5th year Course Book/E.N.T

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

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

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

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

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

2010-2011

8- journal of laryngoscope
9- www.emedicine.com

Syllabus
N
Title of subject Lecturer/Tuttor’s name
o
1 Dr.Hewa asaad
Anatomy and physiology of the larynx
Traumatic conditions of the larynx.
2 Dr.Hewa asaad
Inflammations of the larynx: Acute
3 laryngitis. Dr.Hewa asaad

Inflammations of the larynx: Chronic

6

2010-2011

Neoplasms of the larynx: Benign
5 Dr.Hewa asaad
tumors and cysts
Neoplasms of the larynx: Malignant
6 Dr.Hewa asaad
tumors.
7 Hoarseness Dr.Hewa asaad
Anatomy, Embryology & physiology
8 Dr Yousif Chalabi
of the nose & PNS
congenital anomalies and trauma to the
9 Dr Yousif Chalabi
nose
Acute & Chronic nasal &PNS sinus
10 inflammation Dr Yousif Chalabi

11 Epistaxis Dr Yousif Chalabi
Dr Yousif Chalabi
12 Allergic rhinitis & nasal polyposis
The deformed nose & nasal
13 Dr Yousif Chalabi
obstruction
Dr Yousif Chalabi
14 Tumors of nose & paranasal sinuses
15 Anatomy, physiology of the ear
Physical& radiological assessment of Dr. Muaid Ismaiel Aziz
16
the ear diseases
1 Dr. Muaid Ismaiel Aziz
Symptomatology in ear diseases
7
18 Diseases of the external ear Dr. Muaid Ismaiel Aziz

7

2010-2011

( cong.anomalies , infections, tumors)
19 Diseases of the middle ear ( acute otitis Dr. Muaid Ismaiel Aziz
media)
Diseases of the middle ear (chronic Dr. Muaid Ismaiel Aziz
20
otitis media)
21 Diseases of the inner ear, ear surgeries
Anatomy and physiology of the
22 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
Miscellaneous conditions of the
27 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

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:
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

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
Objectives:
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

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
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

2010-2011

d. Pseudotumors types , clinical features and management
of each type.
Lecture title: Tumors of the larynx: Malignant tumors
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
Objectives: to understand the students the meaning of the
hoarseness & its causes &its treatment, were all
objectives included in the lecture.

12

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

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
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

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
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 .

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

2010-2011

whether medically or surgically conservatively or
radically &how to be followed up properly.
Lecture title: Allergic Rhinitis & Nasal polyposis
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.

b. An introduction to the types of hypersensitivity

reactions &nature of nasal allergy
c. Etiology of allergy &types of allergens

16

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
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

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
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

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
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

2010-2011

Lecture title: Physical & radiological assessment of the
ear diseases
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
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

2010-2011

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)
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)
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

2010-2011

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
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

2010-2011

the toungue , ludwing’s angina and tumours of the oral
cavity
Lecture title : Pharyngitis and pharyngeal abscesses
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
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
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

2010-2011

Lecture title : Misceleneous conditions of the pharynx
and throat
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
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 Subjective
(1-5) 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

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.
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

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

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 )
 MULTIPLE CHOICE QUESTIONS
27

2010-2011

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
regress of the symptoms like septal deviation , turbinate
hypertrophy, nasal polyp.
Medication include :
28

2010-2011

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 .
6. Systemic corticosteroids : oral steroids used for very
sever symptoms during hay fever season.
7. Antileukotrienes : effective against congestion &
mucous

29

2010-2011

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
• Hormonal rhinitis
• Drug- induced rhinitis
• Other forms ( non allergic rhinitis with esinophilia
syndrome, rhinitis due to physical & chemical

30

2010-2011

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
,approximately 1/3 of intrinsic rhinitis patients have nasal
secretion eosinophilia , so clinically IR classified into
Eosinophilic ( obstruction syndrome ) & Non-eosinophilic
( rhinorrhoea syndrome ) groups.

31

2010-2011

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

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
• 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

33

2010-2011

process, then to give his opinion about the final
results.
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

2010-2011

Student feedback on the course
Date : course: year lecturer:
no Evaluation Questions Score Subjective
. (1-5) 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
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
7 Information on the Examination process was well
provided
8 The questions of the exams were related to the
contents of the course
35

2010-2011

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
Department of
Surgery
College of Medicine
36

2010-2011

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

37

2010-2011

Dr. Yousif Ibrahim chalabi
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
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.

38

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:
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.

39

2010-2011

9-How to manage a patients with an obstructed upper
airway obstruction ( stridor) .
10-Diagnosing and treatment of common
otolaryngological diseases.

