ENT
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.
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.
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.
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
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 &
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.
Theory classes should include integrated teaching.
Horizontal Teaching:
General Surgery ? General principles of surgical management like wound healing,
acid-base balance, blood transfusion & sterilisation.
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
& 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
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
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
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.
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
Teaching Hours ? 70 Hours:
Lectures- 50 hours.
One lecture on Medical Ethics
Integrated lectures-10 hours. (2 hours each.)
Teaching methodology
Theory Teaching -
Theory classes include integrated teaching.
Vertical integration with involvement of anatomy, physiology, bio-chemistry, micro-
Neuro-surgery, Radiology, Radiotherapy, General Surgery and Oncology.
Didactic lectures, seminars and short lectures.
Practical Teaching-
Demonstrations, treatment room and endoscopic procedures observation, case
rounds, Audiometry demonstration and OSCE.
Theory Syllabus
I. EAR
MUST KNOW:
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.
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.
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,
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.
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.
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
18) Injuries to ear- traumatic, acoustic trauma and barotrauma
19) Presbyacusis
20) Tinnitus
21) Myringotomy and grommet insertion
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.
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
8) Epidemiology of otitis media and hearing loss in India
9) Hearing aids
10) Acoustic neuroma
11) Deaf mutism
NICE TO KNOW:
1) Surgery for vertigo
2) Surgery for facial palsy
3) Surgery for tumours of the ear
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
II. NOSE AND PARANASAL SINUSES
MUST KNOW:
Basic Sciences:
1) Anatomy and physiology of the nose and paranasal sinuses including olfaction. Nasal
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
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
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.
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,
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.
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
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.
25) Caldwell Luc surgery
DESIRABLE TO KNOW:
1) Maxillectomy: indications and brief steps
2) Maxillofacial trauma types and management, blow out fracture
4) Tests for nasal allergy
5) Choanal Atresia
6) Mucocele of paranasal sinuses
7) Craniopharyngioma
NICE TO KNOW:
1) Rhinomonometry
2) Balloon sinuplasty
3) Navigation techniques
nerve decompression)
5) Microdebrider uses
6) Endoscopic DCR
7) Septorhinoplasty
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
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.
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
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.
8) Plummer Vinson's syndrome
9) Laryngopharyngeal reflux
10) Snoring and obstructive sleep apnoea: basics
11) Stertor
13) Dysphagia
14) Tongue tie
15) Nasopharyngeal carcinoma
16) Pharyngeal pouch
1) Broad outline of management of malignant tumors of Oropharynx.
2) Submandibular gland sialolithiasis
3) 1st and 2ndbranchial arch anomalies
4) Eagles's syndrome
6) Post Cricoid malignancy
7) Pan- endoscopy including laryngoscopy, bronchoscopy, oesophagoscopy
8) Polysomnography and UVPP
9) Corrosive Stricture ? Oesophagus.
NICE TO KNOW:
1) Oesophageal Diverticulum.
2) Drooling
3) Robotic surgeries,
5) Salivary gland diseases
6) Functional evaluation of swallowing disorders
7) Parapharyngeal tumours
IV. LARYNX
Basic sciences:
1) Anatomy and physiology of the larynx.
2) Organisms causing acute laryngotracheal bronchitis.
Clinical Conditions:
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.
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.)
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
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
4) Subglottic stenosis, tracheal stenosis
5) Percutaneous dilatation Tracheostomy
6) Laser
7) Stuttering and stammering
1) Laryngocele
2) Total laryngectomy; indications and steps
3) Post laryngectomy rehabilitation
4) Phonosurgery
6) Co- ablation, cryosurgery
7) Stroboscopy.
IV. HEAD AND NECK
MUST KNOW:
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.
DESIRABLE TO KNOW:
1) Thyroglossal cyst, Sistrunk's operation
2) Neck dissection: basic types and indications
NICE TO KNOW:
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
Must Know:
1. Use of head mirror.
2. Anterior Rhinoscopy.
3. Nasal airway patency tests.
5. Use of tongue depressor and throat examination.
6. Neck node examination.
7. Use of Otoscope, Siegalisation.
8. Aural toileting.
10. Tuning Fork tests (Rinne, Weber & ABC).
11. Fistula Test.
12. Clinical examination of the Facial Nerve.
Desirable to Know:
2. Indirect Laryngoscopy.
3. Cranial Nerves Examination.
4. Bi-digital Palpation for Sub-mandibular Salivary gland.
5. Laryngeal Crepitus.
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.
