The Ear, Nose and Throat (ENT) specialty at the Singapore General Hospital (SGH) was born as a distinct discipline in 1928. At the time, ENT was allocated some beds, an outpatient area and three operating sessions under General Surgery. In 1951, the ENT Unit was formed, although still under the administration of the Surgical Unit. By 1957, a fully independent ENT Department had been established at Stanley’s Block, with self-contained ENT wards, theatres, outpatient clinics and related facilities. With the restructuring of SGH in 1989, the ENT Department was renamed Department of Otolaryngology. Since then, sub-specialisation started and continued to strengthen as the department marched towards the new millennium. Indeed, the Heads of the ENT specialty in SGH had, over the years, worked towards steering it from conception to maturity (Table 1).

Table 1. Heads of SGH ENT Unit/ENT Department/Department of Otolaryngology.

Development of ENT in SGH during the earlier years has already been well documented.^1,2 As such, this article focuses on the activities, events and developments of the department in more recent years.

The department reached a historic milestone with the setting up of the ENT Centre in June 2000. The Centre provides comprehensive ENT services under one roof, including rhinology/endoscopic sinus surgery, head and neck surgery, otology/neuro-otology, voice disorders, sleep apnoea surgery and paediatric otolaryngology.

Laryngology has come a long way since laser was first introduced in the department in 1982 to perform precise laryngeal surgery. Laryngology became an established subspecialty in the department in 1994. The Voice Clinic was set up, providing specialised services like multi-disciplinary stroboscopic assessments, tracheo-oesophageal voice rehabilitation and thyroplasty. The first local Voice Seminar for Professional Voice Users was organised by the department in 2002.

In the Rhinology and Functional Endoscopic Sinus Surgery (FESS) service, the Allergy Clinic provides skin prick tests as part of the management of allergic rhinitis. The service provides endoscopic management of complex medical conditions of the nose and sinuses. Since 1995, annual FESS courses have been organised, attracting interest from as far as Latin America and Japan. Dr DS Sethi, who heads the service, was the first in South Asia to receive the Honor Award from the American Academy of Otolaryngology Head & Neck Surgery in 2002 for his teaching and scientific contributions to the academy. He was also the co-winner of the Mahaley Award for his work on Endoscopic Pituitary Surgery.

Since 1958, multi-disciplinary combined Oncology Clinics have been established to discuss management of head and neck cancers. Multi-disciplinary collaboration also exists in the management of certain head and neck cancers requiring complex reconstructive and intra-cranial surgery. Nasopharyngeal carcinoma (NPC) is the most common head and neck cancer in Singapore, with an incidence of about 12 in 100,000 per year in Chinese males. It constitutes about 6% of all cancers diagnosed in this sex-ethnic group. In 1997, the department was one of three centres in the world to carry out trials in photo-dynamic therapy for recurrent NPC.

Tinnitus is a common symptom affecting an estimated 17% of the population, with 5% being disabling. The SGH Tinnitus Retraining Therapy Programme was launched in 1997 for the first time in Singapore and in Asia.

About 45% of normal adults snore at least occasionally while 25% are habitual snorers, of whom a number have severe obstructive sleep apnoea. As such, snoring/sleep apnoea surgery was developed as a sub-specialty in the department in 1996. The first jaw advancement surgery in Southeast Asia was carried out in the department in 2000. An innovative modified approach for Asians was introduced by the department in 2002 (Fig. 1).

Fig. 1. A Straits Times report on an innovative technique for jaw advancement surgery modified for Asians, which was jointly developed by the department.

The first adult and child cochlear implantation in Singapore took place in SGH in 1989 and 1997, respectively. The department has been recognised locally and regionally for its work in cochlear implantation. For instance, Dr Low Wong Kein was appointed to the Board of Directors, Asia-Pacific Symposium in Cochlear Implants & Related Sciences. From 2001 to 2005, the department directed the Ministry of Health’s national cochlear implant programme for children and adults as well as the national universal newborn hearing screening programme under the Ministry’s Health Service Development Programme. The scheme, which has attracted international media attention, provides subsidies to purchase the costly devices (Fig. 2).

