MSO-HNS NEWSLETTER MESSAGE FROM THE PRESIDENT HOSPITAL IPOH IN FOCUS Malaysian Society of Otorhinolaryngologists and Head & Neck Surgeons

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1 Malaysian Society of Otorhinolaryngologists and Head & Neck Surgeons March 2006 MSO-HNS NEWSLETTER CONTENTS Hospital Ipoh in Focus 1 The ASEAN Rhinology Society- The Past, The Present and The Future 3 Get Connected! Tissue engineering and stem cell research in Otolaryngology UKM 4 Universal Hearing Screening for Newborn -Are We Ready for it? 5 Cruise to The High Seas 6 2 nd Joint Malaysia - Singapore ENT Meeting th Asian Research Symposium On Rhinology Kuala Lumpur 1 st - 3 rd December The President Elect 11 Audiology And Vestibular Workshop 2006 and Otology Review 13 Research Activities in Local Institutions for Surgical Issues in Cochlear Implantation in Very Young Children and Children with Inner Ear abnormalities 16 MSO-HNS Activities Health Camp at Pulau Redang. Thyroid Symposium for ENT Surgeons 18 Editorial Team Yoke-Yeow Yap (Editor-in-chief) Philip Rajan (Asst. Editor) Jeevanan Jahendran (Asst. Editor) Executive Committee President Dr. Siti Sabzah Hashim President Elect Dato Dr. Gurdeep Singh Mann Hon Secretary Dr. Kuljit Singh Hon Treasurer Dr. Jeevanan Jahendran Committee Members Dr. Harvinder Singh Dr. Baharudin Abdullah Dr. K S Sathananthar Dr. Avatar Singh Dr. Zulkifli Mohd Yusof Col. Dr. Zulkaflay Abdul Rahman Dr. Amran Mohamad HOSPITAL IPOH IN FOCUS has been an eventful year for the department of ENT Hospital Ipoh headed by Dato Dr. Gurdeep Singh Mann. There are currently four specialists in the department; Dr.Chong, Dr. Harvinder, Dr. Rosalind and Dr.Philip. Despite the busy clinics and surgical workload, the surgeons have successfully organized and carried out various community and educational projects. The first activity of the year, was the 2 nd Perak Balance Disorder Workshop held in Hospital Taiping targeted on educating General Practitioners on the etiology as well as management of vertigo. This was followed by a one day seminar and workshop titled ENT UPDATE FOR PRIMARY CARE PHYSICIANS & GP S in Ipoh. Prof. Dr Gopala Krishnan and Prof. Dr Raman from Universiti Malaya Medical Center were amongst some of A NOTE FROM THE EDITOR This is the first issue of the MSO- HNS newsletter. The aim of the newsletter is to keep the community of otolaryngologists in our country MESSAGE FROM THE PRESIDENT It gives me great pleasure to announce and present to you our 1 st Newsletter of the MSO-HNS. I must congratulate the editors under the leadership of Dr. Jeevanan and his team for this great effort. The editorial board and the EXCO members would like to share with you current news, announcements and issues relevant to the Malaysian ORL fraternity. It is our hope that L ñ R: Dr Jennifer, Dr Amanjit, Dr Harvinder, Dr Rosalind, Mr Solomon, Dr Mallina the distinguished invited faculty. To enhance the knowledge and surgical skills of the surgeons, world renowned rhinologist, Dr. Dhirambhir Singh Sethi from Singapore was invited to give a live demonstration on challenging rhinology cases. In December, informed regarding events concerning the profession. It will also be a platform where the members of the Society can share their views. With the growing number of members in this Society it is hoped that this newsletter will serve as a vehicle to disseminate information on every member of the Society will come forward to contribute to our newsletter to sustain its viability for purpose of sharing tickling issues, knowledge and fascinating stories in the various aspects of our ORL life. Happy Reading and Bacalah.. Dr. Siti Sabzah Mohd Hashim President MSO-HNS 2005/2006. Associate Professor Cesar Villafuerte from the Philippines shared his expertise on rhinoplasty with doctors in Ipoh.The trainees were not exempt from the activities, having organized a session on ENT emergencies continued on page 3 the activities of ENT surgeons in various parts of the country. Hopefully this will foster greater collaboration in research/ teaching as well as advancement of the field of otorhinolaryngology as a whole. Dr. Yap Yoke Yeow

2 Page 3 continued from page 1 for medical officers and paramedics on September 5th. In order to reach out to the public, an ENT screening clinic was held at SRK Buntong to identify those with common ENT diseases. Two public forums were held to educate the public on ENT problems. In August, the National Hearing Awareness roadshow was jointly organized with the Malaysian Association of Speech Language and Hearing (MASH) and Siemens Hearing Solutions. On September 24th, the department was invited by the Cancerlink Society of Perak to speak on common ENT malignancies. In addition to the above, various lectures were given to nurses, medical students and to the doctors via the various CME activities. Our doctors also found time to attend various courses and conferences both locally and internationally. Two doctors from the department, Dr.Rosalind Simon and Dr. Ng Teck Siang were actively involved in the National Census on hearing