Deafness Awareness:documentary in kannada

https://www.youtube.com/watch?v=YQZayyuI7jA

Finally I made a documentary for the Kannada audience as well.Please share this & help to create awareness about hearing disability & its impact on lives of kids.I also happy to inform that I have finally been able to convince National Rural Health Mission (Dept of Women & Child Health,Karnataka) & they have decided to carry out hearing screening for children all over Karnataka.We are starting a pilot at K C General Hospital & NRHM with six center's outside Bangalore.I have been pursuing this cause & must thank Bangalore Pediatric Society (IAP,Bangalore Branch) to give me a platform to present this cause.This is just the beginning & there is a long road ahead to reach the goal of improving lives of the hearing impaired.Please help to spread awareness about hearing loss & its impact.

Unilateral hearing loss in children

share click share to read.

We have diagnosed 7 cases of unilateral sensorineural hearing loss in children in the last 6 years in our center.I would like to add that clinical history,examination & radiological investigations usually help to find etiology or cause of deafness.3 cases had distinct radiological findings like abnormal inner ear development.Other 3 had history of viral illness like mumps.One case did not have any specific finding & was worked up for autoimmune etiology.
Habilitation & regular follow up is vital.

Working with special or differently abled children

On the International day of persons with disability 3rd December -would like to elaborate the role of my specialty with the differently abled.

The United Nations report of 2013 enumerates 15% of the world population to be living with some form of disability (physical,mental & sensory).In India ,approximately 10% of population suffers from disabilities related to locomotion,vision,hearing & intellect as per the NSSO 2010 report.

All you need has been given to you with your child. You’ve got love. Everything starts from there.

As an ENT surgeon,I routinely work with special children & their parents.The role of an ENT will be in assessing,diagnosing ear, nose,throat problems & helping in habilitation alongside the therapists.
Ear:
Often hearing disability or impairment goes undiagnosed as it is not as explicit or obvious as physical impairment or blindness.Ear wax & middle ear effusions should be regularly attended to as in any other child.
Reduced hearing acuity during infancy and early childhood interferes with the development of speech and language skills, because it is likely that the child will not receive adequate auditory, linguistic, and social stimulation required for speech and language learning, social and emotional development, and that family functioning will suffer accordingly (NIH, 1993).It can be argued that these effects are even larger in a population with an intellectual disability.

There are also communication disorders which can be of several types including expressive language disorder & mixed receptive-expressive language 

Nose: Commonly we come across nasal allergy,infection,muscular tone /nasopharyngeal narrowing due to structural abnormality or adenoids.
Throat:
Specific problems in differently abled children are drooling & swallowing or feeding difficulties.
It is considered abnormal for a child older than four years to exhibit persistent drooling and this problem is most commonly seen in special children.The management is tailored case basis.It can be conservative-speech therapy & oral stimulation therapy to use of Appliances –Dental.We also sometimes use anticholinergic drugs.Injection of botox in the salivary gland & Surgery is reserved for severe cases.

Inter relationships  among development of feeding & swallowing & other developmental domain.
Motor skills -> Ability to hold things -> Delay in self feed
Communication development ->Ability to express need ->Attitude towards food
Medical condition -> Delayed feeding patterns->Need to be fed with food textures

ENT Surgeon plays an important role in feeding & swallowing team.

In conclusion,there is so much to do & help our special kids.Its all about strengthening their abilities...as a team.

"It was ability that mattered, not disability, which is a word I'm not crazy about using." - Marlee Matlin

Advice Before Buying Hearing Aid, FDA Advises

MedlinePlus: Trusted Health Information for You <- click here

Professional needs to assess ear health, agency says

Noise Update

Noise Update (Click here)
More information on noise pollution & prevention.
Interesting statistics & the concept of CAP.

