European Board Examination in Otorhinolaryngology-HNS
UNION EUROPEENNE DES MEDECINS SPECIALISTES (UEMS)EUROPEAN UNION OF MEDICAL SPECIALISTS (UEMS)LOGBOOK OTO-RHINO-LARYNGOLOGY-HEAD AND NECK SURGERY(revision 2018)TRAINING PROGRAMMEINTRODUCTIONThe UEMS ORL Section and Board of Otorhinolaryngology-Head and Neck Surgery has revised the European training programme for the Specialty in 2018. This programme will serve as a guideline for training centres enabling them to meet the European Standard as set out by the European Board of UEMS. We are moving towards competency based assessments. DEFINITIONOtorhinolaryngology-Head and Neck Surgery (ORL-HNS) is the specialty which deals with functions and diseases, trauma, malformations and other disorders in childhood and in adults; of the ear, temporal bone and lateral skull base, nose, paranasal sinuses, anterior skull base and orbit, oral cavity, lips, pharynx, larynx, trachea, oesophagus, head, neck, thyroid, salivary and lacrimal glands and adjacent structures and skin. It also includes investigation and treatment of conditions affecting the auditory, vestibular, olfactory and gustatory senses and disorders of the cranial nerves; as well as human communication in respect of speech, language, voice and swallowing disorders. It also includes the study of related genetic disorders. Some of the conditions diagnosed by Otorhinolaryngologists but located in adjoining areas, will be further managed in close cooperation with these related specialists.THE TRAINING PROGRAMMEThe training programme will consist of the following elements:Acquisition of the principles of surgery in general and theoretical knowledge of anatomy, physiology, pathology, aetiology and symptomatology and treatment of diseases of the ear, temporal bone and lateral skull base, nose, paranasal sinuses and anterior skull base, oral cavity, pharynx, larynx, trachea, oesophagus, head, neck, thyroid, salivary and lacrimal glands and adjacent structures. Special attention should also be given to the theoretical foundation of audiology, phoniatrics, vestibular disease, allergy, immunology, oncology and the basic principles of plastic and reconstructive surgery.Trainees should have access to facilities for temporal bone, paranasal sinus and head and neck dissection. They should be able to familiarize themselves with the basic techniques of surgery on the ear and lateral skull base, nose, paranasal sinuses and anterior skull base, oral cavity, pharynx, larynx, trachea, oesophagus, head, neck, thyroid, salivary and lacrimal glands and adjacent structures, with either real or virtual surgical and endoscopic techniques.A graded increase in clinical responsibilities and surgical experience will be developed and should be recorded in the log book.A list of diagnostic procedures, non-surgical management and surgical management is outlined in the new UEMS ORL Section and Board logbook.The European training programme requires documentation of all skills and operative procedures/management itemized in the section of surgical management. Confirmation of the progression of the trainee to the required competency is necessary.The Log Book will be used in relation to European training exchange programmes and will provide an introduction into advanced skills of the Specialty.Subspecialty logbooks are available for advanced trainees.ASSESSMENT AND EXAMINATIONExamination of the theoretical and practical knowledge of the trainee may be included in the European Training Programmes. Trainees should refer to their National requirements.To achieve the award of the certificate of recognition, the trainee must reach the expected level of knowledge and skills approved by the training programme Director before being eligible to practise as an independent ORL-Specialist.Each trainee must be familiar with all diagnostic and therapeutic (surgical and non-surgical) management associated with the discipline of Otorhinolaryngology and Head and Neck Surgery.The trainer will be responsible for confirming the competence of the trainee for the procedures and management outlined in the log-book in the columns headed “general”. He/she will sign on the date when competency is achieved in the final column 6.The contents of the log book will be continuously updated by the European Board at least every 5 years with respect to new developments. The recommended syllabus for the European Board Exam in ORL-HNS includes this logbook, produced by the UEMS ORL Section, and the Intercollegiate Surgical Curricullum Programme Syllabus.CONTENT OF THE LOGBOOKThe log book is divided into the following sections.IBasic objectives.IIOtology and NeurotologyIIINose and Paranasal sinusesIVLaryngology Head & Neck with PhoniatricsVFacial Plastics and Aesthetic surgeryVIPaediatric OtolaryngologyADiagnostic proceduresBNon-surgical/Medical managementCSurgical managementThe trainee must have knowledge and understanding both the diagnostic, non-surgical and surgical management.In the log-book general and advanced procedures are both listed: General procedures:Under this heading are listed all procedures which every ORL-HNS trainee must be competent in by the end of the training period, so as to to guarantee a medical service which fulfils the recommendation of the UEMS Section and Board, to achieve and maintain the highest standards.Advanced procedures:Under this heading are listed the skills and operative managements which have to be provided by University centres or specialized departments. The trainee is not expected to be able to perform these procedures/managements during the European Training programme. However, all trainees should have seen and been familiar with these procedures.The procedures are divided in three categories:(S)Trainee requires supervision/assistance by the trainer whilst he/she performs the procedure/management (I)Trainee performs the procedure/management independently/alone with the trainer available.