Download ENT – Otolaryngology

ENT – Oto lar yngo logy – Head and Neck Sur gery
Contact Information
Dr. Doug Angel
Phone: 709-579-1003
Fax: 709-579-1708
E-mail: [email protected]
NO ELECTIVE ROTATION will be accepted without written approval from Dr. Angel even if
arranged through other preceptors.
Preceptors (by subspecialization)
Dr. D. Angel - Head and Neck Oncology/Microvascular Reconstructive Surgery
Dr. T. Batten – Neuro-otology
Dr. K. Burrage - Head and Neck Oncology
Dr. C. Drover – General Otolaryngology
Dr. B. Lee – Head and Neck Oncology/Microvascular Surgery
Dr. W. Redmond – Laryngology, General Otolaryngolgy
Dr. L. Savoury - Head and Neck Oncology
Dr. T. Smith - Head and Neck Oncology
Dr. J. Tibbo - Head and Neck Oncology/Microvascular Surgery
Reporting on the First Day
Call Stephanie, 709-579-1003 (Dr. Angel’s Secretary) on the Friday before
your rotation to confirm your schedule.
General Information
Number of Clerks per Rotation: 1
Length of Rotation: 2 weeks
Objectives
Assumptions
Otolaryngology – Head and Neck Surgery is not a core rotation of your Clerkship. Some clerks will be able to
perform a selective or elective in Otolaryngology – Head and Neck Surgery as part of Clerkship. Studies have
estimated that approximately one third of patients seen by Primary Care Physicians have a presenting
problem directly related to the Specialty of Otolaryngology – Head and Neck Surgery.
It is expected that prior to your rotation, you will have reviewed the basic and relevant anatomy, physiology,
and pathology of the Head and Neck specifically:
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Outer, middle, and inner ear
Nose and paranasal sinuses
Aerodigestive tract and larynx
Neck
Thyroid and parathyroid glands
Cranial nerves
Otolaryngology – Head and Neck Surgery is a diverse specialty with subspecialties including:
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General Otolaryngology
Head and Neck Oncology/ Reconstructive Surgery
Endocrine Surgery of the Head and Neck
Rhinology
Laryngology/ Broncho-esophagology
Otology/ Neuro-otology and Skull Base Surgery
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Facial Plastic Surgery
Pediatric Otolaryngology
During your rotation you will be exposed to a broad patient population with a variety of clinical and surgical
problems. Although some of the clinical and surgical cases that you will encounter are beyond the scope of
Primary Care, you should be familiar with common disorders and emergencies affecting the Head and Neck.
Disorders of the Head and Neck
Following the completion of a rotation in Otolaryngology – Head and Neck Surgery, a clerk will be expected:
1. To perform a detailed and thorough history and physical examination of the Head and Neck.
2. To provide a differential diagnosis for presenting signs and symptoms of common Head and Neck
disorders including:
• Otalgia
• Hearing Loss
• Vertigo
• Epistaxis
• Rhinorrhea
• Nasal Obstruction
• Cough
• Dysphagia
• Sore Throat
• Hoarseness
• Upper Airway Obstruction including Sleep Apnea
• Neck Mass
• Thyroid Disease
• Skin Lesions
3. To propose relevant and appropriate investigations of Head and Neck disorders including laboratory
and radiological tests.
4. To propose appropriate management of Head and Neck disorders including appropriate referral to an
Otolaryngologist – Head and Neck Surgeon.
5. To recognize signs and symptoms of emergencies related to the Head and Neck including.
• Mastoiditis and other complications of Otitis media
• Sudden sensorineural hearing loss
• Epistaxis
• Periorbital cellulitis
• Facial and neck trauma
• Deep Neck abscesses and other complications of oral/ oropharyngeal infections
• Airway obstruction including epiglotitis and foreign body aspiration
6. Specifically, the Clerk should be familiar with the following disorders:
• Otology/ Neurootology
• Otitis externa
• Otitis media (acute and serous)
• Cholesteatoma and chronic otitis media
• Conductive and Sensorineural Hearing Loss
• Benign Positional Vertigo
• Menieres Disease
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Vestibular Neuronitis and Labyrinthitis
Facial paralysis
Acoustic Neuroma
Rhinology
o Rhinitis
o Sinusitis and Nasal Polyps
o Nasal Foreign Bodies
o Epistaxis
o Nasal fractures
• Laryngology/ Broncho-esophagology
o Tonsillitis including Infectious Mononucleosis
o Peritonsillar Abscess
o Ludwig’s angina and other deep neck space infections
o Epiglottitis
o Foreign bodies
o Vocal lesions
o GERD/ Laryngopharyngeal Reflux
o Foreign Bodies of the Pharynx/ Larynx/ Esophagus
• Head and Neck Disorders and Oncology
o Cervical Adenopathy
o Cancers of the aerodigestive tract
o Thyroid Nodules, Thyroglossal duct cysts, and other thyroid disorders
o Hyperparathyroidism
o Congenital neck masses including Branchial Cleft and Dermoid Cysts
o Skin Cancer
o Salivary gland neoplasms and other salivary gland disorders
o Facial and Neck Trauma
7. The clerk should demonstrate the following essential clinical skills:
• Otoscopy and pneumatic otoscopy
• Audiologic assessment with tuning forks
• Audiogram interpretation including tympanometry
• Vestibular examination including Dix-Hallpike maneuver
• Particle repositioning maneuver
• Anterior rhinoscopy
• Nasal cautery and nasal packing for epistaxis
• Examination of the oral cavity and oropharynx
• Understanding of flexible nasopharynscopy/ laryngoscopy
• Examination of the skin
• Examination of the salivary glands
• Examination of the thyroid gland
• Examination of the cervical lymphatics
• Cranial nerve examination