In this episode of BackTable ENT, Dr. Gopi Shah interviews Dr. Dhave Setabutr, assistant professor of otolaryngology at Thammasat University, about building a microtia repair program in Bangkok, Thailand.

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SHOW NOTES

First, Dr. Setabutr explains his path through otolaryngology and microtia training and his motivation to move his family and practice to Thailand. Then, he explains how he transitioned from practicing in the United States to practicing in Thailand after he was notified of an opening for an English-speaking otolaryngology professor at a university hospital. He notes that pediatric otolaryngologists are scarce in Thailand, a country of 60-70 million with only 15 fellowship trained pediatric ENTs.

Next, he describes his microtia repair team, which consists of many different specialties, such as a facial plastics surgeon and audiologists. He emphasizes the importance of operating with a co-surgeon in the initial building of a microtia program. Additionally, he delineates differences in the Thai health care system that changed the way he manages his microtia patients. For example, although many of his patients have unilateral microtia, they cannot afford BAHA devices or hearing aids for the contralateral ear because the government does not provide funding for these devices. Also, there is no option to install an FM system in the classroom to amplify sounds for children with hearing deficits. Finally, he only uses rib harvest for reconstruction because it is the most cost-effective technique. Although Thailand has recently implemented universal newborn hearing screenings, many health gaps must be addressed before improving treatments of hearing loss in Thai children.

Then, Dr. Shah and Dr. Setabutr discuss tips on having the initial conversation with parents of a pediatric microtia patient. Because microtia is undetectable on ultrasound, many parents are surprised during the birth of their children. Additionally, parents may have difficulties dealing with this condition because there are no abundant parent support groups for microtia. Dr. Setabutr recommends being able to summarize information in a way parents can understand and to ease their concerns about hearing and development.

Finally, he delves into the technical aspects of microtia repair, including the grading system and surgical procedure. He usually only performs the three-stage surgery on children with grade III microtia who have enough rib cage cartilage to construct a pinna. He keeps the patients in the hospital until their shunts can be removed due to poor wound care resources in Thailand. Finally, he emphasizes the importance of gaining patient and family support before performing the repair surgery.

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