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EENT- #21250


Ear 1 (pdf)
Ear 2 (pdf)
Ear 3 (pdf)
Intro, Eyelids (pdf)
Eyeball Surface 1 (pdf)
Eyeball Surface 2 (pdf)
Internal Eye 1 (pdf)
Internal Eye 2 (pdf)
Nose Conditions (pdf)

 

 
Bill Elkington, DC
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45
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Discussion of the presentation, diagnosis, and treatment of common complaints and disorders of the head: face, eyes, ears, nose, mouth, throat and neck (EENT). Students practice diagnostic and treatment procedures. Discussion on how doctors of chiropractic can participate in the management of patients with head and EENT disorders.
Please select from the list on the right.

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Course Objectives
Top

  1. Employ patient history, examination and special diagnostic tests in the assessment of the HEENT complaints that are most likely to present to a doctor of chiropractic.
  2. Establish a working diagnosis to guide subsequent patient management for HEENT conditions, including referral for further diagnosis or care.
  3. Describe the pathophysiology and natural history of the most common HEENT diseases.
  4. Employ chiropractic therapeutic methods and techniques to treat HEENT problems that are amenable to conservative care.
  5. Describe common measures used by other professionals to diagnose and treat HEENT diseases.
Materials
Top
A. Required Text(s):
  • A Guide to Physical Examination and History Taking (Bates/Bickley), 8th or 9th edition
  • Differential Diagnosis and Management for the Chiropractor (Souza), 3rd edition
    B. Recommended Text(s):

    Recommended
    Color Atlas and Text of Clinical Medicine (Forbes/Jackson)
    References
    Guidelines for Chiropractic Quality Assurance and Practice Parameters (Haldeman, Chapman-Smith, Peterson)
    Chiropractic Principles and Technique (Janse, Hauser and Wells)
    Chiropractic Physiological Therapeutics (Johnson)
    Neurobiologic Mechanisms in Manipulative Therapy (Korr)
    The Chiropractic Theories (Leach)


    C. Required Materials for Lab:
    Physical diagnosis instruments/equipment including an ophthamoscope that is fully charged for every lab.
    • Assignments
    Top

    See course calendar.
    Attendance
    Top
    Attendance is required for the lab and quizzes; recommended for the lecture.
    Grading Criteria
    Top

    1. Examinations and Quizzes:
      1. There will be two quizzes, a written midterm and final exam, and a practical midterm and final exam.
        1. quizzes will be 25-35 points; mostly fill-in-the-blank format; with slide (picture) ID items; quizzes will occur as scheduled on EENT calendar
        2. midterm and final exams will be 80-100 points in multiple choice format; with slide ID items
        3. final exam will be cumulative; about 30% from pre-midterm material
      2. Examinations will include material from this syllabus and its attached learning materials, including the slides, as well as lecture, lab, course notes, handouts and assigned readings.
      3. The final exam will be given during finals week
    2. Grading:
      • Will be based on percentage of total points on quizzes and exams
      • Students must successfully pass both practical exams to receive a grade

    Guaranteed grades are as follows:

    A = 92-100%
    B = 86-91%
    C = 80-85%
    D = 74-79%
    F = < 74%
    Course Competencies
    Top
    -

