Dr. NTR UNIVERSITY OF HEALTH SCIENCES: A.P.

: VIJAYAWADA - 08

GUIDELINES FOR THE SCHEME OF UNIVERSITY EXAMINATION

OTORHINOLARYNGOLOGY
Goal:

The broad goal of the teaching of undergraduate student in

Otorhinolaryngology is to inoculate a rational and scientific basis of diagnosis
and therapeutics.

Objectives:

A. KNOWLEDGE:

At the end of the course, the student shall be able to:

1) Describe the Anatomy & physiology of ear, nose, throat, head & neck

2) Describe the pathophysiology of common diseases in ENT

3) List the indications and perform various diagnostic and Therapeutic procedures
in ENT

4) State the principles and protocols for management of Ear, Nose & Throat
diseases

B. SKILLS:

At the end of the course, the student shall be able to:

1) Prescribe drugs for common ailments;

2) Identifying various conditions of Ear, Nose & Throat diseases clinically

3) Identify, resuscitate and manage ENT emergencies in a simulated

Environment

C. Attitude and communication skills:

At the end of the course, the student shall be able to:

1) Communicate adequately, sensitively, effectively and respectfully with

patients in a language that the patient understands and in a manner
that will improve patient satisfaction and health care outcomes.

2) Establish professional relationships with patients and families that are

positive, understanding, humane, ethical, empathetic, and trustworthy.
 3) Communicate with patients in a manner respectful of patient’s
preferences, values, prior experience, beliefs, confidentiality and privacy.

4) Communicate with patients, colleagues and families in a manner that

encourages participation and shared decision-making.

5) Take and informed consent for invasive investigations & surgical

procedures in ENT

D. INTEGRATION:

Practical knowledge of use of drugs in clinical practice will be acquired

through horizontal and vertical integration with clinical and pre clinical
subjects.

SUMMARY OF TIME ALLOTTED for TEACHING LEARNING

METHODS AND STUDENT ASSESSMENT in
OTORHINOLARYNGOLOGY

Curricular component Time allotted in hours

Lectures 25

Small group teaching/Tutorials / 40

Seminars/integrated teaching

Self‐directed learning 5

AETCOM module (Shared by all depts. 10

in Phase I)
Total 75
(Excluding AETCOM & EC Activities)

To be noted:

• The number of hours mentioned above are rough guidelines that can
be modified to suit the specific requirements of a medical college.
• It is recommended that didactic teaching be restricted to less than
one third of the total time allotted for that discipline.
 • Greater emphasis is to be laid on hands-on training, symposia,
seminars, small group discussions, problem-oriented and problem-
based discussions and self directed learning.
Students must be encouraged to take active part in and share
responsibility for their learning.

DETAILED SYLLABUS (THEORY)

Horizontal Vertical
S.NO TOPIC Competency
Integration Integration
Anatomy and Physiology of ear,
nose, throat, head & neck
Describe the Anatomy & physiology of Human
1 EN1.1
ear, nose, throat, head & neck Anatomy
Describe the pathophysiology of Pathology
2 EN1 2
common diseases in ENT
Diagnostic and Therapeutic
procedures in ENT
Observe and describe the indications
for and steps involved in the
1 performance of Otomicroscopic EN3.1
examination in a simulated
environment
Observe and describe the indications
for and steps involved in the
2 EN3. 2
performance of diagnostic nasal
Endoscopy
Observe and describe the indications
for and steps involved in the
3 EN3 .3
performance of Rigid/Flexible
Laryngoscopy
Observe and describe the indications
for and steps involved in the removal
4 EN1 3..4
of foreign bodies from Ear, Nose,
Throat
Observe and describe the indications
for and steps involved in the
5 surgical procedures in ear, nose & EN1 3..5
throat