(A) Trainee has seen/has been familiar with some advanced proceduresThe relevant trainer should endorse by signing and dating, when the trainee has achieved competency in each particular management or procedure.CHARTERS ON TRAINING AND VISITATIONTrainees are advised to familiarize themselves with the UEMS Charter on Training of Medical Specialists uems.eu The UEMS ORL Section and Board amended this Charter in June 2001 in relation to the requirements for the Specialty of ORL-HNS. The amended document can be found on the Section Website . The website also includes UEMS Charters on:Continuing medical educationQuality assuranceVisitation of training centres.The information for the Log Book may also be collected electronically.TRAINING CENTRE ROTATIONTrainee: ______________________________________________________________NameSurnameBirthdateDates of start and finish of training periodTraining CentreName of TrainerSignature of TrainerAdditional copies can be made of this page if required ATTENDANCE AT ACCREDITED COURSES AND MEETINGSDateCourseCommentsAdditional copies can be made of this page if required. UEMS TRAINING LOGBOOK OF OTO-RHINO-LARYNGOLOGY – HEAD AND NECK SURGERY COMPLETION OF TRAININGTrainee: ___________________________________________________________________________________________________Name Surname BirthdateDate of commencement of training: ______________________________________________________________Date of completion of training: ______________________________________________________________Lead Training CenterName of Trainer in chargeI, the trainer in charge, certify that the register of diagnostic, non-surgical and surgical management shown below is correct.Date: Signature of trainer: I, the trainee certify that the details given refer to diagnostic, non-surgical and surgical management carried out by me personally or were operations at which I acted as assistant.Date: ______________ Signature of trainee: _____________________I. BASIC OBJECTIVESKnowledge of fundamentals inSignature trainer when competency achievedemergency medicine and resuscitationinfection controlantimicrobial therapytransfusions medicine/blood grouping/cross-matching etc. haemostasisoncologywound healinggeneral surgical techniquesbasics in plastic and reconstructive surgerytransplantation medicinesoft tissue and bone traumatologyimmunologyendocrinologyoral and parenteral nutritionbasic psychosomatic investigation/managementradiation protectionmedical quality controlethical principles/consent for operationsocial welfare legislationbasic nutritional medicinebasic laboratory proceduresbasic laboratory investigations,correct taking and handling of samples and interpretation of the resultsnormal blood valuesbacteriology/mycologyprincipal detection of fungi (cell culture)antimicrobial medicationanalysis of tumour-markersallergology laboratory investigationsII. OTOLOGY/NEUROTOLOGYDiseases/Disorders of the earSignature trainer when competency achievedAuricleCongenital malformationsInfectionsInflammatoryBenign & malignant tumoursTraumatic injuriesEar CanalCongenital malformationsInfectionsInflammatoryBenign & malignant tumoursExostosesNecrotizing otitis externaKeratosis obturans/external canal cholesteatomaTraumatic injuriesEar Drum and Middle EarCongenital malformationsAcute & chronic otitis media Benign & malignant tumoursTraumatic injuriesBarotraumaEustachian tube dysfunctionConductive hearing loss in adults & children (congenital & acquired)Inner Ear and Lateral Skull BaseCongenital malformationsSensorineural hearing loss in adults & children (congenital & acquired)Peripheral and central vestibular disordersNon-vestibular balance disordersCauses of tinnitus (including pulsatile tinnitus) & hyperacusisBenign & malignant tumoursInfective disordersTraumatic injuriesHistorySignature trainer when competency achievedSpecific Hearing lossTinnitus (including pulsatile tinnitus)Vertigo / Imbalance / DysequilibriumHyperacusisOtalgia (including referred otalgia)OtorrhoeaAutophonyTullio phenomenonFacial paresisGeneralFamily history of hearing or balance disordersPast history of ear infectionsPast history of otological surgeryHead traumaNoise exposureOtotoxic usage / exposureBarotraumaMigrainePerinatal historyHistory of meningitisTORCH infectionA. Patient assessment and Diagnostic Proceduresa) Clinical ExaminationSignature trainer when competency achieved1. Otoscopy2. Microscopy3. Oto-endoscopyb) Hearing FunctionSignature trainer when competency achieved4. Tuning fork tests5. Clinical hearing testsc) Vestibular functionSignature trainer when competency achieved6. Nystagmus7. Head Impulse test (Halmagyi test)8. Fistula test9. Dix Hallpike test10. Heel toe test (tandem gait test)11. Unterbergers testd) Neurological functionSignature trainer when competency achieved12. Cranial nerve examination including facial nerve 13. Cerebellar examination14. Rombergs Teste) OthersSignature trainer when competency achieved15. Auscultation (for bruits)B. Diagnostic Work-upa) Hearing Function TestsSignature trainer when competency achieved1. Impedance audiometry2. Pure tone audiometry3. Speech audiometry4. Objective hearing tests 4a. Oto-acoustic emissions (OAEs) 4b. Evoked response audiometry (BSER, CERA, ASSR)5. Paediatric audiology 5a. Screening methods 5b. Subjective methods 5c. Objective methodsb) Vestibular Function TestsSignature trainer when competency achieved6. Caloric testing7. Video / Electronystagmography8. VEMPs9. Posturography (Balance platform)10. Rotating chair testc) Facial Nerve Function TestsSignature trainer when competency achieved11. Topodiagnostic testing 11a. Schirmers test 11b. Stapedial reflexes12. Neurophysiological testing 12a. Electromyography (EMG) 12b. Electroneurography (EnoG) 12c. Maximal stimulation test (MST)d) ImagingSignature trainer when competency achieved13. Plain X-ray14. Computerized tomography (to include cone beam CT scanning of the temporal bones)15. Magnetic resonance imaging16. Angiography 16a. CT Angiography 16b. MR Angiography 16c. Cerebral Angiography17. Positron Emission Tomography 18. Radionuclide scanning eg technetium, gallium scanninge) Laboratory TestsSignature trainer when competency achieved19. Relevant blood tests20. Cytology21. Histology22. MicrobiologyC. Non-Surgical ManagementSignature trainer when competency achieved1. Pharmacological treatment 2. Physical rehabilitation3. Ear infections4. Sensorineural hearing loss in adults and children (including screening)5. Conductive hearing loss in adults and children6. Hearing aid rehabilitation7. Tinnitus8. Vertigo and dysequilibrium9. Facial nerve paresis10. Peri-operative management of patients undergoing otological surgery 11. Stereostactic radiosurgeryD. Surgical Management?SIASignature trainer when competency achieved12. Temporal bone dissection (laboratory)X13. Management of oto-haematomaX14. Excision of lesions of the auricleX15. Wax removalX16. Foreign body removalX17. Removal of external auditory canal lesionsX18. Meatoplasty (Soft tissue & bony)X19. Removal of osteomas/exostosesX20. MyringotomyX21. Ventilation tube insertionX22. Myringoplasty (Type1 Tympanoplasty)X23. TympanotomyX24. Mastoidectomy? 24a. CorticalX 24b. Modified radical / radical (Back to front approach)X 24c. Atticotomy / Attico-antrostomy (Front to back approach) X 24d. Combined approach tympanoplastyX 24e. Mastoid obliterationX25. Bone anchored hearing aidsX26. Ossiculoplasty X27. Implantation of prostheses? 27a. Middle ear prosthesis (ossicular prosthesis/implantable hearing aids)X 27b. Cochlear implantsX28. Stapes SurgeryX29. Facial nerve surgery? 29a. DecompressionX 29b. Grafting. Anastomosis surgeryX30. Endolymphatic sac decompressionX31. Vestibular schwannoma surgery? 