Download MGR (The Tamil Nadu Dr. M.G.R. Medical University) MBBS (Bachelor of Medicine and Bachelor of Surgery) 3rd Year ENT Syllabus
Goal:
The broad goal of the teaching of undergraduate students in Otorhinolaryngology is
to acquire adequate knowledge and skills for optimally dealing with common disorders and
emergencies in ENT and principles of rehabilitation of the impaired hearing.
A. Knowledge
At the end of the course, the student will be able to
1. Diagnose and manage the common ENT diseases and emergencies.
2. Adopt the rational use of commonly used drugs keeping in mind their adverse
reactions.
3. Suggest common investigations and interpret their results.
4. Should be in a position to identify the cases which require specialist care.
5. To identify deaf individuals at the earliest and refer them for proper rehabilitation.
6. To recognise Pre - Malignant & Malignant lesions of Head & neck region at an early
stage.
B. Skills
At the end of the course the students should be able to
1. Use Head mirror, Nasal Speculum, tongue depressor, otoscope, Tuning Fork.
2. Aural Toilet (Ear Mopping wet & dry, ear suctioning & syringing)
3. Do Siegalisation
4. Ear wick placement
5. Anterior and Posterior nasal packing for epistaxis
6. Foreign body removal from ear, nose and throat
7. Mastoid dressing
8. Conduct CPR (cardio-pulmonary resuscitation) and First Aid in newborn, children &
Adults including Endotracheal Intubation.
9. To be familiar with drainage of intra-oral & neck abscesses.
10. Assist Emergency procedures like Tracheostomy and endoscopies.
11. Assist Diagnostic Nasal endoscopy, Video Laryngoscopy.
12. Interpret Clinical Audiometry and Tympanometry findings.
C. Integration:
Theory classes should include integrated teaching.
Horizontal Teaching:
General Surgery ? General principles of surgical management like wound healing,
acid-base balance, blood transfusion & sterilisation.
Neurosurgery ? Knowledge of intracranial complications caused by diseases of ENT
region. (Meningitis, intracranial abscess, cavernous sinus thrombophlebitis.)
Ophthalmology ? Knowledge of orbital complications of Sino-nasal disease.
Sino nasal Neoplasm - pathological basis of sinonasal neoplasms, Radiological
investigations. Clinical features and management-2 hours (These lectures will be
handled by faculty from Otorhinolaryngology, Radio diagnosis, radiotherapy, surgical
& medical oncology)
Laryngeal malignancies: Anatomy of larynx, physiology of phonation and
swallowing. Pathology of laryngeal malignancy, Etiology, clinical features and
management of laryngeal malignancies-2 hours. (These lectures will be handled by
faculty from Otorhinolaryngology, radio diagnosis, radiotherapy, surgical & medical
oncology)
Vertical Teaching:
Otology: Anatomy of middle ear, physiology of middle ear. Microbiology of CSOM.
CSOM mucosal and squamosal type, clinical features and management- 2 hours
(These lectures will be handled by faculty from anatomy, Physiology, microbiology
and otolaryngology). Otosclerosis: Pathology, clinical features, investigations and
management -2 hours (These lectures will be handled by faculty from pathology and
otolaryngology)
Rhinology: Anatomy of lateral nasal wall, physiology of nose including Mucociliary
clearance mechanism. Microbiology of sinus infections. Acute and chronic
rhinosinustis and its management-2 hours (These lectures will be handled by faculty
from anatomy, physiology, microbiology and otolaryngology)
Throat ? Chronic Tonsillitis: Anatomy, Microbiology, Pathology, Pharmacology,
Anaesthesia and Otorhinolaryngology - 2 hours.
Airway management: Anatomy of upper airway. Physiological basis of oxygen
transport including nasobronchial reflexes. Acute airway obstruction and its
management. Intubation, Tracheostomy, ventilator support in such conditions and
biochemical changes in these patients.-2 hours
(These lectures will be handled by faculty from anatomy, physiology, anaesthesia and
otolaryngology)
Teaching Hours ? 70 Hours:
Lectures- 50 hours.
One lecture on Medical Ethics
Integrated lectures-10 hours. (2 hours each.)
Seminars - 10 hours. (2 Hours each.)
Teaching methodology
Theory Teaching -
Theory classes include integrated teaching.
Vertical integration with involvement of anatomy, physiology, bio-chemistry, micro-
biology & Pharmacology. Horizontal integration with involvement of Ophthalmology,
Neuro-surgery, Radiology, Radiotherapy, General Surgery and Oncology.
Didactic lectures, seminars and short lectures.
