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Otorhinolaryngology

HEAD & NECK SURGERY

Study Guide

Faculty of Medicine

King Abdulaziz University

Phase I, MBBS

2010

TABLE OF CONTENTS

Topic PageICONS 4

THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM 5

CURRICULUM MAP 6

PHASE 2 6

COURSE SPECIFICATION 6

INTRODUCTION 12

TEACHING STAFF 13

TOPIC OUTLINES 14

NO. LECTURES

1 Anatomy of the Ear & Diseases of external ear2 Otitis media: Classification & complications3 Hearing loss and its management4 Diseases of inner ear (Balance)

5 Anatomy & physiology of the nose & sinusesRhinosinusitis and its complications

6 Allergic rhinitis and nasal polyposis + ESS7 Epistaxis and its management8 Anatomy and physiology of the pharynx + adenotonsillitis9 Pharyngeal diseases & sleep apnea

10 Anatomy and physiology of the larynx + laryngitis11 Diseases of the airway and their management12 Anatomy of the neck & ORL oncology

Faculty of Medicine Name of the Module

NO. PRACTICAL

9 Clinics and 13 Tutorials

Clinics:

1. Prof. Tarek Jamal - General Otolaryngologist2. Dr. Khaled Al-Noury - Neuro-otology-skull base3. Dr. Saad Al-Muhayawi - Head & Neck Surgical Oncologist4. Dr. Khalil Sendi - Pediatric Otolaryngologist5. Dr. Abdulaziz Jifrey - General Otolaryngologist6. Dr. Mohieddin Mandura - General Otolaryngologist7. Dr. Khalid Al-Ghamdi - Facialplastic & General Otolaryngologist8. Dr. Hisham Alem - General Otolaryngologist9. Dr. Afaf Bamanie - Audiologist10. Dr. Abeer Al-Radadi - Otolaryngic allergy

Tutorials:1. Instruments, History & Examination 8. Radiology

2. Nasal Obstruction 9. Neck Masses

3. Sorethroat & Odynophagia 10. ORL Trauma

4. Ear Discharge 11. Revision

5. Epistaxis 12. Students Prepared Topic

6. Horarseness / Tracheostomy 13. Audiology

7. Otalgia

Problem Solving Sessions

1. Ear discharge and Otalgia

3

Faculty of Medicine Name of the Module

4

Phase II ENT Clerkship Faculty of Medicine

Icons The following icons have been used to help you identify the various experiences you will be exposed to.

Learning objectives

Content of the lecture

Independent learning from textbooks

Independent learning from the CD-ROM. The computer cluster is in the 2nd floor of the medical library, building No. 7.

Independent learning from the Internet

Problem-Based Learning

Self- Assessment (the answer to self-assessment exercises will be discussed in tutorial sessions)

The main concepts

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Undergraduate Program Learning Outcomes

CodeLearning Outcomes

KnowledgeBy the end of the program the graduate will be able to:

A1 Describe normal human development across the life-span and how these affect normal structure and function.

A2 Describe normal structure and function of the major systems and how they interrelate.

A3 Describe the molecular, biochemical and cellular basis essential for maintaining homoestasis.

A4 Demonstrate knowledge of the basic medical sciences that explain causes and mechanisms of disease.

A5 Describe the alterations in structure and function of major body systems as a result of illness or injury.

A6 Demonstrate knowledge and understanding of the pharmacological principles of treatment using drugs, their efficacy in the management and symptomatic relief of diseases, as well as their side effects.

A7 Discuss the implications of basic ethical principles, including confidentiality, informed consent, truth telling, and justice, for the care of patients.

A8 recognize the legal background of medical practiceA9 Explain the causes and mechanisms of intoxication.A10 Describe the role of family, community, and culture as factors influencing

patient presentations, interpretations of illness episodes and adherence to treatment episodes.

A11 Demonstrate knowledge and understanding of the natural history of disease and relationships with risk factors and disease prevention.

A12 Recognize and discuss the principles of disease surveillance and screening, disease prevention, communicable disease control, health promotion, and health needs assessment.

A13 Describe strategies to support life-long learning via print and electronic sources to assist in making diagnostic and treatment decisions and to remain current with advances in medical knowledge and practice.

A14 Demonstrate knowledge of how to use the basic medical sciences and clinical skills for clinical decision making and problem solving in the care of patients.

A15 Recognize the scientific basis of health, disease, and medicine in the management of common and high impact conditions in the society.

A16 Demonstrate knowledge of the functional approach to managing chronic conditions, including knowledge of the impact of chronic illness on function.

A17 demonstrate basic knowledge of the global health care delivery system in the community including physicians, hospitals, outpatient centres, health agencies and the role of community agencies in that system.

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Phase II ENT Clerkship Faculty of MedicineA18 Recognize the management of common emergencies and the initial and the

life saving management steps for other emergencies.A19 Identify the "Red flags" indicating seriousness in the different clinical

presentations.

