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Danylo Halytsky Lviv National Medical University
Department of Otorhinolaryngology
Methodical Guide
to practical classes on Otorhinolaryngology
for the 4th year (English Medium) students
of General Medicine faculty
Lviv – 2011
Methodical Guide were prepared by:
MD PhD, Assos.Prof. А.V.Tsymar
MD PhD О.J.Moskalyk
MD PhD А.J.Barylyak
Responsible for the issue:
Prorector for Academic work, Professor M.R.Gzhegotsky
Reviewers:
Got I.M. DMD, PhD, Professor, Head of Department of Surgical Dentistry
and Maxillofacial Surgery, Danylo Halytsky Lviv National Medical University
Orel Yu.G. MD, PhD, Associate Professor of Department of Surgery No 2,
Danylo Halytsky Lviv National Medical University
Isayeva O.S. PhD, Associate Professor Head of Department of Foreign
Languages, Danylo Halytsky Lviv National Medical University
Methodical Guide is recommended for printing by profiling surgical methodical
commission, protocol No “ 45” 20.VI.2011.
2
Contents
Contents……………………………………………………..
3
Subject plans……………….……………………............................ 4
Lesson 1………………………………………………………… 6
Lesson 2………………………………………………………… 8
Lesson 3………………………………………………………
11
Lesson 4………………………………………………………… 13
Lesson 5………………………………………………………… 16
Lesson 6………………………………………………………… 18
Lesson 7………………………………………………………… 21
Lesson 8………………………………………………………… 24
Lesson 9………………………………………………………… 26
Lesson 10……………………………………………………… 29
Lesson 11………………………………………………………. 32
Lesson 12……………………………………………………… 35
Lesson 13……………………………………………………..
38
List of questions for the final module control…………………… 41
List of practical skills, diagnostic and therapeutic manipulations
that a student should gain during the practical classes on Otorhi44
nolaryngology……………………………………….…………..
Scheme of medical history………………………………………. 45
Test’s answers………………………………………………..
46
3
Subject plans
Table 1
Subject plan of lectures in the Department of Otorhinolaryngology
Hour
No
Topic of a lectures
s
1. Acute diseases of the middle ear. External otitis. Acute purulent
2
otitis media. Mastoiditis.
2. Chronic otitis media. Otogenic intracranial complications.
2
3. Nose and paranasal sinuses diseases. Rhinogenic orbital and intra2
cranial complications.
4. Acute and chronic tonsillitis.
2
5. Laryngeal diseases. Infectional granulomas.
2
Total
10
Table 2
Subject plan of independent work in the Department of Otorhinolaryngology
Hour
№
Topic of a lesson
s
1. Additional methods of examination of the ENT organs, CT, MRI.
3
2. Reconstructive surgery of the nose and the face.
3
3. Collateral action of drugs in otolaryngology.
3
4. AIDS in otolaryngology.
3
5. Fungal diseases in otolaryngology.
3
6. Congenital disorders of the ENT organs.
3
7. Medico-social examination in otolaryngology.
3
8. Professional frustration of the ENT organs.
3
9. Costen syndrome.
3
10. The base of phoniatry.
3
11. Herbal medicine in otolaryngology.
3
12. Physiotherapy in otolaryngology.
2
13. Allergic diseases in otolaryngology.
2
14. Dizziness.
2
15. Lviv otolaryngology school.
1
Total
40
4
№
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Table 3
Subject plan of practical classes in the Department of Otorhinolaryngology
Location of pracTopic of a lesson
Hours
tice
Endoscopic examination of the ENT organs.
3
Lecture room,
Clinical anatomy, physiology, examination
hospital departments
methods of the external and middle ear.
Clinical anatomy, physiology, examination
3
Lecture room,
methods of auditory and vestibular analyzers.
hospital departments
Clinical anatomy, physiology, examination
3
Lecture room,
methods of the nose, paranasal sinuses,
hospital departments
pharynx, larynx, trachea, bronchi and
esophagus.
Diseases of the external and middle ear. Acute
3
Lecture room,
purulent otitis media. Mastoiditis. Anthrohospital departments
mastoidotomy.
Chronic suppurative otitis media.
3
Lecture room,
hospital departments
Labyrinthitis. Otogenic intracranial complica3
Lecture room,
tions.
hospital departments
Nonpurulent chronic ear diseases.
3
Lecture room,
hospital departments
Acute and chronical diseases of the nose.
3
Lecture room,
hospital departments
Acute and chronic sinusitis. Rhinogenic orbital
3
Lecture room,
and intracranial complications
hospital departments
Acute and chronic pharyngeal diseases.
3
Lecture room,
hospital departments
Acute and chronic laryngeal diseases.
3
Lecture room,
hospital departments
Traumas, foreign bodies and hemorrhages of
3
Lecture room,
the ENT, urgent care. Defence of medical
hospital departments
history.
Tumors and infectional granulomas of the ENT
2
Lecture room,
organs.
hospital departments
Final control – Module.
2
Lecture room
Total
40
Note:
* While learning a topic a student is awarded scores on traditional system: «5»
– 9 points, «4» – 7 points, «3» – 5 points, «2» – 0 points.
** For access to the final module control a student must obtain at least 65 points
for content modules.
*** final module control: maximum score - 80.
minimum score – 50
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Lesson 1
Topic: Endoscopic examination of ENT organs. Clinical anatomy, physiology and
examination methods of the external and middle ear.
1. The actuality of a topic: diseases of the upper respiratory tract and ear are one of
the most common pathologies in humans. Therefore, knowledge of the methods
and techniques of a visual examination of the upper respiratory tract is an important precondition not only for further practical classes in Otorhinolaryngology,
but also for the training of highly professional general practitioners, i.e. - family
doctors, as a third of all their patients require medical advice and assistance of
Otorhinolaryngologists. Knowledge of the clinical anatomy and physiology of the
auditory analyzer provides an opportunity to recognize in time any disorders of
the specific organ, establish correct diagnosis, prescribe and perform an adequate
treatment.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to master the techniques and examination equipment for an
ENT patient; technique of using a forehead reflector, an otoscope; to master
methods of otoscopy, rhynoscopy (front and rear), pharyngoscopy, indirect laryngoscopy; to learn the clinical anatomy and physiology of the external and middle
ear.
4. The student is expected to learn:
- organization of a working place of the ENT doctor;
- procedures, equipment and methods of the endoscopic examination of an ENT
patient;
- endoscopic view of healthy ears, nose, pharynx and larynx;
- clinical anatomy of the external and middle ears;
- peculiarities of the structure of the ear in children;
- normal and pathological physiology of the middle ear.
5. The student should be able to:
- use a headlight reflector, otoscope;
- conduct an otoscopy and evaluate the obtained endoscopic data;
- conduct a rhinoscopy (front and rear) and evaluate the obtained endoscopic
data;
- conduct a pharyngoscopy, evaluate the state of the oral cavity and oropharynx;
- perform an indirect laryngoscopy and evaluate the obtained data.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 12-20.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna Leighton, Andrew Robson, John Russel. – Edinburgh London New York Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 3-5, 8, 1117.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 3-6, 9-11, 50-76.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 10-27.
6
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001. - P.3-7.
7. Control questions:
 Endoscopic methods of examining the ENT organs.
 Anatomic-topographic features of the external ear.
 Dimensions, anatomic part’s and shapes of the external auditory meatus in
children and adults, peculiarities of skin and cartilagenous framework
structure, its influence on middle ear disorders.
 Anatomic structures of the middle ear.
 Anatomy of tympanic cavity (hearing bones, muscles, tympanic sinuses,
topographical anatomy of a facial nerve).
 Structure and functions of the eardrum.
 Anatomy and functions of the Eustachian tube.
 Normal and pathological physiology of the Eustachian tube.
 Structure of the mastoid process (types of pneumatization and its influence
on the development of pathologic changes in the middle ear).
 Physiology of sound conduction.
8. Tests examples:
I. Identify the correct sequence. Walls of the external auditory meatus:
1. frontal
а. Parotid salivary gland
2. from below
b. Frontal wall of a mastoid process
3. back
c. Bottom of middle cranial fossa
4. overhead
d. Arthral bag of mandibular joint
II. Complement a suggestion. Force of whisper language in dB is ……..
III. The most common way for opening the Eustachian tube is made by contraction of next muscle:
1. - stapedius muscle
2. - tensor tympani muscle
3. - tensor veli palatine muscle.
IV. The external layer of the tympanic membrane in pars tensa is:
1. - epidermal
2. - radial and circular collagen fibers overlaying each other
3. - mucosal
V. The mucosa inside the Eustachian tube is:
1. - multi-layered flat
2. - ciliated, rich in cells that produce mucus
3. - multi-layered cube
VI. The external wall of the tympanic cavity is formed by ………
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VII. What nerves are in the tympanic cavity?
1. - facial nerve, chorda tympani
2. - facial nerve, chorda tympani, tympanic neuroplex
3. - tympanic neuroplex
VIII. In what part of the external ear meatus the skin contains hair follicles and
ceruminous glands, sebaceous glands?
1. - in outer cartilaginous portion
2. - in inner bony portion
3. - in cartilaginous and bony portions
IX. An infection from the external ear meatus through the Santorini fistulas can
penetrate to?
1. - parotid gland
2. – mastoid process
3. – submandibular lymph nodes
X. What is located on the internal surfacr of the mastoid process?
1. - sinus cavernosus
2. - sinus sigmoideus
3. - posterior semicircular ducts
XI. Situational task:
A 25 years old patient appealed to ENT - doctor with complaints that during
plane flight she hads a feeling of fullness in the ears and a hearing loss. After
yawning these effects disappeared. During endoscopic examination no pathology
of the ENT organs was found. Explain, which function of the Eustachian tube was
impaired:
1. soundconduction
2. pressure regulation
3. drainage
4. protection
Lesson 2
Topic: Clinical anatomy, physiology, methods of investigation of hearing and vestibular organs.
1. The actuality of a topic: knowledge of methods and techniques of hearing and
vestibular apparatus examination in adults and children are needed in order to
establish of a proper diagnosis and identify further medical tactics. It will make
possible to avoid diagnostic errors and serious complications, preserve human
hearing, and even life. Among factors affecting hearing may be infectious, toxic,
vascular, traumatic, and many others. Therefore, methods of examination of
acoustic analyzer should possess various specialty physicians, especially family
doctor. Even minor disturbances of the vestibular apparatus could be the first
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2.
3.
4.
5.
6.
symptoms of brain disorders (tumors, aneurysms, strokes, angiopathy, chronic
intoxication, etc.), cerebellum, visual analyzer and other organs and systems.
Therefore, knowledge of anatomy and physiology of vestibular apparatus is
required for a wide range of professionals.
Lesson duration – 3 academic hours.
Purpose of a lesson: to learn how to perform akumetry, to evaluate the results of
tone audiometry and acoustic impendansometry. To evaluate radiography, CT and
MRI data of a temporal bone. To perform topical and differential diagnosis of the
auditory and vestibular apparatus disorders. To study anatomy and physiology of
vestibular analyzer, to determine degree of its functions impairment, be able to
evaluate vestibulometric results.
The student is expected to learn:
- clinical anatomy of the internal ear;
- age peculiarities of the ear structure;
- physiology of the auditory analyzer;
- physiology of the vestibular apparatus;
- subjective methods of hearing investigation: the study of hearing by speaking and whispering language, tuning fork, tone audiometry, speaking
audiometry;
- objective methods of investigation of hearing: acoustic impendansometry,
recording of auditory evoked potentials;
- the study of spontaneous vestibular disorders: dizziness, spontaneous, and
positional and pressing nystagmus, statokinetyc stability, vegetative
disorders.
The student should be able to:
- perform otoscopy;
- determine mobility of the eardrum;
- examine hearing by using language;
- conduct tuning fork tests (Weber, Shvabaha, Rene, Federichi, Zhelle) and be
able to evaluate them;
- analyze audiogram;
- evaluate the major types of tympanograms;
- perform research of spontaneous vestibular disorders;
- perform research of ampular apparatus according to the method of Barani;
- perform research of otolitic apparatus using the method of Voyachyk;
- conduct differential diagnosis of peripheral and central vestibular syndromes.
Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 12-20, 21-32.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 59, 11-19.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 6-8, 52-59.
9
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 10-33.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P. 7-27.
7. Control questions:
 structure of the auditory analyzer (soundconduction and soundperception);
 hearing testing procedure by using language;
 structure of spiral organ;
 characteristics of adequate stimulus for the auditory analyzer;
 soundperception, theory of hearing;
 tuning fork tests (Weber, Shvabaha, Rene, Federichi, Zhelle), technique
and purpose of examination;
 principles of tone audiometry;
 characteristic of the main types of audiometric curves;
 methods of test of Eustachian tube;
 principles of objective audiometry and tympanometry.
8. Tests examples:
I. In the organ of Corti there are the following supporting cells:
1. - only one type of supporting cells - undifferentiated supporting cells
2. - only Deiter’s cells
3. - pillar cells, Deiter’s cells, Hensen’s cells.
II. Membranous labyrinth of cochlea is field with:
1. - endolymph
2. - perilymph
3. - connective tissue
III. The perilymph of the scala tympani communicates with CSF via
1. - Eustachian tube
2. - bulb of a jugular vein
3. - cochlear aqueduct
4. - a.carotis
IV. Which membrane is a gel-like structure, consisting of highly hydrated layers
of collagen, related proteins, and glycosaminoglycans and lies near the surface of
the reticular lamina of the organ of Corti:
1. - basilar membrane
2. - Reissner’s membrane
3. - tectorial membrane
4. - spiral ligament
V. The ionic composition of the fluid in the scala media is similar to that of:
10
1. - extracellular fluid such as the cerebrospinal fluid, thus rich in sodium
and poor in potassium
2. - intracellular fluid, thus rich in potassium and low in sodium
VI. Involuntary rhythmic diphasic motions of eyeballs are named ......…….
VII. Nystagmus which rises or changes at certain position of a patient’s head is
named:
1. - positional
2. - adjusting
3. - pressing
VIII.
Motion of endolymph from an ampoule to the smooth end of semicircular channel is named:
1. - slow
2. - fast
3. - ampoulоpetal
4. - ampoulоfugal
IX. The adequate irritant of an ampular organ is:
1. - linear acceleration
2. - angular acceleration
3. - gravity, centrifugal force, rectilineal acceleration
4. - sound
X. Nystagmus of second degree appears during looking:
1. - toward a fast component of nystagmus
2. - straight
3. - toward a slow component of nystagmus
ХІ. Situational task
A 25 years old patient turned to otorhinolaryngologist with complaints of
hearing loss and tinnitus in the right ear. Otoscopicaly: the right eardrum dimly-pearl,
drawn, hammer handle clear visible, light cone shortened, during Valsalva test
mobility of the eardrum is limited. On tone audiogram a rise of perception thresholds
for air conduction up to 30 dB at all frequencies and air-bone interval within 20 dB
was found. What type of hearing loss can you think of:
1. conductive
2. sensoryneural
3. mixed
4. normal variant
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Lesson 3
Topic: Clinical anatomy, physiology, examination methods of the nose, paranasal
sinuses, pharynx, larynx, trachea, bronchi and esophagus.
1. The actuality of a topic: Patients with pathology of the upper respiratory tract
(URT) see practically all types of doctors. Quite often the reason of chronic tracheobronchitis may be a latent sinusitis or, conversely, sinusitis can be caused by
a chronic nasal or bronchial pathology. Lymphadenoid pharyngeal ring is a powerful immunologic organ that plays a significant role in the formation of local and
systemic immunity, but under the influence of negative factors it can become a
source of infection and cause pathological changes in many organs and body systems. Lesion of the larynx, trachea or esophagus (e.g. foreign body) can become a
reason of airway stenosis, which requires urgent medical assistance (tracheotomy,
esophagoscopy). A number of allergic diseases of the URT are increasing all over
the world. It is impossible to understand the mechanisms of the URT disorders,
pathogenesis, lesion - related complications or distant organs and systems without
a profound knowledge of anatomy, physiology and methods of analysis of the
URT.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to learn clinical anatomy, physiology and methods of examination of the nose, paranasal sinuses, throat, larynx, trachea, bronchi and esophagus
4. The student is expected to learn:
- clinical anatomy of the nose, paranasal sinuses, throat, larynx, trachea, bronchi
and esophagus;
- age peculiarities of these organs;
- physiology and pathophysiology of the upper respiratory tract (URT), bilateral
influence on other organs and systems;
- methods of examination of the upper respiratory tract (URT)
5. The student should be able to
- conduct an endoscopic examination of the upper respiratory tract;
- be able to evaluate the obtained endoscopic data and perform differential diagnosis;
- be able to read X-ray of the paranasal sinuses, nose and ear;
- conduct data analysis of the CT, MRI of paranasal sinuses, nose and ear;
- perform diagnostic and therapeutic manipulations (taking smears from the
nasal cavity, and pharynx, lubricating of the nasal cavity mucosa);
- conduct a research of nasal breathing (test with a cotton wool) and olfactory.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 73-77, 117-120, 162-170, 224-225, 228-229.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 8193, 133, 151-156, 167-176.
12
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 11-35.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 36-49
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.77-94, 177-182, 207-212, 235-246, 275-294, 331-342.
7. Control questions:

