New: 5th year Course Book/E.N.T

Course Book --- otolaryngology ---- department of Surgery ---- Fifth stage2010-2011

Course Book

Of

Otolaryngology

Fifth Stage

Department of Surgery

College of Medicine

2010-2011

1


Course coordinator and list of teachers on this course

Course: otolaryngology

Course coordinator: Dr. Hewa As'ad

Department: surgery- otolaryngology

College: Medicine

Course coordinator link: [email protected]

Tel. +9647701580087

List of teachers on this course:

Dr. Hewa As'ad Abdelkareem

Dr. Yousif Ibrahim chalabi

Dr. Muaid Ismaiel Aziz

Dr. Sherko Saeed Fathullah

2


Course Overview

The course of otolaryngology – head & neck surgery is dedicated to deal with undergraduate level to know the importance of otolaryngology in the daily activities of the junior doctors and the sessions and the lectures are overall based on simple principles and standards for the juniors in otolaryngology to understand the physiology and pathology and management of common diseases & how to deal with emergency situations that they may be faced in their practical work , these lectures given in simple and qualified methods in 28 lectures.

3


Course Objectives

At the end of the course of otolaryngology, the students should be able to master and perform the basic otolaryngology assessment & examinations that are considered fundamentals and learn how to be able to deal with emergency situations. some of these objectives include:

1-Performing ENT examination.2-Deal with a patient complaining of nasal bleeding. 3-How to manage a patients with foreign bodies

inhalations or ingestion. 4-How to manage a patients with an obstructed upper

airway obstruction ( stridor) .5-Diagnosing and treatment of common

otolaryngological diseases.

4


Course Reading List

1-Scott- Brown otolaryngology 2-Logans Turners diseases of ear , nose, throat3-Synopsis otolaryngology4-Makhbool otolaryngology5- Essential Otolaryngology

6- Oxford handbook of ENT emergences7-American journal of otolaryngology-head & neck Surgery8- journal of laryngoscope

9- www.emedicine.com

5


Syllabus

No Title of subject Lecturer/Tuttor’s name

1 Anatomy and physiology of the larynx

Dr.Hewa asaad

2Traumatic conditions of the larynx.

Dr.Hewa asaad

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

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

5Neoplasms of the larynx: Benign tumors and cysts

Dr.Hewa asaad

6Neoplasms of the larynx: Malignant tumors.

Dr.Hewa asaad

7 Hoarseness Dr.Hewa asaad

8Anatomy, Embryology & physiology of the nose & PNS

Dr Yousif Chalabi

9congenital anomalies and trauma to the nose

Dr Yousif Chalabi

10Acute & Chronic nasal &PNS sinus inflammation Dr Yousif Chalabi

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11 Epistaxis Dr Yousif Chalabi

12 Allergic rhinitis & nasal polyposisDr Yousif Chalabi

13The deformed nose & nasal obstruction

Dr Yousif Chalabi

14 Tumors of nose & paranasal sinusesDr Yousif Chalabi

15 Anatomy, physiology of the earDr. Muaid Ismaiel Aziz

16Physical& radiological assessment of the ear diseases


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Symptomatology in ear diseases Dr. Muaid Ismaiel Aziz

18Diseases of the external ear ( cong.anomalies , infections, tumors)


19 Diseases of the middle ear ( acute otitis media)


20Diseases of the middle ear (chronic otitis media)


21 Diseases of the inner ear, ear surgeriesDr. Muaid Ismaiel Aziz

22Anatomy and physiology of the pharynx Dr. Sherko Saeed Fathullah

23 Common diseases of the buccal cavity Dr. Sherko Saeed Fathullah

24 Pharyngitis and pharyngeal abscesses Dr. Sherko Saeed Fathullah

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25 Tonsillitis and adenoids Dr. Sherko Saeed Fathullah

26 Tumors of the pharynx Dr. Sherko Saeed Fathullah

27Miscellaneous conditions of the pharynx and throat Dr. Sherko Saeed Fathullah

28 Neck masses and salivary glands Dr. Sherko Saeed Fathullah

Lecture title: Anatomy and physiology of the larynx.Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand anatomy and physiology of the larynx and their clinical importance, the lecture includes:a. Introduction to laryngeal structure.b. Description of laryngeal structure (laryngeal cartilages and membranes, muscles of the larynx and their actions) demonstrated by figuresc. Description of surface anatomy of the larynx.d. Blood supply, nerve supply, and lymphatic drainage of larynx and their clinical importance.e. Description of functions of larynx.Lecture title: Traumatic conditions of the larynxLecturer: Dr. Hiwa As'adObjectives:

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This lecture is dedicated to help medical students understand management of trauma of larynx and neck which is a common clinical condition that they will face frequently in their practice in hospital and emergency department, the lecture includes:a. Introduction to laryngeal and neck trauma.b. Description of mechanism of injury (blunt trauma injury and penetrating trauma).c. Initial evaluation, clinical assessment, endoscopic assessment and imaging of the larynx.d. Classification of laryngeal injury according to extent of damage.e. Management of laryngeal trauma, goals of laryngeal exploration, laryngeal repair, and management of associated vascular and esophageal injuries.f. Outcome of management of this condition.

Lecture title: Inflammations of the larynx: Acute laryngitisLecturer name: Dr. Hiwa As'adObjectives:

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This lecture is dedicated to help medical students understand this common problem that they will face in their practice in outpatient clinic, emergency department or if they work in otolaryngology or pediatric departments, the lecture includes:a. Introduction to acute laryngitis and its etiological factors.b. Description of clinical types of acute laryngitis. c. Comparison between pediatric patients and adult patients and relative clinical points to be considered.d. Treatment options and outcome.Lecturer title: Inflammations of the larynx: Chronic laryngitisLecturer name: Dr. Hiwa as'adObjectives: This lecture is dedicated to understand this troublesome condition caused by various etiological factors, and its types (specific and non specific), the lecture includes:a. Definition and etiological factors of chronic laryngitis.b. Clinical classification of chronic laryngitis into specific and non-specific, and subgroups of each type.c. Pathology, clinical features, and treatment modality for each type.

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Lecture title: Tumors of the larynx: Benign tumorsLecturer name: Dr. Hiwa As'adObjectives: This lecture is dedicated to help medical students understand this important conditions that might affect respiration and voice of patients that needs specific management, the lecture includes :a. Introduction.b. Classification of benign tumors.c. Clinical features, diagnosis and treatment of each type.d. Pseudotumors types , clinical features and management of each type.Lecture title: Tumors of the larynx: Malignant tumorsLecturer name: Dr. Hiwa As'adObjectives: This lecture is dedicated to help medical students understand this serious condition and develop high sense of suspicious for early diagnosis. It also demonstrates treatment options of this condition, the lecture includes:a. Introduction.b. Classification of carcinoma of larynx.c. Demonstration of etiological factors.d. Clinical features, examination of the larynx and the neck.