1. Chronic suppurative otitis media mucosal disease
2. Chronic adenotonsillitis
3. Deviated nasal septum with sinusitis
4. Nasal polypi
1. Bilateral Ethmoidal polypi
2. Antrochoanal polyp
3. Atrophic rhinitis
4. Rhinosporidiosis
6. Thyroglossal cyst
7. Tongue tie
8. Preauricular sinus
9. Deviated nasal septum
1. Foreign Body removal in Ear, nose & throat.
2. Diagnostic Nasal Endoscopy.
3. Videolaryngoscopy.
4. Anterior nasal packing.
6. Caloric Tests.
7. Positional Tests and Epley's manoeuvre.
8. Pure tone Audiogram and Tympanometry and OtoAcoustic Emissions.
Observation in the Ward:
2. Tracheostomy care.
3. Mastoid dressing.
4. Post- laryngectomy rehabilitation.
5. Nasal Douching.
Observe the following surgeries.
Must Observe:
1. Adenoidectomy and tonsillectomy.
2. Septal Correction. (SMR & Septoplasty.)
4. Myringoplasty.
5. Cortical Mastoidectomy and Tympanoplasty.
6. Endoscopic Nasal Polypectomy.
7. Functional Endoscopic Sinus Surgery.
9. Tracheostomy.
Desirable to observe:
1. Modified Radical Mastoidectomy and Tympanoplasty.
2. Stapedectomy.
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
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
Theory examination
1. Essay
1 x 10 marks = 10 marks
2. Brief Answers
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
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.
OPD instruments
Tonsillectomy and adenoidectomy instruments
Mastoidectomy instruments
Tracheostomy instruments
FESS instruments
Rigid Bronchoscope
Rigid Oesophagoscope
Direct laryngoscope
specimen.
4. Operative Surgery: Common ENT Surgeries.
OS
CE :
Recent advances, Investigation chart (Audiograms), Osteology, Microbiology & Pathology
slides
1. Microbiology slides (streptococci, staphylococci, pneumococci, mycobacterium
tuberculi
Juvenile nasopharyngeal angiofibroma
3. Osteology: Temporal bone, Base of Skull.
FORMATIVE ASSESSMENT
Should be submitted at the end of the posting.
Written test
Practical Test
Fourth Semester
Two:
1. Surgical Anatomy of ear nose &throat.
Presentation
2. Basic ENT clinical examination.
Sixth Semester
One: include
in:
Presentation of 1
1. Nose
2. Throat
cases + OSCE.
3. Ear.
Theory: (Pre-final Postings)
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
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
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
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
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.
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.
--- Content provided by FirstRanker.com ---
A. KnowledgeAt 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.
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
B. SkillsAt 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
--- Content provided by FirstRanker.com ---
4. Ear wick placement5. 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 &
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
Neurosurgery ? Knowledge of intracranial complications caused by diseases of ENTregion. (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
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
faculty from Otorhinolaryngology, radio diagnosis, radiotherapy, surgical & medicaloncology)
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
--- Content provided by FirstRanker.com ---
(These lectures will be handled by faculty from anatomy, Physiology, microbiologyand 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
--- Content provided by FirstRanker.com ---
clearance mechanism. Microbiology of sinus infections. Acute and chronicrhinosinustis 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.
--- Content provided by FirstRanker.com ---
Airway management: Anatomy of upper airway. Physiological basis of oxygentransport 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
--- Content provided by FirstRanker.com ---
otolaryngology)Teaching Hours ? 70 Hours:
Lectures- 50 hours.
One lecture on Medical Ethics
Integrated lectures-10 hours. (2 hours each.)
--- Content provided by FirstRanker.com ---
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-
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
presentations and discussions, theatre live surgical demonstration, attending wardrounds, Audiometry demonstration and OSCE.
Theory Syllabus
I. EAR
MUST KNOW:
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
5) Bacterial flora, specific antibiotic therapy of upper respiratory infection6) 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.
--- Content provided by FirstRanker.com ---
2) Examination of the Ear: Tuning fork tests: Rinne, Weber and Absolute boneconduction. 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,
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
7) Audiometry ? Pure tone; Impedance Audiometry- basics, Assessment of hearingin 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.
