Tag Archives: otoscope

Otoscope and Ophthalmoscope Set Alternatives: Med School Supply

Compare halogen and LED diagnostic kit bulbsWelch 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.

Med School Supply Fiberoptic LED Otoscope Ophthalmoscope SetThe 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.

 

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Compare Welch Allyn Series: Building a Full Diagnostic Set

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:

Relative Price $
$$
$$$
Case
Handle
Otoscope
Ophthalmoscope

Recommended Diagnostic Kit Model Number:

 

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Compare Welch Allyn Series: How to Pick the Best Otoscope

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.


Welch Allyn Compare Series: Pneumatic Otoscope

Pneumatic Otoscope

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.


Welch Allyn Compare Series: Diagnostic Otoscope

Standard Otoscope

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.

Welch Allyn Compare Series: Insufflator BulbThe 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.


Welch Allyn Compare Series: Macroview Otoscope

Macroview Otoscope

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.

Welch Allyn Compare Series: Standard Otoscope TipThe 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:

Approx.
Price *
Type
of Tip
Curette
Opening
Available
in New Kit
Pneumatic Otoscope
$150 Large Base yes special order only
Standard Otoscope
$110 Standard yes no
Macroview Otoscope
$225 Standard no yes
* 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.

 

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Compare Welch Allyn Series: How to Pick the Best Light Source

This is the third installment 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 light sources, which are the physical bulbs that illuminate the ear canal or retina through the otoscope and ophthalmoscope, respectively.

Choices here are limited throughout the industry to either halogen bulbs, which have been the long-standing default in the field, or the newer sexier light-emitting diode (LED) technology. If you’re interested in the bottom-line short version, scroll to the bottom.


Welch Allyn Halogen BulbFirst let’s hit the older (read: cheaper) option that is still the default for diagnostic kits today. Halogen bulbs have been the standard for otoscopes and ophthalmoscopes for a while now, and Welch Allyn has (in their usual fashion) claimed theirs is the best. Halogen lights in general produce a yellow or off-white softer light. This actually comes in handy when viewing a retina, as brighter lights will constrict the pupil, thus making it more difficult to actually see the retina.

The downside to halogen bulbs is that they are somewhat easy to break, and they degrade and burn out faster than LEDs. Historically, halogen bulbs have cost up to $60 to replace, making this a sub-optimal option that doctors just had to put up with. Today, the price has thankfully lowered. Overall, this is now the cheaper option simply because it is the older technology, even though it works reliably well.


Welch Allyn LED Bulbs for Diagnostic KitsDiagnostic kit LED lightsaber bullets bulbs on the other hand are the more expensive option, which is somewhat surprising simply because LED technology of this variety has been around for a lot longer than it has been used in otoscopes, and should theoretically be cheaper. Welch Allyn had previously scoffed at LED lights, but are now making the transition over since competitors have been offering this option. Due to these recent changes, you can still find contradictory representatives that claim LED lights are not needed, while portions of their website claim LED lights as superior. They have however taken some time to create shiny exaggerated graphics, which I will share below. Regardless, do not be surprised if this newer option is not yet offered by most retailers.

Not quite sure how to interpret this one…

LED bulbs produce whiter and brighter light, allowing for clearer visualization of ears and noses. Check out the direct comparison of the two light sources in the top image. The LED is like a light-bazooka in comparison. Med students can just use their LED otoscope and actually forgo carrying a separate penlight to check pupils or look in someone’s throat, as they run on similar LED bulbs (that only cost the expected $2). LEDs use a fraction of the power compared to halogens (which means your handle battery lasts longer), are near-impossible to burn out, and don’t degrade in light quality during extended use. In almost every way, LED bulbs produce harder, better, faster, and stronger light.

The first real downside at this point is the cost, but that is expected to dramatically drop as soon as generic options are created that fit Welch Allyn diagnostic kits. Refuting the claim that the LED can be “too bright” is as easy as dimming the bulb on the power switch. As an aside, I find it amusing that Welch Allyn believes that dimming a halogen bulb, as seen in their demo on the right, somehow produces black-light (I said they were exaggerated). My personal solution, and the setup that I use in my instruments, is keeping the ophthalmoscope halogenated, and using an LED only with the otoscope. I get the best of both worlds. Keep in mind that you may need to open your instruments to insert the LED bulb yourself if your retailer does not provide this service for you. If you have the smarts to get into med school, this shouldn’t be too difficult to figure out. I’m sure there’s a “how many med students does it take to screw in a light bulb” joke somewhere in there.