Practical Teaching-
Demonstrations, treatment room and endoscopic procedures observation, case
presentations and discussions, theatre live surgical demonstration, attending ward
rounds, Audiometry demonstration and OSCE.
Theory Syllabus
I. EAR
MUST KNOW:
Basic sciences:
1) Anatomy: external, middle and inner ear. Anatomy of facial nerve.
2) Anatomy and physiology of Eustachian tube.
3) Anatomy and pneumatisation of temporal bone.
4) Physiology of hearing and vestibular function.
5) Bacterial flora, specific antibiotic therapy of upper respiratory infection
6) Common antibiotics used in ear infections; acute and chronic, topical antibiotics,
ototoxic and vestibulotoxic drugs
Clinical conditions:
1) Symptoms of ear disease and referred pain in the ear.
2) Examination of the Ear: Tuning fork tests: Rinne, Weber and Absolute bone
conduction. Caloric test, Positional test. Instruments for ear examination.
3) Eustachian tube function tests
4) Deafness: types and causes.
5) Diseases of the external ear: Perichondritis; otitis externa; cerumen; foreign body,
hematoma auris, Malignant otitis externa, Keratosis Obturans, preauricular sinus,
Myringitis granulosa
6) Diseases of the middle ear: Acute and Chronic suppurative otitis media
(Mucosal and squamosal disease); Otitis media with effusion, Tympanosclerosis,
Adhesive otitis media, Tuberculous otitis media.
7) Audiometry ? Pure tone; Impedance Audiometry- basics, Assessment of hearing
in Paediatric patients. (Basics)
8) Determination of type and degree of hearing loss by pure tone audiogram.
9) Facial nerve-anatomy, functions and clinical evaluation. Bell's palsy
10) Congenital hearing loss and delayed speech development.
11) Complications of otitis media, intratemporal and intracranial: Mastoiditis (acute
and chronic); facial palsy, labyrinthitis; petrositis; lateral sinus thrombosis;
otogenic meningitis; otogenic brain abscess,
12) Vertigo- how to ask basic history, examination. Meniere's disease
symptomatology and management, BPPV, Vestibular neuronitits
13) X-ray of mastoid; Laws view in normal and in patients with acute or chronic
Mastoiditis
14) Pseudocyst Pinna
15) Ototoxicity
16) Sudden hearing loss
17) Non organic hearing loss
18) Injuries to ear- traumatic, acoustic trauma and barotrauma
19) Presbyacusis
20) Tinnitus
21) Myringotomy and grommet insertion
22) Surgery: Cortical and Modified Radical Mastoidectomy, Tympanoplasty/
Myringoplasty ? Principles and complications. Instruments used.
DESIRABLE TO KNOW:
1) Otosclerosis: Diagnosis and management; basics of Stapedectomy
2) Vestibular function tests, caloric test, positional test.
3) Meniere's disease ?detailed evaluation.
4) Brainstem Audiometry, Electrocochleography, OAE.
5) Tests for recruitment
6) Cochlear implants basics.
7) Tumours of the Ear, Glomus jugulare and tympanicum and squamous cell carcinoma
-Clinical features, diagnosis and management.
8) Epidemiology of otitis media and hearing loss in India
9) Hearing aids
10) Acoustic neuroma
11) Deaf mutism
12) Middle ear risk index (MERI)
NICE TO KNOW:
1) Surgery for vertigo
2) Surgery for facial palsy
3) Surgery for tumours of the ear
4) High resolution CT of Temporal bone
5) Temperomandibular joint disorders
6) Implanatble hearing aids including bone anchored hearing aids
7) CP angle tumours
8) National programme of prevention and control of deafness. NPPCD
9) Congenital ear disorders
II. NOSE AND PARANASAL SINUSES
MUST KNOW:
Basic Sciences:
1) Anatomy and physiology of the nose and paranasal sinuses including olfaction. Nasal
cycle and nasal resistance
2) Viruses and bacteria causing acute and chronic rhinitis and sinusitis
3) Antibiotics used in acute and chronic sinusitis, nasal furunculosis
4) Mechanism of sinonasal allergy (basics)
5) Mucociliary clearance mechanism
Clinical Conditions:
1) Symptoms of nasal diseases; causes of nasal obstruction, and nasal discharge
2) Methods of examination of the nose and paranasal sinuses. Instruments used.
3) Diseases of the nasal septum: deviation of nasal septum and principles of
Management
4) Types of Septal surgery- basics and instruments used
5) Diagnosis and management of nasal bone fracture
6) Epistaxis; anterior and posterior, common causes and emergency management
7) Foreign bodies in nose including Rhinolith.
