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UNION EUROPEENNE DES MEDECINS SPECIALISTES (UEMS)EUROPEAN UNION OF MEDICAL SPECIALISTS (UEMS)

LOGBOOK OTO-RHINO-LARYNGOLOGY-HEAD AND NECK SURGERY(revision 2018)

TRAINING PROGRAMME

INTRODUCTION

The 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.

DEFINITION

Otorhinolaryngology-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.

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THE TRAINING PROGRAMME

The training programme will consist of the following elements:

1. 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.

2. 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.

3. A graded increase in clinical responsibilities and surgical experience will be developed and should be recorded in the log book.

4. A list of diagnostic procedures, non-surgical management and surgical management is outlined in the new UEMS ORL Section and Board logbook.

5. 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 competency level is required.

6. The Log Book will be used in relation to European training exchange programmes and will provide an introduction into advanced skills of the Specialty.

7. Subspecialty logbooks are available for advanced trainees.

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ASSESSMENT AND EXAMINATION

1. Examination of the theoretical and practical knowledge of the trainee may be included in the European Training Programmes. Trainees should refer to their National requirements.

2. 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.

3. 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.

4. 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.

5. The contents of the log book will be continuously updated by the European Board at least every 5 years with respect to new developments.

6. 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 LOGBOOK

The log book is divided into the following sections.

I Basic objectives.II Otology and NeurotologyIII Nose and paranasal sinusesIV Head and NeckV PhoniatricsVI Facial Plastics and Aesthetic surgeryVII Paediatric Otolaryngology

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A Diagnostic proceduresB Non-surgical/Medical managementC Surgical management

The trainee must have knowledge and understanding both the diagnostic, non-surgical and surgical management.

In the log-book are both general and advanced procedures listed: General procedures:

Under this heading all items are listed which must be experienced by the end of the training period by every ORL-HNS trainee, in order 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 procedures

The relevant trainer should endorse by signing and dating, when the trainee has achieved competency in each particular management or procedure.

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CHARTERS ON TRAINING AND VISITATION

Trainees are advised to familiarize themselves with the UEMS Charter on Training of Medical Specialists www.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 www.orluems.com.

The website also includes UEMS Charters on:

1. Continuing medical education2. Quality assurance3. Visitation of training centres.

The information for the Log Book may also be collected electronically.

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http://www.orluems.com/

http://www.uems./

TRAINING CENTRE ROTATION

Trainee: ______________________________________________________________Name Surname Birthdate

Dates of start and finish of training period Training Centre Name of Trainer Signature of Trainer

Additional copies can be made of this page if required

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ATTENDANCE AT ACCREDITED COURSES AND MEETINGS

Date Course Comments

Additional copies can be made of this page if required.

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UEMS TRAINING LOGBOOK OF OTO-RHINO-LARYNGOLOGY – HEAD AND NECK SURGERY COMPLETION OF TRAINING

Trainee: ___________________________________________________________________________________________________Name Surname Birthdate

Date of commencement of training: ______________________________________________________________

Date of completion of training: ______________________________________________________________

Lead Training Center

Name of Trainer in charge

I, 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 OBJECTIVES8

Knowledge of fundamentals inSignature trainer when competency achieved

emergency 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 investigations

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II. OTOLOGY/NEUROTOLOGYDiseases/Disorders of the ear

Signature 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 mediaBenign & 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 disorders

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Non-vestibular balance disordersCauses of tinnitus (including pulsatile tinnitus) & hyperacusisBenign & malignant tumoursInfective disordersTraumatic injuriesHistory

Signature trainer when competency achievedSpecificHearing 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 Examination

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Signature trainer when competency achieved1. Otoscopy2. Microscopy3. Oto-endoscopyb) Hearing Function

Signature trainer when competency achieved4. Tuning fork tests5. Clinical hearing testsc) Vestibular function

Signature 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 function

Signature trainer when competency achieved12. Cranial nerve examination including facial nerve13. Cerebellar examination14. Rombergs Teste) Others

Signature trainer when competency achieved15. Auscultation (for bruits)B. Diagnostic Work-upa) Hearing Function Tests

Signature trainer when competency achieved1. Impedance audiometry2. Pure tone audiometry3. Speech audiometry4. Objective hearing tests 4a. Oto-acoustic emissions (OAEs)

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4b. Evoked response audiometry (BSER, CERA, ASSR)5. Paediatric audiology 5a. Screening methods 5b. Subjective methods 5c. Objective methodsb) Vestibular Function Tests

Signature trainer when competency achieved6. Caloric testing7. Video / Electronystagmography8. VEMPs9. Posturography (Balance platform)10. Rotating chair testc) Facial Nerve Function Tests

Signature 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) Imaging

Signature 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

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18. Radionuclide scanning eg technetium, gallium scanninge) Laboratory Tests

Signature trainer when competency achieved19. Relevant blood tests20. Cytology21. Histology22. Microbiology

C. Non-Surgical ManagementSignature trainer when competency achieved

1. Pharmacological treatment2. 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 surgery11. Stereostactic radiosurgeryD. Surgical Management

S I A Signature trainer when competency achieved12. Temporal bone dissection (laboratory) X13. Management of oto-haematoma X14. Excision of lesions of the auricle X15. Wax removal X16. Foreign body removal X17. Removal of external auditory canal lesions X18. Meatoplasty (Soft tissue & bony) X19. Removal of osteomas/exostoses X20. Myringotomy X21. Ventilation tube insertion X