--- Content provided by FirstRanker.com ---
11) Complications of otitis media, intratemporal and intracranial: Mastoiditis (acuteand 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
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
17) Non organic hearing loss18) Injuries to ear- traumatic, acoustic trauma and barotrauma
19) Presbyacusis
20) Tinnitus
21) Myringotomy and grommet insertion
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
-Clinical features, diagnosis and management.8) Epidemiology of otitis media and hearing loss in India
9) Hearing aids
10) Acoustic neuroma
11) Deaf mutism
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
4) High resolution CT of Temporal bone5) 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
--- Content provided by FirstRanker.com ---
9) Congenital ear disordersII. NOSE AND PARANASAL SINUSES
MUST KNOW:
Basic Sciences:
1) Anatomy and physiology of the nose and paranasal sinuses including olfaction. Nasal
--- Content provided by FirstRanker.com ---
cycle and nasal resistance2) 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
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
Management4) 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.
--- Content provided by FirstRanker.com ---
8) CSF Rhinorrhoea: diagnosis and causes9) 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,
--- Content provided by FirstRanker.com ---
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.
--- Content provided by FirstRanker.com ---
16) Juvenile Nasopharyngeal Angiofibroma clinical features, diagnosis and management17) 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
--- Content provided by FirstRanker.com ---
21) Endoscopic sinus surgery(FESS): indications and basic steps and complications22) 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.
--- Content provided by FirstRanker.com ---
24) Nasal Myiasis25) Caldwell Luc surgery
DESIRABLE TO KNOW:
1) Maxillectomy: indications and brief steps
2) Maxillofacial trauma types and management, blow out fracture
--- Content provided by FirstRanker.com ---
3) CT scan of paranasal sinuses basics4) Tests for nasal allergy
5) Choanal Atresia
6) Mucocele of paranasal sinuses
7) Craniopharyngioma
--- Content provided by FirstRanker.com ---
8) ProptosisNICE TO KNOW:
1) Rhinomonometry
2) Balloon sinuplasty
3) Navigation techniques
--- Content provided by FirstRanker.com ---
4) Endoscopic skull base surgeries (hypophysectomy, orbital decompression and opticnerve decompression)
5) Microdebrider uses
6) Endoscopic DCR
7) Septorhinoplasty
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III. PHARYNXMUST 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
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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.
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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
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abscess. Including instruments4) 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.
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7) Acute and Chronic Retropharyngeal abscess8) Plummer Vinson's syndrome
9) Laryngopharyngeal reflux
10) Snoring and obstructive sleep apnoea: basics
11) Stertor
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12) Foreign body oesophagus13) Dysphagia
14) Tongue tie
15) Nasopharyngeal carcinoma
16) Pharyngeal pouch
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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
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5) Lingual thyroid6) Post Cricoid malignancy
7) Pan- endoscopy including laryngoscopy, bronchoscopy, oesophagoscopy
8) Polysomnography and UVPP
9) Corrosive Stricture ? Oesophagus.
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10) Achalasia CardiaNICE TO KNOW:
1) Oesophageal Diverticulum.
2) Drooling
3) Robotic surgeries,
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4) Thyroid gland diseases5) Salivary gland diseases
6) Functional evaluation of swallowing disorders
7) Parapharyngeal tumours
IV. LARYNX
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MUST KNOW:Basic sciences:
1) Anatomy and physiology of the larynx.
2) Organisms causing acute laryngotracheal bronchitis.
Clinical Conditions:
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1) Symptoms of diseases of the larynx2) 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.
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6) Laryngocele7) 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.)
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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
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tubes.15) Gastroesophageal reflux disease
16) X ray neck; views and indications
17) Flexible laryngoscopy; basic steps and indications.
18) Laryngomalacia
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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
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3) Cricothyrotomy4) Subglottic stenosis, tracheal stenosis
5) Percutaneous dilatation Tracheostomy
6) Laser
7) Stuttering and stammering
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NICE TO KNOW:1) Laryngocele
2) Total laryngectomy; indications and steps
3) Post laryngectomy rehabilitation
4) Phonosurgery
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5) Thyroplasty6) Co- ablation, cryosurgery
7) Stroboscopy.
IV. HEAD AND NECK
MUST KNOW:
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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.
