Curriculum M.S. Otolaryngology (ENT)
The infrastructures and faculty will be as per MCI guidelines.
1. Goals
The goals of MS course in ENT are to produce a competent Otolaryngologist who: Recognizes the health needs of ENT patients and carries out professional obligations in keeping with principles of National Health Policy and professional
ethics. Has the acquired competencies pertaining to ENT that are required to bepracticed in the community and that all levels of health care system. Has acquired skills in effectively communicating with the patient, family and
community. Is aware of the contemporary advances and developments in medical science as related to Otolaryngology. Is oriented to principles of research methodology. Has acquired skills in educating medical and paramedical professionals.
2. Objectives
At the end of MS course in ENT, the student will be able to:
Practice the specialty of Otolaryngology in keeping with the principles of professional ethics.
Recognize the key importance of deafness control programme in the context of health priority of the country.
Take detailed history;
perform physical and local ENT examination including Indirect Laryngoscopy, Anterior, Posterior rhinoscopy, otoscopy, audiometric assessment and interpretation.
Perform relevant investigative and therapeutic procedures for the ENT patient. Interpret important imaging and laboratory results.
Diagnose ENT problems based on the analysis of history, physical examinationand investigative work up.
Plan and deliver comprehensive treatment for ENT pathologies. .
Plan and advice measures for the prevention of deafness, allergies, head neckcancers and to plan rehabilitation accordingly.
Manage ENT emergencies efficiently.
Demonstrate skills in documentations of case details and of morbidity and mortality data relevant to the assigned situation.
Demonstrate empathy and humane approach towards patients and their families and respect their emotions.
Demonstrate communicate skills in explaining management and prognosis,providing counseling and giving health education messages to patients and their families.
Develop skills as self directed learner, recognize continuing educational needs, use appropriate resources and critically analyze relevant published literature in order to practice, evidence, based otolaryngology.
Demonstrate competence in basic concepts of research methodology and epidemiology.
Facilitate learning of medical/nursing students, practicing physicians, Paramedical health workers and other providers as a teacher trainer.
Play the assigned role in the implementation of national deafness programs,effectively and responsibly.
Organize and supervise the desired managerial and leadership skills.
Function as a productive member of a team engaged in health care, research and education.
3. Syllabus
General guidelines: during the training period efforts will always be made that adequate time is spent in discussing ENT problems of public health importance in the country.
3.1 Theory
Basic Sciences
Ear
o Anatomy embryology and ultrastructure of the human ear.
o Physiology of hearing.
o Assessment of hearing.
o Hearing loss.
o Physiology of equilibrium and its application to the dizzy patient.
o Assessment of vestibular function
o Eustachean tube anatomy and physiology
o Facial nerve
Temporal bone
Audiology
o Audiometry and masking.
o Tympanometry
o BERA
Nose and Paranasal Sinuses
o Anatomy and Embryology.
o Physiology.
o Pathophysiology of the ears and nasal sinuses in flight and diving.
o Nasal Septum.
o Evaluation of the nasal airway (Rhinomanometry)
Oral cavity
o The embryology /anatomy of mouth and related faciomaxilllary structure
o Embryology/anatomy and physiology of salivary glands
Pharynx and oesophagus
o Anatomy, embryogensis and physiology of pharynx
o Anatomy and embryogenesis of eosophagus and its relations
o Physiology of deglutination
Larynx and tracheobronchial tree
o Anatomy and embryology
o Physiology of respiration
o Physiology of phonation
Skull base
o Surgical anatomy
o Clinical neuroanotomy
Neck
o Facial spaces of head and neck
o Lymph nodes of head and neck
o Thyroid gland
Imaging and Radiology
o Image taking and interpretation of
o Ultrasound
o Angiography
o Dacrocystography
o X-rays
o CT
o MRI
o Barium studies
o Contrast studies etc with respect to ENT
Basic immunology
Microbiology as related to ENT
Wound healing principle
Intensive care in ENT patients
Anesthesia in ENT
Biomaterials used in ENT
Medical negligence in otolaryngology
Principle of chemotherapy
Principle of radiotherapy
Principle and use of nuclear medicine
Principles of laser surgery
Disorders: Their Medical/Surgical Management Ear
o Etiology and management of inflammatory condition of external and
middle ear
o Pathology of cochlea
o Pathology of vestibular ear
o Diseases of external ear
o Diseases of Eustachian tube
o Ear trauma
o Management of CSOM and cholesteatoma.
