Course title: ORL 431
رقم المقرر ورمزه: أذن (431)
Course Name: Otorhinolaryngology Course –
اسم المقرر: جراحة الأنف والأذن والحنجرة و جراحة الرأس والرقبة
Credit hours: 4 (1+3)
عدد الساعات المعتمدة: 4 ساعات
Contact clock hours:
Theoretical : 1
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.
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.
- To expose students to a practical, realistic and representative cross-section of ear, nose, throat and head and neck problems.
- To teach practical and theoretical aspects of the basic principles of the specialty.
- Create and stimulate the interest of the students for further post graduate studies in this particular specialty.
Summary of Course Contents
- Theoretical part:
Lectures and tutorials are given over a period of 6 weeks.
- 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
f) Communication and Swallowing Disorders (Speech Therapy) sessions
- 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).
- 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)
- 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)
- Complications Of Suppurative Otitis Media
Classification, route of spread, brief clinical picture & management
N.B: Acute mastoiditis and mastoid abscess in more details.
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).
Mechanism of balance
Causes of vertigo (including Meniere’s disease, vestibular neuritis, positional vertigo in some details)
Investigation of a dizzy patient (in short)
- 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
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)
- & 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)
- & 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)
- The Para Nasal Sinuses
Anatomy of the paranasal sinuses
Very brief embryology
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)
- The Salivary Glands
Acute infections (viral and suppurative)
Chronic non-specific and calculus sialoadenitis
- The Oesophagus
Congenital (tracheo-esophageal fistula)
Dysphagia (causes including Zenker’s pouch, achalasia & investigations)
Gastro-esophageal reflux (pathophysiology, clinical presentation, management)
- The Neck
Surgical anatomy of lymphatic drainage.
Neck masses (causes, investigation, treatment)
Thyroglossal cysts, branchial cysts, TB, & metastasis
- & 17 The Pharynx
Anatomy of the pharynx and deep spaces (retro and parapharyngeal)
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
- & 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
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
- Auditory Investigation & Vestibular Analysis
Mechanism of hearing and balance
Tuning fork tests
Tympanometry & impedence
Other audiological tests in brief: speech, ABR
Vestibular tests: Romberg, rotation chair, caloric and ENG.
- Airway obstruction
Causes of airway obstruction
Signs and symptoms of airway obstruction
Tracheostomy, cricothyroidectomy and intubation (indications, technique & complications)
- Communication Disorders
Articulation problems (rhinolalia)
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)
- 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)
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
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)
- ORL surgical procedures
Myringotomy & VTs insertion
Manupilation of fractured nasal bone, Septoplasty & Rhinoplsty
Turbinectomy, SMD & cautery
Endoscopy (laryngoscopy, bronchoscopy & esophagescopy)
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 5th 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 6th week of each set.
Recommended Text Books
- Ear, Nose and Throat (New Edition) by W. Becker (published by Thieme)
- Lecture Notes of Diseases of Ear, Nose and Throat (New Edition) by: P. Bull (published by Blackwell Science).
- Atlas of otolaryngology By: P. Bull
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.
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
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
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
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