    COGNITIVE DOMAIN


    Students will be able to construct and follow a rational diagnostic process in evaluating patients who present with the following EENT symptoms/conditions:
    1. reduced vision
    2. double vision
    3. blurred vision
    4. decreased night vision
    5. red or pink eyes
    6. blood or hemorrhage in eye
    7. crusty, swollen, inflamed eyelids
    8. lumps, bumps, sores on the lids
    9. pain in or around the eye
    10. photophobia
    11. foreign object in the eye
    12. itchy or burning eyes
    13. dry eyes
    14. excessive tearing, watering
    15. swelling around the eyes
    16. black eye
    17. protruding eyes
    18. darkness around or under the eyes
    19. change in the color of the iris
    20. change in size, shape of pupils
    21. ptosis of eyelids
    22. strabismus/lazy eye
    23. altered eye motion
    24. nystagmus
    25. hearing loss
    26. equilibrium/balance problems
    27. dizziness/vertigo
    28. ear ache/pain
    29. fullness, tickling, itching in ear
    30. tinnitus/ringing in the ear
    31. lumps, bumps or sores in ear
    32. HEENT lymphadenopathy
    33. nasal congestion/obstuction
    34. runny nose/excess nasal discharge
    35. boogers
    36. excessive sneezing
    37. dry nose
    38. bloody nose/epistaxis
    39. loss of smell/anosmia
    40. postnasal drip
    41. sore throat
    42. difficulty swallowing/dysphagia
    43. hoarseness/loss of voice
    44. drooling
    45. snoring
    46. obstructive sleep apnea
    47. itchy nose, throat
    48. headache
    49. facial pain
    50. facial weakness

    In addition, students will be familiar with the following symptoms, which sometimes accompany certain EENT conditions as well as conditions related to other body systems:
    1. fever
    2. malaise
    3. weight loss

    Students will be able to explain the clinical utility and indications for the following laboratory, imaging and other diagnostic tests in patients with suspected EENT disease:
    1. rapid strep test
    2. ASO
    3. tonometry
    4. perimetry
    5. MRI
    6. CT scan
    7. audiometry
    8. X-ray;imaging
    9. retinoscopy
    10. slit lamp evaluation
    11. fluorescein techniques
    12. tympanostomy


    Conditions:
    Students will be able to make case management decisions regarding common EENT conditions based on their understanding of the following information regarding each condition. (See key on following page for description of codes).
    Clinical Condition Etiol & Epiderm Patho-phys