8) CSF Rhinorrhoea: diagnosis and causes
9) Nasal allergy ? Diagnosis, evaluation and management, Vasomotor rhinitis
10) Nasal Polyposis; types and management.
11) Inflammation of the nose: Furunculosis of vestibule of the nose, acute rhinitis.
12) Inflammatory diseases of paranasal sinuses: acute and chronic maxillary sinusitis,
frontal sinusitis, Ethmoidal sinusitis and complications of sinusitis.
13) Atrophic rhinitis,
14) Types of fungal sinusitis- invasive and non-invasive; Rhino cerebral Mucormycosis-
clinical features, diagnosis and management ( Broad outline)
15) Nasal Septum Perforations, Septal haematoma and Septal Abscess.
16) Juvenile Nasopharyngeal Angiofibroma clinical features, diagnosis and management
17) Granulomatous diseases of the nose, Rhinoscleroma, Rhinosporidiosis
18) Rhinitis Medicamentosa
19) X-ray of paranasal sinuses and its indications
20) Rigid nasal endoscopy; basic steps and indications
21) Endoscopic sinus surgery(FESS): indications and basic steps and complications
22) Outline of management of benign tumors of nose and paranasal sinuses ? Inverted
Papilloma & Osteoma
23) Outline of management of Malignant tumors of nose and paranasal sinuses ?
Squamous cell carcinoma.
24) Nasal Myiasis
25) Caldwell Luc surgery
DESIRABLE TO KNOW:
1) Maxillectomy: indications and brief steps
2) Maxillofacial trauma types and management, blow out fracture
3) CT scan of paranasal sinuses basics
4) Tests for nasal allergy
5) Choanal Atresia
6) Mucocele of paranasal sinuses
7) Craniopharyngioma
8) Proptosis
NICE TO KNOW:
1) Rhinomonometry
2) Balloon sinuplasty
3) Navigation techniques
4) Endoscopic skull base surgeries (hypophysectomy, orbital decompression and optic
nerve decompression)
5) Microdebrider uses
6) Endoscopic DCR
7) Septorhinoplasty
III. PHARYNX
MUST KNOW:
Basic Sciences:
1) Anatomy and physiology of the Oropharynx, Nasopharynx and Laryngopharynx
2) Commensals of the oral cavity and Oropharynx, Organisms causing acute and
chronic tonsillitis.
3) Antibiotics used in acute and chronic tonsillitis
Clinical Conditions:
1) Symptoms of diseases of Nasopharynx, Oropharynx and Laryngopharynx
Methods of examination ? Nasopharynx Oropharynx and Laryngopharynx.
Instruments used.
2) Diseases of the pharynx: adenoids including x rays; acute and chronic pharyngitis;
Diphtheric pharyngitis;
3) Acute follicular tonsillitis and differential diagnosis of membranous tonsillitis:
chronic tonsillitis; tonsillectomy and adenoidectomy ? indication; Peritonsillar
abscess. Including instruments
4) Dysphagia including acid ingestion emergency management.
5) Ludwig's angina; causes, presentation and management
6) Premalignant lesions of the oral cavity and differential diagnosis of white patch
over tonsil, Oral Candidiasis.
7) Acute and Chronic Retropharyngeal abscess
8) Plummer Vinson's syndrome
9) Laryngopharyngeal reflux
10) Snoring and obstructive sleep apnoea: basics
11) Stertor
12) Foreign body oesophagus
13) Dysphagia
14) Tongue tie
15) Nasopharyngeal carcinoma
16) Pharyngeal pouch
DESIRABLE TO KNOW:
1) Broad outline of management of malignant tumors of Oropharynx.
2) Submandibular gland sialolithiasis
3) 1st and 2ndbranchial arch anomalies
4) Eagles's syndrome
5) Lingual thyroid
6) Post Cricoid malignancy
7) Pan- endoscopy including laryngoscopy, bronchoscopy, oesophagoscopy
8) Polysomnography and UVPP
9) Corrosive Stricture ? Oesophagus.
10) Achalasia Cardia
NICE TO KNOW:
1) Oesophageal Diverticulum.
2) Drooling
3) Robotic surgeries,
4) Thyroid gland diseases
5) Salivary gland diseases
6) Functional evaluation of swallowing disorders
7) Parapharyngeal tumours
IV. LARYNX
MUST KNOW:
Basic sciences:
1) Anatomy and physiology of the larynx.
2) Organisms causing acute laryngotracheal bronchitis.
Clinical Conditions:
1) Symptoms of diseases of the larynx
2) Methods of examination of the larynx. Instruments used
3) Hoarseness of voice
4) Etiology and Management of Stridor in Children and Adults.