6. Observe and describe the indications EN3.6

 for and steps involved in the skills
of emergency procedures in ear, nose
& throat
Management of diseases of ear,
nose & throat
Elicit document and present a correct
history, demonstrate and describe
1 the clinical features, choose the EN4.1
correct investigations and describe the
principles of management of Otalgia
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
2 EN4.2
correct investigations and describe the
principles of management of diseases
of the external Ear
Elicit document and present a correct
history, demonstrate and describe
3. the clinical features, choose the EN4.3
correct investigations and describe the
principles of management of ASOM
Demonstrate the correct technique to
hold visualize and assess the
mobility of the tympanic membrane
4. EN4.4
and its mobility and interpret and
diagrammatically represent the
findings
Elicit document and present a correct
history, demonstrate and describe
5. the clinical features, choose the EN4.5
correct investigations and describe the
principles of management of OME
Elicit document and present a correct
history, demonstrate and describe the
clinical features, choose the correct
6. EN4.6
investigations and describe the
principles of management of
Discharging ear
Elicit document and present a correct
history demonstrate and describe
7. the clinical features, choose the EN4.7
correct investigations and describe the
principles of management of CSOM
Elicit document and present a correct
8. EN4.8
history, demonstrate and describe
 the clinical features, choose the
correct investigations and describe the
principles of management of
squamosal type of CSOM
Demonstrate the correct technique for
9. syringing wax from the ear in a EN4.9
simulated environment
Observe and describe the indications
10. for and steps involved in myringotomy EN4.10
and myringoplasty
Enumerate the indications describe
11. the steps and observe a EN4.11
mastoidectomy
Elicit document and present a correct
history demonstrate and describe
the clinical features, choose the
12. EN4.12
correct investigations and describe the
principles of management of Hearing
loss
Describe the clinical features,
13. investigations and principles of EN4.13
management of Otosclerosis
Describe the clinical features,
investigations and principles of
14. EN4.14
management of Sudden Sensorineural
Hearing Loss
Describe the clinical features,
investigations and principles of
15. EN4.15
management of Noise Induced Hearing
Loss
Observe and describe the indications
16. for and steps involved in the EN4.16
performance of pure tone audiometry
Enumerate the indications and
17. EN4.17
interpret the results of an audiogram
Describe the clinical features,
18. investigations and principles of EN4.18
management of Facial Nerve palsy
Describe the clinical features,
investigations and principles of
19. EN4.19
management of Vertigo

Describe the clinical features,

20. investigations and principles of EN4.20
management of Meniere’s Disease
 Describe the clinical features,
21. investigations and principles of EN4.21
management of Tinnitus
Elicit document and present a correct
history demonstrate and describe
the clinical features, choose the
22. EN4.22
correct investigations and describe the
principles of management of
squamosal type of Nasal Obstruction
Describe the clinical features,
23. investigations and principles of EN4.23
management of DNS
Enumerate the indications observe
24. and describe the steps in a EN4.24
septoplasty
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
25. EN4.25
correct investigations and describe the
principles of management of
squamosal type of Nasal Polyps
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
26. EN4.26
correct investigations and describe the
principles of management of
squamosal type of Adenoids
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
27. EN4.27
correct investigations and describe the
principles of management of
squamosal type of Allergic Rhinitis
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
correct investigations and describe the
28. EN4.28
principles of management of
squamosal type of Vasomotor Rhinitis

Elicit document and present a correct

history demonstrate and describe the
29. EN4.29
clinical features, choose the correct
investigations and
 describe the principles of management
of squamosal type of Acute &
Chronic Rhinitis
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
30. EN4.30
correct investigations and describe the
principles of management of
squamosal type of Epistaxis
Describe the clinical features,
investigations and principles of
31. EN4.31
management of trauma to the face &
neck
Describe the clinical features,
investigations and principles of
32. EN4.32
management of nasopharyngeal
Angiofibroma
Elicit document and present a correct
history demonstrate and describe
clinical features , choose the correct
33. investigations the EN4.33
principles of management of
squamosal type of Acute & Chronic
Sinusitis
Describe the clinical features,
34. investigations and principles of EN4.34
management of Tumors of Maxilla
Describe the clinical features,
investigations and principles of
35. EN4.35
management of Tumors of
Nasopharynx
Describe the clinical features,
investigations and principles of
36. EN4.36
management of Tumors of
Nasopharynx
Describe the clinical features,
investigations and principles of
37. management of Ludwig’s angina EN4.37

Elicit document and present a correct

history demonstrate and describe
38. the clinical features, choose the EN4.38
correct investigations and describe the
principles of management of type of
 dysphagia

Elicit document and present a correct

history, demonstrate and describe
the clinical features, choose the
39. correct investigations and describe the EN4.39
principles of management of
squamosal type of Acute & Chronic
Tonsillitis
Observe and describe the indications
40. for and steps involved in a EN4.40
tonsillectomy / adenoidectomy
Describe the clinical features,
investigations and principles of
41. EN4.41
management of Acute & chronic
abscesses in relation to Pharynx
Elicit, document and present a correct
history, demonstrate and describe the
clinical features and choose the
42. EN4.42
correct investigations describe the
principles of management of
hoarseness of voice
Describe the clinical features,
investigations and principles of
43. EN4.43
management of Acute & Chronic
Laryngitis
Describe the clinical features,
investigations and principles of
44. EN4.44
management of Benign lesions of the
vocal cord
Describe the clinical features,
45. investigations and principles of EN4.45
management of Vocal cord palsy
Describe the clinical features,
investigations and principles of
46. management of Malignancy of the EN4.46
Larynx & Hypopharynx