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22. Myringoplasty (Type1 Tympanoplasty) X23. Tympanotomy X24. Mastoidectomy 24a. Cortical X 24b. Modified radical / radical (Back to front approach) X 24c. Atticotomy / Attico-antrostomy (Front to back approach) X 24d. Combined approach tympanoplasty X 24e. Mastoid obliteration X25. Bone anchored hearing aids X26. Ossiculoplasty X27. Implantation of prostheses 27a. Middle ear prosthesis (ossicular prosthesis/implantable hearing aids) X 27b. Cochlear implants X28. Stapes Surgery X29. Facial nerve surgery 29a. Decompression X 29b. Grafting. Anastomosis surgery X30. Endolymphatic sac decompression X31. Vestibular schwannoma surgery 31a. Translabyrinthine approach X 31b. Retrosigmoid approach X 31c. Middle cranial fossa approach X32. Vestibular neurectomy X33. Glomus tumour surgery X34. Petrosectomy X35. Correction of malformations 35a. Auricle X 35b. Peri-auricular fistulas X 35c. External auditory canal X 35d. Middle ear X36. Repair of injuries 36a. Auricle X 36b. External auditory canal X

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36c. Middle and inner ear including nerves, vessels and middle cranial fossa / posterior cranial fossa dura X37. Surgery of tumours 37a. Auricle X 37b. External auditory canal X 37c. Middle and inner ear including nerves, vessels and middle cranial fossa / posterior cranial fossa dura and temporal bone resection X38. Revision ear surgery XE. Postoperative complications

Signature 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

III. NOSE AND PARANASAL SINUSESDiseases/Disorders

Signature trainer when competency achievedNosecongenital malformations of nose, mid-face (cleft lip, palate), including genetic anomaliesinfections of nose

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Neoplastic 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 malignantbarotraumaA. Patient assessment and Diagnostic Proceduresa) History and Clinical Examination

Signature trainer when competency achieved1. Assessment of nasal symptoms

Specific 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 Function

Signature trainer when competency achieved6. Rhinomanometry7. Acoustic rhinomanometry8. Olfactory tests (subjective and objective)9. Ciliary function testsc) Tests of Imaging

Signature trainer when competency achieved10. Conventional X-ray11. CT scan12. Cone beam CT

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13. 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 Management

Signature trainer when competency achieved18. pharmacological therapy19. specific immunotherapy (hyposensitisation), sublingual immunotherapy20. management of anaphylaxisC. Surgical ManagementNose

S I A Signature trainer when competency achieved21. local and regional anaesthesia X22. Management of epistaxis 22a. nasal packing X 22b. nasal cautery and other endoscopic management X 22c. Medical disease and epistaxis X23. Foreign body removal X24. Nasal Polypectomy X25. Turbinate procedures (including coblation, radiofrequency etc) X26. Septal surgery X27. Revision septoplasty X28. Septorhinoplasty (open and closed, reduction, augmentation, grafting techniques, cleft lip septorhinoplasty ) X29. Rhinophyma operation X30. Correction of congenital malformations (choanal atresia, fistulas, dermoids etc) XParanasal Sinuses

S I A Signature trainer when competency achieved31. Sinus endoscopy X32. Antral lavage X

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33. Endoscopic antrostomy and sinus endoscopy X34. Radical antrostomy X35. Frontal sinus trephination X36. External frontal sinus surgery X37. External ethmoidectomy X38. Endoscopic Sinus Surgery and its possible acute complications 38a) anterior ethmoidectomy X 38b) posterior ethmoidectomy X 38c) frontal recess procedures X 38d) sphenoid sinus procedures X39. Surgery of floor of maxillary sinus X40. Ligation of maxillary, ethmoidal or sphenopalatine artery including endoscopic X41. Orbital decompression procedures X42. Endoscopic dacry-cysto-rhinostomy X43. Management of CSF leak X43. Tumour Surgery 43a) maxillectomy (partial, total) X 43b) lateral rhinotomy X 43c) midfacial degloving X 43d) combined approach to anterior skull base X 43e) orbitotomy X 43f) exenteration of orbit X

43g) surgery of anterior skull base (incl osteoplastic flap, duraplasty and endoscopic) X44.Trauma 44a) soft tissue injuries X 44b) management of fractures of nasal bones and septum and septal haematoma under local or general anesthesia X 44c) paranasal sinus fractures X 44d) fractures of orbit including blowout fractures X 44e) zygomatic fractures X 44f) optic nerve decompression X 44g) reconstruction of anterior skull base X

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IV. HEAD AND NECKDiseases/Disorders of Head and Neck

Head and Neck OncologyOral CavityPharynxLarynxNose and Paranasal SinusesNeck and Unknown primarySalivary glandsThyroid glandSkinBenign diseases Head and NeckOral CavityPharynxLarynxSinonasalVascular malformationsTrauma

1. HEAD AND NECK ONCOLOGYBasic knowledge

Signature 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 oncology

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6. Prevention in H&N oncology7. Clinical databases in H&N oncologyGeneral history

Signature trainer when competency achievedAge, genderFirst symptomsWeight lossSmoking tobacco, chewing tobacco, betel quidAlcohol consumptionViral infectionsEthnicityHistory of previous tumoursPrevious head and neck irradiationFamily history (oncology perspective)OccupationCo-morbiditiesPerformance dataQuality of life

