Description of Otolaryngology Residency Rotations
The PGY1 year is structured as follows:
- Six months on the Otolaryngology service at Mount Sinai Hospital
- One month each on Anesthesia, ICU, Plastic Surgery, Oral-Maxillofacial Surgery, and Neurosurgery, General Surgery
During the ENT rotation, residents are taught the skills to perform complete head and neck examination including indirect laryngoscopy, fiberoptic laryngoscopy, microscopic otoscopy and pneumatic otoscopy. They will acquire skills to take a general and a targeted history and physical exam through supervised patient encounters in the outpatient clinics, learn to present new and established patients in a concise and focused manner, and become adept at preoperative assessment and postoperative patient care.
As part of this rotation, residents become familiar with the perioperative management of otolaryngology patients. Residents acquire core knowledge in all areas of otolaryngology through didactic sessions and departmental lectures while on the otolaryngology service. Furthermore, they will develop basic understanding of diagnostic radiology of the head and neck through monthly interactive radiology conferences. The PGY1 resident participates on daily rounds with the ENT team, assists on a variety of operative cases, and helps with floor work and the resident clinic.
The non-otolaryngology rotations are designed to enhance the basic knowledge of the otolaryngologist-in-training, providing exposure to difficulty airway management, critically ill patients, and patients undergoing odontogenic, cosmetic/reconstructive, and craniofacial procedures.
Mount Sinai Hospital – Pediatrics
The pediatric ENT works closely with the pediatric otolaryngology attendings to care for the outpatient clinic, pediatric emergency department, and inpatient consult service. Residents develop the skills to perform complete head and neck examination including indirect laryngoscopy, fiberoptic laryngoscopy, microscopic otoscopy and pneumatic otoscopy on pediatric patients. Additionally, they acquire skills to take a general and a targeted history and physical exam through supervised patient encounters in the outpatient clinics, learns to present new and established patients in a concise and focused manner, and becomes adept at preoperative assessment and postoperative care of pediatric patients.
Core knowledge in pediatric otolaryngology is acquired on topics including pediatric sleep apnea, tonsillitis, otitis media and externa, disorders the supraglottic, glottis, and subglottic airway, and sinusitis.
Once a month, the resident attends a multidisciplinary cleft lip/palate conference to discuss surgical and medical management of affected children with Plastic Surgery, Oral Surgery, Speech and Swallow Therapy, Social Services, and Nutrition.
Mount Sinai Hospital – Ward/Tracheostomy
The ward/trach junior resident is responsible for overseeing the perioperative inpatient care of the otolaryngology service. With guidance from senior and chief residents as well as attending staff, residents are responsible for evaluating patients in the emergency department, the active surgical inpatient service, the intensive care unit, the step-down unit, and the general ward. This resident is also in charge of the consultation service for bedside and operative tracheostomy, as well as the postoperative management of these patients. Basic airway management skills are taught in depth during this rotation.
PGY2 residents also manage otolaryngology inpatients throughout their hospital admission. Patients admitted to the intensive care or step-down units are followed by the PGY2 under the supervision of the chief resident and the intensivists.
During this rotation, residents become familiar with the perioperative management of otolaryngology patients including: management of patients undergoing major head and neck surgery, treatment of hypo and hypercalcemia, management of complex wounds, diagnosis and treatment of salivary and chyle fistulae, management of nutritional and metabolic deficits, perioperative pharmacotherapy including antibiotics and analgesics, and management of electrolyte imbalances.
Elmhurst Hospital – Junior
With the guidance of senior and chief residents, as well as attending staff, PGY2 residents evaluate patients in the emergency department, an outpatient clinic, a consult service, and an active surgical service. Elmhurst Hospital is a Level 1 Trauma Center located in Elmhurst, Queens. The emergency department provides an excellent source of training in blunt and penetrating trauma. The hospital supports a variety of outpatient clinics in addition to otolaryngology, including oral surgery, endocrine, and neurosurgery. These services provide comprehensive patient care and teach residents the value of integrated multidisciplinary patient care. The otolaryngology clinic provides resident training in all aspects of otolaryngology. The inpatient service is an active ward where the PGY2 residents receive instruction on the management of inpatient general otolaryngology.