Describe the clinical features,

47. investigations and principles of EN4.47
management of Stridor
Elicit document and present a correct
history, demonstrate and describe
48. EN4.48
the clinical features, choose the
correct investigations and describe the
 principles of management of Airway
Emergencies
Elicit document and present a correct
history, demonstrate and describe
the clinical features, choose the
49. EN4.49
correct investigations and describe the
principles of management of foreign
bodies in the air & food passages
Observe and describe the indications
50. for and steps involved in EN4.50
tracheostomy
Observe and describe the care of the
51. EN4.51
patient with a tracheostomy
Describe the Clinical features,
Investigations and principles of
52. EN4.52
management of diseases of
Oesophagus
Describe the clinical features,
investigations and principles of General
53. EN4.53
management of HIV manifestations of Medicine
the ENT

OTORHINOLARYNGOLOGY – PRACTICAL TOPICS

Competency
S.No Topic TLM
no.
DOAP
Elicit document and present an
session,
1 appropriate history in a patient EN2.1
Bedside
presenting with an ENT complaint
clinic
 DOAP
Demonstrate the correct use of a
session,
2 headlamp in the examination of the EN2.2
Bedside
ear, nose and throat
clinic
DOAP
Demonstrate the correct technique of
session,
3 examination of the ear including EN2.3
Bedside
Otoscopy
clinic
DOAP
Demonstrate the correct technique of
session,
4 performance and interpret tuning EN2.4
Bedside
fork tests
clinic
Demonstrate the correct technique of DOAP
examination of the nose & session,
5 EN2.5
paranasal sinuses including the use Bedside
of nasal speculum clinic
DOAP
Demonstrate the correct technique of
session,
6 examining the throat including the EN2.6
Bedside
use of a tongue depressor
clinic
DOAP
Demonstrate the correct technique of
session,
7 examination of neck including EN2.7
Bedside
elicitation of laryngeal crepitus
clinic
DOAP
Demonstrate the correct technique to
session,
8 perform and interpret pure tone EN2.8
Bedside
audiogram & impedance audiogram
clinic
Choose correctly and interpret DOAP
radiological, microbiological & session,
9 EN2.9
histological investigations relevant to Bedside
the ENT disorders clinic
DOAP
Identify and describe the use of y
session,
10 common instruments used in ENT EN2.10
Bedside
surgery
clinic
Describe and identify by clinical DOAP
examination malignant & pre- session,
11 EN2.11
malignant Bedside
ENT diseases clinic
DOAP
Counsel and administer informed
session,
12 consent to patients and their families EN2.12
Bedside
in a simulated environment
clinic
 Identify, resuscitate and manage ENT
emergencies in a simulated DOAP
environment (including tracheostomy, session,
13 EN2.13
anterior nasal packing, removal Bedside
of foreign bodies in ear, nose, throat clinic
and upper respiratory tract)
Demonstrate the correct technique to DOAP
instilling topical medications into session,
14 EN2.14
the ear, nose and throat in a Bedside
simulated environment clinic
DOAP
Describe the national programs for
session,
15 prevention of deafness, cancer, EN2.15
Bedside
noise & environmental pollution
clinic

Learning Resource Material

Books recommended:

1. Textbook of Ear, Nose, throat, Head and Neck Surgery – P Hazarika,

Publisher: CBS publishers & Distributors Pvt Ltd

2. Disease of Ear, Nose and Throat with Head and Neck Surgery - Mohan
Bansal, Publisher: The Health Sciences Publisher.

3. Disease of Ear, Nose and Throat – PL Dhingra.

4. Disease of Nose, Throat and Ear – Logan Turner

EXAMINATION SCHEME (PROPOSED) – OTORHINOLARYNGOLOGY

OTORHINOLARYNGOLOGY MARKS DISTRIBUTION AS PER CBME

Total Marks University Examination Marks Internal

 Assessment

Theory Practical/ clinical+ Oral Theory Practical+ Viva

Theory = 100 Paper = 100 1Longcase =30 100 100

Practical= 2 short case = (2x10) = 20

100
Viva =10

Drugs &Instruments = 10

Logbook = 10M

OSCE = 20

Pass Marks Mandatory 50 % in theory and practical ( 50% combined in theory and
Practical = Practical + Viva) of Theory + practical ( not less than 40% in
Orals each) for eligibility of
appearing the university
Examination