Cognitive SkillsBy the end of the program the graduate will be able to:

B1 Recognize, define and prioritize problems.B2 Demonstrate the ability to acquire new information and data. B3 Critically appraise validity and applicability of acquired information to

one’s professional decisions.B4 Organize, record, research, present, critique, and manage clinical

information.B5 Recognize the limitations of knowledge in medicine and the importance of

triangulation of evidence before reaching a decision.B6 Evaluate the patient’s medical problems.B7 Formulate accurate hypotheses to serve as the basis for making diagnostic

and treatment decisions.B8 Reflect on one’s thinking process and decisions and apply rational

processes.B9 Use appropriate intellectual strategies to deal with uncertainties when they

arise.B10 Demonstrate an understanding of research methodology.B11 Formulate research questions.B12 Draw research hypotheses.B13 Choose appropriate research methodologies and designs.B14 Select appropriate methods of data collection.B15 Analyse and interpret collected data.

Interpersonal Skills & ResponsibilityBy the end of the program the graduate will be able to:

C1 Display the personal attributes of compassion, honesty, and integrity in relationships with patients, families, communities and the medical profession.

C2 Exhibit appropriate value for the sensitive nature of the doctor/patient relationship and the importance of active listening, with attention to the patient’s familial, cultural, and spiritual circumstances.

C3 Demonstrate professionalism and high ethical standards in all aspects of medical practice, specifically competence, honesty, integrity, respect for others, professional responsibility and social responsibility.

C4 Exhibit a capacity for self-evaluation, moral reflection and ethical reasoning to form the basis for a self-directed, lifelong engagement in the responsible, committed, compassionate practice of medicine.

C5 Apply the four principles of ethical and legal knowledge, namely respect for autonomy, beneficience, non-maleficience and justice.

C6 Demonstrate awareness and understanding of the legal and professional responsibilities; and report inappropriate medical practice.

Communication, Information Technology & Numerical SkillsBy the end of the program the graduate will be able to:

D1 work effectively as part of a health care teamD2 communicate effectively with patients, their families and colleagues, both

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Phase II ENT Clerkship Faculty of Medicineverbally and in writing

D3 retrieve information by all means including electronicallyD4 present information clearly in written, electronic and oral formsD5 work within a changing, multi-task environment

Psychomotor SkillsBy the end of the program the graduate will be able to:

E1 Elicit accurate comprehensive and focused medical history by employing techniques that facilitate the patient’s sharing of information.

E2 Conduct a both effective and accurate comprehensive and focused physical examination.

E3 Formulate a differential diagnosis.E4 Select the appropriate laboratory tests and radiographic studies and interpret

their results and use them in making diagnostic and treatment decisions.E5 Formulate and implement a plan of care for both the prevention and

treatment of disease.E6 Educate patients about their health problems and to motivate them to adopt

health promoting behaviors.E7 Use pharmacotherapeutic agents and other therapeutic modalities

effectively.E8 Demonstrate appropriate technique for performing Basic Life Support and

Advanced Life Support.E9 Undertake tasks to initiate and be involved in the care of acutely ill patients.

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CURRICULUM MAP

YOU ARE HERE…

Year 1 Year 2 Year 3 Year 4 Year 5 Internship

Phase I Phase II

Course Specification

For Guidance on the completion of this template, please refer to of Handbook 2

Internal Quality Assurance Arrangements

Institution King Abdulaziz University Hospital - Jeddah

College/Department: Faculty of medicine, ORL Head & Neck Department

A Course Identification and General Information

1. Course title and code: Otorhinolaryngology and Head & Neck (ENT 501)

2. Credit hours: 3 hours

3. Program(s) in which the course is offered.

MBBS (Bachelor of Medicine & Surgery)

4. Name of faculty member responsible for the courseChairman of the Department (Prof. Tarek S. Jamal)

5. Level/year at which this course is offered 4th Year6. Pre-requisites for this course (if any) N/A

7. Co-requisites for this course (if any) N/A

8. Location if not on main campus

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B Objectives

1. Summary of the main learning outcomes for students enrolled in the course.To posses and apply a rational ORL examination and sound theoretical knowledge, this comes through

a condensed theoretical & clinical exposure to common ORL disease.

2. Briefly describe any plans for developing and improving the course that are being implemented. (eg increased use of IT or web based reference material, changes in content as a result of new research in the field)1. Availability of lectures on KAU website.2. Future plan for interactive web teaching.3. Update on new changes in lecture contents.4. Audiovisual aid utilization.5. Encouragement of operating room attendance.

C. Course Description (Note: General description in the form to be used for the Bulletin or Handbook should be attached)

TOPICS to be COVERED No. of weeks Contact Hours

1. Anatomy of the Ear & Diseases of external ear 12. Otitis media: Classification & complications 13. Hearing loss and its management 14. Diseases of inner ear (Balance) 15. Anatomy & physiology of the nose & sinuses Rhinosinusitis and its complications 1

6. Allergic rhinitis and nasal polyposis + ESS 17. Epistaxis and its management 18. Anatomy and physiology of the pharynx + adenotonsillitis 1

9. Pharyngeal diseases & sleep apnea 110. Anatomy and physiology of the larynx + laryngitis 1

11. Diseases of the airway and their management 112. Anatomy of the neck & ORL oncology 1

2 Course components (total contact hours per semester):

Lecture:12

Tutorial: 7 hrsThree in every clinic2 ½ hrs. per tutorial

Laboratory: 10Clinics3 hrs.