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e. Radiological investigations and other relevant investigations to assess tumor extension and spread.f. Staging and grading of Ca larynx.g. Demonstration of strategy of treatment and the options available for this condition. Lecture title: HoarsenessLecturer name: Dr. Hiwa As'adObjectives: to understand the students the meaning of the hoarseness & its causes &its treatment, were all objectives included in the lecture.

Lecture title: Anatomy & Physiology of nose & paranasal sinusLecturer : Dr. Yousif ChalabiObjective: To emphasize the importance of anatomy &its variations especially the osteomeatal complex in the clinical managements of common nose &sinus chronic diseases & correction of nose & nasal septum both for physiological & cosmetic purposes , the lecture includes

a. an embyrological introduction to explain some congenital variation of nose like choanal atresia

b. anatomy of external nose &its skeleton to explain the anatomical dangerous region of nose &anatomical & physiological background of cosmetic nasal surgery.

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c. anatomy &physiology of nasal fossae & its wall , their role in respiration

d. anatomy of paranasal sinuses &their variation with its impact on pathogenesis of chronic sinus diseases & facial pain

Lecture title: congenital anomalies and trauma to the noseLecturer: Dr Yousif ChalabiObjectives : to emphasize the importance of early diagnosis of some congenital anomalies as a cause of embarrassed respiration in neonates & infants for urgent interference &to explain the clinical managements of broken nose &face both medically &legally in addition to its impact on possible intra cranial ,base of skull , cosmetic & respiratory complications to guarantee early proper detection &management to prevent subsequent sequels. The lecture includes a quick review of embryological formation of nose. its openings & anatomy of nasal skeleton , Choanal atresia , fracture nasal bone &facial bones (Leforts) fractures , Foreign bodies in nose & their managements.

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Lecture title : Acute & Chronic nasal &paranasal sinus inflammationLecturer: Dr Yousif ChalabiObjectives: To consider the predisposing factors& their prevention in the etiology of acute nasal & paranasal sinus (PNS) infections & to emphasize the effects of prompt & early treatments in prevention of persistence of infections & changing to chronic state. And how to manage whether medically or surgically the chronic state.The lecture includes

a. A quick review of key points of previous lectureb. Acute viral &bacterial infections of nose &PNSc. Chronic non-specific nasal &PNS inflammationd. Chronic specific nasal & PNS infectione. Managements including the medical & surgical way

of treatmentsLecture title: EpistaxisLecturer: Dr Yousif ChalabiObjectives : This lecture is dedicated to emphasize the importance of epistaxis as one of common acute emergencies in medicine in general & to teach the students how to manage it as first-aid , general &specific ENT managements . How to identify its causes as a local nasal causes or general systemic causes especially the

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blood dyscriasis causes . How to be treated specifically , generally & how to prevent & guard against it .The lecture includes

a. A quick review of key points of previous lectureb. an introduction to epistaxisc. Causes as a local nasal causes &general systemic

causesd. Management including the lab hematological.,

radiological & endoscopical way to find the cause as local nasal or general systemic . how to be treated whether medically or surgically conservatively or radically &how to be followed up properly.

Lecture title: Allergic Rhinitis & Nasal polyposisLecturer: Dr Yousif ChalabiObjectives: to emphasize the role of preventative measures especially the avoidance of allergens .proper use of immunization & medical treatmentsIn reducing the complaint & severity of allergic patients. How to differentiate the different causes of wet nose including infections allergy & intrinsic vasomotor rhinitis &how to be treated properly .The lecture is dedicated to make the students understand the nature of common nasal problem of polyposis & how to differentiate it from normal or hypertrophied turbinates . To emphasize the

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role of medical treatment as an effective measures in the early & small polypi or as a preliminary measures for effective radical treatment or follow up for those treated surgically.The lecture includes

a. A quick review of key points of previous lectureb. An introduction to the types of hypersensitivity

reactions &nature of nasal allergyc. Etiology of allergy &types of allergensd. Management including the differentiation &how to

diagnose different types of wet nose. Allergy dermatological & hematological test in addition to proper way of prevention &treatments

e. Nasal polyposis as a pathogenesis , diagnosis & treatments whether medically emphasizing the role of proper use of cortisone in a non contra-indicated patients or surgically whether conservatively or radically by FEES or conventionally by traditional surgical way

Lecture title : The deformed nose & nasal obstructionLecturer: Dr Yousif ChalabiObjectives: This lecture is dedicated to emphasize the role of cosmetic nasal surgery with consideration of nasal passage for proper respiratory functions which so

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frequently threatened by some surgeon not considering the physiological aspect of nasal function &how to deal with nose surgically both for physiological & cosmetic purposes . It also aims to make the students understanding the causes of nasal obstruction &to differentiate the pathological from normal physiological obstructions of nasal cycle .The lecture includes

a. A quick review of the key points of previous lectureb. A review of the nasal respiratory physiology

&anatomy of the nasal skeletonc. Causes of deformed nose &nasal obstructiond. Management including the requested examination

whether endoscopically or by imaging (CT SCAN) to determine the causes &sites of obstructions & how to be treated whether medically or surgically whether for cosmetic or physiological purpose separately or in combinations.