For 1st & 2nd Internal Assessment exams single paper will be given as per
the prescribed syllabus decided by respective departments of each college

Timing Month Theory Practical & Viva

3rd Professional Year January 50 --

Part 1
August 100 100

Format for Theory Examinations

(All the 1 Internal Assessments & University Theory Examination)

For Paper-1 Total: 50 Marks 1 ½ hours

 I. 1 Long answer questions 15 marks each - 15 M
II. 6 Short answer questions 5 marks each - 30 M
(2 problem based questions, 1 AETCOM question)
III. Objective questions
1. 5 MCQ’s 1mark each - 5M

Scheme of marking for theory paper

Topics as per curriculum Plan of Max Marks allotted

Anatomy and physiology of Ear 12
Anatomy and physiology of Nose and PNS 10
Anatomy and physiology of Pharynx 8
Anatomy and physiology of Oral Cavity 5
Anatomy and physiology of larynx & trachea 7
Anatomy and physiology of esophagus 6
Miscellaneous 2
50
Special note: Demarcation of topics is tentative only as some amount of
overlapping is unavoidable between these topics. Deviation up to 25% is
acceptable.

Format for Theory Examinations

(All the 2 Internal Assessments & University Theory Examination)

For Paper-1 Total: 100Marks 3hours

IV. 2 Long answer questions 15 marks each - 30 M
V. 10 Short answer questions 5 marks each - 50 M
(2 problem based questions, 1 AETCOM question)
VI. Objective questions
1. 20 MCQ’s 1mark each - 20M

Scheme of marking for theory paper

Topics as per curriculum Plan of Max Marks allotted

Disease of Ear 25
Disease of Nose and PNS 20
Disease of Pharynx 15
Disease of Oral Cavity 10
Disease of larynx & trachea 15
Disease of esophagus 10
Miscellaneous 5
100
Special note: Demarcation of topics is tentative only as some amount of
overlapping is unavoidable between these topics. Deviation up to 25% is
acceptable.

Scheme of making for theory paper / 2nd internal assessment

Type of No. of No. of pages Expected Weightage of Marks
question questions required for answering Marks allotted
Answer time (min)
booklet
MCQ’s(3 20 30 20 x 1 20
case
scenarios, 2
reasoning,
testing
cognitive
domain)
Structure 10 (2x5 40 2 x 15 30
essay
question/
2 Pages)
long
question
Short answer 30 (3x10 110 10 x 5 50
question (two 10 Pages)
problem
based and
one on
AETCOM)

50 pages 180 min 100

approx
 Scheme for internal assessment theory

Total Marks Distribution

1st Internal 50 1x5 = 15M (Long Question)
6x5 = 30M (Short Question)
1x5 = 5M (MCQ’s)

2nd Internal 50 1x5 = 15M (Long Question)

5x5 = 25M (Short Question)
1x5 = 5M (AETCOM Question)
1x5 = 5M (MCQ’s)
Scheme of Making for practical examination

Scheme of making for practical examination

Morning Session

No. of cases Duration (min) Weightage of Marks allotted

marks allotted

Long Case 1 30 25

Short Case 2 20 2 x 10 20

OSCE 5 stations with one 30 5x5 25

blank station

Afternoon Session

Viva 10 10

X-rays and 10 10
instruments

Logbook 10 10

Total 100

SAMPLE QUESTION PAPER

 Subject: Otorhinolaryngology

LONG ESSAY QUESTIONS

1) Define otosclerosis, etiopathogenesis, clinical features & Surgical management?

( 2+3+3+7M)
2) A 60 year old man presented with hoarseness of voice over the last 3 months and
complaining of difficulty in swallowing. Patient is a known smoker since 20 years. What
is your provisional diagnosis and discuss the management?