Clinical examinationSignature trainer when competency achieved

General ENT examination including videolaryngoscopyPalpation of the primary lesionPalpation of the neckAssesment of cranial nerves and swallowingAdditional examination and imaging

Signature trainer when competency achievedBiopsy of primaryKnowledge of Ultrasound of the neck +/- cytological diagnosisPanendoscopyKnowledge of CT / MRIKnowledge of PET-CT / PET-MRIKnowledge of Assesment Chest (x ray / CT)

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Knowledge of Additional assesments (audiogram, CT, US, OPG….)Knowledge about Treatment and Treatment modalities

Signature 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 Treatment

Signature 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 fistulaSpeech and swallowing impairmentMucositis, dermatitisOsteradionecrosisHypothyroidism

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1.A ORAL CAVITYAdditional history

Signature trainer when competency achievedArticulationSwallowingSurgical Treatment

S I A Signature trainer when competency achieved1. Local surgery (incl. laser) X2. Open neck surgery – pull through procedure X3. Marginal mandibulectomy X4. Segmental mandibulectomy X

Neck nodes (see paragraph neck)

1.B PHARYNXNasopharynxAdditional history

Signature trainer when competency achievedUnilateral middle ear effusion in the adultNasal blockageNeck massNose bleedingCranial nerve involvementPatients origin and ethnicitySurgical Treatment

S I A Signature trainer when competency achieved5. Local surgery X6. Maxillary swing X

Neck nodes (see paragraph neck)OropharynxAdditional history

Signature trainer when competency achievedPain, otalgia

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ArticulationSwallowingSnoringHPV infectionSurgical Treatment

S I A Signature trainer when competency achieved7. Tonsillectomy X8. Transoral surgery (robotic surgery, toes) X9. Pharyngotomy X10. Mandibulotomy (mandibular split, mandibular swing) X11. Neck nodes (see paragraph neck)

HypopharynxAdditional history

Signature trainer when competency achievedSwallowingOtalgiaSurgical Treatment

S I A Signature trainer when competency achieved12. Endoscopic surgery (TORS, TOUSS, laser-surgery…) X13. Pharyngectomy with/ without laryngectomy X14. Partial pharyngectomy with near total laryngectomy X15. Partial pharyngectomy with total laryngectomy X16. Total pharyngectomy with total laryngectomy X17. Total pharyngo-laryngo-esophagectomy with reconstruction(to plastic surgery) X

Neck nodes (see paragraph neck)1.C LARYNX

Additional historySignature trainer when competency achieved

Pain, otalgiaDysphonia

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SwallowingDyspnoeaNeck massSurgical Treatment

S I A Signature trainer when competency achieved18. Endoscopic surgery X19. Alle procedures zijn op zijn minst supervised X20. Partial or total laryngectomy X21. Primary or secondary placement of vocal prosthesis X22. Maintenance and change of speech prosthesis X

Neck nodes (see paragraph neck)

1.D NOSE AND PARANASAL SINUSESAdditional history

Signature trainer when competency achievedRepeated rhino-sinusitisObstructionEpistaxisRhinorrheaFacial painCranial nerve involvementSurgical Treatment

S I A Signature trainer when competency achieved23. Endonasal surgical procedures (including navigation systems) X24. Maxillectomy (partial, total) X25. Lateral rhinotomy X26. Midfacial degloving X27. Orbitotomy and Exenteration of orbit X28. Surgery of anterior skull base (incl osteoplastic flap, duraplasty and endoscopic) X

Neck nodes (see paragraph neck)1.E NECK AND UNKNOWN PRIMARY

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GrowthPainSurgical Treatment

S I A Signature trainer when competency achieved29. Single node resection X30. Sentinal node procedures X31. Neck dissection procedures (local, selective, radical, conservative) X

1.F SALIVARY GLANDSAdditional history

Signature trainer when competency achievedMass within the salivary glandPersistent lesion consistent with an accessory salivary gland tumourFacial nerve paresisPainSurgical Treatment

S I A Signature trainer when competency achieved32. Submandibular gland surgery X33. Parotid (partial or total) surgery (Levels I to V according to the ESGS classification) X34. Reconstruction (local flaps, SCM and SMAS, Fat) X

Neck nodes (see paragraph neck)1.G THYROID GLAND


Family history of thyroid diseaseAge <14 or >70, nodular goiterDysphoniaSymptoms of hypo- or hyperthyroidismPrevious radiation (iodine, external radiation)Surgical Treatment

S I A Signature trainer when competency achieved26

35. Hemithyroidectomy X36. Total thyroidectomy X37. Parathyroidectomy X

Neck nodes (see paragraph neck)1.H SKIN


UV-light/ excessive sun exposure / history of sunburnsFair skinMolesPrecancerous lesion/ (resected) skin tumours in pastSurgical Treatment

S I A Signature trainer when competency achieved38. Sentinel node technique in melanoma X39. Limited surgecal excision (including local reconstruction) X40. Extended surical excision X41. (Skin-) Reconstruction of the nose, lip and other structures X42. Parotidectomy X

Neck nodes (see paragraph neck)2. BENIGN DISEASES HEAD AND NECK

2.A ORAL CAVITYKnowledge

Signature trainer when competency achievedEpithelial lesions (leukoplakia, erytroplakia, papiloma, lichen planus….)Conginatal malformationsGlossal diseasesDental related diseasesInfectious diseasesImmunology diseasesHalitosisSurgical Treatment

