Professor Mashudu Tshifularo, Head of the Department of Otorhinolaryngology in the Faculty of Health Sciences at the University of Pretoria, recently delivered an expert lecture titled “World's first 3D-printed middle ear transplant: Technological Advances in the 4IR.” In March he made international news headlines when he pioneered the world’s first middle ear transplant using 3D-printed bones. Xolani Mathibela spoke to him and his patient Thabo Molishiwa.

XM: What influenced your interest in Otorhinolaryngology?

MT: Interestingly enough, I never wanted to specialise because it was not easy studying medicine at UKZN (University of KwaZulu-Natal), it was very difficult to get accepted into the school of medicine school back then. After graduation I did my community service, then I looked back and said ‘what’s next for me?’ I could not just be a general practitioner, then I realised that there were very few doctors who specialised in Otorhinolaryngology. I decided to specialise in it, and to this day I have no regrets. I never wanted to focus on just one organ. That is why I deal with the ear, nose and throat.

XM: What does Otorhinolaryngology entail?

MT: Otorhinolaryngology is about diseases of the ears, nose and throat. And the reason why these three are grouped together is because they are related. A patient may complain about an ear ache but the nerve supply and some developmental muscles and vessels are interrelated. So this means that one might think the problem is with the ear only to find that the problem is actually with the sinus or throat.

XM: What challenges did you encounter while pursuing this research that led to you pioneering the world’s first 3D-printed middle ear transplant?

MT: My research was done over 10 years. Many medical and research companies did not believe in my research, including those in the UK, Germany and China. However, while presenting to them I had to be cautious that they do not steal my work. It was only three years ago that I decided to [research] 3D-printed bones. I bought myself some books to understand 3D printing better since no one was interested in this. At some point I wanted to build a mini-lab at home to educate myself some more. 3D printing with some medical input saved me. It took me long because nobody believed in what I was doing. Even medical companies turned me down. This period has really humbled me. Never expect anything to reach its full maturity within a short period of time.

XM: How many of your patients have regained hearing thus far?

MT: One. After operating on the first patient, we are [working on] ethics approval for this procedure. Then after that we will do clinical trials, then write down operational procedure, the likely outcomes and the likely complications. Ethics are of importance for now, maybe after six months all this will be completed. We have had more than 100 calls from across the world, indicating that this procedure is in demand.

UP Dean of the Faculty of Health Sciences, Prof Tiaan de Jager, Vice-Chancellor Prof Tawana Kupe, patient Thabo Molishiwa who has regained his hearing thanks to surgery performed by Prof Mashudu Tshifularo (extreme right). 

XM: What material do you use to create these artificial bones?

MT: We use titanium similar to that used for the hip (replacements) and we use the smallest bone in the body – a rice-sized particle. We are hoping to use bone dust from the patient in future, meaning that we are going to take your stem cell or your own bone, whatever ruminant you have, and create your own bone material so that your body does not reject it. The aim is not to use the same material with every patient, it is important to advance. 

XM: How long does it take to create the 3D bones?

MT: Seventy-two hours max.

XM: Can 3D printing help with a common hearing disorder such as tinnitus?

MT: If the bones are affected then 3D-printed bones can play a major role.

XM: Tell us about the future of artificial intelligence in the fourth industrial revolution.

MT: The Fourth Industrial Revolution (4IR) is changing the world, even our patients are so smart these days they ask questions while googling answers. 4IR is here and artificial intelligence is taking over and we cannot stop it, South Africa needs to jump in otherwise we will be left behind. The entire medical innovation treatment and research sector is changing completely. Currently, we are into robotics – meaning that in few years to come I will be able to operate on a patient in Ghana while in South Africa via computer. Soon we are going to have tailor-made medicine for patients by taking their blood and DNA and whatever machine we will be using by then will let us know which medication will work better for that specific patient. At the moment that is what is happening with patients with cancer. This means that people are going to live longer and chronic diseases will be a thing of the past. The future is too bright.

XM: How is 4IR going to make a difference in South Africa, particularly in the health sector?

MT: 4IR is going to change job choices everywhere, including in the health sector. A computer is going to assist in so many levels when it comes to the health sector. My wish is that we have a biometric system for every patient so that doctors can access medical records on the tip of the finger rather than carrying files. Computers and robots are taking over, 4IR is here and let us embrace it.

XM: Where to from here?

MT: I am currently doing my second PhD in Otorhinolaryngology and I am praying for investors to give us money to build an Otorhinolaryngology hospital focusing only on hearing research and rehabilitation – treatments for cochlear implants, middle ear implants, brain stem implants and bone-anchored hearing aids. I hope to train more young doctors and nurses and get young scientists involved to work on 4IR and see what to innovate in the Otorhinolaryngology area with the available technology. Funding is more important at the moment. A blank cheque will do. It is up to UP to help me develop a centre for excellence in this area.

Interview with the first recipient of the 3D-printed middle ear transplant, Thabo Molishiwa, from Soshanguve.

XM: What was wrong with your hearing before the operation?

TM: I had two accidents prior to this middle ear transplant. In 1999, a storeroom door hit my ear very hard and in 2016 I was attacked with a torch light that destroyed my eardrum and I lost hearing completely. For years my ear was very painful.

XM: How did you find out about Prof Tshifularo?

TM: After I was attacked, I went to a private general practitioner who referred me to Steve Biko Academic Hospital, where I was attended to by different doctors. For the first time I was told that there was a hole in my ear and that they were going to operate my ear in order to close it, to ease the pain. During my second appointment, Prof Tshifularo told me about his research and asked if I would allow him to test it on me. For three months I refused because of the pain I was feeling and potential consequences of this surgery since I was going to be his first patient for this procedure. But one day I sat down and thought about it, and I allowed him to perform the surgery. I have no regrets.

XM: How much of your hearing did you get back?

TM:  About 75%. I made a wise decision by allowing him to perform that surgery on me. But I am not going to lie, I was nervous, but it was a risk I was willing to take since my ear was already damaged.

XM: How do you feel about Prof Tshifularo?

TM: That man is a hero, I will forever be grateful. Had it not been for him I would still be in pain to this day. I would advise anyone who suffers from ear-related problems to make an appointment and visit Prof Tshifularo’s office.