Lecture title : Tumors of nose & paranasal sinusesLecturer: Dr Yousif ChalabiObjectives: The lecture is dedicated to make the students understanding the nature of tumors &how the malignant tumors present with specific signs & symptoms to be differentiated from benign one .What are the predisposing factor & the definite causes to be diagnosed early before

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extension to nearby vital & dangerous area of eye & intracranially . Although generally they are rare tumors but they carry a great morbidity & mortality necessating a special considerations by the juniors &the surgeon. Also to teach the students how these tumors presents with different signs & symptoms making the patients wandering among different specialty until diagnosed too late as a nasal or paranasal malignant tumors.The lecture includes:

a. A quick reviews of key points of previous lectureb. classifications of tumors as benign & malignant with

their different types . Histological classification & staging of tumors

c. predisposing & etiological factor for tumor causationd. Managements including the diagnosis of tumors

whether benign or malignant &the best selected way of treatments whether surgically or by DXRT or combined in addition to their prognosis

Lecture title : Embryology , anatomy, physiology of the earLecturer name: Dr. Muaid Ismaiel AzizObjectives: This lecture is dedicated to help medical students understand embryology, anatomy and physiology

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of the ear and their clinical importance, the lecture will deal with followings :

1. Embryological development of the ear2. Anatomical parts of the ear3. Anatomical landmarks of the ear4. Functions of the ear

Lecture title: Physical & radiological assessment of the ear diseasesLecturer name: Dr. Muaid Ismaiel AzizObjectives: in this lecture the students will learn how to examine & get diagnosis of the ear diseases as its includes;

1. The different ways of ear examination2. What you will see in normal ear examination to make

differentiation from disease ear 3. Audio logical assessment & its interpretation4. Role of plain x-ray & ct scan in ear disease & their

indications. Lecture title: Symptomatology in ear diseasesLecturer name: Dr. Muaid Ismaiel AzizObjectives: to know different ear disease symptoms as deafness (hearing loss), tinnitus (perceptive noisy sound),

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vertigo (rotating movement of the surrounding or the patient himself with fixed environment ) , otalgia (pain in the ear). So you will get information about above topics shortly including their classifications, differential diagnosis , diagnosis & treatments.

Lecture title: Diseases of the external ear ( cong. anomalies, infections, tumors )Lecturer name: Dr. Muaid Ismaiel AzizObjectives: to make the student oriented with the different ear diseases starting from external ear diseases, in this lecture will discuss the congenital diseases like auricle deformity ( bat ear) , preauricular sinus , otitis externa & its most common causes & types & its treatment ,also will concentrate on benign & malignant tumors like osteoma , basal cell carcinoma .

Lecture title : Diseases of the middle ear (acute otitis media)Lecturer name: Dr. Muaid Ismaiel AzizObjectives: in this lecture the student will face the most important & commonest pathology which is middle ear infection (otitis media), pathology, types, causes, diagnosis & treatment.

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Lecture title : Diseases of the middle ear (chronic otitis media)Lecturer name: Dr. Muaid Ismaiel AzizObjectives: chronic OM classified into safe & unsafe disease, so its important to know both types & its pathology & treatment , also will discuss different classifications for CSOM & which of them is useful.

Lecture title : Diseases of the inner ear , ear surgeriesLecturer name: Dr. Muaid Ismaiel AzizObjectives: in this lecture some of the inner ear disease which is more common than other inner ear disease like otosclerosis , meniers disease will discussed briefly in addition the students will get good & sufficient information about the common ear surgeries like myringotomy , myringoplasty.

Lecture title : Anatomy and physiology of the pharynxLecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture the students will get enough information Concentrating on boundaries and parts of the pharynx including naso , oro and laryngopharynx, as well as muscles , nerve supplies with short notes on the anatomy of soft palate .

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In physiology, function of pharyngeal lymphoid tissue and deglutition are discussedLecture title : Common diseases of the buccal cavityLecturer name: Dr. Sherko Saeed FathullahObjectives: Some of the common diseases of otolarygologist interest are described including : stomatitis , aphthous ulcers , Behcet’s syndrome tongue ulcers and AIDS , notes on cysts of mouth , carcinoma of the toungue , ludwing’s angina and tumours of the oral cavityLecture title : Pharyngitis and pharyngeal abscessesLecturer name: Dr. Sherko Saeed FathullahObjectives: in this lecture the students will know about common disease in the community (pharyngitis) Acute and chronic specific and non specific pharyngitis as well as acute and chronic pharyngeal abscesses, Pharyngitis and pharyngeal abscesses,& how these conditions can be dealt with.Lecture title : Tonsillitis and adenoidsLecturer name: Dr. Sherko Saeed FathullahObjectives: Concentrating on acute and chronic tonsillitis with their complications .Tonsillectomy and post operative cares , Peritonsillar abscess ,Clinical features of

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nasopharyngeal tonsillitis , its complication and adenoidectomy , Pharyngitis and pharyngeal abscessesLecture title : Tumors of the pharynxLecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture will deal with important subject which is tumors of pharynx & its includeTumors of the nasopharynxTumors of the oropharynxTumors of the laryngopharynxLecture title : Misceleneous conditions of the pharynx and throat Lecturer name: Dr. Sherko Saeed FathullahObjectives: including Globus hysterics , palate and pharyngeal palsy , pharyngeal spasm , pharyngeal pouch , trismus , cleft palate and elongated styloid process Lecture title : Neck masses and salivary glandsLecturer name: Dr. Sherko Saeed FathullahObjectives: in this lecture will discuss Thyroglossal cyst and fistula , branchial cyst , cystic hygroma sternomastoid tumor as well as mumps , submandibular gland calculus and sialography.

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Student feedback for the subject of a lecture

Date: course: year: lecturer: title:

No. Evaluation Questions Score(1-5)

Subjective Remarks

1 The objectives and key messages of the subject were clear

2 The contents of the subject were useful and related to the main objectives of the course

3 The materials were prepared carefully as needed

4 The lecturer/ tutor while lecturing tried to analyze the principles, contents and the important points of the subject simply and properly.

5 The lecturer/ tutor while lecturing kept my attention.

6 The lecturer/ tutor came into the classroom on time and was committed to the duration of the lecture.

7 The lecturer's behavior in the classroom was calm and respectful

8 The slides used in the lecture were clear and attractive.

9 At the end of the lecture, the lecturer

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gave the students a chance for questions and comments. His/ her answers were complete.

10 The reading sources are new and compatible with the subject.Total score

1-very bad 2–bad 3–medium 4- good 5-verygood

Examinations.

Types of questions:

1-short essay.

2-long essay.

3-multiple choice questions.

4-Single choice questions

Time of exam.

3 Three hours.

The number of questions and marks are variables :

The methods of correction of answers depend on key answers of single choice and key for multiple choice questions & its usually that false answer

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will council the true answer in MCQ (either one for one or two for one) and correction and marks are given accordingly.

Advices and directions for all students before and during exams.

