing, tying, instruments, preoperative requirements, wound care, hemostasis, nutrition, shock, complications, and surgical anatomy pearls. Section II goes over the main general surgery areas, including GI hormones, GI bleeds, hernias, laparoscopy, trauma, burns, bariatric surgery, appendicitis, ostomies, fistulas, IBD, portal hypertension, other hepatobiliary diseases, the breast, endocrine, melanoma, vascular, and intensive care unit knowledge. The third and final section hits the surgical subspecialties, including pediatrics, plastics, hand, otolaryngology, thoracic, cardiovascular, transplant, orthopedics, neurosurgery, and urology. This book is around 800 pages long, and while the question and answer format allows for a faster read, you should generally focus on the general surgery knowledge and the topics that specifically correspond to your surgical service.
Included with this latest version is the promise of free “Mobile Access.” As of now, the jury is still out as to whether this is legitimate, as a number of students have had a hard time actually accessing it through their phones without paying the additional ~$45 app price through Android or Apple. It may be fixed in the future, but don’t purchase this book thinking it will instantly be on your phone.
Surgical Recall can be the downfall for the occasional medical student who believes this is the only book needed during surgery. Indeed it will seem like a cheat sheet, whereby memorizing this book will produce superstar results in the operating room and floors (and it will). However, the NBME Surgery Shelf Exam doesn’t care about the things that make awesome operating room medical students that get all the obscure attending questions. There is no Surgery Shelf question on one-handed ties, no Surgery Shelf question on drain choices, and no Surgery Shelf question on how your attending likes their coffee. Make the distinction: there is OR / floor knowledge, and there is NBME Surgery Shelf exam knowledge, with a minority of overlap. You need both to go for the gold on your surgery clerkship, and Surgical recall is the tool to help with the former.
ENT Secrets, now in its third edition, is the next step up in otolaryngology texbooks for medical students. Previously, this site discussed Primary Care Otolaryngology (reviewed here) as a light read to get through a mandatory ENT rotation or look knowledgeable about otolaryngology in a primary care setting. However, this is not an appropriate strategy for a med student on a sub-internship. To hit the next level of looking awesome, we recommend ENT Secrets.
The benefit of this text book is that it is comprehensive enough for fourth year medical students to learn the fundamentals of every otolaryngology topic, without becoming a monster hardcover. Residents are more likely to reference Pasha or Lee (>1000 pages!), but these are a bit too large and extensive for most medical students on a one month rotation. They are better suited for Ear-Nose-Throat boards, whereas ENT Secrets is better used for things like getting pimped, and not looking like a newbie.
As with many other books in the “Secrets” series, the book is broken down into subspecialties and reads in question and answer format, with numbered titles followed by detailed definitions of terms and scenarios. You’ll get all the usual imaging and diagrams you would expect. This also comes with the online Student Consult. Some of the features, such as online note taking, seem outright useless (please, someone comment if they disagree). However the ability to access the text electronically means you can embrace the med student geek inside you and read while waiting for the bus. It also means you can gank key figures and use them in powerpoint presentations.
If you’re about to hit your ENT sub-internship, this is the recommended book for you. Otherwise, for mandatory clerkships, stick to the recommended reading, or Otolaryngology for Primary Care.
Primary Care Otolaryngology by Mark Wax is one of those great tiny books to just breeze through in an afternoon, regardless of your specialty. It has a great balance of brevity and high yield knowledge, specifically highlighting otolaryngology surgical emergencies and general ENT knowledge. The information is easily applied to a number of non-ENT rotations, specifically in regards to outpatient primary care, and reading x-rays. ENT topics in general are pretty straight forward: easy to learn and easy to teach, which means you look like a star med student when you point out a concha bullosa on a random CT in the emergency room, floors, or outpatient setting, and then explain what it means.
You can buy a physical copy, or get the eBook for free online through The American Academy of Otolaryngology Head and Neck Surgery.