New: 5th year Course Book/E.N.T

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New: 5th year Course Book/E.N.T

  1. 1. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Course Book Of Otolaryngology Fifth Stage Department of Surgery College of Medicine 2010-2011 1
  2. 2. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Course coordinator and list of teachers on this course Course: otolaryngology Course coordinator: Dr. Hewa As'ad Department: surgery- otolaryngology College: Medicine Course coordinator link: hewa_ent@yahoo.com Tel. +9647701580087 List of teachers on this course: Dr. Hewa As'ad Abdelkareem Dr. Yousif Ibrahim chalabi Dr. Muaid Ismaiel Aziz Dr. Sherko Saeed Fathullah 2
  3. 3. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Course Overview The course of otolaryngology – head & neck surgery is dedicated to deal with undergraduate level to know the importance of otolaryngology in the daily activities of the junior doctors and the sessions and the lectures are overall based on simple principles and standards for the juniors in otolaryngology to understand the physiology and pathology and management of common diseases & how to deal with emergency situations that they may be faced in their practical work , these lectures given in simple and qualified methods in 28 lectures. 3
  4. 4. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Course Objectives At the end of the course of otolaryngology, the students should be able to master and perform the basic otolaryngology assessment & examinations that are considered fundamentals and learn how to be able to deal with emergency situations. some of these objectives include: 1-Performing ENT examination. 2-Deal with a patient complaining of nasal bleeding. 3-How to manage a patients with foreign bodies inhalations or ingestion. 4-How to manage a patients with an obstructed upper airway obstruction ( stridor) . 5-Diagnosing and treatment of common otolaryngological diseases. 4
  5. 5. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Course Reading List 1-Scott- Brown otolaryngology 2-Logans Turners diseases of ear , nose, throat 3-Synopsis otolaryngology 4-Makhbool otolaryngology 5- Essential Otolaryngology 6- Oxford handbook of ENT emergences 7-American journal of otolaryngology-head & neck Surgery 5
  6. 6. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 8- journal of laryngoscope 9- www.emedicine.com Syllabus N o Title of subject Lecturer/Tuttor’s name 1 Anatomy and physiology of the larynx Dr.Hewa asaad 2 Traumatic conditions of the larynx. Dr.Hewa asaad 3 Inflammations of the larynx: Acute laryngitis. Dr.Hewa asaad 4 Inflammations of the larynx: Chronic laryngitis. Dr.Hewa asaad 6
  7. 7. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 5 Neoplasms of the larynx: Benign tumors and cysts Dr.Hewa asaad 6 Neoplasms of the larynx: Malignant tumors. Dr.Hewa asaad 7 Hoarseness Dr.Hewa asaad 8 Anatomy, Embryology & physiology of the nose & PNS Dr Yousif Chalabi 9 congenital anomalies and trauma to the nose Dr Yousif Chalabi 10 Acute & Chronic nasal &PNS sinus inflammation Dr Yousif Chalabi 11 Epistaxis Dr Yousif Chalabi 12 Allergic rhinitis & nasal polyposis Dr Yousif Chalabi 13 The deformed nose & nasal obstruction Dr Yousif Chalabi 14 Tumors of nose & paranasal sinuses Dr Yousif Chalabi 15 Anatomy, physiology of the ear Dr. Muaid Ismaiel Aziz 16 Physical& radiological assessment of the ear diseases Dr. Muaid Ismaiel Aziz 17 Symptomatology in ear diseases Dr. Muaid Ismaiel Aziz 18 Diseases of the external ear Dr. Muaid Ismaiel Aziz 7
  8. 8. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 ( cong.anomalies , infections, tumors) 19 Diseases of the middle ear ( acute otitis media) Dr. Muaid Ismaiel Aziz 20 Diseases of the middle ear (chronic otitis media) Dr. Muaid Ismaiel Aziz 21 Diseases of the inner ear, ear surgeries Dr. Muaid Ismaiel Aziz 22 Anatomy and physiology of the pharynx Dr. Sherko Saeed Fathullah 23 Common diseases of the buccal cavity Dr. Sherko Saeed Fathullah 24 Pharyngitis and pharyngeal abscesses Dr. Sherko Saeed Fathullah 25 Tonsillitis and adenoids Dr. Sherko Saeed Fathullah 26 Tumors of the pharynx Dr. Sherko Saeed Fathullah 27 Miscellaneous conditions of the pharynx and throat Dr. Sherko Saeed Fathullah 28 Neck masses and salivary glands Dr. Sherko Saeed Fathullah Lecture title: Anatomy and physiology of the larynx. Lecturer name: Dr. Hiwa As'ad Objectives: 8
  9. 9. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 This lecture is dedicated to help medical students understand anatomy and physiology of the larynx and their clinical importance, the lecture includes: a. Introduction to laryngeal structure. b. Description of laryngeal structure (laryngeal cartilages and membranes, muscles of the larynx and their actions) demonstrated by figures c. Description of surface anatomy of the larynx. d. Blood supply, nerve supply, and lymphatic drainage of larynx and their clinical importance. e. Description of functions of larynx. Lecture title: Traumatic conditions of the larynx Lecturer: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand management of trauma of larynx and neck which is a common clinical condition that they will face frequently in their practice in hospital and emergency department, the lecture includes: a. Introduction to laryngeal and neck trauma. b. Description of mechanism of injury (blunt trauma injury and penetrating trauma). c. Initial evaluation, clinical assessment, endoscopic assessment and imaging of the larynx. 9
  10. 10. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 d. Classification of laryngeal injury according to extent of damage. e. Management of laryngeal trauma, goals of laryngeal exploration, laryngeal repair, and management of associated vascular and esophageal injuries. f. Outcome of management of this condition. Lecture title: Inflammations of the larynx: Acute laryngitis Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand this common problem that they will face in their practice in outpatient clinic, emergency department or if they work in otolaryngology or pediatric departments, the lecture includes: a. Introduction to acute laryngitis and its etiological factors. b. Description of clinical types of acute laryngitis. c. Comparison between pediatric patients and adult patients and relative clinical points to be considered. 10
  11. 11. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 d. Treatment options and outcome. Lecturer title: Inflammations of the larynx: Chronic laryngitis Lecturer name: Dr. Hiwa as'ad Objectives: This lecture is dedicated to understand this troublesome condition caused by various etiological factors, and its types (specific and non specific), the lecture includes: a. Definition and etiological factors of chronic laryngitis. b. Clinical classification of chronic laryngitis into specific and non-specific, and subgroups of each type. c. Pathology, clinical features, and treatment modality for each type. Lecture title: Tumors of the larynx: Benign tumors Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand this important conditions that might affect respiration and voice of patients that needs specific management, the lecture includes : a. Introduction. b. Classification of benign tumors. c. Clinical features, diagnosis and treatment of each type. 11
  12. 12. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 d. Pseudotumors types , clinical features and management of each type. Lecture title: Tumors of the larynx: Malignant tumors Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand this serious condition and develop high sense of suspicious for early diagnosis. It also demonstrates treatment options of this condition, the lecture includes: a. Introduction. b. Classification of carcinoma of larynx. c. Demonstration of etiological factors. d. Clinical features, examination of the larynx and the neck. e. Radiological investigations and other relevant investigations to assess tumor extension and spread. f. Staging and grading of Ca larynx. g. Demonstration of strategy of treatment and the options available for this condition. Lecture title: Hoarseness Lecturer name: Dr. Hiwa As'ad Objectives: to understand the students the meaning of the hoarseness & its causes &its treatment, were all objectives included in the lecture. 12