Practical/Fieldwork/Internship: Audiovisual1 hr. / clinic

Other:Operating room attendance3 hrs. / OR4 OR / week

3. Additional private study/learning hours expected for students per week. (This should be an average :for the semester not a specific requirement in each week)

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Phase II ENT Clerkship Faculty of Medicine Student self learning

4. Development of Learning Outcomes in Domains of Learning

For each of the domains of learning shown below indicate:

The course is intended to develop a brief summary of the knowledge and skill;

To cite theoretical and practical knowledge in ORL

A description of the teaching strategies to be used in the course to develop that knowledge or skill;

1. Lectures 3. Clinical postings 2. Tutorials 4. Revision on end of posting

The methods of student assessment to be used in the course to evaluate learning outcomes in the domain concerned.

OSCE and MCQ's in final

a. Knowledge

(i) Description of the knowledge to be acquired

- Recall of basic science knowledge in ORL.- Recognize common ORL diseases and management.- Transfer early referral to ORL of complicated cases.- Exposure to clinical cases.- Foundation of future postgraduate study in ORL.

(ii) Teaching strategies to be used to develop that knowledge

a)Lectures d) Audiovisual tapes b) Tutorials e) Websites c) Clinical postings

(iii) Methods of assessment of knowledge acquired

a) OSCE at the end of posting

b) MCQ's at the end of the year

b. Cognitive Skills

(i) Cognitive skills to be developed

1. Solve common ORL diseases. 2. Identify the complications when present. 3. Refer complicated and urgent cases

(ii) Teaching strategies to be used to develop these cognitive skills

1. Clinical teaching2. Tutorial3. Bedside teaching

(iii) Methods of assessment of students cognitive skills

a) Clinical cases

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Phase II ENT Clerkship Faculty of Medicine b) MCQ's at the end of the year c) OSCE

c. Interpersonal Skills and Responsibility

(i) Description of the interpersonal skills and capacity to carry responsibility to be developed

1. Respect the assigned ORL teaching hours. 2. Pursuit further ORL career

(ii) Teaching strategies to be used to develop these skills and abilities

1. Demonstration during clinical postings.2. Application of ORL examination process between the students.3. Employment of audiovisual tapes for basic ORL skills.4. Employment of dummies for examination.

(iii) Methods of assessment of students interpersonal skills and capacity to carry responsibility

- Observation of students to generate a safe ORL examination.

d. Communication, Information Technology and Numerical Skills

(i) Description of the skills to be developed in this domain.

1. Communicate with other health care provider 2. Acquire the skills of information technology 3. Provide an evidence based medical management

(ii) Teaching strategies to be used to develop these skills

- Problem solving seminars- Clinical cases

(iii) Methods of assessment of students numerical and communication skills

Through observation at the assigned teaching sessions.

e. Psychomotor Skills (if applicable)

(i) Description of the psychomotor skills to be developed and the level of performance required

1. Apply the theoretical knowledge into the ORL cases. 2. Construct a recognized scheme of differential diagnosis and investigate for the provided cases. 3. Perform a sound treatment for the common cases. 4. Separate the common from the uncommon ORL problems. 5. Detect and manage common ORL problems 6. Discover and diagnose those conditions that need more special ORL care.

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(ii) Teaching strategies to be used to develop these skills

1. Real patient's examination in the clinics.2. Real scenarios during mini-seminars.3. Peer clinical examination

(iii) Methods of assessment of students psychomotor skills

1. Staff observation during patient examination.2. Review tutorials.3. OSCE at end of postings.

5. Schedule of Assessment Tasks for Students During the Semester

Assessment

Assessment task (eg. essay, test, group project, examination etc.)

Week due Proportion of Final Assessment

1OSCE at the end of clerkship 40%

2 Final written MCQ's at the end of the rotation 60%3

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5

6

7

8

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D. Student Support1. Arrangements for availability of faculty for individual student consultations and academic advice. (include amount of time faculty are available each week)

1. Each staff assures his presence in his office during the designated office hours. (3 hrs. / week)2. Attendance of the ORL clinics as each staff runs a clinic on specific time and date of the week.3. Each staff conducts a tutorial during specific date of the week.

E Learning Resources1. Required Text(s) - Lecture note on ENT by Bull - Otorhinolaryngology head & Neck Surgery by Prof. Tarek S. Jamal

2. Essential References New short Textbook of Otolaryngology – latest edition by M.S. McCormick, WJ Primorse and JJ MacKenzie – latest edition

3- Recommended Books and Reference Material (Journals, Reports, etc) (Attach List)1. Lecture Note on ENT by Bull. – latest edition

2.Oto-Rhino-Larngology, Head & Neck Surgery by Prof. Tarek S. Jamal – latest edition

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Phase II ENT Clerkship Faculty of Medicine3.A New Short Textbook of Otolaryngology by M.S. McCormick, WJ Primrose and JJ MacKenzie.

- latest edition

4.An Illustrated Color Text: ENT and Head & Neck Surgery by R.S. Dhillon, C.A. East. – latest edition

5.Clinical ENT: An Illustrated Textbook by Gerald M. O'Donoghue, Grant J. Bates and Anthony A. Narula. --

latest edition

6.Handouts on Audiology by Dr. Afaf Bamanie

4-.Electronic Materials, Web Sites etc

Lectures on ENT at KAU website5- Other learning material such as computer-based programs/CD, professional standards/regulations

Active electronic learning on KAU website (on development)

F. Facilities Required

Indicate requirements for the course including size of classrooms and laboratories (ie number of seats in classrooms and laboratories, extent of computer access etc.)

