Diploma in Laryngology and Otology (DLO)

 

 

P.G. Curriculum

Diploma in Laryngology and Otology (DLO)

Index

 

 

 

1. Goals

 

 

2. Objectives

 

                                 

3. Syllabus 

 

 

4. Teaching Program

 

 

5. Posting

 

 

6. Assessment

 

 

7. Job Responsibilities

 

 

8. Suggested Books 

 

 

9. Model Test Papers

 

                   

 

             

 

 

 

 

 

 

P.G. Curriculum

Diploma in Laryngology and Otology (DLO)

 

The infrastructures and faculty of the department of ENT will be as per MCI guidelines.

 

1. Goals 

 

The goals of DLO course in ENT are to produce a competent Otolaryngologist who:

•   Recognizes the health needs of ENT patients and carries out professional obligations in keeping with principles of National Health Policy and professional ethics.
•   Has the acquired competencies pertaining to ENT that are required to be practiced in the community and that all levels of health care system.
•   Has acquired skills in effectively communicating with the patient, family and community.  
•   Is aware of the contemporary advances and developments in medical science as related to Otolaryngology.  
•    Is oriented to principles of research methodology.  
•    Has acquired skills in educating medical and paramedical professionals.

    

2. Objectives

 

At the end of DLO course in ENT, the student will be able to :

•    Practice the speciality of Otolaryngology in keeping with the principles of professional ethics. 
•    Recognize the key importance of deafness control programme in the context of health priority of the country.  
•   Take detailed history, perform physical and local ENT examination including Indirect Laryngoscopy, Anterior, Posterior rhinoscopy, otoscopy, audiometric assessment and interpretation. 
•    Perform relevant investigative and therapeutic procedures for the ENT patient.
•        Interpret important imaging and laboratory results.
•   Diagnose ENT problems based on the analysis of history, physical examination and investigative work
•         Plan and deliver comprehensive treatment for ENT pathologies. .
•    Plan and advise measures for the prevention of deafness, allergies, head neck cancers and to plan rehabilitation accordingly. 
•                    Manage ENT emergencies efficiently.
•    Demonstrate skills in documentations of case details and of morbidity and mortality data relevant to the assigned situation.
•    Demonstrate empathy and humane approach towards patients and their families and respect their emotions. 
•   Demonstrate communicate skills in explaining management and prognosis, providing counseling and giving health education messages to patients and their families. 
•    Develop skills as self directed learner, recognize continuing educational needs, use appropriate resources and critically analyze relevant published literature in order to practice, evidence, based otolaryngology. 
•      Demonstrate competence in basic concepts of research methodology and epidemiology.
•    Facilitate learning of medical/nursing students, practicing physicians, para-medical health workers and other providers as a teacher trainer.
•    Play the assigned role in the implementation of national deafness programs, effectively and responsibly.
•          Organize and supervise the desired managerial and leadership skills.
•      Function as a productive member of a team engaged in health care, research and education. 

 

3. Syllabus

 

1. 1. Theory

 

 BASIC SCIENCES

 

 Ear 

•  Anatomy embryology and ultrastructure of the human ear.
•  Physiology of hearing.
•  Assessment of hearing. 
•  Hearing loss.
•  Physiology of equilibrium and its application to the dizzy patient.
•  Assessment of vestibular function
•  Eustachean tube anatomy and physiology
•  Facial nerve
•  Temporal bone

 

 Audiology

•  Audiometry and masking. 
•  Tympanometry
•   BERA

 

 Nose and Paranasal Sinuses  Anatomy and Embryology.

•  Physiology.
•  Pathophysiology of the ears and nasal sinuses in flight and diving.
•  Nasal Septum.
•  Evaluation of the nasal airway (Rhinomanometry)

 

 Oral cavity

•  The embryology /anatomy of mouth and related faciomaxilllary structure        Embryology/anatomy and physiology of salivary glands

 

 Pharynx and oesophagus

•  Anatomy, embryogensis and physiology of pharynx
•  Anatomy and embryogenesis of eosophagus and its relations  Physiology of deglutination

 

 Larynx and tracheobronchial tree

•  Anatomy and embryology
•  Physiology of respiration
•  Physiology of phonation

 

 Skull base   Surgical anatomy

•  Clinical neuroanotomy

 

 Neck

•  Facial spaces of head and neck
•  Lymph nodes of head and neck  
•  Thyroid gland

 

 imaging and radiology   

• Image taking and interpretation of ultrasound, angiography, dacrocystography,     x-rays, CT,.MRI, barium studies ,contrast studies etc with respect to ENT