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S I A Signature trainer when competency achieved43. Excision biopsy X44. Local surgery (incl. laser) X45. Rerouting salivary duct X46. Resection submandibular gland X

2.B PHARYNXNasopharynxKnowledge

Signature trainer when competency achievedAdenoidThornwald cystJuvenile angiofibromaSurgical Treatment

S I A Signature trainer when competency achieved47. Adenoidectomy X48. Endoscopic transnasal or transoral surgery (Thorwald cyst….) X49. Juvenile angiofibroma: endoscopic or open surgery (+/- embolisation) X

OropharynxKnowledge

Signature trainer when competency achievedEpithelial lesions (leukoplakia, erytroplakia, papiloma, lichen planus….)Conginatal malformations (schisis, cyst….)Infectious diseasesHalitosisSurgical Treatment

S I A Signature trainer when competency achieved50. Tonsillectomy, tonsillotomy X51. Endoscopic surgery X52. Transoral surgery X53. Transoral robotic surgery X54. Open surgery X

Hypopharynx28

KnowledgeSignature trainer when competency achieved

GlobusDysphagia (See also chapter on Phoniatrics)Zenker's diverticulumCricopharyngeal pathologiesForeign bodiesCongenital malformationsSurgical Treatment

S I A Signature trainer when competency achieved55. Dilatation procedures X56. Endoscopic Treatments of Zenker's diverticulum (stapler, laser) X57. External surgery of Zenker's diverticulum X58. Endoscopic myotomy of cricopharyngeal muscle X59. External myotomy of cricopharyngeal muscle X60. Foreign body removal X61. Surgery of congenital anomalies X62. Pharyngotomy X

2.C LARYNXKnowledgeSee also chapter on Phoniatrics Signature trainer when competency achievedBenign intraepithelial lesionsGranuloma, polyp, nodule, Reinke oedema, cystLaryngoceleStenosis (congenital or acquired)Vocal cord paralysisCongenital malformations ( larynomalcia, cleft, web)Surgical Treatment

S I A Signature trainer when competency achieved63. Endoscopic surgery (including laser) for benign intraepithelial lesions, granuloma,

polyp, nodule, Reinke oedema, cyst X64. Augmentation procedures X

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65. Open surgery (laryngofissure, framework surgery) X66. Closure tracheostomy X

2.D NOSE AND PARANASAL SINUSESKnowlegde

Signature trainer when competency achievedInverted PapillomaBenigne lesions and tumours (solid tumours, angiofibroma, fibrous dysplasia)Foreign bodyCongenital fistulaOzenaOlfactory and gustatory disordersCSF leakageTraumaNosebleedSurgical Treatment

Signature trainer when competency achievedSee chapter on Rhinology

2.E NECKKnowledge

Signature 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 exploration

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Surgical TreatmentS I A Signature trainer when competency achieved

67. Diagnostic lymph node dissection X68. Removal of congenital cyst /fistula X69. Local tumour surgery X70. Sistrunk procedure X71. Removal laryngocele X72. Drainage deep neck abcess X73. Paraganglioma X

2.F SALIVARY GLANDSKnowledge

Signature trainer when competency achievedESGS classification of salivary ductal pathologies - LSD classificationESGS classification of parotid surgeryImmunological disordersInfectionsSalivary stonesBenign neoplasmsSurgical Treatment

S I A Signature trainer when competency achieved

74. Interventional sialendoscopy (stone related, dilatation, biopsy) X75. Combination / open procedures stone removal X76. Accessory salivary gland biopsy/ open biopsy salivary gland tumour X77. Procedures of salivary ducts X78. Submandibular surgery X79. Parotid partial or total surgery X80. Salivary gland wounds and ductal repair X

2.G THYROID GLANDKnowledge

Signature trainer when competency achieved

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Goiter (normal or toxic thyroid function)Thyroid nodule(benign atoxic, benign toxic, malignant)ThyroiditisParathyroid functional disorders and neoplasmsSurgical Treatment

S I A Signature trainer when competency achieved81. Hemithyroidectomy X82. Total thyroidectomy X83. Parathyroidectomy X

3. AIRWAY DISORDERS (larynx and trachea)History

Signature trainer when competency achievedDysphoniaHoarsnessSwallowing problemsNeck painInfections/ neck diseasesTraumaClinical examination

Signature trainer when competency achievedPalpationFiberoptic (video-) laryngoscopyTransnasal fiberoptic (video-) tracheobronchoscopyTracheobronchoscopic cytology/ histopathologyOesophagoscopy (rigid or fiberoptic)Knowledge about additional diagnostics

Signature trainer when competency achievedChest x-rayCT-scan / 3-D reconstructionMRILung function test

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Blood gassesKnowledge of Diseases

Signature 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 Treatment

S I A Signature trainer when competency achieved84. Removal of foreign bodies (rigid and /or flexible endoscopes) X85. Endotracheal intubation X86. Tracheostomy X87. Cricothyroidotomy X88. Local closure of trachea X89. Endoscopic laser and dilatation procedures X90. Open procedures (larynx and) trachea X91. Closure of tracheostoma X

Management of complicationsSignature trainer when competency achieved

Stridor/ dyspnoeaPost-operative bleeding, infectionsDysphagia, hoarseness

4. DIGESTIVE TRACK/OESOPHAGUSHistorySee also chapter on Phoniatrics Signature trainer when competency achieved

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Swallowing problemsRegurgitationRetrosternal painWeight lossCoughing (nightly)RefluxClinical examination