1-Read the question twice before answering.2-Think of the answer before writing.3-Plan your answer in a separate page before

writing it down on the answer paper.4-Arrange the answer in the form of introduction,

contents and the final part so that the student organizes his/her answer

Samples of MCQ , Single choice , long and short essays

Single choice question

1. middle turbinate is formed by:

(….)A. vomer bone

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(….)B. Ethmoid bone(….)C. Maxilla bone(….)D. All of the above(….)E. none of the abovethe correct answer is ( B )

MULTIPLE CHOICE QUESTIONS

1. Regarding carcinoma of the larynx:

a. SCC is the most common pathologyb. Smoking has no any role in incidencec. Neck mass ( lymph node invasion )is more incident

with glottis carcinomad. Surgery always curative

The answers as fallow a. T , b. F , c. F , d. F

SHORT ASSAY ON TREATMENT OF ALLERGIC RHIINITIS

ANSWER

Treatment: includes allergen avoidance, pharmacotherapy , immunotherapy & surgery which is

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rarely needed when there is local pathology affecting the regress of the symptoms like septal deviation , turbinate hypertrophy, nasal polyp.Medication include :

1. Antihistamines : these rapidly relieve running, itching, & sneezing, but have little effect on blockage. 1st generation antihistamines ( chlorphenramine & diphenhydramine) should be avoided because of sedation effect , its better to use non-sedative 2nd generation like (loratidine, fexofenadine).

2. Topical corticosteroids: these are most effective for treatment of rhinitis especially if started prior to allergen exposure, it reduces inflammation, nasal , eye symptoms & improve sense of smell e.g ( mometasone , beclomethasone , fluticasone ).

3. Sodium cromoglicate: its weak effective against all rhinitis symptoms but useful for children aged less than 4 years.

4. Decongestant : topically used for reducing nasal obstruction ,but increase rhinorroea . Systemic decongestant not effective with systemic side effects.

5. Ipratropium bromide : this atropine –like nasal spray is useful against rhinorrhoea .

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6. Systemic corticosteroids : oral steroids used for very sever symptoms during hay fever season.

7. Antileukotrienes : effective against congestion & mucous Production.

8. Nasal douching : Its effective in seasonal rhinitis. 9. Immunotherapy : Indicated in patients with sever symptoms not get response to routine medical treatments.

write long assay on an intrinsic rhinitis

Answer : Is a non-infective , non allergic condition. Like many diseases whose etiology is obscure , its also termed as perennial rhinitis or vasomotor rhinitis which is still perhaps the commonest term.

The term ( non allergic rhinitis ) is commonly applied to a diagnosis of any nasal condition in which the symptoms are identical to those seen in allergic rhinitis but an allergic etiology has been excluded .These non allergic entities can be broadly be classified as :

Idiopathic rhinitis ( vasomotor rhinitis ,or non allergic non infectious perennial rhinitis )

Non allergic occupational rhinitis Hormonal rhinitis Drug- induced rhinitis

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Other forms ( non allergic rhinitis with esinophilia syndrome, rhinitis due to physical & chemical factors, food-induced rhinitis, emotional rhinitis, atrophic rhinitis ).

unlike allergic rhinitis there are no specific diagnostic tests for non allergic rhinitis & diagnosis is made on the basis of rhinitis symptoms in the absence of identifiable allergy ( by allergy skin test ) , structural abnormality, immune deficiency, sinus disease or other causes.

Clinical presentation : there are 6 main symptoms of rhinitis ,these are nasal congestion ,sneezing, nasal itching , rhinorrhoea , hyposmia & postnasal discharge , of these nasal symptoms significant sneezing & itching are highly suggestive of allergic rhinitis & tend not to occur with intrinsic rhinitis , very marked nasal congestion & significant hyposmia tend to be symptoms of non allergic rhinitis. Rhinitis presenting in childhood is almost invariably of allergic etiology , whereas adult onset rhinitis is more likely to be due to intrinsic rhinitis .

Allergic rhinitis is always associated with nasal eosinophilia ( more than 25% of nasal smear cells are eosinophils) ,whereas non allergic rhinitis ( intrinsic rhinitis ) may or may not associated with eosinophilia ,approximately 1/3 of intrinsic rhinitis patients have nasal secretion eosinophilia , so clinically

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IR classified into Eosinophilic ( obstruction syndrome ) & Non-eosinophilic ( rhinorrhoea syndrome ) groups.

The eosinophilic variety of (IR) was characterized by marked nasal congestion , profuse rhinorrhoea , hyposmia , marked inferior turbinate hypertrophy which is mild in the other group& mucoid nasal secretion , also nasal polyposis is more frequent in eosinophilic groups.

Rhinorrhoea is profuse in both groups but more in non-eosinophilic group which is a predominant feature. The rhinorhoea group tend to occur in relatively advanced age whereas the nasal obstruction group tend to occur in middle age .Other clinical differences between the 2 groups are marked mucosal thickening frequently occurs in the eosinophlic group which is evident on plain radiological examination of the sinuses, also noted that patient with eosinophilic (IR) frequently have asthma & occasionally aspirin sensitivety ,neither of which occurs in the non-eosinophilic (IR) group. One of the most clinically obvious differences is dramatic response of the eosinophilic group to intranasal steroids & poor response of the other group to any therapy apart from anticholinergic agents.-------------------------------------------------------------------------------------------------------------------------------------------

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From now on every course should have its own

external examiner with identified roles.The one who can play the role of an external examiner should:

Have an academic post with the scientific rank of assistant Professor and higher.

He/she should be an active, reputable and experienced academic staff in his field or a related field to the course.

He/she should have not participated in lecturing or administering of the course.

The roles of the external examiner are: Evaluating the contents and the program of the

course. Prior to the exam , he /she should contribute to

choosing the questions and looking at the ideal answers.

Evaluating the process of the examinations: he/she should see all the marked exam papers, then choose randomly nine marked papers: three with high marks, three with medium and three with low marks.

Evaluating the students' feedbacks He/she should participate in the final meeting of the

first round examinations committee and give his assessment on the entire course and the examination

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process, then to give his opinion about the final results.

He/she should participate in the final meeting of the second round examinations committee and should have a main vote on those problems that may face them.

Then the lecturer/ tutor in charge will respond to the external examiner's questions and will reply officially to all the questions and clarify the reasons.

