RCS visiting fellow: Myanmarese head and neck surgeon Tin Maung Win collaborating with ENTUK

The goal of this programme was to collaborate on audiological medicine in practice: preventive, curative, and rehabilitative aspects.

Location and period of the programme

The programme was carried out at four different UK institutions involved in the surgical treatment and rehabilitation of those with deafness, namely Gloucestershire Hospitals NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, De Montfort University, Mary Hare School from 21 March to Tuesday 4 April 2017.

Wednesday 22 March

On arrival to Heathrow Airport, our team went to Gloucestershire Royal Hospital where we met Dr. Robin Youngs, the organizer and coordinator of this programme, who later introduced us to Mrs Annie Marie Mitchell, Head of Hearing Services at the hospital. Mrs Mitchell acquainted us with the set-up of audiology rooms, sound treated rooms, hearing aid fitting rooms, balance and vestibular rooms. We also had a chance to see the free-field audiometry and play audiometry for children.

Thursday 23 March

We were introduced to the ABR (Audition Brainstem Response) when Mrs. Shikal undertook the procedure on a 5-year-old child with congenital CMV (Cytomegalovirus) infection. In the evening, our team got to view the brilliant performance of Dr. Mathew Clark, Consultant ENT surgeon in Gloucestershire Royal Hospital, in endoscopic middle ear surgery. He took part in two cases of endoscopic myringoplasty using perichondrium of tragal cartilage and one other case: endoscopic removal of cholesteatoma (acquired) and ossiculoplasty.

Friday 24 March

Mr. Chris Gordon gave us some documents and a short lecture on the detailed procedure of VNG (videonystagmography). Before doing the vestibular and balance test, the patient is required to answer the questionnaire and to send a complete record of his or her medical history to the audiologists. The professionals then review the record and conduct the test accurately.

Monday 27 March

Mr Duncan Jackman, Director of International Affairs at the Royal College of Surgeons of England, informed the participants of the programme about the RCS Travel Grant Award and discussed about the future plans. Our team then set forth to Leicester where we were warmly welcomed by Mr. Robert Frost, a consultant audiologist from De Montfort University, at the train station.

Tuesday 28 March 

At De Montfort University, Mr. Rakesh Patel, Associate Head of Allied Health Science, De Montfort University, delivered a presentation about the university: Audiology at DMU, the teaching methods utilized there to train the students and so on. After that, our Professor, Dr. Khin Hla Hla, gave a presentation regarding the current situations in our country from a medical professional point of view and we established an open discussion on three main issues:

(1) Upgrades on our audiology unit to international level in terms of human resources, audiology facility set-up and training.

(2) Student exchange programme (with De Montfort University, Leicester)

(3) Participation in the service to the school for the deaf in Tarmwe Township, Myanmar (under Ministry of Social Welfare) and applying the knowledge and experience that will be achieved after the visit to Mary Hare School for the deaf, in respective fields

In the afternoon, Mr Robert Frost explained about the newborn hearing screening and NHS screening guideline in the UK.

Wednesday 29 March

We paid a visit to the Hearing Services at Leicester Royal Infirmary and learnt about its hearing aid fitting, hearing aid repair and patient counseling. In the evening, we met Mr. William Brassington at Nottingham University Hospital. He described details of the Cochlear Implant Programme and showed us around the hospital including the Research Unitand the Ear Mould Lab.

Thursday 30 March

By train, we travelled to York to attend the ENTUK Spring Annual Meeting 2017 to which Professor Daw Khin Hla Hla was formally invited as guest of honour.

Monday 3 April

We explored the Mary Hare School at Newbury and came across the school's finest lecture rooms, study rooms, student accommodation, science laboratories, Arlington Arts Centre, dining room, swimming pool and Audiology department. Afterwards, we talked with the principal of the school about the future coordination between Mary Hare School and Yangon School for the deaf.

This visit benefited me a lot regarding my practice in Myanmar. We had the opportunity to observe diagnosis, treatment, education and rehabilitation of those with deafness. It also compelled me to develop middle ear surgery for those with deafness due to middle ear diseases such as cholesteatoma. It also inspired us with new ideas to establish balance clinics in our country.

I also witnessed concise yet effective lectures delivered in UK universities. Although it is impossible to transfer the teaching methods because of the difference in students' cultural backgrounds, I am motivated to establish novel teaching techniques based on this experience.

This visit also gave me insight into how a properly coordinated cochlear implant programme is conducted. We are now starting to put in place neonatal hearing screening and seeing how the UK universal hearing screening programme works is of great use to us.

During the two-week-long visit, we discussed the following points and issues with the UK professionals and gained priceless information and knowledge to take further actions and to push the plans forward:

(1) Upgrades on our Audiology unit to international level in terms of human resources, Audiology facility set-up and training.

(2) Student exchange programme (with De Montfort University, Leicester)

(3) Participation in the service to the school for the deaf in Tarmwe Township, Myanmar (under Ministry of Social Welfare) and applying the knowledge and experience achieved at Mary Hare School for the deaf in respective fields.

(4) Set-up of hearing aid fitting and ear mould lab.

(5) Recruitment of more human resources and establishment of Audiology courses such as diplomas to be opened and training abroad and Master programs.

Significant deafness affects around 10% of Myanmar's population (WHO survey) - approximately 6 million people. This visit helped me become aware of the need to develop Audiology concerning hearing and balance for best patient care.

(1) Human Resources

• to lead the unit with medical officers with Master degrees in Audiology is an urgent need;
• to set up various organizations with full strength for Audiology unit;
• to hire more audiometrists to carry out promotive, preventive, curative, rehabilitative activities in Audiology service; to open more Audiology courses (diplomas etc)

(2) Facilities

• facilities for Audiology training courses, hearing aid fitting and ear mould lab;
• support for MOHS needed for training opportunities, and organizations to set up financial support;
• collaboration at university level is also needed.

After the programme, it became clear to me that the development of surgical

services for the unfortunate with deafness is not just about the surgical procedure itself but

also has to be part of an integrated multi-disciplinary package of diagnosis, treatment and

rehabilitation. This programme was part of a long-term capacity building partnership aimed at

deepening an established link between the UK and Myanmar and I certainly believe that we

have fulfilled that objective.