Mediclinic surgeon performs first middle-ear surgery using 3D technology

Posted on 20 March 2019

Professor Mashudu Tshifularo from Mediclinic Medforum performed successful middle-ear surgery using 3D technology – the first procedure of its kind in the world.

A 40-year-old patient who had his middle ear damaged in a car accident may soon be able to hear again, thanks to innovative surgery using cutting-edge 3D-printing technology. The procedure involves replacing the damaged hammer, anvil, stirrup and the ossicles that make up the middle ear by transplanting tiny, 3D-printed titanium bones.

“This patient had suffered significant trauma,” explains Professor Mashudu Tshifularo, “and in fact had damaged all of the bones that make up the middle ear. Without them, he couldn’t hear. So we needed to perform what’s known as conductive hearing loss rehabilitation surgery.”

Typically, this surgery would involve a partial or singular prosthetic replacement or implant of the affected bones. “We’d look to connect the broken bones to another bone. But these bring a few problems: they’re not very efficient or very stable, and they have a tendency to fall away.”

Professor Tshifularo explains that he has been looking closely at this issue as part of his second PhD project. “I have been looking at this problem for ten years. But in the past two years, I started to focus on this new potential solution: can we use 3D printing to recreate the bones we need – down to the exact size, weight, function – to reconstruct a whole new, working middle ear system?”

In a breakthrough for ENT surgery in SA, Professor Tshifularo is able to say yes – he has successfully recreated and replaced a patient’s entire middle-ear system. He and his team performed the world-first surgery at the Steve Biko Academic Hospital in Pretoria, using titanium bones 3D-printed and provided by a local manufacturer, BunnyCorp.

Professor Tshifularo says this new surgery is not comparable to traditional surgery. Conductive hearing loss rehabilitation is one of the more complex ENT surgeries that can require up to 4 hours in theatre. Typically, a patient who has had his middle ear mechanism repaired by the traditional implant procedure will have to wait 4-6 weeks for the swelling to subside. “Sometimes we have to wait up to three months after implant surgery to confirm that the patient’s hearing is back to normal,” he says.

This new surgery makes the whole process easier and less painful for the patient, who is already out of hospital, a day or two after surgery.

This innovation is good news for anyone who may suffer from hearing problems – a significant part of the population. The South African Hearing Institute warns that our hearing ability naturally declines from the age of 30 or 40 – and that by age 80, more than half of us will suffer from some form of significant hearing loss. Hearing loss can also occur as a result of trauma, disease or infection, and may be inherited.

It is also good news for ENT surgeons, who have struggled to source the donated organs they need for transplant patients. Professor Tshifularo hopes it will also be good news for surgeons in other fields. “We’ve seen it used in orthopaedic and maxillofacial, even ophthalmology and cardiology surgery,” he says. “So why not ENT? My hope is that now we have arrived at this point, this will become the gold standard in this treatment, and that we will be able to embrace 3D printing in other ENT surgeries.”

Professor Tshifularo is an ENT specialist who practices at Mediclinic Medforum. He is also head of the Department of Otorhinolaryngology at the University of Pretoria, and leads the Steve Biko Robert Kerr Cochlear Implants Project – which provides cochlear implant surgery for patients from poor communities.

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