Signature trainer when competency achievedPalpationFlexible (transnasal) laryngo-pharyngoscopy/ oesophagoscopyFunctional tests of swallowing disordersFEESRigid oesophagoscopyKnowledge about additional diagnostics

Signature trainer when competency achievedSwallow x-ray / videoSwallow CT-scanChest CT-scanMRI in selected casesKnowledge of Diseases

Signature trainer when competency achievedTraumatic perforations (iatrogenic)Chemical traumaForeign bodiesInfectionsAchalasia, hiatal hernia, benign and malignant tumoursSurgical Treatment

S I A Signature trainer when competency achieved92. Swallowing rehabilitation X93. Removal of foreign bodies X94. Endoscopic biopsy and tumour staging X

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95. Repair of tracheoesophageal fistula XManegement of Complications

Signature trainer when competency achievedInfection, post-operative bleedingPerforation, mediastinitisVocal cord palsy

5. SNORING AND OTHER SLEEP RELATED BREATHING DISORDERS (SRBD)History

Signature trainer when competency achievedNon-restful sleepExcessive daytime sleepinessLoud snoringObserved ApneaDecreased cognitive functions, depressionHeadachesClinical examination

Signature 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 diagnostics

Signature trainer when competency achievedEpworth sleepiness scale ESSPolysomnographic sleep study, AH-indexPulmologist, cardiologist Consultation

Options: pupillometry, cephalometry, spirometry, blood test, drug induced sleep endoscopy (DISE), daytime sleep studiesDiseases

Signature trainer when competency achievedObstructive SnoringUpper Airway Resistance Syndrome

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Sleep Apnea Syndrome Obstructive, CentralTreatmentSurgical / Nonsurgical: according to the severity of the SRBDPrimary surgeryPositive airway pressure Treatment (PAP)

Reduction of body weightNon Surgical Treatment


Drugs: Modafonil in cases of persisting daytime sleepiness symptoms after CPAPOral appliances in mild to moderate OSA

CPAP, APAP, Bi-level PAP, according to severity of OSA, positional and REM-stage related OSA, pressure demandSurgical Treatment

S I A Signature trainer when competency achieved

96. Septoplasty, turbinoplasty, FESS, adenoid removal, tonsillotomy/tonsillectomy, UPPP, palatal radiofrequency, radiofrequency of the base of the tongue, tracheostomy X

97. Multi level surgery, soft palate stiffening implants X

98. Hypoglossal nerve stimulation implants, hyoid suspension, maxillo-mandibular advancement (MMA) X

Management of ComplicationsSignature trainer when competency achieved

Acute airway obstructionDysphagia and retronasal reflux

6. VASCULAR MALFORMATIONSHistory

Signature trainer when competency achievedAge of onset, Progression, SymptomsFunction cranial nervesOther diseases/ syndromatic

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Family historyClinical examination

Signature trainer when competency achievedENT- examinationPalpationCranial nervesKnowlegde about additional diagnostics

Signature trainer when competency achievedUltrasoundMRIPharyngoscopyDNA analysis, Hormonal blood /urine testDiseases according to Calssification ISVA 2014

Signature trainer when competency achievedVascular tumours: Infantile hemangioma Congenital hemangioma Pyogenic granuloma OthersVascular malformations: Venous malformation Capillary malformation Lymphatic malformation Arteriovenous malformations Combined malformations OthersNon Surgical Treatment

Signature trainer when competency achievedIntraleasionalPropanololLow dose radiotherapy

37

Surgical TreatmentS I A Signature trainer when competency achieved

99. Local excision XManagement of Complications

Signature trainer when competency achievedBleedingAirway obstructionAbundant drainingCranial nerve damage

V. PHONIATRICS1. DYSPHAGIA

Diseases/DisordersSignature trainer when competency achieved

Benign 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 cancerOther – Dysphagia caused by...Apoplectic strokeM. ParkinsonMyasthenia gravisLateral amyotrophic sclerosisDementiaDISH/M. ForrestierPalsy of N. hypoglossusHistory

Signature trainer when competency achieved38

SpecificDisturbed swallowing for dry food, liquidsCoughing during food intakeVoice changes during food intakeNasal regurgitationGeneralFeverPast history of pneumoniaLoss of body weightClinical Examination

S I A Signature trainer when competency achievedGeneralAssessment of orofacial function XAssessment of tongue coordination and motion XAssesssment of velar function XFunction of the Nn. VII, IX, X, XII XAssessment of oral bolus residua XEndoscopyFEES – Fiberoptic endoscopic evaluation of swallowing XRigid Laryngoscopy (70°, 90°) XEsophagoscopy XEsophageal manometry XUltrasonographySonography of tongue during swallowing XOtherAutomatic digital swallowing recordings (acoustic or electric devices) XAuscultation (lung) XDiagnostic work up

Signature trainer when competency achievedImagingVideofluoroscopyCT, MRI, PET, Scintigraphy...Laboratory tests

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Blood testsInflammation markersCytologyMedical Treatment

Signature trainer when competency achievedPharmacological treatmentArtificial salivaCorticoids (cave: contraindications)ChemotherapyRadiotherapyPhysical rehabilitationLogopedic therapyPhysiotherapeutic therapysEMG BiofeedbackAdditional therapyDefinition of special nutritionInfusion or stomach tube nutritionSurgical Treatment