-------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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Student feedback on the course

Date : course: year lecturer:

no. Evaluation Questions Score(1-5)

Subjective Remarks


2 The contents of the subject were useful and were related to the main objectives of the course

3 The coordinator teacher had worked hard to prepare the materials

4 The coordinator teacher had worked hard to cooperate and prepare the course

5 The lecturers were carefully selected and were expert in their fields

6 The coordinator teacher gave a good attention to the students' criticisms and claims

7 Information on the Examination process was well provided

8 The questions of the exams were related to the contents of the course

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9 There is a potential to promote and develop the course in the following areas:

10 Total of the levels

1-very bad 2- bad 3-medium 4-good 5-very good

Course Book

Of

Otolaryngology

Fifth Stage

Department of Surgery

College of Medicine35


2010-2011

Course coordinator and list of teachers on this course

Course: otolaryngology

Course coordinator: Dr. Hewa As'ad

Department: surgery- otolaryngology

College: Medicine

Course coordinator link: [email protected]

Tel. +9647701580087

List of teachers on this course:

36


Dr. Hewa As'ad Abdelkareem

Dr. Yousif Ibrahim chalabi


Dr. Sherko Saeed Fathullah

Course Overview

The course of otolaryngology – head & neck surgery is dedicated to deal with undergraduate level to know the importance of otolaryngology in the daily activities of the junior doctors and the sessions and the lectures are overall based on simple principles and standards for the juniors in otolaryngology to understand the physiology and pathology and management of common diseases & how to deal with emergency situations that they may be faced in their practical work , these lectures given in simple and qualified methods in 28 lectures.

37


Course Objectives

At the end of the course of otolaryngology, the students should be able to master and perform the basic otolaryngology assessment & examinations that are considered fundamentals and learn how to be able to deal with emergency situations. some of these objectives include:

6-Performing ENT examination.7-Deal with a patient complaining of nasal bleeding. 8-How to manage a patients with foreign bodies

inhalations or ingestion.

38


9-How to manage a patients with an obstructed upper airway obstruction ( stridor) .

10- Diagnosing and treatment of common otolaryngological diseases.

Course Reading List

1-Scott- Brown otolaryngology 2-Logans Turners diseases of ear , nose, throat3-Synopsis otolaryngology4-Makhbool otolaryngology5- Essential Otolaryngology

6- Oxford handbook of ENT emergences7-American journal of otolaryngology-head & neck Surgery

39


8- journal of laryngoscope 9- www.emedicine.com

Syllabus

No Title of subject Lecturer/Tuttor’s name

1 Anatomy and physiology of the larynx

Dr.Hewa asaad

2Traumatic conditions of the larynx.

Dr.Hewa asaad

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

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

5Neoplasms of the larynx: Benign tumors and cysts

Dr.Hewa asaad

6Neoplasms of the larynx: Malignant tumors.

Dr.Hewa asaad

40


7 Hoarseness Dr.Hewa asaad

8Anatomy, Embryology & physiology of the nose & PNS

Dr Yousif Chalabi

9congenital anomalies and trauma to the nose

Dr Yousif Chalabi

10Acute & Chronic nasal &PNS sinus inflammation Dr Yousif Chalabi

11 Epistaxis Dr Yousif Chalabi

12 Allergic rhinitis & nasal polyposisDr Yousif Chalabi

13The deformed nose & nasal obstruction

Dr Yousif Chalabi

14 Tumors of nose & paranasal sinusesDr Yousif Chalabi

15Embryology, anatomy, physiology of the ear


16Physical& radiological assessment of the ear diseases


17

Symptomatology in ear diseases Dr. Muaid Ismaiel Aziz

18Diseases of the external ear ( cong.anomalies , infections, tumors)


19 Diseases of the middle ear ( acute otitis media)


20 Diseases of the middle ear (chronic Dr. Muaid Ismaiel Aziz

41


otitis media)

21 Diseases of the inner ear, ear surgeriesDr. Muaid Ismaiel Aziz

22Anatomy and physiology of the pharynx Dr. Sherko Saeed Fathullah

23 Common diseases of the buccal cavity Dr. Sherko Saeed Fathullah

24 Pharyngitis and pharyngeal abscesses Dr. Sherko Saeed Fathullah

25 Tonsillitis and adenoids Dr. Sherko Saeed Fathullah

26 Tumors of the pharynx Dr. Sherko Saeed Fathullah

27Miscellaneous conditions of the pharynx and throat Dr. Sherko Saeed Fathullah

28 Neck masses and salivary glands Dr. Sherko Saeed Fathullah

Lecture title: Anatomy and physiology of the larynx.Lecturer name: Dr. Hiwa As'ad Objectives: This lecture is dedicated to help medical students understand anatomy and physiology of the larynx and their clinical importance, the lecture includes:a. Introduction to laryngeal structure.

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b. Description of laryngeal structure (laryngeal cartilages and membranes, muscles of the larynx and their actions) demonstrated by figuresc. Description of surface anatomy of the larynx.d. Blood supply, nerve supply, and lymphatic drainage of larynx and their clinical importance.e. Description of functions of larynx.Lecture title: Traumatic conditions of the larynxLecturer: Dr. Hiwa As'adObjectives: This lecture is dedicated to help medical students understand management of trauma of larynx and neck which is a common clinical condition that they will face frequently in their practice in hospital and emergency department, the lecture includes:a. Introduction to laryngeal and neck trauma.b. Description of mechanism of injury (blunt trauma injury and penetrating trauma).c. Initial evaluation, clinical assessment, endoscopic assessment and imaging of the larynx.d. Classification of laryngeal injury according to extent of damage.e. Management of laryngeal trauma, goals of laryngeal exploration, laryngeal repair, and management of associated vascular and esophageal injuries.

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f. Outcome of management of this condition.

Lecture title: Inflammations of the larynx: Acute laryngitisLecturer name: Dr. Hiwa As'adObjectives: This lecture is dedicated to help medical students understand this common problem that they will face in their practice in outpatient clinic, emergency department or if they work in otolaryngology or pediatric departments, the lecture includes:a. Introduction to acute laryngitis and its etiological factors.b. Description of clinical types of acute laryngitis. c. Comparison between pediatric patients and adult patients and relative clinical points to be considered.d. Treatment options and outcome.Lecturer title: Inflammations of the larynx: Chronic laryngitisLecturer name: Dr. Hiwa as'ad

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Objectives: This lecture is dedicated to understand this troublesome condition caused by various etiological factors, and its types (specific and non specific), the lecture includes:a. Definition and etiological factors of chronic laryngitis.b. Clinical classification of chronic laryngitis into specific and non-specific, and subgroups of each type.c. Pathology, clinical features, and treatment modality for each type.