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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:
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1) Neck traumaPractical 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
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regarding the theory, clinical, ward and OT activities.Must Know:
1. Use of head mirror.
2. Anterior Rhinoscopy.
3. Nasal airway patency tests.
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4. Paranasal sinuses examination.5. Use of tongue depressor and throat examination.
6. Neck node examination.
7. Use of Otoscope, Siegalisation.
8. Aural toileting.
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9. Eliciting Mastoid tenderness.10. Tuning Fork tests (Rinne, Weber & ABC).
11. Fistula Test.
12. Clinical examination of the Facial Nerve.
Desirable to Know:
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1. Post ? nasal Examination.2. Indirect Laryngoscopy.
3. Cranial Nerves Examination.
4. Bi-digital Palpation for Sub-mandibular Salivary gland.
5. Laryngeal Crepitus.
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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.
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Long case:1. Chronic suppurative otitis media mucosal disease
2. Chronic adenotonsillitis
3. Deviated nasal septum with sinusitis
4. Nasal polypi
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Short cases:1. Bilateral Ethmoidal polypi
2. Antrochoanal polyp
3. Atrophic rhinitis
4. Rhinosporidiosis
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5. Facial palsy6. Thyroglossal cyst
7. Tongue tie
8. Preauricular sinus
9. Deviated nasal septum
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Observation in OPD:1. Foreign Body removal in Ear, nose & throat.
2. Diagnostic Nasal Endoscopy.
3. Videolaryngoscopy.
4. Anterior nasal packing.
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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:
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1. Ward rounds and case discussion.2. Tracheostomy care.
3. Mastoid dressing.
4. Post- laryngectomy rehabilitation.
5. Nasal Douching.
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Observation in the OT:Observe the following surgeries.
Must Observe:
1. Adenoidectomy and tonsillectomy.
2. Septal Correction. (SMR & Septoplasty.)
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3. Myringotomy and Grommet insertion.4. Myringoplasty.
5. Cortical Mastoidectomy and Tympanoplasty.
6. Endoscopic Nasal Polypectomy.
7. Functional Endoscopic Sinus Surgery.
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8. Tongue tie release.9. Tracheostomy.
Desirable to observe:
1. Modified Radical Mastoidectomy and Tympanoplasty.
2. Stapedectomy.
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3. Micro-laryngeal Surgeries.4. Pre-auricular sinus excision.
5. Thyroglossal cyst excision ? Sistrunk Procedure.
6. Young `s operation.
Nice to observe:
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1. Thyroidectomy.
2. Total Laryngectomy.
3. Total Maxillectomy.
Reference learning resources
1. Diseases of ear, nose and throat-Dhingra current edition
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2. Short practice of Otolaryngology-Prof. KK Ramalingam3. 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
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7. Scott Brown Otolaryngology, 7th editionTheory examination
1. Essay
1 x 10 marks = 10 marks
2. Brief Answers
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5 x 4 marks = 20 marks3. Short Notes
5 x 2 marks = 10 marks
-----------------
Total marks = 40 marks
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-----------------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.)
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--------------Total
30 marks
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Viva
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: 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.
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2. Common instruments used in otolaryngology:OPD instruments
Tonsillectomy and adenoidectomy instruments
Mastoidectomy instruments
Tracheostomy instruments
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Septal surgery instrumentsFESS instruments
Rigid Bronchoscope
Rigid Oesophagoscope
Direct laryngoscope
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3. Specimens: Laryngectomy specimen, Maxillectomy specimen & Thyroidectomyspecimen.
4. Operative Surgery: Common ENT Surgeries.
OS
CE :
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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
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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.
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Clinical postingWritten test
Practical Test
Fourth Semester
Two:
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One: Case1. Surgical Anatomy of ear nose &throat.
Presentation
2. Basic ENT clinical examination.
Sixth Semester
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Three: Common Diseases and Their ManagementOne: include
in:
Presentation of 1
1. Nose
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Long case & 2 Short2. Throat
cases + OSCE.
3. Ear.
Theory: (Pre-final Postings)
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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
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Practical examination should be held at the end of the final posting. 1 long case and 2 shortcases 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
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MEDICAL ETHICSThe 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
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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
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Common CRRI orientation programme at the beginning of the CRRI posting where ENT isspecifically 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.
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