Physician Assistant Program:

Clinical Medicine I Objectives: ENT- ENT Module

Objectives

ENT Goals
1. To enhance the student's ability to diagnose and treat pathology of the ENT system.
2. To critically analyze the approach to diagnosis of ENT disorders.
3. To develop innovative and unique approaches to diagnosis and treatment of ENT problems.

ENT Overview

Class I
1. Define Otorhinolaryngology.
2. Distinguish between branchial clefts, arches and pouches.
3. Describe how branchial clefts are related to congenital defects.
4. Recognize the drainage patterns of the lymphatics of the head and neck.
5. Identify the location of the facial nerve.
6. Identify Stensen's and Wharton's ducts.
7. Discuss the importance of the vermillion border.

Class II
1. Identify common instruments used in the care of the ENT patient
2. Define the importance of branchial clefts, arches and pouches.
3. Define the embryologic milestones in the development of the ENT structures.

ENT Emergencies

Class I
1. Describe sudden deafness and explain why this problem can be a medical emergency.
2. Discuss the pathogenesis, symptoms and physical findings of a patient with epistaxis.
3. Discuss the treatment of epistaxis, anterior and posterior.
4. Given a patient with possible airway obstruction identify the most appropriate imaging technique.

Class II
1. Describe the various types of LeFort fractures.
2. Recognize the anatomic landmarks compromised in facial fractures and the potential  complications  from

     these disruptions
3. Discuss the initial treatment of a patient with severe facial deformity from fracture.
4. Describe the management of the airway in a patient with facial trauma.
5. Discuss the initial management of a patient with laryngeal trauma.
6. Discuss laboratory tests that may need to be done to evaluate a patient with epistaxis
7. Identify the syndromes/diseases that commonly cause hearing loss and/or cleft lip.

Ear Infections

Class I
1. Describe the pathogenesis of otitis media.
2. Describe the symptoms and physical findings of acute otitis media.
3. Describe the non-pharmacologic treatment of otitis media.
4. Discuss the indications for pneumatic equalization tube placement.
5. Compare and contrast the pathogenesis, symptoms, physical findings and treatment of serous otitis

     media with that of acute otitis media.
6. Describe the pathogenesis of otitis externa.
7. Describe the symptoms and physical findings of otitis externa.
8. Describe the treatment for otitis externa.
9. Discuss common patient education for health promotion and disease prevention.

Class II
1. Discuss the following complications that may result from otitis media.
a. hearing loss
b. cholesteotoma
c. tympanic membrane perforation
d. mastoiditis
2. Outline indications for referral of patients with otitis media or otitis externa.
3. Identify the pathogenesis and physical findings of bullous myringitis
4. Describe the signs and symptoms of TMJ dysfunction.
5. Describe the noninvasive management of TMJ dysfuntion.
6. Given a patient with one of the following problems, identify the most appropriate imaging technique:
a. mastoiditis
b. cholesteotoma
c. TMJ dysfunction

Audiology and Practical ENT Lab

Class I
1. Describe the screening procedures to detect hearing deficits.
2. Discuss the common causes of hearing loss.
3. Describe the audiologic assessment.
4. Interpret a standard audiologic assessment.
5. Formulate prevention strategies to decrease hearing loss.
6. Identify the hearing and speech milestones for children.
7. Perform flexible and direct laryngoscopy.
8. Distinguish between MRI and CT of the head.

Ear Trauma and “Dizziness”

Class I
1. Identify three treatments for cerumen impaction and the risks and benefits of each.
2. Describe the approach to treatment of a foreign body in the ear canal.
3. Describe acoustic neuroma in terms of prevalence, signs, symptoms, and evaluation.
4. Distinguish between vertigo and dizziness.
5. Discuss the differential diagnosis for a patient presenting with vertigo.
6. Outline therapeutic options for the treatment of vertigo.
7. Describe the criteria for ENT referral for the patient with vertigo.

Class II
1. Given a patient with a possible acoustic neuroma identify the most appropriate imaging technique.
2. Discuss the management of a hematoma to the pinna.
3. Describe the management of a pinna laceration that is through the cartilage.