Lecture title: Tumors of the larynx: Benign tumorsLecturer name: Dr. Hiwa As'adObjectives: This lecture is dedicated to help medical students understand this important conditions that might affect respiration and voice of patients that needs specific management, the lecture includes :a. Introduction.b. Classification of benign tumors.c. Clinical features, diagnosis and treatment of each type.d. Pseudotumors types , clinical features and management of each type.Lecture title: Tumors of the larynx: Malignant tumorsLecturer name: Dr. Hiwa As'ad

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Objectives: This lecture is dedicated to help medical students understand this serious condition and develop high sense of suspicious for early diagnosis. It also demonstrates treatment options of this condition, the lecture includes:a. Introduction.b. Classification of carcinoma of larynx.c. Demonstration of etiological factors.d. Clinical features, examination of the larynx and the neck.e. Radiological investigations and other relevant investigations to assess tumor extension and spread.f. Staging and grading of Ca larynx.g. Demonstration of strategy of treatment and the options available for this condition. Lecture title: HoarsenessLecturer name: Dr. Hiwa As'adObjectives: to understand the students the meaning of the hoarseness & its causes &its treatment, were all objectives included in the lecture.

Lecture title: Anatomy & Physiology of nose & paranasal sinusLecturer : Dr. Yousif Chalabi

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Objective: To emphasize the importance of anatomy &its variations especially the osteomeatal complex in the clinical managements of common nose &sinus chronic diseases & correction of nose & nasal septum both for physiological & cosmetic purposes , the lecture includes

e. an embyrological introduction to explain some congenital variation of nose like choanal atresia

f. anatomy of external nose &its skeleton to explain the anatomical dangerous region of nose &anatomical & physiological background of cosmetic nasal surgery.

g. anatomy &physiology of nasal fossae & its wall , their role in respiration

h. anatomy of paranasal sinuses &their variation with its impact on pathogenesis of chronic sinus diseases & facial pain

Lecture title: congenital anomalies and trauma to the noseLecturer: Dr Yousif ChalabiObjectives : to emphasize the importance of early diagnosis of some congenital anomalies as a cause of embarrassed respiration in neonates & infants for urgent interference &to explain the clinical managements of broken nose &face both medically &legally in addition to

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its impact on possible intra cranial ,base of skull , cosmetic & respiratory complications to guarantee early proper detection &management to prevent subsequent sequels. The lecture includes a quick review of embryological formation of nose. its openings & anatomy of nasal skeleton , Choanal atresia , fracture nasal bone &facial bones (Leforts) fractures , Foreign bodies in nose & their managements.

Lecture title : Acute & Chronic nasal &paranasal sinus inflammationLecturer: Dr Yousif ChalabiObjectives: To consider the predisposing factors& their prevention in the etiology of acute nasal & paranasal sinus (PNS) infections & to emphasize the effects of prompt & early treatments in prevention of persistence of infections & changing to chronic state. And how to manage whether medically or surgically the chronic state.The lecture includes

f. A quick review of key points of previous lectureg. Acute viral &bacterial infections of nose &PNSh. Chronic non-specific nasal &PNS inflammationi. Chronic specific nasal & PNS infection

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j. Managements including the medical & surgical way of treatments

Lecture title: EpistaxisLecturer: Dr Yousif ChalabiObjectives : This lecture is dedicated to emphasize the importance of epistaxis as one of common acute emergencies in medicine in general & to teach the students how to manage it as first-aid , general &specific ENT managements . How to identify its causes as a local nasal causes or general systemic causes especially the blood dyscriasis causes . How to be treated specifically , generally & how to prevent & guard against it .The lecture includes

e. A quick review of key points of previous lecturef. an introduction to epistaxisg. Causes as a local nasal causes &general systemic

causesh. Management including the lab hematological.,

radiological & endoscopical way to find the cause as local nasal or general systemic . how to be treated whether medically or surgically conservatively or radically &how to be followed up properly.

Lecture title: Allergic Rhinitis & Nasal polyposisLecturer: Dr Yousif Chalabi

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Objectives: to emphasize the role of preventative measures especially the avoidance of allergens .proper use of immunization & medical treatmentsIn reducing the complaint & severity of allergic patients. How to differentiate the different causes of wet nose including infections allergy & intrinsic vasomotor rhinitis &how to be treated properly .The lecture is dedicated to make the students understand the nature of common nasal problem of polyposis & how to differentiate it from normal or hypertrophied turbinates . To emphasize the role of medical treatment as an effective measures in the early & small polypi or as a preliminary measures for effective radical treatment or follow up for those treated surgically.The lecture includes

f. A quick review of key points of previous lectureg. An introduction to the types of hypersensitivity

reactions &nature of nasal allergyh. Etiology of allergy &types of allergensi. Management including the differentiation &how to

diagnose different types of wet nose. Allergy dermatological & hematological test in addition to proper way of prevention &treatments

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j. Nasal polyposis as a pathogenesis , diagnosis & treatments whether medically emphasizing the role of proper use of cortisone in a non contra-indicated patients or surgically whether conservatively or radically by FEES or conventionally by traditional surgical way

Lecture title : The deformed nose & nasal obstructionLecturer: Dr Yousif ChalabiObjectives: This lecture is dedicated to emphasize the role of cosmetic nasal surgery with consideration of nasal passage for proper respiratory functions which so frequently threatened by some surgeon not considering the physiological aspect of nasal function &how to deal with nose surgically both for physiological & cosmetic purposes . It also aims to make the students understanding the causes of nasal obstruction &to differentiate the pathological from normal physiological obstructions of nasal cycle .The lecture includes

e. A quick review of the key points of previous lecturef. A review of the nasal respiratory physiology

&anatomy of the nasal skeletong. Causes of deformed nose &nasal obstructionh. Management including the requested examination

whether endoscopically or by imaging (CT SCAN) to

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determine the causes &sites of obstructions & how to be treated whether medically or surgically whether for cosmetic or physiological purpose separately or in combinations.

Lecture title : Tumors of nose & paranasal sinusesLecturer: Dr Yousif ChalabiObjectives: The lecture is dedicated to make the students understanding the nature of tumors &how the malignant tumors present with specific signs & symptoms to be differentiated from benign one .What are the predisposing factor & the definite causes to be diagnosed early before extension to nearby vital & dangerous area of eye & intracranially . Although generally they are rare tumors but they carry a great morbidity & mortality necessating a special considerations by the juniors &the surgeon. Also to teach the students how these tumors presents with different signs & symptoms making the patients wandering among different specialty until diagnosed too late as a nasal or paranasal malignant tumors.The lecture includes:

e. A quick reviews of key points of previous lecturef. classifications of tumors as benign & malignant with

their different types . Histological classification & staging of tumors

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g. predisposing & etiological factor for tumor causationh. Managements including the diagnosis of tumors

whether benign or malignant &the best selected way of treatments whether surgically or by DXRT or combined in addition to their prognosis