disorders. Our department staff participated actively in various research activities. Numerous studies and case reports have been published or are being reviewed. Despite a busy schedule we continue to support our fraternity with active participation in MSO- HNS/MMA/SCHOMOS. THE ASEAN RHINOLOGY SOCIETY THE PAST, THE PRESENT AND THE FUTURE Dr Harvinder Singh The idea to form a rhinology group amongst the members of Asean ORL Federation that have a similar interest in rhinology became an issue since the 5 th Asean ORL Congress in Jakarta in The interest became more evident during the Advances in Rhinology Meeting in Manila and the Advanced Sinus Symposium in Philadelphia. It became a reality during the 12 th International Symposium on Infection and Allergy of the Nose (ISIAN) meeting in Seoul, Korea, October ASEAN RHINOLOGY GROUP On October 10 th, 1993, an ASEAN RHINOLOGY GROUP (ARG) was formed during the above 12 th ISIAN Meeting. This group was supported by the ASEAN ORL Federation to promote the objectives of the Federation in the field of Rhinology. The ARG was also recognized and became a board member of the International Rhinology Society (IRS). A temporary secretariat was formed with Dr Chaweewan Bunnag and Dr Kanit Muntarbborn, from Thailand acting as coordinators. Under Dr Chaweewan s leadership, a book on Asean Rhinology was published, containing the papers of Asean and European rhinologists. THE SOCIETY OF ASEAN RHINOLOGIST (THE STAR) In Manila, Philippines, during the ISIAN Congress, October 7 th 1998, the name was changed to The Society of ASEAN Rhinologist (STAR). This Society was chaired by Dr Gil Vincente from Philippines, Dr. Damayanti as the secretary, Dr. Benjamin Campomanes as the Treasurer. THE ASEAN RHINOLOGY SOCIETY (ARS) In Brunei, during the 10 th Asean ORL-HNS Congress (2003), the leadership changed hands to Prof Dato B.S Gendeh and Dr KS Sathananthar as Secretary General. Their task was to register this society and make it official. On February 25 th, 2004 during the 10 th Asia-Oceania meeting in Kuala Lumpur, Malaysia the name STAR changed to the ASEAN RHINOLOGY SOCIETY (ARS). Office Bearers of the ARS President: Prof Dato Dr BS Gendeh President Elect: Dr Trimartani Kunto (Indonesia) Secretary General: Dr KS Sathananthar Deputy Sec-Gen I: Dr Harvinder Singh Deputy Sec-Gen II: Dr Retno S Wardani (Indonesia) Treasurer General: Dr Kuljit Singh Deputy Treasurer General: Dr Usha Devi Arumainathan The ASEAN Rhinology Society was registered in Kuantan, Pahang, Malaysia on 8 th December, 2004 by Dr KS Sathananthar, Dr Harvinder Singh and Dr Maria Ithaya Rasan. The logo of this society was specifically designed by Dr Maria Ithaya Rasan. This society was finally launched and accepted in Bali, Indonesia on 24 th. August, 2005 in conjunction with the 11th Asean ORL-HNS Congress

3 Page 4 GET CONNECTED! The computer is next to my table, access is freely provided by the University and I check my 5 times a day, just as religiously as the Muslim prayers. Living in the age of Information and Communication Technology (ICT) Everyday in every mainstream newspaper there is a full-page advertisement by the mobile telcos, each one outdoing, out pricing the other. Well, this is indeed the age of ICT. One remains connected even when one is on a holiday overseas. There is ample ways to remain in touch with your loved ones. And its not that costly, provided the conversation and connection is done briefly and to the point. Whenever we attend conferences abroad, we look for the drug sponsored internet booths and look up the local papers and send our s. we just cannot live without news from home. Yet, when it comes to disseminating news within our Society, we are way back in the Dark Ages. Maybe the Stone Age even. The Exco tries its best to keep everyone informed of all activities. The most significant step over the years is to have a permanent secretariat at the Academy of Medicine. With Ms Kong at the helm, much effort has been put in to update the mailing list. Yet, when our members move, they never inform the Secretariat. How in the world can he get any notices. Man has not evolved to develop mental telepathy! Which brings me to the next point. We all should get connected. I mean let s get online. Let us tap into the power of the Internet. We have the Yahoo e-group. And those on this e-group are constantly updated. Dr. Suzina has been yelling away the Annual Scientific Meeting in Kota Baru due on the 19 th of March. Dr Kuljit has been announcing away the Malaysia Singapore Meeting due on the 25 th of March. If you are not connected, you are out of the circle of my friends. Ok, not everyone is as lucky as me. The computer is next to my table, access is freely provided by the University and I check my 5 times a day, just as religiously as the Muslim prayers. Even without the power of the Net, all Society Members must instinctively know there are Annual events that MUST take place. Like the Annual Scientific meeting, the Annual Health Camp, the Annual Mal Sing meeting. Just pick up the phone and call the Exco. Guys, the bottom