Practical ENT
Practical ENT
As per the Competency Based Medical Education Curriculum (NMC)
Fourth Edition
Vikas Sinha MS
Dean/Principal, Professor ENT Shantabaa Medical College
Amreli, Gujarat, India

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Practical ENT
First Edition: 2004
Second Edition: 2005
1st Reprint: 2006
2nd Reprint: 2008
3rd Reprint: 2009
4th Reprint: 2011
5th Reprint: 2013
6th Reprint: 2015
Third Edition: 2017
Fourth Edition: 2022
9789354655463
Printed at
My students
and
in loving memory of my Father, Mother and Brother
This book is truly practical, unique, and to the point. This is best practical guide to ENT residents and specialists, I have ever seen. The style is so unique that it vividly represents a thorough bedside teaching from the master. I really believe that one can get the knowledge of ENT, which cannot be attainable from heavy-volume Western textbooks.
DR YONG JU JANG
MD PhD
Professor, Department of Otolaryngology and Head and Neck Surgery
Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
Professor Sinha is a well-known ENT specialist who is traveling a lot to Asia and Europe to enhance his knowledge and experience in the latest development of ENT. His focus is especially on teaching the younger colleagues, and this book is ideal for this. It presents the latest standards of ENT in history taking, diagnosis and treatment. I congratulate Professor Sinha for this excellent book, and hope it will be widely spread and used. Every MBBS and MS students will also find in this book a good comprehension of ENT diseases. I wish this book a great success. All the best from Stuttgart.
DR WOLFGANG GUBISCH
Ex-Professor, Marienhospital, Stuttgart, Germany
Practical ENT book has elegantly captures the essence of ENT. It is very comprehensive and well written. The clinical history and examination has been well written with additional clinical points that will make it very clear and easy to understand. This book will truly benefit every reader, whichever level he/she may be. My compliments to Dr Vikas Sinha for this excellent work.
DR PREPAGERAN
Professor, Department of Otolaryngology and Head and Neck Surgery
University Malaya Medical Centre, Kuala Lumpur, Malaysia
As a very comprehensive synopsis of basic otolaryngology, the book serves as an excellent resource for the undergraduate medical students commencing their ward posting and practical instruction in otolaryngology, and a good refresher prior to the examination. The book would also serve as a useful resource for postgraduates to reappraise them of the “must know” facts of the subject, especially so with regard to the sections on X-rays, operations, audiology, osteology, instruments and FAQs.
DR ALOK THAKAR
MS FRCS (Edin)
Professor, Department of Otolaryngology and Head and Neck Surgery
All India Institute of Medical Sciences, New Delhi, India
The author has made commendable effort to simplify and present a wealth of clinical information on otorhinolaryngology in this book. The clinical material is very useful for all who wish to have comprehensive understanding of ENT. The book will be of immense help to the medical students to sharpen their clinical acumen. This book is highly recommended to the medical students.
DR ASHOK K GUPTA
Ex-Professor, Department of Otolaryngology and Head and Neck Surgery
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Foreword
I am pleased to write the foreword for Practical ENT authored by Dr Vikas Sinha. This book gives a detailed and precise insight into clinical history taking, examinations, case studies, instruments and operative procedures. I would like to highlight the lucid language and comprehensive contents of the chapters which make the subject interesting. This book should also help the students in observing clinical techniques and patient rounds. I congratulate Dr Vikas Sinha for the tremendous efforts he has put in to make this book as complete as possible. The chapters are well planned and organized. I am sure this will be of immense help to all the medical students as well as aspiring surgeons.
MV Kirtane
Ex-Professor
Department of Otorhinolaryngology and Head and Neck Surgery
Seth GS Medical College and KEM Hospital
Mumbai, Maharashtra, India
Foreword
It gives me great pleasure to write the foreword of the book Practical ENT written by Dr Vikas Sinha. This book is the result of a painstaking and laborious effort by the author to provide a systematic approach to the learning of the subject of otorhinolaryngology for the undergraduate students. The comprehensive chapters on importance of history taking and clinical examination of otorhinolaryngology will help the student imbibe the basics of ENT. The important topics for practical aspects of the undergraduate curriculum have been adequately dealt with in this book. Practical topics like different foramina of skull base, applied anatomy of skull bones, technique and intricacies in cranial nerve examination, audiology, calorimetry and study of X-rays relevant to ENT have been properly highlighted. I recommend this book to all the undergraduates to refresh their knowledge while preparing for their practical examinations. I feel this book will go a long way in fulfilling the pressing need for good undergraduate books in our specialty.
