New Application: Neurotology
Review Committee for Otolaryngology
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
PROGRAM PERSONNEL AND RESOURCES
Program Director
Briefly describe how the program director will coordinate combined interdisciplinary educational
conferences that emphasize cooperative diagnostic efforts and surgical team approaches to operative
therapy with neurological surgeons, and combined approaches to rehabilitative efforts with physical
medicine and rehabilitation physicians. [PR II.A.4.p)]
Click here to enter text.
Resources
1. Indicate whether the following resources are available to the program [PR II.D.1.]
a) A temporal bone dissection laboratory ................................................................... ☐ YES ☐ NO
b) Testing facilities for complete auditory and vestibular evaluation and cranial nerve monitoring
............................................................................................................................... ☐ YES ☐ NO
2. This form must include data for the most recently completed academic year from each participating
site in the neurotology program. The list should include all procedures performed by the
otolaryngology/neurotology service. [PR II.D.2.]
PROCEDURE
CATEGORIES
CPT Code(s)
Site #1
Approaches for Skull Base Surgery
Middle fossa
61590, 61591,
#
approach for removal 61592, 66970
of tumor
Posterior fossa approach for removal tumor
Translabyrinthine 61526, 61595
#
Retrosigmoid/
61595
#
Suboccipital
Transcochlear
61596
#
Transcondylar
61597
#
Transpetrosal
61598
#
Combined
61530
#
approach for CPA
Middle fossa approach-Other
Semicircular canal 61590
#
dehiscence
Decompression of 69960
#
IAC
Repair encephalocele
Posterior fossa
62121
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Site #2
Site #3
Site #4
Total
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Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 8/2015
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PROCEDURE
CATEGORIES
CPT Code(s)
Site #1
Site #2
Middle Fossa
62120
#
#
Resection of Neurotologic Tumors
Glomus Tumor Surgery
Tympanomastoid 69552
#
#
Jugulare,
69554, 61615
#
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extradural
Jugulare,
61616
#
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intradural
Middle fossa tumors
Extradural/
61605
#
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Petrous apex
IAC lesions
61606
#
#
Cavernous sinus, 61607
#
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extradural
Kawase triangle,
61608
#
#
intradural
Facial nerve tumor 69970
#
#
Posterior fossa tumors
Retrosigmoid,
61615
#
#
extradural
Retrosigmoid,
61616, 61518,
#
#
intradural
61619
Translabyrinthine 61616, 61526,
#
#
61530
Temporal bone resection
Temporal bone
69150, 69155,
#
#
resection
69535
Reconstruction after Resection of Neurotologic Tumors
By tissue graft (fat,
61618, 20926
#
#
fascia, etc.)
By local or regional
61619
#
#
vascularized flap
Other Skull Base Surgery
Middle fossa approach-Other
Semicircular canal 61590
#
#
dehiscence
Decompression of 69960
#
#
IAC
Repair CSF leak
Transmastoid
69670
#
#
Intracranial
62100
#
#
Stereotactic Radiation for Skull Base Lesions
One complex lesion 61798
#
#
Application of
61800
#
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stereotactic frame
Auditory Brainstem Implant
Auditory brainstem
61875
#
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implant
Other Relevant Cases
Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Total
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Updated 8/2015
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PROCEDURE
CATEGORIES
Facial Nerve Surgery
Decompression:
Lateral to
geniculate
ganglion
Decompression:
TotalTranstemporal
Facial Nerve
Repair:
Intratemporal
Facial Nerve
Repair:
Extracranial
XII-VII
Anastomosis
Nerve Graft
Harvest
Facial Nerve Repair:
Medial to geniculate
ganglion
Ear canal procedures
CPT Code(s)
Site #1
Site #2
Site #3
Site #4
Total
69720
#
#
#
#
#
69725, 69955
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69740
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64864
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64868
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64885, 64886
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69745
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69140, 69145,
69205, 69222,
69420, 69421,
69424, 69433,
69436
69310, 69320
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Reconstructive
procedures
Middle Ear and Mastoid procedures
Tympanoplasty
69610, 69620,
69631, 69632,
69633
Tympanomastoide 69635, 69636,
ctomy
69637, 69641,
69642, 69643,
69644, 69645,
69646
Mastoidectomy
69501, 69502,
69505, 69511
Revision
69601, 69602,
Mastoidectomy
69603, 69604,
69605
Mastoid
69670
Obliteration
Stapedectomy
69650, 69660,
69661, 69662
Middle ear
69440, 69450
exploration
Glomus
69550
tympanicum,
transcanal
Perilymph fistula
69666, 69667
repair
Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 8/2015
Page 3 of 9
PROCEDURE
CATEGORIES
CPT Code(s)
Vestibular Surgery
Endolymphatic
69805, 69806
Sac Surgery
Labyrinthectomy- 69905
transcanal
Labyrinthectomy- 69910
transmastoid
Rehabilitative Surgery
Congenital Aural
69310
Atresia
Cochlear
69930
Implantation
Electromagnetic
69710
Hearing Device
Removal/repair 69711
Bone Conduction 69714
Device
With
69715
mastoidectomy
Replacement
69717, 69718
DIAGNOSES
Glomus tumor (tympanicum); Glomus
tumor (jugulare)
Vestibular schwannoma (acoustic
neuroma)
Facial nerve tumor
Site #1
Site #2
Site #3
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Total
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FELLOW APPOINTMENTS - OTHER LEARNERS
Briefly describe how the program director will ensure the presence of other learners, including
otolaryngology residents, residents from other specialties, unaccredited neurotology fellows, other
subspecialty fellows, PhD students, and nurse practitioners, will not interfere with the appointed fellows’
education. [PR III.C.]