Clinical anatomy of the nose and paranasal sinuses (peculiarities of
blood supply, and innervation).

Physiology of the nose and paranasal sinuses.

Examination methods of the nose and paranasal sinuses.

Clinical anatomy of the pharynx (blood supply, and innervation).

Structure of palatine tonsils and functions of Waldeyer's-Pirogov
tonsillar ring.

Clinical anatomy and physiology of the larynx.

Examination methods of the larynx and pharynx.

Clinical anatomy, physiology and methods of examination of trachea,
bronchi and esophagus.
8. Tests examples:
I. The thickest wall of a frontal sinus is:
1 - from below
2 - back
3 - front
4 – middle
II. Ciliary movement of the nasal ciliated epithelium is directed to:
1 - to nostrils
2 - to choanas
3 - chaotically
III. The Kiesselbach plexus, or the Little area is located:
1 - in anteroinferior part of nasal septum
2 - in posteroinferior part of nasal septum
3 - in anterosuperior part of nasal septum
IV. Which nasal sinus drains to the middle meatus?
1 - maxillary sinus та nasolacrimal duct
2 - frontal sinus, frontal and middle cells of ethmoidal sinus
3 - frontal sinus, maxillary sinus, frontal and middle cells of ethmoidal
sinus
V. To the second degree of hypertrophy of palatal tonsils correspond:
1 - palatal tonsils come into contact with each other
13
2 - palatal tonsils come forward for front palatal handles on 1/3
distances between the edge of front palatal handle and tongue
3 - palatal tonsils are hidden after front palatal handles
4 - palatal tonsils come forward for front palatal handles on 2/3
distances between the edge of front palatal handle and tongue
VI. Space between the capsule of palatal tonsil and pharyngeal muscles is filled
with:
1 - fat
2 - lymphoid tissue
3 - connective tissue
VII. Postpharyngeal space is connected with:
1 - with frontal mediastinum
2 - with back mediastinum
3 - with parapharyngeal space
VIII. Laryngeal stenosis appears in case of paralysis of a:
1 - superior laryngeal n.
2 - inferior laryngeal n.
3 - glossopharyngeal n.
IX. Nerve which carries out motive innervation of the larynx is:
1 - laryngeal superior
2 - glossopharingeus
3 - facialis
4 - laryngeal inferior
X. Which of the main bronchial tubes is shorter and wider?
1 - right
2 - left
ХІ. Situational task.
A 34 year old patient visited an otorhinolaryngologist with complaints on
headaches, aggravated when bending a head forward and exercisising, general
weakness, fever, disturbance of nasal breathing, purulent nasal discharge from the
right nostril. During the endoscopic examination from the right side were revealed
hyperemia and swelling of nasal mucous membrane, purulent discharge in middle
pathway. What lesions of paranasal sinus can be suspected?
1. left frontal, maxillary
2. sphenoid, right frontal, front cell of ethmoidal labyrinth
3. right frontal, maxillary, front cell of ethmoidal labyrinth
4. right frontal, maxillary, rear cell of ethmoidal labyrinth
5. right frontal, front cell of ethmoidal labyrinth, sphenoid
14
Lesson 4
Topic: Diseases of the external and middle ear. Acute purulent otitis media. Mastoiditis. Anthromastoidotomy.
1. The actuality of a topic:Acute diseases of the external and middle ear are one of
the most common medical problems among the diseases of the URT. Quite often
they cause a hearing loss and the increase in a number of deaf people, and also
sometimes lead to the development of severe, life-threatening intracranial complications. Knowledge of etiology, pathogenesis and clinics of ear diseases gives
an opportunity to recognize its destruction in time, diagnose accurately, and
prescribe an appropriate treatment.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: To learn how to diagnose acute processes in the external and
middle ear, to make differential diagnosis between them, to provide an appropriate treatment.
4. The student is expected to learn:
- mechanisms of a sulfur crust formation and its removal technique;
- etiology, pathogenesis, clinical signs of external otitis, otitis media, mastoiditis;
- peculiarities of acute purulent otitis media in infants and in some acute
infectious diseases;
- principles of treatment of acute inflammation of the external and middle ear;
- possible complications of acute purulent otitis media.
5. The student should be able to:
- conduct otoscopy;
- evaluate a condition of the external auditory meatus skin, presence of sulfur
crust or any other pathological changes;
- evaluate a condition of tympanic membrane;
- determine presence of auditory function injury and its degree;
- conduct differential diagnosis of the external or middle ear injury;
- assess data of radiological examination of the temporal bone;
- perform examination of a hearing function;
- evaluate data from akumetry and audiometry;
- plan examination and treatment for acute external otitis and purulent otitis
media;
- clean the external auditory meatus, pneumatic massage of the tympanic
membrane;
- input Turunda in the cavity of the external auditory meatus;
- apply an ear bandage and a heating compress on the ear.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 33-49.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 21-38,
57-58.
15
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 77-112, 123-125.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 50-80.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P. 36-43, 44-49.
7. Control questions:

Pathogenesis of sulfur crust, removal techniques

External otitis: etiology, pathogenesis, classification, clinical picture,
diagnosis, treatment