Nose and Sinus

Class I
1. Discuss the pathogenesis of acute and chronic sinusitis.
2. Discuss signs and symptoms of acute, recurrent and chronic sinusitis.
3. Compare and contrast treatment of acute and chronic sinusitis.
4. Identify possible complications of sinusitis.
5. Discuss pathogenesis of allergic rhinitis.
6. Describe signs and symptoms of allergic rhinitis.
7. Distinguish between the clinical presentations of infectious vs. allergic rhinitis.
8. Discuss common patient education for health promotion and disease prevention.

Class II
1. Describe indications for ENT referral and/or surgical intervention for chronic sinusitis.
2. Briefly describe pathogenesis, presentation and treatment of nasal polyps.
3. Briefly describe the pathogenesis and treatment of vasomotor rhinitis.
4. Describe the approach to treatment of a foreign body in the nose.
5. Identify the malignant and benign tumors of the nose and sinuses.
6. Identify causes of nasal congestion other than allergic or infectious.
7. Given a patient with acute or chronic sinusitis identify the most appropriate imaging technique.
8. Given a patient with nasal trauma identify the most appropriate imaging technique.
9. Describe the management of a patient with a nasal fracture.

Oral Pathology

Class I
1. Discuss the pathogenesis, symptoms and physical findings in sjogren's syndrome.
2. Describe the treatment of a patient with sjogren's syndrome.
3. Identify the presentation and treatment of oral candidiasis, glossitis, stomatitis, gingivitis, and oral

    gonorrhea.
4. Discuss oral papilloma and it's treatment.
5. Define ranula.

Pharynx and Larynx

Class I
1. Discuss the differential diagnosis for a patient with acute sore throat.
2. Describe the causative organisms, symptoms, and physical findings for: viral pharyngitis, streptococcal infection and mononucleosis. How may these be differentiated?
3. Describe the treatment for: streptococcal infection of the tonsils, mononucleosis, and viral pharyngitis.
4. Describe the symptoms, physical findings and treatment of a peritonsillar abscess.
5. Discuss the common causes of hoarseness.
6. Describe evaluation and treatment of acute laryngitis.
7. Describe the pathogenesis, symptoms and physical findings of epiglottitis in a child.
8. Discuss the treatment of epiglottitis.
9. Describe the pathogenesis, symptoms and physical findings of croup.
10. Differentiate between presentation and treatment of epiglottitis and croup.
11. Discuss common patient education for health promotion and disease prevention.

Class II
1. List the current indications for tonsillectomy.
2. Identify the reasons for referral for hoarseness.
3. Describe the criteria for diagnosis of rheumatic fever.
4. Understand the effect of rheumatic fever on the heart.

Head and Neck

Class II
1. Identify the risk factors for head and neck cancers.
2. List the most common types of head and neck cancers.
3. Discuss presenting symptoms and physical findings of head and neck cancers.
6. Discuss the pathogenesis, symptoms and physical findings with mumps and parotitis.
7. Describe the treatment of a patient with mumps and parotitis.
8. Describe the evaluation of the patient with a neck mass.
9. Identify neck masses requiring urgent or emergent evaluation by an Otorhinolarygologist.

Clinical Faculty:

Harold C. Pillsbury III, MD, FACS , Professor and Chair
Thomas J. Dark Distinguished Professor
BA, MD: George Washington University
Residency: University of North Carolina at Chapel Hill
Special Interests: neurotology, head & neck tumors, cochlear implantation 

Carolyn J. Brown, MS, CCC-SLP/A , Clinical Assistant Professor
BS, MS: Indiana State University
MS: University of Illinois
Special Interests : coclear implantation and profoundly deaf children 

Craig A. Buchman, MD, FACS , Professor
BS: University of Georgia
MD: University of Florida
Residency: University of Pittsburgh School of Medicine
Fellowship: House Ear Institute and Clinic, Los Angeles, CA
Special Interests : otology, neurotology, skull base surgery

Robert A. Buckmire, MD , Associate Professor
BA: Boston University
MD: University of Virginia School of Medicine
Fellowship: Vanderbilt University Voice Center, Nashville, TN
Residency: University of North Carolina at Chapel Hill
Special Interests: Voice and swallowing disorders, diagnostic and laryngeal EMG, laryngeal framework surgery, microsurgical treatment of laryngeal pathology