1. Accommodation (Lecture rooms, laboratories, etc.)

1. Main auditorium for general ORL lectures2. ORL clinics (9 rooms, 10 clinics / week)3. Conference room attached to the clinic module.4. Conference room in the ORL department5. Conference room on the 6th floor at the hospital (available on demand)6. The libraries (hospital and faculty)

2. Computing resources Internet

3. Other resources (specify --eg. If specific laboratory equipment is required, list requirements or attach list)

G Course Evaluation and Improvement Processes1 Strategies for Obtaining Student Feedback on Effectiveness of Teaching a) Confidential completion of standard course evaluation questionnaire. b) Residents in ORL feedback.

2 Other Strategies for Evaluation of Teaching by the Instructor or by the Department

Focused group discussion Staff feedback

3 Processes for Improvement of Teaching

Workshop attendance e.g.: PBL, evidence based medicine

4. Processes for Verifying Standards of Student Achievement (eg. check marking by an independent faculty member of a sample of student work, periodic exchange and remarking of a sample of assignments with a faculty member in another institution)

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Not available

5. Describe the planning arrangements for periodically reviewing course effectiveness and planning for improvement.

a) The presence of a course evaluation task force within the ORL department where meeting are held twice a year to evaluate and validate the contents and methods of teaching strategies.

b) The presence of an educational committee task force within the faculty where there is a continuous monitoring of the teaching process among the different departments and sensing the standards set by the faculty.

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TEACHERS CONTACTS

Name Department E-mail Office Extension No.

Prof. Tarek S. Jamal ENT [email protected] 18282

Dr. Khaled I. Al-NouryENT [email protected] 18286

Dr. Saad Al-Muhayawi ENT 18299

Dr. Khalil S. SendiENT [email protected] 18284

Dr. Abdulaziz A. JifreyENT [email protected] 20231

Dr. Mohieddin M Mandura

ENT [email protected] 18285

Dr. Khalid B. AlGhamdi

ENT [email protected] 18296

Dr. Hisham B. AlemENT [email protected] 18289

Dr. Afaf BamanieENT [email protected] 18093

Dr. Abeer Al-Radadi ENT [email protected] -

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mailto:[email protected]










Topic OutlinesOtolaryngology Head & Neck Surgery

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Lecture 1: Anatomy and Physiology of the Ear and Disease of External EarDepartment: ENTLecturer: Prof. Tarek S. Jamal

At the end of the lecture you should be able to: 1) Describe the anatomy of the ears2) Describe the main functions of the ears3) Describe the pathophysiological changes in the

external ear4) Describe the main treatment modality of external

ear diseases

Topic:AnatomyPhysiologyEtiological factorsClinical presentationInvestigationsTreatment of common external ear diseases

Independent learning from ENT textbooks- Lecture note on ENT by Bull

- Otorhinolaryngology head & Neck Surgery

by Prof. Tarek S. Jamal

- New short Textbook of Otolaryngology – latest edition

by M.S. McCormick, WJ Primorse and JJ MacKenzie

- An Illustrated Color Text: ENT and Head & Neck

Surgery by R.S. Dhillon, C.A. East. – latest edition

- Clinical ENT: An Illustrated Textbook . - latest edition

by Gerald M. O'Donoghue, Grant J. Bates and Anthony

A. Narula

- Handouts on Audiology by Dr. Afaf Bamanie

Self-assessmentBriefly answer the following short question:

Otitis externa is a common ORL problem. Enumerate the etiological factors that lead to its

Student Notes: .

18

Phase II ENT Clerkship Faculty of Medicinedevelopment and propagation.

Lecture 2: Otitis Media: classification & complications Department: ENTLecturer: Dr. Abdulaziz Jifrey

At the end of the lecture you should be able to: 1. Describe the anatomy of the tympanic

membrane and middle ear2. Describe the main functions of the ear3. Describe the pathophysiological changes of

acute/chronic/otitis media with effusion.4. Describe the main treatment modality during

otitis media.

Topics:a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of common Otitis media










A. Narula


Self-assessmentBriefly answer the following short question:What are the classification and complications of otitis media?

Student Notes: .

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Lecture 3: Hearing impairment (loss) and managementDepartment: ENTLecturer: Dr. Afaf Bamanie

At the end of the lecture you should be able to: 1. Describe the anatomy of the auditory system 2. Describe the mechanism of hearing3. Know the major aetiologies of pathologic ear

and the central auditory system4. Describe the main treatment modality during

of the hearing loss

Topics:AnatomyPhysiologyEtiological factorsClinical presentationInvestigationsTreatment of different types of hearing loss










A. Narula



Hearing loss is one of most frequent complain in the practice of otology, what are the types of hearing loss based on the anatomical portions of the auditory system and enumerate the causes of hearing loss in each type

Student Notes: .

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Lecture 4: Diseases of the Inner Ear (Balance) Department: ENTLecturer: Dr. Khaled Al-Noury

At the end of the lecture you should be able to: 1. Describe the anatomy of the inner ear2. Describe the main functions of the ear3. Describe the pathophysiological changes of

balance disorder4. Describe the main treatment modality during

vertigo

Topics:a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of common vertigo










A. Narula


Self-assessmentBriefly answer the following short question:What are the clinical features and treatment of Mineire's disease, BPPV and vestibular neuronitis.