 Basic immunology 

•  Microbiology as related to ENT
•  Wound healing principle
•  Intensive care in ENT patients
•  Anesthesia in ENT
•  Biomaterials used in ENT
•  Medical negligence in otolaryngology
•  Principle of chemotherapy
•  Principle of radiotherapy
•  Principle and use of nuclear medicine
•  Principle of laser surgery

 

 DISORDERS: THEIR MEDICAL/SURGICAL MANAGEMENT

 

 EAR

Etiology and management of inflammatory condition of external and middle ear

•  Pathology of cochlea
•  Pathology of vestibular ear
•  Diseases of external ear
•  Diseases of Eustachian tube

 Ear trauma

•  Management of CSOM and cholesteatoma. 
•  Complications of  CSOM and their management
•  Otosclerosis etiopathogenesis and management 
•  Menier’s disease etiopathogenesis and management
•  Sensorineural hearing loss causes and management

 Vertigo

•  Otalgia causes and management
•  Tinnitus causes and management

 Ototoxicity

•  Acoustic neuroma
•  Epithelial tumours of EAC and middle ear
•  Glomous tumour of ear
•  Facial nerve disorder, etiopathogenesis and management

 Cochlear implants

•  Rehablitation of hearing impaired
•  Reconstruction of ear

 

 NOSE AND PNS

•  Conditions of external nose
•  Abnormalities of smell
•  Mechanism and treatment of allergic rhinitis
•  Food allergy and rhinitis
•  Infective rhinitis and sinusitis 
•  Complications of sinusitis
•  Intrinsic rhinitis
•  Nasal polyps
•  CSF rhinorrhoea
•  Fracture of facial skeleton
•  Rhinoplasty
•  Epistaxis
•  Snoring and sleep apnea
•  Non healing granulomas of nose
•  Facial pain and headache
•  Aspects of dental surgery for ENT 
•  Trans sphenoidal hypophysectomy
•  The orbit with relation with nose
•  Cysts,granulomas and tumours of jaws, nose and sinuses
•  Deviated septum and septoplasty
•  Neoplasm of nasal cavity
•  Neoplasm of PNS

 ORAL CAVITY AND SALIVARY GLAND

•  Common disorder of oral cavity
•  Tumors of oral cavity
•  Non neoplastic disorder of oral cavity
•  Neoplasm of salivary gland 1.bengin 2.malignant

 

 PHARYNX AND ESOPHAGUS

 Acute and chronic infection of pharynx

•   Neurological affective of pharynx
•  Pharyngeal pouches

 Abscesses in relation to the pharynx

•  Angiofibroma
•  Nasopharyngeal malignancy
•  Tumours of oropharynx and lymphomas of head and neck  Tumours of hypopharynx
•  The oesophagus in otolaryngology.   Dysphagia
•  Foreign bodies of food passage

 

 LARYNX

•  Acute and chronic laryngitis
•  Disorders of voice
•  Management of obstructive airway and tracheostomy
•  Trauma and stenosis of larynx
•  Neurological affections of larynx
•  Tumours of larynx (benign & malignant)
•  Congenital lesion of larynx and stridor

 

 NECK /FACE

•  Benign disease of neck
•  Metastatic neck disease
•  The thyroid gland benign / malignant disorders
•  Tumours of infratemporal fossa and parapharyngeal space  Facial plastic surgery.
•  Plastic and reconstructive surgery of head and neck

 

 PAEDIATRICS OTOLARYNGOLOGY

•  Genetic factors and deafness
•  Causes of deafness
•  Testing hearing in children
•  Screening and surveillance for hearing impairment in pre school children
•  Otitis media with effusion
•  Acute and chronic suppurative otitis media in children  Surgery of congenital absence of external /middle ear  Management of hearing impaired child.
•  Cochlear implantation in children
•  Vesitublar disorder in children
•  Speech and language development
•  Foreign body in ear and nose
•  Congential anomalies in nose
•  Craniofacial anomalies
•  Nasal obstruction , rhinnohrea in infants and children
•  Tonsils and adenoids
•  Dental development ,orthodontics, cleft lip and palate
•  Sleep apnea
•  Stertor and stridor
•  Acute laryngeal infections
•  Home care of tracheostomised children
•  Branchial cleft anomalies, thyroglossal cyst and fistula.
•  Tumors of head and neck in children
•  The drooling child
•  Recurrent respiratory papillomatosis
•  Pediatrics anesthesia

 

1. 2. Practical 

 History and examination: History taking pertaining to Otolaryngology and examination like: anterior and posterior rhinoscopy, oral cavity examination, indirect laryngoscopy, otoscopy, neuro-otology testing, tuning fork testing, audiometry, impedance and vestibular function testing, examination of Eustachian tube, functional examination of nose, transillumination test.  Neck examination, examination of cranial nerves & cervical lymph nodes.  Nasal endoscopy, flexible fibreoptic laryngoscopy, micro-ear examination (according to the facilities available in the department).