  13. 13. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecture title: Anatomy & Physiology of nose & paranasal sinus Lecturer : Dr. Yousif Chalabi Objective: To emphasize the importance of anatomy &its variations especially the osteomeatal complex in the clinical managements of common nose &sinus chronic diseases & correction of nose & nasal septum both for physiological & cosmetic purposes , the lecture includes a. an embyrological introduction to explain some congenital variation of nose like choanal atresia b.anatomy of external nose &its skeleton to explain the anatomical dangerous region of nose &anatomical & physiological background of cosmetic nasal surgery. c. anatomy &physiology of nasal fossae & its wall , their role in respiration d.anatomy of paranasal sinuses &their variation with its impact on pathogenesis of chronic sinus diseases & facial pain Lecture title: congenital anomalies and trauma to the nose Lecturer: Dr Yousif Chalabi 13
  14. 14. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Objectives : to emphasize the importance of early diagnosis of some congenital anomalies as a cause of embarrassed respiration in neonates & infants for urgent interference &to explain the clinical managements of broken nose &face both medically &legally in addition to its impact on possible intra cranial ,base of skull , cosmetic & respiratory complications to guarantee early proper detection &management to prevent subsequent sequels. The lecture includes a quick review of embryological formation of nose. its openings & anatomy of nasal skeleton , Choanal atresia , fracture nasal bone &facial bones (Leforts) fractures , Foreign bodies in nose & their managements. Lecture title : Acute & Chronic nasal &paranasal sinus inflammation Lecturer: Dr Yousif Chalabi Objectives: To consider the predisposing factors& their prevention in the etiology of acute nasal & paranasal sinus (PNS) infections & to emphasize the effects of prompt & early treatments in prevention of persistence of infections & changing to chronic state. And how to manage whether medically or surgically the chronic state. The lecture includes 14
  15. 15. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 a. A quick review of key points of previous lecture b. Acute viral &bacterial infections of nose &PNS c. Chronic non-specific nasal &PNS inflammation d. Chronic specific nasal & PNS infection e. Managements including the medical & surgical way of treatments Lecture title: Epistaxis Lecturer: Dr Yousif Chalabi Objectives : This lecture is dedicated to emphasize the importance of epistaxis as one of common acute emergencies in medicine in general & to teach the students how to manage it as first-aid , general &specific ENT managements . How to identify its causes as a local nasal causes or general systemic causes especially the blood dyscriasis causes . How to be treated specifically , generally & how to prevent & guard against it . The lecture includes a. A quick review of key points of previous lecture b.an introduction to epistaxis c. Causes as a local nasal causes &general systemic causes d.Management including the lab hematological., radiological & endoscopical way to find the cause as local nasal or general systemic . how to be treated 15
  16. 16. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 whether medically or surgically conservatively or radically &how to be followed up properly. Lecture title: Allergic Rhinitis & Nasal polyposis Lecturer: Dr Yousif Chalabi Objectives: to emphasize the role of preventative measures especially the avoidance of allergens .proper use of immunization & medical treatments In reducing the complaint & severity of allergic patients. How to differentiate the different causes of wet nose including infections allergy & intrinsic vasomotor rhinitis &how to be treated properly .The lecture is dedicated to make the students understand the nature of common nasal problem of polyposis & how to differentiate it from normal or hypertrophied turbinates . To emphasize the role of medical treatment as an effective measures in the early & small polypi or as a preliminary measures for effective radical treatment or follow up for those treated surgically. The lecture includes a. A quick review of key points of previous lecture b.An introduction to the types of hypersensitivity reactions &nature of nasal allergy c. Etiology of allergy &types of allergens 16
  17. 17. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 d.Management including the differentiation &how to diagnose different types of wet nose. Allergy dermatological & hematological test in addition to proper way of prevention &treatments e. Nasal polyposis as a pathogenesis , diagnosis & treatments whether medically emphasizing the role of proper use of cortisone in a non contra-indicated patients or surgically whether conservatively or radically by FEES or conventionally by traditional surgical way Lecture title : The deformed nose & nasal obstruction Lecturer: Dr Yousif Chalabi Objectives: This lecture is dedicated to emphasize the role of cosmetic nasal surgery with consideration of nasal passage for proper respiratory functions which so frequently threatened by some surgeon not considering the physiological aspect of nasal function &how to deal with nose surgically both for physiological & cosmetic purposes . It also aims to make the students understanding the causes of nasal obstruction &to differentiate the pathological from normal physiological obstructions of nasal cycle .The lecture includes a. A quick review of the key points of previous lecture 17
  18. 18. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 b. A review of the nasal respiratory physiology &anatomy of the nasal skeleton c. Causes of deformed nose &nasal obstruction d.Management including the requested examination whether endoscopically or by imaging (CT SCAN) to determine the causes &sites of obstructions & how to be treated whether medically or surgically whether for cosmetic or physiological purpose separately or in combinations. Lecture title : Tumors of nose & paranasal sinuses Lecturer: Dr Yousif Chalabi Objectives: The lecture is dedicated to make the students understanding the nature of tumors &how the malignant tumors present with specific signs & symptoms to be differentiated from benign one .What are the predisposing factor & the definite causes to be diagnosed early before extension to nearby vital & dangerous area of eye & intracranially . Although generally they are rare tumors but they carry a great morbidity & mortality necessating a special considerations by the juniors &the surgeon. Also to teach the students how these tumors presents with different signs & symptoms making the patients wandering among different specialty until diagnosed too late as a nasal or paranasal malignant tumors. 18
  19. 19. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 The lecture includes: a. A quick reviews of key points of previous lecture b.classifications of tumors as benign & malignant with their different types . Histological classification & staging of tumors c. predisposing & etiological factor for tumor causation d. Managements including the diagnosis of tumors whether benign or malignant &the best selected way of treatments whether surgically or by DXRT or combined in addition to their prognosis Lecture title : Embryology , anatomy, physiology of the ear Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: This lecture is dedicated to help medical students understand embryology, anatomy and physiology of the ear and their clinical importance, the lecture will deal with followings : 1.Embryological development of the ear 2.Anatomical parts of the ear 3.Anatomical landmarks of the ear 4.Functions of the ear 19