31a. Translabyrinthine approachX 31b. Retrosigmoid approachX 31c. Middle cranial fossa approachX32. Vestibular neurectomyX33. Glomus tumour surgeryX34. PetrosectomyX35. Correction of malformations? 35a. AuricleX 35b. Peri-auricular fistulasX 35c. External auditory canalX 35d. Middle earX36. Repair of injuries? 36a. AuricleX 36b. External auditory canalX 36c. Middle and inner ear including nerves, vessels and middle cranial fossa / posterior cranial fossa duraX37. Surgery of tumours? 37a. AuricleX 37b. External auditory canalX 37c. Middle and inner ear including nerves, vessels and middle cranial fossa / posterior cranial fossa dura and temporal bone resectionX38. Revision ear surgeryXE. Postoperative complicationsSignature trainer when competency achievedComplications of general and local anaesthesiaBleeding / haematomaInfectionConductive hearing losSensorineural hearing losVertigo / imbalanceTinnitusHyperacusisFacial nerve paresisTaste disturbanceNumbness of the auricleCSF leakageIntracranial infectionLower cranial neuropathyIII. NOSE AND PARANASAL SINUSESDiseases/DisordersSignature trainer when competency achievedNosecongenital malformations of nose, mid-face (cleft lip, palate), including genetic anomaliesinfections of noseNeoplastic conditions:benign and malignantnasal and facial traumaEpistaxisinflammatory and allergic conditions (rhino-allergology)Paranasal Sinusescongenital malformationsrhinosinusitis: atopic, non-atopic, bacterial, fungal, allergic fungal etcInflammatory and granulomatous systemic conditions including sarcoid, tuberculosis etcneoplastic conditions: benign and malignant BarotraumaA. Patient assessment and Diagnostic Proceduresa) History and Clinical ExaminationSignature trainer when competency achieved1. Assessment of nasal symptomsSpecific History: nasal obstruction, rhinorrhoea, anosmia, hyposmia, facial pain, epistaxis2. Anterior and posterior rhinoscopy3. Nasal endoscopy4. visual documentation (example: photography, videoendoscopy)5. Ethnic variation, proportions of face, effects of agingb) Tests of FunctionSignature trainer when competency achieved6. Rhinomanometry7. Acoustic rhinomanometry8. Olfactory tests (subjective and objective)9. Ciliary function testsc) Tests of ImagingSignature trainer when competency achieved10. Conventional X-ray11. CT scan12. Cone beam CT13. MRI scan14. Isotope scan15. Angiography16. Understanding the use of navigation devicesd) Allergy Investigations17.Understanding and performing clinical tests for atopy (such as skin prick tests, RAST, nasal provocation tests, etc)B. Non-Surgical ManagementSignature trainer when competency achieved18. pharmacological therapy19. specific immunotherapy (hyposensitisation), sublingual immunotherapy20. management of anaphylaxisC. Surgical ManagementNose?SI ASignature trainer when competency achieved21. local and regional anaesthesiaX22. Management of epistaxis? 22a. nasal packingX 22b. nasal cautery and other endoscopic managementX 22c. Medical disease and epistaxisX23. Foreign body removalX24. Nasal PolypectomyX25. Turbinate procedures (including coblation, radiofrequency etc)X26. Septal surgeryX27. Revision septoplastyX28. Septorhinoplasty (open and closed, reduction, augmentation, grafting techniques, cleft lip septorhinoplasty )X29. Rhinophyma operationX30. Correction of congenital malformations (choanal atresia, fistulas, dermoids etc)XParanasal SinusesS I A Signature trainer when competency achieved31. Sinus endoscopyX32. Antral lavageX33. Endoscopic antrostomy and sinus endoscopyX34. Radical antrostomyX35. Frontal sinus trephinationX36. External frontal sinus surgeryX37. External ethmoidectomyX38. Endoscopic Sinus Surgery and its possible acute complications? 38a) anterior ethmoidectomyX 38b) posterior ethmoidectomyX 38c) frontal recess proceduresX 38d) sphenoid sinus proceduresX39. Surgery of floor of maxillary sinusX40. Ligation of maxillary, ethmoidal or sphenopalatine artery including endoscopicX41. Orbital decompression proceduresX42. Endoscopic dacry-cysto-rhinostomyX43. Management of CSF leakX43. Tumour Surgery? 43a) maxillectomy (partial, total)X 43b) lateral rhinotomyX 43c) midfacial deglovingX 43d) combined approach to anterior skull baseX 43e) orbitotomyX 43f) exenteration of orbitX 43g) surgery of anterior skull base (incl osteoplastic flap, duraplasty and endoscopic)X44.Trauma? 44a) soft tissue injuriesX 44b) management of fractures of nasal bones/septum and septal haematoma under local or general anaesthesiaX 44c) paranasal sinus fracturesX 44d) fractures of orbit including blowout fracturesX 44e) zygomatic fracturesX 44f) optic nerve decompressionX 44g) reconstruction of anterior skull baseXIV. LARYNGOLOGY, HEAD & NECK, PHONIATRICSDiseases/Disorders of Head and NeckHead and Neck OncologyOral Cavity PharynxLarynxNose and Paranasal SinusesNeck and Unknown primarySalivary glandsThyroid glandSkinBenign diseases Head and NeckOral Cavity PharynxLarynxSinonasalVascular malformationsTrauma1. LARYNGOLOGY/HEAD AND NECK ONCOLOGYBasic knowledgeSignature trainer when competency achieved1. Carcinogenesis, molecular biology and immunobiology in H&N oncology2. Epidemiology and biostatistics of cancer management3. TNM staging4. Basics of cancer management 4a. Indications and limitations of surgery 4b. Biophysics of radiotherapy - indications and side effects 4c. Chemotherapy agents - indications and side effects 4d. Biologic/Immuno therapy - indications and side effects5. Clinical trials in H&N oncology6. Prevention in H&N oncology7. Clinical databases in H&N oncologyGeneral historySignature trainer when competency achievedAge, genderFirst symptomsWeight lossSmoking tobacco, chewing tobacco, betel quidAlcohol consumptionViral infectionsEthnicity History of previous tumoursPrevious head and neck irradiationFamily history (oncology perspective)OccupationCo-morbiditiesPerformance dataQuality of lifeClinical examinationSignature trainer when competency achievedGeneral ENT examination including videolaryngoscopyPalpation of the primary lesionPalpation of the neckAssesment of cranial nerves and swallowingAdditional examination and imagingSignature trainer when competency achievedBiopsy of primary Knowledge of Ultrasound of the neck +/- cytological diagnosisPanendoscopyKnowledge of CT / MRIKnowledge of PET-CT / PET-MRIKnowledge of Assesment Chest (x ray / CT)Knowledge of Additional assesments (audiogram, CT, US, OPG….)Knowledge about Treatment and Treatment modalitiesSignature trainer when competency achievedMultidisciplinairy management of cancer patientsTreatment planning – single versus multimodal TreatmentPrinciples and safety of lasers in H&N managementReconstruction options for H&N defectsFlap physiology and wound healingSingle or mutiple non-surgical therapies: a. Radiotherapy b. Chemotherapy c. Immunological