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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
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



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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.




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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.




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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

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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                         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
4 laryngitis.                                               Dr.Hewa asaad



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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                           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
                                                              Dr. Muaid Ismaiel Aziz
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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                          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)
                                             Dr. Muaid Ismaiel Aziz
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:


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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.


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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.

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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.


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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.

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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


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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

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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

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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


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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


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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.

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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




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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 )

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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

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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


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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

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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 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
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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
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.


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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 )
     MULTIPLE CHOICE QUESTIONS
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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                    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

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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                     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

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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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.


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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                    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
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
  • 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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                    2010-2011

    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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                         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
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
7 Information on the Examination process was well
   provided
8 The questions of the exams were related to the
   contents of the course
                                             35
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                          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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                      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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   2010-2011

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
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.




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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:
  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.


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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                 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

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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                         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

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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                           2010-2011

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

   Inflammations of the larynx: Chronic
4 laryngitis.                                                 Dr.Hewa asaad

     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

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Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                          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)
                                                             Dr. Muaid Ismaiel Aziz
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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                         2010-2011


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:
          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:

                                             44
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
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:

                                       45
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
Lecturer name: Dr. Hiwa As'ad
Objectives: This lecture is dedicated to help medical
students understand this important conditions that might


                                       46
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
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.

                                       47
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   2010-2011

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.
   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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   2010-2011



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.

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

                                       49
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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.
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
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


                                       50
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                      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
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

                                          51
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                      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
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

                                          52
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
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

                                       53
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
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 :

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


                                       54
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;
  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
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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   2010-2011

               ( 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
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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   2010-2011

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
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

                                       57
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

                                       58
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 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
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.
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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.
   5-Read the question twice before answering.
   6-Think of the answer before writing.


                                   61
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                     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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                    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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                     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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                   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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                    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
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
  • 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


                                       68
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                    2010-2011

    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
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                         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
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
7 Information on the Examination process was well
   provided
8 The questions of the exams were related to the
   contents of the course
                                             70
Course Book ---   otolaryngology ---- department of Surgery ----   Fifth stage
                                          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

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5th year Course Book/E.N.T

  • 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. 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. 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. 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. 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. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 4 laryngitis. Dr.Hewa asaad 6
  • 7. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 Dr. Muaid Ismaiel Aziz 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
  • 8. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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) Dr. Muaid Ismaiel Aziz 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
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 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
  • 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. 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. 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 )  MULTIPLE CHOICE QUESTIONS 27
  • 28. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 29. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 30. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 31. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 32. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 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 • 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
  • 34. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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 7 Information on the Examination process was well provided 8 The questions of the exams were related to the contents of the course 35
  • 36. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 37. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 38. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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 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
  • 39. 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: 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
  • 40. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 41. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 42. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 Traumatic conditions of the larynx. 2 Dr.Hewa asaad Inflammations of the larynx: Acute 3 laryngitis. Dr.Hewa asaad Inflammations of the larynx: Chronic 4 laryngitis. Dr.Hewa asaad 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
  • 43. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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) Dr. Muaid Ismaiel Aziz 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
  • 44. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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: 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: 44
  • 45. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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: 45
  • 46. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand this important conditions that might 46
  • 47. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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. 47
  • 48. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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. 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
  • 49. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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. 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 49
  • 50. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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. 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 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 50
  • 51. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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 51
  • 52. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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 52
  • 53. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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 53
  • 54. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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 : 1. Anatomical parts of the ear 2. Anatomical landmarks of the ear 3. Functions of the ear 54
  • 55. 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; 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 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
  • 56. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 ( 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 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
  • 57. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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 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 57
  • 58. 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 58
  • 59. 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 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
  • 60. 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. 60
  • 61. 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. 5-Read the question twice before answering. 6-Think of the answer before writing. 61
  • 62. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 63. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 64. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 65. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 66. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 67. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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
  • 68. 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 • 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 68
  • 69. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 2010-2011 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. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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 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 7 Information on the Examination process was well provided 8 The questions of the exams were related to the contents of the course 70
  • 71. Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage 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