  20. 20. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecture title: Physical & radiological assessment of the ear diseases Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: in this lecture the students will learn how to examine & get diagnosis of the ear diseases as its includes; 1.The different ways of ear examination 2.What you will see in normal ear examination to make differentiation from disease ear 3.Audio logical assessment & its interpretation 4.Role of plain x-ray & ct scan in ear disease & their indications. Lecture title: Symptomatology in ear diseases Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: to know different ear disease symptoms as deafness (hearing loss), tinnitus (perceptive noisy sound), vertigo (rotating movement of the surrounding or the patient himself with fixed environment ) , otalgia (pain in the ear). So you will get information about above topics shortly including their classifications, differential diagnosis , diagnosis & treatments. Lecture title: Diseases of the external ear ( cong. anomalies, infections, tumors ) 20
  21. 21. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: to make the student oriented with the different ear diseases starting from external ear diseases, in this lecture will discuss the congenital diseases like auricle deformity ( bat ear) , preauricular sinus , otitis externa & its most common causes & types & its treatment ,also will concentrate on benign & malignant tumors like osteoma , basal cell carcinoma . Lecture title : Diseases of the middle ear (acute otitis media) Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: in this lecture the student will face the most important & commonest pathology which is middle ear infection (otitis media), pathology, types, causes, diagnosis & treatment. Lecture title : Diseases of the middle ear (chronic otitis media) Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: chronic OM classified into safe & unsafe disease, so its important to know both types & its pathology & treatment , also will discuss different classifications for CSOM & which of them is useful. Lecture title : Diseases of the inner ear , ear surgeries 21
  22. 22. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: in this lecture some of the inner ear disease which is more common than other inner ear disease like otosclerosis , meniers disease will discussed briefly in addition the students will get good & sufficient information about the common ear surgeries like myringotomy , myringoplasty. Lecture title : Anatomy and physiology of the pharynx Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture the students will get enough information Concentrating on boundaries and parts of the pharynx including naso , oro and laryngopharynx, as well as muscles , nerve supplies with short notes on the anatomy of soft palate . In physiology, function of pharyngeal lymphoid tissue and deglutition are discussed Lecture title : Common diseases of the buccal cavity Lecturer name: Dr. Sherko Saeed Fathullah Objectives: Some of the common diseases of otolarygologist interest are described including : stomatitis , aphthous ulcers , Behcet’s syndrome tongue ulcers and AIDS , notes on cysts of mouth , carcinoma of 22
  23. 23. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 the toungue , ludwing’s angina and tumours of the oral cavity Lecture title : Pharyngitis and pharyngeal abscesses Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture the students will know about common disease in the community (pharyngitis) Acute and chronic specific and non specific pharyngitis as well as acute and chronic pharyngeal abscesses, Pharyngitis and pharyngeal abscesses,& how these conditions can be dealt with. Lecture title : Tonsillitis and adenoids Lecturer name: Dr. Sherko Saeed Fathullah Objectives: Concentrating on acute and chronic tonsillitis with their complications .Tonsillectomy and post operative cares , Peritonsillar abscess ,Clinical features of nasopharyngeal tonsillitis , its complication and adenoidectomy , Pharyngitis and pharyngeal abscesses Lecture title : Tumors of the pharynx Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture will deal with important subject which is tumors of pharynx & its include Tumors of the nasopharynx Tumors of the oropharynx Tumors of the laryngopharynx 23
  24. 24. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecture title : Misceleneous conditions of the pharynx and throat Lecturer name: Dr. Sherko Saeed Fathullah Objectives: including Globus hysterics , palate and pharyngeal palsy , pharyngeal spasm , pharyngeal pouch , trismus , cleft palate and elongated styloid process Lecture title : Neck masses and salivary glands Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture will discuss Thyroglossal cyst and fistula , branchial cyst , cystic hygroma sternomastoid tumor as well as mumps , submandibular gland calculus and sialography. Student feedback for the subject of a lecture Date: course: year: lecturer: title: No. Evaluation Questions Score (1-5) Subjective Remarks 1 The objectives and key messages of the subject were clear 2 The contents of the subject were useful and related to the main 24
  25. 25. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 objectives of the course 3 The materials were prepared carefully as needed 4 The lecturer/ tutor while lecturing tried to analyze the principles, contents and the important points of the subject simply and properly. 5 The lecturer/ tutor while lecturing kept my attention. 6 The lecturer/ tutor came into the classroom on time and was committed to the duration of the lecture. 7 The lecturer's behavior in the classroom was calm and respectful 8 The slides used in the lecture were clear and attractive. 9 At the end of the lecture, the lecturer gave the students a chance for questions and comments. His/ her answers were complete. 10 The reading sources are new and compatible with the subject. Total score 1-very bad 2–bad 3–medium 4- good 5-verygood Examinations. 25
  26. 26. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 • Types of questions: 1-short essay. 2-long essay. 3-multiple choice questions. 4-Single choice questions • Time of exam. 3 Three hours. • The number of questions and marks are variables : The methods of correction of answers depend on key answers of single choice and key for multiple choice questions & its usually that false answer will council the true answer in MCQ (either one for one or two for one) and correction and marks are given accordingly. • Advices and directions for all students before and during exams. 1-Read the question twice before answering. 2-Think of the answer before writing. 26
  27. 27. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 3-Plan your answer in a separate page before writing it down on the answer paper. 4-Arrange the answer in the form of introduction, contents and the final part so that the student organizes his/her answer • Samples of MCQ , Single choice , long and short essays  Single choice question 1.middle turbinate is formed by: (….)A. vomer bone (….)B. Ethmoid bone (….)C. Maxilla bone (….)D. All of the above (….)E. none of the above the correct answer is ( B ) 27
