Stories from the Road

Gregory J. Basura, MD, PhD, Chair AAO-HNSF Humanitarian Efforts Committee Chair, with personal reflection from Erasmas Muganda, MBChB, FCORL(SA), and commentary from Tashneem Harris, MBChB, FCORL(SA)

Gregory J. Basura, MD, PhDOtologic medical and surgical care in low-resource areas of the world are typically identified as a top priority in humanitarian outreach. The growing population in places like Africa presents unique challenges to identify and manage increasing levels of hearing loss and chronic ear disease including cholesteatoma. Dedicated otologic medical and surgical training is a priority to meet the population’s needs. Many humanitarian outreach programs in Africa target otologic needs within the country; however, otologic training is unfortunately often constrained by a lack of otologic equipment and qualified instructors with limited time to sufficiently train African physicians and their trainees.

In March 2022 the first dedicated otologic surgical training fellowship began at the University of Cape Town (UCT) in Cape Town, South Africa. Under the direction of Tashneem Harris, MBChB, FCORL(SA), fellowship director and AAO-HNSF 2023 Nikhil J. Bhatt, MD International Humanitarian Award recipient, Erasmus Muganda, MBChB, FCORL(SA), from Zimbabwe, spent one year at UCT expanding his otologic surgical skill set and graduated in March 2023 as the first official otology fellow on the continent of Africa. Dr. Muganda has since returned to Zimbabwe after the one-year dedicated otology fellowship to serve his patients and to expand otologic training for his otolaryngology residents.

During the one-year fellowship, Dr. Muganda spent his time in the operating theater with Dr. Harris learning and performing a broad scope of otologic surgeries, including tympanoplasty, stapedectomy, ossicular chain reconstruction, canal wall up and canal wall down tympanomastoidectomy, and placement of cochlear implants.

He also practiced his surgical skills in the dedicated temporal bone dissection labs and participated in weekly virtual lectures with me through a cooperative that also started in March 2022 and has been ongoing every week since.

Location of University of Cape Town Otology Fellowship in South Africa. Visit the AAO-HNSF Humanitarian Efforts map for more information at https://www.entnet.org/get-involved/humanitarian-efforts/map/.

Location and Need

Hearing loss and ear disease are quite common in low-resource areas as they are throughout the world. Dr. Harris and Dr. Muganda regularly see perforated ear drums and chronic otitis media with accompanying skin cysts, known as cholesteatomas, that require surgical care. Moreover, skull base fractures from traumas can lead to inner ear and mechanical hearing loss as well as facial nerve injuries and cerebrospinal fluid leaks. These surgical problems require a fundamental understanding of the temporal bone and a dedicated level of surgical training to manage.

From a Passion to the First Otology Fellow in Africa

Erasmas Muganda, MBChB, FCORL(SA)

Erasmas Muganda, MBChB, FCORL(SA), Muganda, ZimbabweEarly on in residency, I wanted to dedicate myself to otology. With limited opportunities in Zimbabwe, I had the fortunate opportunity to visit Stanford University as a resident and participate in an observership under Nikolas H. Blevins, MD. That experience solidified my passion for otology. After residency, I went to Yonsei University in South Korea, for a mini fellowship in otology in 2020. In 2021 during MED-EL’s visit to Zimbabwe, I mentioned that I wanted to participate in a formal otologic surgical fellowship. Thereafter, conversations with Johan J. Fagan, MD,  professor and chair of otolaryngology at the UCT, and Dr. Harris, otologist at UCT, occurred, and a partnership with MED-EL led to the first dedicated otologic surgical fellowship in Africa. I was selected as this first fellow.

When I received the formal invitation to be the first otology fellow trained by Dr. Harris in South Africa, I jumped at the opportunity and started preparing the necessary immigration paperwork. I was glad I completed the fellowship—it was intense, one-on-one, patient-centered, practical training. I gained significant practical experience in the operating room as I was allowed to perform many of the operations myself. Moreover, I would complement my operating room experiences with regular and fully dedicated temporal bone dissection lab sessions.

Dr. Harris would supervise me in the lab herself during the weekends and in the operating room. I also had the opportunity to work with Gregory J. Basura, MD, PhD, who would visit UCT and specifically venture out to teach me and help me in the temporal bone lab dissections. In addition, he conducted and continues to conduct weekly virtual lectures and case discussions online where invited colleagues from the University of Michigan give lectures on audiology and vestibular medicine. I was humbled when D. Bradley Welling, MD, PhD, a senior otologist, started joining the online lectures and participating in teaching.

I will use my skills to offer better care to my patients in Zimbabwe and train my residents with the hope of offering a fellowship in otology in Zimbabwe in the future. I am hoping to continue learning and improving my skills as an otologist. I would advocate for more resources to be channeled toward ear and hearing care in my country and in Africa at large because ear and hearing care has been trivialized for a long time in Africa. I would encourage any of my fellow African ENT colleagues who are interested in otology to apply and ideally participate in the UCT otology fellowship. I fully believe it meets the international standards in an African environment where our challenges are significant.

Statement from Fellowship Director Tashneem Harris, MBChB, FCORL(SA)

Tashneem Harris, MBChB, FCORL(SA)The morbidity and mortality of ear disease is often overlooked in low-resource countries where the burden of ear disease is particularly high. There is also a paucity of specialized otology services and otology training facilities in Africa, which means that otolaryngologist-head and neck surgeons are not able to effectively meet patients’ needs either due the lack of resources or lack of otological surgical skills.

The otology fellowship at Groote Schuur Hospital is the first otology fellowship in Africa and aims to train otolaryngology surgeons who will then return to the state service in their home country, allowing them to train others in their departments, which will hugely impact the quality of service they are able to provide.

The current otology fellow is from Ghana and the only otolaryngologist-head and neck surgeon for over two million people. By acquiring the necessary otological surgical skills, he will be able to provide an otology service to his patients.

An important part of the fellowship is the collaboration with Dr. Basura. By providing online lectures and connecting virtually, teaching takes place regularly despite a very heavy clinical workload, thus providing an uninterrupted schedule in which training is not compromised. This collaboration is a critical element of the collective success of the otology fellowship. It also provides ongoing clinical support, mentorship, and the sharing of knowledge through discussion of difficult cases.

University of Cape Town—Otology Fellowship

Typical Service Commitment: 12 months

Clinical Emphasis:

• Tympanoplasty
• Tympanomastoidectomy (canal wall up and canal wall down)
• Stapedectomy/stapedotomy
• Ossicular chain reconstruction
• Cochlear implantation
• Temporal bone tumors
• Temporal bone fractures

Financial Aspects: MED-EL-sponsored clinical fellowship
Language Skills: English
Global Region: South Africa
Research Opportunities: Clinical

Services Provided:

• Office-based otology
• Operative/surgical otology
• Temporal bone lab surgical dissection
• Weekly virtual lectures covering all topics of otology and associated fields (audiology, vestibular, etc.).

Additional Information: https://www.entnet.org/humanitarian-efforts/university-of-cape-town-otology-fellowship/

Coordinator Contact Information

Name: Gregory J. Basura, MD, PhD
Email: gbasura@umich.edu
Address: Department of Otolaryngology/Head and Neck Surgery, Division of Otology/Neurotology-Skull Base Surgery, 1500 Medical Center Drive, Ann Arbor, MI 48109

For more about Humanitarian Efforts campaigns happening around the world go to the AAO-HNSF Humanitarian Efforts online repository of information and resources.