Student Notes: .

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Phase II ENT Clerkship Faculty of MedicineLecture 5: Anatomy and Physiology of the Nose & Rhinitis Department: ENTLecturer: Dr. Khalid Al-Ghamdi

At the end of the lecture you should be able to: 1. Describe the anatomy of the nose and

paranasal sinus2. Describe the main functions of the nose and

sinuses3. Describe the pathophysiological changes

during rhinitis4. Describe the main treatment modality during

upper respiratory tract infection.

Topics:a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of common rhinologic diseases










A. Narula


Self-assessmentBriefly answer the following short question:Allergic rhinitis is a common on ORL problem. Enumerate the etiological factors that lead its development.

Student Notes: .

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Phase II ENT Clerkship Faculty of MedicineLecture 6: Allergic Rhinitis and Nasal Polyposis + ESS Department: ENTLecturer: Dr. Khalid Al-Ghamdi

At the end of the lecture you should be able to: 1. Describe the anatomy of the nose and

paranasal sinus2. Describe the main functions of the nose and

sinuses3. Describe the pathophysiological changes

during allergic rhinitis and chronis sinusitis4. Describe the main treatment modality during

an attack on allergic rhinitis











A. Narula


Self-assessmentBriefly answer the following short question:Chronic rhinosinusitis can be a devastating disease if left untreated. List four major complications of this disease.

Student Notes: .

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Phase II ENT Clerkship Faculty of MedicineLecture 7: Epistaxis and its ManagementDepartment: ENTLecturer: Dr. Hisham Alem

At the end of the lecture you should be able to: 1. Describe the blood supply to nose

2. Describe nasal physiology

3. Describe the pathophysiological of epistaxis

4. Describe the main treatment modality of

epistaxis





- New short Textbook of Otolaryngology – latest

edition






A. Narula



Epistaxis is a common ORL problem. Enumerate the etiological factors that lead to its development and propagation.

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Phase II ENT Clerkship Faculty of MedicineLecture 8: Anatomy and Physiology of the Pharynx + AdenotonsillitisDepartment: ENTLecturer: Dr. Hisham Alem

At the end of the lecture you should be able to: 1. Describe anatomy of the pharynx and

adenoids2. Describe physiology of adenotonsillitis3. Describe the main treatment modality of

adenotonsillitis

Topics:a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of common pharyngeal diseases





edition






A. Narula


Self-assessmentBriefly answer the following short question:Adenotonsillitis is the commonest ORL problem. Enumerate the etiological factors that lead to its development and propagation.

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Lecture 9: Pharyngeal Diseases and Sleep ApneaDepartment: ENT Lecturer: Dr. Khaled Al-Noury At the end of the lecture you should be able to:

1. Describe the anatomy of the nasopharynx, oropharynx and hypopharynx

2. Describe main functions of the pharynx.3. Describe the pathophysiological changes of

pharyngitis and sleep apnea.4. Overview of common causes, clinical

manifestation, clinical presentation, diagnosis and treatment of pharyngeal disease and sleep apnea.

5. Complications of pharyngeal diseases and sleep apnea.

Topics:a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of common pharyngeal diseases





edition






A. Narula



Tonsillitis one of the most common disease entities and sleep apnea is a serious condition.

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Phase II ENT Clerkship Faculty of MedicineEnumerate the etiological factors that lead to its development and propagation.

Lecture 10: Anatomy and Physiology of the Larynx and Lalyngitis

Department: ENTLecturer: Dr. Mohieddin Mandura

At the end of the lecture you should be able to: 1. Describe the anatomy of the larynx2. Describe the main functions of the lalynx3. Describe the pathophysiological changes

during laryngitis4. Describe the main treatment modality

duringa. laryngitis b. laryngeal diseasesc. due to vocal abuse

Topic:AnatomyPhysiologyEtiological factorsClinical presentationInvestigationsTreatment of common laryngeal diseases

Independent learning from ENT textbooks- Lecture note on ENT by Bull - Otorhinolaryngology head & Neck Surgery by Prof. Tarek S. Jamal- New short Textbook of Otolaryngology – latest edition by M.S. McCormick, WJ Primorse and JJ MacKenzie - An Illustrated Color Text: ENT and Head & Neck Surgery by R.S. Dhillon, C.A. East. – latest edition- Clinical ENT: An Illustrated Textbook . - latest edition by Gerald M. O'Donoghue, Grant J. Bates and Anthony A. Narula- Handouts on Audiology by Dr. Afaf Bamanie

Self-assessment

Briefly answer the following short question:Hoarseness is a common ORL problems.

Student Notes: .

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Phase II ENT Clerkship Faculty of MedicineEnumerate the etiological factors

Lecture 11: Diseases of Airway and Management Student Notes: .