 

 Monitoring skills:  Temperature recording, capillary blood sampling, arterial  blood sampling.  Cardio-respiratory monitoring, post-op patient monitoring  and management accordingly, tracheostomy care, blood gas analysis, airway management.  

 

 Therapeutic skills: Tracheostomy, anterior/posterior nasal packing, ear packing, syringing, foreign body removal from ear/nose/throat, airway management,  nasogastric feeding, endotracheal intubation, cardiopulmonary resuscitation, administration of oxygen, venepuncture and establishment of vascular access, administration of fluids, blood, blood components, parenteral nutrition, common dressings, abscess drainage and basic principles of rehabilitation.

 

 Diagnostic skills: Interpretation of X-rays/CT/MRI of Head, nose and paranasal  sinuses, ear, neck & chest.  Understanding of audiograms, ENG. BERA, ultrasonographic abnormalities. 

 

 Surgical skills: The first year resident observes the general layout and working of the OT, understands the importance of maintaining sanctity of the OT, scrubbing,   working and sterilization of all the OT instruments, know-how of endoscopes, microscopes and laryngoscopes. He/She is responsible for shifting of OT patients, for participating in the surgery as second assistant and for post op management of the patient in recovery and in ward.    

 The residents are provided with the facilities for temporal bone and cadaveric dissection which are checked periodically. 

 

4. Teaching Program 

 

1. 1. General Principles

• Acquisition of practical competencies being the keystone of postgraduate medical education, postgraduate training is to be skills oriented.
• Learning in postgraduate program is to be essentially self-directed and primarily emanating from clinical and academic work.  The formal sessions are merely meant to supplement this core effort.

 

1. 2. Teaching Sessions

• Journal club 
• Speciality clinic
• Thesis meeting.
• Seminar
• Case Presentation.
• Central session (held in hospital auditorium regarding various  topics like CPC, guest lectures, student seminars, grand round, sessions on basic sciences, biostatistics, research methodology, teaching methodology, health economics, medical ethics and legal issues).

 

1. 3. Teaching Schedule 

 

                            Journal club/Seminar                                                                        Once a week

                            Speciality clinic (Vertigo/head neck cancer)                                  Once a week

                            Thesis Meeting                                                                                   Once a week

                            Seminar/Case presentation                                                              Twice a week

                            Central Session                                                                                  Once a month

             

Note:

•  All sessions are to be attended by the faculty members.  All PGs are supposed to attend the sessions except the ones posted in emergency.
•  All the teaching sessions are assessed by the consultants at the end of session and marks are given out of 10 and kept in the office for internal assessment.
•  Attendance of the Residents at various sessions has to be at least 75%.

 

5. Postings 

 

• The post graduate students should rotate to all the sections in the department.

 

• 1^st yr Resident      Alternate weekly duties in Ward and OPD/ Audiology/Neuro-otology.
• 2^nd yr Resident     Alternate weekly duties in OT and OPD/ Audiology/Neurootology

 

 

• No posting at one area is more than 2 weeks at a stretch. 

 

• During first year the resident will work under direct supervision of the 2^nd year resident/senior resident and consultant on call.  He/She will be responsible for taking detailed history, examination of patients as per the file record and send appropriate investigations as advised by seniors. Initially all procedures are to be observed and then done under supervision of seniors and during 2^nd year can do procedures independently. The second year resident is responsible for the pre-op work up of the patient, surgical planning and understanding the rationale of surgery. He/She is the first assistant in surgery and is responsible for anticipating intra-op and post-op complications and managing them.  In addition, 2nd year, resident will be posted in speciality clinics and will also be responsible for making of discharge cards including referrals.  

 

6. Assessment

• All the PG residents are to be assessed daily for their academic activities and also periodically.

 

1. 1. General Principles

 

•                                       The assessment is valid, objective and reliable.
•                                       It covers cognitive, psychomotor and affective domains.
•        Formative, continuing and summative (final) assessment is also conducted in theory as well as practicals/clinicals.  In addition, thesis is also assessed separately.

 

1. 2. Formative Asessment

• The formative assessment is continuous as well as end-of-term.  The former is to be based on the feedback from the senior residents and the consultants concerned.  End-of-term assessment is held at the end of each semester.  Formative assessment will not count towards pass/fail at the end of the program, but will provide feedback to the candidate. 

 

1. 3. Internal Assessment

• The performance of the Postgraduate student during the training period should be monitored throughout the course and duly recorded in the log books as evidence of the ability and daily work of the student. Marks should be allotted out of 100 as followed.

