JINNAH SINDH MEDICAL UNIVERSITY
STUDY GUIDE
PROGRAM MBBS
MODULE TITLE Head and Neck & Special Senses-II (ENT)
ACADEMIC YEAR Fourth year-2024
INTRODUCTION The Head & Neck and Special Senses-II module is related to diseases
of the Ear, Nose and Throat (ENT). ENT diseases are serious public
health problems because of their universal distribution, and the
morbidities associated thereof, which they cause due to inherent
physiological function that take place in head and neck region. This
study guide is to be used for 4th year students of Jinnah Sindh
Medical University.
RATIONALE This course, along with the ENT rotations, aims to produce graduate
capable of dealing with common conditions related to Ear, Nose
and Throat; in tertiary and primary health care settings. The long-term
goal is to contribute to the national provision of health care providers
who can take part in the reduction of impairment among the
population.
OUTCOMES By the end of the Head and Neck & Special Senses-II module and
ENT rotation, students must be able to justify the diagnoses and
management plans of common, uncomplicated ENT-related
conditions in emergency and non-emergency situations.
DEPARTMENTS 1. Community Medicine
INVOLVED 2. ENT
3. Pathology
MODULE By the end of the module, the students should be able to:
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OBJECTIVES
LECTURES 1. Noise Pollution
COMMUNITY Describe Noise & Vibration
MEDICINE Identify Noise sources & measurements
Explain adverse health effects of noise
Discuss Noise Management
2. Cancers related to Head and Neck
Describe various cancers of Head & neck
Identify risk factors of head & neck cancers
Explain the control & prevention of head & neck cancers
ENT 1. Diseases of External Ear (wax/ foreign body)
Describe the etiology, clinical presentation, investigations,
treatment and complications of impacted wax, frunculosis and
foreign body
Diagnose pre-auricular cyst/ sinus
Discuss the etiology, clinical presentation, investigations,
treatment and complications for: Myringitis bullosa and
Perichondritis
2. Trauma to external ear
Describe etiology, clinical presentation, investigations,
treatment and complications of trauma to pinna and
traumatic rupture of tympanic membrane
3. Acute Otitis externa
Discuss the etiology, clinical presentation, investigations,
treatment and complications for- Acute otitis externa
Discuss the etiology, clinical presentation, investigations,
treatment and complications for Fungal infections of ear
4. Malignant Otitis Externa I
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Discuss the etiology, clinical presentation, investigations,
treatment and complications for Malignant otitis externa
5. Malignant Otitis Externa II
Discuss the etiology, clinical presentation, investigations,
treatment and complications for Malignant otitis externa
6. Benign tumors of external ear
Discuss the etiology, clinical presentation, investigations,
treatment and complications for Benign tumors of external ear
7. Malignant tumors of external ear
Discuss the etiology, clinical presentation, investigations,
treatment and complications for Malignant tumors of external
ear
8. Acute otitis Media-I
Discuss the etiology, clinical presentation, investigations,
treatment and complications of Acute otitis Media-I
Discuss the etiology, pathophysiology, clinical presentation,
examination findings, investigations and treatment plan for:
Acute necrotizing otitis media
9. Acute otitis Media-II
Discuss the etiology, clinical presentation, investigations,
treatment and complications of Acute otitis Media-II
Discuss the etiology, pathophysiology, clinical presentation,
examination findings, investigations and treatment plan for:
Acute necrotizing otitis media
10. Chronic suppurative otitis media- I
Discuss the etiology, clinical presentation, investigations,
treatment and complications of Chronic suppurative otitis
media- I
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Describe the diagnosis and management of the complications
of otitis media
Discuss the etiology, pathophysiology, clinical presentations,
examination findings, investigations and treatment plans for
Serous otitis media.
Describe the diagnosis and management of the complications
of otitis media and mastoiditis
11. Chronic suppurative otitis media- II
Discuss the etiology, clinical presentation, investigations,
treatment and complications of Chronic suppurative otitis
media- II
Describe the diagnosis and management of the complications
of otitis media
Discuss the etiology, pathophysiology, clinical presentations,
examination findings, investigations and treatment plans for
Serous otitis media.
Describe the diagnosis and management of the complications
of otitis media and mastoiditis
12. Deafness & Audiogram-I
Define deafness
List causes of deafness
Interpret investigation findings related to deafness
(Audiogram, tympanogram) - I
13. Deafness & Audiogram-II
Define deafness
List causes of deafness
Interpret investigation findings related to deafness
(Audiogram, tympanogram)- II
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14. Vertigo & Tinnitus
Discuss the clinical presentation and treatment options for
vestibular neuritis, benign paroxysmal positional vertigo,
Meniere’s Disease, and migraine-associated vertigo.