o Complications of CSOM and their management
o Otosclerosis etiopathogenesis and management
o Menier’s disease etiopathogenesis and management
o Sensorineural hearing loss causes and management
o Vertigo
o Otalgia causes and management
o Tinnitus causes and management
o Ototoxicity
o Acoustic neuroma
o Epithelial tumours of EAC and middle ear
o Glomous tumour of ear
o Facial nerve disorder, etiopathogenesis and management
o Cochlear implants
o Rehablitation of hearing impaired
o Reconstruction of ear
Nose and paranasal sinuses
o Conditions of external nose
o Abnormalities of smell
o Mechanism and treatment of allergic rhinitis
o Food allergy and rhinitis
o Infective rhinitis and sinusitis
o Complications of sinusitis
o Intrinsic rhinitis
o Nasal polyps
o CSF rhinorrhoea
o Fracture of facial skeleton
o Rhinoplasty
o Epistaxis
o Snoring and sleep apnea
o Non healing granulomas of nose
o Facial pain and headache
o Aspects of dental surgery for ENT
o Trans sphenoidal hypophysectomy
o The orbit with relation with nose
o Cysts,granulomas and tumours of jaws, nose and sinuses
o Deviated septum and septoplasty
o Neoplasm of nasal cavity
o Neoplasm of PNS
Oral cavity and Salivary Glands
o Common disorder of oral cavity
o Tumors of oral cavity
o Non neoplastic disorder of oral cavity
o Neoplasm of salivary gland 1.bengin 2.malignant
Pharynx and Esophagus
o Acute and chronic infection of pharynx
o Neurological affective of pharynx
o Pharyngeal pouches
o Abscesses in relation to the pharynx
o Angiofibroma
o Nasopharyngeal malignancy
o Tumours of oropharynx and lymphomas of head and neck
o Tumours of hypopharynx
o The oesophagus in otolaryngology.
o Dysphagia
o Foreign bodies of food passage
Larynx
o Acute and chronic laryngitis
o Disorders of voice
o Management of obstructive airway and tracheostomy
o Trauma and stenosis of larynx
o Neurological affections of larynx
o Tumours of larynx (benign & malignant)
o Congenital lesion of larynx and stridor
Neck /Face
o Benign disease of neck
o Metastatic neck disease
o The thyroid gland benign / malignant disorders
o Tumours of infratemporal fossa and parapharyngeal space
o Facial plastic surgery.
o Plastic and reconstructive surgery of head and neck
Paediatrics Otolaryngology
o Genetic factors and deafness
o Causes of deafness
o Testing hearing in children
o Screening and surveillance for hearing impairment in pre school children
o Otitis media with effusion
o Acute and chronic suppurative otitis media in children
o Surgery of congenital absence of external /middle ear
o Management of hearing impaired child.
o Cochlear implantation in children
o Vesitublar disorder in children
o Speech and language development
o Foreign body in ear and nose
o Congential anomalies in nose
o Craniofacial anomalies
o Nasal obstruction , rhinnohrea in infants and children
o Tonsils and adenoids
o Dental development ,orthodontics, cleft lip and palate
o Sleep apnea
o Stertor and stridor
o Acute laryngeal infections
o Home care of tracheostomised children
o Branchial cleft anomalies, thyroglossal cyst and fistula.
o Tumors of head and neck in children
o The drooling child
o Recurrent respiratory papillomatosis
o Pediatrics anesthesia
3.2 Practical
History taking pertaining to Otolaryngology and examination like:
anterior and posterior rhinoscopy
oral cavity examination
indirect laryngoscopy
otoscopy
neuro-otology testing
tuning fork testing
audiometry
impedance and vestibular function testing
examination of Eustachian tube
functional examination of nose
transillumination test
Neck examination
examination of cranial nerves
Examination of cervical lymph nodes
Nasal endoscopy
flexible fibreoptic laryngoscopy
micro-ear examination (according to the facilities available in the department).
Monitoring skills
Temperature recording
Capillary blood sampling
Arterial blood sampling
Cardio-respiratory monitoring
Post-operative patient monitoring and management accordingly,
Tracheostomy care
Blood gas analysis
Airway management.
