EAR, NOSE, THROAT AND HEAD & NECK SURGERY (ENT, H & N SURGERY) Paper XXI

Course description

The students will learn about the basic principles and practice of Ear, Nose, Throat and Head and Neck diseases. The overall course will be covered during third phase of the MBBS programme and it is closely related to most of the major MBBS subjects namely basic sciences, ophthalmology, dentistry and facio-maxiallary surgery, neuro-surgery and neurology, cardio-thoracic surgery and plastic and reconstructive surgery.

The course has been designed in such a way that the students will develop skills to communicate effectively with patients, colleagues and related professionals. Special emphasis has been given to prevention of disease whenever possible.

At the end of the course the students will be able to manage common ENT and Head & Neck diseases, will be able to refer cases to appropriate centers when needed and will be able to implement school health and community programmes.

General objectives

Students will be able to

  • elicit appropriate history related to ENT and Head and Neck diseases from the patients, relatives and attendants.
  • identify the instruments needed for ENT and Head and Neck examination and learn the correct uses of these instruments during clinical examination.
  • perform thorough ENT and Head and Neck examination and interpret findings.
  • order relevant investigations and interpret them correctly.
  • treat common ENT and Head and Neck diseases by prescribing appropriate medications and perform minor procedures.
  • identify those patients that need referral and refer them to the appropriate centres.
  • recognize common ENT and Head & Neck emergencies and try to manage them immediately and if this is not possible refer such patients to an appropriate centre.
  • counsel and communicate effectively with patients, relatives and professional colleagues regarding treatment, possible complications and prognosis of the diseases.
  • conduct school health and community programmes and screening of the hearing impaired in the community.

Specific objectives

Students will be able to

  • recall clinical anatomy of external, middle and inner ears; nasal passages; paranasal sinuses; orbit; oral cavity, pharynx; larynx; neck spaces; thyroid gland; salivary glands and base of skull.
  • recall clinical physiology of hearing and understand the role of inner ear in maintaining the balance of the body.
  • recall clinical physiology of smell and deglutition and recall the role of the upper airway in protecting the lower respiratory tract and recall clinical physiology of respiration and voice production.
  • develop appropriate communication skill with patients, relatives, colleagues and related professionals.

II. History taking and clinical examination

Students will be able to

  • elicit history of ENT and Head & Neck diseases from all patients.
  • describe proper positioning of the patients for clinical ENT and Head & Neck examination and demonstrate correct method of physical examination.
  • identify the instruments needed for ENT and Head & Neck examination and demonstrate correct method of their use.
  • outlines the importance of audiogram, tympanogram, caloric test and conduct clinical tests for hearing and balance.
  • distinguish between various types of hearing impairment.
  • distinguish between congenital, inflammatory, traumatic, neoplastic degenerative and allergic conditions.

III. Preventive aspects

Students will be able to

  • describe the role of the environment and personal habits causing ENT and Head and Neck diseases.
  • describe the role of preventive medicine in reducing the morbidity in ENT and
  • Head and Neck diseases in the community.
  • Identify hearing impaired risk groups in the community and detect early hearing impairment.
  • recognize speech and language disorder in the community and role of speech therapy in preventive, therapeutic and rehabilitative aspects.
  • plan and implement school health and community programmes.

