Department of Otorhinolaryn gology

Otolaryngology ServicesAudio-vestibular Services

Speech Therapy ServicesEducation for Hearing Impaired

TWENTY FIVE YEARS OF ORL SERVICES

DEPARTMENT OF OTORHINOLARYNGOLOGY

RIPAS Hospital, Bandar Seri Begawan

Founded in 1984 and now located on the 3rd floor of the specialist Block, RIPAS hospital, Department of Otorhinolaryngology has been providing modern high quality services based on recent trends and advancements to both adult and pediatric patients in Borneo region. This department is endeavoring to evolve into a Centre of Excellence in the whole region. These services are provided through its four main units:

Team of very well trained surgeons and paramedical staff provide excellent ORL care following internationally approved strict protocols which are constantly upgraded. Department is well equipped and most modern examination, investigative and operative equipments are available.

Our mission in ORL department is to provide most modern high quality services based on recent trends and advancements, advocating evidence based medicine and patient’s choice, and to provide training for medical, paramedical, and other healthcare personnel.

Our objectives are:

1. Complete patient care system: diagnosis, and management of ORL problems.

2. Full audiology services : audio-vestibular tests, rehabilitation, hearing aids fitting

3. Speech therapy services: and therapy for swallowing disorders.

4. Community care: including care for deaf children and their rehabilitation.

5. Prevention of all the preventable ORL conditions and

6. Training of medical and paramedical staff.

Our goal is to accomplish the stated ‘mission’ and the defined ‘objectives’

The Present The following services are offered by ORL department.

Otorhinolaryngology services:

Daily ORL consultation clinics and special clinics like, JCC, vertigo clinic, sleep clinic.In-patients are managed with care and compassion in ward 11, ward 10, ward 2 and 1. 24 hour Emergency Services are provided through two tier system.

Surgery - the ORL unit deals with:

o Surgery for chronic ear infections (mastoidectomy)

o Surgery for hearing impairment (tympanoplasty, ossiculoplasty, stapes surgery

o Endoscopic nasal & sinus surgery (FESS); Endoscopic DCR

o Microlaryngeal and phonosurgery

o Adult & pediatric airway management

o Surgery for thyroid, parathyroid glands

o Surgery for head & Neck neoplasm.

o Surgery for head & Neck infections.

o Voice restoration after laryngectomy

o Surgery for benign & malignant diseases of nose and sinuses

o Surgery for snoring and sleep disorders

o Combined procedures with Neurosurgery / MFS

Neuro-otology ServiceSpeech Therapy Services Educational for the Hearing Impaired

These services are provided with competent staff using latest and most modern equipments. Separate report is attached for these services.

Work load chart: 1984 till April 2009

The PastHistory of Services development:

ENT Department was non-existent in Brunei Darussalam before 1982 and all the problems related to ENT conditions were treated either by general surgeons.

1984 Proper ENT unit with limited facilities was established. There were three ENT operation sessions per week, one and half day ENT outpatient clinic at RIPAS hospital and one day ENT outpatient clinic at Kuala Belait hospital.

1986: Facilities consisted of proper audiology facilities, microsurgery of ear and larynx, nasal surgery, reconstructive surgical procedures and all types of head & neck surgeries with basic ENT diagnostic and therapeutic facilities. ENT specialist coverage with the basic audiological services was provided on weekly basis at SSB hospital, Kuala Belait.

1990 Two ENT surgeon went for training in newer and popular ‘functional endoscopic sinus surgery’ and equipment for it were procured.

1994 Audio-vestibular investigative facilities were upgraded with the addition of Electronystagmography, Cranio-corpography, Evoked response audiometry, Otoacoustic emission system, Balance Master set and Myoton Electric Stimulation set.

1995 – 1998 Proposals were submitted to Ministry of Health to start Cochlear Implant surgery in Brunei. One surgeon and one audiologist from the department went to Australia to attend Cochlear Implant Training. New sophisticated operating microscope was purchased.

1999- 2000 Department of Otorhinolaryngology was relocated to its new premises on the third floor of Specialist building and all ORL services were provided at one place. .Three new ENT diagnostic systems, examination microscope were purchased; Walk-in clinics were abolished and appointment system was re-introduced.

2001-2002 Cochlear Implant surgery was developed. First Cochlear Implant surgery was performed with the help of Professor Lokman from UKM, Malaysia. This year is also important because visit of Professor Suchitra from Thailand, Professor Suzuki from Japan and Professor Allan Kerr from Belfast.

2003 – 2005 FESS surgery set up was upgraded with the purchase of new endoscopy system and Xomed XPS 2000 power tool system. .Three doctors went to attend advance FESS surgical workshop, otology update conference was conducted by Professor Allen Kerr..

2006 – April 2009 successful 1st International FESS workshop was conducted, sleep medicine was introduced. First sleep laboratory was established.

History of manpower development

1984 Dr. Joseph Lim, specialist; Datin Lim - audiometrician and one Speech therapist

1985 Dr. P. K. Garg joined as Senior Medical Officer. ENT unit now had one specialist,one SMO, one audiologists and one speech therapist.

1989 Dr. Stephen Chellaya joined as medical officer and Mr Anthony Tan as audiologist. 1990 Dr. Soe Tin joined as specialist; Miss Lily Khoo joined as Teacher for Deaf; MissWati Bujang joined as Speech Therapist. ENT unit had two specialists, one SMO, one MO,two audiologists, one SLT and one teacher for deaf.

1991 Dr.Harjeet Singh joined as audiologist, Dato Joseph Lim retired and Dr. Soe Tin

was appointed as Head of ENT. Mr. Tan left at the end of his contract.