15. Epistaxis
Discuss the etiology, clinical presentation, investigations,
treatment and complications of Epistaxis
16. Deviated nasal septum
Discuss the etiology, clinical presentation, investigations,
treatment and complications of Deviated nasal septum
17. Nasal Polyps
Define Polyps
Diagnose Ethmoidal and Antrochoanal Polyps based on
history, clinical findings and investigation findings
Discuss management plans for Ethmoidal and Antrochoanal
Polyps
Diagnose Bleeding Polyps based on data provided
Discuss management plan for Bleeding Polyps
18. Nasal Septal diseases
Classify Nasal Septal diseases
Discuss the etiology, clinical presentation, investigations,
treatment and differential diagnose of Nasal Septal diseases
Describe etiology and pathophysiology for syphilis and leprosy.
Diagnose syphilis and leprosy based on symptoms and signs
and, investigation findings
Develop treatment and follow plans for the above mentioned
conditions
19. Acute and chronic sinusitis
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Discuss the etiology, pathophysiology, clinical presentation,
examination findings, investigations, differential diagnosis and
treatment plans for: Acute Sinusitis and Chronic Sinusitis.
Based on data provided, diagnose complications of the
above mentioned conditions
Suggest treatment plan for these conditions
20. Rhinoliths
Diagnose Rhinoliths based on examination & investigation
findings
Discuss management plan for Rhinoliths
21. Fungal sinusitis
Diagnose Fungal sinusitis based on data provided
Discuss management plan for Fungal sinusitis
22. Diseases of Salivary glands
Diagnose diseases of salivary gland (benign neoplastic, non-
neoplastic and parotitis), thyroid gland and lymph nodes
based on clinical presentations and investigation findings
Justify selection of treatment options for the salivary gland
conditions
23. Oral cavity ulcers
Justify diagnosis, investigations, differential diagnosis and
treatment plans for oral cavity ulcers (Aphthus ulcers, Thrush
& Leukoplakia)
Justify diagnosis, investigations, differential diagnosis and
treatment plans for oral cavity ulcers (Traumatic, Vincents
Angina, Agranulocytic Tuberculous Behcet’s Syndrome and
Ulcerative lesions of Oral Cavity)
24. Neoplastic conditions of Oral cavity
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Classify Neoplastic conditions of Oral cavity
Justify diagnosis, investigations, differential diagnosis and
treatment plans for Neoplastic conditions of Oral cavity
Diagnosis, investigations, differential diagnosis and treatment
plans for Oral Malignant Ulcers.
25. Neoplasms of salivary glands
Classify Neoplasms of salivary glands
Justify diagnosis, investigations, differential diagnosis and
treatment plans for Neoplasms of salivary glands
26. Tonsils
Justify diagnosis, investigations, differential diagnosis and
treatment plans for Tonsillitis, Peri-tonsillitis and abscess.
27. Adenoids
Justify diagnosis, investigations, differential diagnosis and
treatment plans for Adenosis
28. Acute and chronic inflammations of larynx
Diagnose laryngitis based on symptoms and signs, and
investigation findings
Develop treatment and follow up plans for the above
mentioned conditions
Describe the etiology and pathophysiology of supraglottitis
and laryngitis
Justify diagnosis, investigations, differential diagnosis and
treatment plans for supraglottitis and laryngitis
29. Vocal Nodules and Paralysis
Describe the etiology, pathophysiology, investigations and
principles of treatment for Vocal Nodules and Vocal cord
paralysis
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30. Diphtheria
Describe the etiology and pathophysiology of Diphtheria
Diagnose Diphtheria based on symptoms and signs and,
investigation findings
Develop treatment and follow plans for the above mentioned
condition
31. Dysphagia
Describe etiology, pathophysiology, differential diagnosis and
investigations for dysphagia (oral, pharyngeal and
esophageal)
Describe indications, contraindications and complication of
Esophagostomy
Justify diagnosis, investigations, and differential diagnosis for
common conditions of the hypo-pharynx (including Plummer-
Vinson or Paterson-Kelly syndrome, pharyngeal pouch (zenker
diverticulum)
32. Neck masses and fistulas
Classify Neck masses and fistulas
Justify diagnosis, investigations, differential diagnosis and
treatment plans for Neck masses and fistulas
Diagnose Hypoglossal cyst/ sinus, Branchial Cyst and Branchial
Fistula
Justify diagnosis, investigations, differential diagnosis
and treatment plans for Ludwig’s angina
Justify diagnosis, investigations, differential diagnosis
and treatment plans for Pharyngeal and
Retropharyngeal abscesses.