    Nat. History
    & course

    		 Exam & Dx Rx/Mgmt
    Age Related Eye Conditions
    Cataracts 3 3 3 1,2,3,7 3,5,6,7
    Glaucoma 3 3 3 1,2,3,4,7 1,2,6,7
    Macular Degeneration 3 3 3 1,2,3,7 3,5,6
    Presbyopia 2 2 2 1,2,3,4,7 7
    Congenital Defects
    Congenital cataracts 2 2 2 1,2,3,7 3,5,6,7
    Degenerative Diseases
    Retinitis pigmentosa 2 2 2 1,2,3,7 3,5
    Eyelid Disorders
    Blepharitis 2 2 2 1,2,3 7
    Chalazion 3 3 3 1,2,3,4 2,3
    Ectropion 2 2 2 1,2,3,4 5,6,7
    Entropion 2 2 2 1,2,3,4 1,2,5,7
    Pinguecula 2 2 2 1,2,3 5,6
    Pterygium 2 2 22 1,2,3 5,6
    Ptosis 3 3 3 1,2,3,4,6,7 1,6,7
    Sty/Hordeolum 3 3 3 1,2,3 1,2,6
    Hypoxia/Hyperoxia
    Retinal vessel occlusion 3 3 3 1,2,3,6,7 5,6
    Infection
    Blepharitis 2 2 2 1,2,3 2,3,5,7
    Conjunctivitis 3 3 3 1,2,3 5
    Corneal ulcers and infections 3 3 3 1,2,3,7 5,6
    Eye Inflammation
    Chemosis 2 2 2 1,2,3 2,5,7
    Episcleritis 2 2 2 1,2,3 5,6,7
    Hypertensive retinopathy 3 3 3 1,2,3,7 1,3,4,5,6,7
    Optic neuritis 3 3 3 1,2,3 6
    Scleritis 2 2 2 1,2,3 6
    Uveitis 3 3 3 1,2,3,7 2,3,6
    Other
    Coloboma of the iris 2 2 2 1,2,3,7 6
    Dacryoadenitis 2 2 2 1  
    Eye floaters 2 2 2 1,2,3 7
    Keratoconus 1 1 1 1,2,3  
    Strabismus 3 3 3 1,2,3 4,6
    Tear Duct Disorders
    Blocked tear duct 2 2 2 1,2,3 1,5,6,7
    Keratoconjunctivitis sicca 2 2 2 1,2,3 3,5
    Trauma
    Corneal injury 2 2 2 1,2,3,7 5,6
    Tumor
    Melanoma of the eye 2 2 2 1,2,3,6,7 5,6
    Optic Glioma 2 2 2 1,2,3,6,7 5,6
    Retinoblastoma 2 2 2 1,2,3,6,7 6
    Vision loss and blindness
    Amaurosis fugax 2 2 2 1,2,3  
    Amblyopia 2 2 2 1,2,3,7 4,5,6
    Astigmatism 2 2 2 1,,2,3,7 7
    Blindness 3 3 3 1,2,3 1,3,5
    Tay-Sachs disease 1 1 1 11,2,3,7  
    Retinitis Pigmentosa 2 2 2 1,2,3,7  
    Retinoblastoma 2 2 2 1,2,3,6,7 6
    Retrolental Fibroplasia 1 1 1 2  
    Gonococcal Ophthalmia 1 1 1    
    Colorblindness 2 2 2 7  
    Farsightedness 2 2 2 1,2,3 7
    Nearsightedness 2 2 2 1,2,3 7
    Optic atrophy 2 2 2 1,2,3,7 5
    Ears
    Hearing Loss
    Age-related hearing loss 2 2 2 1,2,3,7 5,7
    Occupational hearing loss 2 2 2 1,2,3,6,7 5,6,7
    Otosclerosis 2 2 2 1,2,3,6,7 5,6,7
    Sensorineural deafness 2 2 2 1,2,3,6,7  
    Infections
    Acute otitis media 3 3 3 1,2,3,4,7 1,3,5,6,7
    Chronic otitis media 3 3 3 1,2,3,4,7 1,3,5,6,7
    Infectious myringitis 1 1 1    
    Otitis externa; acute 3 3 3 1,2,3 1,2,3,5,6,7
    Otitis externa; chronic 3 3 3 1,2,3 1,2,3,5,6,7
    Ramsay Hunt syndrome 2 2 2 1,2,3  
    Inflammation
    Labyrinthitis 3 3 3 1,2,3,4,6,7 1,2,4,5,6
    Other
    Aural polyps 1 1   3  
    Benign ear cyst or tumor 1 1   3  
    Ear discharges,bleeding 2 2 2 1,2,3,4 1,2,3,5,6
    Otosclerosis 2 2 2 1,2,3,6,7 1,3,5,6
    Meniere's disease 2 2 2 1,2,3,6,7 1,3,5,6
    Pina abnormalities and low set ears 1 1   3  
    Wax blockage 3 3 3 1,2,3,4 1,2,6,7
    Acoustic Trauma 2 2 2 1,2,3,7  
    Ear barotrauma 2 2 2 1,2,3 1,5,6,7
    Ear foreign body 2 2 2 1,2,3 1,5,6
    Ruptured ear drum 2 2 2 1,2,3 2,5
    Mouth
    Other
    Breath odor 2 2 2 3 3,5
    Canker sores 2 2 2 3 2,3
    Chapped lips 2 2 2 1,2,3 3,6
    Cleft lip and palate 1 1 1 3 6
    Fever blister 1 1 1 3 5
    Gingivitis 1 1 1 3 5,7
    Herpes labialis 2 2 2 3,7 2,3
    Leukoplakia 2 2 2 1,2,3 5,6
    Mouth ulcers 2 2 2 1,2,3 5,6
    Oral cancer 2 2 2 1,2,3,7 5,6
    Oral candidiasis (adult) 2 2 22 1,2,3 3,5,6
    Periodontitis 1 1 1 3 7
    Perioral dermatitis 1 1   3  
    Pharyngitis 2 2 2 1,2,3,4,7 1,2,3,5,6
    Tongue
    Geographic tongue 1 1 1 1,2,3 5
    Glossitis 1 1 1 1,2,3 5,7
    Glossopharyngeal neuralgia 1 1 1 1,2,3 5,7
    Macroglossia 1 1 1    
    Posterior tongue carcinoma          
    Tongue tie 1 1 1 1,2,3 6
    Congental Developmental/Acquired Structural
    Nasal polyps 2 2 2 1,2,3,7 1,2,5,6
    Rhinophyma 2 2 2 1,2,3,7 1,2,5,6
    Infection
    Sinusitis 3 3 3 1,2,3,4,6,7 1,2,3,5,6
    Sinusitis; chronic 3 3 3 1,2,3,4,6,7 1,2,3,5,6
    Inflammation
    Vasomotor rhinitis 1 1 1 3 5
    Trauma/Injury
    Foreign body nose 2 2 2 1,2,3 5,7
    Nose Fracture 2 2 2 1,2,3 5,6,7
    Nosebleed - injury 2 2 2 1,2,3 5,6,7