Click here to enter text.
EDUCATIONAL PROGRAM
Regularly Scheduled Didactic Sessions
1. List the type and frequency of didactic sessions that will be included in the program. Add rows as
needed. [PR IV.A.3.]
Type
Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Frequency
Updated 8/2015
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Type
Frequency
2. Describe how the program director will ensure that fellows participate in both planning and
conducting conferences. [PR IV.A.3.a).(1)]
Click here to enter text.
3. Describe how the program director will ensure that both faculty members and fellows attend and
participate in multidisciplinary conferences. [PR IV.A.3.a).(2)]
Click here to enter text.
4. Provide a list of all the didactic sessions that will be given during the two-year educational program.
Add rows as needed. [PR IV.A.3.b)-c)]
Title of Session
Topic
Presenter
Patient Care
Indicate the settings and activities in which fellows will demonstrate competence in each of the
following areas of patient care. Also indicate the method(s) used to assess competence.
Competency Area
Settings/Activities
Performance of key procedures, including: [PR IV.A.5.a).(2).(a)]
Lateral skull base approach to Click here to enter text.
the jugular fossa
[PR IV.A.5.a).(2).(a).(i)]
Middle cranial fossa
Click here to enter text.
craniotomy
[PR IV.A.5.a).(2).(a).(ii)]
Retrosigmoid approach to the Click here to enter text.
cerebellopontine angle
[PR IV.A.5.a).(2).(a).(iii)]
Translabyrinthine approach to Click here to enter text.
Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Assessment Method(s)
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Updated 8/2015
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Competency Area
Settings/Activities
the cerebellopontine angle
[PR IV.A.5.a).(2).(a).(iv)]
Medical and surgical
Click here to enter text.
management strategies, including
intracranial exposure, as well as
the postoperative care necessary
to treat congenital, inflammatory,
neoplastic, idiopathic, and
traumatic diseases of the petrous
apex, internal auditory canal,
cerebellopontine angle, cranial
nerves, and lateral skull base,
including the occipital bone,
temporal bone, craniovertebral
junction, and vascular neoplasms
of the lateral and posterior fossa
skull base
[PR IV.A.5.a).(2).(b)]
The habilitation and rehabilitation Click here to enter text.
of the vertiginous patient, and the
treatment of intracranial and
intratemporal facial nerve
disorders
[PR IV.A.5.a).(2).(c)]
Assessment Method(s)
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Medical Knowledge
Indicate the activities (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which
fellows will demonstrate knowledge in the following area. Also indicate the method(s) that will be used
to evaluate fellow knowledge.
Area of Knowledge
Neurotology to a level
appropriate for unsupervised
practice, as defined by the
required didactic curriculum
[PR IV.A.5.b).(1)]
Settings/Activities
Click here to enter text.
Assessment Method(s)
Click here to enter text.
Practice-based Learning and Improvement
1. Briefly describe one planned learning activity in which fellows engage to identify strengths,
deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set
learning and improvement goals; and identify and perform appropriate learning activities to achieve
self-identified goals (life-long learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)
Click here to enter text.
2. Briefly describe one planned quality improvement activity or project that will allow the fellow to
demonstrate an ability to analyze, improve, and change practice or patient care. Describe planning,
implementation, evaluation, and provisions of faculty member support and supervision that will
guide this process. [PR IV.A.5.c).(4)] (Limit response to 400 words)
Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 8/2015
Page 6 of 9
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3. Briefly describe how fellows will receive and incorporate formative evaluation feedback into daily
practice. (If a specific tool is used to evaluate these skills, have it available for review by the site
visitor.) [PR IV.A.5.c).(5)] (Limit response to 400 words)
Click here to enter text.