AK Gupta MS, FICS
Director, Professor ENT
Geetanjali Medical College and Hospital
Udaipur, Rajasthan, India
Preface to the Fourth Edition
The medical branch is always changing and the changes are always very fast and rapid especially in medical science. A young doctor must know competencies of ENT which may be required in the medical field. In this new edition, I have tried to add certain competencies of ENT which are essential to know in Otorhinolaryngology and Head and Neck Surgery. The practical demonstration is always the best way to teach or learn and the clinical postings are the ideal process to learn clinical methods and competencies. The books are just supplement of it. My students are my best motivating factors and I always learn something new with them. I have made efforts in this edition to impart some extra knowledge to my students so that they are abreast in ENT with anybody and anywhere in the world. The effort has been made in this new edition to make students understand certain ENT competences in very simple, lucid language. I believe given any situation of practicing ENT, this will help the students to prepare themselves in better way for the practical situations. This will be another step forward to the students to learn certain basic ENT competencies in the vast field of ENT in a better way and in confident way.
Vikas Sinha
Preface to the Third Edition
There are many textbooks of ENT by the noted, distinguished and eminent otolaryngologists who command great respect from the ENT fraternity. Yet I believe there is a need for a genuine and short book of ENT dealing mainly with the history taking part, clinical examination and practical aspect of ENT where students can quickly go through the history and viva-voce aspect. This book is primarily meant for the undergraduate students, especially for those who have first posting in ENT. The postgraduates are advised to refer other referral and advanced books of ENT for better knowledge and understanding of the subject. Frequently Asked Questions (FAQs) is a chapter in which students can quickly revise the things while preparing for the examinations. It does not mean that only these types of questions are being asked in the examination. Students must go through the textbook for detailed knowledge of the subject. The Italic face of the text of this book is suggestive of theoretical aspect of the subject. It is not possible to include everything of otolaryngology as it is not a textbook and efforts have been made on my part to cover all the practical aspects and related questions of table viva. I might have missed many things but sincere efforts have been made to cover the larger portion.
I am extremely thankful to my undergraduate and postgraduate students for encouraging me to write this short book Practical ENT. My every clinical lecture has been a new lesson for me. Every lecture has taught me something, and in every lecture I learn new things from my students. I am extremely thankful to them. My patients are another source of inspiration, as without them I would not have made any attempt to write this book. My all residents deserve lot of credit for helping me to update my knowledge for the latest things in ENT. My daughters Swastika and Shijita, were too generous to help me in every stage of my book writing as the entire process of writing of this book took lots of valuable time which I should have passed with them. My all-family members including my late brother, bhabhi, and sister encouraged me to write a book of ENT since beginning.
Vikas Sinha
Acknowledgments
I am thankful to the Government of Gujarat, India to allow me to use the clinical material from the hospital for writing and publishing this book. I am also thankful to KB Bhargava, SK Bhargava and TM Shah to allow me to use few illustrations from their book Short Textbook of ENT Disease, Sixth Edition 2002 to include in my book.
I am truly indebted to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Dr Madhu Choudhary (Director-Educational Publishing), Ms Pooja Bhandari (Production Head), Ms Samina Khan (Executive Assistant to Director-Educational Publishing), Dr Aditya Tayal (Development Editor), Mr Rajesh Sharma (Production Coordinator), Mr Vakil Khan (Proofreader), Mr Kulwant Singh (DTP Operator), Mr Arman Ali (Graphic Designer), and all other support staff at Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who worked tirelessly in a highly professional and cooperative manner to complete this project. I acknowledge their editorial support and guidance despite several challenges.
Competency Table
Number | The student should be able to: | Core (Y/N) | Chapter | Page Number |
---|---|---|---|---|
EN2.1 | Elicit document and present an appropriate history in a patient presenting with an ENT complaint | Y | 1 to 10 | 1-111 |
EN2.2 | Demonstrate the correct use of a headlamp in the examination of the ear, nose and throat | Y | 17 | 171-172 |
EN2.3 | Demonstrate the correct technique of examination of the ear including Otoscopy | Y | 2, 17 | 5 to 35, 172 |
EN2.4 | Demonstrate the correct technique of performance and interpret tuning fork tests | Y | 2 | 21-23 |
EN2.5 | Demonstrate the correct technique of examination of the nose and paranasal sinuses including the use of nasal speculum | Y | 3, 17 | 36-59, 172 |
EN2.6 | Demonstrate the correct technique of examining the throat including the use of a tongue depressor | Y | 4, 5, 6 | 60-67, 68-69, 70-75 |
EN2.7 | Demonstrate the correct technique of examination of neck including elicitation of laryngeal crepitus | Y | 7, 8, 9 | 76-92, 93-99, 100-103 |
EN2.8 | Demonstrate the correct technique to perform and interpret pure tone audiogram and impedance audiogram | Y | 14 | 150-159 |