Therapeutic skills
Tracheostomy,
Anterior/posterior nasal packing
Ear packing, syringing,
Foreign body removal from ear/nose/throat,
Airway management
Nasogastric feeding
Endotracheal intubation
Cardiopulmonary resuscitation
Administration of oxygen
Venepuncture and establishment of vascular access
Administration of fluids, blood, blood components, parenteral nutrition
Common dressings
Abscess drainage
Basic principles of rehabilitation.
Diagnostic skills
Interpretation of X-rays/CT/MRI of Head, nose and paranasal sinuses, ear,
neck & chest
Understanding of audiograms, ENG. BERA, ultrasonographic abnormalities
Surgical skills:
The first year resident observes the general layout and working of the OT,
understands the importance of maintaining sanctity of the OT, scrubbing,
working and sterilization of all the OT instruments, know-how of endoscopes,
microscopes and laryngoscopes. He/She is responsible for shifting of OT
patients, for participating in the surgery as second assistant and for post op
management of the patient in recovery and in ward. The second year resident
is responsible for the pre-op work up of the patient, surgical planning and
understanding the rationale of surgery. He/She is the first assistant in surgery
and is responsible for anticipating intra-op and post-op complications and
managing them. The final year resident should be able to perform
minor/medium surgeries independently and assist in medium and major/extra
major surgeries. He/She should be able to handle all emergencies and post
operative complications independently and is responsible for supervision and
guidance of his/her juniors.
The residents are provided with the facilities for temporal bone and cadaveric
dissection which are checked periodically.
4. Teaching Program
4.1. General Principles
Acquisition of practical competencies being the keystone of postgraduate medical
education, postgraduate training is skills oriented.
Learning in postgraduate program is essentially self-directed and primarily
emanating from clinical and academic work. The formal sessions are merely meant
to supplement this core effort.
4.2. Teaching Sessions
Bedside Teaching Round
Seminar
Journal Club
Case discussion
4.3. Teaching Schedule
Suggested departmental teaching schedule is as follows:
Journal club/Seminar Once a week
Speciality clinic (Vertigo / head neck cancer). Once a week
Thesis meeting. Once a week
Seminar/Case Presentation. Once a week
Seminar/Case Presentation. Once a week
Central session Once a week
Note:
3 All sessions are to be attended by the faculty members. All PGs are
supposed to attend the sessions except the ones posted in emergency.
4 All the teaching sessions are assessed by the consultants at the end of
session and marks are given out of 10 and kept in the office for internal
assessment.
5 Attendance of the Residents at various sessions has to be at least 75%.
7. Assessment
All the PG residents are to be assessed daily for their academic activities also periodically.
7.1. General Principles
6 The assessment is valid, objective and reliable.
7 It covers cognitive, psychomotor and affective domains.
8 Formative, continuing and summative (final) assessment is also conducted in
theory as well as practicals/clinicals. In addition, thesis is also assessed
separately.
7.2. Formative Assessment
The formative assessment is continuous as well as end-of-term. The former is to be
based on the feedback from the senior residents and the consultants concerned.
End-of-term assessment is held at the end of each semester (upto the 5th semester).
Formative assessment will not count towards pass/fail at the end of the program, but
will provide feedback to the candidate.
7.3. Internal Assessment
The performance of the Postgraduate student during the training period
should be monitored throughout the course and duly recorded in the log books as
evidence of the ability and daily work of the student. Marks should be allotted out of
100 as followed.
Sr. No. Items Marks
1. Personal Attributes 20
2. Clinical Work 20
3. Academic activities 20
4. End of term theory examination 20
5. End of term practical examination 20
1. Personal attributes:
Behavior and Emotional Stability: Dependable, disciplined, dedicated, stable in
emergency situations, shows positive approach.
Motivation and Initiative: Takes on responsibility, innovative, enterprising, does
not shirk duties or leave any work pending.
Honesty and Integrity: Truthful, admits mistakes, does not cook up information,
has ethical conduct, exhibits good moral values, loyal to the institution.
Interpersonal Skills and Leadership Quality: Has compassionate attitude
towards patients and attendants, gets on well with colleagues and paramedical
staff, is respectful to seniors, has good communication skills.