Course Reading List

1-Scott- Brown otolaryngology
2-Logans Turners diseases of ear , nose, throat

40

2010-2011

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

Syllabus
N
Title of subject Lecturer/Tuttor’s name
o
1 Dr.Hewa asaad
Anatomy and physiology of the larynx

41

2010-2011

Traumatic conditions of the larynx.
2 Dr.Hewa asaad
Inflammations of the larynx: Acute

Inflammations of the larynx: Chronic

Neoplasms of the larynx: Benign
5 Dr.Hewa asaad
tumors and cysts
Neoplasms of the larynx: Malignant
6 Dr.Hewa asaad
tumors.
7 Hoarseness Dr.Hewa asaad
Anatomy, Embryology & physiology
8 Dr Yousif Chalabi
of the nose & PNS
congenital anomalies and trauma to the
9 Dr Yousif Chalabi
nose
Acute & Chronic nasal &PNS sinus
10 inflammation Dr Yousif Chalabi

11 Epistaxis Dr Yousif Chalabi
Dr Yousif Chalabi
12 Allergic rhinitis & nasal polyposis
The deformed nose & nasal
13 Dr Yousif Chalabi
obstruction
14 Tumors of nose & paranasal sinuses Dr Yousif Chalabi

42

2010-2011

Embryology, anatomy, physiology of Dr. Muaid Ismaiel Aziz
15
the ear
Physical& radiological assessment of Dr. Muaid Ismaiel Aziz
16
the ear diseases
1 Dr. Muaid Ismaiel Aziz
Symptomatology in ear diseases
7
Diseases of the external ear Dr. Muaid Ismaiel Aziz
18
( cong.anomalies , infections, tumors)
19 Diseases of the middle ear ( acute otitis Dr. Muaid Ismaiel Aziz
media)
Diseases of the middle ear (chronic Dr. Muaid Ismaiel Aziz
20
otitis media)
21 Diseases of the inner ear, ear surgeries
Anatomy and physiology of the
22 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
Miscellaneous conditions of the
27 pharynx and throat Dr. Sherko Saeed Fathullah

43

2010-2011

28 Neck masses and salivary glands Dr. Sherko Saeed Fathullah

Lecture title: Anatomy and physiology of the larynx.
Objectives:
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:
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:

44

2010-2011

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
Objectives:
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:

45

2010-2011

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.

Lecture title: Tumors of the larynx: Benign tumors
students understand this important conditions that might

46

2010-2011

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
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.

47

2010-2011

Lecture title: Hoarseness
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.
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

48

2010-2011

Lecture title: congenital anomalies and trauma to the
nose
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
Objectives: To consider the predisposing factors& their
prevention in the etiology of acute nasal & paranasal
sinus (PNS) infections & to emphasize the effects of

49

2010-2011

prompt & early treatments in prevention of persistence of
infections & changing to chronic state. And how to
manage whether medically or surgically the chronic state.
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
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 .
e. A quick review of key points of previous lecture

f. an introduction to epistaxis

50

2010-2011

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
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.

51

2010-2011

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
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

52

2010-2011

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
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

53

2010-2011

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
students understand anatomy and physiology of the ear
and their clinical importance, the lecture will deal with
followings :

1. Anatomical parts of the ear
2. Anatomical landmarks of the ear
3. Functions of the ear

54

2010-2011

Lecture title: Physical & radiological assessment of the
ear diseases
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
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

55

2010-2011

( cong. anomalies, infections, tumors )
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)
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)
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.

56

2010-2011

Lecture title : Diseases of the inner ear , ear surgeries
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
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
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

57

2010-2011

the toungue , ludwing’s angina and tumours of the oral
cavity
Lecture title : Pharyngitis and pharyngeal abscesses
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
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
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

58

2010-2011

Lecture title : Misceleneous conditions of the pharynx
and throat
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
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 Subjective
(1-5) 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
59

2010-2011

objectives of the course

3 The materials were prepared carefully
as needed
tried to analyze the principles,
contents and the important points of
the subject simply and properly.
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.
60

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.
5-Read the question twice before answering.
6-Think of the answer before writing.

61

2010-2011

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:
(….)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
62

2010-2011

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
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 :
63

2010-2011

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.
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

64

2010-2011

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
• Hormonal rhinitis
• Drug- induced rhinitis
• Other forms ( non allergic rhinitis with esinophilia
syndrome, rhinitis due to physical & chemical

65

2010-2011

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
,approximately 1/3 of intrinsic rhinitis patients have nasal
secretion eosinophilia , so clinically IR classified into
Eosinophilic ( obstruction syndrome ) & Non-eosinophilic
( rhinorrhoea syndrome ) groups.

66

2010-2011

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.
----------------------------------------------------------------------
---------------------------------------------------------------------

67

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
first round examinations committee and give his
assessment on the entire course and the examination

68

2010-2011

process, then to give his opinion about the final
results.
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

2010-2011

Student feedback on the course
Date : course: year lecturer:
no Evaluation Questions Score Subjective
. (1-5) 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
prepare the materials
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
7 Information on the Examination process was well
provided
8 The questions of the exams were related to the
contents of the course
70

2010-2011

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

5th year Course Book/E.N.T

More Related Content

Viewers also liked

Similar to 5th year Course Book/E.N.T

More from College of Medicine, Sulaymaniyah

Recently uploaded

5th year Course Book/E.N.T