Acute otitis media, classification, etiology

Pathogenesis of the acute otitis media

Clinic of different forms of acute otitis media

Treatment of acute otitis media, paracentesis

Peculiarities of clinical signs of acute otitis media in infants

Etiology and pathogenesis of acute mastoiditis

Clinical signs and principles of treatment of mastoiditis

Atypical mastoiditis, peculiarities of clinical signs

Differential diagnosis between mastoiditis and lymphadenitis of intratemporal area.
8. Tests examples:
I. What factors lead to development of the external otitis?
1. skin infecting of the external ear canal
2. infectious diseases
3. narrow external ear canal
4. hyperfunction of sulphuric glands
II. Paracentesis of eardrum must be done in the following quadrant:
1. anterior - superior
2. anterior - inferior
3. posterior - superior
4. posterior - inferior
III. In case of acute mastoiditis the hearing loss has a ………………..character
IV. In case of acute mastoiditis, when we’ll conduct a test of Vebera
lateralization of sound it’ll be directed to:
1 healthy ear
2 affected ear
3 absent
V. Complication of acute otitis media in newborns is called?
1 mastoiditis
16
2 otoantritis
3 chronical otitis
4 apical mastoiditis
VI. In case of uncomplicated acute otitis media the audiometric examination will
show:
1 sensoryneural hearing loss
2 conductive hearing loss
3 combined hearing loss
4 normal hearing
VII. What is typical for the external ear canal furuncle?
1. deep hearing loss and tinnitus
2. mild ear pain, pus in the external ear
3. ear painthat increases during chewing
VIII. Objective otoscopic symptoms of mastoiditis:
1 presence of large eardrum perforation
2 infiltration of inferior wall of the external ear meatus
3 invagination and marginal redness of eardrum
4 infiltration of posterior-superior wall of the external ear meatus
IX.
Paracenteses of the tympanic membrane is performed in the following
quadrant.......
X. What is meant under the term “Gradenigo’s symptom”?
1. acute otitis media, trigeminitis, abducens paralysis.
2. facialis, chronical otitis media without cholesteatoma.
3. sensoryneural hearing loss, facialis.
4. apex mastoiditis, acute otitis media, facialis.
ХІ. Situational task.
A 34 year old patient visited an otorhinolaryngologist with complaints on pain
in the right ear, with irradiation to the right temple and upper jaw teeth from the right
side, hearing loss, feeling fullness in the right ear, headaches, general weakness,
decreased appetite, fever up to 38,50 C. The patient was ill for 4 days, without
medical treatment. Palpation and percussion of kid and mastoid process is not
painful. The external ear canal was found otoscopically free, there were no secretions.
Hyperaemic eardrum was infiltrated, without cognitive contours and protrusion more
pronounced in posterior-superior quadrant. The right ear perceived whispering at a
distance of 2,5 m. What diagnosis is possible?
1. right side acute purulent otitis media, I stage
2. right side acute purulent otitis media, II stage
3. right side acute purulent otitis media, III stage
4. right side acute purulent otitis media, mastoiditis
17
Lesson 5
Topic: Chronic suppurative otitis media.
1. The actuality of a topic: Nowadays a high prevalence of chronic suppurative
otitis media, which belongs to severe ear diseases still remains actual. This
pathological process is one of the main reasons of human deafness and, in
addition, leads to appearance of such diseases as labyrinth, facial nerve paresis,
intracranial complications. Therefore, knowledge of etiology, pathogenesis,
pathological anatomy, clinical features, principles of chronic purulent otitis media
treatment and its potential complications is extremely important in the work of
wide range of specialists, i.e. - otorhinolaryngologists, neurologists, optometrists,
neurosurgeons, internists, pediatricians, infectious disease specialists.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to study etiology, pathogenesis, pathological anatomy,
clinical signs of two major forms of chronic purulent otitis media such as chronic
purulent otitis media without osteolisis and without cholesteatoma and chronic
purulent otitis media with osteolisis and with cholesteatoma. To learn how to
diagnose chronic purulent otitis media, make differential diagnosis and determine
a rational therapeutic approach. To be familiar with ear surgery.
4. The student is expected to learn:
- etiology, pathogenesis, pathological anatomy of chronic purulent otitis
media;
- classification and clinical features of major forms of chronic purulent otitis
media;
- differential diagnosis between chronic purulent otitis media without
osteolysis and without cholesteatoma and chronic purulent otitis media
with osteolysis and with cholesteatoma;
- occurrence mechanism and possible complications of cholesteatoma;
- principles of conservative treatment of major forms of chronic purulent
otitis media;
- principles and indications for surgical treatment of major forms of chronic
purulent otitis media.
5. The student should be able to:
- allocate symptoms (including patient’s complaints and illness history data)
that indicate the presence of chronic purulent otitis media;
- conduct otoscopic examination, evaluate condition of the middle ear eardrum, tympanic cavity, its pathological contents;
- perform hearing tests, access data from acumetry, audiometry and
vestybulometry;
- analyze data from radiographic tests of temporal bone, CT, MRI;
- make a plan of examination and chronic suppurative ear disease treatment –
both conservative and surgical;
- be able to wash and clean ears, put ear drops into middle ear cavity and
auditory tube, apply ear bandage.
6. Reference literature:
18
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 49-57.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 40-44.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 77-92, 113-119
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 80-104.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.51-53.
7. Control questions:
 Etiology and pathogenesis of chronic purulent otitis media (ChPOM).
 Classification of ChPOM.
 Clinical signs and diagnosis of major forms of ChPOM.
 Differential diagnosis between chronic purulent otitis media without
osteolysis and without cholesteatoma and chronic purulent otitis media
with osteolisis and with cholesteatoma.
 Cholesteatoma: appearance mechanisms, possible complications.
 Principles of conservative treatment of ChPOM.
 Indications and contraindications for tympanoplasty and its basic types.
 Principles of surgical treatment for patients with chronic purulent otitis
media with osteolysis and with cholesteatoma.
8. Example of tests questions:
I. In case of chronic otitis media without cholesteatoma perforation of the eardrum is located at:
1. pars tensa
2. pars flacida
3. pars tensa and pars flacida
4. there is no perforation
II. Reconstructive surgical treatment of conductive structures in case of chronic
otitis media is called........
III. Set correct sequences. Type of otitis media and localization of process in the
middle ear:
1. Chronic otitis media without cholesteatoma
а. all floors
2. Chronic otitis media with cholesteatoma
b mostly middle and inferior
floors
c. only inferior floor
IV. What is meant under the term “Cholesteatoma”?
19
1. epidermal structure, which develops in the middle ear cavities on a
background of the chronic destructive process
2. benign bone tumor of the middle ear with a capacity for destruction
3. nonpurulent skin disease of external auditory meatus witch can spread to
the middle ear cavity
V. What pathological elements of chronic middle otitis do you know?
1. hyperkeratosis, scarring, granulation
2. cholesteatoma, hyperkeratosis
3. polyps, granulation, cholesteatoma
4. cholesteatoma, caries, ulceration
VI. Set correct sequences. Type of otitis media and type of perforation:
1. Chronic otitis media without cholesteatoma
а. marginal
2. Chronic otitis media with cholesteatoma
b. central
VII. What is the purpose of tympanoplasty?
1. cleaning of the ear in case of chronic otitis and proof dry perforation
2. reconstruction of the external ear in case of chronic otitis
3. proceeding of conductive system of middle ear
VIII. What semicircular canal is more frequently affected in case of chronic otitis media?
1. labyrinth is never affected
2. anterior semicircular canal
3. posterior semicircular canal
4. lateral semicircular canal
IX. Set correct sequences. Type of otitis and type of hearing loss:
1. Acute diffuse external otitis
а. hearing is normal
2. Acute localized external otitis
b. conductive hearing loss
3. Localized labyrintitis
c. deafness
4. Diffuse purulent labyrintitis
d. sensoryneural hearing
loss
X. In case of one-side chronic otitis media without cholesteatoma test the
Vebera will be directed to:
1. healthy ear
2. affected ear
3. absent
ХІ. Situational task.
A 34 year old patient complained about purulent discharge, hearing loss, slight
pain in the right ear. Worsening is due to swimming in the open water reservoir. The
20
patient considers himself to be sick for 10 years. Periodically, regeneration of
purulent discharge from ears was observed, several times underwent the treatment
with a temporary effect. Palpation and percussion of pinna and mastoid process were
painless. Otoscopically: in the right external auditory meatus – there was purulent
discharge without any smell. After cleaning the external meatus the eardrum was
found to be hyperemic, swollen, in the rear quadrants there was marked an oval
perforation, which does not reach the drum ring (anulus tympanicus). The tympanic
cavity is filled with purulent content. VL AS/AD. 6/3m. Test Rine on the right ear is negative. The Weber test - lateralisation of sound to the right ear. What diagnosis is
possible?
1. right acute purulent otitis media
2. right chronic purulent otitis media with osteolysis and with
cholesteatoma, acute stage
3. right chronic purulent otitis media without osteoyisis and without cholesteatoma, acute stage
4. right acute purulent otitis media, mastoiditis
Lesson 6
Topic: Labyrinthitis. Otogenic intracranial complications.
1. The actuality of a topic: despite the significant reduction of intracranial
complications, pathology is still in the center of attention for otolaryngologists and
other medical specialtists (neurologists, neurosurgeons, infectious disease specialists,
ophthalmologists, anesthesiologists, etc.). According to different authors the number
of deaths in the result of intracranial complications ranges from 15% to 50%. So
each specialist to whiom a patient is referred to, especially a family doctor should, be
able to recognize beginning of the intracranial complications in time.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to study etiology, pathogenesis, pathological anatomy,
clinical signs, diagnosis, differential diagnosis and treatment principles of
different forms of labyrinthitis. To understand the possible ways of spreading of
infection from the middle ear cavity to the brain cavity. To study symptoms of the
intracranial complications, differential diagnosis and methods of examination in
different forms of the intracranial complications. To master the main methods of
treatment of otogenic intracranial complications.
4. The student is expected to learn:
- etiology and pathogenesis of labirynthitis;
- pathomorphological forms of labirynthitis;
- division of labirynthitis depending on the pathways of infection in the inner
ear;
- clinical forms of labirynthitis;
- differential diagnosis of cerebellar abscess and labirynthitis;
- basic methods of conservative and surgical treatment of various forms of
labirynthitis;
- etiology and pathogenesis of intracranial complications in case of the ear
disease;
21
- pathways and penetration stages of infection from the middle ear cavity to
the brain cavity;
- meningeal symptoms in case of otogenic meningitis;
- clinic and principles of otogenic meningitis treatment;
- pathogenesis, clinical signs of the brain and cerebellum otogenic abscesses;