Fig. 2. The Bangkok Post reported on 2 October 2002 the subsidy scheme for cochlear implants in Singapore, a Ministry of Health initiative spearheaded by the department.

Prior to the setting up of Kandang Kerbau Women and Children’s Hospital in 1997, most of the complex paediatric upper airway obstructive cases were managed in the department.

The Listen & Talk Programme was established in 2001. It provides comprehensive quality services for hearing-impaired children and adults. Hearing impairment is common, with about 5 in 1,000 children born with some degree of hearing loss. About 8% of the population suffer from hearing impairment, particularly the elderly. Age-related hearing loss is so common that by 80 years of age, about 50% are expected to have significant hearing loss.

World-renowned Auditory-Verbal therapy consultant Ms Judith Simser was engaged in 2001 for a year to train a core group of Auditory-Verbal therapists in SGH, one of whom achieved certification by Auditory Verbal International in July 2004, the first in Singapore and the third in Asia to do so (Fig. 3).

Fig. 3. Singapore’s first hospital-based Auditory-Verbal therapy programme was established in 2001 with the help of world-renowned international Auditory-Verbal therapy consultant Ms Judith Simser (third from left).

In 2004, a partnership was formed with the National Kidney Foundation’s Children Medical Fund (NKF CMF) to set up the NKF CMF-SGH Centre for Hearing and Cochlear Implants. The Centre aims to provide world-class comprehensive and holistic care for hearing-impaired individuals, as well as to carry out education/training and research in this area.

A national ENT training progamme has been in place since the mid-1990s. The programme is administered by the Specialist Training Committee, which has been chaired by the department since 2002. Weekly core teaching sessions for all ENT trainees in Singapore have been held in the premises of SGH for the past few years. Expertise from the various hospitals has been drawn upon to conduct the sessions. For the six-year training programme, trainees go on four- to eight- monthly rotation postings to various hospitals. Hands-on training in the operating theatre has been complemented by "virtual" training on cadavers in the laboratory. To facilitate this, cadaveric dissection facilities are available and complimentary registrations have been offered to trainees to attend the hands-on instructional workshops conducted by the department. To facilitate e-learning, an SGH "ENT Training Room" equipped with some of the latest audio-visual equipment was set up in the department in 2004.

Despite the push for the use of technology to augment teaching, traditional Grand Ward Rounds are still routinely being conducted for teaching as well as for patient care. These Rounds draw on input from senior doctors and previous Heads of the department like Drs N Kunaratnam and Seow Li Jin. Other continuing medical education programmes include journal clubs, radiology conferences, tumour boards and clinical rounds. Medical Officers posted to the Department go through an induction training course at the start of the posting, including a hands-on airway workshop conducted by the Department of Anaesthesia and Surgical Intensive Care.

The department has been recognised for its contributions to teaching. Two staff members have been appointed as Clinical Associate Professors by the National University of Singapore. Drs Christopher Goh and Goh Yau Hong were awarded the undergraduate Best Teacher’s Award in 2000 and 2002, respectively. Besides overseas and local undergraduates, the department has hosted a number of overseas clinical and research fellows.

The department also conducts regular teaching workshops. The first annual "ENT Instructional Course Week" was held from 15 to 25 July 2004, during which the 9th FESS course, 3rd Otology/Neuro-otology course, 1st Head & Neck course and General Practitioner workshop were successfully held (Fig. 4). The department has also conducted workshops for nurses, paramedicals, teachers and the public.

Fig. 4. The first annual ENT Instructional Course Week, organised from 15 to 25 July 2004, was a resounding success.