2. Clinical Work:
Availability: Punctual, available continuously on duty, responds promptly on
calls and takes proper permission for leave.
Diligence: Dedicated, hardworking, does not shirk duties, leaves no work
pending, does not sit idle, competent in clinical case work up and management.
Academic ability: Intelligent, shows sound knowledge and skills, participates
adequately in academic activities, and performs well in oral presentation and
departmental tests.
Clinical Performance: Proficient in clinical presentations and case discussion
during rounds and OPD work up. Preparing Documents of the case
history/examination and progress notes in the file (daily notes, round discussion,
investigations and management) Skill of performing bed side procedures and
handling emergencies.
3. Academic Activity: Performance during presentation at Journal club/ Seminar/
Case discussion/Stat meeting and other academic sessions. Proficiency in skills
as mentioned in job responsibilities.
4. End of term theory examination conducted at end of 1st, 2nd year and after 2
years 9 months
5. End of term practical/oral examinations after 2 years 9 months.
Marks for personal attributes and clinical work should be given annually by
all the consultants under whom the resident was posted during the year. Average of
the three years should be put as the final marks out of 20.
Marks for academic activity should be given by the all consultants who have
attended the session presented by the resident.
The Internal assessment should be presented to the Board of examiners for
due consideration at the time of Final Examinations.
7.4. Summative Assessment
9 Ratio of marks in theory and practicals will be equal.
10 The pass percentage will be 50%.
11 Candidate will have to pass theory and practical examinations separately.
A. Theory
Title Marks
Paper 1: Basic Sciences as related to Ear, Nose & Throat diseases. 100
Paper 2: Principles & Practice of Ear, Nose & Throat diseases. 100
Paper 3: Operative Surgery & Principles of General Surgery as
applied to ENT. 100
Paper 4: Recent advances in ENT diseases. 100
________
Total 400
________
Curriculum M.S. Otolaryngology (ENT)
316
B. Practical
One Long Case = 100
Two Short Cases 100 each = 200
Oral :
Viva (10 each with 4 examiners). = 40
Instruments. = 20
Specimens = 10
Bones (Temporal bone, Skull) = 10
Investigations( CT, MRI, Audiogram,
BERA, Impedance, ENG, X-Ray
(according to the facilities available
in the department). = 20
____________
Total 400
____________
8. Job Responsibilities
During first year the resident will work under direct supervision of the 2nd/3rd year
resident/senior resident and consultant on call. He/She will be responsible for taking
detailed history, examination of patients as per the file record and send appropriate
investigations as advised by seniors. Initially all procedures are to be observed and
then done under supervision of seniors and during 2nd/3rd year can do procedures
independently. In 2nd year, resident is posted in specialty clinics and is also
responsible for making of discharge cards including referrals. In 3rd year, the
resident is encouraged to make independent decisions in management of cases.
He/She is also involved in teaching of undergraduate students in OPDs.
The first year resident observes the general layout and working of the OT,
understands the importance of maintaining sanctity of the OT, scrubbing, working
and sterilization of all the OT instruments, know-how of endoscopes, microscopes
and laryngoscopes. He/She is responsible for shifting of OT patients, for participating
in the surgery as second assistant and for post op management of the patient in
recovery and in ward. The second year resident is responsible for the pre-op work
up of the patient, surgical planning and understanding the rationale of surgery.
He/She is the first assistant in surgery and is responsible for anticipating intra-op and
post-op complications and managing them. The final year resident should be able to
perform minor/medium surgeries independently and assist in medium and
major/extra major surgeries. He/She should be able to handle all emergencies and
post operative complications independently and is responsible for supervision and
guidance of his/her juniors.
9. Suggested Books -
9.1. Core books:
Name of Books.
Diseases of ear, nose and throat. Scott Brown
Head and Neck surgery. PM Stell & AGD Maran
Surgery of the Ear. Glasscock & Shambaugh
Otolaryngology - Head & Neck Surgery.Cummings.
Diseases of ear, nose and throat.Logan Turner
Diseases of ear, nose and throat.PL Dhingra
Audiological assessment. Anirban Biswas
9.2. Reference Books:
Name of Books. Author
Otolaryngology, Otology & Neurotology. Paprella & Micheal.
Essentials of endoscopic sinus surgery.S. Stamberger
Colour Atlas of Head & Neck Surgery. Jatin P Shah
9.3. Journals
Archives Otolaryngology.