- principles of the brain abscesses treatment;
- pathogenesis, clinical signs of sinus sigmoideus thrombosis;
5. The student should be able to:
- choose the symptoms of labirynthitis based on the complaints and anamnesis
data, to identify the causes of a disease;
- conduct differential diagnosis between labirynthitis and pathology of the
cerebellum;
- create a plan of treatment for patients with different forms of labirynthitis;
- diagnose otogenic intracranial complications;
- conduct differential diagnosis between different forms of intracranial
complications;
- analyze CT, MRI;
- create a plan of examination and treatment for patients with different forms of
intracranial complications;
- conduct otoscopy, examination of hearing using spoken language and tuning
fork, evaluate data from audiometry and tympanometry;
- to conduct examinations and assess vestibular function;
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 57-63.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.49-58.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 77-99, 129-138, 144-154.
4. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P. 53-55.
7. Control questions:
 etiology, pathogenesis and clinical signs of different forms of labirynthitis;
 division of labirynthitis depending on the pathways of infection to the
inner ear;
 pathomorphological forms of labirynthitis (serous, purulent, necrotic);
 clinical forms of labirynthitis: limited, acute diffuse serous labirynthitis,
acute diffuse purulent labirynthitis, necrotizing labirynthitis;
 differential diagnosis between labirynthitis and pathology of the
cerebellum;
 main methods of labirynthitis treatment;
 etiology of otogenic intracranial complications;
22
 pathways of infection from the middle ear cavity to the brain cavity;
 otogenic meningitis (clinical signs and principles of treatment);
 sinus sigmoideus thrombosis and otogenic sepsis (pathogenesis, clinical
signs);
 otogenic abscess of the brain hemispheres and cerebellum (clinical signs
and principles of treatment);
 Extra- and subdural abscess of the middle and posterior cranial fossa
(clinical signs and principles of treatment);
8. Tests examples:
I. What is labirinthitis?
1. nonpurulent complication of chronic otitis
2. inflammatory process of the internal ear
3. anomaly of development of the internal ear
II. What are the signs of general brain symptoms in case of otogenic intracranial
complication?
1. meningeal signs
2. hypertensive syndrome
3. dislocation syndrome
III. What signs are included to meningeal symptomocomplex?
1. meningeal signs and general blood changes
2. hypertensive syndrome and meningeal signs
3. meningeal signs and inflammatory changes in neurolymph
IV. What signs are not typical for symptoms of temporal brain abscess?
1. Sensory aphasia.
2. Adiadokhokinesis.
3. Letheral aphasia.
4. Ataxia.
V. What are the main symptoms of labyrinthitis?
1. earpain, sticking out of auricle, hearing loss, headache.
2. hearing loss, vertigo, spontaneous nystagmus, nausea and vomitting.
3. hearing loss, paropsis, headache, tinnitus, nystagmus.
4. neck muscles stiffness, hearing loss.
VI. What are the best methods of investigation in case of otogenic intracranial complications?
1. diaphanoscopia and contrast X-ray
2. CT and MRI
3. electroencephalography та electronistagmography
23
VII. Through what cerebral venous sinuses infection can be spread from the middle
ear?
1. sinus cavernosus.
2. sinus sigmoideus.
3. sinus sagitalis.
4. sinus petrosus.
VIII. Presence of nystagmus at chronic otitis can testify for:
1. mastoiditis
2. labyrinthitis, cerebellum abscess
3. subdural, epidural abscess
4. sinus sygmoideus thrombosis
IX. What changes in neurolymph can be found in case of meningitis?
1. increasing of sugar, proteins and chlorides level
2. increasing amounts of proteins and decreasing of leucocytes
3. increasing pressure, increasing amounts of proteins and leucocytes
X. In what type of otitis media complication appear more often?
1. chronical otitis media without cholesteatoma
2. chronical otitis media with cholesteatoma
3. equally often
ХІ. Situational task
A 39 year old patient was transported to the ENT department with complaints
about intense headache that increases on sound stimulus, pain in the right ear,
purulent discharge from the ear, nausea, vomiting. Body temperature was 39.5 C. Patient considers himself to be ill for 7 days. OBJECTIVE: the patient was lying on one
side with the head tilted backwards. Pulse rate was 94 beats per minute. The
neurological examination revealed a stiff neck, symptoms of Kerniha, Brudzynsky.
Otoscopically: thickened earrum , in the rear quadrants there was a visible crack-like
perforation, through which pus flows out. Whisper language it not perceived by the
right ear. In the blood test: white blood cells - 19 x 109/l, leukocyte formula deviated
to the left. Erythrocyte sedimentation rate - 38 mm / hr. What diagnosis can be suuggested?
1. acute purulent otitis media. Otogenic meningitis
2. acute purulent otitis media . Otogenic cerebellum abscesses
3. chronic purulent otitis media . Otogenic abscesses cerebellum
4. acute purulent otitis media . Sigmoid sinus thrombosis
Lesson 7
Topic:
Nonpurulent chronical ear diseases.
1. The actuality of a topic: A large group of nonpurulent diseases of the middle and
inner ear is the most common cause of progressive hearing loss in adults and in
children. Various negative factors can cause these pathological processes, e.g.
24
iatrogenic (unreasonable prescription of ototoxical drugs), vascular (ischemia,
stroke), traumatic, metabolic disorders, decreased reactivity of an organism, etc.
Proper treatment and prevention of such diseases is impossible without profound
knowledge of etiology, pathogenesis and clinical signs.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to study etiology, pathogenesis, clinical signs, differential
diagnosis of the middle otitis with efusion, sensoryneural hearing loss, otosclerosis,
Meniere's disease. To learn main principles of rational treatment and prevention of
nonpurulent ear disease.
4. The student is expected to learn:
- etiology, pathogenesis of the middle otitis with efusion, sensoryneural
hearing loss, otosclerosis, Meniere's disease;
- clinical signs and differential diagnosis of nonpurulent ear diseases;
- first aid during the attack of Meniere's disease;
- ways of otosclerosis treatment;
- methods of sensoryneural hearing loss treatment.
5. The student should be able to:
- choose the symptoms of the middle otitis with efusion, sensoryneural
hearing loss, otosclerosis, Meniere's disease based on the complaints and
anamnesis;
- conduct otoscopic examination, to perform hearing investigations by
speaking and tuning fork test, to assess data from audiometry and
vestibulometry;
- perform vestibular investigations, to assess data from vestibulometry;
- analyze data from radiographic investigations of temporal bone, CT, MRI;
- create a plan of examination for patients with middle otits with efusion,
sensoryneural hearing loss, otosclerosis, Meniere's disease;
- give first aid to the patient during an attack of Meniere disease;
- create a plan of treatment for patients with middle otits with efusion,
sensoryneural hearing loss, otosclerosis, Meniere's disease;
- be able to perform pneumatic massage of eardrum, blow of the Eustachian
tube by Politzer method, be familiar with the technique of the Eustachian
tube catheterisation.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 63-72.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.39-40,
45-47
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 77-92, 93-99, 129-138,
144-153.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 88-101.
25
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.33-43, 49-51.
7. Control questions:
 etiology, pathogenesis and clinical signs of patients with the middle otitis with
efusion.
 ways of treatment of the middle otits with efusion, prophylaxis.
 etiology, pathogenesis and clinical signs of sensoryneural hearing loss.
 diagnostic investigations of sensoryneural hearing loss.
 methods of treatment and of prophylaxis of sensoryneural hearing loss. Hearing aids.
 atelectasis otitis media, retraction pockets.
 clinical signs, diagnostic investigations and ways of otosclerosis treatment.
 etiology, pathogenesis and clinical signs of Meniere's disease.
 first aid to the patient during the attack of Meniere disease, methods of its
treatment.
 prophylaxis of fibrosious forms of chronic otitis media (adhesive otitis).
8. Tests examples:
I. Underline middle otitis with efusion?
1. violation of the Eustahian tube
2. inflamation of ea drum
3. inflammation of the external auditory meatus
IІ. Otoscopic view in case of the middle otitis with efusion will show?
1. eardrum hyperemic
2. marginal perforation of eardrum
3. central perforation of eardrum
4. eardrum is sharply drawn, cloudy
IІІ. Hearing loss in case of postinfluenza damage of soundperception system is
caused by:
1. toxicity of the virus to the nerve cells, development of
labyrinth edema, disturbance of the inner ear microcirculation
2. deficiency of blood supply at the level of spinal artery,
development of labyrinth edema, disturbance of the inner ear
microcirculation
3. selective accumulation of influenza viruses in the inner ear
ІV. What investigation is necessary to conduct for diagnostics of sensoryneural
hearing loss?
1. Tympanometry
2. pure tone audiometry
3. X-ray
4. CT scanning
26
V. What is the most typical symptoms of sensoryneural hearing loss?
1. ear pain
2. feeling of fullness in the ear
3. subjective tinnitus
4. nausea
5. vomiting
VІ. What histological changes can happen in case of otosclerosis?
1. replacement of dense bone capsule on labyrinth on more
denser
2. replacement of dense bone capsule on labyrinth on fragile
3. replacement of dense bone capsule on labyrinth on the sponge
VІІ. What is the nature of tonal audiometry in case of otosclerosis?
1. absence of air-bone interval
2. presence of air-bone interval
3. normal air-bone difference
VІІІ. What signs are not typical for Meniere's disease?
1. attacks of vertigo
2. normal hearing
3. loss of balance
4. cold sweat, nausea, vomiting
5. hearing loss
ІХ. Name the test used for detecting edema of endolymphatic sac ……
Х. What are the methods of treatment of Meniere's disease?
1. symptomatic and physiotherapy
2. conservative and surgical
3. chemotherapy and radiation
ХІ. Situational task.
A 30 year old patient complains about hearing loss and tinnitus in left ear. He
considers himself to be sick for 10 days. Symptoms appeared after acute respiratory
infections. OBJECTIVE: the external auditory meatus is free, there is no discharge.
Eardrum is pearl-gray, movable, clear informative contours. VL AS- 1m, AD-6m.
Rine test - positive. Vebera test – laterality of sound to the right ear. In pure tone
audiometry: air-bone interval is missing, but curves are descending nature with
increased thresholds of air and bone conduction on 30-40 dB, mainly at high
frequencies. What diagnosis is possible?
1. secretory otitis
2. otosclerosis
3. acute sensoryneural hearing loss
4. Meniere's disease
27
Lesson 8
Topic:
Acute and chronical diseases of the nose.
1. The actuality of a topic: Nose diseases are the most common pathology of the
upper respiratory tract. Taking into account importance of the nose functions and its
relationship with other organs and systems it is understandable why these
pathological processes can affect the whole human body. The number of allergic
respiratory diseases is increasing every day, including allergic rhinitis. Knowledge of
etiology, pathogenesis, clinical diagnostics of thenose allows to establish a diagnosis
correctly, prescribe a proper treatment, prevent the development of various
complications in other organs and body systems.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to learn how to diagnose nose furuncle, acute and chronic
rhinitis, allergic rhinitis, nasal septum deviation, to conduct differential diagnosis
of various forms of nasal lesions and determine a rational therapeutic tactics.