In 1958, ENT was the first specialty in Singapore to use the operating microscope for performing and learning ear surgery.1 For the first time in the mid-1960s, residents were taught cadaveric temporal bone surgery. An observation tube for teaching was acquired for the microscope and residents took turns to learn delicate microsurgical techniques. Prior to that, the mallet and gouge were frequently used in mastoid surgery. Today, microscopic ear surgery is routinely demonstrated, taught and documented on television monitors.

An SGH-Ngee Ann Polytechnic-Canossian School research partnership in 1999 led to the production of an innovative interactive CD-Rom for rehabilitation of hearing-impaired children. For its collaborative work with Aromatrix Pte Ltd on "Health Evaluation on the Human Nose Using the Odormat Technology", the department received The Enterprise Challenge (Prime Minister’s Office) Enterprise Award in 2002. It received a similar award for its work on the development of a screening kit for NPC in 2003.

The department has also been active in other areas of research. Three of its staff have won the SGH Excellent Publication Award. Research projects carried out in the department with National Medical Research Council grants included analysis of gene expression profiles for human NPC; efficacy of percutaneous hyaluronic acid injection to improve voice and swallowing in patients with unilateral vocal fold paralysis; generation and characterisation of human NPC cell lines; and genotypic and phenotypic correlation of hereditary non-syndromic hearing loss in Singapore.

The department has been active in promoting a healthy lifestyle. It took the lead in organising the President’s Challenge Health Relay 80 in 2004 (Fig. 5). Aimed at promoting charity, health, fun and solidarity, the event involved almost the entire healthcare industry in Singapore. The department also chairs the Workplace Health Promotion Committee, which successfully organised a mass health screening exercise for SGH staff in October 2004.

Fig. 5. The department took the lead in organising the President’s Challenge Health Relay 80 on 12 September 2004.

The department promotes community service. Among its contributions, it has organised a Charity Jogathon to raise funds for needy hearing-impaired persons and conducted hearing screening tests for the community (Fig. 6). Its staff have also volunteered their services to the New Voice Club of the Singapore Cancer Society.

Fig. 6. As a community service, the department organised a Charity Jogathon on the International Day for the Deaf on 28 September 2002.

The department has also been conducting outreach programmes, such as ENT Workshops in countries including Vietnam, Myanmar, India, Indonesia and Malaysia (Fig. 7).

Fig. 7. As part of the department’s Outreach Programme, the department conducted ENT training in Vietnam in April 2000.

Annual departmental retreats, aimed at promoting continual improvement, give medical, nursing, paramedical and administrative staff an opportunity to reflect, plan and team build.

Since the early 1990s, a highlight of the department’s social calendar has been the Year-end/New Year Party. This annual event is a gesture of appreciation to departmental staff as well as friends and colleagues from other departments. At the event, a "No MC Award" has been traditionally given to ENT staff to encourage them to stay healthy throughout the year. This practice has been discontinued since the SARS outbreak in 2003. Since 2000, the department has combined resources with the Department of Plastic Surgery to jointly organise this event.

"ElephaNT" can be read as "ENT" for short, and the animal can certainly be an appropriate department mascot. The elephant provides good service to mankind (in transportation and logging), uses its trunk to feel and satisfy its curiosities and is willing to learn new tricks. Similarly, the department provides good service to patients, undertakes research to address various curiosities in ENT practice and is keen to learn and impart new knowledge. Like the Flying Elephant, the department readily "spreads its wings" to establish an international presence (Fig. 8).

Fig. 8. The Elephant (ENT for short) can be an appropriate department mascot.

ENT in SGH has over the last 80 years risen from obscurity to prominence. Today, it is a leader in its own right in many aspects of service, teaching and research.

1. Kunaratnam N. Otorhinolaryngology — head and neck surgery — its beginnings and development in Singapore. Ann Acad Med Singapore 1991; 20:714-20.
2. Seow LJ. The early years of otolaryngology in Singapore — 1946 to 1977. Ann Acad Med Singapore 2003; 32:843-5.