therapy d. Combination of the above with surgeryCurative versus palliative therapySurgery a. Primary surgery b. Salvage surgery c. Palliative surgeryKnowledge about peri-operative support including nutrition and infection preventionFunctional rehabilitationBest supportive (palliative) careKnowledge of Side effects and complications of TreatmentSignature trainer when competency achievedManagement of side effects, toxicity, and infectionsManagement of surgical complications (haematoma, bleeding, chyle leakage, infection, trismus, salivary fistula….)Management of non-surgical complications (voice, swallowing, prosthesis, cosmitics….)Management of side effects airway obstruction and airway managementOro- / pharyngo- cutaneous fistula Speech and swallowing impairmentMucositis, dermatitis OsteradionecrosisHypothyroidism1.A ORAL CAVITYAdditional historySignature trainer when competency achievedArticulationSwallowingSurgical TreatmentSIASignature trainer when competency achievedLocal surgery (incl. laser)XOpen neck surgery – pull through procedureXMarginal mandibulectomyXSegmental mandibulectomyXNeck nodes (see paragraph neck)1.B PHARYNXNasopharynxAdditional historySignature trainer when competency achievedUnilateral middle ear effusion in the adultNasal blockageNeck massNose bleedingCranial nerve involvementPatients origin and ethnicitySurgical TreatmentSIASignature trainer when competency achievedLocal surgeryXMaxillary swingXNeck nodes (see paragraph neck)OropharynxAdditional historySignature trainer when competency achievedPain, otalgiaArticulationSwallowingSnoringHPV infectionSurgical TreatmentSIASignature trainer when competency achievedTonsillectomyXTransoral surgery (robotic surgery, toes)XPharyngotomyXMandibulotomy (mandibular split, mandibular swing)XNeck nodes (see paragraph neck)HypopharynxAdditional historySignature trainer when competency achievedSwallowingOtalgiaSurgical TreatmentSIASignature trainer when competency achievedEndoscopic surgery (TORS, TOUSS, laser-surgery…)XPharyngectomy with/ without laryngectomyXPartial pharyngectomy with near total laryngectomy XPartial pharyngectomy with total laryngectomy XTotal pharyngectomy with total laryngectomy XTotal pharyngo-laryngo-esophagectomy with reconstruction(to plastic surgery)XNeck nodes (see paragraph neck)1.C LARYNXAdditional historySignature trainer when competency achievedPain, otalgiaDysphoniaSwallowingDyspnoeaNeck massSurgical TreatmentSIASignature trainer when competency achievedEndoscopic surgeryXPartial or total laryngectomyXPrimary or secondary placement of vocal prosthesisXMaintenance and change of speech prosthesisXNeck nodes (see paragraph neck)1.D NOSE AND PARANASAL SINUSESAdditional historySignature trainer when competency achievedRepeated rhino-sinusitisObstructionEpistaxisRhinorrheaFacial painCranial nerve involvementSurgical TreatmentSIASignature trainer when competency achievedEndonasal surgical procedures (including navigation systems)XMaxillectomy (partial, total)XLateral rhinotomyXMidfacial deglovingXOrbitotomy and Exenteration of orbitXSurgery of anterior skull base (incl osteoplastic flap, duraplasty and endoscopic)XNeck nodes (see paragraph neck)1.E NECK AND UNKNOWN PRIMARYAdditional historySignature trainer when competency achievedGrowthPainSurgical TreatmentSIASignature trainer when competency achievedSingle node resectionXSentinal node proceduresXNeck dissection procedures (local, selective, radical, conservative)X1.F SALIVARY GLANDSAdditional historySignature trainer when competency achievedMass within the salivary glandPersistent lesion consistent with an accessory salivary gland tumourFacial nerve paresisPainSurgical TreatmentSIASignature trainer when competency achievedSubmandibular gland surgeryXParotid (partial or total) surgery (Levels I to V according to the ESGS classification)XReconstruction (local flaps, SCM and SMAS, Fat)XNeck nodes (see paragraph neck)1.G THYROID GLANDAdditional historySignature trainer when competency achievedFamily history of thyroid diseaseAge <14 or >70, nodular goitreDysphoniaSymptoms of hypo- or hyperthyroidismPrevious radiation (iodine, external radiation)Surgical TreatmentSIASignature trainer when competency achievedHemithyroidectomyXTotal thyroidectomyXParathyroidectomyXNeck nodes (see paragraph neck)1.H SKINAdditional historySignature trainer when competency achievedUV-light/ excessive sun exposure / history of sunburnsFair skinMolesPrecancerous lesion/ (resected) skin tumours in pastSurgical TreatmentSIASignature trainer when competency achievedSentinel node technique in MelanomaXLimited surgical excision (including local reconstruction)XExtended surical excision X(Skin-) Reconstruction of the nose, lip and other structuresXParotidectomyXNeck nodes (see paragraph neck)2. LARYNGOLOGY/BENIGN DISEASE HEAD AND NECK2.A ORAL CAVITYKnowledgeSignature trainer when competency achievedEpithelial lesions (leukoplakia, erytroplakia, papiloma, lichen planus….)Conginatal malformationsGlossal diseasesDental related diseasesInfectious diseasesImmunology diseasesHalitosisSurgical TreatmentSIASignature trainer when competency achievedExcision biopsyXLocal surgery (incl. laser) XRerouting salivary ductXResection submandibular glandX2.B PHARYNXNasopharynxKnowledgeSignature trainer when competency achievedAdenoidThornwald cystJuvenile angiofibromaSurgical TreatmentSIASignature trainer when competency achievedAdenoidectomyXEndoscopic transnasal or transoral surgery (Thornwald cyst….)XJuvenile angiofibroma: endoscopic or open surgery (+/- embolisation)XOropharynxKnowledgeSignature trainer when competency achievedEpithelial lesions (leukoplakia, erytroplakia, papiloma, lichen planus….)Conginatal malformations (schisis, cyst….)Infectious diseasesHalitosisSurgical TreatmentSIASignature trainer when competency achievedTonsillectomy, tonsillotomyXEndoscopic surgeryXTransoral surgeryXTransoral robotic surgeryXOpen surgeryXHypopharynxKnowledgeSignature trainer when competency achievedGlobusDysphagia (See also chapter on Phoniatrics)Zenker's diverticulumCricopharyngeal pathologiesForeign bodiesCongenital malformationsSurgical TreatmentSIASignature trainer when competency achievedDilatation proceduresXEndoscopic Treatments of Zenker's diverticulum (stapler, laser)XExternal surgery of Zenker's diverticulumXEndoscopic myotomy of cricopharyngeal muscleXExternal myotomy of cricopharyngeal muscleXForeign body removalXSurgery of congenital anomaliesXPharyngotomyX2.C LARYNXKnowledgeSee also chapter on PhoniatricsSignature trainer when competency achievedBenign intraepithelial lesionsGranuloma, polyp, nodule, Reinke oedema, cystLaryngoceleStenosis (congenital or acquired)Vocal cord paralysisCongenital malformations ( larynomalcia, cleft, web)Surgical TreatmentSIASignature trainer when competency achievedEndoscopic surgery (including