يسرى عبدالحى خليل السيد

ORL 431Course

وصف المقرر:

يهدف هذا المقرر إلى إيصال المعلومات النظرية الضرورية وكذا الخبرات الأكلينيكية ( العملية ) لطلبة السنة الرابعة بكلية الطب.ويتكون المقرر من المحاضرات، حلقات النقاش،العيادات، التدريب السريري، كذا العمليات الجراحية.وتشمل هذه الأنشطة جميع أقسام أمراض الأنف والأذن والحنجرة وكذا جراحات الرأس والرقبة. كما يُعنى هذا المقرر بطرق العلاج المختلفة في تخصص الأذن والأنف والحنجرة وكذا كيفية التعامل مع الحالات الطارئة في هذا التخصص.

Course Description

The Otorhinolaryngoly course is for the fourth-year medical students. The course is conducted in 3 regular cycles and an optional summer cycle. Each cycle is of 6-week duration.

The course is conducted through interactive lectures, tutorials and clinical activities including clinics, bed side teachings, pre and post operative rounds, operative sessions, and rotation in the communication and swallowing disorders (speech) and audiology units.

Course Objectives

1. To expose students to a practical, realistic and representative cross-section of ear, nose, throat and head and neck problems.
2. To teach practical and theoretical aspects of the basic principles of the specialty.
3. Create and stimulate the interest of the students for further post graduate studies in this particular specialty.

Summary of Course Contents

1. Theoretical part:

Lectures and tutorials are given over a period of 6 weeks.

2. Practical part:

The students are divided into 2 groups to be allocate alternately to the ORL and the Ophthalmology units within the period of the 6 weeks period to attend the following clinical activities:

a)     Outpatients clinics

b)     Pre and post operative rounds

c)     Bed side teaching

d)     Operative sessions

e)     Audiology

f)      Communication and Swallowing Disorders (Speech Therapy) sessions

Course Outline

I Lectures

1. Anatomy , Physiology & Embryology Of The Ear

Anatomy of the external, middle and inner ears.

Brief anatomy of the central connection.

Nerve supply and earache.

Very brief embryology.

Physiology of the ear. (Eustachian tube and Hearing & Balance).

2. External Ear Diseases & Acute Otitis Media

Congenital anomalies of the external ear in brief (protruding ear, preauricular sinus, accessory auricles, microtia & atresia)

Miscellaneous diseases of the external ear (Wax, ear syringing).

Perichondritis (causes, clinical manifestations & treatment)

Otitis externa (classification, clinical manifestations & management)

Acute otitis media (etiology, pathology, clinical manifestations & management)

Recurrent acute otitis media (definition & management)

3.  Chronic Otitis Media

Classification & definitions

Otitis media with effusion (Pathology, causes, clinical picture & management)

Chronic suppurative otitis media (Pathology, causes, clinical picture & management)

Adhesive otitis externa (very brief)

4. Complications Of Suppurative Otitis Media

Classification, route of spread, brief clinical picture & management

N.B: Acute mastoiditis and mastoid abscess in more details.

5. Deafness

Conductive hearing loss (etiology with special attention to otosclerosis and management)

Sensorineural hearing loss (SNHL) causes including congenital, traumatic, infective, noise induced, ototoxicity and presbyacusis, acoustic neuroma)

Management of SNHL including a brief idea about hearing aids and cochlear implant

Sudden sensorineural hearing loss (short topic).

6. Vertigo

Mechanism of balance

Causes of vertigo (including Meniere’s disease, vestibular neuritis, positional vertigo in some details)

Investigation of a dizzy patient (in short)

7. Facial Nerve

Anatomy (course and type of fibres in some details)

Pathology of nerve injury

Electrophysiological test in brief (nerve excitability and ENoG)

Causes of facial nerve paralysis

Clinical picture

Tests for location of the site of injury

Management of otogenic facial paralysis (Bell’s, as a complication of OM, traumatic and Ramsy Hunt’s syndrome)

8. & 9: Diseases Of The Nose I

Anatomy of the external nose and nasal cavity

Blood supply in some details

Physiology (functions of the nose)

Congenital disorders (choanal atresia)

Vestibulitis & furunculosis (causes, clinical picture, complications, & treatment)

Epistaxis (Causes and management)

Diseases of the septum (Deviation, perforation, hematoma & abscess)