    Elaboration of Coding Definitions Regarding the Conditions

    The following codes refer to the depth of coverage for Etiology and Epidemiology; Pathophysiology, and; Natural History and Course:

    0 No coverage or content
    1 Introduction, without test items
    2 Moderate class discussion and/or handout material, with test items
    3 Extensive discussion and/or handout material, with test items

    For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

    1 Presenting Sx: Presenting symptoms related to condition are discussed
    2 History findings: Relevant personal and family history are discussed
    3 Exam findings: General physical exam findings are discussed.
    4 Chiro. Findings: Posture, subluxation, muscle tone and length, trigger pts.
    5 Lab findings: Blood, urine, CSF ...
    6 Imaging findings: Normal, CT, CAT, MRI ...
    7 Special test findings: e.g.. Sweat test for cystic fibrosis, spirometry for asthma.

    For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

    1 Chiropractic: Adjustments, soft tissue techniques
    2 PT: Physical therapy modalities of all types
    3 Nutrition/Suppl: Diet and supplement recommendations
    4 Exercise: Stretching, strengthening, aerobic exercise recommendations
    5 Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance.
    6 Medical Drugs, antibiotics, surgical procedures, radiotherapy...
    7 Other: Acupressure/puncture, massage, homeopathic or herbal Rx..
    8 Guidelines: If published, do you refer to them regarding this condition?



    PSYCHOMOTOR DOMAIN


    Students will be able to conduct an appropriate physical examination of the head, eyes, ears, nose and throat areas using the following procedures:
    1. Inspection
    2. Palpation
    3. Auscultation
    4. Ophthalmoscopic examination
    5. Otoscopic examination
    6. Nasoscopic examination
    7. Examination of nose and sinuses
    8. Examination of mouth and throat
    9. Neck examination (thyroid gland and lymph nodes)
    10. Headache evaluation
    11. Standard tests of vision and hearing

    In addition, students will be able to seek and detect the following signs:
    1. Exophthalmos
    2. Red eye
    3. Limbal injection
    4. Anisocoria
    5. Mydriasis
    6. Miosis
    7. Nonreactive/hyporeactive pupil
    8. Irregular pupil
    9. Ptosis
    10. Dry eye
    11. Papilledema
    12. Increased cup to disc ratio
    13. Optic atrophy
    14. Medullated nerve fibers
    15. Abnormal A-V ratio
    16. Focal constrictions
    17. A-V crossing change
    18. Preretinal and retinal hemorrhage
    19. Pigmentary disturbance
    20. Hard exudates
    21. Soft exudates
    22. Drusen
    23. Ocular swelling
    24. Vascular obstruction
    25. Serous otitis
    26. External otitis
    27. Otitis media
    28. Barotitis
    29. Tonsilitis
    30. Follicular tonsilitis
    31. Lymphadenopathy/lymphadenitis
    32. Thyroid enlargement