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Department: ENTLecturer: Dr. Khalil Sendi

At the end of the lecture you should be able to: 1. Describe the anatomy of the airway2. Difference between pediatric and adult

airway3. Differentiate between the multiple etiological

cause of airway disease, congenital acquired, infectious and traumatic

4. Differentiate between various modalities of management according to the situation and diagnosis

Topic:

a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of airway diseases

Independent learning from ENT textbooks- Lecture note on ENT by Bull - Otorhinolaryngology head & Neck Surgery by Prof. Tarek S. Jamal- New short Textbook of Otolaryngology – latest edition by M.S. McCormick, WJ Primorse and JJ MacKenzie - An Illustrated Color Text: ENT and Head & Neck Surgery by R.S. Dhillon, C.A. East. – latest edition- Clinical ENT: An Illustrated Textbook . - latest edition by Gerald M. O'Donoghue, Grant J. Bates and Anthony A. Narula- Handouts on Audiology by Dr. Afaf Bamanie

Self-assessmentBriefly answer the following short question:What is the common cause of stridor in a one month old girl?

Lecture 12: Anatomy of the Neck & ORL Oncology

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Phase II ENT Clerkship Faculty of MedicineDepartment: ENTLecturer: Dr. Saad Al-Muhayawi

At the end of the lecture you should be able to: 5. Describe the anatomy of the neck6. Describe the main functions of the lymphatic

system7. Describe the pathophysiological changes in

head & neck mass8. Describe the main treatment modality discuss

in this lecture

Topics:a.Anatomyb. Physiologyc.Etiological factorsd. Clinical presentatione.Investigationsf.Treatment of common pathology










A. Narula



1. What are the lymphatic groups in head and neck areas?

2. What is the radiological for head and neck mass.

Student Notes: .

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TUTORIAL

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Phase II ENT Clerkship Faculty of MedicineTutorial 1: Instruments, History and Examination

TUTORS: Dr. Mohieddin Mandura Department: ORLDr. Saad Al-MuhayawiDr. Khaled Al-NouryProf. Tarek Jamal

SUMMARY:

In student volunteers, students will perform history and examination on volunteer.

The students should be able to identify the different ENT instruments and the technique

of examination.

OBJECTIVES:

To know the different ENT instruments and how to use them.

To know how to perform examination of different ENT areas.

READING:

Otorhinolaryngology head & Neck Surgery


Video cassettes available at our clinic and at ORL secretary

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Tutorial 2: Nasal Obstruction

TUTORS: Dr. Khalid Al-Ghamdi Department: ORLDr. Hisham AlemProf. Tarek JamalDr. Khaled Al-Noury

SUMMARY:

In student volunteers, students will perform nasal examination on volunteer.

The students should be able to identify the anatomical areas of the nose, paranasal sinuses

and the nasopharynx.

OBJECTIVES:

To perform nasal examination

To interpolate the findings

To organize if there is abnormalities seen during the examination.

READING:




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Tutorial 3: Sorethroat & Odynophagia

TUTORS: Dr. Abdulaziz Jifrey Department: ORLDr. Khalil SendiDr. Mohieddin Mandura

SUMMARY:


The students should be able to identify the anatomical areas of the mouth cavity,

oropharynx and hypopharynx.

OBJECTIVES:

To perform examination of these areas and to palpate them. Palpate the neck and

differentiate between tonsillitis and pharyngitis.



READING:




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Tutorial 4: Otorrhea

TUTORS: Dr. Abeer Al-Radadi Department: ORLDr. Khalid Al-GhamdiDr. Hisham AlemDr. Abdulaziz Jifrey

SUMMARY:

In student volunteers, students will perform A, B, C, examination on a volunteer

supposed to have otorrhea.

The students should be able to identify the proper approach to a patient with otorrhea and

examination to otorrhea.

OBJECTIVES:

To perform examination on patient who has otorrhea



READING:




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Tutorial 5: Epistaxis

TUTORS: Dr. Hisham Alem Department: ORLDr. Khalid Al-GhamdiDr. Saad AL-MuhayawiDr. Abdulaziz JifreyDr. Abeer Al-Radadi

SUMMARY:


The students should be able to identify the anatomical areas of the nose, paranasal sinuses

and the nasopharynx

OBJECTIVES:

To perform the basic epistaxis history and examination

To perform basic epistaxis examination

Interpret the findings of the investigations

To organize further management in ENT

READING:




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Tutorial 6: Hoarseness

TUTORS: Dr. Khalil Sendi Department: ORLProf. Tarek JamalDr. Abeer Al-Radadi

SUMMARY:

In student volunteers, students will observe the different modalities of examination of the

larynx, different instruments, mirror, scope, flexible nasopharyngoscopy and differentiate

between the normal anatomy, vocal cord modality - any abnormality.

OBJECTIVES:

Observe the examination

Know the normal structure

See if any abnormality

READING:




37


Tutorial 7: Otalgia

TUTORS: Dr. Khaled Al-Noury Department: ORLProf. Tarek JamalDr. Saad Al-Muhayawi

SUMMARY:

In student volunteers, students will perform ear examination on volunteer.

The students should be able to identify the anatomical areas of the ear.

OBJECTIVES:

To perform ear examination



READING:




38


Tutorial 8: Radiology

TUTORS: Dr. Hisham Alem Department: ORLDr. Khaled Al-NouryProf. Tarek Jamal

SUMMARY:

The students should be able to identify the anatomical areas of head & neck.