4. Briefly describe one example of a learning activity in which fellows engage to develop the skills
needed to use information technology to locate, appraise, and assimilate evidence from scientific
studies and apply it to their patients' health problems. [PR IV.A.5.c).(6)-(7)] (Limit response to 400
words)
The description should include:
 Locating information
 Using information technology
 Appraising information
 Assimilating evidence information (from scientific studies)
 Applying information to patient care
Click here to enter text.
5. Briefly describe how fellows will participate in the education of patients, families, students, and other
health professionals: [PR IV.A.5.c).(8)] (Limit your response to 400 words)
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Interpersonal and Communication Skills
1. Briefly describe one learning activity in which fellows develop competence in communicating
effectively with patients and families across a broad range of socioeconomic and cultural
backgrounds, and with physicians, other health professionals, and health-related agencies. [PR
IV.A.5.d).(1)-(2)] (Limit response to 400 words)
Click here to enter text.
2. Briefly describe one learning activity in which fellows develop their skills and habits to work
effectively as members or leaders of a health care team or other professional group. In the
example, identify the members of the team, responsibilities of the team members, and how team
members communicate to accomplish responsibilities. [PR IV.A.5.d).(3)] (Limit response to 400
words)
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3. Briefly describe how fellows will be provided with opportunities to act in a consultative role to other
physicians and health professionals. [PR IV.A.5.d).(4)] (Limit response to 400 words)
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4. Briefly describe how fellows will be provided with opportunities to maintain comprehensive, timely,
and legible medical records, if applicable. [PR IV.A.5.d).(5)] (Limit response to 400 words)
Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 8/2015
Page 7 of 9
Click here to enter text.
Professionalism
Briefly describe the learning activity(ies), other than lecture, by which fellows develop a commitment to
carrying out professional responsibilities and an adherence to ethical principles, including: compassion,
integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect
for patient privacy and autonomy; accountability to patients, society, and the profession; and sensitivity
and responsiveness to a diverse patient population, including diversity in gender, age, culture, race,
religion, disabilities, and sexual orientation. [PR IV.A.5.e).(1)-(5)] (Limit response to 400 words)
Click here to enter text.
Systems-based Practice
1. Describe the learning activity(ies) through which fellows achieve competence in the elements of
systems-based practice: working effectively in various health care delivery settings and systems,
coordinate patient care within the health care system; incorporating considerations of costcontainment and risk-benefit analysis in patient care; advocating for quality patient care and optimal
patient care systems; and working in interprofessional teams to enhance patient safety and care
quality. [PR IV.A.5.f).(1)-(5)] (Limit response to 400 words)
Click here to enter text.
2. Describe an activity that fulfills the requirement for experiential learning in identifying system errors
and implementing potential systems solutions. [PR IV.A.5.f).(6)] (Limit response to 400 words)
Click here to enter text.
Curriculum Organization and Fellow Experiences
1. How will the program ensure that fellows are provided with graduated responsibility for patients in
both inpatient and outpatient environments? [PR IV.A.6.a).(1)]
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2. Briefly describe how the program will ensure that fellows document, in the ACGME Case Log
System, their experiences as both assistant surgeon and surgeon in surgical procedures. [PR
IV.A.6.a).(3)]
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3. Briefly describe the planned experience in audiometric testing. [PR IV.A.6.a).(4)]
Click here to enter text.
4. Briefly describe the planned experiences in neurological surgery, neurology, neuropathology,
neuroradiology and, physical medicine and rehabilitation. [PR IV.A.6.a).(5)]
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Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 8/2015
Page 8 of 9
Fellows’ Scholarly Activities
1. Briefly describe how research methodology, epidemiology, statistical methods, experimental design
and manuscript preparation will be addressed in the curriculum. [PR IV.B.1.a)-b)]
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2. Briefly describe how fellows will be provided with protected time for the pursuit of scholarly activities
and research. [PR IV.B.3.a)]
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FELLOW DUTY HOURS IN THE LEARNING AND WORKING ENVIRONMENT
Clinical Responsibilities
1. Briefly describe the planned composition of the surgical teams. [PR VI.E.2.]
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2. Briefly describe how the program director will ensure the work of the caregiver team is assigned to
team members based on each fellow’s level of education, experience, and competence. [PR
VI.E.3.]
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Teamwork
1. Describe the planned composition of the interprofessional teams. [PR VI.F.2.]
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2. Describe how the program director will ensure fellows collaborate with surgical residents, and
especially with faculty, other physicians outside of their specialty, and non-traditional health care
providers, to best formulate treatment plans for an increasingly diverse patient population. [PR
VI.F.3.]
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3. Describe how the program director will ensure that fellows assume personal responsibility to
complete all tasks to which they are assigned (or which they voluntarily assume) in a timely fashion.
[PR VI.F.4.]
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Neurotology
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 8/2015
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