laser) for benign intraepithelial lesions, granuloma, polyp, nodule, Reinke oedema, cystXAugmentation proceduresXOpen surgery (laryngofissure, framework surgery)XClosure tracheostomyX2.D NOSE AND PARANASAL SINUSESKnowlegdeSignature trainer when competency achievedInverted PapillomaBenign lesions and tumours (solid tumours, angiofibroma, fibrous dysplasia)Foreign bodyCongenital fistulaOzena/Atrophic RhinitisOlfactory and gustatory disordersCSF leakageTraumaNosebleedSurgical TreatmentSignature trainer when competency achievedSee chapter on Rhinology2.E NECKKnowledgeSignature trainer when competency achievedCongenital neck masses (thyroglossal duct cyst, branchial anomalies, vascular malformations)Benign tumours (paraganglioma, schwannoma, lipoma, hemangioma)Infectious and inflammatory lymphadenopathies (tuberculosis, cat-scratch, actinomycosis, toxoplasmosis, HIV)Deep neck infections: microbiology, diagnoses and TreatmentNeck trauma a.Clinical presentation b.Mechanisms of injury c.Neck trauma zones d.Mandatory vs. elective neck explorationSurgical TreatmentSIASignature trainer when competency achievedDiagnostic lymph node dissectionXRemoval of congenital cyst /fistulaXLocal tumour surgeryXSistrunk procedureXRemoval laryngoceleXDrainage deep neck abcessXParagangliomaX2.F SALIVARY GLANDSKnowledgeSignature trainer when competency achievedESGS classification of salivary ductal pathologies - LSD classificationESGS classification of parotid surgery Immunological disordersInfectionsSalivary stonesBenign neoplasmsSurgical TreatmentSIASignature trainer when competency achievedInterventional sialendoscopy (stone related, dilatation, biopsy)XCombination / open procedures stone removalXAccessory salivary gland biopsy/ open biopsy salivary gland tumourXProcedures of salivary ductsXSubmandibular surgeryXParotid partial or total surgeryXSalivary gland wounds and ductal repairX2.G THYROID GLANDKnowledgeSignature trainer when competency achievedGoitre (normal or toxic thyroid function)Thyroid nodule (single/multiple, benign atoxic, benign toxic, malignant)ThyroiditisParathyroid functional disorders and neoplasmsSurgical TreatmentSIASignature trainer when competency achievedHemithyroidectomyXTotal thyroidectomyXParathyroidectomyX3. AIRWAY DISORDERS (larynx and trachea)HistorySignature trainer when competency achievedDysphoniaHoarsnessSwallowing problemsNeck painInfections/ neck diseasesTraumaClinical examinationSignature trainer when competency achievedPalpationFiberoptic (video-) laryngoscopyTransnasal fiberoptic (video-) tracheobronchoscopyTracheobronchoscopic cytology/ histopathologyOesophagoscopy (rigid or fiberoptic)Knowledge about additional diagnosticsSignature trainer when competency achievedChest x-rayCT-scan / 3-D reconstructionMRILung function testBlood gassesKnowledge of DiseasesSignature trainer when competency achievedInfectious diseasesVocal cord palsyLaryngoceleInhalation traumaPenetrating/ blunt traumaPosttraumatic stenosisForeign bodiesCongenital stenosisBenign tumours (fibroma, haemangioma, pseudotumour)Local tracheal compression (vascular diseases, mediastinal diseases/ tumours)Surgical TreatmentSIASignature trainer when competency achievedRemoval of foreign bodies (rigid and /or flexible endoscopes)XEndotracheal intubationXTracheostomyXCricothyroidotomyXLocal closure of tracheaXEndoscopic laser and dilatation proceduresXOpen procedures (larynx and) tracheaXClosure of tracheostomaXManagement of complicationsSignature trainer when competency achievedStridor/ dyspnoeaPost-operative bleeding, infectionsDysphagia, hoarseness4. DIGESTIVE TRACT/OESOPHAGUSHistorySee also chapter on PhoniatricsSignature trainer when competency achievedSwallowing problemsRegurgitationRetrosternal painWeight lossCoughing (nightly)RefluxClinical examinationSignature trainer when competency achievedPalpationFlexible (transnasal) laryngo-pharyngoscopy/ oesophagoscopyFunctional tests of swallowing disordersFEESRigid oesophagoscopyKnowledge about additional diagnosticsSignature trainer when competency achievedSwallow x-ray / videoSwallow CT-scanChest CT-scanMRI in selected casesKnowledge of DiseasesSignature trainer when competency achievedTraumatic perforations (iatrogenic)Chemical traumaForeign bodiesInfectionsAchalasia, hiatal hernia, benign and malignant tumoursSurgical TreatmentSIASignature trainer when competency achievedSwallowing rehabilitationXRemoval of foreign bodiesXEndoscopic biopsy and tumour stagingXRepair of tracheoesophageal fistulaXManegement of ComplicationsSignature trainer when competency achievedInfection, post-operative bleedingPerforation, mediastinitisVocal cord palsy5. SNORING AND OTHER SLEEP RELATED BREATHING DISORDERS (SRBD)HistorySignature trainer when competency achievedNon-restful sleepExcessive daytime sleepinessLoud snoringObserved ApneaDecreased cognitive functions, depressionHeadachesClinical examinationSignature trainer when competency achievedENT basic examination including: transnasal flexible rhinolaryngoscopy (Müller manoeuvre), nasal obstruction, adenoids, tonsil hyperplasia, base of the tonge hyperplasia, maxillofacial malformations, pharyngeal and laryngeal obstructionsObesityAdditional diagnosticsSignature trainer when competency achievedEpworth sleepiness scale ESS/Friedmann ClassificationPolysomnographic sleep study, AH-indexPulmologist, cardiologist ConsultationOptions: pupillometry, cephalometry, spirometry, blood test, drug induced sleep endoscopy (DISE), daytime sleep studiesDiseasesSignature trainer when competency achievedObstructive SnoringUpper Airway Resistance SyndromeSleep Apnea Syndrome Obstructive, CentralTreatmentSurgical / Nonsurgical: according to the severity of the SRBDPrimary surgeryPositive airway pressure Treatment (PAP)Reduction of body weightNon Surgical TreatmentSignature trainer when competency achievedDrugs: Modafonil in cases of persisting daytime sleepiness symptoms after CPAPOral appliances in mild to moderate OSACPAP, APAP, Bi-level PAP, according to severity of OSA, positional and REM-stage related OSA, pressure demandSurgical TreatmentSIASignature trainer when competency achievedSeptoplasty, turbinoplasty, FESS, adenoidectomy, tonsillotomy/tonsillectomy, UPPP, UP2, palatal radiofrequency, radiofrequency of the base of the tongue, tracheostomyXMulti level surgery, soft palate stiffening implantsXHypoglossal nerve stimulation implants, hyoid suspension, maxillo-mandibular advancement (MMA)XManagement of ComplicationsSignature trainer when competency achievedAcute airway obstructionDysphagia, Velopharyngeal Insufficiency (VPI) and retronasal reflux6. VASCULAR MALFORMATIONSHistorySignature trainer when competency achievedAge of onset, Progression, SymptomsFunction cranial nervesOther diseases/ syndromaticFamily historyClinical examinationSignature trainer when competency