OBJECTIVES:

To interpret the radiology findings in ENT for adenoid and sinus

To organize the modality of radiology according to clinical

READING:




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Tutorial 9: Neck Masses

TUTORS: Dr. Saad Al-Muhayawi Department: ORLDr. Khalil SendiDr. Mohieddin ManaduraDr. Abdulaziz Jifrey

SUMMARY:

In student volunteers, students will perform ENT examination on volunteer.

The students should be able to identify the anatomical areas of the head & neck.

OBJECTIVES:

To perform complete ENT examinations



READING:




40


Tutorial 10: ORL Trauma

TUTORSS: Dr. Mohieddin Mandura Department: ORLDr. Khalid Al-GhamdiDr. Hisham AlemDr. Abdulaziz Jifrey

SUMMARY:

In student volunteers, students will perform A, B, C examination on a volunteer supposed

to have a major trauma.

The students should be able to identify the proper approach to a patient with a major

trauma and examination to identify ORL trauma

OBJECTIVES:

To perform examination on patient who has ORL trauma



READING:




41


Tutorial 11: Revision

TUTORS: Prof. Tarek Jamal Department: ORLDr. Khalid Al-GhamdiDr. Saad Al-MuhayawiDr. Abdulaziz JifreyDr. Abeer Al-Radadi

SUMMARY:

The students will review most of the practice topic given in ENT practical

The students should be able to know the most common diseases in ENT practice

OBJECTIVES:

To perform ENT examination


To organize if there is abnormalities seen during the examination and how to

manage them

READING:




42


Tutorial 12: Students' Prepared Topic

TUTOR: Prof. Tarek Jamal Department: ORL

SUMMARY:

Each group will prepare a topic of their choice which were discuss during the tutorial and

given in ENT practical.

The students should be able to know the most common diseases in ENT practice

OBJECTIVES:

To demonstrate their grasp of the knowledge of the theoretical and practical

knowledge they obtained.

To show the application of the theoretical background to the clinical situations.

To prepare them how to present their information.

READING:




43


Tutorial 13: Clinical Audiology

TUTOR: Dr Afaf Bamanie Department: ORL/Audiology unit

SUMMARY:

In the clinical sessions, the students learn how to perform otoscopy (ear examination by

the otoscope) and how to perform the tunning fork tests and interpret the different

scenarios. They observe the procedure of tympanometry and audiometry that is carried by

an experienced staff member on another volunteer staff or student. They learn to

interpret different models of tympanograms and audiograms. The students learn the

clinical application of the different audiological procedures that used to identify the site

of lesion. Lastly hearing aid types introduced to them that used for aural rehabilitation

OBJECTIVES:

To perform ear examination


To identify any abnormalities seen during the examination.

To know the clinical application of the profession of audiology including hearing

screening

To make sure that they are well informed in the mechanism of hearing

To interpret the tunning fork findings

To interpret a tympanogram

To interpret an audiogram

To know the clinical values of tympanometry, audiometry, otoacoustic emissions,

and auditory brainstem response test

To know the different hearing aid types

READING:

Hand outs and lecture materials that are given

By Dr Afaf Bamanie

44


Self Directed Learning

“Independent learning is a very essential skill for tomorrow’s doctors. We will train you to gain this important skill by asking you to read independently about specific topics in ORL and Head & Neck Surgery”

45


Study Anatomical variation of the Ear Radiologically and Embriologically.

You may use the following objectives as guidelines:

describe the anatomical structure of different parts of the ear

relate the congenital malformation to the specific physiological alteration of the

ear function


by Prof. Tarek S. Jamal (pp. 71 – 88)

- American Academy websites

I would recommend you to use the key word – otology

46


Study Anatomical variation of the Nose and Paranasal Sinuses Radiologically and Embriologically.


describe the anatomical structure of different nasal compartments


nose and paranasal sinuses function




I would recommend you to use the key word – nose and paranasal

sinuses

47


Study Anatomy of the neck and different pathological diseases


describe the anatomical structure of different parts of the neck.

relate the pathological disease to the specific age and anatomical site of the neck

mass.




I would recommend you to use the key word – neck mass

48


Study Anatomical variation of the Larynx Embriologically.


describe the anatomical structure of different laryngeal compartments


laryngeal function




I would recommend you to use the key word – nose and paranasal

sinuses

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Make a brief summary on the anatomy of the peripheral and central portions of the auditory system as well as on mechanism of hearing. Enumerate the causes of hearing loss and the different types of treatment to restore hearing.


Describe the anatomical structure of different parts of the auditory system

Describe the contribution of each part of the auditory system to hearing

mechanism.

Based on the anatomical parts of the auditory system enumerate the causes of

hearing loss

Names of the different audiological procedures that might used to assess the

auditory system to reach to the diagnosis

Mention the different modality of aural rehabilitation that can be used to restore

hearing and improve comunications

Reading

- Handouts and lecture notes

by Dr Afaf Bamanie

- American Academy of audiology and ASHA .org websites

I would recommend you to use the key word – hearing loss, causes,

treatment, and Hearing aid

50


PSL

PSL process

The clinical scenario

Key information

Explore the problem

What you know

What you need to know

Identify learning issues

Self/group study

Share the knowledge

Solve the problem

Give feedback & reflect

51


Aims of the PSL sessions

Provide differential diagnosis of ear discharge

Describe the principles of management of acute myocardial

infarction

Describe the principles of management of otalgia according to the

etiology

Describe the principles of ear development at birth

Prerequisite

You should be able to describe the gross anatomy of the ear

You should be able to take a full ORL history including a risk

factor profile

52


Learning opportunity




by Gerald M. O'Donoghue, Grant J. Bates and Anthony A. Narula

Try to access CD-ROM series about the ORL. The computer cluster is in the 2nd floor of the medical library, building No. 7.