S I A Signature trainer when competency achievedPEG XDilatation of esophageal sphincter/esophagus XComplications

Signature trainer when competency achievedAspirationPneumoniaCachexia

2. DYSPHONIADiseases/Disorders

Signature trainer when competency achievedNon-organic dysphoniaHyperfunctional dysphoniaHypofunctional dysphonia

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Mixed dysphoniaPsychogenic dysphoniaPsychogenic aphoniaOrganic dysphoniaLaryngitisReinke’s edemaVocal chord polyp/cystLaryngeal papillomaLaryngeal cancerLarynx traumaOtherVocal palsyLuxation of ArytaenoidSpasmodic dysphoniaDysarthrophoniaMutational voice disorderCervicogenic dysphoniaHistory

Signature trainer when competency achievedSpecificHoarsenessVocal fatigueReduced voice dynamicsClear one’s throatGeneralStressRefluxVertebral symptomsClinical Examination

S I A Signature trainer when competency achievedGeneralAuditory/visual/palpatory examination X

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Maximum phonation time XPerceptual voice assessment by GRBAS/RBH XPhonetography XMean fundamental frequency XEndoscopyDirect/indirect rigid laryngoscopy XLaryngostroboscopy XFlexible transnasal laryngoscopy XHigh-speed recordings XDiagnostic work up

Signature trainer when competency achievedImagingCT, MRI of vocal tract/larynxElectrophysiologyElectroglottographyElectromyographyOtherGastroscopy/PH-analysisAudiometryAerodynamic measurementsMedical Treatment

Signature trainer when competency achievedLogopedic therapyCorticoids (cave: contraindications)Inhalation therapySurgical Treatment

S I A Signature trainer when competency achievedBotulinum toxin treatment XPhonosurgery XLaryngeal framework surgery XComplications

Signature trainer when competency achievedPermanent Dysphonia/Aphonia

42

Dyspnoea3. ACQUIRED LANGUAGE DISORDERS

Diseases / Acquired Speech & Language disordersSignature trainer when competency achieved

DysphasiaDysarthriaApraxiaAcquired Fluency DisordersDysglossiaHistory

Signature trainer when competency achievedSpecificUnintelligible SpeechTotal loss of verbal speechAnosmiaGeneralStrokeTraumaDiplegia/Hemiplegia/QuadroplegiaClinical Examination

S I A Signature trainer when competency achievedGeneralAuditory/visual/palpatory examination XAssessment of tongue coordination and motion XAssesssment of velar function XFunction of the Nn. VII, IX, X, XII XPerceptual evaluation of nasality XEndoscopyFiberoptic endoscopic evaluation of velum function XUltrasonographySonography of tongue during speech XOther

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Audiometry XNasalance measurement XDiagnostic work up

Signature trainer when competency achievedImagingCT, MRIPET, Scintigraphy...Laboratory testsSerology of neurotropic germsNeurologic assessmentEMG, ENG etc.Medical Treatment

Signature trainer when competency achievedPharmacological treatmentRadiotherapyLogopedic/Linguistic therapyComplications

Signature trainer when competency achievedPermanent loss of communication competence

4. DEVELOPMENTAL LANGUAGE DISORDERSDiseases / Developmental Language disorders

Signature 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 syndromaHistory

Signature trainer when competency achievedSpecificUnintelligible Speech/dyslaliaReduced expressive vocabularyDisturbed speech perception

44

DysgrammatismGeneralDelayed psychomotor developmentDelayed cognitive developmentClinical Examination

S I A Signature trainer when competency achievedGeneralAuditory/visual/palpatory examination XAssessment of tongue coordination and motion XAssesssment of velar function XAssessment of face and jaw morphology XAssessment of balance XComplex speech assessment XUltrasonographySonography of tongue during speech XDiagnostic work up

Signature trainer when competency achievedAudiometryNarrow band or pure tone audiometryImpedance measurementsTEOAE, DPOAE, BERAImagingCerebral Sonography, CT, MRILaboratory testsMetabolic diagnosticsGenetic assessmentNeuropediatric assessmentPsychomotoric TestingEEGOphthalmologic assessmentEyesight-testMedical Treatment

Signature trainer when competency achieved45

Logopedic/Speech Language therapyErgotherapyPhysiotherapyComplications

Signature trainer when competency achievedPermanent deficit or loss of communication competenceIlliteracy

5. FLUENCY DISORDERSDiseases / Fluency disorders

Signature trainer when competency achievedStutteringClutteringMixed fluency disorderHistory

Signature trainer when competency achievedSpecificNon-fluent speechRepetitions of phonemes, syllables, words, part of sentencesToniRespiratory DyscoordinationFacial symptomsGeneralNon-voluntary movementsPsychosocial problemsClinical Examination

S I A Signature trainer when competency achievedGeneralAuditory/visual/palpatory examination XAssessment of tongue coordination and motion XAssesssment of phonatory respiration XComplex fluency assessment XQuestionnaires

46

Fluency disorder-related quality of life questionnaire XOthersAudiometry XDiagnostic work up

Signature trainer when competency achievedImagingCerebral CT, MRILaboratory testsGeneticsNeurologic assessmentEEGMedical Treatment

Signature trainer when competency achievedLogopedic/Speech Language therapyPharmacotherapyPsycotherapyComplications

Signature trainer when competency achievedPermanent fluency disorderSocial isolation