Residents also develop skills in interpretation of diagnostic medical imaging modalities including: plain radiography, computerized tomography, magnetic resonance imaging, positron emission tomography, and contrast studies of the aerodigestive tract. Furthermore, they become familiar with diagnostic modalities common to the evaluation of otolaryngology patients, such as audiology, vestibular testing, and electrophysiologic evaluation of the facial nerve.
Finally, because of the wide range of ethnicities and demographics seen in these patient populations, residents develop an acute sensitivity for cultural and religious factors that may impact the delivery of care.
PGY 3 –
Mount Sinai Hospital – Sinus/Plastics
The Mount Sinai Facial Plastics and Sinus Service is designed to instruct the PGY3 on the management of patients with sinus and allergy disease and facial plastics. There is an active outpatient office and inpatient census, and collaboration exists within the allergy and immunology services.
During this rotation, residents become intimately familiar with anatomy, physiology, and imaging of the paranasal sinuses, and understand the potential complications of acute and chronic sinusitis as well as their diagnosis and management. They practice medical management and learn the role of sinus surgery in the treatment of sinus disease, and develop an appreciation for the multidisciplinary management of patients with allergic disorders and sinus disease (including RAST and skin testing and the role of immunotherapy). The residents acquire both basic and advanced understanding of benign and malignant diseases affecting the nose and paranasal sinuses, and learn the performance of sinus surgery using endoscopic and open approaches. They also develop a thorough understanding and appreciation of the indications and contraindications for aesthetic surgery. They also learn the range of aesthetic procedures including conventional rhinoplasty, facelift, liposuction, blepharoplasty, use of facial augmentation prosthetics, otoplasty, the role of botulinum toxin in ameliorating wrinkles, the use of lasers for facial resurfacing, and the use of the chemical peel.
Elmhurst/Queens Hospital and Research
The dedicated 3-month research time is uniquely blended into a part-clinical, part-research experience of 6 months’ duration during the PGY3 year. Clinical responsibilities are carried out at either Elmhurst or Queens Hospital. The PGY3 independently examines, diagnoses, and treats patients seen in clinic under the supervision of the attending physician, and is responsible for the perioperative care of these patients. Both hospitals offer a busy clinic setting and plentiful operating room time to provide an excellent clinical experience. Because the PGY3 is the only resident staffing Otolaryngology at Queens Hospital, this resident has the opportunity to evaluate and manage all clinic patients and develop a sense of independence.
During the research days of this rotation, the resident, under the guidance of a faculty research mentor, learns skills in scientific investigative techniques and data analysis: basic science techniques, chart review and data collection, statistical analysis of data, formulation of research proposals, and presentation to research committees. Icahn School of Medicine is fortunate to have many active basic and clinical science laboratories. The PGY3 research resident can choose from the several laboratories within the department or perform research in a related department. In addition to the research experience offered in the department of otolaryngology, the institution offers a wide variety of opportunities in other departments including immunology, radiation oncology, neurosurgery, plastic surgery, neurology, and others.
Residents are required to present their data at scheduled research meetings and the resident research review for the department. Furthermore, they are expected to prepare a manuscript for publication and submit an abstract to regional or national meeting.
Bronx VA – Junior
The Bronx Veterans Hospital rotation for the PGY3 contributes a great learning experience in general otolaryngology, facial plastic surgery and head and neck oncology. The VA clinic is attended by a PGY5 resident, a PGY3 resident, and a supervising attending. During this rotation, there is a particular focus on developing an understanding for the diagnosis and management of patients with allergy. This includes skin testing and immunotherapy. Furthermore, a complex hearing and balance center provides full services for exposure and learning about adjunct hearing and balance testing, as well as the interpretation of these results.
The veteran population is a consistent source of head and neck cancer cases, which are treated with the most current diagnostic and management methods, including microvascular free tissue transfer. Multidisciplinary cancer care is available at the VA, and a bi-weekly Tumor Board conference is held with the collaborating services.