  28. 28. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011  MULTIPLE CHOICE QUESTIONS 1.Regarding carcinoma of the larynx: a. SCC is the most common pathology b.Smoking has no any role in incidence c. Neck mass ( lymph node invasion )is more incident with glottis carcinoma d.Surgery always curative The answers as fallow a. T , b. F , c. F , d. F  SHORT ASSAY ON TREATMENT OF ALLERGIC RHIINITIS ANSWER Treatment: includes allergen avoidance, pharmacotherapy , immunotherapy & surgery which is rarely needed when there is local pathology affecting the 28
  29. 29. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 regress of the symptoms like septal deviation , turbinate hypertrophy, nasal polyp. Medication include : 1.Antihistamines : these rapidly relieve running, itching, & sneezing, but have little effect on blockage. 1st generation antihistamines ( chlorphenramine & diphenhydramine) should be avoided because of sedation effect , its better to use non-sedative 2nd generation like (loratidine, fexofenadine). 2.Topical corticosteroids: these are most effective for treatment of rhinitis especially if started prior to allergen exposure, it reduces inflammation, nasal , eye symptoms & improve sense of smell e.g ( mometasone , beclomethasone , fluticasone ). 3.Sodium cromoglicate: its weak effective against all rhinitis symptoms but useful for children aged less than 4 years. 4.Decongestant : topically used for reducing nasal obstruction ,but increase rhinorroea . Systemic decongestant not effective with systemic side effects. 5.Ipratropium bromide : this atropine –like nasal spray is useful against rhinorrhoea . 29
  30. 30. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 6.Systemic corticosteroids : oral steroids used for very sever symptoms during hay fever season. 7.Antileukotrienes : effective against congestion & mucous Production. 8. Nasal douching : Its effective in seasonal rhinitis. 9. Immunotherapy : Indicated in patients with sever symptoms not get response to routine medical treatments.  write long assay on an intrinsic rhinitis Answer : Is a non-infective , non allergic condition. Like many diseases whose etiology is obscure , its also termed as perennial rhinitis or vasomotor rhinitis which is still perhaps the commonest term. The term ( non allergic rhinitis ) is commonly applied to a diagnosis of any nasal condition in which the symptoms are identical to those seen in allergic rhinitis but an allergic etiology has been excluded .These non allergic entities can be broadly be classified as : • Idiopathic rhinitis ( vasomotor rhinitis ,or non allergic non infectious perennial rhinitis ) • Non allergic occupational rhinitis 30
  31. 31. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 • Hormonal rhinitis • Drug- induced rhinitis • Other forms ( non allergic rhinitis with esinophilia syndrome, rhinitis due to physical & chemical factors, food-induced rhinitis, emotional rhinitis, atrophic rhinitis ). unlike allergic rhinitis there are no specific diagnostic tests for non allergic rhinitis & diagnosis is made on the basis of rhinitis symptoms in the absence of identifiable allergy ( by allergy skin test ) , structural abnormality, immune deficiency, sinus disease or other causes. Clinical presentation : there are 6 main symptoms of rhinitis ,these are nasal congestion ,sneezing, nasal itching , rhinorrhoea , hyposmia & postnasal discharge , of these nasal symptoms significant sneezing & itching are highly suggestive of allergic rhinitis & tend not to occur with intrinsic rhinitis , very marked nasal congestion & significant hyposmia tend to be symptoms of non allergic rhinitis. Rhinitis presenting in childhood is almost invariably of allergic etiology , whereas adult onset rhinitis is more likely to be due to intrinsic rhinitis . Allergic rhinitis is always associated with nasal eosinophilia ( more than 25% of nasal smear cells are eosinophils) ,whereas non allergic rhinitis ( intrinsic rhinitis ) may or may not associated with eosinophilia 31
  32. 32. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 ,approximately 1/3 of intrinsic rhinitis patients have nasal secretion eosinophilia , so clinically IR classified into Eosinophilic ( obstruction syndrome ) & Non-eosinophilic ( rhinorrhoea syndrome ) groups. The eosinophilic variety of (IR) was characterized by marked nasal congestion , profuse rhinorrhoea , hyposmia , marked inferior turbinate hypertrophy which is mild in the other group& mucoid nasal secretion , also nasal polyposis is more frequent in eosinophilic groups. Rhinorrhoea is profuse in both groups but more in non- eosinophilic group which is a predominant feature. The rhinorhoea group tend to occur in relatively advanced age whereas the nasal obstruction group tend to occur in middle age . Other clinical differences between the 2 groups are marked mucosal thickening frequently occurs in the eosinophlic group which is evident on plain radiological examination of the sinuses, also noted that patient with eosinophilic (IR) frequently have asthma & occasionally aspirin sensitivety ,neither of which occurs in the non- eosinophilic (IR) group. One of the most clinically obvious differences is dramatic response of the eosinophilic group to intranasal steroids & poor response of the other group to any therapy apart from anticholinergic agents. ---------------------------------------------------------------------- --------------------------------------------------------------------- 32
  33. 33. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011  From now on every course should have its own external examiner with identified roles. The one who can play the role of an external examiner should: • Have an academic post with the scientific rank of assistant Professor and higher. • He/she should be an active, reputable and experienced academic staff in his field or a related field to the course. • He/she should have not participated in lecturing or administering of the course. The roles of the external examiner are: • Evaluating the contents and the program of the course. • Prior to the exam , he /she should contribute to choosing the questions and looking at the ideal answers. • Evaluating the process of the examinations: he/she should see all the marked exam papers, then choose randomly nine marked papers: three with high marks, three with medium and three with low marks. • Evaluating the students' feedbacks 33
  34. 34. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 • He/she should participate in the final meeting of the first round examinations committee and give his assessment on the entire course and the examination process, then to give his opinion about the final results. • He/she should participate in the final meeting of the second round examinations committee and should have a main vote on those problems that may face them. • Then the lecturer/ tutor in charge will respond to the external examiner's questions and will reply officially to all the questions and clarify the reasons. ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- 34
  35. 35. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Student feedback on the course Date : course: year lecturer: no . Evaluation Questions Score (1-5) Subjective Remarks 1 The objectives and key messages of the subject were clear 2 The contents of the subject were useful and were related to the main objectives of the course 3 The coordinator teacher had worked hard to prepare the materials 4 The coordinator teacher had worked hard to cooperate and prepare the course 5 The lecturers were carefully selected and were expert in their fields 6 The coordinator teacher gave a good attention to the students' criticisms and claims 35
  36. 36. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 7 Information on the Examination process was well provided 8 The questions of the exams were related to the contents of the course 9 There is a potential to promote and develop the course in the following areas: 10 Total of the levels 1-very bad 2- bad 3-medium 4-good 5-very good Course Book Of Otolaryngology Fifth Stage 36