Selecting an LED bulb may seem like a no-brainer. However, choosing this optional component in your diagnostic kit should come down to the question as whether this sexy super-light is actually needed. For the large majority of medical students, the answer is no, and the prices offered by Welch Allyn should serve as a deterrent, if the option is offered by retailers at this point.


In summary, the direct comparison is as follows:

Approx. Price Lifetime *
Color and Intensity
Halogen Bulb
$25 ~7 months Soft yellow
LED Bulb
$90 ~25 years Bright white
* refers to the total time when the bulb is actually on and in use

Still can’t decide? Let us help! Check all that apply:

My retailer doesn’t even offer LED, and I’m not really a do-it-yourself kinda person.
Money is of no concern in the purchase of my instruments.
I have a habit of dropping my cell phone frequently.
I want to learn on the same components as everyone else, including the people teaching me.
I want to learn physical exam techniques using the absolute best equipment at my disposal.
I’m never going to use this diagnostic kit after med school, and will probably not use it that much in med school either.

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Compare Welch Allyn Series: How to Pick the Best Case

This is the second 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 cases, which is one of the easier choices to make as it doesn’t directly affect the use of your medical instruments.

The choices are straight forward: soft or hard casing. While many people instantly jump at the hard case, there are actually benefits and drawbacks to each.


Welch Allyn Hard CaseFirst, let’s look at the hard case, seen right, which are usually the default option offered upon purchasing a Welch Allyn diagnostic set.  Hard cases are designed to provide a shell of hard plastic around your instruments, with some padding between the case itself and the instruments inside. As such, dropping your Welch Allyn kit in a hard case is more likely to prevent the actual instruments themselves from directly feeling the shock of the floor. The other great benefit is that the inside of the case is basically a molding of the instrument components, meaning each part has its own place, and everything stays organized.

The biggest downside is that the hard case is somewhat bulky.  While it will fit into an empty white coat pocket, it will be somewhat of a tight fit to get the fabric around the corners.  It goes without saying that most med students don’t put too many other things in the white coat pocket that will carry their diagnostic kit, as it makes things difficult or impossible to fit everything. The downside of the organization benefit is that the molded inner casing essentially requires the user to organize everything before being able to close the case at all.  Some people find this annoying, especially if they are in a rush or have only one hand free.  It also means you can’t really re-use the case for new or other instruments. Lastly, the side-zipper requires the user to remove the entire kit from their pocket and set it down on a table to open. It’s rather difficult to access instruments directly from a pocket, or one-handed.


Welch Allyn Soft CaseNow let’s turn towards the soft case.  Depending on the retailer, you may need to specially request a soft case if you so desire it, but keep in mind that Welch Allyn instruments will most likely fit into any standard soft case, even if it is not made by Welch Allyn. The biggest benefit of soft casing is that it is a bit more convenient to use.  Instruments sit longitudinally inside the case, covered by a flexible padding layer, with an opening on top. The width of soft casing is thinner than the hard casing and without the hard corners, which means it easily slips into white coat pockets, even with other things in them. This flexibility and ability to squish into its surroundings also means it can even be slipped into pants pockets.  This is incredibly useful on a Pediatrics clerkship where white coats are optional.  The other big benefit is that the top opening allows for instruments to just be slipped in and out of the case while it’s still in your pocket.  No table for setup or organization time is needed.  Just grab and drop back in when done.  Lastly, it is important to mention that the open space inside the case means additional instruments can be placed within it.  When I bring a diagnostic kit with a soft case, my tuning fork and reflex hammer are stored within it in one convenient package as well. Thinking ahead, new or upgraded instruments do not require a new soft case, as they can be re-used.

The downsides are just the opposites.  Welch Allyn claims “both cases provide sufficient protection,” but the truth is that the soft case will transmit impact with the floor more than the hard casing. It also means instruments are laying loose inside the soft case and can bump and rub against each other.  This generally doesn’t actually represent any threat to the instruments as Welch Allyn claims all of their instruments are incredibly durable, but it should be pointed out.  As things are loose, grabbing otoscope tips that migrated to the bottom can be troublesome, but this is a moot point if you don’t need to bring your own tips because the clinic supplies them.