 

Sr. No.	Items		Marks
1.	Personal Attributes		20
2.	Clinical Work		20
3.	Academic activities		20
4.	End of term theory examination		20
5.	End of term practical examination		20

 

1. Personal attributes

 Behavior and Emotional Stability: Dependable, disciplined, dedicated, stable in emergency situations shows positive approach.

 Motivation and Initiative: Takes on responsibility, innovative, enterprising, does not shirk duties or leave any work pending.

 Honesty and Integrity: Truthful, admits mistakes, does not cook up information, has ethical conduct, exhibits good moral values, loyal to the institution.  

 Interpersonal Skills and Leadership Quality: Has compassionate attitude towards patients and attendants, gets on well with colleagues and paramedical staff, is respectful to seniors, has good communication skills. 

 

2. Clinical Work:

 Availability: Punctual, available continuously on duty, responds promptly on calls and takes proper permission for leave. 

 Diligence: Dedicated, hardworking, does not shirk duties, leaves no work pending, does not sit idle, competent in clinical case work up and management.

 Academic ability: Intelligent, shows sound knowledge and skills, participates adequately in academic activities, and performs well in oral presentation and departmental tests.  

 Clinical Performance: Proficient in clinical presentations and case discussion during rounds and OPD work up. Preparing Documents of the case history/examination and progress notes in the file (daily notes, round discussion, investigations and management) Skill of performing bed side procedures and handling emergencies.

 

3. Academic Activity: Performance during presentation at Journal club/ Seminar/ Case discussion/ Stat meeting and other academic sessions.  Proficiency in skills as mentioned in job responsibilities.  

 

4. End of term theory examination conducted at end of 1^st year and after 9 months.

 

5. End of term practical/oral examinations after 1 year 9 months.

 

•   Marks for personal attributes and clinical work should be given annually by all the consultants under whom the resident was posted during the year. Average of the three years should be put as the final marks out of 20.

 

• Marks for academic activity should be given by the all consultants who have attended the session presented by the student. 

 

•  The Internal assessment should be presented to the Board of examiners for due consideration at the time of Final Examinations. 

 

1. 4. Summative Assessment

 

•  Ratio of marks in theory and practicals will be equal.
•  The pass percentage will be 50%.

 Candidate will have to pass theory and practical examinations separately.

A. Theory examination
Title		Marks
Paper 1: Basic Sciences as related to Ear, Nose & Throat.		100
Paper 2: Principles & Practice of Ear, Nose & Throat		100
Paper 3: Operative Surgery of ENTand recent advances.		100
Total		300

                                                 

B. Practical examination 

1. Long Case (1)                                                                                    100
2. Short Cases(2) 50 marks each                                                            100
3. Viva Voce                                                                                  100

                                                                                                                                     

                                                                                                                             Total               300

                                     

 

7. Job Responsibilities

 

During first year the resident will work under direct supervision of the 2^nd year resident/senior resident and consultant on call.  He/She will be responsible for taking detailed history, examination of patients as per the file record and send appropriate investigations as advised by seniors. Initially all procedures are to be observed and then done under supervision of seniors and during 2^nd year can do procedures independently.  In 2^nd year, resident is posted in speciality clinics and is also responsible for making of discharge cards including referrals.  In 2^nd year, the resident is encouraged to make independent decisions in management of cases. He/She is also involved in teaching of undergraduate students in OPDs.

 

The first year resident observes the general layout and working of the OT, understands the importance of maintaining sanctity of the OT, scrubbing,   working and sterilization of all the OT instruments, know-how of endoscopes, microscopes and laryngoscopes. He/She is responsible for shifting of OT patients, for participating in the surgery as second assistant and for post op management of the patient in recovery and in ward.   The second year resident is responsible for the pre-op work up of the patient, surgical planning and understanding the rationale of surgery.  He/She is the first assistant in surgery and is responsible for anticipating intra-op and post-op complications and managing them.  

 

8. Suggested Books & Journals  

       

1. 1. Books

                   

•  Diseases of ear, nose and throat, Scott Brown
•  Head and Neck surgery, PM Stell & AGD Maran
•  Surgery of the Ear, Glasscock & Shambaugh
•  Otolaryngology - Head & Neck Surgery, Cummings 
•  Diseases of ear, nose and throat, Logan Turner
•  Diseases of ear, nose and throat, PL Dhingra
•  Audiological assessment, Anirban Biswas
•  Otolaryngology, Otology & Neurotology, Paprella & Micheal S.
•  Essentials of endoscopic sinus surgery, Stamberger  Colour Atlas of Head & Neck Surgery, Jatin P Shah

 

1. 2. Journals

•  Archives Otolaryngology.
•  Journal of Laryngology & Otology.
•  Journal of Otolaryngology, clinics of North America.  Indian Journal of Otolaryngology& Head &Neck.

 

9. Model Test Papers