  37. 37. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Department of Surgery College of Medicine 2010-2011 Course coordinator and list of teachers on this course Course: otolaryngology Course coordinator: Dr. Hewa As'ad Department: surgery- otolaryngology 37
  38. 38. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 College: Medicine Course coordinator link: hewa_ent@yahoo.com Tel. +9647701580087 List of teachers on this course: Dr. Hewa As'ad Abdelkareem Dr. Yousif Ibrahim chalabi Dr. Muaid Ismaiel Aziz Dr. Sherko Saeed Fathullah Course Overview The course of otolaryngology – head & neck surgery is dedicated to deal with undergraduate level to know the importance of otolaryngology in the daily activities of the junior doctors and the sessions and the lectures are overall based on simple principles and standards for the juniors in otolaryngology to understand the physiology and pathology and management of common diseases & how 38
  39. 39. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 to deal with emergency situations that they may be faced in their practical work , these lectures given in simple and qualified methods in 28 lectures. Course Objectives At the end of the course of otolaryngology, the students should be able to master and perform the basic otolaryngology assessment & examinations that are considered fundamentals and learn how to be able to deal 39
  40. 40. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 with emergency situations. some of these objectives include: 6-Performing ENT examination. 7-Deal with a patient complaining of nasal bleeding. 8-How to manage a patients with foreign bodies inhalations or ingestion. 9-How to manage a patients with an obstructed upper airway obstruction ( stridor) . 10- Diagnosing and treatment of common otolaryngological diseases. Course Reading List 40
  41. 41. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 1-Scott- Brown otolaryngology 2-Logans Turners diseases of ear , nose, throat 3-Synopsis otolaryngology 4-Makhbool otolaryngology 5- Essential Otolaryngology 6- Oxford handbook of ENT emergences 7-American journal of otolaryngology-head & neck Surgery 8- journal of laryngoscope 9- www.emedicine.com 41
  42. 42. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Syllabus N o Title of subject Lecturer/Tuttor’s name 1 Anatomy and physiology of the larynx Dr.Hewa asaad 2 Traumatic conditions of the larynx. Dr.Hewa asaad 3 Inflammations of the larynx: Acute laryngitis. Dr.Hewa asaad 4 Inflammations of the larynx: Chronic laryngitis. Dr.Hewa asaad 5 Neoplasms of the larynx: Benign tumors and cysts Dr.Hewa asaad 6 Neoplasms of the larynx: Malignant tumors. Dr.Hewa asaad 7 Hoarseness Dr.Hewa asaad 8 Anatomy, Embryology & physiology of the nose & PNS Dr Yousif Chalabi 9 congenital anomalies and trauma to the nose Dr Yousif Chalabi 10 Acute & Chronic nasal &PNS sinus inflammation Dr Yousif Chalabi 42
  43. 43. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 11 Epistaxis Dr Yousif Chalabi 12 Allergic rhinitis & nasal polyposis Dr Yousif Chalabi 13 The deformed nose & nasal obstruction Dr Yousif Chalabi 14 Tumors of nose & paranasal sinuses Dr Yousif Chalabi 15 Embryology, anatomy, physiology of the ear Dr. Muaid Ismaiel Aziz 16 Physical& radiological assessment of the ear diseases Dr. Muaid Ismaiel Aziz 17 Symptomatology in ear diseases Dr. Muaid Ismaiel Aziz 18 Diseases of the external ear ( cong.anomalies , infections, tumors) Dr. Muaid Ismaiel Aziz 19 Diseases of the middle ear ( acute otitis media) Dr. Muaid Ismaiel Aziz 20 Diseases of the middle ear (chronic otitis media) Dr. Muaid Ismaiel Aziz 21 Diseases of the inner ear, ear surgeries Dr. Muaid Ismaiel Aziz 22 Anatomy and physiology of the pharynx Dr. Sherko Saeed Fathullah 23 Common diseases of the buccal cavity Dr. Sherko Saeed Fathullah 24 Pharyngitis and pharyngeal abscesses Dr. Sherko Saeed Fathullah 43
  44. 44. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 25 Tonsillitis and adenoids Dr. Sherko Saeed Fathullah 26 Tumors of the pharynx Dr. Sherko Saeed Fathullah 27 Miscellaneous conditions of the pharynx and throat Dr. Sherko Saeed Fathullah 28 Neck masses and salivary glands Dr. Sherko Saeed Fathullah Lecture title: Anatomy and physiology of the larynx. Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand anatomy and physiology of the larynx and their clinical importance, the lecture includes: a. Introduction to laryngeal structure. b. Description of laryngeal structure (laryngeal cartilages and membranes, muscles of the larynx and their actions) demonstrated by figures c. Description of surface anatomy of the larynx. d. Blood supply, nerve supply, and lymphatic drainage of larynx and their clinical importance. e. Description of functions of larynx. Lecture title: Traumatic conditions of the larynx Lecturer: Dr. Hiwa As'ad Objectives: 44
  45. 45. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 This lecture is dedicated to help medical students understand management of trauma of larynx and neck which is a common clinical condition that they will face frequently in their practice in hospital and emergency department, the lecture includes: a. Introduction to laryngeal and neck trauma. b. Description of mechanism of injury (blunt trauma injury and penetrating trauma). c. Initial evaluation, clinical assessment, endoscopic assessment and imaging of the larynx. d. Classification of laryngeal injury according to extent of damage. e. Management of laryngeal trauma, goals of laryngeal exploration, laryngeal repair, and management of associated vascular and esophageal injuries. f. Outcome of management of this condition. Lecture title: Inflammations of the larynx: Acute laryngitis Lecturer name: Dr. Hiwa As'ad Objectives: 45
  46. 46. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 This lecture is dedicated to help medical students understand this common problem that they will face in their practice in outpatient clinic, emergency department or if they work in otolaryngology or pediatric departments, the lecture includes: a. Introduction to acute laryngitis and its etiological factors. b. Description of clinical types of acute laryngitis. c. Comparison between pediatric patients and adult patients and relative clinical points to be considered. d. Treatment options and outcome. Lecturer title: Inflammations of the larynx: Chronic laryngitis Lecturer name: Dr. Hiwa as'ad Objectives: This lecture is dedicated to understand this troublesome condition caused by various etiological factors, and its types (specific and non specific), the lecture includes: a. Definition and etiological factors of chronic laryngitis. b. Clinical classification of chronic laryngitis into specific and non-specific, and subgroups of each type. c. Pathology, clinical features, and treatment modality for each type. 46
  47. 47. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecture title: Tumors of the larynx: Benign tumors Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand this important conditions that might affect respiration and voice of patients that needs specific management, the lecture includes : a. Introduction. b. Classification of benign tumors. c. Clinical features, diagnosis and treatment of each type. d. Pseudotumors types , clinical features and management of each type. Lecture title: Tumors of the larynx: Malignant tumors Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand this serious condition and develop high sense of suspicious for early diagnosis. It also demonstrates treatment options of this condition, the lecture includes: a. Introduction. b. Classification of carcinoma of larynx. c. Demonstration of etiological factors. d. Clinical features, examination of the larynx and the neck. 47