PGY 4 –
Mount Sinai Hospital – Otology/Neurotology
The Mount Sinai Otology division is an active service during which the PGY4 is instructed on the management of patients with a wide variety of otologic and skull base diseases and procedures. Clinical entities range from chronic infection and neoplastic processes, to cochlear implants and bone anchored hearing aids. A multidisciplinary program comprised of the otolaryngology, neurosurgery, a cochlear implant program, and audiology services contributes to both patient care and resident education.
During this rotation, residents become competent in the diagnosis and management of otologic and neurotologic disease, develop surgical skills in the management of otologic disease, and become adept at the assessment and management of the vertiginous patient. Furthermore, they develop a thorough knowledge of the anatomy of the temporal bone and the skull base region, the pathophysiology of acute and chronic otologic disease, and imaging studies of the temporal bone and the cerebellopontine angle region. They become well-versed in the diagnostic tests used to evaluate the middle and inner ear, including both the vestibular system and hearing.
Residents acquire a thorough knowledge of the bacteriology and virology associated with middle ear, mastoid complex, and inner ear disease, as well as the antibiotic pharmacology utilized for the management of otologic infectious diseases. They learn the indications and contraindications for use of assistive hearing devices and fully understand the selection, evaluation and surgery for candidates for cochlear implants. They also become intimately familiar with the anatomy of the facial nerve and the disease processes that can lead to facial paralysis, and are knowledgeable about surgery of the facial nerve and methods for rehabilitation of the paralyzed face. Through the surgical experience on the rotation as well as instruction in the temporal bone laboratory, they develop competency in surgical approaches to the middle ear, inner ear, temporal bone and cerebellopontine angle. Outside of patient care, residents develop leadership and teaching skills by instructing junior residents in the operating room and in the temporal bone laboratory.
Mount Sinai Hospital – Laryngology
The Mount Sinai Laryngology rotation instructs the PGY4 on the management of patients with voice, speech and swallowing disorders. A multidisciplinary program in laryngology is comprised of otolaryngology, speech pathology, professional voice therapy, and neurolaryngology. During this rotation, residents become competent in the diagnosis and management of disorders of the larynx and cervical esophagus. Residents identify the indications for diagnostic laryngoscopy, microlaryngoscopy, esophagoscopy, and bronchoscopy, and develop a core knowledge (indication, instrumentation, limitation, contraindications) on commonly performed endoscopic procedures of the upper airway including phonomicrosurgery, microlaryngoscopy and biopsy, microlaryngoscopy with laser, transoral endoscopic resection of carcinoma, laser safety and use of various lasers, direct laryngoscopy, management of caustic ingestion injuries of the pharynx and esophagus, partial laryngectomy, cordotomy, arytenoidectomy, and arytenoidpexy.
While working with attending staff in the outpatient setting, residents perform and achieve competence in office flexible laryngoscopy and esophagoscopy, videostroboscopy, and endoscopic evaluation of swallow. They further learn office treatment options for laryngeal lesions, spasmodic dysphonia, vocal fold paralysis, including office laser usage and office injection. Furthermore, they are exposed to office tests for dysphonia and dysphagia, including 24-hour pH probe testing, laryngeal electromyography, and phonatory function testing.
Elmhurst Hospital – Trauma/Plastics
Elmhurst Hospital is a busy trauma emergency ward and general otolaryngology service. The PGY4 on service focuses on sinus disease and surgery, as well as facial plastic surgery. PGY4 residents on this rotation utilize and continue to hone administrative skills through the independent planning of all resident activities and the integration of these with ongoing departmental educational activities and scheduling of patients for operative intervention.
The active trauma service provides comprehensive training in head and neck blunt and penetrating trauma. The otolaryngology team works together with the oral-maxillofacial and plastic surgery departments to provide a multidisciplinary trauma service (basic and advanced principles of repair of maxillo-mandibular fractures including open/closed techniques, internal fixation, evaluation and re-establishment of occlusal relations and the diagnosis and management of post-operative complications).