4. The student is expected to learn:
- etiology, pathogenesis and clinical signs of nose furuncle, mechanism of
complications development, medical tactics;
- etiology, pathogenesis and clinical signs of acute rhinitis, prophylaxis of
complications;
- types of nasal septum deviation, principles of surgical correction;
- modern classification of chronic rhinitis;
- etiology, pathogenesis and clinical signs of different forms of chronic rhinitis,
and ways of their treatment;
- etiology, pathogenesis and clinical signs of allergic rhinitis, methods of
treatment;
- methods of optical endoscopy for diagnosis and treatment of nose and paranasal
sinuses diseases.
5. The student should be able to:
- distinguish complaints and anaemnesis data, select the symptoms typical for
nasal septum deviation, nasal furuncle, acute and chronic rhinitis;
- conduct the front and rear rhonoscopy and give a clinical assessment of the
results;
- perform an examination of the nasal respiratory and olfactory functions;
- assess X-ray, CT, MRI data of patients with rhinologic pathology;
- perform lavage of the nasal cavity, putting serviettes to the nasal cavity,
conduct anemization of the nasal mucosa.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 82-103.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.95-109
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 186-213, 222-247.
28
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 105-136.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.90-107.
7. Control questions:
 etiology, pathogenesis and clinical signs of nose furuncle, treatment;
 acute rhinitis, etiology, pathogenesis and clinical signs, principles of treatment;
 classification of chronic rhinitis;
 etiology of chronic rhinitis;
 clinical signs, diagnosis, differential diagnosis, treatment of chronic catarrhal
rhinitis;
 clinical signs, diagnosis, differential diagnosis, treatment of chronic hypertrophic rhinitis;
 clinical signs, diagnosis, differential diagnosis, treatment of chronic atrophic
rhinitis;
 etiology, pathogenesis of allergic rhinitis, classification;
 principles of treatment of allergic rhinitis;
 nasal septum deviation, principles of surgical correction;
 prevalence, etiology, pathogenesis, clinical signs of Ozena;
 treatments of Ozena;
 methods of videoendoscopic examination in rhinology.
8. Tests examples:
I.
What are the main symptoms of nasal septum deviation?
1 - olfactory disorders
2 - disorders of nose breathing
3 - sneezing
4 – nose discharge
II.
cal:
For the third stage of acute rhinitis the following characteristics are typi1.
- producing a clear watery discharge from the nose, easy congestion of
the nasal airway, headache, hyposmia. Duration - 2-3 days.
2. - easy indisposition, can be marked: a subfebril fever, dryness, itching
in the nose, sneezing, moderate pain in pharynx, headache. Duration a few hours till 24 hours.
3. - at this stage the amount of nasal discharge is decreased, it changes
into mucus and in case of joining bacterial superinfection – purulent.
Duration 2-3 days.
III.
In case of chronic hypertrophic rhinitis correct surgical treatment (turbinoplasty) consists of
1. - complete removal of the lower turbinate
2. - only one side complete removal of the lower turbinate.
29
3. - submucosal resection of the lower turbinate
IV.
In case of diffuse nose bleeding the following methods are used:
1. - anterior and posterior tamponades
2. - cauterization of nose mucus by nitro-acidic silver solutions, by
trichloroacetic or chromic acid, electrocoagulation
3. - electrocoagulation
V.
Set correct sequences. Types of chronic rhinitis
1. catarrhal
а. conservative
2. hypertrophic
b. surgical
3. atrophic
c. half surgical
4. vasomotor
Types of treatment
VI.
What surgical interferences are used for the treatment of nasal septum
deviation?
1 - ethmoidotomy
2 - conhothomy
3 - coagulation of lower nasal turbinate
4 - septoplasty
VII.
Why in case of acute rhinitis the meal is often tasteless?
1 - due to the edema of the mucous membranes lining the nasal cavity
and blockade of olfactory crack.
2 - due to acute atrophy of olfactory nerve.
3 - due to the development such complication as inflammation or
atrophy of tongue papillae
VIII.
What is nose furuncle?
1. - it is an inflammation of hair sacs, located in the middle meatus
2. - it is a local affecting the mucous membranes lining the nasal
3. - it is an inflammation of hair sacs, located in the area of nose vestibulum or on his external surface
IX.
What is rhinolith?
1.
incrassated and stritified mucous membranes lining the nasal cavity
as a result of laying of mineral salts which are contained in the secret
of mucus and lachrymal glands
2.
old bloody clot
3.
nasal stone, which arises up at laying of mineral salts which are
contained in the secret of mucus and lachrymal glands around an
extraneous body
4.
cicatrical changes of mucus after operative treatment
X.
Variety of allergic rhinstis, which is observed in the period of flowering
30
of cereals, herbares, trees, is called......
ХІ. Situational task.
A 57 year old patient entered ENT department with complaints on pain, redness,
edema in nose tip, general weakness, fever up to 380 C. He considers himself to be
sick for 3 days. From the life story it is known that he has diabetes. During the
examination it was revealed: that nose tip tissue is congested, swollen, sharply
painful on palpation. Front rhinoscopy: local swelling with area of necrosis in the
center in the left vestibulum. What diagnosis will you suggest?
1. Erysipelas of the nose
2. Ozena
3. Rhinoskleroma
4. Furuncle of the nose
5. Rhinofima
Lesson 9
Topic:
Acute and chronic sinusitis. Rhinogenic orbital and intracranial complications
1. The actuality of a topic: Currently there is a rapid growth of the incidents of acute
and chronic rhinosinusitis. Inflammatory processes of paranasal sinuses often result
in the development of chronic bronchitis, bronchial asthma, pneumonia. Sinusitis can
cause serious orbital and intracranial complications that could threaten human life.
Therefore, knowledge of clinical signs, principles of diagnosis and treatment of these
diseases is necessary in clinical practice for physicians of different profiles, i.e. - otorhinolaryngologists, neurosurgeons, neurologists, ophthalmologists, infectious
disease specialists, surgeons, family doctors, etc.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to learn how to diagnose acute and chronic forms of
rhinosinusitis, exercise rhinogenous orbital and intracranial complications, make
differential diagnosis and determine rational treatment tactics.
4. The student is expected to learn:
- etiology, pathogenesis, clinical signs and differential diagnosis of acute and
chronic rhinosinusitis;
- clinical classification of rhinosinusitis;
- characteristics of acute rhinosinusitis in children;
- anatomical preconditions for development of orbital and intracranial
complications;
- etiology, pathogenesis, clinical signs and differential diagnosis of orbital
and intracranial complications;
- principles of treatment of acute and chronic rhinosinusitis, orbital and
intracranial complications;
- types of surgical interventions on paranasal sinuses;
- principles of optical endoscopy for diagnosis and treatment of paranasal
sinuses diseases.
31
5. The student should be able to
- distinguish complaints and anamnesis data, select the symptoms typical for
acute and chronic rhinosinusitis, rhinogenous orbital and intracranial
complications;
- conduct an external inspection, palpation, percussion of paranasal sinuses
projection areas, conduct front and back rhinoscopy, give a clinical
assessment of the results;
- assess X-ray, CT, MRI data of patients with pathology of paranasal
sinuses;
- assess data of blood and cerebrospinal fluid examinations cytological and
bacteriological content of the of paranasal sinuses;
- create a plan of treatment of patients with acute and chronic rhinosinusitis,
and with orbital and intracranial rhinogenous complications;
- perform lavage of the nasal cavity, conduct anemization of nasal mucosa,
local anesthesia for maxilary sinus puncture.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 103-116.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.111117.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 186-213.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 136-150
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.107-110, 121-122
7. Control questions:
 etiology, pathogenesis of acute sinusitis.
 primary, secondary sinusitis.
 clinical signs, diagnosis, differential diagnosis, principles of treatment of acute
sinusitis.
 puncture of the maxillary sinus, technique, complications.
 peculiarities of odontogenic maxillary sinusitis.
 clinical signs, diagnosis, differential diagnosis, principles of treatment of
chronic sinusitis (conservative, types of surgical interventions)
 classification of chronic sinusitis
 principles of functional videoendoscopic surgery for acute and chronic
sinusitis.
 pathways of infection from paranasal sinuses into the skull cavity and orbit.
 clinical signs, differential diagnosis, principles of treatment of rhinogenous
orbital complications: reactive edema of the orbit and eyelids, orbital abscess,
32
orbital osteoperyostitis, subperiosteal abscess and retrobulbar, orbital
phlegmon.
 clinical signs, differential diagnosis, principles of treatment of rhinogenous
orbital complications, i.e. arachnoiditis, purulent meningitis, sepsis, thrombosis
of the cavernous and upper sagittal sinus, frontal lobe brain abscess.
8. Tests examples:
I. The presence of purulent nasal discharge in the middle nasal pathway indicates
on the inflammatory process in the following sinuses?
1. maxillary, anterior cells of ethmoidal labyrinth, frontal
2. posterior cells of ethmoidal labyrinth, maxillary, frontal
3. anterior cells of ethmoidal labyrinth, maxillary, frontal,
sphenoid
4. maxillary, frontal
IІ. What is the most frequent pathway of infection to paranasal sinus?
1. sinus trauma
2. rhinogenous, odontogenic
3. hematogenous
IІІ. The most typical complaints in case of acute sphenoidytis are …..
1. dizziness, feeling of pressure in the occipital area and behind
the eyeball, periodic difficulties with nasal breathing
2. anosmiya, accumulation of crusts on the back throat wall,
cough
3. feeling of pressure behind the eyeball, accumulation of crusts
on the back throat wall, difficulties with nasal breathing
ІV. The most typical complaints in the of acute inflammation of ethmoidal cells
are..
1. pain in the forehead, which increases with physical exercise,
bending the head forward, tearing, photophobia, discharge from
the nose
2. pain in the root of the nose, the inner edge of an orbit, difficulty
of nasal breathing, itchy nose and sneezing attacks.
3. pain in the root of the nose, the inner edge of an orbit, difficulty
of nasal breathing, nasal discharge, a possible violation of
olfaction
V. In case of maxillary sinus needle puncture Kulikovsky needle is introduced
through the following nasal passage?
1. superior
2. middle
3. inferior
VІ. Name the signs of cavernous sinus thrombosis
33
1. common symptoms of sepsis, swelling of eyelids, two-sided
exophthalmos, lesions of III, IV, V, VI cranial nerves, limited
mobility of eyeballs
2. common symptoms of sepsis, lesions of I cranial nerves.
3. high body temperature, chills, facial nerve paresis, unilateral
exophthalmos
VІІ. What are the local signs of orbital phlegmon?
1. exophthalmos, lack of eyeball movement, pain while pressing the
eyeball
2. pain while pressing orbital bone edges, exophthalmos
3. exophthalmos, limitation of eyeball mobility, diplopia, anizokoria
VІІІ. What are the local symptoms of brain abscess of the frontal lobe?
1. euphoria, negligence, motor aphasia, ahrafiya, diplopia
2. sensory aphasia, euphoria, negligence, ahrafiya
3. euphoria, negligence, motor aphasia, ahrafiya
ІХ. In case of rhinogenous arachnoiditis in cerebrospinal fluid is observed
1. increased level of glucose
2. moderate pleotcytosis
