Singapore company NousQ has created a robotic, automated, sensor-controlled, handheld applicator called CLiXX® that promises to revolutionise ventilation ear tube surgery for children. As with many start-ups, the technology aspect of the company’s story is complemented by an equally fascinating personal story that inspired the inception of the company.

Surgeon and company founder Dr Lynne Lim shared her story with me during my time as their mentor during the MedTech Innovator Asia Pacific programme. NousQ is one of the six selected start-up participants that CC is supporting as part of our commitment to the programme.

Dr Lim’s ENT specialisation is from the Royal College of Surgeons Edinburgh, with further subspecialisations in paediatric and ear and hearing domains in America and Japan. A decade ago, she was in rural Cambodia on a humanitarian medical mission. She could remove neck lumps in young kids who were awake with just local anaesthesia. But she was unable to help youngsters who had trekked for days seeking surgery for glue ears.

The reason? There was no microscope or general anaesthesia – and children can’t tolerate instruments being used to insert tubes for glue ears while awake. Back home in Singapore, she saw her young daughter getting her ears pierced with a handheld applicator. Click-click and it was done. And that was Dr Lim’s ‘aha!’ moment.

Rising to the challenge of glue ear

Glue ear is the number one reason why children have hearing loss, use antibiotics and undergo surgery with general anaesthesia. 80% of children will have an ear infection by the age three. When medications fail, surgeons put a 1.5 mm grommet ventilation tube onto the eardrum to drain middle ear fluid.

Current surgery has scheduling delays of nine to 12 months in developed countries, as they require general anaesthesia, many micro instruments, expensive surgical microscope and an operating theatre setup. The surgery is costly and time consuming. There is almost a day’s commitment time of children and caregivers for fasting, admission, observation and medical leave after the surgery. Families may even need to travel to hospitals far away from their homes to access the care.

What will the benefits be?

The aim of CLiKX is to insert grommet tubes for glue ears in the clinic, without general anaesthesia and without need for microscope. It is a novel, sensor-guided, automated, handheld applicator that aims to insert a grommet tube precisely in one second at the click of a button.

For developed countries, NousQ sees it as a gamechanger that will reduce anaesthesia risks, cut cost drastically, shorten scheduling delays and inconvenience – and ultimately increase adoption of tube surgeries so that kids will not risk hearing loss. In developing countries, it could help many millions of kids who could never access this care as operating theatres, general anaesthesia and microscope resources are very scarce.

What’s next?

I’ve been supporting Dr Lim and the team on industry best practices for design and development of medical devices. We’ve discussed commonly underestimated aspects of early-stage start-ups such as the quality management system, human factor studies, staging of design changes and IP protection.

NousQ is now working to freeze the design of CLiKX by incorporating usability data from clinic trials. With CC’s input, they expect to tweak and finalise an improved version of the device, avoid costly mistakes and reduce wasted time. I look forward to forging an enduring partnership with NousQ and helping them achieve their goals.

Yan Lin Lye
Head of Medtech APAC

Yan Lin Lye has spent over 10 years working in and with start ups across the world to help commercialise their cutting edge technology. She currently leads Cambridge Consultants medtech commercial activity in APAC.

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