St. Barnabas Hospital – Trauma
St. Barnabas Hospital is a busy Level I trauma hospital, where residents rotate during the PGY4 year in order to gain additional experience in management of facial trauma. On trauma cases, the PGY4 resident works together with the oral-maxillofacial surgery department to utilize basic and advanced principles of repair of maxillo-mandibular fractures, including open/closed techniques, internal fixation, evaluation and re-establishment of occlusal relations, and the diagnosis and management of post-operative complications. Furthermore, the resident participates in the care of patients with isolated dental trauma, learning about the anatomy and clinical care of teeth, as well as the workup and performance of orthognathic surgery.
PGY 5 –
Mount Sinai Hospital – Head and Neck Chief
The Mount Sinai Head and Neck service provides a busy, largely inpatient rotation during which PGY5 residents receive instruction on the management of patients with head and neck tumors. A multidisciplinary program in head and neck cancer is comprised of the otolaryngology, neurosurgery, radiation oncology, medical oncology, and speech/language pathology services.
During this rotation, residents gain a comfort level with the diagnosis and management of head and neck tumors, develop an appreciation for the multidisciplinary management of head and neck cancer, and closely conduct perioperative management of complex head and neck surgical patients, including the management of patients who have undergone microvascular free tissue transfer. They develop a thorough knowledge of the therapeutic options for the management of head and neck cancer, as well as the indications and contraindications for surgery, radiation therapy, and chemotherapy.
Residents learn to manage complex wounds and understand the use of perioperative antibiotics and pharmacotherapy and the management of difficult wounds in the head and neck region. By working with the attendings in the operating room, they develop thorough knowledge of the anatomy, pathology, and biologic behavior of neoplasms involving the upper aerodigestive tract and salivary glands, as well as the surgical procedures that are utilized in the management of these neoplastic conditions. They also acquire both basic and advanced understanding of head and neck reconstructive surgery with respect to the options for reconstruction of various defects. The thyroid/parathyroid volume is very large, and the residents acquire a complete knowledge of endocrine surgery involving the thyroid and parathyroid glands, including the anatomy, embryology and the potential complications associated with this surgery.
Mount Sinai Hospital – Clinic Chief
There is a large resident-run clinic at the Mount Sinai Hospital, overseen by a number of attending physicians in conjunction with the “clinic chief resident.” The PGY5 resident helps to mentor junior residents and physician extenders by seeing patients together with them and presenting treatment plans to supervising attendings. Involvement with this busy clinic provides a great experience in longitudinal care of the otolaryngology patient, and allows learning, both in an office setting and in the operating room, of all the different subspecialties of our diverse field.
Elmhurst Hospital – Chief
As mentioned previously, Elmhurst Hospital has an active trauma emergency ward and general otolaryngology service. The PGY5 chief resident on service has the opportunity during this final rotation to capitalize on the breadth and depth of disease and surgery that is carried out at Elmhurst. In this sense, the chief rotation at Elmhurst serves much like an elective rotation, where the chief resident may choose to focus on anything from complex head and neck reconstruction, to inflammatory ear disease or cosmetic facial plastic surgery.
Bronx VA – Chief
The Bronx Veterans Hospital rotation for the PGY5 contributes a great learning experience in general otolaryngology, facial plastic surgery, and head and neck oncology.
Developing an understanding for the diagnosis and management of patients with allergy is a focus during this rotation, including skin testing and immunotherapy. Furthermore, a complex hearing and balance center provides full services for exposure to and learning about adjunct hearing and balance testing, as well as the interpretation of these results.
The Bronx VA makes the most advanced diagnostic and management methods and multidisciplinary cancer care available to the veteran population among whom a stream of head and neck cancer cases occurs. Bi-weekly Tumor Board conferences are held with the collaborating services. This resident is also responsible for detailed preparation of Integrated Quality Improvement conference material, including a thoughtful evaluation of the cases presented.
Department of Otolaryngology-Head and Neck Surgery