5) Paralysis of Vocal cords including bilateral abductor palsy.
6) Laryngocele
7) Puberphonia and functional aphonia
8) Inflammatory lesions of the larynx. eg: acute laryngitis, acute Epiglottitis
9) Vocal cord nodules, contact ulcer and polyps and Reinke's edema
10) Benign tumors of larynx (including Papilloma Larynx.)
11) Premalignant lesions of the Larynx.
12) Malignant tumors of larynx: etiology, clinical presentation, classification and broad
management.
13) FB larynx, trachea and bronchus presentation and management.
14) Tracheostomy: Indications, techniques and complications. Types of Tracheostomy
tubes.
15) Gastroesophageal reflux disease
16) X ray neck; views and indications
17) Flexible laryngoscopy; basic steps and indications.
18) Laryngomalacia
19) Microlaryngoscopy and surgery and direct laryngoscopy: Indications and basic steps.
Including instruments.
DESIRABLE TO KNOW:
1) Tuberculosis of the larynx.
2) Basic speech disorders including stuttering
3) Cricothyrotomy
4) Subglottic stenosis, tracheal stenosis
5) Percutaneous dilatation Tracheostomy
6) Laser
7) Stuttering and stammering
NICE TO KNOW:
1) Laryngocele
2) Total laryngectomy; indications and steps
3) Post laryngectomy rehabilitation
4) Phonosurgery
5) Thyroplasty
6) Co- ablation, cryosurgery
7) Stroboscopy.
IV. HEAD AND NECK
MUST KNOW:
Basic Sciences:
Broad anatomy of neck nodes, levels or groups
Clinical Conditions:
1) TB of neck nodes: diagnosis and management.
2) Secondaries in the neck: common sites of primary, diagnosis and broad management.
3) Neck Space infections - causes and management.
DESIRABLE TO KNOW:
1) Thyroglossal cyst, Sistrunk's operation
2) Neck dissection: basic types and indications
NICE TO KNOW:
1) Neck trauma
Practical syllabus
Includes attending out-patient department, observing the treatment protocol followed
in the OPD by the consultants, Proper history taking & clinical examination of
patients and case presentation to the teaching faculty. They should maintain log book
regarding the theory, clinical, ward and OT activities.
Must Know:
1. Use of head mirror.
2. Anterior Rhinoscopy.
3. Nasal airway patency tests.
4. Paranasal sinuses examination.
5. Use of tongue depressor and throat examination.
6. Neck node examination.
7. Use of Otoscope, Siegalisation.
8. Aural toileting.
9. Eliciting Mastoid tenderness.
10. Tuning Fork tests (Rinne, Weber & ABC).
11. Fistula Test.
12. Clinical examination of the Facial Nerve.
Desirable to Know:
1. Post ? nasal Examination.
2. Indirect Laryngoscopy.
3. Cranial Nerves Examination.
4. Bi-digital Palpation for Sub-mandibular Salivary gland.
5. Laryngeal Crepitus.
Nice to Know:
1. Vestibular Function Tests (Romberg, Tandem Walking)
2. Eustachian Tube Tests. (Valsalva)
Each student should present minimum 3 cases (Ear, Nose & Throat) in the clinical
postings.
Long case:
1. Chronic suppurative otitis media mucosal disease
2. Chronic adenotonsillitis
3. Deviated nasal septum with sinusitis
4. Nasal polypi
Short cases:
1. Bilateral Ethmoidal polypi
2. Antrochoanal polyp
3. Atrophic rhinitis
4. Rhinosporidiosis
5. Facial palsy
6. Thyroglossal cyst
7. Tongue tie
8. Preauricular sinus
9. Deviated nasal septum
Observation in OPD:
1. Foreign Body removal in Ear, nose & throat.
2. Diagnostic Nasal Endoscopy.
3. Videolaryngoscopy.
4. Anterior nasal packing.
5. Cautery for Epistaxis.
6. Caloric Tests.
7. Positional Tests and Epley's manoeuvre.
8. Pure tone Audiogram and Tympanometry and OtoAcoustic Emissions.
Observation in the Ward:
1. Ward rounds and case discussion.
2. Tracheostomy care.
3. Mastoid dressing.
4. Post- laryngectomy rehabilitation.
5. Nasal Douching.
Observation in the OT:
Observe the following surgeries.