IV. Diagnosis and management

Students will be able to

  • Describe causes, pathophysiology, clinical features, diagnosis and management of:
  • Diseases of external ear: congenital anomalies of the external ear, trauma of the external ear, perichondritis, impacted wax, pre-auricular sinus, otitis external, otomycosis, foreign body in the ear and neoplasms of the external ear.
  • Diseases of the middle ear: myringitis, acute otitis media, otitis media with effusion, chronic suppurative otitis media, barotrauma, otosclerosis, neoplasms and differential diagnosis of conductive hearing loss.
  • Diseases of the inner ear: presbyacusis, labyrinthitis, ototoxicity, Meniere’s disease, benign paroxysmal positional vertigo (BPPV), noise induced hearing loss, sudden deafness, differential diagnosis of vertigo with or without hearing loss, acoustic neuroma, differential diagnosis of sensory neural hearing loss and early detection and management of a hearing impaired/deaf child.
  • Diseases of facial nerve: recall clinical anatomy of the facial nerve; the causes, pathophysiology, clinical features, diagnosis and management of facial nerve paralysis.
  • Disease of the nose and paranasal sinuses: vestibulitis, furunculosis, deviated nasal septum, foreign body, nasal bones fracture, septal haematoma and abscess, nasal polyps, rhinosinusitis, allergic rhinitis, epistaxis, atrophic rhinitis, scleroma, rhinosporidiosis, neoplasms of the nose and parasasal sinuses and differential diagnosis of nasal obstruction.
  • Disease of the oral cavity and pharynx: adenoids, nasopharynageal angiofibroma, carcinoma of nasopharynx, carcinoma of tongue and oral cavity, oral manifestations of systemic diseases, carcionoma of pharynx, foreign body of pharynx, tonsillitis and peritonsillar abscess, tonsillar neoplasms, pharyngitis, differential diagnosis of dysphagia.
  • Diseases of the larynx: laryngitis, acute epiglottitis, vocal nodule/polyp, papilloma larynx, acute laryngotracheobronchitis, foreign body in the larynx, carcinoma of the larynx, differential diagnosis of stridor and hoarseness, and indications, techniques, complications and postoperative management o tracheostomy.
  • Diseases of aerodigestive tract: types, clinical features, complications diagnosis and management of foreign body in the esophagus and bronchus.
  • Diseases of head and neck: recall clinical anatomy of deep neck spaces and describe causes, pathophysiology, clinical features, diagnosis and management of Ludwig’s angina, retro and parapharyngeal space abscess; clinical importance, diagnosis and management of cervical lymphadenopathy: differential diagnosis of neck swellings; developmental anomalies of pharyngeal arches (thyroglossal cyst, branchial cyst/fistula), lymphangioma and diseases of the salivary glands and thyroids.

V. Emergencies

Students will be able to

  • differentiate between emergency and non-emergency conditions in ENT and Head and Neck diseases.
  • manage epistaxis and secondary hemorrhage after tonsillectomy.
  • manage acute episode of vertigo.
  • remove foreign bodies from ear, nose and oro-pharynx.
  • change tracheostomy tube in tracheostomised patients.
  • drain mastoid abscess, peritonsillar abscess, neck abscesses and septal haematomal/abscess.
  • manage severe acute otitis external, acute nasal vestibulitis/ furunculosis with cellulitis and complications acute rhinosinusitis.

Clinical experience

Students will be able to

  • elicit appropriate history, perform clinical examination, record findings, investigate and manage common ENT and Head & Neck diseases.
  • assist faculty members/postgraduate residents with the assessment of the patient’s condition and institute appropriate treatment with the help of faculty members/postgraduate residents.
  • assist with treatment including performance of surgical procedures.
  • remove foreign bodies whenever possible and assist in removal of foreign bodies of oesophagus and bronchus.
  • adopt methods used to arrest hemorrhage in ENT and Head & Neck conditions.
  • assist faculty members/residents to provide effective counseling for follow up.
  • learn effective communications among professional colleagues, patients and their relatives.

Internship

Graduates will be able to

  • examine the patients and execute management with due consultation with faculty members for the remaining days of their posting.
  • deal with common ENT and Head and Neck emergencies such as manage epistaxis and secondary hemorrhage after ENT and Head and Neck Surgery, manage acute episode of vertigo; remove foreign bodies from ear, nose and oro- pharynx: change tracheostomy tube in tracheostomised patients; drain mastoid abscess; peritonsillar abscess, neck abscesses and septal haematoma/abscess, manage severe acute otitis external, acute nasal vestibulitis/furunculosis with cellulitis and complications acute rhinosinusitis.
  • perform minor procedures like IG packing, chemical cautery, nasal packing, syringing ear, caloric test etc.
  • assist in routine and emergency surgical procedures and their post operative care.
  • attend teaching/learning programme of the department such as: seminars, journal club, special clinic, grand rounds etc.
  • attend at least two emergency duties with postgraduate residents during their posting.

Textbooks

1. Text Book of Ear, Nose, Throat and Head and Neck Surgery, by Prof. Rakesh Prasad Shrivastav,

2. Logan and Turner’s Diseases of the Nose, Throat and Ear, by AGD Maran, KM Vaghese Company,

3. Short text Book of Ear, Nose and Throat Diseases, by Pracy, Sigler and Stell

4. Hall and Colman’s Diseases of the Nose, Throat and Ear and Head and Neck, by Bernard H. Colman.