    Students will be able to select and properly employ the following treatment techniques:
    1. Suboccipital stretch
    2. Cervical lymphatic enhancement
    3. Ear "adjustment" (J)
    4. Ear pump
    5. Ear acupoint stimulation
    6. Sinus percussion/stimulation techniques
    7. Sinus acupoint stimulation
    8. Sinus pump
    9. Irrigation of the ear/ cerumen removal
    10. Lid flipping and foreign body removal techniques of the eye
    11. Eustachian tube opening decongestion technique

    In addition, students will be able to advise and instruct patients regarding the following home care concepts and activities as they apply to specific EENT conditions:

    1. Eye: foreign body removal
    2. Ears: cerumen removal/softening and Eustachian tube opening


    AFFECTIVE DOMAIN


    Students will be expected to demonstrate the attitudes and behaviors of a professional during all lectures and labs.
    Weekly Calendar of Learning Objectives
    Top
    Week Dates Topics/Learning objectives
    Week 1

    Lec: Introduction: review of course syllabus, conduct and goals. Eye Conditions
    Lab: Roll call, orientation to lab. Eye examination

    Assignment: Bates (eye exam); Sousa ch 43 (eye SX)

    Week 2

    Lec: Eye conditions
    Lab: Eye exam

    Assignment: Bates (eye exam); Sousa ch 43 (eye SX)
    Week 3

     

    Lec: Eye conditions
    Lab: Eye exam

    Assignment: Bates and Sousa - as above
    Week 4

    Lec: Eye conditions;
    Lab: Eye exam

    Assignment: Bates and Sousa - as above
    Week 5

    Lec: Ear Conditions quiz #1
    Lab:

    Assignment: Bates (ear & hearing exam) Sousa ch 18, 45, 46, 47 (dizziness, ear pain, hearing loss, tinnitus)
    Week 6

    Lec: Ear Conditions
    Lab: Lab Practical: eye exam

    Assignment: Bates (ear & hearing exam) Sousa ch 18, 45, 46, 47 (dizziness, ear pain, hearing loss, tinnitus)
    Week 7

     

    Lec: Midterm exam- No lecture
    Lab: No lab

    Assignment:

    Week 8

    Lec: Ear Conditions
    Lab: Ears: exam; hearing eval; dizziness eval; treatments

    Assignment: Bates (ear & hearing exam) Sousa ch 18, 45, 46, 47 (dizziness, ear pain, hearing loss, tinnitus)

    Week 9

    Lec: Ear Conditions
    Lab: Ears: exam; hearing eval; dizziness eval; treatments


    Assignment: Bates (ear & hearing exam) Sousa ch 18, 45, 46, 47 (dizziness, ear pain, hearing loss, tinnitus)

    Week 10

     

    Lec: Nose and Sinus Conditions
    Lab: Nose and sinuses: exam and treatments

    Assignment: Bates (nose and sinus exam) Sousa ch 44 (facial pain) and ch 48 ( nosebleed)

    Week 11

    Lec: Throat and Mouth Conditions; quiz #2
    Lab: Throat and Mouth: exam and treatments

    Assignment: Bates (throat and mouth exam) Sousa ch 49 (sore throat)
    Week 12

     

    Lec: Neck and Head Conditions
    Lab: Neck and Head: exam and treatments

    Assignment: Bates (head and neck exam) Sousa ch 17 (headache)
    Week 13

    Lec: Wrap-up
    Lab: Final Practical exam: HENMTN

    Assignment: Study for the final.
    Week 14 Final Exams - as scheduled; final practical re-takes
    Week 15 Final Exams - as scheduled
    Please Note
    This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
    Maintained by Northwestern College of Chiropractic
    Last updated: 16 August, 2006
     

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