3. increased level of protein
Х. Treatment principles of rhinogenous cavernous sinus thrombophlebitis are the
following
1. surgical sanitation of infection foci, antibiotics, anticoagulants
2. central holinolitycs, surgical sanitation of infection foci,
antibiotics
3. intramuscular antibiotics, intravenous antibiotics, anticoagulants
ХІ. Situational task..
A 18 year old patient turned to otorhinolaryngologist with complaints about
headaches in frontal area, aggravated by bending head forward, and physical stress,
disturbance of nasal breathing, purulent discharge from the nose. The patient had
been suffering for nearly one week. OBJECTIVE: during palpation and percussion in
frontal area tenderness mostly on the right side is marked. Nasal mucosa is hyperemic
and swollen. Nasal passages are narrowed. Purulent discharge in right middle nasal
pathway is observed. What is a preliminary diagnosis?
1. acute rhinitis II stage
2. trigeminal neuralgia
3. acute purulent frontitis
4. acute purulent maxillary sinusitis
Lesson 10
Topic: Acute and chronic pharyngeal diseases.
34
1. The actuality of a topic: disease of the pharynx is a common pathology among
children and young population, which makes this pathology of social significance. Lymphadenoid pharyngeal ring is of great importance in the formation of
local and systemic immunity. However, the pathological process in tonsils can
cause lesions of the heart, kidneys, upper air passage ways, connective tissue,
nervous system and other organs. On the other hand, the pathology of internal
organs could negatively influence on the state of the pharynx. Therefore, etiology,
pathogenesis, clinical pathology and methods of investigation should be clear for
doctors of any specialty.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to learn how to diagnose acute and chronic throat pathology,
local and long-term complications, carry out differential diagnosis with throat
lesions of infectious diseases (diphtheria, infectious mononucleosis, etc.), administer adequate therapy.
4. The student is expected to learn:
- classification, clinical signs of acute tonsillitis;
- differential diagnosis of primary and secondary tonsillitis;
- etiology, pathogenesis, classification, clinical signs of pharyngeal
diphtheria;
- etiology, pathogenesis, classification, clinical signs of and principles of
treatment of peritonsillar abscesses;
- etiology, pathogenesis, clinical signs of retropharyngeal abscess, medical
tactics;
- principles of rational antibiotic therapy of acute throat diseases;
- clinical and laboratory characteristics of chronic tonsillitis;
- classification of chronic tonsillitis by Soldatov;
- principles of conservative and surgical treatment of chronic tonsillitis;
- prophylaxis of chronic tonsillitis;
- etiology, pathogenesis, clinical signs of hypertrophy lymphadenoid
pharyngeal ring, the principles of treatment;
5. The student should be able to
- distinguish, complaints and anamnesis data, select the typical symptoms for
pharyngeal pathology;
- conduct palpation of regional lymph nodes, evaluate the results;
- conduct oropharyngoscopy, front and back rhinoscopy (epipharyngoscopy),
evaluate received endoscopic data;
- be familiar with palmar nasopharyngeal examination in children and adults;
- take smears from the nasal cavity and oropharynx for biological research
(diphtheria);
- conduct lubrication, irrigation of pharyngeal mucosa, lavage of tonsils
lacunas;
- create a plan of examination of patients with throat pathology;
- administer a rational therapy for patient;
6. Reference literature:
35
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 126-161.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.177185.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 295-320, 355-362.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 161-205.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P. 183-191, 198-204, 213-225.
7. Control questions:
 etiology, pathogenesis, classification, clinical picture and treatment
principles of acute and chronic pharyngitis;
 Soldatov’s classification of chronic tonsillitis;
 etiology, clinical picture, diagnosis, differential diagnosis leptotrichosis;
 etiology, pathogenesis, clinical picture, classification, diagnosis of acute
primary tonsillitis;
 etiology, pathogenesis, clinical picture, classification, diagnosis of acute
secondary tonsillitis;
 differential diagnosis of various forms of tonsillitis;
 principles of therapy of acute tonsillitis;
 etiology, pathogenesis, classification, clinical picture of complications after
acute tonsillitis, prevention and methods of treatment;
 etiology, pathogenesis, classification, clinical picture of chronic tonsillitis;
 diagnosis and principles of treatment of chronic tonsillitis (conservative,
surgical);
 prophylaxis of chronic tonsillitis;
 etiology, pathogenesis, classification, and clinical picture, principles of
treatment of adenoiditis, indications to surgical treatment;
 etiology, pathogenesis, clinical picture of tonsil hypertrophy, principles of
diagnostics and therapy;
8. Tests examples:
I. Pharyngitis is:
1.
- inflammation of the oral and nasopharyngeal mucosa
2.
- inflammation of the pharyngeal tonsil
3.
- inflammation of palatine tonsils
II. Symptoms of acute tonsillitis:
1.
- diffuse sore throat and painful “empty” swallowing
2.
- sharp painful “ filled ” swallowing
3.
- sharp pain in the throat, increasing while opening the mouth
36
III. For retropharyngeal abscess is typical:
1.
The tonsils are red, enlarged and covered with an exudates or studded
with white follicles.
2.
The tonsils are red, enlarged and covered with an thick, gray-green,
plaque-like membranous exudates which flows out outside from tonsil on
the uvula and soft palate, and firmly connected with tonsils fabric so, that
at the attempt of it removal will lead to bleeding and the erosive surface
appears
3.
Tonsil is covered by a pseudomembrane (formed by the necrosis of the
superficial layer of the mucous membrane and the tonsil). Removal of the
pseudomembrane reveals ulceration
4.
Swollen erythematous mucosa of the oropharynx and hypopharynx, often
with edema of the uvula and soft palate. The tonsils are red and enlarged
5.
Unilateral erythema and swelling of the anterior tonsillar pillar and soft
palate with deviation of the uvula to the opposite side.
6.
Erythema and edema of the oropharynx, bulging of the posterior pharyngeal wall.
IV. For which infection is typical: primarily affects young adults, who present with
non-specific malaise, fatigue, and low-grade fever, they commonly complain of sore
throat and tender cervical adenopathy, diffuse erythema of the oropharynx and tonsils
often mimicking bacterial tonsillitis, the tonsils may appear almost necrotic, diffuse
cervical adenopathy is present bilaterally, hepatosplenomegaly, CBC and mono spot
are useful in diagnosis:
1.
- purulent acute tonsillitis
2.
- pharyngeal diphtheria
3.
- Vincent's angina
4.
- infectional mononucleosis
V. Acute tonsillitis is caused by:
1.
- fusiform bacillus and spirochete
2.
- beta hemolytic streptococcus
3.
- Leptrotrix Buccalis
4.
- Epstein-Barr virus
5.
- corynebacterium diphtheria
VI.
Latent period of diphtheria takes ...... days.
VII. Acute infection which is characterized by a rapid onset of the throat pain simultaneously with pain on swallowing associated with fever, tonsils are red, enlarged
and covered with an exudates or studded with white follicles is called .......
VIII. Hypertrophy of palatal tonsils is more frequently observed at the age of:
1 - 2-3 years
2 - 7-10 years
37
3 - 14-16 years
IX. Increasing pharyngeal pain, often unilateral with radiation to the ear on the affected side, and increasing disphagia with eventual difficulty in handling secretions
and opening the mouth. Unilateral erythema and swelling of the anterior tonsillar pillar and soft palate with deviation of the uvula to the opposite side is called......
X.
Treatment of peritonsillar abscess
1.
surgical (needle aspiration or incision and drainage of the peritonsillar
space)
2.
conservative (widespread antibiotics, anti-inflammatory treatment)
3.
at the beginning it is conservative, if it fails - surgical
ХІ. Situational task.
An 18 years old patient enrolled in the infectious department with complaints of a
sore throat, general weakness, fever up to 38.50C, difficulty in opening of the mouth.
The patient considers himself to be sick during 5 days. Patient was treated of lacunar
angina. A temporary improvement was observed. After four days the patient experienced the change for the worse in the throat, body temperature increased once again,
the opening of the mouth became difficult. OBJECTIVE: opening of the mouth is
incomplete, palatine tonsils are loose, covered by fibrinous films, which are easily
removable and do not go beyond the tonsils. There is visible protrusion of the right
half of soft palate and swelling of right front palatal arch, uvula is bulging and
displaced to the opposite direction. Give the preliminary diagnosis.
1. pharyngeal diphtheria
2. pharyngeal tumor
3. leptotrichosis
4. peritonsillar abscess
5. retropharyngeal abscess
Lesson 11
Topic: Acute and chronic laryngeal diseases.
1. The actuality of a topic: all pathological processes of the larynx are very
dangerous for the development of airway obstruction that may cause an asphyxia.
Syndromes of this region lesions are very diverse and often are faced by doctors
of different specialties (internists, pediatricians, infectiologists, allergists,
gastroenterologists, endocrinologists, neurologists, etc.). Profound knowledge of
etiology, pathogenesis and clinical signs of laryngeal pathology will help to avoid
diagnostic and therapeutic errors in medical practice.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: to learn how to diagnose acute and chronic laryngeal
lesions (acute laryngitis, epiglotitis, phlegmonic laryngitis, laryngeal edema,
laryngeal stenosis, chondroperihondrytis, laryngeal diphtheria, chronic laryngitis),
conduct differential diagnosis of laryngeal pathology, provide emergency aid for
acute laryngeal stenosis, administer rational therapy in case of laryngeal diseases.
38
4. The student is expected to learn:
- etiology, pathogenesis, classification of laryngeal edema;
- emergency aid for laryngeal edema;
- classification and stages of laryngeal stenosis;
- treatment methods of acute and chronic laryngitis;
- classification of laryngeal stenosis, stages of laryngeal stenosis;
- classification of laryngeal stenosis, laryngeal stenosis stage acute stenosing
laryngotracheitis (ASLT) in children;
- ways of treatment of ASLT;
- ways of conducting differential diagnosis of laryngeal diphtheria and ASLT;
- indications for laryngeal intubation, tracheostomy and conochotomy techniques.
5. The student should be able to
- establish a preliminary diagnosis of laryngeal lesions on the basis of
complaints and objective examination of a patient;
- make a plan of additional examinations of a patient and to administer a rational
therapy;
- perform laryngeal examinations: external inspection, palpation of the laryngeal
area and regional lymph nodes, indirect laryngoscopy;
- conduct differential diagnosis of laryngeal lesions
- care for tracheostoma and tracheostoma cannula;
- give an urgent care for acute laryngeal stenosis.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 172-204.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.185202, 204
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 321-354.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 206-233.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.247-258, 323-327.
7. Control questions:
 Etiology, pathogenesis, clinical signs of acute laryngitis, treatment.
 Etiology, main pathogenetic factors that cause respiratory tract stenosis in
children in case of ASLT.
 Methods of treatment, urgent care at ASLT.
 Differential diagnosis of ASLT and diphtheria.
 Etiology, clinical signs, treatment of epiglotitis and phlegmonous laryngitis.
 Etiology, clinical signs, treatment of laryngeal diphtheria.
39