Lecture title : Anatomy, physiology of the earLecturer name: Dr. Muaid Ismaiel AzizObjectives: This lecture is dedicated to help medical students understand anatomy and physiology of the ear and their clinical importance, the lecture will deal with followings :

1. Anatomical parts of the ear2. Anatomical landmarks of the ear3. Functions of the ear

Lecture title: Physical & radiological assessment of the ear diseasesLecturer name: Dr. Muaid Ismaiel AzizObjectives: in this lecture the students will learn how to examine & get diagnosis of the ear diseases as its includes;

5. The different ways of ear examination

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6. What you will see in normal ear examination to make differentiation from disease ear

7. Audio logical assessment & its interpretation8. Role of plain x-ray & ct scan in ear disease & their

indications. Lecture title: Symptomatology in ear diseasesLecturer name: Dr. Muaid Ismaiel AzizObjectives: to know different ear disease symptoms as deafness (hearing loss), tinnitus (perceptive noisy sound), vertigo (rotating movement of the surrounding or the patient himself with fixed environment ) , otalgia (pain in the ear). So you will get information about above topics shortly including their classifications, differential diagnosis , diagnosis & treatments.

Lecture title: Diseases of the external ear ( cong. anomalies, infections, tumors )Lecturer name: Dr. Muaid Ismaiel AzizObjectives: to make the student oriented with the different ear diseases starting from external ear diseases, in this lecture will discuss the congenital diseases like auricle deformity ( bat ear) , preauricular sinus , otitis externa & its most common causes & types & its

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treatment ,also will concentrate on benign & malignant tumors like osteoma , basal cell carcinoma .

Lecture title : Diseases of the middle ear (acute otitis media)Lecturer name: Dr. Muaid Ismaiel AzizObjectives: in this lecture the student will face the most important & commonest pathology which is middle ear infection (otitis media), pathology, types, causes, diagnosis & treatment.Lecture title : Diseases of the middle ear (chronic otitis media)Lecturer name: Dr. Muaid Ismaiel AzizObjectives: chronic OM classified into safe & unsafe disease, so its important to know both types & its pathology & treatment , also will discuss different classifications for CSOM & which of them is useful.

Lecture title : Diseases of the inner ear , ear surgeriesLecturer name: Dr. Muaid Ismaiel AzizObjectives: in this lecture some of the inner ear disease which is more common than other inner ear disease like otosclerosis , meniers disease will discussed briefly in addition the students will get good & sufficient

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information about the common ear surgeries like myringotomy , myringoplasty.

Lecture title : Anatomy and physiology of the pharynxLecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture the students will get enough information Concentrating on boundaries and parts of the pharynx including naso , oro and laryngopharynx, as well as muscles , nerve supplies with short notes on the anatomy of soft palate .In physiology, function of pharyngeal lymphoid tissue and deglutition are discussedLecture title : Common diseases of the buccal cavityLecturer name: Dr. Sherko Saeed FathullahObjectives: Some of the common diseases of otolarygologist interest are described including : stomatitis , aphthous ulcers , Behcet’s syndrome tongue ulcers and AIDS , notes on cysts of mouth , carcinoma of the toungue , ludwing’s angina and tumours of the oral cavityLecture title : Pharyngitis and pharyngeal abscessesLecturer name: Dr. Sherko Saeed FathullahObjectives: in this lecture the students will know about common disease in the community (pharyngitis) Acute

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and chronic specific and non specific pharyngitis as well as acute and chronic pharyngeal abscesses, Pharyngitis and pharyngeal abscesses,& how these conditions can be dealt with.Lecture title : Tonsillitis and adenoidsLecturer name: Dr. Sherko Saeed FathullahObjectives: Concentrating on acute and chronic tonsillitis with their complications .Tonsillectomy and post operative cares , Peritonsillar abscess ,Clinical features of nasopharyngeal tonsillitis , its complication and adenoidectomy , Pharyngitis and pharyngeal abscessesLecture title : Tumors of the pharynxLecturer name: Dr. Sherko Saeed Fathullah Objectives: in this lecture will deal with important subject which is tumors of pharynx & its includeTumors of the nasopharynxTumors of the oropharynxTumors of the laryngopharynxLecture title : Misceleneous conditions of the pharynx and throat Lecturer name: Dr. Sherko Saeed FathullahObjectives: including Globus hysterics , palate and pharyngeal palsy , pharyngeal spasm , pharyngeal pouch , trismus , cleft palate and elongated styloid process

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Lecture title : Neck masses and salivary glandsLecturer name: Dr. Sherko Saeed FathullahObjectives: in this lecture will discuss Thyroglossal cyst and fistula , branchial cyst , cystic hygroma sternomastoid tumor as well as mumps , submandibular gland calculus and sialography.

Student feedback for the subject of a lecture

Date: course: year: lecturer: title:

No. Evaluation Questions Score(1-5)

Subjective Remarks


2 The contents of the subject were useful and related to the main objectives of the course

3 The materials were prepared carefully as needed

4 The lecturer/ tutor while lecturing tried to analyze the principles, contents and the important points of the subject simply and properly.

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5 The lecturer/ tutor while lecturing kept my attention.

6 The lecturer/ tutor came into the classroom on time and was committed to the duration of the lecture.

7 The lecturer's behavior in the classroom was calm and respectful

8 The slides used in the lecture were clear and attractive.

9 At the end of the lecture, the lecturer gave the students a chance for questions and comments. His/ her answers were complete.

10 The reading sources are new and compatible with the subject.Total score

1-very bad 2–bad 3–medium 4- good 5-verygood

Examinations.

Types of questions:

1-short essay.

2-long essay.

3-multiple choice questions.

4-Single choice questions

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Time of exam.

3 Three hours.

The number of questions and marks are variables :

The methods of correction of answers depend on key answers of single choice and key for multiple choice questions & its usually that false answer will council the true answer in MCQ (either one for one or two for one) and correction and marks are given accordingly.

Advices and directions for all students before and during exams.