6. HEARING IMPAIRMENTS AS PART OF COMMUNICATION DISORDERSDiseases / Hearing impairments

Signature trainer when competency achievedConductive hearing loss and mixed hearing lossSensorineural hearing loss (cochlear and retrocochlear)Sudden sensorineural hearing loss (SSHL)Central hearing lossAuditory processing disorderTinnitusHistory

Signature trainer when competency achievedSpecific

47

Time and dynamic of onsetDescription of impairment right/left earBalance disturbancesKnown etiologyEffects on voice, speech, and language communication abilitiesPrevious diagnostic and therapeutic measuresGeneralAdditional handicaps, diseasesDelayed psychomotor developmentDelayed cognitive developmentClinical Examination

S I A Signature trainer when competency achievedENT examination including binaural otoscopy/otomicroscopy, verbal acumetric test and tuning fork tests XDiagnostic work up

Signature trainer when competency achievedAudiological testsAge-specific subjective tests (free-field audiometry, pure-tone audiometry, speech audiometry)Newborn hearing screeningObjective audiometryVestibular testingImagingCT, MRILaboratory testsSerologic testsGenetic assessment if necessaryIndication of Consultant DiagnosticsPaediatrics/NeuropaediatricsNeurologistPsychologistOphthalmologistUrologist

48

Medical TreatmentSignature trainer when competency achieved

Supply with hearing devices(Re-) Habilitation proceduresDisorder- specific advice e.g. in SSHL pharmacological treatment, hyperbaria

ComplicationsSignature trainer when competency achieved

Permanent deficit or loss of communication competence

VI. FACIAL PLASTICS AND AESTHETIC SURGERYDiseases/Disorders

Signature trainer when competency achievedCongenital malformationsInfectionsInflammatoryBenign & malignant tumoursTraumatic injuriesHistory

Signature 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 wrinkles

49

Aging faceAging neckNeurosensory disturbancesGeneralFamily history of agingPast history of non-invasive proceduresPast history of facial plastic surgeryFacial traumaSun exposureOtotoxic usage / exposureMigrainePerinatal historyTORCH infectionClinical Examination

Signature trainer when competency achievedGeneralassessment of the face and ethnic variationfacial analysiseffects of aging processassessment of skinpsychological assessment / screeningphotographyinvestigation of the cranial nerves, clinicalfacial paralysis gradinganterior rhinoscopyendoscopymicroscopycomputer imagingTests of Functionrhinomanometryacoustic rhinometryolfactory testscytology of nasal mucosa

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allergy 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 tomography3D AnalysisNon-surgical management

Signature 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)

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wrinkle treatment, other methodsmanagement of scar tissuelipolysiswound dressingsprosthetic options for ear, nose, etc.Surgical Management

S I A Signature trainer when competency achievedtopical, local and regional anaesthesia Xsuture techniques Xturbinate surgery Xexcision techniques for cutaneous malignancies XTraumaRepair Soft Tissue Injury/Lacerations XFacial Nerve Repair XLacrimal Duct Repair XNasal Fracture XFrontal Sinus Fracture XNasoethmoid Fracture XSkull/Cranial Fracture XMidface Fracture XMalar (Zygoma) Fracture XOrbital Fracture XMandibular Fracture XOther XCongenitalHemangioma/Lymphangioma Resection X Treatment XChoanal Atresia Repair XCleft Lip Unilateral Repair X Bilateral Repair XAlveolar Cleft Repair X

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Cleft Palate Repair XCraniofacial Procedure XMicrotia Reconstruction XOtoplasty XOther Auricular Revision XOther XReconstructiveMandible Reconstruction XFacial Bone Grafting/Reconstruction XOrthognathic Procedures XGrafts Split Thickness X Full Thickness X Composite X Dermal/Dermal-Fat X Cartilage Grafts Auricular X Rib X Septal XFlaps Local X Regional X Distal X Free X Lip X Detachment of Pedicle Flap XFacial Nerve Reconstruction Nerve Graft X Gold Weight X Lower Lid Tightening X Microneurovascular Flap X Muscle Sling X Static Sling X

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Other XScar Revision Surgery Z-Plasty X W-Plasty/Geometric Broken Line Closure X Complex Other X Full Face Dermabrasion XTissue Expanders XOther XCosmetic/ReconstructiveRhinoplasty XSeptorhinoplasty XSeptoplasty XBlepharoplasty (count bilaterals as 1 procedure only; count upper & lower blephs each as 1 procedure) Upper Cosmetic X Upper Functional X Lower w/ fat repositioning X Lower X Skin Pinch XRhytidectomy: Extended SMAS X W/Smart Lipo Laser X Deep Plane X Mini-Lift X W/ Smart Lipo Laser X Plication Lift X W/ Smart Lipo Laser XMidface Lift XMentoplasty (Chin) Augmentation X Reduction XFacial Implants (e.g. malar) XCoronal/Frontal Lift X

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Browlift XEndoscopic Forehead Lift XTranstemporal XTricophytic XCervicofacial Liposuction XSkin Resurfacing Dermabrasion (major-not scars) X Chemical Peel (medium & deep only) X Face, Eyelid, and/or Perioral Laser Resurf. X Laser Treatment of Vascular Lesions XFat Transfer XOther XComplications

