Geriatric ENT: ENT Care for the Elderly

The patient population of people more than 65 years old in the population are an integral part of ENT Outpatients.
Like pediatric,Geriatric patients also need a targeted approach to their diseases because they have special issues unique to their population.

The commonest problems I get refereed in the elderly is dizziness and hearing loss. I must mention here that chronic ear infections commonly called as CSOM is the third common diagnosis.
When I used to work in a tertiary care cardiac center, the common presentation was nose bleed due to blood thinners.
Apart from above common presentations,we are very careful in the elderly who present with any swellings or change invoice or breathing and swallowing problems to rule out Head and Neck masses.If the symptoms are of more than 4-6 weeks or any suspicion, a transnasal flexible laryngoscopy is immediately performed in outpatients.

I love interacting with the senior citizens.Its not all about me advicing them, I also get to learn lessons from their wisdom. 

Team for Early Intervention of 0-6 years children with communication disorders

This is not really a blog post with medical information but its a platform I am using to request readers to connect me with like minded professionals.

I am Dr Sheelu Srinivas with following qualifications 

and practising in Bangalore for a decade now.

M.S. ENT (G.S.M.C.and K.E.M.Hospital, Mumbai),MBBS (T.N.M.C.& BYL Nair Hospital, Mumbai)

Specialist Registrar and Associate Specialist U.K. 2001-2006 May

Consultant ENT Surgeon and Department Coordinator Fortis B.G.Rd June 2006-Mar 2015

Honorary Consultant  at Indira Gandhi Institute of Child Health and Spastics Society of Karnataka

•Specialised Training in Pediatric ENT including airway reconstruction and Cochlear implants at CHUV Lausanne, Switzerland (Prof Monnier) and Hacettappe University Ankara Turkey (Prof Seneroglu: Pioneer in operating Anomalous Cochlea)

•Pediatric Disability Training: Deafness and communication disorders including Autism

Balavidyalaya Chennai ,DHVANI Methodolody for Deaf children ,Training the trainer course

Com DEALL, Bangalore: Certificate course in communication disorders in children with disabilities

AVT Courses by Advanced Bionics, Medel and Cochlear Companies

I want to start an Early intervention Center for children with Speech and communication delays.This includes kids from birth to 6 years who may have various childhood concerns like hearing loss,Autism spectrum disorder and so on.

I am looking for investors and also building a team.This team needs passionate psychologists,special educators,occupations therapists and audiologists and speech language therapist.

Iam sure there are many dedicated individuals doing this kind of work and would like to connect with them.Kindly message us on sheelusent@gmail.com 

Tongue tie

Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the floor of their mouth is shorter than usual.

Some babies who have tongue-tie don't seem to be bothered by it.

In others, it can restrict the tongue's movement, making it harder to breastfeed.

Other potential problems could be difficulty in sticking tongue out and sticking it side to side.

Treatment of choice depends on the infant's ability to feed. 

Division with scissors in outpatients is the optimum treatment up until the age of 12 weeks after which, without general anaesthetic, it is not feasible

There is anxiety among parents that child will not learn speech and language due to tongue:this is not true. Learning speech and language is a higher skill.

Drooling in Children | ENT E-Learning Hub

Drooling in Children | ENT E-Learning Hub

OPD Consultations: Messages buried in the words.

In clinical practice, patients come and tell their stories.Some just say a few words and for others there can be many things going on.
And the clinician listens,not just listens,actively listens.

OPD consultations requires professional judgment and expertise, it can be quite tiring when done well. To completely empty oneself of ones own prejudices, patterns of responding and frame of reference, and to try to understand all of this about another person is an act of great generosity and respect. It is a commitment of not only time, but mental energy and a preparedness to explore another person’s world and see the way life appears to them. 

Active listening is an advanced communication skill, which takes practise and constant awareness to avoid slipping into the patterns summarised as roadblocks.These type of ‘roadblocks’ include: • ordering • threatening • moralising • excessive/inappropriate questioning • advising.

When we suggest solutions after all this listening, interactions and examinations, we take responsibilities.

However some people still leave the consultations unhappy.