5-Read the question twice before answering.6-Think of the answer before writing.7-Plan your answer in a separate page before

writing it down on the answer paper.8-Arrange the answer in the form of introduction,

contents and the final part so that the student organizes his/her answer

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Samples of MCQ , Single choice , long and short essays

Single choice question

2. middle turbinate is formed by:

(….)A. vomer bone(….)B. Ethmoid bone(….)C. Maxilla bone(….)D. All of the above(….)E. none of the abovethe correct answer is ( B )

MULTIPLE CHOICE QUESTIONS

4. Regarding carcinoma of the larynx:

e. SCC is the most common pathologyf. Smoking has no any role in incidenceg. Neck mass ( lymph node invasion )is more incident

with glottis carcinomah. Surgery always curative

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The answers as fallow a. T , b. F , c. F , d. F

SHORT ASSAY ON TREATMENT OF ALLERGIC RHIINITIS

ANSWER

Treatment: includes allergen avoidance, pharmacotherapy , immunotherapy & surgery which is rarely needed when there is local pathology affecting the regress of the symptoms like septal deviation , turbinate hypertrophy, nasal polyp.Medication include :

8. Antihistamines : these rapidly relieve running, itching, & sneezing, but have little effect on blockage. 1st generation antihistamines ( chlorphenramine & diphenhydramine) should be avoided because of sedation effect , its better to use non-sedative 2nd generation like (loratidine, fexofenadine).

9. Topical corticosteroids: these are most effective for treatment of rhinitis especially if started prior to allergen exposure, it reduces inflammation, nasal ,

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eye symptoms & improve sense of smell e.g ( mometasone , beclomethasone , fluticasone ).

10. Sodium cromoglicate: its weak effective against all rhinitis symptoms but useful for children aged less than 4 years.

11. Decongestant : topically used for reducing nasal obstruction ,but increase rhinorroea . Systemic decongestant not effective with systemic side effects.

12. Ipratropium bromide : this atropine –like nasal spray is useful against rhinorrhoea .

13. Systemic corticosteroids : oral steroids used for very sever symptoms during hay fever season.

14. Antileukotrienes : effective against congestion & mucous Production.

8. Nasal douching : Its effective in seasonal rhinitis. 9. Immunotherapy : Indicated in patients with sever symptoms not get response to routine medical treatments.

write long assay on an intrinsic rhinitis

Answer : Is a non-infective , non allergic condition. Like many diseases whose etiology is obscure , its also termed

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as perennial rhinitis or vasomotor rhinitis which is still perhaps the commonest term.

The term ( non allergic rhinitis ) is commonly applied to a diagnosis of any nasal condition in which the symptoms are identical to those seen in allergic rhinitis but an allergic etiology has been excluded .These non allergic entities can be broadly be classified as :

Idiopathic rhinitis ( vasomotor rhinitis ,or non allergic non infectious perennial rhinitis )

Non allergic occupational rhinitis Hormonal rhinitis Drug- induced rhinitis Other forms ( non allergic rhinitis with esinophilia

syndrome, rhinitis due to physical & chemical factors, food-induced rhinitis, emotional rhinitis, atrophic rhinitis ).

unlike allergic rhinitis there are no specific diagnostic tests for non allergic rhinitis & diagnosis is made on the basis of rhinitis symptoms in the absence of identifiable allergy ( by allergy skin test ) , structural abnormality, immune deficiency, sinus disease or other causes.

Clinical presentation : there are 6 main symptoms of rhinitis ,these are nasal congestion ,sneezing, nasal itching , rhinorrhoea , hyposmia & postnasal discharge , of these nasal symptoms significant sneezing & itching are highly suggestive of allergic rhinitis & tend not to occur with

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intrinsic rhinitis , very marked nasal congestion & significant hyposmia tend to be symptoms of non allergic rhinitis. Rhinitis presenting in childhood is almost invariably of allergic etiology , whereas adult onset rhinitis is more likely to be due to intrinsic rhinitis .

Allergic rhinitis is always associated with nasal eosinophilia ( more than 25% of nasal smear cells are eosinophils) ,whereas non allergic rhinitis ( intrinsic rhinitis ) may or may not associated with eosinophilia ,approximately 1/3 of intrinsic rhinitis patients have nasal secretion eosinophilia , so clinically IR classified into Eosinophilic ( obstruction syndrome ) & Non-eosinophilic ( rhinorrhoea syndrome ) groups.

The eosinophilic variety of (IR) was characterized by marked nasal congestion , profuse rhinorrhoea , hyposmia , marked inferior turbinate hypertrophy which is mild in the other group& mucoid nasal secretion , also nasal polyposis is more frequent in eosinophilic groups.

Rhinorrhoea is profuse in both groups but more in non-eosinophilic group which is a predominant feature. The rhinorhoea group tend to occur in relatively advanced age whereas the nasal obstruction group tend to occur in middle age .Other clinical differences between the 2 groups are marked mucosal thickening frequently occurs in the eosinophlic group which is evident on plain radiological

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examination of the sinuses, also noted that patient with eosinophilic (IR) frequently have asthma & occasionally aspirin sensitivety ,neither of which occurs in the non-eosinophilic (IR) group. One of the most clinically obvious differences is dramatic response of the eosinophilic group to intranasal steroids & poor response of the other group to any therapy apart from anticholinergic agents.-------------------------------------------------------------------------------------------------------------------------------------------

From now on every course should have its own

external examiner with identified roles.The one who can play the role of an external examiner should:

Have an academic post with the scientific rank of assistant Professor and higher.

He/she should be an active, reputable and experienced academic staff in his field or a related field to the course.

He/she should have not participated in lecturing or administering of the course.

The roles of the external examiner are: Evaluating the contents and the program of the

course.66


Prior to the exam , he /she should contribute to choosing the questions and looking at the ideal answers.

Evaluating the process of the examinations: he/she should see all the marked exam papers, then choose randomly nine marked papers: three with high marks, three with medium and three with low marks.

Evaluating the students' feedbacks He/she should participate in the final meeting of the

first round examinations committee and give his assessment on the entire course and the examination process, then to give his opinion about the final results.

He/she should participate in the final meeting of the second round examinations committee and should have a main vote on those problems that may face them.

Then the lecturer/ tutor in charge will respond to the external examiner's questions and will reply officially to all the questions and clarify the reasons.

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Student feedback on the course

Date : course: year lecturer:

no. Evaluation Questions Score(1-5)

Subjective Remarks


2 The contents of the subject were useful and were related to the main objectives of the course

3 The coordinator teacher had worked hard to

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prepare the materials4 The coordinator teacher had worked hard to

cooperate and prepare the course 5 The lecturers were carefully selected and were

expert in their fields6 The coordinator teacher gave a good attention to

the students' criticisms and claims7 Information on the Examination process was well

provided8 The questions of the exams were related to the

contents of the course9 There is a potential to promote and develop the

course in the following areas:10 Total of the levels

1-very bad 2- bad 3-medium 4-good 5-very good

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New: 5th year Course Book/E.N.T

Education

Transcript of New: 5th year Course Book/E.N.T