  48. 48. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 e. Radiological investigations and other relevant investigations to assess tumor extension and spread. f. Staging and grading of Ca larynx. g. Demonstration of strategy of treatment and the options available for this condition. Lecture title: Hoarseness Lecturer name: Dr. Hiwa As'ad Objectives: to understand the students the meaning of the hoarseness & its causes &its treatment, were all objectives included in the lecture. Lecture title: Anatomy & Physiology of nose & paranasal sinus Lecturer : Dr. Yousif Chalabi Objective: To emphasize the importance of anatomy &its variations especially the osteomeatal complex in the clinical managements of common nose &sinus chronic diseases & correction of nose & nasal septum both for physiological & cosmetic purposes , the lecture includes e. an embyrological introduction to explain some congenital variation of nose like choanal atresia f. anatomy of external nose &its skeleton to explain the anatomical dangerous region of nose &anatomical & physiological background of cosmetic nasal surgery. 48
  49. 49. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 g.anatomy &physiology of nasal fossae & its wall , their role in respiration h.anatomy of paranasal sinuses &their variation with its impact on pathogenesis of chronic sinus diseases & facial pain Lecture title: congenital anomalies and trauma to the nose Lecturer: Dr Yousif Chalabi Objectives : to emphasize the importance of early diagnosis of some congenital anomalies as a cause of embarrassed respiration in neonates & infants for urgent interference &to explain the clinical managements of broken nose &face both medically &legally in addition to its impact on possible intra cranial ,base of skull , cosmetic & respiratory complications to guarantee early proper detection &management to prevent subsequent sequels. The lecture includes a quick review of embryological formation of nose. its openings & anatomy of nasal skeleton , Choanal atresia , fracture nasal bone &facial bones (Leforts) fractures , Foreign bodies in nose & their managements. 49
  50. 50. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecture title : Acute & Chronic nasal &paranasal sinus inflammation Lecturer: Dr Yousif Chalabi Objectives: To consider the predisposing factors& their prevention in the etiology of acute nasal & paranasal sinus (PNS) infections & to emphasize the effects of prompt & early treatments in prevention of persistence of infections & changing to chronic state. And how to manage whether medically or surgically the chronic state. The lecture includes f. A quick review of key points of previous lecture g. Acute viral &bacterial infections of nose &PNS h. Chronic non-specific nasal &PNS inflammation i. Chronic specific nasal & PNS infection j. Managements including the medical & surgical way of treatments Lecture title: Epistaxis Lecturer: Dr Yousif Chalabi Objectives : This lecture is dedicated to emphasize the importance of epistaxis as one of common acute emergencies in medicine in general & to teach the students how to manage it as first-aid , general &specific ENT managements . How to identify its causes as a local nasal causes or general systemic causes especially the 50
  51. 51. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 blood dyscriasis causes . How to be treated specifically , generally & how to prevent & guard against it . The lecture includes e. A quick review of key points of previous lecture f. an introduction to epistaxis g.Causes as a local nasal causes &general systemic causes h.Management including the lab hematological., radiological & endoscopical way to find the cause as local nasal or general systemic . how to be treated whether medically or surgically conservatively or radically &how to be followed up properly. Lecture title: Allergic Rhinitis & Nasal polyposis Lecturer: Dr Yousif Chalabi Objectives: to emphasize the role of preventative measures especially the avoidance of allergens .proper use of immunization & medical treatments In reducing the complaint & severity of allergic patients. How to differentiate the different causes of wet nose including infections allergy & intrinsic vasomotor rhinitis &how to be treated properly .The lecture is dedicated to make the students understand the nature of common nasal problem of polyposis & how to differentiate it from normal or hypertrophied turbinates . To emphasize the 51
  52. 52. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 role of medical treatment as an effective measures in the early & small polypi or as a preliminary measures for effective radical treatment or follow up for those treated surgically. The lecture includes f. A quick review of key points of previous lecture g.An introduction to the types of hypersensitivity reactions &nature of nasal allergy h.Etiology of allergy &types of allergens i. Management including the differentiation &how to diagnose different types of wet nose. Allergy dermatological & hematological test in addition to proper way of prevention &treatments j. Nasal polyposis as a pathogenesis , diagnosis & treatments whether medically emphasizing the role of proper use of cortisone in a non contra-indicated patients or surgically whether conservatively or radically by FEES or conventionally by traditional surgical way Lecture title : The deformed nose & nasal obstruction Lecturer: Dr Yousif Chalabi Objectives: This lecture is dedicated to emphasize the role of cosmetic nasal surgery with consideration of nasal passage for proper respiratory functions which so 52
  53. 53. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 frequently threatened by some surgeon not considering the physiological aspect of nasal function &how to deal with nose surgically both for physiological & cosmetic purposes . It also aims to make the students understanding the causes of nasal obstruction &to differentiate the pathological from normal physiological obstructions of nasal cycle .The lecture includes e. A quick review of the key points of previous lecture f. A review of the nasal respiratory physiology &anatomy of the nasal skeleton g.Causes of deformed nose &nasal obstruction h.Management including the requested examination whether endoscopically or by imaging (CT SCAN) to determine the causes &sites of obstructions & how to be treated whether medically or surgically whether for cosmetic or physiological purpose separately or in combinations. Lecture title : Tumors of nose & paranasal sinuses Lecturer: Dr Yousif Chalabi Objectives: The lecture is dedicated to make the students understanding the nature of tumors &how the malignant tumors present with specific signs & symptoms to be differentiated from benign one .What are the predisposing factor & the definite causes to be diagnosed early before 53
  54. 54. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 extension to nearby vital & dangerous area of eye & intracranially . Although generally they are rare tumors but they carry a great morbidity & mortality necessating a special considerations by the juniors &the surgeon. Also to teach the students how these tumors presents with different signs & symptoms making the patients wandering among different specialty until diagnosed too late as a nasal or paranasal malignant tumors. The lecture includes: e. A quick reviews of key points of previous lecture f. classifications of tumors as benign & malignant with their different types . Histological classification & staging of tumors g. predisposing & etiological factor for tumor causation h. Managements including the diagnosis of tumors whether benign or malignant &the best selected way of treatments whether surgically or by DXRT or combined in addition to their prognosis Lecture title : Anatomy, physiology of the ear Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: This lecture is dedicated to help medical students understand anatomy and physiology of the ear and their clinical importance, the lecture will deal with followings : 54
