K Number
K030857
Device Name
MAHE PEDIATRIC NASO PHARYNGOSCOPE ITS ASSOCIATED AND ANCILLARY EQUIPMENT AND ENDOSCOPIC ACCESSORIES
Manufacturer
Date Cleared
2003-10-16

(212 days)

Product Code
Regulation Number
874.4760
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MAHE Pediatric Naso-Pharyngoscope is intended for use only by qualified surgeons. Do not use the instrument for any purpose other than its intended application. The MAHE Pediatric Naso-Pharyngoscope has been designed to be used with a light source, documentation equipment and video monitor for sinuscopy diagnosis and treatment within the nasal cavity and nasal pharynx. The MAHE Pediatric Naso-Pharyngoscope is indicated for visual exam during diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx. The MAHE International Pediatric NASOPHARYNGOSCOPE is indicated for visual examination during a diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx.
Device Description
The MAHE Pediatric Naso-Pharyngoscope has been designed to be used with a light source, documentation equipment and video monitor for sinuscopy diagnosis and treatment within the nasal cavity and nasal pharynx.
More Information

Not Found

No
The summary describes a standard naso-pharyngoscope for visual examination and does not mention any AI/ML components or capabilities.

Yes.
The device is indicated for use during "treatment" procedures within the nasal cavity and nasal pharynx.

Yes
The Intended Use section explicitly states that the device is for "sinuscopy diagnosis" and "visual exam during diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx."

No

The device description explicitly states it is a "Naso-Pharyngoscope," which is a physical instrument used for visual examination. It also mentions being used with a light source, documentation equipment, and video monitor, all of which are hardware components.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The MAHE Pediatric Naso-Pharyngoscope is a medical device used for visual examination directly within the nasal cavity and nasal pharynx. It is an instrument used in vivo (within the living body) to visualize anatomical structures.
  • Intended Use: The intended use clearly states it's for "visual exam during diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx." This involves direct observation, not testing of samples.

Therefore, the MAHE Pediatric Naso-Pharyngoscope falls under the category of an endoscopic device used for direct visualization, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The MAHE Pediatric Naso-Pharyngoscope is intended for use only by qualified surgeons. Do not use the instrument for any purpose other than its intended application.
The MAHE Pediatric Naso-Pharyngoscope has been designed to be used with a light source, documentation equipment and video monitor for sinuscopy diagnosis and treatment within the nasal cavity and nasal pharynx.
The MAHE Pediatric Naso-Pharyngoscope is indicated for visual exam during diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx.

Product codes (comma separated list FDA assigned to the subject device)

EOB

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

nasal cavity and nasal pharynx

Indicated Patient Age Range

Pediatric

Intended User / Care Setting

qualified surgeons

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

KARL STORZ NASOPHARYNGOSCOPE (FLEXIBLE OR RIGID) K945381

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 874.4760 Nasopharyngoscope (flexible or rigid) and accessories.

(a)
Identification. A nasopharyngoscope (flexible or rigid) and accessories is a tubular endoscopic device with any of a group of accessory devices which attach to the nasopharyngoscope and is intended to examine or treat the nasal cavity and nasal pharynx. It is typically used with a fiberoptic light source and carrier to provide illumination. The device is made of materials such as stainless steel and flexible plastic. This generic type of device includes the antroscope, nasopharyngolaryngoscope, nasosinuscope, nasoscope, postrhinoscope, rhinoscope, salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier.(b)
Classification. Class II.

0

030857

OCT 1 6 2003

510 (k) Summary of Safety and Effectiveness

DEVICE NAME:MAHE Pediatric Naso Pharyngoscope its associated and ancillary equipment and endoscopic accessories
COMMON/USUAL NAMEPediatric Naso-Pharyngoscope and Accessories
CLASSIFICATION NAMEPediatric Naso-Pharyngoscope and Accessories
PREDICATE DEVICESKARL STORZ NASOPHARYNGOSCOPE (FLEXIBLE OR RIGID) K945381
SUBMITTED BY:Paul Cart
MAHE International Inc
490 Craighead St
Nashville, TN 37204
615-269-7256
ESTABLISHMENT #9007726

The MAHE Pediatric Naso-Pharyngoscope is intended for use only by qualified surgeons. Do not use the instrument for any purpose other than its intended application.

The MAHE Pediatric Naso-Pharyngoscope has been designed to be used with a light source, documentation equipment and video monitor for sinuscopy diagnosis and treatment within the nasal cavity and nasal pharynx.

The MAHE Pediatric Naso-Pharyngoscope is indicated for visual exam during diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx.

The MAHE Pediatric Naso-Pharyngoscope are designed, manufactured, and tested according to Voluntary Safety Standards IEC 601-1 and IEC 601-2-18.

When compared with the predicate devices, the MAHE Pediatric Naso-Pharyngoscope does not incorporate any significant change in intended use, method of operation, material, or design that could affect the safety or effectiveness.

Only physicians who have received thorough previous training in the art of flexible sinuscopy should use this instrument.

1

Predicate Device Comparison

FeatureNew DevicePredicate
Optical System
Field of view95 degree80+/-4 degree
Depth of view3-50mm3-50mm
Working length300-420mm320mm
Sheath
Shaft2.7mm2.7 mm
Distal end2.8mm2.8 mm
MaterialIdenticalIdentical
Bending Section
Up120160+3,-10
Down100130 +5,-10
Sterilization Method(s)
Weightnot more than 0.8 kg.5-.7 kg

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular border with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the top half of the circle. Inside the circle is a stylized symbol that resembles three human profiles facing to the right, with flowing lines suggesting movement or connection.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 1 6 2003

MAHE International, Inc. c/o Paul Cart 490 Craighead Nashville, TN 37204

Re: K030857

Trade/Device Name: MAHE Pediatric Naso Pharyngoscope its associated and Ancillary equipment and endoscopic accessories Regulation Number: 21 CFR 874.4760 Regulation Name: Nasopharyngoscope (flexible or rigid) and accessories Regulatory Class: Class II Product Code: EOB Dated: September 24, 2003 Received: September 24, 2003

Dear Mr. Cart:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

3

Page 2 - Paul Cart

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4613. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely vours.

A. Károlyi Károly

A. Ralph Rosenthal, M.D. Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

STATEMENT FOR INDICATIONS FOR USE

510 (k) Number :

Device Name: MAHE International Pediatric NASOPHARYNGOSCOPE

Indications for Use:

The MAHE International Pediatric NASOPHARYNGOSCOPE is indicated for visual examination during a diagnostic and therapeutic procedure within the nasal cavity and nasal pharynx.

(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRD, Office of Device Evaluation (ODE)

Karin Bohm

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, And Radiological Devices

510(k) Number: K03083

OR Over-the-Counter Use:_ Prescription Use: (Per 21 CFR 801.109)