Noise induced hearing loss -my article in Deccan Herald 18th November 2013

Cochlear Implants:benefits & how it differs from hearing aids

This amateur video is recorded in my office by a student learning communication.I thank her for helping me to create awareness.Dr Sheelu Srinivas

Ayudh Pooja: Significance for a surgeon and workplace

Surgery is an important event in a patient's life.As a surgeon,I not only have the important task of selecting the right patient,explaining to the patients the risks & complications of surgery but also to impress upon them the need of post operative care.There are lots of guidelines & evidence based indications to decide for a surgery.We provide detailed information for the patient & family what to expect during surgery.Lets go through the journey of undergoing surgery in a hospital briefly..

Let me share a prayer to impress upon readers the trust the patients put into the surgeons while going through an operation...

Prayer Before Surgery

"Loving Father, I entrust myself to your care this day; guide with wisdom and skill the minds and hands of the medical people who minister in your Name, and grant that every cause of illness be removed, I may be restored to soundness of health and learn to live in more perfect harmony with you and with those around me. Through Jesus Christ. Amen." 

On the day of surgery,we meet the patient & family before taking them to the operation theatre. Post operative pain care is very important along with dressings & other medications.There is also special dietary need in every patient.I give a detailed description of how the surgery went to the patient & family.

However sometimes while doing all the above ,we may miss to impress the need of regular post operative follow up.If the patient does not stay local,it should be organised where he stays or call patient at appropriate intervals.

In ENT,there are some surgeries like tonsillectomy,myringoplasty where just a couple of out patient follow ups are fine.However most of other operations like mastoid surgery,nasal surgeries like endoscopic sinus surgery need further attention.

Lets talk about simple surgery like Septoplasty. Usually it does not need follow up of months but first few weeks are important.Post operative nasal suctions are necessary for healing.It prevents adhesions & infections.Nasal douchings or cleaning is also explained to patients.

Another nasal surgery like endoscopic sinus surgery may need longer follow up.Especially if its done for nasal polyposis,patient may need long term nasal treatments also.Thus the indication for surgery also decides the follow up post operative.Its the same for mastoid surgeries.Post operative cavity care should be stressed upon.

Surgeries like Cochlear Implantation are life long commitments for the reasons that its a new technology & complicated procedure.The importance of auditory verbal therapy I have stressed upon in a previous blog.

The success of surgery & appropriate healing not only depends on the operation itself but also on post operative care.

We do our best with all the wisdom & knowledge & pray to Almighty to skill our hands & minds.

Sharing the picture of Ayudha Puja in our department.Similar prayers are offered in the operation theatres where we express our gratitude to God for granting us the tools to fulfill our duties.

"Be it the plough, be it a vegetable cutter or be it Soorya Kiran Air Craft, the Ayudha Puja is a worship of whatever implements one may use in day-to-day life.If one can make a conscious effort to see the divine in the tools and objects one uses each day, it will help one to see one’s work as an offering to God.""

Patient Expectations & Exceeding them!

After completing medical school,we gain knowledge to treat a patient & bedside manners.However there is no training about " the customer" approach to a patient & keeping up to their expectations.

Especially if working in the private sector (though scenario is changing in government sector too!)-patients are customers & the provision of medical service will succeed if delivering the desired customers.

What I write next is my personal opinion after working in private sector for 7 years in a city where most of my patients are internet savvy & have presented to me after goggling their symptoms!Before this I was in government sector in India & NHS in the UK for 10 years & did not really have to consciously behave in a certain way with patients!

Like it or not ...we have to accept the trend & change accordingly !

Patients present to us with an expectation & act accordingly.We as professionals deliver not only clinical quality but also have to satisfy their implied wishes.It took me some time to understand this.

While I listen to a patient's story & examine him-I may come to a conclusion.However if I look busy or am in a hurry- patient most of the time may doubt my conclusion or may feel that I am not paying attention.

Here comes the difference.."Doctors and patients have very different optical regarding quality". 