line is this is OUR Society, if we don t get interested in its activities, then we don t belong. So, get in touch, keep in touch. Prof. Abdullah Sani The Immediate Past President of MSO-HNS TISSUE ENGINEERING AND STEM CELL RESEARCH IN OTOLARYNGOLOGY UKM Dr Aminuddin Saim Ampang Putri Medical Centre Tissue engineering is a field of research with interdisciplinary cooperation between clinicians, cell biologists, and materials research scientists. In otorhinolaryngology, head and neck surgery, tissue engineering techniques opens up new ways for cell and tissue repair in this medical field. In Malaysia tissue engineering began in the year 2000 with the establishment of a tissue engineering laboratory in HUKM pioneered by Prof Madya Dr Ruszymah Idrus and myself. It began with autologous auricular cartilage and septal cartilage for reconstructive surgery. In the year 2001, we successfully filed a patented new technique in culturing human chondrocytes. Following this, work began on reconstructing the trachea and advancements were made in an animal model (mouse) and presently work is being continued on larger animals (sheep). Before long we hope to start on human clinical trials. The laboratory has successfully filed another patented technique in producing an absorbable biomaterial, Human Plasma Derivative (HPD) which is useful in producing injectable cartilage. A clinical trial on orthopedic knee surgery was done successfully late last year. In otolaryngology, injectable cartilage has huge potential especially in disorders of the larynx and pharynx. Culturing respiratory epithelium was a great challenge to the team, but we have successfully cultured human and sheep respiratory epithelium harvested from nasal turbinates since A geneexpression study of respiratory epithelium has been done to observe the growth of these cells so as to understand the process of cell differentiation in the hope that ultimately we can line engineered cartilage with respiratory epithelium in tissueengineered trachea. Work on engineered bone has been established since 2003, however most of it has been applied to orthopedic surgery like spinal continued on page 6

4 Page 5 UNIVERSAL HEARING SCREENING FOR NEWBORNS ARE WE READY FOR IT? Dr Philip Rajan Hospital Ipoh Congenital deafness is estimated to affect 1-3 per 1000 livebirths, making it the most common birth disorder. In Malaysia, selective or high-risk screening for newborns is currently practiced in most hospitals. This only screens those who are at a higher risk of having hearing impairment eg neonatal jaundice, meningitis and syndromic children or those in neonatal intensive care units. It is estimated that up to 50% of newborns with hearing impairment remain undetected with current hearing screening programmes. Universal Newborn Hearing Screening (UNHS) screens all newborns with the aim of identifying all newborns with hearing impairment particularly those with non-syndromic congenital hearing loss. Early Detection Research data has shown UNHS increases the detection of newborns with hearing loss. In a controlled trial of 8 years in the United Kingdom, UNHS increased the detection of permanent childhood impairment before the age of 6 months from 31% to 74%. Early Intervention Early detection of hearing loss is important for proper development of speech, language and academic achievement. Studies have shown that earlier intervention leads to better vocabulary and verbal reasoning skills. Yoshinaga-Itano et al (2001) in a comparison study between hospitals that practiced universal newborn hearing screening and those without found children born in hospitals with hearing screens had better language outcomes. Screening Methods AABR (automated auditory brainstem response) and TEOAE Hearing Impaired Teen to Study Electronic Engineering (The Star, 6th Jan 2006) (transient evoked otoacoustic emission). TEOAE s are simple, non-invasive tests and do not require skilled personnel. In Malaysia, a study by Abdullah A et al (2005) from HUKM, TEOAE was found to be sensitive, close to 100% but moderately specific. Problems Encountered Implementation of newborn hearing screening programmes has been proven to improve earlier detection of hearing impairment and intervention. However studies from HUKM and HUSM (Mukari SZ et al, 2005; Khairi MD et al 2005; Abdullah A et al, 2006) have shown that complete success has been hampered by a number of factors which include poor follow-up, parental compliance, inadequate training of healthcare professionals, lack of public awareness on childhood hearing loss and accessibility of services. Intervention-Hearing Aids/ Cochlear Implants Once hearing impairment is identified, intervention, usually in the form of a hearing-aid, is given. Cochlear implants are reserved for those with profound hearing loss. Ideally these children should be implanted before two years of age. Do we need UNHS? Although the exact prevalence of non-syndromic hearing loss or hearing loss of unknown causes in our population is not known, we do know it exists based on studies from HUKM and HUSM (25% of 51 and 