Journal of Laryngology & Otology.
Journal of Otolaryngology, clinics of North America.
Indian Journal of Otolaryngology& Head &Neck
10. Model Test Papers
MODEL QUESTION PAPER
MS (Ear, Nose and Throat)
Paper-I
Basic Sciences as related to Ear, Nose & Throat diseases
Max. Marks:100 Time: 3 hrs
• Attempt ALL questions
• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS
I What is three tier mechanisms of larynx? Describe its clinical applications.
II D iscuss the applied surgical anatomy of middle ear spaces.
III D raw a diagram showing osteo meatal complex. Explain its role in endoscopic
sinus surgery.
IV D escribe the 2nd stage of deglutition.
V W rite briefly on anatomy of pathway of olfaction. Elaborate the theories of
olfaction.
VI D iscuss the development of 2nd branchial arch. Enlist the various anomalies
associated with it.
VII D iscuss the theories of bone conduction.
VIII E numerate the anomalies of the pinna.
IX D iscuss the anatomy of the fossa of rosenmuller and its clinical importance.
X D iscuss the anatomy of pterygo-palatine fossa.
Curriculum M.S. Otolaryngology (ENT)
319
MODEL QUESTION PAPER
MS (Ear, Nose and Throat)
Paper-II
Principles & Practice of Ear, Nose & Throat diseases
Max. Marks:100 Time: 3 hrs
• Attempt ALL questions
• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS
I Enumerate the causes of unilateral nasal obstruction in a young male. Write
briefly on etiopathogenesis of angiofibroma.
II D iscuss the etiopathogenesis of Meniere’s disease.
III D iscuss the clinical features and pathology of glomus tumor.
IV E laborate the TNM classification of supraglottic carcinoma and write about its
management.
V W hat are the premalignant lesions of larynx. Discuss their management.
VI D iscuss the pathogenesis and the tests for recruitment.
VII W hat is the pathology of noise induced hearing loss.
VIII W rite about the etiopathogenesis, clinical presentation and management of
necrotizing otitis media
IX W rite briefly on role of impedance audiometry in middle ear pathologies.
X W hat is optokinetic nystagmus. Discuss its clinical significance and testing
procedures.
MODEL QUESTION PAPER
MS (Ear, Nose and Throat)
Paper-III
Operative Surgery of Principles of General surgery as applied to ENT
Max. Marks:100 Time: 3 hrs
• Attempt ALL questions
• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS
I Describe the indications and surgical technique of near total laryngectomy.
II E numerate the types of neck dissections and write briefly on their indications.
III W hat is immunotherapy and its role in Head and Neck Cancers.
IV D iscuss the extra nasal indications of endoscopic sinus surgery.
V E numerate the extra temporal complications of otitis media and write about the
management of sigmoid sinus thrombosis.
VI W rite briefly on types of osteotomies in Rhinoplasty.
VII D iscuss the surgical management of pleomorphic adenoma of parotid.
VIII D iscuss the types of thyroiditis and the management of Hashimoto’s thyroiditis.
IX D escribe the surgical treatments for postcricoid carcinoma.
X D iscuss the role of microvascular flaps in malignancies of oral cavity.
MODEL QUESTION PAPER
MS (Ear, Nose and Throat)
Paper-IV
Recent advances in ENT diseases
Max. Marks:100 Time: 3 hrs
• Attempt ALL questions
• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS
I Enumerate the types of lasers and write briefly on its role in laryngeal
pathologies.
II W hat is photodynamic theory. Describe its role in nasopharyngeal carcinoma.
III D escribe the selection criteria for cochlear implant and write briefly on
advantages of multi channel implants.
IV W hat is bone anchored Hearing Aid ? Discuss the indications and surgical
procedure.
V W hat is spastic dysphonia. Describe its management.What is otoendoscopy.
Describe its clinical applications.
VI W hat is otoendoscopy. Describe its clinical applications.
VII D escribe the advantages of image guided sinus surgery.
VIII D iscuss the role of intra-op nerve monitoring in ear surgery.
IX W rite briefly on indications and types of laryngeal prosthesis for post
laryngectomy patients.
X W hat are otoacoustic emissions ? Write about its clinical application.
No comments:
Post a Comment