Graham Fraser Fellowship 2005- Henry Pau

I am honoured to have been awarded the 2005 Graham Fraser Fellowship which enabled me to spend six months with Professor Gibson in Sydney, Australia. I would like to reveal some highlights of my time with Professor Gibson and his team at Sydney Cochlear Implant Centre and have attached an interview with Prof which was also published in the November, 2005 issue of ENT News.

Weeks leading up to the Fellowship….

Timing has never been our strongest point and when it came to having our first child, there was no exception. Joshua was born on 28^th December, 2004 and our original plan was for me to fly out on 7^th January, 2005 so that I could start my Fellowship on 17^th January as planned and for Hannah and Joshua to come and join me a week or so later. However, it was proved to be rather too ambitious to take a 2 weeks old baby all the way to Australia only by his mother and the whole plan was also complicated by the hospitalization of Joshua for his physiological jaundice. Dr Fraser and Prof. Gibson were extremely kind and understanding of our situation and agreed to postpone the start date of my Fellowship to early February.

Arriving at Sydney

It is law in New South Wales, Australia that one cannot rent a place without physically having viewed the property- it would be rather awkward for overseas visitors like us to arrange accommodation prior to arrival. Prof and Alex Gibson very kindly offered us to stay at their house for the first few weeks, but despite the constant reassurance from Alex that they would not hear Joshua’s cry, I had to turn them down as we feared the incredibly loud noise that Joshua could generate would seriously disturb their sleep. It would not be a good idea to have your baby waking your Prof and his wife up every night, especially at the beginning of your job!! We therefore arranged to stay at a serviced apartment in CBD (Central Business Centre) for the first few weeks before we found a house in Balmain, a suburb which is ideal for families with small children. Balmain is also very close to where Prof lives, which, is convenient as Prof always kindly offers to give you a lift to work.

Daily timetable

	Monday	Tuesday	Wednesday	Thursday	Friday
am		Children’s Theatre	RPA (public)	Children’s Theatre	Mater Theatre
pm	Rooms	SCIC clinic	Rooms	Rooms	Mater Theatre

The best days for operating are Thursday mornings and Friday all day. The Fellow will be operating (nearly always doing cochlear implants) under close one to one supervision and Prof is a great teacher- he would give you the confidence to “drill away” and in the meantime he would give you tips on how to avoid trouble. Prof has many unique and great ideas about performing cochlear implant surgery, for example, small postauricular incision, minimal mastoidectomy, identifying facial nerve electrically using a stimulator and tight subperiosteal pocket, and the experience was unique and invaluable.

I also saw a wide range of otological and neurotological patients in his rooms and learnt how to perform transtympanic electrocochleography (ECochG) for his Meniere’s and implant patients. His routine pre-implantation assessments included CT, MRI, promontory stimulation (using the same principle as ECochG) and vestibular function test.

I was performing one of the many implants under Prof’s supervision.

The Theatre

The atmosphere of his theatre is perfect for the Fellow as it is always calm, friendly and unrushed. There was always ample time to perform and discuss all the cases. Prof insisted on performing intraoperative monitoring of every implant in the form of electric auditory brainstem response (EABR) and this was carried out by Dr Halit Sanli who was our biomedical engineer and Kirsty Gardner-Berry who was an audiologist.

The set-up for the intraoperative testing of the implant device

Sydney Cochlear Implant Centre (SCIC)

I went along to Prof’s clinic at the SCIC every Tuesday afternoon and they have an incredibly dedicated team of surgeons, audiologists, scientists, teacher of the deaf, social workers and managers who provide an excellent pre-, peri- and post- operative service, not only for Sydney and Australia, but also for the Asia Pacific Region and for the world as I have seen many patients who had traveled from the Middle East and Asia to receive treatments from the SCIC.

Academic work

Prof has great enthusiasm in academic work and we had many interesting discussions on our chosen subjects, electrophysiology & auditory neuropathy and molecular biology of the ear respectively. We were fortunate enough to have our first publication within my first three months and have submitted two more manuscripts by the end of my Fellowship. I also presented two papers at the Asia Pacific Cochlear Implant Symposium in Hong Kong in November, 2005.

Because of my molecular biology background, Prof sent me to Newcastle (about two hours north of Sydney) to meet up with a scientist called Alan Bricta. Alan has a group studying the neurophysiological pathways of the ear and I spent a few days in his laboratory learning about his work.

Neurophysiological studies on an isolated but alive murine inner ear in Alan’s lab.

An ENT clinic with a difference

Prof organized for me to help in a clinic at the outback of Australia with Neil Bousfield who is an ENT surgeon from Sydney. We set off at six o’clock in the morning from Bankstown Airport, a small airfield in Sydney, in a small 9 seater plane which was owned by the Royal Australian Flying Doctors. The journey was about 4 hours before we landed in an outback town called Brewarrina. The terminal of this airfield was a hut with one toilet in it. The pilot kindly warned me about the local brown snakes which sometimes hid under the toilet seat as it was the coolest place there. On the way to the hospital, one could really feel the vastness of Australia. The earth was certainly red and the area suffered severely from drought.

Brewarrina was a typical outback town: poor and apparently lawless as the windows at the court house and the police station were smashed. The local pub still had a white lounge and a black lounge which demonstrated the still existing racial discrimination in Australia. The hospital was small but clean. The clinic was not equipped with ENT instruments and the team had to bring their own from Sydney. Patients who required operations would need to be transferred to Sydney for their surgery.

The 9 seater that took us to Brewarrina

Publications

1. Pau H, Parker A, Sanli H & Gibson WPR (2005) Displacement of electrodes of a cochlear implant into the vestibular system: intraoperative and postoperative electrophysiological analyses (Case report) Acta Oto-Laryngologica (In press)

Papers submitted

1. Henry Pau, William P.R. Gibson and Halit Sanli (2005) Transtympanic Electric Auditory Brainstem Response (TT-EABR) (Paper- clinical study): the importance of the positioning of the stimulating electrode- Submitted to Cochlear Implant International, June 2005.

2. Henry Pau, William P. R. Gibson, Kirsty Gardner- Berry and Halit Sanli (2005) Cochlear implantations in Children with Waardenburg’s Syndrome: an electrophysiological and psychophysical review (Paper- clinical study)- Submitted to Cochlear Implant International, July 2005.

Presentations

International

1. Henry Pau, William P. R. Gibson, Kirsty Gardner- Berry and Halit Sanli (2005) Cochlear implantations in Children with Waardenburg’s Syndrome: an electrophysiological and psychophysical review.

The 5^th Asia Pacific Symposium on Cochlear Implants and Related Science, Hong Kong, Nov., 2005.

2. Pau H, Parker A, Sanli H & Gibson WPR (2005) Displacement of electrodes of a cochlear implant into the vestibular system: intraoperative and postoperative electrophysiological analyses.

The 5^th Asia Pacific Symposium on Cochlear Implants and Related Science, Hong Kong, Nov., 2005.

Regional

1. Molecular Otology (2005). Temporal Bone Course, Royal Prince Alfred Hospital, Sydney, Australia.

Acknowledgement

Prof and Alex looked after us very well indeed throughout our time in Sydney. We would also like to thank Kathy and Rosemary at Prof’s rooms and the team of professionals at the Sydney Cochlear Implant Centre for making our stay a pleasant and memorable one. Finally, I feel privileged to have been one of the Graham Fraser Fellows as this Fellowship has enabled me to learn about cochlear implantation from one of the best otologists in the world.