EN2.9 | Choose correctly and interpret radiological, microbiological and histological investigations relevant to the ENT disorders | Y | 11 | 112-116 |
EN2.10 | Identify and describe the use of common instruments used in ENT surgery | Y | 17 | 171-197 |
EN2.12 | Counsel and administer informed consent to patients and their families in a simulated environment | Y | 12 | 117-118 |
EN2.13 | Identify, resuscitate and manage ENT emergencies in a simulated environment (including tracheostomy, anterior nasal packing, removal of foreign bodies in ear, nose, throat and upper respiratory tract) | Y | 3, 13 | 42-45, 131-137, 146-147 |
EN2.14 | Demonstrate the correct technique to instilling topical medications into the ear, nose and throat in a simulated environment | Y | 13 | 147-148 |
EN3.1 | Observe and describe the indications for and steps involved in the performance of Otomicroscopic examination in a simulated environment | N | 2 | 34-35 |
EN3.2 | Observe and describe the indications for and steps involved in the performance of diagnostic nasal Endoscopy | N | 13 | 145-146 |
EN3.3 | Observe and describe the indications for and steps involved in the performance of Rigid/Flexible Laryngoscopy | N | 13 | 141-142 |
EN3.4 | Observe and describe the indications for and steps involved in the removal of foreign bodies from ear, nose and throat | N | 13 | 146-147 |
EN3.5 | Observe and describe the indications for and steps involved in the surgical procedures in ear, nose and throat | N | 13 | 119-149 |
EN3.6 | Observe and describe the indications for and steps involved in the skills of emergency procedures in ear, nose and throat | N | 3, 13 | 42-45, 131-142, 146-147 |
EN4.2 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of diseases of the external Ear | Y | 2 | 11 to 15 |
EN4.3 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of ASOM | Y | 2 | 29-30 |
EN4.4 | Demonstrate the correct technique to hold visualize and assess the mobility of the tympanic membrane and its mobility and interpret and diagrammatically represent the findings | Y | 2 | 15-20 |
EN4.6 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of Discharging ear | Y | 2 | 6-7, 26-27 |
EN4.7 | Elicit document and present a correct history demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of CSOM | Y | 2 | 26-28 |
EN4.8 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of CSOM | Y | 2 | 31-34 |
EN4.9 | Demonstrate the correct technique for syringing wax from the ear in a simulated environment | Y | 13 | 148-149 |
EN4.10 | Observe and describe the indications for and steps involved in myringotomy and myringoplasty | Y | 13 | 127-130 |
EN4.11 | Enumerate the indications, describe the steps and observe mastoidectomy | Y | 13 | 124-126 |
EN4.12 | Elicit document and present a correct history demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of Hearing loss | Y | 2 | 7 |
EN4.16 | Observe and describe the indications for and steps involved in the performance of pure tone audiometry | Y | 14 | 152 |
EN4.17 | Enumerate the indications and interpret the results of an audiogram | Y | 14 | 153-155 |
EN4.18 | Describe the clinical features, investigations and principles of management of Facial Nerve palsy | Y | 2, 10 | 9, 107-110 |
EN4.19 | Describe the clinical features, investigations and principles of management of Vertigo | Y | 2 | 7 to 8 |
EN4.21 | Describe the clinical features, investigations and principles of management of Tinnitus | Y | 2 | 8 to 9 |
EN4.22 | Elicit document and present a correct history demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Nasal Obstruction | Y | 3 | 36-37 |
EN4.23 | Describe the clinical features, investigations and principles of management of DNS | Y | 3 | 48 |
EN4.24 | Enumerate the indications, observe and describe steps in the septoplasty | Y | 3 | 49-50 |
EN4.25 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Nasal Polyps | Y | 3 | 53-54 |
EN4.26 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Adenoids | Y | 6-13 | 74-75, 123 |
EN4.27 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Allergic Rhinitis | Y | 3 | 38-39 |
EN4.28 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Vasomotor Rhinitis | Y | 3 | 37 |
EN4.30 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Epistaxis | Y | 3 | 40-45 |
EN4.32 | Describe the clinical features, investigations and principles of management of nasopharyngeal Angiofibroma | Y | 3 | 56 |
EN4.33 | Elicit document and present a correct history demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Acute and Chronic Sinusitis | Y | 3 | 57-58 |
EN4.39 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of squamosal type of Acute and Chronic Tonsillitis | Y | 6 | 71-73 |
EN4.40 | Observe and describe the indications for and steps involved in a tonsillectomy / adenoidectomy | Y | 13 | 119-123 |
EN4.42 | Elicit, document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of hoarseness of voice | Y | 7 | 84-87 |
EN4.44 | Describe the clinical features, investigations and principles of management of Benign lesions of the vocal cord | Y | 7 | 78, 80-84 |
EN4.45 | Describe the clinical features, investigations and principles of management of Vocal cord palsy | N | 7 | 84-87 |
EN4.46 | Describe the clinical features, investigations and principles of management of Malignancy of the Larynx and Hypopharynx | Y | 7 | 90-92 |
EN4.49 | Elicit document and present a correct history, demonstrate and describe the clinical features, choose the correct investigations and describe the principles of management of foreign bodies in the air and food passages | Y | 13 | 137-141 |
EN4.50 | Observe and describe the indications for and steps involved in tracheostomy | Y | 13 | 131-137 |
EN4.51 | Observe and describe the care of the patient with a tracheostomy | Y | 13 | 133-135 |