20% of 165), from two studies among children from schools for the deaf (Ruszymah BHI et al, 2005; Elango S, 1993). From the HUKM pilot-study of 4437 babies, UNHS succeeded in reducing the average age of diagnosing hearing impairment to 3.56 months from 48 months. Do we have adequate services for intervention? Audiological, speech and ENT services and intervention are available in all state hospitals. In the government sector, highly specialized surgical intervention such as cochlear implants is however currently only available at our local universities. We definitely need more trained otologists and additional audiologists and speech therapists in anticipation of the earlier and increased detection of the hearing impaired. A successful outcome is dependant on a multidisciplinary cooperation involving ENT, audiological, paediatric, maternity and public health services. As with the introduction of any new program, teething problems will be encountered initially, but with time, experience and regular audits, it will mature into an efficient and rewarding service both for patients and health care providers. For more information on the references, kindly contact the author at: prajan333@yahoo.com Universal Newborn Hearing Screening (UNHS) screens all newborns with the aim of identifying all newborns with hearing impairment particularly those with non-syndromic congenital hearing loss.

5 Page 6 continued from page 4 fusion and long bone regenesis. Work with engineered skin has shown the best promise so far. In humans it has been applied in patients with extensive burns and in Otology it was used following mastoid surgery to line the cavity. The results were very encouraging and hopefully we can extend its use to other areas as well. Human adult stem cell has been used in dedifferentiating cells to cartilage, bone and hopefully to all cell lines. More research is being done with regards to stem cell at the present time, and its impact on clinical applications in the future if successful is mindboggling. With our humble beginnings in the Otolaryngology Department in HUKM 6 years ago, we have come of age and currently hold seven patents of which one is an international patent. We have produced 19 international papers, 30 local papers and have won several awards from Geneva, the Ministry of Higher Education and the Ministry of Science and Technology. With continuous support from the government, the team will continue its research in tissue engineering and stem cell work and hopefully became a center of reference in this particular field. For those interested to know more about the laboratory and its activities please log on to our website: my/tissueengineering/index.htm CRUISE TO THE HIGH SEAS Dr Harvinder Singh Committee Member MSO-HNS Kampung Kuantan is famous for its fireflies. It is said that there are only two places in the world that hold fireflies, the other place being the Amazonian jungle! The Malaysian Society of Otorhinolaryngology Head & Neck Surgeons (MSO-HNS) had it s 6 th Annual ENT Camp in Kampung Raja Musa, Kuala Selangor on 15 th January, The Society managed to assemble 17 ENT Surgeons throughout the country for this noble cause. The team assembled in Kuala Selangor the night before to witness the miracle and mystery of the kelip-kelip in Kampung Kuantan. ìdo we look seasick to you?íí Kampung Kuantan is famous for its fireflies. It is said that there are only two places in the world that hold fireflies, the other place being the Amazonian jungle! Firefly is a type of insect from the beetle family. The Pterotype tener species are the largest species found here. The tail of the fireflies produces light. Each light flashed by each insect is produced at an accurate interval of 3 seconds! Imagine watching thousands of fireflies flashing their lights at an accurate rhythm in sync with each other. On 15 th January, the health camp was officiated by YB Dato Dr Lim Thuang Seng, Selangor State Exco. The President of MSO- HNS, Prof. Dr Abdullah Sani from University Kebangsaan Malaysia (UKM), welcomed all the dignitaries, ENT Surgeons and the local kampong folks to this camp. A total number of 200 rural folks took full opportunity to get free ENT examination. Besides getting the ear, nose & throat examined, there was also blood pressure, sugar and cholesterol monitoring done. The camp eased of at noon and the team of ENT Surgeons moved on to the next agenda, that was a tour of the Northport. This tour lasted for an hour after which all raced to the Westport to board the Superstar Gemini for the cruise to the high seas!we departed Westport at 8pm, and soon everybody was exploring the ship. Lots of delicious and sumptuous food was available on board. Entertainment in the form of live shows catered for both adults and children alike. Once the boat was in international waters, the casino was open to legal patrons till the wee hours in the morning. To end the cruise, the view of the sunrise was not to be missed the next morning. We were back at 10 am on Sunday and it was time to say goodbye. Till we meet again next year, Bon Voyage!!