achievedENT- examinationPalpationCranial nervesKnowlegde about additional diagnosticsSignature trainer when competency achievedUltrasoundMRIPharyngoscopyDNA analysis, Hormonal blood /urine testDiseases according to Classification ISVA 2014Signature trainer when competency achievedVascular tumours: Infantile hemangioma Congenital hemangioma Pyogenic granuloma Others Vascular malformations: Venous malformation Capillary malformation Lymphatic malformation Arteriovenous malformations Combined malformations OthersNon Surgical TreatmentSignature trainer when competency achievedIntralesionalPropanololLow dose radiotherapySurgical TreatmentSIASignature trainer when competency achievedLocal excisionXManagement of ComplicationsSignature trainer when competency achievedBleedingAirway obstructionAbundant drainingCranial nerve damage3. PHONIATRICS1. DYSPHAGIADiseases/DisordersSignature trainer when competency achievedBenign DisorderOedema of tongue and/or larynxMalignant disorderDysphagia after surgery for oral and oropharyngeal cancerDysphagia following hypopharyngeal and/or laryngeal resectionDysphagia following radiotherapy of oropharyngeal cancerDysphagia following radiotherapy of hypopharyngeal and/or laryngeal cancerDysphagia following Infratemporal Fossa Approach SurgeryOther – Dysphagia caused by...Apoplectic strokeM. ParkinsonMyasthenia gravisLateral amyotrophic sclerosisDementiaDISH/M. ForrestierPalsy of N. hypoglossusHistorySignature trainer when competency achievedSpecificDisturbed swallowing for dry food, liquidsCoughing during food intakeVoice changes during food intakeNasal regurgitationGeneralFeverPast history of pneumoniaLoss of body weightClinical ExaminationSIASignature trainer when competency achievedGeneralAssessment of orofacial functionXAssessment of tongue coordination and motionXAssesssment of velar function XFunction of the Cranial Nerves. VII, IX, X, XII XAssessment of oral bolus residue XEndoscopyFEES – Fiberoptic endoscopic evaluation of swallowingXRigid Laryngoscopy (70°, 90°)XOesophagoscopyXOesophageal manometryXUltrasonographySonography of tongue during swallowingXOther Automatic digital swallowing recordings (acoustic or electric devices)XAuscultation (neck & lung)XDiagnostic work upSignature trainer when competency achievedImagingVideofluoroscopyCT, MRI, PET, ScintigraphyLaboratory testsBlood testsInflammation markersCytologyMedical TreatmentSignature trainer when competency achievedPharmacological treatment Artificial salivaCorticosteroids (cave: contraindications)ChemotherapyRadiotherapyPhysical rehabilitationLogopedic therapyPhysiotherapeutic therapysEMG BiofeedbackAdditional therapyDefinition of special nutritionInfusion or stomach tube nutritionSurgical TreatmentSIASignature trainer when competency achievedPEGXDilatation of esophageal sphincter/esophagus XComplicationsSignature trainer when competency achievedAspirationPneumoniaCachexia2. DYSPHONIADiseases/DisordersSignature trainer when competency achievedNon-organic dysphoniaHyperfunctional dysphoniaHypofunctional dysphoniaMixed dysphoniaPsychogenic dysphoniaPsychogenic aphoniaOrganic dysphoniaLaryngitisReinke’s edemaVocal chord polyp/cystLaryngeal papillomaLaryngeal cancerLarynx traumaOtherVocal palsyLuxation of ArytenoidSpasmodic dysphoniaDysarthrophoniaMutational voice disorderCervicogenic dysphoniaHistorySignature trainer when competency achievedSpecificHoarsenessVocal fatigueReduced voice dynamicsThroat=clearingGeneralStressRefluxVertebral symptomsClinical ExaminationSIASignature trainer when competency achievedGeneralAuditory/visual/palpatory examinationXMaximum phonation timeXPerceptual voice assessment by GRBAS/RBHXPhonetographyXMean fundamental frequencyXEndoscopyDirect/indirect rigid laryngoscopyXLaryngostroboscopyXFlexible transnasal laryngoscopyXHigh-speed recordings XDiagnostic work upSignature trainer when competency achievedImagingCT, MRI of vocal tract/larynxElectrophysiologyElectroglottography ElectromyographyOtherGastroscopy/PH-analysisAudiometryAerodynamic measurementsMedical TreatmentSignature trainer when competency achievedLogopedic therapy Corticosteroids (cave: contraindications)Inhalation therapySurgical TreatmentSIASignature trainer when competency achievedBotulinum toxin treatmentXPhonosurgeryXLaryngeal framework surgeryXComplicationsSignature trainer when competency achievedPermanent Dysphonia/AphoniaDyspnoea3. ACQUIRED LANGUAGE DISORDERSDiseases / Acquired Speech & Language disordersSignature trainer when competency achievedDysphasiaDysarthriaApraxiaAcquired Fluency DisordersDysglossiaHistorySignature trainer when competency achievedSpecificUnintelligible SpeechTotal loss of verbal speechAnosmiaGeneralStrokeTraumaDiplegia/Hemiplegia/QuadroplegiaClinical ExaminationSIASignature trainer when competency achievedGeneralAuditory/visual/palpatory examinationXAssessment of tongue coordination and motionXAssesssment of velar functionXFunction of the Nn. VII, IX, X, XIIXPerceptual evaluation of nasalityXEndoscopyFiberoptic endoscopic evaluation of velum functionXUltrasonographySonography of tongue during speechXOtherAudiometryXNasalance measurementXDiagnostic work upSignature trainer when competency achievedImagingCT, MRIPET, ScintigraphyLaboratory testsSerology of neurotropic germsNeurologic assessmentEMG, ENG, contemporary methodsMedical TreatmentSignature trainer when competency achievedPharmacological treatment RadiotherapyLogopedic/Linguistic therapy ComplicationsSignature trainer when competency achievedPermanent loss of communication competence4. DEVELOPMENTAL LANGUAGE DISORDERSDiseases / Developmental Language disordersSignature trainer when competency achievedSpecific developmental language disorderDevelopmental language disorder caused by cerebral diseaseDevelopmental language disorder caused by hearing disorderDevelopmental language disorder caused by genetics and/or syndromaHistorySignature trainer when competency achievedSpecificUnintelligible Speech/dyslaliaReduced expressive vocabularyDisturbed speech perceptionDysgrammatismGeneralDelayed psychomotor developmentDelayed cognitive developmentClinical ExaminationSIASignature trainer when competency achievedGeneralAuditory/visual/palpatory examinationXAssessment of tongue coordination and motionXAssesssment of velar functionXAssessment of face and jaw morphologyXAssessment of balanceXComplex speech assessmentXUltrasonographySonography of tongue during speechXDiagnostic work upSignature trainer when competency achievedAudiometryNarrow band or pure tone audiometryImpedance measurementsTEOAE, DPOAE, BERAImagingCerebral Sonography, CT, MRILaboratory testsMetabolic diagnosticsGenetic assessmentNeuropediatric assessmentPsychomotoric TestingEEGOphthalmologic assessmentEyesight-testMedical TreatmentSignature trainer when competency achievedLogopedic/Speech Language