1994 Dr. A.C. Gupta and Dr Vasanthan joined as medical officer, Miss Jacqueline Ronald

joined as speech therapist;. Datin Lim retired. Mr. Tan rejoined as audiologist. ENT dept now

consisted of one specialist, one SMO, three medical officers, two audiologist three SLT and

one teacher for hearing impaired.

1995 Dr. Ved Vrat joined as medical officer; Dr. Harjeet Singh audiologist left Brunei Darussalam; Miss Jacqueline Ronald speech therapist resigned from the services.

1997 Dr. Tiong joined as specialist and left in 1991 at the end of his contract.

1998 Dr. Soe Tin retired and Dr. P.K. Garg was appointed as head of the ENT department.

1999 Dr. Nayan Parekh and Dr Zulkarnain joined the department as specialist. Dr. Vijayanand joined as senior medical Officer, Dr. Dk. Norsuhazenah joined as medical officer; Mr. Tan, audiologist left Brunei at the end of his contract.

2001 Dr. Hjh Susalnoor joined as medical officer. Dr. Suhail Mansoor joined as locum medical officer. Mr. Vijayanand resigned. Dr. Vasanthan left for New Zealand.

2003 Dr. Gowthman joined as medical officer; Dr. Hjh Susalnoor was promoted as SMO.

2004 Dr. Sara Nanin joined as medical officer.

2006 Dr. Zulkarnain left to start his own practice.

2007 Dr. Ved Vrat was promoted as SMO and Dr. Sohail Mansoor as acting SMO. In 2007 Dr. Sharma joined as specialist and left in 2009.

2008 Dr. Pg Siti Rafida joined as senior medical officer; Dr. Ranjit Peter and Dr. Helin joined as medical officers. In August 2008, Dr. Helin was promoted as acting senior medical.

2009 Dr. Fakrudeen joined as medical officer in April and was promoted to acting senior medical post on May, 2009.

Achievements:From a very humble beginning, ORL department has developed in to one of the finest department. New services have been started and others have been upgraded

1. Cochlear Implant center was established in 2001 and three cochlear implants were performed in Brunei Darussalam..

2. Functional endoscopic sinus surgery introduced in 1995 has been developed in thedepartment to very high degree of sophistication.

3. Ultrasonic Harmonic scalpel is in use for past 4 year for surgeries of oropharynx. 4. Neuro-Otology – induction of sophisticated equipments like video-nystegmography. 5. Dedicated Voice Clinic and Dysphagia Problem Clinic are conducted regularly.6. Sleep disorders & snoring medicine has developed according to our expectations. 7. Temporal bone laboratory has been started for the benefit of trainee doctors.8. Seminars, workshops and conferences are conducted regularly. 10th Asean – ORL

conference in 2003. Other workshops were in 1997, 2001, 2005, 2006, 2007 & 2008.9. Continuing Medical Education program: is regularly conducted in department.

Projected development in next five years:

1. Neuro-Otology Services - Vertigo Clinic: will be developed further to bring them to International standards in next five years. 2. Cochlear implant program is now not operational due to lack of manpower and, the present implants needs to be upgraded. All efforts will be made to restart it.

3. Dedicated Voice Clinic and Dysphagia Problem Clinic: frequency of these clinics is increased to once in a week and newer and better diagnostic tools will be procured. 4. Universal Neonatal Screening program: plans are under way to start ‘Universal Neonatal screening program’ where every new born baby will have his or her hearing assessment during the first few days of birth. 5. Laser application in surgical ENT practice6. ORL Allergy Services7. Bone Anchored Hearing Aids (BAHA)8. Regular major international seminars in ENT & Head & Neck surgery9. Setting up of multi-media computer-assisted documentation center for ENT10. Extended audiology services and speech Therapy services11. Establish and develop more areas of sub-specialties in the department

12. Develop fully functional complete ENT subunits at district hospitals levels 13. Develop full audio-vestibular facilities at district hospital level14. Develop full Speech Therapy facilities at district hospital level.15. Improved rehabilitation program for hearing impaired 16. Updates in Cochlear Implants - Hi-Resolution Bionic Ear System in next 5 years.

Human resource development:

To provide proper care to our patients and to upgrade our services, adequate manpower is an absolute necessity. We aim to project our manpower requirement in a scientific way and let the Ministry of Health know our needs and requirement through various forms.

Present Strength ( i n t he yea r Apr i l 2009 )

Position Strength On-duty Vacancy

1. Specialist ENT Surgeon 3 2 1Clinical Specialist (ENT) 1 1 0

2. Senior Medical Officer 2 3 03. Medical Officer 6 8 04. Audiometrist (Audiologist) 3 3 05. Speech Therapist 5 5 06. Teacher for Hearing impaired 2 2 27. Nursing Staff 10 9 18. Clinic Attendant 3 3 09. Am’ah 4 2 210. Clerk 1 0 111. Record Assistant/Receptionist 2 2 0

Projected manpower requirement in five years:

Projected manpower requirement is based on the following:

a) Better and extended servicesb) Weekly ORL specialist services at Tutong hospital. and Kuala Belait hospital.c) Work load in Audiology clinics and Speech Therapy clinic has increased. d) In the next 5-10 years, many new services will be started.e) Increase of population in next five years should be taken in account.

Considering above factors, a conservative estimate for ENT doctors in ORL Department will be as follows:

YEAR 2010 YEAR 2015

Specialists 6 (5 RIPAS, 1 KB) 8 (6 RIPAS, 1 KB, 1 Tutong)

SMOs 6 (4 RIPAS, 1 KB, 1 Tutong) 8 (6 RIPAS, 1 KB, 1 Tutong)

MOs 10 (8 RIPAS, 1 KB, 1 Tutong) 15 (12 RIPAS, 2KB, 1 Tutong)