I would recommend you to use the key words – ear discharge & case study –in the search engine google (www.google.com). The aim is to recognize the rich resources in the web.

o http://www . Google.com

53

http://www/


PSL Case 1A 13 year old boy was brought to your clinic by his parents with a history of

bilateral ear discharge for 3 months

His parents noticed lately that he frequently wakes up at night for few

minutes and then returns to sleep and this is getting more and more as time

passes by. Meanwhile, his snoring which was for many years prior to his

presentation is getting worst and he constantly opens his mouth at night

while sleeping.

On further history taking, his parents stated that he has a hyperactive

personality and frequent history of upper respiratory tract infection in

addition to early morning sneezing, itching and frequent sorethroat.

Examination findings:

- ears: bilateral wet central perforation

- nose: pale, blue nasal mucosa

: large inferior turbinates

: watery – mucoid nasal secretions

- Throat: hypertrophied unhealthy tonsils

- neck: jugulodigastric lymphadenopathy

Questions: 54

Phase II ENT Clerkship Faculty of Medicine1. What is the differential diagnosis?

2. Mention 3 relevant investigations.

3. Mention the main treatment modality in such case.

PSL Case 2A 13 year old boy was brought to your clinic by his parents with a history of

progressive bilateral nasal obstruction for 3 years.

His parents noticed lately that he frequently wakes up at night for few

minutes and then returns to sleep and this is getting more and more as time

passes by. Meanwhile, his snoring which was for many years prior to his

presentation is getting worst and he constantly opens his mouth at night

while sleeping.

On further history taking, his parents stated that he has a hyperactive

personality and frequent history of upper respiratory tract infection in

addition to early morning sneezing and itching.

His parents are first degree relatives and his mother has had bronchial

asthma at childhood.


- transverse skin crease across his nasal dorsum

- pale – blue nasal mucosa

- large inferior turbinates

- watery – mucoid nasal secretions

- mild S – shape septal deviation

- hypertrophied tonsils

- the rest of head & neck – unremarkable 55


Questions:

1. What is the differential diagnosis?



PSL Case 3

A 20-year-old patient presented with midline neck swelling for 3 years

moving on protruding the tongue outside not increasing the size and no

other associated neck masses.

Questions:

1. What is your differential diagnosis?

2. What are the important points in the history?

3. What are the important points in the clinical examination?

4. How you will manage the patient?

56


PSL Case 4A 7-year-old boy had an episode of common cold 1 week ago. Since

yesterday, he developed right ear ache and fever. Today, the pain is

severe and irritable. His nose is still blocked.

On examination:

Ears: external auditory canals, normal not tender

T.M.S: Left: severely retracted, not congested

Right: bulged, red color, no anatomic detail can be seen.

Nose: airflow reduced bilateral

- large congested turbinates

- mucopus

Throat: congested granular post., pharyngeal wall and mucopus

Questions:



3. Mention the 3 main treatment modalities in such case. 57


PSL Case 5

A 20 year old male involved in a road traffic accident brought to emergency

room. He was not using seatbelt. He was conscious with epistaxis, nasal

obstruction, hoarseness and mild stridor.

On examination:

- vital signs: within normal limit

- airway patent apart from hoarseness and mild stridor

- moderate epistaxis, nasal edema and deformity

- neck examination: no injury to cervical spine, ecchymosis

anterior part of the neck. Tenderness over thyroid cartilage

- direct laryngoscoy: laryngeal mucosal tear, mild edema but

normal vocal cord mobility.

- Rest of head and neck, rest of the body: unremarkable

Questions:




58


PSL Case 6A 35 year old female who came to your OPD clinic and has complained of

hard of hearing since 10 years. She reported progressive deterioration of

hearing particularly after each pregnancy. Recently, she reported a lot of

domestic problems with her husband because of her poor discrimination of

speech that she becomes withdrawn and likes to stay alone by her self. There

is no h/o ear infection, trauma or trauma. There is no h/o drug exposure or

noise exposure. There is a family h/o hearing loss (her mother at age 30)


- Intact and normal appearance of both auricles

- Intact external ear canal in both ears

- Intact tympanic membrane in both ears

- Nasal and throat examination revealed no abnormalities

- Renné test are negative in both ears

Questions:

1. What are the differential diagnoses?


3. Mention the different options of treatment modality in such case.

59


A Learning issues

At the end of the first session you will be able identify the learning issues which related to the above clinical problem. Try to summarize these learning issues in the table below. We recommend you to learn about these issues. This will help you to solve the problem in the next session.

Learning issues Notes …………………………………………………………………………

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60

Phase II ENT Clerkship Faculty of Medicine ……………………………………………………………

61


FurtherReading

- Lecture note on ENT by Bull









A. Narula

- Handsout on Audiology by Dr. Afaf Bamanie

62

King Abdul

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