Laryngeal edema, etiology, urgent care.
Etiology for acute and chronic laryngeal stenosis.
Classification, clinical signs, stages, treatment of laryngeal stenosis.
Types of tracheostomy, indications, complications.
Structure of tracheostomical cannula, care for her and tracheostoma.
Classification and clinical signs of chronic laryngitis.
Hyperplastic laryngitis, principles of laryngeal microsurgery.
Etiology, pathogenesis, clinical signs of laryngeal сhondroperiсhondrytis,
treatment.
 Techniques and indications for conicotomy.
 Disorders of innervation of internal laryngeal muscles, etiology.
8. Tests examples:
I.
In case of acute laryngotracheitis edema will be present mostly in:
1. - subglottis
2. - glottis
3. - supraglottis
II. Dysphonia is:
1. - violation of swallowing
2. - complete absence of voice
3. - violation of cleanness, force and timbre of voice
4. - violation of breathing
III. Conicotomy is:
1. - transverse cutting of all neck layers between the lower edge of cricoid
cartilage and overhead edge of the first tracheal ring
2. - transverse cutting of all neck layers on the level of hypothyroid ligament
3. - transverse cutting of all neck layers on the level of crycothyroid ligament
IV. In case of middle tracheotomy thyroid gland is moved:
1. - up
2. - down
3. - nowhere
V.
Laryngoscopic view in case of acute laryngotracheitis:
1. - narrowing of subglottic space by
2. - hyperemia and infiltration of vocal cords
3. - hyperemia and infiltration of laryngeal ventricles
VI.
Set correct sequence. Ethiologic forms of croup.
a - pseudo 1. diphtheria.
2. subglottic laryngitis
b - real
3. pathology of cardiovascular system.
40
VII. Laryngoscopyc view in case of chronic catarrhal laryngitis?
1. - hyperemia and diffuse bulge of laryngeal mucus
2. - hyperemia and hyperplasia of laryngeal mucus
3. - pseudo tumors on vocal folds
VIII. Set correct sequences. Stages of laryngeal stenosis:
methods of treatment:
a - compensation
1. conservative
b - subcompensation
2. conicotomy
c - decompensation
3. laryngeal intubation
d - terminal
4. tracheotomy
IX. The main etiological factors for development of laryngeal chondroperichondritis:
1. - traumas, laryngeal foreign bodies, high intubation, malignant tumours, acute
infections, tuberculosis, syphilis, radial therapy
2. - typical acute tonsillitis, laryngeal scleroma, chronic pneumonias, kidney
insufficiency
3. - bronchial tubes and gullet foreign bodies, stagnant phenomena in larynx at
respiratory and cardiac insufficiency.
X.
What are typical symptoms for phlegmonous laryngitis?
1. - pain during swallowing, aphonia, high temperature, without a chill
2. - difficult general condition, high temperature, moderate pain during
swallowing, hoarseness, laboured exhalation
3. - difficult general condition, high temperature, often with a chill, severe pain
during swallowing, hoarseness, difficulty of breathing and change of
gemogram
ХІ. Situational task.
A 42 year old patient complains on feeling of dryness and tickling in the throat,
hoarseness and fast voice tiredness, rough "barking" cough. The patient has been
suffering for two days, due to hypothermia. During indirect laryngoscopy it was
found that the laryngeal mucosa is hyperemic and swollen, vocal folds are pink,
thickened, movable during phonation. In the lumen of the larynx viscous secret is
available. What preliminary diagnosis can be made?
1. laryngeal edema
2. phlegmonic laryngitis
3. laryngeal angina
4. acute catarrhal laryngitis
5. acute hyperplastic laryngitis
Lesson 12
Topic: Trauma, foreign bodies and hemorrhages of ENT, urgent care. respiratory
tract and esophagus.
41
1. The actuality of a topic: Traumas, foreign bodies, bleeding from the upper
respiratory tract are very dangerous for human life. Rendering an immediate
professional aid in such cases should be done by physician of any specialty:
otorhinolaryngologists,
surgeons,
family
doctors,
anesthesiologists,
reanimatologist, traumatologists, dentists. Therefore, knowledge of etiology,
pathogenesis, clinical signs of emergency conditions in otolaryngology is
necessary for the correct evaluation of the clinical situation in order to provide
adequate medical care.
2. Lesson duration – 3 academic hours.
3. Purpose of a lesson: To learn how to diagnose and provide first aid for traumas,
foreign bodies of the upper respiratory tract and bleeding as a result. To
determine a rational therapeutic approach.
4. The student is expecte to learn:
- etiology, pathogenesis and clinical signs of the nose and paranasal sinuses
traumatic injuries, first aid.
- foreign body in the nasal cavity and rhinolith, medical management
- etiology, pathogenesis and clinical signs of nosebleeding. Principles of first
aid, treatment and prevention;
- traumatic injuries of the ear, foreign body in external auditory meatus:
symptoms, diagnosis, treatment;
- trauma of the pharynx, laryngeal and medical management;
- foreign body of the pharynx and larynx, trachea and bronchi: etiology, clinical
signs, diagnostic, urgent care;
- foreign body and burns in esophagus, principles of emergency care.
5. The student should be able to:
- distinguish complaints and anamnesis data, select the symptoms typical for
traumas, foreign body, bleeding from the upper respiratory tract;
- conduct an examination of the nasal cavity, throat, larynx and external
auditory meatus and detect signs specific to foreign bodies;
- diagnose injuries of the upper respiratory tract and provide the necessary
assistance to a patient;
- assess x-ray data picture, computed tomography and magnetic resonance
imaging;
- foreign body removal from the external auditory meatus, nose and pharynx;
- provide first aid to patients with bleeding from the upper respiratory tract;
- be familiar with the techniques of the anterior and posterior nasal
tamponade, reposition of the nasal bones;
- give first aid in case of the eardrum trauma, middle and inner ear
concussion.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 34-40, 82-85, 90-93, 126-131172-177, 201-204, 224-231.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
42
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P.22, 26,
29-30, 45, 47-48, 95-96, 105, 119-122, 195-202.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 120-123, 126-128, 139143, 212-221, 413-431.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 58-60, 79, 112-122, 151-153, 226-232.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.66-74, 231-232, 270-272, 320-322, 362-367, 455-471, 510518.
7. Control questions:
 Methods of primary surgical wounds treatment.
 Prevention of tetanus.
 Classification and clinical signs of nasal bones fracture.
 Diagnostic tactics in case of nasal bones fractures.
 Diagnosis and treatment of nasal septum hematoma.
 Combined trauma of the nose, paranasal sinuses, face and related spaces.
Principles of medical tactics.
 Injuries of pharynx, treatment tactics.
 Traumas of larynx and trachea, clinical signs, treatment.
 Esophageal burns, tactics for patients with chemical burns of esophagus.
 Traumatic rupture of the tympanic membrane, treatment tactics.
 Othematoma, etiology, treatment principles.
 Etiology of nasal bleeding, principles of first aid.
 Local methods of nasal bleeding arrest.
 Differential diagnosis of throat bleeding.
 Methods of foreign bodies removal from the external auditory meatus;
 Principles of foreign bodies removal from the nasal cavity;
 Clinical signs, diagnosis of the larynx, trachea, bronchi and esophagus
foreign bodies, methods of removal;
 Preparing of the patient for bronchoscopy, esophagoscopy;
 Burns and freezing of the external ear and nose, first aid.
8. Example of tests questions:
I. Indicate correct position for a patient in case of nosebleeding
1. semisitting, head is sloping back
2. semisitting, head is sloping forward
3. lying, head is sloping back
IІ. Name local reasons of the nasal bleeding:
1. acute and chronic sinusitis, tumors of paranasal sinuses,
atherosclerosis
2. tumors of the nose, frontal dry rhinitis, atrophic rhinitis
3. hypertension, atherosclerosis, blood diseases
43
ІІI. Damage caused to the tympanic membrane can be ……..
1. direct and indirect
2. sharp and blunt
3. diffuse and limited
ІV. Foreign body of the external auditory meatus can be …….
1. freely laid down
2. firmly fixed, swelling
3. freely laid, firmly fixed, swelling, alive
4. cartilage, bone, swelling
V. In case of longitudinal temporal bone fracture the following situation is
observed:
1. perforation of the tympanic membrane through which the
blood and cerebrospinal fluid is released, the function of cochlear and vestibular
apparatus is disturbed slightly
2. complete loss of the cochlear function and vestibular
apparatus, paralysis of a facial nerve
VІ. Nasal foreign body are removed by …….
1. forceps
2. cleaning of the nasal cavity by isotonic solution
3. blunt hook, pushed towards the nasopharynx
4. blunt hook, pushed towards the nostrils
VІІ. Which of the following are NOT typical characteristics of laryngeal foreign
body
1. strong and long lasting cough
2. difficulty in breathing, asphyxia is possible in children
3. pain in the chest
4. cyanosis of the lips, face skin
5. hoarse voice
6. feeling pain and pressure in the throat
VІІІ. Foreign body in the bronchi are more often detected
1. rightward
2. leftward
ІХ. Patients with nasal septum abscess complained about ……
1. sharp difficulty of nasal breathing, feeling of heaviness in the head
2. difficulty of nasal breathing, purulent discharge from both halves of
the nose
3. difficulty of nasal breathing, purulent discharge from one half of the
nose
44
Х. It is NOT possible to detect the presence of foreign body in the larynx using …
1. X-ray examination
2. palpation of laryngeal area
3. auscultation
4. indirect laryngoscopy
5. direct laryngoscopy
ХI. Situational task.
A 75 year old patient visited ENT doctor with complaints about the pain in the
lower part of pharynx and sternum. The patient experienced difficulticy in swallowing food. The amount of saliva in oral the cavity increased. It is known from
anamnesis that the symptoms appeared after the patient ate roasted chicken.
OBJECTIVE: during indirect laryngoscopy a large accumulation of saliva in the
pear-shaped corners was found. What is a preliminary diagnosis ?
1. tracheal foreign body
2.hypopharynx foreign body
3. esophageal foreign body
4. foreign body of the larynx
Lesson 13
Topic: Tumors and infectional granulomas of the ENT organs.
1.
The actuality of topic: about 7000 new ENT-cancer patients are detected in
Ukraine every year, it is up to 7.8% from general cancer pathology. The upper
respiratory tract tumors, especially malignant, are the most difficult and urgent
problem in modern otorhinolaryngology. There is tendency to the increase of their
amount because of delayed diagnosis, complexity and duration of the treatment, high
frequency of recurrences. Over the past decade the number of patients with
tuberculosis of the upper respiratory tract and lung, primary and secondary syphilis
has greatly increased. Therefore, knowledge of the clinic, early diagnosis of tumors
and infectious granulomas of upper resperitory tract are necessary to a wide range of
physicians.
2. Lesson duration – 2 academic hours.
3. Purpose of a lesson: to learn how to suspect a tumor or infectious granuloma of
the upper respiratory tract, set a preliminary diagnosis, differentiate diagnosis,
determine rational treatment tactics for this category of patients, depending on the
tumor localization and morphology and causative agent of infectious granulomas.
4. The student is expected to learn:
- clinical signs, diagnosis and ways of treatment of the ENT benign tumors;
- clinical signs, diagnosis and methods of treatment of the ENT malignant
tumors;
- etiology, clinical signs, diagnosis and methods of treatment of the upper
respiratory tract infectious granulomas.
5. The student should be able to
- distinguish, complaints and anamnesis data, select the symptoms typical for the
ENT tumors or infectious granulomas;
45
- identify objective symptoms that indicate the presence of a tumor or infectious
granulomas of the upper resperitory tract and ears;
- create a plan of examinations to confirm a diagnosis of a tumor or infectious
granulomas of the upper respiratory tract and ears (radiography, CT, MRI ,
biopsy, laboratory diagnosis) and be able to assess them;
- take a smear from the nose and pharynx, to make a local anesthesia of the nasal
and pharyngeal mucosa before taking a biopsy;
- create a plan of patient’s treatment with the above mentioned pathology.
6. Reference literature:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 205-212, 213-223.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 23,
27, 44, 48, 100-102, 123-126, 135-136, 141-144, 186, 191-192, 207-215.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. Philadelphia New York: Lippincott-Raven. – 1997. – P. 468-480.
4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe Medical Publications Ltd. – 1987. – P. 108-109, 154-173, 210, 217-241.
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.53, 59-65, 110-112, 113-117, 193-197, 227-230, 259-269,
310-319, 358-361504-509.
7. Control questions:
 Classification of the ENT tumors.
 Clinical signs, diagnosis of the transitional (marginal) tumors of the upper
respiratory tract.
 Treatment methods of the benign ENT tumors.
 Clinical signs, diagnostics and treatment ways of laryngeal cancer.
 Malignant tumors of tonsils, ways of treatment.
 Principles of early diagnosis of malignant tumors of upper respiratory
tract and ear.
 Etiology, pathogenesis, classification, epidemiology, clinics of scleroma,
principles of treatment.
 Clinical signs and treatment of the ENT tuberculosis.
 Clinical signs and treatment of the ENT syphilis.
8. Tests examples:
I. What are the typical complaints of patients with laryngeal fibroma?
1. «barking cough», hoarseness, sore throat
2. hoarseness, dysphonia
3. attack of coughing, hoarseness
IІ. Tubercular ulcers of the mucous membrane of the mouth, pharynx, larynx have
the following carachteristics:
46
1. copper-red in color, clear the edges, "polished" bottom
2. dark red in color,clear the edges, "polished" bottom
3. pale pink in color, have jagged edges, the bottom is covered with
granulation
IІІ. Which of the following are the signs of the 1st stage of laryngeal cancer:
1. tumor has a limited area of one laryngeal floor
2. tumor is located within two laryngeal floors
3. metastases in the neck lymph nodes
IV. Which of the following are the stages of scleroma:
1. knotted-infiltrative, hypertrophic, scarry
2. dystrophy, atrophy, sclerosis
3. knotted-infiltrative, diffusely-infiltrative, scarry
V. In which paranasal sinuses osteoma is most often developed?
1. sphenoid
2. ethmoidal; cells
3. maxillary
4. frontal
VІ. Which of the following are the signs of the 2nd stage of nasal cavity cancer
1. affects two anatomical divisions with focal bone
destruction, tumor does not grow beyond the nasal cavity, regional metastases
are not detected
2. tumor is limited to one anatomical part, without bone
destruction, regional metastases are not detected
3. tumor extends beyond the nasal cavity, regional metastases
are not detected
VІІ. What paranasal sinus most often is amazed by malignant tumors?
1. sphenoid
2. ethmoidal; cells
3. maxillary
4. frontal
VІІІ. Hairy polyp is detected at the age of ……..