10. & 11 Diseases Of The Nose II

Acute rhinitis (etiology, clinical , treatment and complications)

Chronic Rhinitis (classification)

Allergic Rhinitis (pathology, clinical & management)

Non allergic rhinitis

Atrophic rhinitis (definition , pathology, clinical and brief treatment)

Nasal polyps (types, cause, pathology & treatment)

12. The Para Nasal Sinuses

Anatomy of the paranasal sinuses

Very brief embryology

Brief physiology

Acute and chronic sinusitis (causes, clinical, investigation, treatment)

Fungal sinusitis (in brief)

Complications of sinusitis (classification with special attention to the orbital complications, investigation and general treatment)

13.  The Salivary Glands

Anatomy

Brief physiology

Acute infections (viral and suppurative)

Chronic non-specific and calculus sialoadenitis

Auto-immune diseases

14. The Oesophagus

Anatomy

Physiology (deglutition)

Congenital (tracheo-esophageal fistula)

Dysphagia (causes including Zenker’s pouch, achalasia & investigations)

Gastro-esophageal reflux (pathophysiology, clinical presentation, management)

15. The Neck

Surgical anatomy of lymphatic drainage.

Neck masses (causes, investigation, treatment)

Thyroglossal cysts, branchial cysts, TB, & metastasis

16.  & 17 The Pharynx

Anatomy of the pharynx and deep spaces (retro and parapharyngeal)

Physiology

Adenoids

Snoring and sleep apnea

Acute infections of the oropharynx (acute tonsillitis, infectios mononucleosis, scarlet fever, diphtheria, Vincents angina, monoliasis, acute pharyngitis)

Complications of infections (quinsy, para and retropharyngeal abscesses, Ludwig’s angina)

Chronic pharyngitis & tonsillitis

18.  & 19 The Larynx

Anatomy and physiology of the larynx

Laryngeal paralysis (causes, clinical presentations & treatment)

Congenital diseases (laryngomalacia, web, subglottic hemangioma and stenosis).

Acute infections (acute laryngitis, croup, epiglottitis, diphtheria).

Benign swellings of the larynx (Singer’s nodules, polyp, intubation granuloma).

Chronic specific and non specific laryngitis

II Tutorials

1.  Orientation

Orientation with the course and the exams

Symptomlogy: Deafness, otorrhea, earache, tinnitus & vertigo

                        Nasal obstruction, smell abnormalities, nasal obstruction

                        Dysphagia, hoarseness, snoring & stridor

ENT & neck physical examination

2.  Auditory Investigation & Vestibular Analysis

Mechanism of hearing and balance

Tuning fork tests

PTA

Tympanometry & impedence

Other audiological tests in brief: speech, ABR

Vestibular tests: Romberg, rotation chair, caloric and ENG.

3.  Airway obstruction

Causes of airway obstruction

Signs and symptoms of airway obstruction

Investigations

Tracheostomy, cricothyroidectomy and intubation (indications, technique & complications)

Sleep apnea

4.  Communication Disorders

Delayed speech

Articulation problems (rhinolalia)

Stroboscopy

Voice therapy

5.  ORLTtumor

Tumor of the ears (BSC & SCC of the auricle in brief, Exostosis and osteoma, Acoustic neuroma)

Tumor of the nose (BSC, Rhinophyma, papilloma vestibule, inverted papilloma, osteoma & SCC)

Tumor of the pharynx (Angiofibroma, Carcinoma nasopharynx, SCC of oropharynx, lymphoma tonsils)

Tumor of the esophagus (SCC and adenocarcinoma)

Tumor salivary gland (pleomorphic and malignant tumor in general)

Tumor of the larynx (single and multiple papillamatosis, SCC)

6.  Trauma & Foreign Bodies

Trauma auricle (laceration & hematoma)

Traumatic perforation of tympanic membrane

F. B ear

Fracture temporal bone

Fracture nasal bone

Other trauma (septal hematoma, epistaxis, CSF rhinorrhea)

F.B nose

Blow out fracture

Trauma to sinuses in brief

FB pharynx and esophages

Perforation of esophagus

Trauma to larynx in brief

FB tracheobronchial tree in details

7. Radiology

X rays nasal bones: normal & fracture

Plain X rays sinuses (three views): normal & sinusitis

CT sinuses (normal, sinusitis, fungal sinusitis, complications of sinusitis, benign and malignant tumor)