  55. 55. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 1. Anatomical parts of the ear 2.Anatomical landmarks of the ear 3.Functions of the ear Lecture title: Physical & radiological assessment of the ear diseases Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: in this lecture the students will learn how to examine & get diagnosis of the ear diseases as its includes; 5.The different ways of ear examination 6.What you will see in normal ear examination to make differentiation from disease ear 7.Audio logical assessment & its interpretation 8.Role of plain x-ray & ct scan in ear disease & their indications. Lecture title: Symptomatology in ear diseases Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: to know different ear disease symptoms as deafness (hearing loss), tinnitus (perceptive noisy sound), vertigo (rotating movement of the surrounding or the patient himself with fixed environment ) , otalgia (pain in 55
  56. 56. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 the ear). So you will get information about above topics shortly including their classifications, differential diagnosis , diagnosis & treatments. Lecture title: Diseases of the external ear ( cong. anomalies, infections, tumors ) Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: to make the student oriented with the different ear diseases starting from external ear diseases, in this lecture will discuss the congenital diseases like auricle deformity ( bat ear) , preauricular sinus , otitis externa & its most common causes & types & its treatment ,also will concentrate on benign & malignant tumors like osteoma , basal cell carcinoma . Lecture title : Diseases of the middle ear (acute otitis media) Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: in this lecture the student will face the most important & commonest pathology which is middle ear infection (otitis media), pathology, types, causes, diagnosis & treatment. Lecture title : Diseases of the middle ear (chronic otitis media) Lecturer name: Dr. Muaid Ismaiel Aziz 56
  57. 57. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Objectives: chronic OM classified into safe & unsafe disease, so its important to know both types & its pathology & treatment , also will discuss different classifications for CSOM & which of them is useful. Lecture title : Diseases of the inner ear , ear surgeries Lecturer name: Dr. Muaid Ismaiel Aziz Objectives: in this lecture some of the inner ear disease which is more common than other inner ear disease like otosclerosis , meniers disease will discussed briefly in addition the students will get good & sufficient information about the common ear surgeries like myringotomy , myringoplasty. Lecture title : Anatomy and physiology of the pharynx Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture the students will get enough information Concentrating on boundaries and parts of the pharynx including naso , oro and laryngopharynx, as well as muscles , nerve supplies with short notes on the anatomy of soft palate . In physiology, function of pharyngeal lymphoid tissue and deglutition are discussed Lecture title : Common diseases of the buccal cavity 57
  58. 58. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Lecturer name: Dr. Sherko Saeed Fathullah Objectives: Some of the common diseases of otolarygologist interest are described including : stomatitis , aphthous ulcers , Behcet’s syndrome tongue ulcers and AIDS , notes on cysts of mouth , carcinoma of the toungue , ludwing’s angina and tumours of the oral cavity Lecture title : Pharyngitis and pharyngeal abscesses Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture the students will know about common disease in the community (pharyngitis) Acute and chronic specific and non specific pharyngitis as well as acute and chronic pharyngeal abscesses, Pharyngitis and pharyngeal abscesses,& how these conditions can be dealt with. Lecture title : Tonsillitis and adenoids Lecturer name: Dr. Sherko Saeed Fathullah Objectives: Concentrating on acute and chronic tonsillitis with their complications .Tonsillectomy and post operative cares , Peritonsillar abscess ,Clinical features of nasopharyngeal tonsillitis , its complication and adenoidectomy , Pharyngitis and pharyngeal abscesses Lecture title : Tumors of the pharynx Lecturer name: Dr. Sherko Saeed Fathullah 58
  59. 59. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Objectives: in this lecture will deal with important subject which is tumors of pharynx & its include Tumors of the nasopharynx Tumors of the oropharynx Tumors of the laryngopharynx Lecture title : Misceleneous conditions of the pharynx and throat Lecturer name: Dr. Sherko Saeed Fathullah Objectives: including Globus hysterics , palate and pharyngeal palsy , pharyngeal spasm , pharyngeal pouch , trismus , cleft palate and elongated styloid process Lecture title : Neck masses and salivary glands Lecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture will discuss Thyroglossal cyst and fistula , branchial cyst , cystic hygroma sternomastoid tumor as well as mumps , submandibular gland calculus and sialography. Student feedback for the subject of a lecture Date: course: year: lecturer: title: 59
  60. 60. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 No. Evaluation Questions Score (1-5) Subjective Remarks 1 The objectives and key messages of the subject were clear 2 The contents of the subject were useful and related to the main objectives of the course 3 The materials were prepared carefully as needed 4 The lecturer/ tutor while lecturing tried to analyze the principles, contents and the important points of the subject simply and properly. 5 The lecturer/ tutor while lecturing kept my attention. 6 The lecturer/ tutor came into the classroom on time and was committed to the duration of the lecture. 7 The lecturer's behavior in the classroom was calm and respectful 8 The slides used in the lecture were clear and attractive. 9 At the end of the lecture, the lecturer gave the students a chance for questions and comments. His/ her answers were complete. 10 The reading sources are new and 60
  61. 61. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 compatible with the subject. Total score 1-very bad 2–bad 3–medium 4- good 5-verygood Examinations. • Types of questions: 1-short essay. 2-long essay. 3-multiple choice questions. 4-Single choice questions • Time of exam. 3 Three hours. • The number of questions and marks are variables : The methods of correction of answers depend on key answers of single choice and key for multiple choice questions & its usually that false answer will council the true answer in MCQ (either one for one or two for one) and correction and marks are given accordingly. 61
  62. 62. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 • Advices and directions for all students before and during exams. 5-Read the question twice before answering. 6-Think of the answer before writing. 7-Plan your answer in a separate page before writing it down on the answer paper. 8-Arrange the answer in the form of introduction, contents and the final part so that the student organizes his/her answer • Samples of MCQ , Single choice , long and short essays  Single choice question 2.middle turbinate is formed by: 62
  63. 63. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 (….)A. vomer bone (….)B. Ethmoid bone (….)C. Maxilla bone (….)D. All of the above (….)E. none of the above the correct answer is ( B )  MULTIPLE CHOICE QUESTIONS 4.Regarding carcinoma of the larynx: e. SCC is the most common pathology f. Smoking has no any role in incidence g.Neck mass ( lymph node invasion )is more incident with glottis carcinoma h.Surgery always curative The answers as fallow a. T , b. F , c. F , d. F  SHORT ASSAY ON TREATMENT OF ALLERGIC RHIINITIS 63
