Oto-Rhino-Larynology (ENT)

OTO-RHINO-LARYNGOLOGY (ENT) - HEAD & NECK SURGERY

The broad goal of the teaching of undergraduate students in Otorhinolaryngology is that the
undergraduate students should acquire adequate knowledge and skills for optimally dealing with
common disorders and emergencies and principles of the impaired hearing.

Objectives

a) Knowledge
At the end of the course, the student shall be able to:
1. Describe the basic pathophysiology of common Ear, Nose and Throat (ENT) diseases and
emergencies.
2. Adopt the rational use of commonly used drugs, keeping in mind their adverse reactions.
3. Suggest common investigative procedures and their interpretation.

b) Skills
At the end of the course, the student shall be able to:
1. Examine and diagnose common Ear, Nose and Throat problems including the premalignant
and malignant disorders of the head and neck.
2. Manage Ear, Nose and Throat (ENT) problems at the primary level of care and be able to
refer whenever necessary.
3. Assist and carry out minor surgical procedures like ear syringing, ear dressings, nasal packing
etc.
4. Assist in certain procedures such as tracheostomy, endoscopies and removal of foreign
bodies.

c) Integration
The undergraduate training in Ear, Nose and Throat (ENT) - Head & Neck Surgery will provide an
integrated approach with other disciplines especially Neuro Sciences Ophthalmology and
General Surgery.

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 Revised Syllabus
Final MBBS [III MBBS], 6th and 7th Semesters

ENT - Head & Neck Surgery

(New regulations - Guidelines of MCI Notification)

THEORY [75 hours]

EAR [32 LECTURES - 1 hour each]:

1. Introduction to Otology and Anatomy of the external ear including brief embryology.
2. Anatomy of the middle ear - I:
Eustachian tube, tympanic cavity - its 6 walls, contents, blood supply and nerve supply.
3. Anatomy of the middle ear - II:
Aditus Ad antrum, mastoid antrum, Mac. Even’s triangle, mastoid air cell system, embryology
of the middle ear.
4. Physiology of hearing - the role of the external and the middle ear.
5. Audiological evaluation - I:
Tuning fork tests, tests for Eustachian tube function, pure tone audiometry, impedance
audiometry.
6. Audiological evaluation - II:
Investigations like Bekesy audiometry, speech audiometry, BERA and tests for recruitment and
tone decay.
7. External ear diseases - I:
Congenital anomalies, Traumatic conditions like hematoma auris, avulsion and lacerations of the
pinna, FB ear.
8. External ear diseases - II:
Inflammatory conditions like perichondritis, external otitis - including classification of otitis
externa, viral infections, furuncle, diffuse otitis externa, reactive otitis externa, otomycosis.
9. External ear diseases - III:
Miscellaneous conditions like pseudocyst of the pinna, cerumen, keratosis obturans, malignant
otitis externa etc.
10. External ear diseases - IV:
Non-inflammatory Lesions.
11. Neoplastic conditions of External Ear Benign & Malignant.
12. Acute suppurative otitis media and barotrauma.
Definition of ASOM, its etio-pathology, clinical features and management. Barotrauma-
Bio-mechanics, clinical features, management and prevention.
13. Acute mastoiditis.
Definition, etio-pathology, clinical features, management and complications.
14. Chronic non-suppurative otitis media.
Eustachian tube dysfunction, secretory otitis media – etio-pathology, clinical features
and management, atelectasis, adhesive otitis media, tympanosclerosis and cholesterol
granuloma.
15. Chronic suppurative otitis media – Tubo-tympanic disease.
Definition, etio-pathology, clinical features, stages, investigations, treatment.

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16. Chronic suppurative otitis media – Attico-antral disease.
Definition, etio-pathology, clinical features, investigations, treatment. Tubercular otitis media.
17. Complications of Otitis media – Extra-cranial.
Mastoid absesses, petrositis, labyrinthitis, facial nerve paralysis, otogenic tetanus etc.
18. Complications of Otitis media - Intracranial.
Meningitis, extradural abscess, subdural abscess, brain abscess, lateral sinus thrombophlebitis,
otogenic hydrocephalus, etc.
19. Otosclerosis.
Definition, etio-pathology, types, clinical features, investigations and treatment.
20. Anatomy of the inner ear.
21. Physiology of hearing - the role of the inner ear.
22. Physiology of the vestibular apparatus.
23. Vestibular function tests.
24. Labyrinthitis.
Types, viral labyrinthitis, circumscribed labyrinthitis, serous labyrinthitis, suppurative labyrinthitis and
toxic labyrinthitis [ototoxicity].
25. Traumatic conditions.
Fracture of the temporal bone, CSF otorrhoea, perilymph fistula, acoustic trauma and noise
induced hearing loss.
26. Meniere’s disease.
Definition, etio-pathology, clinical features, investigations and treatment.
27. Tumours of the middle ear and the mastoid including glomus tumours and acoustic
neuroma.
28. Presbyacusis and deaf-mutism.
29. Deafness.
Types, etiology of conductive and sensorineural deafness, management - including hearing
aids and cochlear implant.
30. Labyrinthine vertigo.
Definition, causes, evaluation and management.
31. Tinnitus.
Definition, types, causes, evaluation and management.
32. Otogenic facial palsy.
Causes, features, management and prevention.

