Year 4 ENT4: Ear, Nose and Throat
- Mr Nick Eynon-Lewis
- Nicholas.EynonLewis@bartsandthelondon.nhs.uk
Introduction
Overarching aims:
1. To demonstrate a basic knowledge of the anatomy of the head and neck including the cranial nerves.
2. To demonstrate an understanding of ear, nose and throat and head and neck pathology.
3. To be familiar with the presentation and management of the common and important conditions of the ear, nose and throat and head and neck.
4. To demonstrate a basic knowledge of the aetiology, presentation and management of head and neck cancer.
Sessions
Introduction to ENT
The Ear (1 & 2)
- Know the basic anatomy and physiology of hearing.
- Have a basic understanding of the physiology of balance.
- Be able to list the causes of vertigo.
- Know that ear conditions usually present with one or more of the following symptoms: hearing loss, otorrhoea, otalgia, tinnitus and vertigo.
- Have a basic understanding of pure tone audiometry and tympanometry.
- Be able to list the common causes of hearing loss in adults and children.
- Understand the difference between conductive and sensorineural hearing loss.
- Know how to conduct Rinnes and Webers tests and be able to interpret the results.
- Know the aetiology, presentation and management of perichondritis, ear canal farunculosis and exostosis, otitis externa and malignant otitis externa, chronic suppurative otitis media (CSOM), acute otitis media (AOM) and glue ear (SOME).
- Understand that nasopharyngeal carcinoma can present with a middle ear effusion.
- Understand that otalgia can be caused by ear conditions or can be caused by referred pain.
- Have a basic knowledge of the diagnosis and management of the otological causes of vertigo.
Voice
- Know the basic anatomy of the larynx and the physiology of voice production.
- List the causes of hoarseness.
- Know the appearance of vocal fold nodules, cysts and polyps.
- Understand the aetiology of benign vocal fold swellings.
- Be familiar with the term and know the appearance of Reinkes oedema.
- Be familiar with the term and know the appearance of recurrent respiratory papillomatosis
- List the causes of vocal fold palsy
- Know the presentation and management of vocal fold palsy.
- Know that voice therapy forms an important part of the management of voice disorders.
Rhinology and Facial Plastic Surgery
- Know the basic anatomy of the nose and paranasal sinuses.
- Be able to list the differential diagnoses for a patient presenting with nasal obstruction.
- Know the presentation, investigation and management of acute and chronic rhinitis, nasal polyps and sinusitis.
- Know the presentation and management of the complications of sinusitis.
- Know the causes and management of septal perforation.
- Know the causes and management of epistaxis.
- Know how to manage a fractured nose and in particular know the time frame for manipulation.
ENT - Emergencies & Urgent Referrals
- Be aware of head & neck infections and abscesses.
- Know that tonsillitis can be complicated by peritonsillar abscess.
- Know how to manage a peritonsillar abscess.
- Understand the terms stridor and stertor.
- Know the causes of airway obstruction in adults and children.
- Know the basic management of the conditions causing airway obstruction.
- Understand the importance and different ways of securing a safe airway.
- Understand the indications for cricothyroidotomy and tracheostomy.
- Understand the causes and management of epistaxis
- Know the complications of otitis media.
- Know that sudden sensorineural hearing loss is an emergency.
- Know the complications of sinusitis.
- Know the presentation & management of ENT foreign bodies.
- Be able to assess and know the basic management of head & neck trauma.
ENT - Paediatric
- Understand that Paediatric ENT conditions are common.
- Appreciate the basic clinical embryology of the head & neck and understand the important anatomical differences with adults.
- Understand the management of ENT foreign bodies.
- Ear - Understand the congenital and syndromic conditions that effect the external, middle and internal ear.
- Ear - Know the techniques for assessing hearing in children and be aware of the national screening programme.
- Ear - Know the presentation and management of glue ear, acute otitis media and CSOM
- Ear - Know the complications of ear infection
- Nose - Know that neonates are obligate nasal breathers and understand the management of choanal atresia.
- Nose - Know the management of epistaxis in children.
- Nose - Know the presentation and management of the complications of sinusitis.
- Throat/ Neck - Understand the difference between stridor and stertor.
- Throat/ Neck - Know the causes, presentation and management of airway obstruction in children.
- Throat/ Neck - Know the differential diagnosis of neck swellings in children.
Head and Neck
- Know the basic anatomy of the head & neck.
- Head & Neck Cancer:
- Know the aetiology and pathology of head and neck cancer.
- Understand that the presentation will depend on the site and size of the tumour.
- Understand that a tumour may present with metastatic cervical lymphadenopathy.
- Be familiar with the concept of the TNM classification.
- Understand the place of surgery, radiotherapy and chemotherapy in the treatment of Head and Neck cancer.
- Be familiar with the multidisciplinary approach and the indications for an urgent (2 week wait) referral.
- Hoarseness, Dysphagia, Airway Obstruction (Adult):
- List the causes of hoarseness.
- List the common causes of dysphagia.
- Know how dysphagia may be investigated.
- Be familiar with the diagnosis and management of stridor and stertor.
- Be familiar with the term obstructive sleep apnoea (OSA).
- Know the causes and management of OSA.
- Facial nerve:
- Know the anatomy of the facial nerve.
- Be able to list the causes of facial palsy.
- Be familiar with the concept of upper and lower motor neurone facial nerve palsy and understand that an upper motor neurone palsy may allow frontal sparing.
- Understand the immediate and long term management of facial palsy.
- Understand that the care of the eye is paramount in the immediate management.
- Be familiar with the term Bell’s palsy and understand that it is a diagnosis of exclusion.
- Swellings of the neck (Adult):
- Be able to describe the triangles of the neck.
- Know how to describe a lump in the neck i.e site, size, shape, surface, consistency, surrounds, pulsatility, trans-illumination and movement on swallowing and tongue protrusion.
- Be able to list the causes of neck lumps in adults and children.
- Know the differential diagnosis and management of a salivary gland swelling.
- Know the differential diagnosis and management of a thyroid swelling.
- Know the diagnostic features and treatment of thyroglossal and branchial cysts.
- Know that investigation may include ultrasound, CT and MRI (and sometimes radioisotope scanning for thyroid disease).
- Know the differential diagnosis for cervical lymphadenopathy and understand why examination of the upper aerodigestive tract is important.
- Understand the difference between fine needle aspiration biopsy, incisional and excisional biopsy and the indications for these.
ENT-Head & Neck anatomy