Signature trainer when competency achievedInfectionAsymmetryProlonged edemaProlonged erythemaContour deformitiesFacial paralysisImplant extrusionSkin necrosisKeloidChemosislagophthalmosPtosisSubconjunctival hemorrhageVision lossAnosmiaEpistaxisSeptal perforationNeurosensory deficitsMalocclusion

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VII. PAEDIATRIC OTORHINOLARYNGOLOGY1. OTOLOGY

Diseases/DisordersSignature trainer when competency

achievedAcute otitis mediaOtitis media with effusionChronic otitis mediaChronic otitis media with cholesteatomaSensorineural hearing loss of various causes and degreesFacial nerve disordersSyndromes and malformationsHistory


SpecificOtalgiaOtorrheaHearing lossTinnitusVertigo and balance disordersHyperacusisFacial nerve disordersGeneralFamily history of hearing or balance disordersPerinatal historyHistory of otitis mediaPast history of infectious diseasesHead/ear injuryNoise exposureOtotoxic usage / exposure

56

Clinical 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 Treatment


Pharmacological treatmentReferral for hearing aid placementSurgical Treatment

S I ASignature trainer when competency

achievedForeign body removal XMyringotomy XVentilation tube insertion XTympanoplasty XAntrotomy XMastoidectomy - simple XCochlear implants, BaHa X

2. LARYNGOLOGY AND PHONIATRICS57

Diseases/DisordersSignature trainer when competency

achievedStridor of various causes ( congenital, infective, posttraumatic, tumours, iatrogenic, OSAS, foreign body)History


Familiar 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 Examination


GeneralGeneral ORL examinationInitial assessment of a patient with stridor – determine urgency/correlate with breatheNasal flaringRetractions: suprasternal, sternal, subcostalCyanosis (perioral)Rapid respiratory rateDesaturationDiscomfort/distressDiagnostic Procedures

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Flexible-endoscopy of the larynx, trachea, bronchiRigid endoscopyLaryngomicroscopyLaboratory testsMicrobiology testsImaging (x-ray, MSCT, MRI, angiography, esophagography)Medical Treatment


Pharmacological treatment (antibiotics, corticosteroids therapy, inhalations, propranolol therapy)Surgical Treatment


achievedRemoval of foreign bodies from the larynx, trachea, bronchi and oesophagus XEndotracheal intubation XTracheotomy - tracheostomy XEndolaryngeal surgery of tumours XEndolaryngeal laser surgery of tumours in the upper aerodigestive tract XManagement of laryngo-tracheal stenosis X

3. RHINOLOGY AND ALLERGOLOGY AND FACIAL PLASTIC SURGERYDiseases/Disorders


Rhinosinusitis (with or without nasal polyps, acute, chronic, related to comorbiditiesRhinitis (infective and allergic)EpistaxisTraumaSeptal deviationChoanal atresiaTumoursHistory

59


Familiar history PrenatalBirth: method of deliveryNeonatalNasal obstructionNasal secretionCoughHeadacheSnoringSleep disturbanceClinical Examination


GeneralGeneral 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 Treatment


Pharmacological treatmentSurgical Treatment

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achievedControl of epistaxis XNasal packing/cautery XForeign body removal XReposition of nasal fractures XIncising abscess XSeptal hematoma XSoft tissue injuries XOtoplasty XSeptal surgery XPediatric endoscopic surgery XDacryocystorhinostomy in children XCleft patient rhinoplasty XCorrections of malformations (e.g. choanal atresia, fistulae, dermoids, etc) XJuvenile angiofibroma endoscopic/open surgery X

4 HEAD AND NECKDiseases/Disorders


Oral cavity, pharynxAdenotonsillar diseaseNeck swelling ( various causes: congenital, infective, tumours)Injuries to the head and neckHistory


PrenatalNeonatalNasal obstructionSleep apnoeaRecurrent tonsillitisComplications of tonsillitis

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Carrier stateDrooling and speech problemClinical Examination


GeneralGeneral ORL examinationNasopharyngoscopySpecific assessment of the complaintDiagnostic ProceduresLaboratory testsMicrobiology testsSleep studiesUltrasound examination of the neckImaging ( CT, MRI)FNA/biopsy as requiredPlain X-ray

Computerized tomography (to include cone beam CT scanning of the temporal bones)Magnetic resonance imagingAngiographyPositron Emission Tomographytechnetium, gallium scanningRelevant blood testsCytologyHistologyMicrobiologyMedical Treatment


Pharmacological treatment (antibiotics, steroids, propranolol)Surgical Treatment

S I A Signature trainer when competency 62

achievedAdenoidectomy XTonsillectomy and tonsillotomy XAbscess tonsillectomy (hot tonsillectomy) XArrest of postadenotonsillectomy haemorrhage XForeign body removal XTransoral removal of salivary calculi XDrainage of abscessPeri- and retrotonsillar XPara- and retropharyngeal XCorrection of malformationsLingual and labial frenulum XRanula XCysts inclusion XMacroglossia XSurgery of simple neck injuries XSurgery of tumours:a) thyreoglossal duct/cyst Xb) branchial cyst Xc) neck fistulae Xd) single lymphnode Xe) benign tumours including salivary glands Xf) Incision and drainage of neck abscess Xg) Surgery of benign skin tumours Xh) Surgery of vascular tumours XSurgery of the thyroid glandHemithyroidectomy XTotal thyroidectomy X

5 POSTOPERATIVE COMPLICATIONSSignature trainer when competency

achieved63

Complications 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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