NOSE [20 LECTURES - 1 Hour each]:

1. Anatomy of the nose and paranasal sinuses-I.
Introduction to rhinology, anatomy of the external nose/vestibule and nasal cavity - nasal
septum, roof and floor.
2. Anatomy of the nose and paranasal sinuses-II.
Anatomy of the lateral wall of the nasal cavity including ostio-meatal complex, nerve and blood
supply.
3. Anatomy of the nose and paranasal sinuses-III.
Anatomy of the paranasal sinuses.
4. Physiology of the nose and paranasal sinuses.

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 5. Radiology for nose and paranasal sinuses and nasal endoscopy.

6. Congenital and developmental anomalies after brief embryology of the nose and paranasal
sinuses. Include: Choanal atresia, cleft lip and palate, external nasal deformities etc.
7. Inflammatory conditions of the external nose and vestibule - vestibulitis, furuncle, cellulitis,
dangerous area of the nose-cavernous sinus thrombophlebitis, rhinophyma.

8. Traumatic conditions including fracture of the nasal bones, fracture of the nasal septum, Le-Fort
fractures, CSF rhinorrhoea, FB nasal cavities, myiasis, rhinolith etc.
9. Deviated nasal septum.
Etio-pathology, clinical features, management.
10. Rhinitis-I.
Classification, Acute rhinitis and chronic non-specific rhinitis.
11. Rhinitis-II.
Chronic specific rhinitis including tuberculosis, leprosy, syphilis, scleroma, rhinosporidiosis
and other fungal infections, atrophic rhinitis, rhinitis sicca, rhinitis medicamentosa and rhinitis
caseaosa.
12. Rhinitis-III.
Allergic rhinitis and vasomotar rhinitis.
13. Acute sinusitis.
Etio-pathology, types, clinical features, investigations and treatment.
14. Chronic sinusitis.
Etio-pathology, types, clinical features, investigations and treatment.
15. Complications of sinusitis.
16. Nasal polyposis
Etio-pathology, types, clinical features, investigations and treatment.
17. Adenoids.
Anatomy, functions, adenoiditis/hypertrophy, clinical features, investigations and treatment.
18. Neoplastic conditions of the nose, paranasal sinuses and nasopharynx.
Classification and emphasize on inverted papilloma, juvenile nasopharyngeal angiofibroma,
squamous cell carcinoma of the maxillo-ethmoid complex and nasopharyngeal carcinoma.
19. Epistaxis.
Applied anatomy, etiology, management.
20. Snoring and sleep apnea syndrome.
Etiology, evaluation, treatment and complications.

LARYNX AND PHARYNX [15 CLASSES  - 1 hour each]:

1. Anatomy and physiology of the larynx.
2. Anatomy and physiology of the pharynx.
3. Embryology and congenital disorders of the larynx, pharynx, tracheobronchial tree and
esophagus.
4. Traumatic conditions of the upper aero-digestive tract including foreign body. Upper aero-
digestive tract endoscopy.

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 5. Laryngitis-I.
Classification, Acute laryngitis and chronic non-specific laryngitis.
6. Laryngitis-II.
Chronic specific laryngitis.
7. Disorders of voice abuse, vocal nodule and vocal polyp.
8. Neurological conditions of the larynx.
Sensory and motor paralysis of the larynx: etio-pathology, types, clinical features, management.
9. Neoplastic conditions of the larynx with emphasis to recurrent respiratory papillomatosis and
squamous cell carcinoma of the larynx.
10. a) Acute pharyngitis.
Non-specific and specific, DD of white patch on the tonsils.
b) Acute tonsillitis.
Types, etiology, clinical features, management
11. Chronic pharyngitis, keratosis pharyngis and chronic tonsillitis - types, etio-pathology, clinical
features and management.
12. Tonsillectomy: Indications, contraindications, technique, postop care and complications.
13. Neoplastic conditions of the oropharynx and hypopharynx.
14. Neck space infections.
Parapharyngeal abscess, retropharyngeal abscess, quinsy, Ludwig’s angina.
15. Causes of stridor and tracheostomy.