ІХ. What pharyngeal neoplasm does not belong to benign?
1. limphoepithelioma
2. fibroma
3. papilloma
4. lymphangioma
Х. Method of treatment of the laryngeal fibroma is….
1. cryosurgery
2. use of sclerotic drug
47
3. radiotherapy
4. surgery
Х. Situational task.
A 64 year old patient visited an ENT doctor with complaints about hoarsness
and a sore throat. He considered himself to be sick for 2 months, underwent selftreatment (NSAIDs), but his health didn’t improve. According to his case history he
had been working as an electric welder for 39 years. He was a heavy smoker (30
cigarettes per day), regularly abusing alcohol. Objectively: laryngeal mucous
membrane is pale, atrophic. Right vocal fold is thickene in the anterior region there is
an excess structure with jagged edges, about 2 mm in size. The fold mobility is
limited during fonation. What is a preliminary diagnosis?
1. Laryngeal fibroma
2. Laryngeal scleroma
3. Laryngeal tuberculosis
4. Laryngeal cancer
48
List of students questions for the final module control
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Main stages of otorhinolaryngology development as an independent medical
discipline.
History of otorhinolaryngology in Ukraine.
History of otorhinolaryngologic department of Danylo Halytsky LNMU.
Main guides of development and achievements in modern
Otorhinolaryngology.
Upper respiratory tract and analyzers, their functional significance.
Clinical anatomy of the external ear.
Clinical anatomy of the tympanic membrane. Peculiarities of the tympanic
membrane location and structure in infants.
Clinical anatomy of the tympanic cavity.
Walls and floors of the tympanic cavity.
Auditory ossicles and muscles of the tympanic cavity.
Clinical anatomy of mastoid bone. Types of mastoid bone structure. Age
peculiarities of mastoid.
Clinical anatomy, physiology of auditory tube. Peculiarities of its structure in
childhood.
Clinical anatomy of the inner ear.
Structure of the cochlea. Adequate stimulus for acoustic analyzer.
Mechanism of soundconduction (air and bone conduction).
Pathways of acoustic analyzer.
Theories of soundperception.
Clinical anatomy of the inner ear vestibulum.
Clinical anatomy of the inner ear semicircular canals.
Structure of the ampular receptor. Adequate stimuli.
Structure of the otolitic apparatus. Adequate stimuli.
Vestibular nuclei and their connections.
Vestibular reflexes.
Rules of Ewald.
Definition of auditory tube patency.
Hearing investigation by language and tuning fork.
Pure tone and speech audiometry.
Differential diagnostics lesions of sound conducting apparatus and sound
perception apparatus.
Spontaneous vestibular disorders.
Research methods of ampular receptor (caloric, rotary, pressor test).
Investigation of otolitic function.
Clinical anatomy of the external nose.
Clinical anatomy of the nasal cavity.
Clinical anatomy of nasal lateral wall.
Structure of the nasal septum.
Blood supply and innervation of the nasal cavity.
Age peculiarities of the paranasal sinuses.
49
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
Clinical importance of paranasal cavities. Clinical anatomy of the maxillary
sinus.
Clinical anatomy of the frontal sinus.
Clinical anatomy of the ethmoidal cells.
Clinical anatomy of the sphenoid sinus.
Clinical physiology of the nasal cavity and paranasal sinuses.
Importance of nasal breathing for a child organism. Research methods of
paranasal sinuses and nose.
Clinical anatomy of the pharynx, its anatomic part’s.
Anatomy of lymphadenoid pharyngeal ring. Age peculiarities.
Structure of palatine tonsils, blood supply, innervation.
Physiology of lymphadenoid pharyngeal ring.
Research methods of the pharynx.
Topography of the larynx.
Laryngeal cartilages and ligaments.
Laryngeal muscles.
Laryngeal innervation.
Clinical anatomy of the larynx.
Physiological functions of the larynx.
Investigation methods of the larynx in adults and children.
Anatomy of the esophagus: topography, walls, physiological narrowing.
Hematoma and perichondritis of pinna.
Sulphuric cork, clinics, methods of removal.
External otitis: forms, etiology, clinics, treatment.
Acute purulent otitis media. Etiology, pathogenesis, clinics.
Peculiarities of acute purulent otitis media in infants.
Peculiarities of acute purulent otitis media due to infectious diseases: influenza,
scarlet fever, measles, tuberculosis.
Treatment of acute purulent otitis media.
Treatment of acute purulent otitis media in the first stage. Indications and
technique of parasentosis.
Acute
mastoiditis:
definition,
clinics,
diagnostics,
treatment.
Antromastoidotomy.
Atypical forms of mastoiditis.
Complications of acute purulent otitis media.
Chronic purulent inflammation of the middle ear: obligatory signs,
classification.
Chronic purulent otitis media without osteolysis and without cholesteatoma,
clinic, treatment.
Chronic purulent otitis media with osteolysis and with cholesteatoma.
Cholesteatoma. Diagnostics, clinic, treatment.
Differential diagnosis between chronic purulent otitis media without osteolysis
and without cholesteatoma and chronic purulent otitis media with osteolysis
and with cholesteatoma.
Conservative treatment of the chronic purulent otitis media.
50
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
Types of ear operations due to chronic suppurative otitis media
Labyryntytis: forms, clinic, treatment.
Pathways and distribution stages of infection from the ear to the cranial cavity.
Otogenic brain abscess: symptoms, treatment.
Sinus thrombosis and otogenic sepsis: symptoms, treatment.
Otogenic meningitis: symptoms and treatment.
Men'yera disease: etiology, pathogenesis, clinical signs.
Treatment of Menier’s disease.
Methods of treatment of acute vestibular dysfunction.
Sensoryneural hearing loss: causes, clinical signs.
Treatment of acute and chronic sensoryneural hearing loss.
Otosclerosis: pathogenesis, clinics, modern methods of surgical treatment.
Nose furuncle, clinics, treatment.
Acute rhinitis: etiology, pathogenesis, clinical signs and treatment.
Acute rhinitis in infants.
Chronic rhinitis: etiology, pathogenesis, pathological anatomy, classification.
Chronic catarrhal rhinitis: symptoms, differential diagnosis, treatment.
Chronic hypertrophic rhinitis: symptoms, differential diagnosis, treatment.
Chronic atrophic rhinitis: symptoms, differential diagnosis, treatment.
Ozena: symptoms, differential diagnosis, principles of treatment.
Vasomotor rhinitis, allergic type: etiology, clinic, treatment.
Vasomotor rhinitis, neurovegetative type: etiology, clinic, treatment.
Hematoma and abscess of nasal septum: symptoms, treatment.
Deviation of the nasal septum, synechia and atresia of the nasal cavity, clinics,
treatment.
Classification of acute and chronic sinusitis.
General and local signs of acute and chronic sinusitis.
Acute and chronic ethmoiditis: symptoms, treatment.
Acute maxillary sinusitis: symptoms, treatment.
Chronic maxillary sinusitis: forms, clinic, treatment.
Chronic odontogenic maxillary sinusitis: symptoms, diagnosis, treatment.
Acute and chronic frontal sinusitis: symptoms, treatment.
Acute and chronic sphenoidal sinusitis: symptoms, treatment.
Chronic hyperplastic sinusitis: etiology, clinic, combined treatment.
Rhinogenous intracranial complications: infection pathways, types of
complications, principles of treatment.
Rhinogenous orbital complications: infection pathways, types of
complications, principles of treatment
Classification of tonsillitis.
Catarrhal tonsillitis: symptoms, treatment.
Angina follicularis: symptoms, treatment.
Lacunar tonsillitis: symptoms, differential diagnosis, treatment.
Ulcer Simanovsky Vincent tonsillitis: etiology, clinic, treatment.
Secondary tonsilittis.
Lymphatic (monocytar) tonsillitis: etiology, clinic, treatment.
51
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
Pharyngeal Diphtheria: symptoms, differential diagnosis.
Quinsy and peritonsilar abscess: etiology, classification, treatment.
Acute tonsillogenic sepsis: symptoms, treatment.
Retropharyngeal abscess in children: symptoms, treatment.
Parapharyngeal abscess in children: symptoms, treatment.
Adenoid vegetations: symptoms, treatment.
Hypertrophy of palatine tonsils: symptoms, treatment.
Chronic tonsillitis: etiology, pathogenesis, classification.
Local signs of of chronic tonsillitis.
Types of decompensation of chronic tonsillitis.
Conservative treatment of chronic tonsillitis.
Surgical treatment of chronic tonsillitis.
Leptotrichosis: symptoms, treatment.
Acute pharyngitis: etiology, clinical, treatment.
Chronic pharyngitis: etiology, forms, clinical, treatment.
Acute catarrhal laryngitis: aetiology, clinical, treatment.
Acute epiglotitis: symptoms, treatment.
Phlegmonous laryngitis: symptoms, treatment.
Epiglottis abscess: symptoms, treatment.
Chondroperichondritis of larynx: causes, clinical, treatment.
Acute stenosing laryngotracheitis in children: etiology, pathogenesis,
clinical signs.
Acute stenosing laryngotracheitis in children. First aid.
Chronic laryngitis: etiology, forms, clinic.
Laryngeal paresis and paralysis: causes, laryngoscopic picture, methods
of treatment.
Juvenile nasopharyngeal angiofibroma: symptoms, diagnosis, removal
techniques.
Malignant tumors of paranasal sinuses and nose: diagnosis, treatment.
Malignant tumors of the pharynx: localization, clinical treatment.
Laryngeal benign tumors.
Laryngeal papillomatosis in adults and children.
Precancerous laryngeal lessions.
Cancer laryngeal: etiology, localization, clinical, stages of disease
development.
Principles of early diagnostics of laryngeal cancer.
Treatment of laryngeal cancer.
Surgical treatment of laryngeal cancer, its types, indications.
Scleroma of the upper airways: etiology, pathologic anatomy, stage,
treatment.
Tuberculosis of the upper respiratory tract: clinical manifestations,
differential diagnosis.
Syphilis of the upper respiratory tract: clinical manifestations, differential
diagnosis.
Value of prophylactic examinations and dispensary for prevention of the
52
154.
155.
156.
157.
158.
159.
160.
161.
162.
163.
164.
165.
166.
167.
168.
169.
170.
171.
upper respiratory tract diseases and their complications.
Ear foreign body, methods of removing.
Bleeding from the ear.
Injuries of the ears, traumatic rupture of the tympanic membrane.
Nasal foreign body. Means of its removal. Rhinolith.
Injuries of nose and paranasal sinuses: classification, clinical signs, treatment.
Nasal bleeding: causes, symptoms, methods of blood arrest.
Pharyngeal foreign body: symptoms, treatment.
Laryngeal stenosis: definition, causes of acute and chronic laryngeal
stenosis.
Stages of laryngeal stenosis, principles of treatment (medication,
prolonged intubation, tracheotomy).
Tracheostomy: indications, its types, technique.
Esophageal foreign body: symptoms, diagnosis, removal techniques.
Complications of esophageal foreign bodies: symptoms, treatment tactics.
Esophageal burns: Causes, pathologic anatomy, clinical stage.
First aid for esophageal burns.
Airway foreign body: causes of aspiration , anamnesis, characteristics of
foreign bodies.
Laryngeal foreign body: symptoms, methods of removing in adults and
children.
Tracheal foreign body: symptoms, removal techniques.
Bronchial foreign body: types of stenosis, clinics, removal techniques.
53
List of practical skills, diagnostic and therapeutic manipulations that student
should learn during Otorhinolaryngologсal practical studies
І. Be able to use headlight reflector.
ІІ. To learn the following techniques:
1. Forward rhinoscopy.
2. Rear rhinoscopy.
3. Oropharyngoscopy.
4. Indirect laryngoscopy.
5. Otoscopy.
ІІІ. Learn how to perform the following manipulations:
6. Fitting sling bandage.
7. Taking smears from the nasal cavity and pharynx.
8. Lubrication of the nasal and pharyngeal mucous membrane.
9. Insufflation and instillation of medication to the ears, nose and pharynx.
10.Tracheostoma hygienic procedures and care tracheostomic cannula.
11.Removing sulfur crust from the external auditory meatus.
12.Fitting ear bandages and ear compresses.
ІV. Be able to explain main types of the upper respiratory tract X-ray picture:
13.Frontal X-ray of paranasal sinuses.
14.Lateral X-ray of nasal bones.
15.Lateral X-ray of paranasal sinuses.
16.X-ray of a temporal bone.
17.CT and MRI scanning of the upper respiratory tract.
V. Be able to evaluate the results of acumetry and pure tone audiometry test:
18.Hearing investigation by whispering and spoken language.
19.Hearing investigation by tuning fork.
20.Basic types of tonal audiogram.
VІ. Be able to conduct and evaluate research results of the simplest vestibular tests:
21.Coordination tests.
22.Fukuda stepping test.
23.Fukuda and Bazarov writing test.
24.Kefalograma.
25.Rotary test.
54
Scheme of medical history
1. Passport data (full name, age, occupation, profession, home address).
2. Date of a patient’s visit to the hospital (by ambulance, direction from policlinic).
3. Patient complaints.
4. Anamnesis of a patient’s disease and life style.
5. General status: skin, peripheral lymph nodes, cardiovascular, respiratory,
digestive tract, musculoskeletal system.
6. Special status:
а) front rhinoscopy: external review of the nose, front rhinoscopy in I and II
positions (mucosa, nasal passages and turbinate’s, and nasal septum), respiratory
and olfactory examination;
b) oropharyngoscopy: gums, teeth, oral mucosa and pharynx, tonsils, soft palate,
posterior pharyngeal wall;
c) Rear rhinoscopy: nasal arch, hoanes, rear ends the nasal turbinate’s, pharyngeal
opening of the Eustahian tube;
d) laryngoscopy: epiglottis, entrance to the larynx, oral mucosa, vestibular and
vocal folds, glottis, respiratory and voice features, motility of larynx;
d) otoscopy: clearance and skin of the external auditory meatus, eardrum and its
visual signs.
7. Previous diagnosis.
8. Additional clinical and laboratory investigation:
а) Hearing investigation;
d) vestibulometry;
c) X-ray investigation;
d) puncture of paranasal sinuses, tympanic cavity, abscesses;
e) blood urine tests and;
f) pathohistomorphological investigation.
9. Differential diagnosis.
10.Final diagnosis.
11.Treatment.
12.Diary.
13.Prognosis.
14.Epicrisis.
15.Abstract behind one of the issues (determined by a teacher), which relates to
the treated disease of a patient: etiology, pathogenesis, etc..
55
Tests answers:
Lesson 1
I
II
1d, 2а, 3b,
4c.
30
dB
Lesson 2
I
II
III
3
1
3
Lesson 3
I
II
3
2
III
IV
V
3
1
2
IV
3
III
1
V
IV
3
Lesson 5
I
II
1
III
thympanoplas- 1b,2a
ty
Lesson 6
I
II
2
1
Lesson 7
I
II
1
4
Lesson 8
I
II
2
3
III
3
VII VII
I
tympanic mem- 2
1
brane
VI
nystagmu
s
2
Lesson 4
I
II
III
IV
1
4 conductive 2
VI
V
4
VI
1
VII
1
VIII
4
IX
2
X
2
VII
2
VIII
2
IX
1
X
1
V
2
VI
2
IV
V
VI
VII
1
3
1b,2a
4
IV
2
V
2
VII VIII
3
4
VI
2
III
IV
V
VI
1
2
3
3
III
IV
V
VI
3
1
1a,2b,3c,4
a
4
VII
2
VII VII
I
2
2
IX
Posteriorinferior
X
XI
1
2
2
XI
1
XI
3
X
1
VII
IX
I
4 1a,2b,3d,4c
VIII
2
IX
3
XI
3
X
XI
2
3
X
2
XI
1
IX
X
XI
glycerol-test
2
3
VII VII
I
1
3
56
IX
IX
X
XI
3
seasonal
4
Lesson 9
I
II
1
2
III
1
Lesson 10
I
II
III
1
2
6
IV
3
IV
4
V
3
V
2
VI
10
VI
1
VII
1
VII
acute tonsillitis
VIII
3
VIII
2
IX
2
III
3
IV
3
V
1
VI
2b,1a
VII
1
VIII
1ab,24d,3
c
Lesson 12
I
II
2
2
III
1
IV
3
V
1
VI
4
VII
3
VIII
1
III
1
IV
3
V
4
VI
1
VII
3
57
VIII
(under 1
year)
XI
3
IX
peritonsillar
abscess
Lesson 11
I
II
1
3
Lesson 13
I
II
2
3
X
1
IX
1
X
1
X
3
XI
4
XI
4
IX
1
X
2
XI
3
IX
1
X
4
XI
4
58