Following are excerpts from a well written article I was reading as to why this can happen:
"However, there can be risks in suggesting solutions. It takes responsibility away from the other person. It implicitly disempowers the other person by saying: ‘You can’t solve the problem, but I am better/smarter/more worldly than you, so I have to do it for you’. This can make the person feel belittled or patronised. A person will usually have been pondering their problem for some time before they present with it. If a solution seems obvious to the listener after only a short time, the chances are it is obvious enough to have occurred to the person with the problem as well. To suggest otherwise is an insult to their intelligence. Therefore the issues then become: have they already tried the solution? Presumably it has already failed, what factors led to its failure? If they have not tried the obvious solution, why not? What are the other factors about the situation that means they have decided not to proceed with the obvious solution? More active listening is needed! A sign that suggesting solutions at this particular point is not appropriate is when the speaker starts to block the suggestions. This can be frustrating to both parties, and distract them from teasing out all the thoughts and emotions about the problem. Alternatively, some people simply ‘shut down’, outwardly appearing passive and compliant, but inwardly disengaged and resigned to not getting the help they really need. Avoiding the other’s concerns A third type of ‘roadblock’ is avoiding the other’s concerns by: • diverting • logical argument • reassuring. These roadblocks deny the person the opportunity to talk about their problems, or worse still, try to convince them that they really aren’t serious problems, and they are foolish to be worried about them."
Active listening More than just paying attention 
Kathryn Robertson, MBBS, FRACGP, MEd, is Senior Lecturer, Department of General Practice, University of Melbourne, and a general practitioner, Victoria. k.robertson@unimelb.edu.au
http://www.racgp.org.au/afpbackissues/2005/200512/200512robinson.pdf

‘You can learn to be a better listener, but learning it is not like learning a skill that is added to what we know. It is a peeling away of things that interfere with listening, our preoccupations, our fear, of how we might respond to what we hear’. Ian McWhinney

Family Centered Early Intervention Africa 2017

Issuing Medical Certificate

As an ENT Surgeon,I issue post operative off work certificate to patients.However in the outpatients,we should be careful in issuing certificates.
On personal ground,I disagree taking off work for small cough colds.Most of the people who ask such certificate are people who are bored of their work and have already taken off before consulting me.When they visit the clinic,they will argue that they were not well previous day and now they have paid my consultation fees.Well! consultation was done for your medical ailments and if it was told by patient that they are visiting me for a certificate-I would have refused to see them in the first place.

Another group who come for certificates are parents of school going kids.The family would have gone on holidays or to attend family functions and then appear to the doctors for a certificate.I blindly refuse to give such certificates.

I was once called for an enquiry where I had written date of resuming as 2/2/13 and the patient made it 12/12/13.This is true and I was so very overwhelmed that after that I never gave certificates for about 2 years .For operated ones,I used to ask ward secretary to type.Handwritten can easily be played around!Also in below article it has mentioned that take the signature of patient and an unrelated witness on the certificate which we occasionally follow in practice.

Here I share a well written article on docplus by DR Professor Prabhakar.Also the comments following it are informative
https://www.docplexus.in/#/app/posts/8fcb924f-a49b-494f-8c40-ff5874088220?utm_term=Email-Digest-0-eve&utm_campaign=Email-Digest&utm_medium=Email&utm_source=Docplexus.in&utm_content=CTA

Criteria For Issuance Of Medical Certificate

What kind of legal precautions can we take against violent incidents of non-issue of medical certificates? Patients seek medical certificates (MC) even for cold and cough these days to remain absent from work since they are bored with the same routine and mechanical working conditions. The purpose of seeking medical certificate documentation by any kind of patients is most important whether for the government or private sector. If for government purpose, patient is informed that certificate issued by a private physician will be invalid in such a condition so that the patient should at once convince of regarding this legal statement. Even then patient forces and insists for MC, certificates may be issued mentioning and confirming that the genuine purpose of MC whether it is true to patients knowledge free of cost. God alone knows how these so called certificates are accepted in working places whether government or private industries that are issued by government or private doctors and vice-versa. It is very well known that authorization should be mandatory to issue such medical certificates; however there is paucity of this issue in government protocols because MC issued by the private doctor is also valid in some companies. In such conditions it is always worth to ask the patient convincingly what is the purpose of MC and what he/she is going to do with that and whether MC granted by private doctor is valid or not valid in her/his company etc. These are the preliminary questions that may help to gain the confidence of any patient more so with poor and pity psychiatric patients. Once the purpose is revealed we will have to ask is it true and what for- very soothingly. Why all this in-patients will come deciding everything about MC issuing problems and even ready for fight and assault if the same is not issued, so much fixed in their minds, and prejudiced and preplanned, that’s how our mind works for the future consequences management, of course. Nicely we will have to solace the patients regarding invalidity and unacceptability of these so called MC stories issued by private firms. Repeatedly confirm whether patient is asking for medical treatment certificate or medical consultation fees certification if so we will have to issue both. When so called law protectors exhibit such irrelevance and carelessness towards such type of incidents, then God alone is the ultimate protector and destroyer of this material world. In the first instance police stayed away from this incidence because they thought they are dealing with a psychiatric patient and why to give trouble this is mercy and kindness always shown towards any patient suffering from disease of mind. Therefore prophylactic cautions that work are important than so-called these legal precautions. These are very few precautions not amounting to cautions only, when private doctor issuing MC to adamant patients who insist upon and force doctors to grant MC. Only we can take these simple cordial precautionary steps to prevent further legal mishaps-so enough of this violation. 

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