6 Page 8 2 nd Joint Malaysia - Singapore ENT Meeting 2006 The climax of the meeting was a free paper presentation by the postgraduate students of the universities of both countries. The second annual meeting was held on the 25 th of March 2006 at the National University Hospital, Singapore. It was a half day event encompassing lectures from surgeons in both countries. The climax of the meeting was a free paper presentation session by the postgraduate students of the universities of both countries. A total of six presentations were made and the winner was Dr. Annette Ang of Singapore with her topic titled Nasal Polyposis An Immunohistochemical Study of Cell Cycle Regulator Proteins. Two speakers from Malaysia won the second and third prizes. Dr. Marina of UKM receiving her second prize for her work on Botox injection for drooling patients Dr. Tan Ing Ping of UM receiving the third prize for his work on Worm Infestation and its relationship to Allergic Rhinitis

7 Page th ASIAN RESEARCH SYMPOSIUM ON RHINOLOGY KUALA LUMPUR 1 st -3 rd DECEMBER 2005 A research symposium on rhinology was held for the first time in Malaysia with almost 300 participating delegates from countries in Asia and the Middle East. This is the biggest rhinology event ever held in our country and the theme of the event was Rhinology: New Frontiers and Challenges. Our scientific chairman, Prof Dr Abdullah Sani put up an interesting programme consisting of 12 symposias, 5 plenaries and 15 instructional courses. Seven pre and post congress workshops were conducted successfully by various coordinators in UKM and UMMC. A wide range of ENT products were exhibited at various booths showcasing the latest technology in various fields including image guided surgery, microscopes, telescopes and the latest drugs in the market. The event was officiated by Yang Berhormat Dato Dr Chua Soi Lek, Minister of Health Malaysia and the grand dinner was graced by His Majesty Seri Paduka Baginda Yang di-pertuan Agong and Her Majesty Raja Permaisuri Agong. A varied group of speakers from all over the world were invited to attend this conference. Among the more prominent ones were Paul van Cauwenberg from Belgium, Reda Kamel from Egypt, MV Kirtane from India and Ricardo Carrau and Bruce Gordon from the US. Not forgetting our friends from across the Causeway, Dr. Sethi, Prof Siow Jin-Keat, Prof Wang De-Yun, Abhilash Balakrishnan and Kenny Pang among others for their contribution. Local participation was truly encouraging, many thanks for the efforts of the local faculty who made this congress truly successful. A research symposium on rhinology was held for the first time in Malaysia with almost 300 participating delegates from countries in Asia and the Middle East.. Things that will be long cherished by the foreign delegates, was the unforgettable experience of having the King and Queen gracing the banquet dinner. The icing on the cake for the delegates was the invitation to the palace the following day where they had high tea together with Her Majesty. Yang Berhormat Datoí Dr. Chua Soi Lek, Minister of Health Malaysia, chief guest of the opening ceremony, seen here together with the Organizing Committee To sum it up, bravo to the Organizing Committee for making ARSR 2005 a truly successful congress and we look forward to the next big rhinology event; ISIAN The Organizing Committee and the Chairman Prof Datoí Dr. BS Gendeh together with His Majesty Seri Paduka Baginda Yang Di-Pertuan Agong and Her Majesty Raja Permaisuri Agong