33. Sleep apnea syndrome
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• Justify diagnosis, investigations, differential diagnosis and
treatment plans for Sleep apnea syndrome
34. Tracheostomy
Describe the indications, contraindications, complications,
operation steps and post-operative care for tracheostomy
35. Benign & Malignant laryngeal tumors
Classify Laryngeal tumors
Diagnose Papilloma Larynx, Laryngeal Polyps based on
symptoms and signs, and investigation findings
Discuss the etiology, symptoms and signs and, investigation
findings, and differential diagnosis of Laryngeal Carcinoma
justify diagnosis, investigations, and differential diagnosis for
pyriform fossa carcinoma, and post cricoid carcinoma
36. Radiology of ENT
Identify and describe the radiological findings on different x-ray
related to the ear, nose and throat.
PATHOLOGY 1. Pathogens causing infections of the ear.
List the pathogens causing infections of the ear
Discuss the pathophysiology and clinical features of the
infections.
2. Pathogens causing infections of the nose.
List the pathogens causing infections of the nose
Discuss the pathophysiology and clinical features of the
infections.
3. Pathogens causing infections of the throat.
List the pathogens causing infections of the throat
Discuss the pathophysiology and clinical features of the
infections.
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ENT INSTRUMENT By the end of the rotation in ENT, student should be able to identify
IDENTIFICATION the instruments listed below and discuss their indications and
contraindications (where applicable):
1. Adenoid curette
2. Ashe’s Forceps
3. Ballenger Swivel Knife
4. Boyle Davis mouth gag
5. Bronchoscopes (Rigid/flexible)
6. Ear speculum
7. Endoscopes
8. Endotracheal Tube, Cuffed/Non-cuffed
9. Freer elevator
10. Head lights
11. Indirect laryngoscope mirror
12. Jobsons Horne probe
13. Knot pusher
1. Laryngoscope Macintosh
14. Laryngoscopes
15. Luc’s forceps
16. McGill Forceps
17. Nasal Snare
18. Nasal Speculum
2. Nasopharyngoscope
3. Oesophagoscopes
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19. Otoscope
20. Posterior Rhinos copy mirror
21. Sucker Pharyngeal
22. Suction nozzle
23. Suction Tube
24. Tilly’s Nasal Dressing Forceps
25. Tongue depressor
26. Tonsil holding forceps
27. Tonsil snare
28. Tonsillar artery forceps
29. Tracheal Dilator
30. Tracheostomy Tubes
31. Trocar and Cannula
32. Tuning forks
33. Walsham’s Forceps
CLINICAL By the end of the ENT rotation, students should be able to:
SKILLS
Examine Cranial nerves relevant to ENT (Olfactory nerve,
Trigeminal nerve, Facial nerve, Vestibulocochlear nerve,
Glossopharyngeal nerve, Hypoglossal nerve)
Examine ear for foreign body and of posterior nasal space by
posterior Rhinoscopy
Examine the oropharynx and the neck of real patients under
direct supervision
Palpate the neck to assess the lymph-nodes and salivary
glands in the neck
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Perform a complete regional examination on real patients
correctly
Perform Otoscopy as per protocol on real patients, under
direct supervision
Take history appropriately from a patient with an ENT related
condition
Use nasal speculum appropriately for examination
Use otoscope to aid in examination of the external auditory
canal and the tympanic membrane
Use the finger palpation method for examination of oral cavity
and tongue
Use the tongue blade to aid inspection of the buccal cavity
Use tuning forks for hearing tests and interpretation of the
findings
Write clear and focused histories legibly in order to make
correct provisional diagnoses
PROFESSIONAL Demonstrate punctuality and regularity in all teaching sessions
BEHAVIOR Deal with colleagues (peers, seniors and juniors), other
members of the health care team and patients and
their attendants with respect
Demonstrate compassion and ethical behavior while dealing
with patients (i.e. during history taking, examinations and
discussions)
Demonstrate empathy towards the health care team
members and patients (along with their attendants) through
verbal and non-verbal communication
Demonstrate clarity in verbal and written communications at
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all times
INTERNAL Internal assessment will be according to JSMU policy. The
ASSESSMENT details of internal assessment will be determined by the
respective institutions.
Internal assessment carries 20% weightage in the final, end- of -
year examination
ANNUAL MCQs and OSCE/OSPE (observed + unobserved)
EXAMINATION
COURSE Course will be evaluated through a feedback form which will
EVALUATION be posted on the JSMU website
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