Rotations

The Otolaryngology Residency is a five-year program designed to give residents the education and clinical training necessary for progressively increasing responsibility in patient care management. 

The PGY-1 year is structured as follows:

  • Six months on the Otolaryngology service at The Mount Sinai Hospital
  • One month each on Anesthesia, ICU, Plastic Surgery, Oral-Maxillofacial Surgery, Neurosurgery, and 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. You 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.

You also will 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. You will develop a basic understanding of diagnostic radiology of the head and neck through monthly interactive radiology conferences. You participate on daily rounds with the ENT team, assist on a variety of operative cases, and help 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 difficult airway management, critically ill patients, and patients undergoing odontogenic, cosmetic/reconstructive, and craniofacial procedures.

The PGY-2 year takes place at The Mount Sinai Hospital and at Elmhurst Hospital.

The Mount Sinai Hospital – Pediatrics

The pediatric ENT resident works closely with the pediatric otolaryngology attendings to care for the outpatient clinic, pediatric emergency department, and inpatient consult service. You develop the skills to perform complete head and neck examinations, including indirect laryngoscopy, fiberoptic laryngoscopy, microscopic otoscopy and pneumatic otoscopy on pediatric patients. You 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 care of pediatric patients.

You will gain core knowledge in pediatric otolaryngology on topics including pediatric sleep apnea, tonsillitis, otitis media and externa, disorders of the supraglottic, glottis, and subglottic airway, and sinusitis. Once a month, you attend a multidisciplinary cleft lip/palate conference to discuss surgical and medical management of affected children with other units including 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, you 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.  You also are 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.

PGY-2 residents also manage otolaryngology inpatients throughout their hospital admission. Patients admitted to the intensive care or step-down units are followed by the PGY-2 resident under the supervision of the chief resident and the intensivists.

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, PGY-2 residents evaluate patients in the emergency department, an outpatient clinic, a consult service, and an active surgical service. 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 PGY-2 residents receive instruction on the management of inpatient general otolaryngology.

You 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. Residents become familiar with diagnostic modalities common to the evaluation of otolaryngology patients, such as audiology, vestibular testing, and electrophysiologic evaluation of the facial nerve.

Because of the diverse patient populations, residents develop an acute sensitivity for cultural and religious factors that may impact the delivery of care.

The PGY-3 year is structured as follows:

The Mount Sinai Hospital – Sinus/Plastics

The Mount Sinai Facial Plastics and Sinus Service is designed to instruct you 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, you become familiar with anatomy, physiology, and imaging of the paranasal sinuses, and you understand the potential complications of acute and chronic sinusitis as well as their diagnosis and management. Residents 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). 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.  You also develop a thorough understanding and appreciation of the indications and contraindications for aesthetic surgery. Residents 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 three-month research time is uniquely blended into a part-clinical, part-research experience of six months’ duration during your PGY-3 year.  Clinical responsibilities are carried out at either Elmhurst or Queens hospital. Residents independently examine, diagnose, and treat patients seen in clinic under the supervision of the attending physician, and are 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 PGY-3 is the only resident staffing otolaryngology at Queens Hospital, you have the opportunity to evaluate and manage all clinic patients and develop a sense of independence.

During the research days of this rotation, you learn, under the guidance of a faculty research mentor, skills in scientific investigative techniques and data analysis. These include: basic science techniques, chart review and data collection, statistical analysis of data, formulation of research proposals, and presentation to research committees. The Icahn School of Medicine has many active basic and clinical science laboratories. You can choose from the several laboratories within the Department or perform research in a related department. There are also a wide variety of opportunities in other departments including Immunology, Radiation Oncology, Neurosurgery, Plastic Surgery, Neurology, and others.

You are required to present your data at scheduled research meetings and the resident research review for the Department. You are also expected to prepare a manuscript for publication and submit an abstract to a regional or national meeting.

James J. Peters VA Medical Center – Junior

This rotation for the PGY-3 resident contributes a great learning experience in general otolaryngology, facial plastic surgery, and head and neck oncology. The clinic is attended by a PGY-5 resident, a PGY-3 resident, and a supervising attending. There is a particular focus on developing an understanding of the diagnosis and management of patients with allergy disease. This includes skin testing and immunotherapy. A complex hearing and balance center provides full services for learning about adjunct hearing and balance testing and interpreting the results.

The patient 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 and a bi-weekly Tumor Board conference is held with the collaborating services.

The PGY-4 year takes place at The Mount Sinai Hospital, Elmhurst Hospital Center and St. Barnabas Hospital.

The Mount Sinai Hospital – Otology/Neurotology

The Mount Sinai Otology division is an active service during which the PGY-4 resident 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.

You 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. You 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. Residents 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 used for the management of otologic infectious diseases. You learn the indications and contraindications for use of assistive hearing devices and fully understand the selection, evaluation, and surgery for candidates for cochlear implants. Residents also become intimately familiar with the anatomy of the facial nerve and the disease processes that can lead to facial paralysis, and learn about surgery of the facial nerve and methods for rehabilitation of the paralyzed face. You develop competency in surgical approaches to the middle ear, inner ear, temporal bone and cerebellopontine angle. Residents also develop leadership and teaching skills by instructing junior residents in the operating room and in the temporal bone laboratory.

The Mount Sinai Hospital – Laryngology

The Mount Sinai Hospital Laryngology rotation instructs the PGY-4 resident on the management of patients with voice, speech, and swallowing disorders. This multidisciplinary program in laryngology is comprised of otolaryngology, speech pathology, professional voice therapy, and neurolaryngology. Residents become competent in the diagnosis and management of disorders of the larynx and cervical esophagus. You 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. This includes 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, you perform and achieve competence in office flexible laryngoscopy and esophagoscopy, videostroboscopy, and endoscopic evaluation of swallow. You learn office treatment options for laryngeal lesions, spasmodic dysphonia, and vocal fold paralysis, including office laser usage and office injection.  You 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

The PGY-4 service focuses on sinus disease and surgery, as well as facial plastic surgery.  PGY-4 residents on this rotation use and continue to hone administrative skills through the independent planning of all resident activities and the integration 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. (This includes 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

Residents rotate during the PGY-4 year in order to gain additional experience in management of facial trauma. On trauma cases, the PGY-4 resident works together with the Oral-Maxillofacial Surgery department to use 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. You participate 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.

The PGY-5 year is structured as follows:

The Mount Sinai Hospital – Head and Neck Chief

The Mount Sinai Head and Neck service provides a busy, largely inpatient rotation during which PGY-5 residents receive instruction on the management of patients with head and neck tumors. This multidisciplinary program in head and neck cancer includes the otolaryngology, neurosurgery, radiation oncology, medical oncology, and speech/language pathology services.

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. You 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.

You 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, you 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 used in the management of these neoplastic conditions. Residents also acquire both basic and advanced understanding of head and neck reconstructive surgery and the options for reconstruction of various defects. The thyroid/parathyroid volume is very large, and 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.

The 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 PGY-5 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

The PGY-5 chief resident on service has the opportunity during this final rotation to capitalize on the breadth and depth of disease and surgery at Elmhurst.  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.

James J. Peters VA Medical Center – Chief

This rotation for the PGY-5 chief resident 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 disease is a focus, including skin testing and immunotherapy. 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 most advanced diagnostic and management methods and multidisciplinary cancer care are available to the veteran population. Bi-weekly Tumor Board conferences are held with the collaborating services. You also are responsible for detailed preparation of Integrated Quality Improvement conference material, including a thoughtful evaluation of the cases presented.