Must Observe:
1. Adenoidectomy and tonsillectomy.
2. Septal Correction. (SMR & Septoplasty.)
3. Myringotomy and Grommet insertion.
4. Myringoplasty.
5. Cortical Mastoidectomy and Tympanoplasty.
6. Endoscopic Nasal Polypectomy.
7. Functional Endoscopic Sinus Surgery.
8. Tongue tie release.
9. Tracheostomy.
Desirable to observe:
1. Modified Radical Mastoidectomy and Tympanoplasty.
2. Stapedectomy.
3. Micro-laryngeal Surgeries.
4. Pre-auricular sinus excision.
5. Thyroglossal cyst excision ? Sistrunk Procedure.
6. Young `s operation.
Nice to observe:
1. Thyroidectomy.
2. Total Laryngectomy.
3. Total Maxillectomy.
Reference learning resources
1. Diseases of ear, nose and throat-Dhingra current edition
2. Short practice of Otolaryngology-Prof. KK Ramalingam
3. Logan Turner-Otolaryngology
4. Diseases of ear, nose throat- Mohan Bansal
5. Textbook of ear nose and throat ?SS Tuli
6. Textbook of ear, nose and throat and head and neck surgery- Hazarika
7. Scott Brown Otolaryngology, 7th edition
Theory examination
1. Essay
1 x 10 marks = 10 marks
2. Brief Answers
5 x 4 marks = 20 marks
3. Short Notes
5 x 2 marks = 10 marks
-----------------
Total marks = 40 marks
-----------------
Practical Examination
Long case: 1 30 minutes 15 marks
Short case: 2 30 minutes 10 marks
OSCE: 5 stations one mark each 5 marks (3 minutes per station : total 15 minutes.)
--------------
Total
30 marks
---------------
Viva
: 10 marks (Radiology, Instruments, Specimen, Operative surgery)
Internal Assessment : 20 marks (Theory 10, Practical 5 + Log Book 5)
VIVA:
1. Radiology including X-ray and CT images, contrast radiology on various ENT
disorders.
2. Common instruments used in otolaryngology:
OPD instruments
Tonsillectomy and adenoidectomy instruments
Mastoidectomy instruments
Tracheostomy instruments
Septal surgery instruments
FESS instruments
Rigid Bronchoscope
Rigid Oesophagoscope
Direct laryngoscope
3. Specimens: Laryngectomy specimen, Maxillectomy specimen & Thyroidectomy
specimen.
4. Operative Surgery: Common ENT Surgeries.
OS
CE :
Observer station (ENT Clinical Examination, Tuning Fork Tests, Neck Swelling etc...),
Recent advances, Investigation chart (Audiograms), Osteology, Microbiology & Pathology
slides
1. Microbiology slides (streptococci, staphylococci, pneumococci, mycobacterium
tuberculi
2. Pathology slides: Inverted papilloma, squamous cell carcinoma, rhinosporidiosis,
Juvenile nasopharyngeal angiofibroma
3. Osteology: Temporal bone, Base of Skull.
FORMATIVE ASSESSMENT
Should be submitted at the end of the posting.
Clinical posting
Written test
Practical Test
Fourth Semester
Two:
One: Case
1. Surgical Anatomy of ear nose &throat.
Presentation
2. Basic ENT clinical examination.
Sixth Semester
Three: Common Diseases and Their Management
One: include
in:
Presentation of 1
1. Nose
Long case & 2 Short
2. Throat
cases + OSCE.
3. Ear.
Theory: (Pre-final Postings)
Unit ?I: Diseases of the Nose & Paranasal Sinuses and their management.
Unit ? II: Diseases of the Throat & Neck and their management.
Unit ? III: Diseases of the Ear and their management.
Unit - IV: Model Theory Examination of entire syllabus including recent advances.
INTERNAL ASSESSMENT TEST
Practical examination should be held at the end of the final posting. 1 long case and 2 short
cases including OSCE.
Theory exam (Unit IV) should be based on integrated lectures and short lectures and held at
the end of the teaching schedule.
OSCE and viva should be held at the end of each clinical posting
MEDICAL ETHICS
The formal medical ethics class should be attended by all MBBS students as per general
curriculum. The introductory class in ENT should address medical ethics and code of conduct
in the classrooms and clinics.
INTEGRATED TEACHING
As per "C"
RECORD / LOG BOOK
This should be followed as recommended by the University. This will ensure uniformity
among various colleges and hence better to standardise.
CRRI Orientation
Common CRRI orientation programme at the beginning of the CRRI posting where ENT is
specifically addressed to 1. Examine and diagnose common ENT problems 2. To assist and
carry out minor surgical procedures like ear syringing, dressing, nasal packing etc, 3. To
assist emergency ENT surgeries such as Tracheostomy, endoscopies and removal of foreign
bodies.
This post was last modified on 02 July 2021