Still can’t decide? Let us help! Check all that apply:

I have a habit of dropping my cell phone frequently.
Ease of use is the most important aspect.
When I’m done using the vacuum, I never wind up the wire properly.
I want to keep my instruments as well protected and preserved as possible.
My school bag is a gigantic mess, but I know where everything is.
Presentation is everything.

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Compare Welch Allyn Series: How to Pick the Best Battery and Handle

This is the first 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 handles and power sources, which house the battery and provide power for the otoscope or ophthalmoscope head. If you’re interested in the bottom-line short version, scroll to the bottom.

Welch Allyn Universal Desk Charger Not Needed for Med StudentsThe easiest way to start is to say what you do NOT need, and that is the Welch Allyn Universal Desk Charger (seen right).  These clunky things run upwards of $200 and represent the superfluous up-sell. The concept is good in theory, in that you can just drop your instruments into one of the holes to get it charged. As a med student on the wards, such a tactic is sub-optimal at best and a good way to get your gear stolen at worst. The actual handles have their own methods of charging which do not require this costly and unnecessary extension cord.

Now let’s turn to the real decision: Welch Allyn NiCad or Lithium Lightsaber power handle.  Each one has its pros and cons, but understanding your use of your Welch Allyn diagnostic kit as a med student is what should really determine your buying trend. Most med schools only require you to purchase and use personal diagnostic kits during the teaching of physical exam techniques in the preclinical years, with very rare use in specific clinics during third and fourth year of medical school. You should ascertain usage patterns at your med school to make sure you don’t jump at the high end model when it will only be used a handful of times for the entirety of your medical school training.


Welch Allyn Nickel Cadmium Battery Powered HandleThe Welch Allyn Nickel-Cadmium (NiCad) handle (shown left) is the baseline model that will serve as a cheaper but reliable power source.  The NiCad battery inside can be recharged by plugging the handle directly into any wall socket.  One of the biggest benefits of this power source over the Lithium below is that it can be converted to normal C-battery use. I have seen several med students forget to charge their handle, subsequently lose power in the middle of clinic, and then look really foolish for the rest of the day. With this model, having a couple of batteries in your bag means you can pop them in and keep going strong when the charge dies.  This is especially ideal for developing countries with unpredictable electrical sources, should you decide to go abroad.

 

There are a couple of downsides to the NiCad battery. First, it is heavier than the Lithium handles.  For most people, this is not significant and not an issue whatsoever. The only other consideration is that there are rumors (often times furthered by Welch Allyn representatives) that NiCad batteries in general may experience “charge memory” or “memory effect.” This refers to a historic observation that NiCad batteries will remember the point at which you charge them as “empty,” thus not utilizing the full capacity.  Most modern observations of this effect require over 1000 charges and partial-discharges for this to actually take effect. Suffice it to say, I have never heard of any medical student or resident complain about their NiCad handle losing charge time, and this may possibly by a result of the overall infrequency of use. Many medical students can get through all of medical school on just one set of 2 C batteries in their diagnostic kit.


Welch Allyn Lithium Ion Rechargeable HandleNext we have the “superior” (read: more expensive) option, the Lithium Ion battery powered Welch Allyn diagnostic kit handle.  This is one of their up-sells, advertised as “twice the battery life with just half the weight.”  It mostly speaks for itself, but there are a few considerations. Like the NiCad handle, it can be plugged into any electrical outlet via the hidden electrical AC plug within the handle.  However this handle cannot be converted to use C batteries.  In other words, when you run out of juice in this thing, you’re done until you can charge it in the wall again.  Again, keep in mind that a full charge will get you pretty far, so weigh things based on your schools requirements.  Another possibly-insignificant difference with this handle is that the green push-and-twist power button is on the side of the handle itself instead of on the top edge. There’s really no difference in ease of use.


In summary, the direct comparison is as follows:

Approx. Price Battery Life Compare Weight Recharge Options
Nickel Cadmium $150 ~60 minutes less light Wall Outlet or C Batteries
Lithium Ion $300 ~120 minutes lighter Wall Outlet only

Still can’t decide?  Let us help!  Check all that apply:

My med school requires infrequent usage of diagnostic kits.
Money is of no concern in the purchase of my instruments.
I have a habit of losing things easily.
I have a habit of forgetting to charge my cell phone.
I want to learn physical exam techniques using the absolute best equipment at my disposal.
I want to look like a jedi.

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