After placing the ear speculum during a myringotomy for PE tube placement, which instrument would be required next?

In the context of a myringotomy for the placement of pressure equalization (PE) tubes, after placing the ear speculum, the next appropriate instrument would be the Buck ear speculum. This instrument is specifically designed for holding the ear open, allowing for better visualization and access to the tympanic membrane. The Buck ear speculum has a wider opening and a longer rim, which facilitates manipulation during the procedure.

Using the Buck ear speculum is critical in ensuring that the surgeon has an unobstructed view of the eardrum, which is essential for making an accurate incision and ensuring correct placement of the PE tube. Proper visualization is paramount during this procedure to avoid damage to surrounding structures and ensure a successful outcome.

In contrast, injectable anesthesia is typically administered before the procedure begins, not as a subsequent step after the ear speculum is placed. Forceps and an endoscope may also be used in specific situations during a myringotomy, but they do not serve the immediate purpose of enhancing visibility and access to the tympanic membrane right after the speculum is in place. Therefore, the Buck ear speculum is the most appropriate choice at this stage of the procedure.