Blow out fracture

Plain X ray & CT pharynx (normal, choanal atresia, adenoid, FB, angiofibroma, SCC, para and retropharyngeal abscess)

Plain X rays larynx (epiglottitis, croup)

Tracheobronchial tree FBs

Plain X ray esophagus (FBs)

Barium swallow (normal, tumors, stricture, pouch, achalasia)

Plain X ray salivary gland (stones)

Sialogram in brief

CT in brief

CT temoral bone (complications of otitis media, fracture temporal bone & acoustic neuroma)

MRI (acoustic neuroma)

8. ORL surgical procedures

Myringotomy & VTs insertion

Tympanoplasty

Mastoidectomy

Manupilation of fractured nasal bone, Septoplasty & Rhinoplsty

Turbinectomy, SMD & cautery

FESS.

Endoscopy (laryngoscopy, bronchoscopy & esophagescopy)

Adenotonsillectomy

Examinations

There are 2 examinations:

A.    Continuous Assessment Examination

Forty Multiple Choice questions (MCQs) that carries 1 mark per question.

The examination is held usually in the 5^th week of each set.

B.    Final Examination

This is a 30 items Objective Structured Clinical Examination (OSCE). Each question carries 2 marks that equals to a 60 marks. The questions are in the form of slide show and is held on the 6^th week of each set.

Recommended Text Books

1. Ear, Nose and Throat (New Edition)  by W. Becker (published by Thieme)
2. Lecture Notes of Diseases of Ear, Nose and Throat (New Edition) by: P. Bull (published by Blackwell Science).
3. Atlas of otolaryngology By: P. Bull

References

1.     Diseases of the ENT, Head and Neck Surgery by Ballenger

2.     ORL and HN Surgery by Cumming et al.

3.     Scott-Brown’s Diseases of Ear, Nose and Throat by Allan Kerr

Examples of MCQs in ENT 341 course

Mark the single most appropriate answer:

1.      Hair follicles in the external auditory canal are seen in

A.      its whole length

B.      bony part

C.      cartilaginous part

D.      junction of the bony and cartilaginous part

 

2.      Marginal perforations in the tympanic membrane is usually due to:

A.      acute otitis media.

B.      barotrauma.

C.      otitis media with effusion.

D.      tuberculous otitis media.

E.       attico-antral chronic suppurative otitis media.

 

3.      Patients with sensori neural hearing loss will have

A.      normal air conduction and abnormal air conduction

B.      normal bone conduction and abnormal air conduction

C.      both air and bone conductions are abnormal

D.      air bone gap

E.       non of the above

 

4.      The following is disruption of the nerve trunk

A.      neurotmesis

B.      axonotmesis

C.      neuropraxia

D.      synkinesia

E.       neurotrauma

 

5.      Which of the following malignant tumors has the best prognosis?

A.      pyriform fossa carcinoma

B.      nasopharyngeal cancer

C.      vocal fold carcinoma

D.      esophageal carcinoma

E.       carcinoma posterior third of the tongue

6.      Stridor occurring immediately following thyroid surgery may be due to:

A.      unilateral recurrent laryngeal nerve paralysis

B.      combined superior and recurrent laryngeal nerve paralysis in one side

C.      bilateral recurrent laryngeal nerve paralysis

D.      laryngomalacia

E.       none of the above

 

7.      Trismus in common feature of:

A.      chronic tonsillitis

B.      chronic pharyngitis

C.      hypertrophy of the tonsils

D.      peritonsillar abscess

E.       huge adenoid

 

8.      A newborn with respiratory obstruction relieved by crying and aggravated by sucking most likely has:

A.      choanal atresia

B.      vascular ring

C.      subglottic stenosis

D.      bilateral vocal folds paralysis

E.       croup

 

9.      A rhinolith is a:

A.      fibroma of the nose

B.      long standing foreign body in the nose

C.      nasal osteoma

D.      fungus infection of the nose

 

10.   Intracranial venous sinus thrombosis due to chronic suppurative otitis media is more likely to affect:

A.      cavernous sinus

B.      superior sagittal sinus

C.      lateral sinus

D.      superior petrosal sinus

E.       inferior petrosal sinus

Answers

1.      C

2.      E

3.      C

4.      A

5.      C

6.      C

7.      D

8.      A

9.      B

10.   C