The patient assesses the technical quality of medical care indirectly by evidence of the interest and concern of professionals with their health and well being. Such evidence is perceived through empathy.

In this context, it is understood that quality is the totality of features and characteristics of a service that affects its ability to satisfy stated or implied wishes.A high satisfaction with the medical service provided leads to a high level of customer loyalty.

Therefore, we understand that customer satisfaction is both a goal and a marketing tool. Thus Medicine and Marketing concepts have common and can share tools and objectives, favoring the doctor-patient relationship and promoting quality health care in our society.

I just want to end by an old saying in medicine(after all the fuss written above)

First..Do No Harm....

Understanding Cochlear Implant benefits

In the out patient clinic,I try to spend time with a family to explain them about the candidacy & outcomes of cochlear implants.
However this article from ASHA summarizes the facts so well & I thought I should share it for everyone's benefit.

It highlights the changes in candidacy  over last 2 decades & how over time we are able to understand the speech benefits or limitations of a cochlear implant.

There is so much still to know why the outcomes are variable & researchers working to standardize them.

Just click on the title above -it takes you to the article.

http://www.asha.org/public/hearing/treatment/mind_hears.htm

International Ear Care Day 3rd March

Everyone knows prevention is better than cure.
I believe that the message of not using ear buds is the most important of all ear care tips.Next is preventing water entering the ear especially dirty water..I have met people who as a routine wash their ear canal or shall I say flush their ear canal with water to clean it!!!This is really not required...

Next step especially in children is treating colds & upper respiratory tract infections.If a child has ear pain following colds-he may be having an ear infection.

In adults some preventable tips are about loud noise exposure & ototoxic drugs.Avoid listening to loud music & use protection if working in an industry with loud noise exposure.

The link below can be explored for further care....

WHO | Millions have hearing loss that can be improved or prevented

Take a break....learn something new!

There are times when we feel things have slowed down & we are in need of motivation.

There are times when you reach a goal you set for yourself & then suddenly realize what next...

The next step could be improve on what we did or learn something new.....

Improving is an or should be an ongoing process as medicine is ever evolving ....

Learning something new is daunting or as some will put it challenging.......It's like this infant who is in a swimming pool with others around her swimming.She is seriously observing & thinking when will I swim?

Only when she is trained & finally thrown in the pool-she will swim!

I have recently taken some new lessons which I would like to share..

I become a life member of Society for regenerative medicine & tissue engineering.I went & sat in their 9th Annual conference at Bangalore recently.And  among all those research scientists ..I felt I am doing nothing worthwhile.I am only the end user..of somebodies hard work.There were talks mainly on Stem cell research as well as advances in regenerative medicine.

So inspiring ...though i have to start right from the beginning...i felt like that child in picture sitting comfortably on a floater BUT eagerly wanting to learn more & swim.
Its a long process ..involves lots of reading.Its like going back to school.But that's the future, so we have to get involved.Lots of work is done in stem cell on skin tissue,etc.However for sensory organs like of hearing still scientists are understanding the mechanics & finding way to go ahead.
I would specially like to thank one of the scientists -Dr Joshua Peter ,who recently joined our hospital & inspired me to learn more.

As regarding improving on we already know & expand our horizons by further training.The conference organised by Dr Meghanath at Hyderabad on Mastering the techniques of sinus surgery did exactly that!.The masters gathered at the meet were Prof PJ Wormald (Australia),Prof Graham Scott (USA),Prof Sethi (Singapore) & our own Indian Masters.Watching these masters operate was a treat..Prof Wormald showed great interest in teaching us.His idea of "building blocks" for understanding sinus anatomy & drainage pathways made things so simple.
There you see "building blocks"...again.

Its the child in us who should be eager to learn....there is so much to learn & motivate yourself.
Then you will be bubbly again!

Allergen Avoidance: Is it worthwhile?

One of the common clinical diagnosis I make on daily basis is allergic rhinitis or allergic rhinosinusitis.