Raymond D. Cook, MD , Assistant Professor
Otolaryngology/Head and Neck Surgery - Wake Medical Center
BS: University of Georgia
MD: University of North Carolina School of Medicine
Residency: Duke University Medical Center
Fellowship: Farrior Facial Plastics and Reconstructive Surgery, Tampa, FL
Special Interests: facial cosmetic and reconstructive surgery, reconstruction of local scars and skin cancers

Marion E. Couch, MD, PhD, FACS , Assistant Professor
BS: Michigan State University
PhD: Rush University
MD: Rush Medical College
Residency: Johns Hopkins University School of Medicine
Special Interests: head and neck surgical oncology, thyroid surgery, microvascular free tissue transfer reconstruction

Brett E. Dorfman, MD, Assistant Professor
Otolaryngology/Head & Neck Surgery - Wake Medical Center
BA: Cornell University
MD: Emory University School of Medicine
Internship: Duke University Medical Center
Residency: Duke University Medical Center
Special Interests : Rhinology, allergy, sinus surgery

Amelia F. Drake, MD, FACS , Professor 
Newton D. Fischer Distinguished Professor 
BA: Cornell University 
MD: University of North Carolina at Chapel Hill 
Residency: University of Michigan 
Fellowship: Cincinnati Children's Hospital
Special Interests : pediatric otolaryngology, pediatric airway disorders 

Michael O. Ferguson, MD , Assistant Professor
Otolaryngology/Head & Neck Surgery - Wake Medical Center
BA: University of North Carolina at Chapel Hill
MD: University of North Carolina at Chapel Hill
Residency and Internship: University of North Carolina at Chapel Hill
S pecial Interests : General and pediatric otolarygology, rhinology, allergy, and sinus surgery

Scott D. Meredith, MD, FACS , Associate Professor 
Otolaryngology/Head & Neck Surgery-Wake Medical Center
BS, MD: University of Virginia
Residency and Fellowship: University of Virginia
Special Interest : head and neck oncology

Austin S. Rose, MD , Assistant Professor
BA: Duke University
MD: University of North Carolina School of Medicine
Internship: General Surgery, Univ. of North Carolina School of Medicine
Residency: Oto/HNS, Univ. of North Carolina School of Medicine
Fellowship: Pediatric Otolaryngology, Johns Hopkins Hospital
Special Interests: pediatric otolaryngology, diagnostic and reconstructive airway surgery, chronic ear disease

Patricia A. Roush, AuD , Clinical Instructor
BA: University of Massachusetts
MA: University of Iowa
AuD: University of Florida, Gainesville
Special Interests: pediatric audiology

Brent A. Senior, MD, FACS, FARS , Associate Professor 
BS: Wheaton College
MD: University of Michigan
Residency: The Combined Otolaryngology Training Program of Boston University and Tufts University
Fellowship: Rhinology and Sinus Surgery (David W. Kennedy, MD), University of Pennsylvania Medical Center, Philadelphia, PA
Special Interests : sinus surgery, rhinology, allergy, sleep disorders, snoring 

William W. Shockley, MD, FACS , Professor 
W. Paul Biggers Distinguished Professor
BA, MD: Indiana University
Residency: University of Cincinnati
Fellowship: Head & Neck Surgery Associates, Methodist Hospital, Indianapolis, IN
Special Interests : facial plastic and reconstructive surgery, head and neck tumor surgery 

Carol G. Shores, MD, PhD, FACS , Assistant Professor 
BS: University of Florida
MD, PhD: University of North Carolina at Chapel Hill
Postdoc: Glaxo Research Institute
Residency and Internship: University of North Carolina at Chapel Hill
Special Interests : General ENT with research interests in developing new genetic based diagnostic tests and treatments for head and neck squamous cell carcinoma, and in the genetics of hearing loss
Holly Teagle, AuD , Clinical Instructor
BA: University of Arkansas, Fayetteville, AR
MA: Univeristy of Iowa, Iowa City, IA
AuD: University of Florida, Gainesville
Special Interest : Pediatric cochlear implantation

Mark C. Weissler, MD, FACS , Professor
J.P. Riddle Distinguished Professor 
BA, MD: Boston University Six Year Medical Program
Residency: Harvard University
Fellowship: Head & Neck Oncologic Surgery, University of Cincinnati
Special Interests : head and neck tumor surgery, adult voice disorders