Orientation to Hospital Rotation Malak Gazzaz ENT Demonstrator Umm Al Qura University

Welcome!

This description conveys the true scope of practice of these specialists: the medical and surgical management of any disorder in the entire head and neck region and its related structures (excluding, of course, the eyes and the brain—reserved for ophthalmologists, neurologists, and neurosurgeons). In 1896, a group of prac- ticing ophthalmologists and otolaryngologists conducted a 2-day program of sci- entific presentations in Kansas City, which led to the formation of the Western Ophthalmological, Otological, Laryngological and Rhinological Association. This association was the genesis of the very first specialty board organization in the United States, the American Board of Ophthalmology, formed in 1917, and its successor, the American Board of Otolaryngology, formed in 1924. In 1978 the specialty was renamed Otolaryngology—Head and Neck Surgery to reflect the increase in the breadth of this complex surgical field. Now, head and neck surgery, oncology, skull base surgery, and cosmetic, and reconstructive facial plastics officially became the oto- laryngologist’s realm of expertise.

Otorhinolargyngology Shortened for Otolaryngology! Larynx: throat Rhino: nose Oto: ear Ology: the study of “Otorhinolargyngology” is made up of several Latin root words: ology means the study of the ear (oto), the nose (rhino), and the throat (laryn, as in the word larynx). This long word is frequently shortened to Otolaryngology.

What is ENT? It involves diagnosis, medical treatment and surgical intervention for a variety of diseases affecting the ear, nose and throat as well as related areas of the neck, head and face. hearing loss, tinnitus (ringing), ear infections, balance disorders and ear pain Treatment of the nose includes the sinuses, allergies, nasal polyps, excessive or frequent nosebleeds, snoring and sleep apnea as well as the ability to breathe through and smell with the nose. Management of the throat includes voice and swallowing difficulties as well as treatment for sore throats, enlarged tonsils or adenoids and problems with the upper digestive tract or esophagus Treatment for the head and neck involves management of cranial nerves, cancerous and non-cancerous tumors, facial trauma or facial paralysis and deformities of the head, neck and face.

A wonderful specialty! Combination of surgical and medical problems Diverse patient population Challenging Use of cutting-edge surgical technology Diverse patient population of infants, children, and adults Challenging due to the complexity of anatomy of the head and neck -for example, cochlear implants, the realm of a subspecialty of otology and neurotology, are the only bionic devices available for implantation in infants, children, and adults. Cochlear implants combine breakthroughs in acoustics and microcircuitry with microsurgical ap- proaches to the temporal bone to provide an option for patients who no longer benefit from hearing aids. Three-dimensional CT-guided imaging techniques have enabled sinus surgeons and skull base surgeons to access complex regions of the head and neck with greater precision and safety. -Surgical cases range in complexity from simple tonsillectomies and myringotomies to mi- crosurgery of the ear and skull base, benign and malignant head and neck tumor surgery, reconstructive airway surgery, nasal and sinus surgery, microscopic voice surgery, and even cosmetic facial plastic and reconstructive procedures.

What makes a good Otolaryngologist?  Prefers working with his or her hands  Always brings new creative approaches to the same problem  Enjoys extensive patient contact  Likes seeing the immediate results of treatment  Is a perfectionist who pays close attention to details

Fellowships and Subspecialty Training Sinus Surgery/Rhinology Laryngology Otology, Neurotology, and Skull Base Surgery Head and Neck Surgery Pediatric Otolaryngology Facial Plastics/Reconstructive Surgery

The doctor-patient relationship Long term Short term Head and neck surgeons General otolaryngologists or sinus surgeons Pediatric otolaryngologists Otologists Laryngologists Facial plastics Head and neck surgeons often have long-term relationships with their patients. General otolaryngologists or sinus surgeons may care for adults with chronic up- per aerodigestive tract infections for months or years. Pediatric otolaryngologists may see children for years to manage recurrent infection or chronic airway prob- lems. Otologists maintain long-term relationships to follow hearing loss, chronic mastoiditis, tumors of the skull base, and Meniere disease. Head and neck on- cologists follow patients for the duration of their disease, and then to monitor re- currence following surgery, radiation, or chemotherapy. Laryngologists may have long-term relationships with patients who have vocal cord paralysis, spasmodic dysphonia, laryngeal carcinoma, or professional voice issues. Facial plastics sur- geons’ relationships with their patients are typically brief.

Otolaryngology - Head and Neck Surgery Course 3 weeks Duration Week 1: Lectures Week 2: Clinical Rotation Week 3: Clinical Rotation

Otolaryngology - Head and Neck Surgery Course Course Coordinators: Dr. Ameen Al-Herabi Dr. Osama Marglani

Kind Abdulaziz medical city (National Guard Hospital), Jeddah Kind Abdullah medical city, Makkah Al-Zaher Hospital, Makkah Al-Noor Specialist Hospital, Makkah. King Faisal Hospital, Makkah Hera’a General Hospital, Makkah. Kind Abdulaziz medical city (National Guard Hospital), Jeddah King Fahad Hospital, Jeddah

Clinical Rotation OR Ward Clinic

See daily Otolaryngology – Head & Neck Surgery practice How patients are interviewed ( history taking ) How to examine ear, nose, throat, head and neck. To use common instrument in diagnosis and management Learn basic Audiological test and its interpretation.

Otology How to use the otoscope Describe landmarks on visualization of the tympanic membrane Recognize and describe abnormal findings on ear examination Perform Weber and Rinne tuning fork tests Obtain a history characterizing dizziness to differentiate vestibular versus non-vestibular causes of dizziness Perform Weber and Rinne tuning fork tests and be able to differentiate between conductive and sensorineural hearing loss using tuning fork tests, i.e. understand the difference between bone conduction and air conduction

Sinus Surgery/Rhinology Examine the nose using a headlight and nasal speculum Recognize a septal deviation Recognize nasal polyps and differentiate it from normal anatomy (turbinates) Identify Little’s area, a common site of epistaxis Advise a patient with recurrent epistaxis on epistaxis precautions, and witness management of simple nosebleed Order appropriate investigations for acute and chronic sinusitis

Head and Neck Surgery To examine the neck and recognize normal and abnormal structures Describe relevant characteristics of a neck mass Order appropriate investigations of a neck mass

Evaluation Methods

Last years’ results 2011

References ENT Toronto Notes

References Lecture Notes On Diseases of Ear, Nose & Throat, By E. H. Miles Foxen

References New Short Textbook of Otolaryngology, By MS McCormick, W J Primrose