therapyErgotherapyPhysiotherapyComplicationsSignature trainer when competency achievedPermanent deficit or loss of communication competenceIlliteracy5. FLUENCY DISORDERSDiseases / Fluency disordersSignature trainer when competency achievedStutteringClutteringMixed fluency disorderHistorySignature trainer when competency achievedSpecificNon-fluent speechRepetitions of phonemes, syllables, words, part of sentencesToniRespiratory DyscoordinationFacial symptomsGeneralNon-voluntary movementsPsychosocial problemsClinical ExaminationSIASignature trainer when competency achievedGeneralAuditory/visual/palpatory examinationXAssessment of tongue coordination and motionXAssesssment of phonatory respiration XComplex fluency assessment XQuestionnairesFluency disorder-related quality of life questionnaireXOthersAudiometryXDiagnostic work upSignature trainer when competency achievedImagingCerebral CT, MRILaboratory testsGeneticsNeurologic assessmentEEGMedical TreatmentSignature trainer when competency achievedLogopedic/Speech Language therapyPharmacotherapyPsycotherapyComplicationsSignature trainer when competency achievedPermanent fluency disorderSocial isolation6. HEARING IMPAIRMENTS AS PART OF COMMUNICATION DISORDERSDiseases / Hearing impairmentsSignature trainer when competency achievedConductive hearing loss and mixed hearing lossSensorineural hearing loss (cochlear and retrocochlear)Sudden sensorineural hearing loss (SSHL)Central hearing lossAuditory processing disorderTinnitusHistorySignature trainer when competency achievedSpecificTime and dynamic of onsetDescription of impairment right/left ear Balance disturbancesKnown etiologyEffects on voice, speech, and language communication abilitiesPrevious diagnostic and therapeutic measuresGeneralAdditional handicaps, diseasesDelayed psychomotor developmentDelayed cognitive developmentClinical ExaminationSIASignature trainer when competency achievedENT examination including binaural otoscopy/otomicroscopy, verbal acumetric test and tuning fork testsXDiagnostic work upSignature trainer when competency achievedAudiological testsAge-specific subjective tests (free-field audiometry, pure-tone audiometry, speech audiometry)Newborn hearing screening Objective audiometry Vestibular testing ImagingCT, MRILaboratory testsSerologic testsGenetic assessment if necessaryIndication of Consultant DiagnosticsPaediatrics/NeuropaediatricsNeurologistPsychologistOphthalmologistUrologistMedical TreatmentSignature trainer when competency achievedSupply with hearing devices(Re-) Habilitation proceduresDisorder- specific advice e.g. in SSHL pharmacological treatment, hyperbariaComplicationsSignature trainer when competency achievedPermanent deficit or loss of communication competenceV. FACIAL PLASTICS AND AESTHETIC SURGERYDiseases/DisordersSignature trainer when competency achievedCongenital malformationsInfectionsInflammatoryBenign & malignant tumoursTraumatic injuriesHistorySignature trainer when competency achievedSpecificNasal deformityNasal obstructionProminent earAural atresiaFractures of the facial bonesFacial paralysisDermatochalasisPtosisVolume loss of the soft tissues of the faceSkin atrophyPigmentary disturbances of the skinSkin wrinklesAging faceAging neckNeurosensory disturbancesGeneralFamily history of agingPast history of non-invasive proceduresPast history of facial plastic surgeryFacial traumaSun exposureOtotoxic usage / exposureMigrainePerinatal historyTORCH infectionClinical ExaminationSignature trainer when competency achievedGeneralassessment of the face and ethnic variationfacial analysiseffects of aging processassessment of skinpsychological assessment / screening photographyinvestigation of the cranial nerves, clinicalfacial paralysis gradinganterior rhinoscopyendoscopymicroscopycomputer imagingTests of Functionrhinomanometryacoustic rhinometryolfactory testscytology of nasal mucosaallergy testsairstream simulationphotography, videographyInterpretation of relevan imagingultrasound scan (a- and b-mode)X-ray conventional, OPGCephalometryinterpretation of a. CT-scan b. MR-imaging c. Isotope scan (szinti-scan) d. Angiography e. PET-CTdigital volume tomography 3D AnalysisNon-surgical managementSignature trainer when competency achievedpharmocological therapytopical drug applicationchemical peelslaser therapyintense light therapynoninvasive tissue therapyintense ultrasound and related methodspercutaneous cryotherapypercutaneous, minimally invasive tissue ablationmanagement of woundsapplication of botulinum toxins and neuromodulatorsa. for reconstructive purposesb. for the treatment fo facial paralysis and other neural deficitsc. for cosmetic purposes including wrinkle treatmentd. for wound healing and improved scarringapplication of fillers (temporary and permanent)wrinkle treatment, other methodsmanagement of scar tissuelipolysiswound dressingsprosthetic options for ear, nose, etc.Surgical ManagementSIASignature trainer when competency achievedtopical, local and regional anaesthesiaXsuture techniquesXturbinate surgery Xexcision techniques for cutaneous malignanciesXTraumaRepair Soft Tissue Injury/LacerationsXFacial Nerve RepairXLacrimal Duct RepairXNasal FractureXFrontal Sinus FractureXNasoethmoid FractureXSkull/Cranial FractureXMidface FractureXMalar (Zygoma) FractureXOrbital FractureXMandibular FractureXOtherXCongenital Hemangioma/Lymphangioma?? ? ResectionX? ? TreatmentXChoanal Atresia RepairXCleft Lip?? ? ? Unilateral RepairX? ? ? Bilateral RepairXAlveolar Cleft RepairXCleft Palate RepairXCraniofacial ProcedureXMicrotia ReconstructionXOtoplastyXOther Auricular RevisionXOtherXReconstructiveMandible ReconstructionXFacial Bone Grafting/ReconstructionXOrthognathic ProceduresXGrafts?? Split ThicknessX? Full ThicknessX? CompositeX ?Dermal/Dermal-FatX? Cartilage Grafts?? ? ? AuricularX? ? ? RibX? ? ? SeptalXFlaps?? ? LocalX? ?RegionalX? ? DistalX? ? FreeX? ? LipX? ? Detachment of Pedicle FlapXFacial Nerve Reconstruction?? Nerve GraftX? Gold WeightX? Lower Lid TighteningX? Microneurovascular FlapX? Muscle SlingX? Static SlingX? OtherXScar Revision Surgery?? ? Z-PlastyX? ? W-Plasty/Geometric Broken Line ClosureX? ? Complex OtherX? ? Full Face DermabrasionXTissue ExpandersXOtherXCosmetic/ReconstructiveRhinoplastyXSeptorhinoplastyXSeptoplastyXBlepharoplasty (count bilaterals as 1 procedure only; count upper & lower blephs each as 1 procedure)? Upper ?CosmeticX Upper FunctionalX Lower w/ fat repositioningX LowerX Skin PinchXRhytidectomy:? Extended SMASX? ? W/Smart Lipo LaserX Deep PlaneX Mini-LiftX? ? W/ Smart Lipo LaserX Plication LiftX? ? W/ Smart Lipo LaserXMidface LiftXMentoplasty (Chin)?? ? ? AugmentationX? ? ? ReductionXFacial Implants (e.g. malar)XCoronal/Frontal LiftXBrowliftXEndoscopic Forehead LiftXTranstemporalXTricophyticXCervicofacial LiposuctionXSkin Resurfacing?? Dermabrasion (major-not scars)X? Chemical