HEAD AND NECK [7 LECTURES - 1 hour each]:

1. Applied anatomy of the neck including lymphatics.
2. Midline and lateral neck swellings.
Classification and emphasis on thyroglossal cyst, ectopic thyroid, branchial cyst, tubercular
lymphadenitis, metastatic lymph node and parapharyngeal tumors.
Evaluation of neck mass.
3. Inflammatory conditions of Salivary glands and sialolithiasis.
4. Salivary gland tumors including pleomorphic adenoma of the parotid glands, Warthim’s tumor,
mucoepidermoid carcinoma and ranula.
5. Rationale and types of neck dissections.
6. Recent advances in ENT-Head & Neck surgery, including lasers
7. Thyroid gland and its diseases.

Tutorials (small group discussion) (15 classes of 2 hours each = 30 hours)

1. Management of Epistaxis
2. Management of Facial trauma
3. Management of Laryngeal trauma
4. Management of foreign bodies in ENT
5. Management of obstructed airway
6. Management of Deep neck space infections
7. Radiology of Nose & PNS and Mastoids
8. Radiology of neck including Barium swallow
9. Common surgeries of the nose / PNS and instruments used
10. Common surgeries of the ear and instruments used

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11. Common surgeries of the throat / neck and instruments used
12. Evaluation of hearing including Basic Audiology
13. Evaluation of vertigo including basic vestibular function tests
14. Evaluation of a case of neck swelling
15. Evaluation of a case of hoarseness
16. Evaluation of nasal mass
17. Evaluation of dysphagia

PRACTICALS [Clinical Postings] - 140 hours (2 months):

1. Introductory classes on clinical 7 classes of 3 hours
methodology of history taking and each. [21 hours]
examination of the ear, nose,
throat, head & neck.

2. Case discussions with emphasis 25 classes of 3 hours

on common ENT disorders like - each. [75 hours]
a) Chronic suppurative otitis media
b) Deviated nasal septum
c) Chronic rhinosinusitis
d) Chronic tonsillitis/adenotonsillitis
e) Atrophic rhinitis
f) Ethmoidal polyposis
g) Antrochoanal polyp
h) Rhinosporidiosis etc.
i) Allergic rhinitis
j) Oral Cavity & Oropharyngeal Cancer
k) Thyroglossal Cyst, ranula & branchial Cyst.
l) Neck Swelling including Thyroid
m) Parotid & Submandibular swelling

3. OPD postings 6 classes of 3 hours

To observe certain common each. [18 hours]
investigations and minor procedures
like audiological tests, caloric test,
syringing, antral lavage, nasal packing,
foreign body removal from ENT,
Examination of the ears under microscope,
nasal endoscopy, flexible laryngoscopy etc.

4. OT postings 6 classes of 3 hours

To observe certain common ENT each. [18 hours]
surgeries like adenotonsillectomy, septoplasty,
upper aero-digestive tract endoscopies,
intranasal antrostomy / Caldwel-Luc operation / Endoscopic Sinus Surgery
tracheostomy, micro-otological and microlaryngeal
surgeries, etc.

5. Practical audiology, ENT instruments 3 classes of 3 hours

and ENT radiology [demonstration] each. [9 hours]

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Reference Books:
1. Logan Turner’s Nose, Throat and Ear. Edited by AGD Maran, 10th Edition, 2000.
2. Diseases of the Ear, Nose and Throat. P. L. Dhingra, 2nd Edition, 2000.
3. Diseases of the Ear, Nose and Throat by Hall and Collman.
4. Fundamentals of Ear, Nose and Throat & Head and Neck diseases, by S. K. De,
6th edition, 1998.
5. Disease of Ear, Nose, Throat, Ms. Magbool Edition, 2000.
6. Manual of Endoscopic Sinus Surgery Hazarika P. & Nayak D. R., 2nd Edition, 2013-14.
7. Manual of Microsurgery of temporal bone and TEP. (Including laser in E.N.T.) Edited by
Hazarika P. & Nayak D. R., 2nd Edition, 1999.
8. Text book on Ear, Nose & Throat by Prof. Tuli.
9. Clinical and Operative Methods in ENT - Head and Neck Surgery by Prof. P. Hazarika &
Dr. Dipak Ranjan Nayak.
10. Text book of ENT - Head & Neck Surgery by Prof. P. Hazarika, Dipak R. Nayak &
R. Balakrishnan. 3rd edition, CBS Publishers, 2013

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