 
Just writing a nasal spray or antiallergic is not enough.Patient education about allergen avoidence is very important.

I have listed below the information on allergen avoidence.

First question before we proceed- Is allergen avoidence effective?

Evidence that allergen avoidance is effective

Many studies show that strict avoidance is effective in reducing the severity of asthma and allergic disease and the need for medications. People with asthma kept in environments free of dust mite for long periods of time improve their symptoms, but significantly, bronchial hyperresponsiveness also improves.

The big question is whether these measures can be transferred to real life situations and applied in a practical and cost-effective manner.

A meta-analysis of such studies reported in 1998 (3) purported to show that allergen avoidance was ineffective. However, this study was flawed in that it included studies where allergen reduction was not achieved, and other effective studies were excluded. In five of six studies where allergen exposure was documented for six months or more, there was significant improvement in the active group (4).
(courtsey allergy.org.au )

Lets talk about the main culprits -indoor allergens & pollen.Also mentioned in the tables below about avoidence measures.

Indoor Allergens

 The most important indoor allergens are house dust mite, cat, cockroach and mould. Carpets are reservoirs for dust mite and their food, and maintain an optimal environment for dust mite growth. They also accumulate other allergens such as cat, cockroach and mould allergens.Mattresses are a good home for dust mite. They should be vacuumed regularly, but can also be enclosed in an impervious cover.
 Also worth mentioning is the woollens- blankets or sweaters.They should be replaced with cotton one.Layered clothing than a thick woollen jacket!

Avoidance measures for Indoor Allergens

Ideal measures: Remove carpet and replace with hard surface (where practicle and affordable) Sweep and dust regularly with moist cloth to prevent dust rising Encase mattress and pillow in material impervious to dust mite Remove drapes and replace with roll-up blinds Get rid of soft toys Keep bedroom uncluttered Get rid of pets (if there is a confirmed pet allergy) Store clothes for changes of seasons in plastic bags after cleaning Less effective methods: Dry-clean carpets then vacuum regularly with machine with HEPA exhaust filter Exclude pets from the bedroom Do not use evaporative cooling which increases humidity and encourages growth of dust mite and mould Attend to leaks and damp in the home Rely on electricity for heating and cooking and avoid unflued gas heaters

 

Avoidance measures for other allergens

Pollen can travel great distances on wind and it may appear a hopeless task to avoid them, but there are some simple measures which can reduce exposure to them.It may not be possible to put into practice all these measures, but at least some of them will be effective in reducing allergen exposure.

Measures to reduce pollen exposure

During pollen seasons:  Avoid visiting high pollen areas in spring. Drive with car windows closed and airconditioner on recycle. Some models of cars have pollen filters incorporated in their airconditioning system. Keep windows of home closed . Avoid mowing of lawn and wear a mask if working out of doors. Try to do essential garden work after rain, which has removed pollen from the atmosphere. Avoid outdoors on windy days. Wear glasses or sunglasses to reduce the chances of pollen impacting on the conjunctivae. Shower and wash hair to remove pollen before going to bed. Use a clothes dryer or hang clothes indoors instead of line-drying. Choose garden plants which are low pollinators. Even though pollens travel great distances, some may cause problems if in high concentration in a local area such as a garden. Refer to pollen counts when available.

 

Cost-effectiveness of allergen avoidance

Patients are becoming more dissatisfied with the need for continuing drug therapy, and are seeking other ways of controlling disease. Some asthma studies have shown that allergen avoidance reduces the need for medications.

The advantages of allergen avoidance are:

• It is safe and without side-effects.
• It decreases the amount of medications required. This can lead to significant financial savings.
• It improves efficacy of medication.
• It is safe in pregnancy.
• It may reduce the risk of development of allergic disease in young children.

 Allergen avoidance measures often require a change in behaviour patterns.

Last but not the least.... food allergies especially if I am treating a child!

 Take care !