Peel (medium & deep only)X? Face, Eyelid, and/or Perioral Laser Resurf.X? Laser Treatment of Vascular LesionsXFat TransferXOtherXComplicationsSignature trainer when competency achievedInfectionAsymmetryProlonged edemaProlonged erythemaContour deformitiesFacial paralysisImplant extrusionSkin necrosisKeloidChemosislagophthalmosPtosisSubconjunctival hemorrhageVision lossAnosmiaEpistaxisSeptal perforationNeurosensory deficitsMalocclusionVI. PAEDIATRIC OTORHINOLARYNGOLOGY1. OTOLOGYDiseases/DisordersSignature trainer when competency achievedAcute otitis mediaOtitis media with effusionChronic otitis mediaChronic otitis media with cholesteatomaSensorineural hearing loss of various causes and degrees Facial nerve disordersSyndromes and malformationsHistorySignature trainer when competency achievedSpecificOtalgiaOtorrheaHearing lossTinnitusVertigo and balance disordersHyperacusisFacial nerve disordersGeneralFamily history of hearing or balance disordersPerinatal historyHistory of otitis mediaPast history of infectious diseasesHead/ear injuryNoise exposureOtotoxic usage / exposureClinical ExaminationSignature trainer when competency achievedGeneralGeneral ORL examinationMicroscopyOto-endoscopyDiagnostic ProceduresClinical hearing testsLaboratory testsMicrobiology testsAudiometric evaluationTympanometryScreening methodsABR,ASSR,OAEImaging (x-ray, CT, MRI, angiography)Evaluate and identify complicationsMedical TreatmentSignature trainer when competency achievedPharmacological treatment Referral for hearing aid placementSurgical TreatmentSIASignature trainer when competency achievedForeign body removal XMyringotomy XVentilation tube insertionXTympanoplastyXAntrotomyXMastoidectomy - simpleXCochlear implants, BaHaX2. LARYNGOLOGY & PHONIATRICSDiseases/DisordersSignature trainer when competency achievedStridor of various causes ( congenital, infective, posttraumatic, tumours, iatrogenic, OSAS, foreign body)HistorySignature trainer when competency achievedFamily historyPrenatalBirth: method of deliveryRespiratory compromisePost-natal: ICU stay/intubation?ER visits/hospital stays?Stridor: awake or asleep, postureExercise (in)toleranceSleep apnoeaQuality of voice/cryFailure to thriveEating/swallowing disordersClinical ExaminationSignature trainer when competency achievedGeneralGeneral ORL examinationInitial assessment of a patient with stridor – determine urgency/correlate with breathing/Failure to ThriveNasal flaring Retractions: suprasternal, sternal, subcostalCyanosis (perioral)Rapid respiratory rateDesaturationDiscomfort/distressDiagnostic ProceduresFlexible-endoscopy of the larynx, trachea, bronchiRigid endoscopyLaryngomicroscopyLaboratory testsMicrobiology testsImaging (x-ray, MSCT, MRI, angiography, esophagography)Medical TreatmentSignature trainer when competency achievedPharmacological treatment (antibiotics, corticosteroids therapy, inhalations, propranolol therapy)Surgical TreatmentSIASignature trainer when competency achievedRemoval of foreign bodies from the larynx, trachea, bronchi and oesophagusXEndotracheal intubationXTracheotomy - tracheostomyXEndolaryngeal surgery of tumoursXEndolaryngeal laser surgery of tumours in the upper aerodigestive tractXManagement of laryngo-tracheal stenosisX3. RHINOLOGY, ALLERGOLOGY & FACIAL PLASTIC SURGERYDiseases/DisordersSignature trainer when competency achievedRhinosinusitis (with or without nasal polyps, acute, chronic, related to comorbiditiesRhinitis (infective and allergic)EpistaxisTraumaSeptal deviationChoanal atresiaTumoursHistorySignature trainer when competency achievedFamiliar history PrenatalBirth: method of deliveryNeonatalNasal obstructionNasal secretionCoughHeadacheSnoringSleep disturbanceClinical ExaminationSignature trainer when competency achievedGeneralGeneral ORL examinationClinical assessment of patencyNasal endoscopyEndoscopy of the nasopharynxDiagnostic ProceduresLaboratory testsMicrobiology testsCiliary function testsBiopsy of the nasal mucosa and analysis of ciliary motilityAllergy testsImaging (CT, MRI)Sleep studiesMedical TreatmentSignature trainer when competency achievedPharmacological treatment Surgical TreatmentSIASignature trainer when competency achievedControl of epistaxisXNasal packing/cautery XForeign body removalXReposition of nasal fracturesXIncising abscessXSeptal hematomaXSoft tissue injuriesXOtoplastyXSeptal surgery XPediatric endoscopic surgeryXDacryocystorhinostomy in childrenXCleft patient rhinoplastyXCorrections of malformations (e.g. choanal atresia, fistulae, dermoids, etc)XJuvenile angiofibroma endoscopic/open surgeryX4 LARYNGOLOGY/HEAD & NECKDiseases/DisordersSignature trainer when competency achievedOral cavity, pharynxAdenotonsillar diseaseNeck swelling ( various causes: congenital, infective, tumours)Injuries to the head and neckHistorySignature trainer when competency achievedPrenatalNeonatalNasal obstructionSleep apnoeaRecurrent tonsillitisComplications of tonsillitisCarrier stateDrooling and speech problemClinical ExaminationSignature trainer when competency achievedGeneralGeneral ORL examinationNasopharyngoscopySpecific assessment of the complaintDiagnostic ProceduresLaboratory tests Microbiology testsSleep studiesUltrasound examination of the neckImaging ( CT, MRI)FNA/biopsy as requiredPlain X-rayComputerized tomography (to include cone beam CT scanning of the temporal bones)Magnetic resonance imagingAngiographyPositron Emission Tomographytechnetium, gallium scanningRelevant blood testsCytologyHistologyMicrobiologyMedical TreatmentSignature trainer when competency achievedPharmacological treatment (antibiotics, steroids, propranolol)Surgical TreatmentSIASignature trainer when competency achievedAdenoidectomyXTonsillectomy and tonsillotomyXAbscess tonsillectomy (hot tonsillectomy)XArrest of postadenotonsillectomy haemorrhageXForeign body removalXTransoral removal of salivary calculiXDrainage of abscess?Peri- and retrotonsillarXPara- and retropharyngealXCorrection of malformations?Lingual and labial frenulumXRanulaXCysts inclusionXMacroglossiaXSurgery of simple neck injuriesXSurgery of tumours:?a) thyroglossal duct/cystXb) branchial cystXc) neck fistulaeXd) single lymph node excisionXe) benign tumours including salivary glandsXf) Incision and drainage of neck abscessXg) Surgery of benign skin tumoursXh) Surgery of vascular tumoursi) Surgery of malignant tumoursXSurgery of the thyroid gland?HemithyroidectomyXTotal thyroidectomyX5 POSTOPERATIVE COMPLICATIONSSignature trainer when competency achievedComplications of general and local anaesthesiaBleeding / haematomaInfectionConductive hearing lossSensorineural hearing lossVertigo / imbalanceTinnitusHyperacusisFacial nerve paresisTaste disturbanceNumbness of the auricleCSF leakageIntracranial infectionLower cranial neuropathy ................
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