SHORT ESSAY QUESTIONS

3) Define Epistaxis? Describe the detail arterial supply of lateral wall of Nose with
diagrams? ( 2+3M)
4) Write a short note on BAHA? (5M)
5) Indications of Tracheostomy, Describe the post operative care of Tracheostomy tube?
(2+3M)
6) Physiology of Deglutition? (5M)
7) Define Vertigo, Causes & management of vertigo? (2+3M)
8) Define Stridor, etiology and types? (2+3M)
9) Classification of Antihistamines & explain the Mechanism of action? (2+3M)
10) Define CSOM, types and management? (2+3M)
11) Anatomy of tonsil in details, grading and types of Tonsillitis? (2+3M)
12) Define Nasalpolyposis? Types and etiopathogenesis of Nasalpolyposis? (2+3M)

MCQ’s:
1. A 25-year-old female patient presented with history of bilateral hearing loss
and tinnitus which worsened during pregnancy. She can hear better in
noisy environment. She speaks in a low volume monotonous voice.
Examination showed intract eardrums bilaterally and Rinne test negative
bilaterally. Pure tone audiometry is given below. What is the most probable
diagnosis:

a. Meniere’s disease
b. Secretory otitis media

c. Bilateral acoustic neuroma

d. Otosclerosis

2. Frey’s syndrome is due to cross connection of auriculotemporal nerve with

which nerve after parotid surgery:
a. Sympathetic cholinergic fibres

b. Facial nerve

c. Glossopharyngeal

d. Greater superficial petrosal

3. Hearing loss in Meniere’s disease is of what type:

 a. Fluctuating SNHL

b. Progressive retrocochlear

c. Conductive hearing loss

d. Mixed Hearing loss

4. Haller cells are present in:

a. Roof of maxillary sinus

b. Floor of maxillary sinus

c. Lateral wall of Sphenoid

d. Anterior wall of frontal

5. Cottle’s test is for the patency of the nares in:

a. Atrophic rhinitis

b. Rhinosporidiosis

c. Deviated nasal septum

d. Hypertrophied inferior turbinate

6. Which of the following organism is known to cause

atrophic rhinitis?

a. Klebsiella pneumonia

b. Klebsiella ozaenae

c. Streptococcus pneumonia

d. Streptococcus foetidis

7. The ideal time for tonsillectomy after an attack of quinsy is:

 a. 2 weeks
b. 3 weeks
c. 6 weeks
d. 12 weeks
8. Tubercular laryngitis affects primarily:
a. Anterior commissure

b. Posterior commissure of larynx

c. Anywhere within the larynx

d. Superior surface of larynx

9. Cricothyroid muscle is supplied by:

a. Internal laryngeal nerve

b. External laryngeal nerve

c. Recurrent laryngeal nerve

d. Glossopharyngeal nerve

10. The most common cause of stridor in infant and children is:

a. Congenital subglottic stenosis

b. Laryngomalacia

c. Vocal cord paralysis

d. Foreign body in airway

11. Schwartz sign is seen in

a. CSOM

b. Meniere’s disease

c. Otosclerosis

d. Tympanosclerosis
12. Malignant otitis externa is caused by

a. Staphylococcus

b. Pseudomonas aeruginosa

c. Candida albicans

d. Haemophilus influenza

13. Myringotomy is most commonly done in which quadrant

a. Anterio- Inferior

b. Anterio- Superior

c. Posterio- Superior

d. Posterio- Inferior

14. False regarding gradenigo syndrome

a. Retro-orbital pain

b. Facial Palsy

c. Persistence ear discharge

d. Diplopia

15. Picket – fence spiking fever seen in

a. Extradural abscess

b. Brain abscess

c. Otitic hydrocephalus

d. Lateral sinces thrombophlebitis

16. Frequency of tuning fork used in the Weber or Rinne’s test

a. 256 Hz

b. 512 Hz

c. 1024 Hz
d. 2048 Hz
17. Infectious mononucleosis is caused by

a. Herpes simplex vines

b. Cytomegalovirus

c. Epstein – barr vines

d. Varicella – Zoster vines

18. Lateral view radiography of soft tissue neck showing “Thumb Print”
sign seen in

a. Acute laryngitis

b. Acute Pharyngitis

c. CROUP

d. Acute Epiglottis

19. The most common complication of acute tonsillitis

a. Peritonsillar abscess or Quinsy

b. Tonsillolith

c. Tonsillar Cyst

d. Chronic Tonsillitis

20. Antrochoanal polyps originate from

a. Ethmoidal Sinus

b. Maxillary Sinus

c. Sphenoid Sinus

d. Frontal Sinus
 DEPARTMENT OF ENT

ANSWER KEY (MCQ’s)

Question No Answers
1 D
2 B
3 A
4 A
5 C
6 B
7 C
8 B
9 B
10 B
11 C
12 B
13 A
14 B
15 D
16 B
17 C
18 D
19 A
20 B