  64. 64. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 ANSWER Treatment: includes allergen avoidance, pharmacotherapy , immunotherapy & surgery which is rarely needed when there is local pathology affecting the regress of the symptoms like septal deviation , turbinate hypertrophy, nasal polyp. Medication include : 8.Antihistamines : these rapidly relieve running, itching, & sneezing, but have little effect on blockage. 1st generation antihistamines ( chlorphenramine & diphenhydramine) should be avoided because of sedation effect , its better to use non-sedative 2nd generation like (loratidine, fexofenadine). 9.Topical corticosteroids: these are most effective for treatment of rhinitis especially if started prior to allergen exposure, it reduces inflammation, nasal , eye symptoms & improve sense of smell e.g ( mometasone , beclomethasone , fluticasone ). 10. Sodium cromoglicate: its weak effective against all rhinitis symptoms but useful for children aged less than 4 years. 64
  65. 65. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 11. Decongestant : topically used for reducing nasal obstruction ,but increase rhinorroea . Systemic decongestant not effective with systemic side effects. 12. Ipratropium bromide : this atropine –like nasal spray is useful against rhinorrhoea . 13. Systemic corticosteroids : oral steroids used for very sever symptoms during hay fever season. 14. Antileukotrienes : effective against congestion & mucous Production. 8. Nasal douching : Its effective in seasonal rhinitis. 9. Immunotherapy : Indicated in patients with sever symptoms not get response to routine medical treatments.  write long assay on an intrinsic rhinitis Answer : Is a non-infective , non allergic condition. Like many diseases whose etiology is obscure , its also termed as perennial rhinitis or vasomotor rhinitis which is still perhaps the commonest term. The term ( non allergic rhinitis ) is commonly applied to a diagnosis of any nasal condition in which the symptoms are identical to those seen in allergic rhinitis but an allergic etiology has been excluded .These non allergic entities can be broadly be classified as : 65
  66. 66. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 • Idiopathic rhinitis ( vasomotor rhinitis ,or non allergic non infectious perennial rhinitis ) • Non allergic occupational rhinitis • Hormonal rhinitis • Drug- induced rhinitis • Other forms ( non allergic rhinitis with esinophilia syndrome, rhinitis due to physical & chemical factors, food-induced rhinitis, emotional rhinitis, atrophic rhinitis ). unlike allergic rhinitis there are no specific diagnostic tests for non allergic rhinitis & diagnosis is made on the basis of rhinitis symptoms in the absence of identifiable allergy ( by allergy skin test ) , structural abnormality, immune deficiency, sinus disease or other causes. Clinical presentation : there are 6 main symptoms of rhinitis ,these are nasal congestion ,sneezing, nasal itching , rhinorrhoea , hyposmia & postnasal discharge , of these nasal symptoms significant sneezing & itching are highly suggestive of allergic rhinitis & tend not to occur with intrinsic rhinitis , very marked nasal congestion & significant hyposmia tend to be symptoms of non allergic rhinitis. Rhinitis presenting in childhood is almost invariably of allergic etiology , whereas adult onset rhinitis is more likely to be due to intrinsic rhinitis . 66
  67. 67. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Allergic rhinitis is always associated with nasal eosinophilia ( more than 25% of nasal smear cells are eosinophils) ,whereas non allergic rhinitis ( intrinsic rhinitis ) may or may not associated with eosinophilia ,approximately 1/3 of intrinsic rhinitis patients have nasal secretion eosinophilia , so clinically IR classified into Eosinophilic ( obstruction syndrome ) & Non-eosinophilic ( rhinorrhoea syndrome ) groups. The eosinophilic variety of (IR) was characterized by marked nasal congestion , profuse rhinorrhoea , hyposmia , marked inferior turbinate hypertrophy which is mild in the other group& mucoid nasal secretion , also nasal polyposis is more frequent in eosinophilic groups. Rhinorrhoea is profuse in both groups but more in non- eosinophilic group which is a predominant feature. The rhinorhoea group tend to occur in relatively advanced age whereas the nasal obstruction group tend to occur in middle age . Other clinical differences between the 2 groups are marked mucosal thickening frequently occurs in the eosinophlic group which is evident on plain radiological examination of the sinuses, also noted that patient with eosinophilic (IR) frequently have asthma & occasionally aspirin sensitivety ,neither of which occurs in the non- eosinophilic (IR) group. One of the most clinically obvious differences is dramatic response of the eosinophilic group to intranasal steroids & poor response 67
  68. 68. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 of the other group to any therapy apart from anticholinergic agents. ---------------------------------------------------------------------- ---------------------------------------------------------------------  From now on every course should have its own external examiner with identified roles. The one who can play the role of an external examiner should: • Have an academic post with the scientific rank of assistant Professor and higher. • He/she should be an active, reputable and experienced academic staff in his field or a related field to the course. • He/she should have not participated in lecturing or administering of the course. The roles of the external examiner are: • Evaluating the contents and the program of the course. • Prior to the exam , he /she should contribute to choosing the questions and looking at the ideal answers. • Evaluating the process of the examinations: he/she should see all the marked exam papers, then choose 68
  69. 69. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 randomly nine marked papers: three with high marks, three with medium and three with low marks. • Evaluating the students' feedbacks • He/she should participate in the final meeting of the first round examinations committee and give his assessment on the entire course and the examination process, then to give his opinion about the final results. • He/she should participate in the final meeting of the second round examinations committee and should have a main vote on those problems that may face them. • Then the lecturer/ tutor in charge will respond to the external examiner's questions and will reply officially to all the questions and clarify the reasons. ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- 69
  70. 70. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Student feedback on the course Date : course: year lecturer: no . Evaluation Questions Score (1-5) Subjective Remarks 1 The objectives and key messages of the subject were clear 2 The contents of the subject were useful and were related to the main objectives of the course 3 The coordinator teacher had worked hard to prepare the materials 4 The coordinator teacher had worked hard to cooperate and prepare the course 5 The lecturers were carefully selected and were expert in their fields 70
  71. 71. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 6 The coordinator teacher gave a good attention to the students' criticisms and claims 7 Information on the Examination process was well provided 8 The questions of the exams were related to the contents of the course 9 There is a potential to promote and develop the course in the following areas: 10 Total of the levels 1-very bad 2- bad 3-medium 4-good 5-very good 71

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