Baby swallowing button battery: Flexi Bronchoscopy, ENT: Dr. Sheelu Srinivas: Fortis Hospitals Bangalore...

Pediatric Airway:Who should visit a Pediatric ENT Specialist?

Pediatric Airway Program

Airway Clinic : A multidisciplinary approach with the team including ENT Surgeon specializing in Pediatric airway, Pediatric Pulmonologist and equipped with outpatient endoscopic setup to complete ICU back up for open airway surgeries.

Tracheostomy Program

Swallowing Evaluation and FEES (Functional Endoscopic Evaluation of Swallowing)

Whom to refer?

1.       Noisy Breathers especially babies with failure to thrive

2.       Infants and children with stridor

3.       Babies with recurrent croup

4.       Children with recurrent pneumonias

5.       Wheeze or asthma not responding to regular treatment to look for associated airway pathologies

6.       NICU Babies or kids with increased respiratory effort post extubation

7.       Swallowing and Feeding difficulty in babies

8.       Infants and children with congenital malformations of head and neck

What happens when babies come to hospital?

First they will have an outpatient consultation with ENT surgeon. We perform outpatient flexible nasolaryngoscopy and swallowing assessment. Referral to other specialties including pulmonology, speech therapy will be done as required.

Flexible Nasolaryngoscopy

If further assessments of lower airways are required, then micro laryngoscopy and Bronchoscopy under anesthesia will be planned.

Depending on final diagnosis, management including conservative, endoscopic procedure or open airway surgery will be planned.

Doctor Patient Encounter : Paternalistic versus Mutualistic

A doctor patient encounter in out patients is the consultation.A consultation has to be used as a means to understand patients ideas,concerns and expectations about their illness.This is called Concordance.Concordance is the quality of consultation.

The old fashioned paternalistic approach is no more accepted by many patients. The free availability of information about medical conditions on the internet means patients can now arrive at a consultation with sheaves of paper to challenge the doctors authoritative knowledge.
Mutualistic Approach is the way forward.

Unlike the words Compliance or Adherence we use for the patients.Better concordance leads to compliance and adherence to treatment.

If we do not involve them in this way,there are bound to be misunderstanding and dissatisfaction.

Usually any doctor spends time in a consultation to reach a diagnosis after listening to patient symptoms and clinical examination.
However once in a while you meet a patient who believes that the doctor has not spent enough time with them.What causes this confusion or misunderstanding?

How do we decide with whom to spent how much time?
It appears that the time of interaction is decided by presenting symptom OR rather how quickly the patient comes to the main complains.
Simple example is that if someone has an acute infection,it's a simple and short consultation within allotted 15-20 minutes.(with an average consultation time of 8 minutes)
Versus if someone has a chronic illness or a disability,then doctor needs to spend more time.

We come across patients who are having simpler diagnosis complaining about spending less time with them ( well precisely that's whats its going to be) I understand the patients perspective that for him/her illness is illness or grave for some.

As a doctor I feel that they can make a list of questions or concerns before visiting the doctor(especially since internet gives a lot of info) and get them answer promptly.Rather than quoting internet or what they have read or other specialists have told them.

Mutualistic Approach brings benefits to both patients and doctors....

Why do we help others? For our own happiness and wellbeing...

Can Helping Others Help You Find Meaning in Life?

6 years Post cochlear implantation mainstream education and speech language

External Speech Processor Upgrade for Cochlear Implants: What are the criteria for upgrade?

The Cochlear Implant system consists of an internal part which is surgically inserted  and an external Processor.

Internal component 

intraoperative snapshot of internal part

The external component is switched on 2-4 weeks after surgery

external procesor

The magnet (beige) of external processor is seen 

The external processor has to be maintained and cared for so that the child is always listening to sounds.

The processor care can be categorised in two groups:

I. Providing repairs,replacements and batteries.Some components are covered in warranty and we always prepare parents to keep aside an amount for these regular maintainance in our pre operative councelling.

II.To provide access to newer technology which can provide improved perception of speech to the implantee.
Usually the external processor is changed anywhere between 3-10 years (on an average of 5 years,child may need a new speech processor).

Newer technologies may provide better access to spoken language and ease/comfort of use.

Following links provide information on processor upgrade criteria in Australia and Canada where upgrades are government sponsored.

www.hearing.com.au

Sharing the Canadian Guidelines for Processor upgrades  for Pediatric Cochlear Implant users

https://www.cadth.ca/speech-processor-upgrades-pediatric-patients-cochlear-implants-clinical-evidence-and-guidelines

2015 - The year which lead me from a job to a career

There is a not of unrest amongst doctors these days.The growth of private corporate hospitals is  making it difficult for private practices to survive.Managers in these hospitals are looking for turnovers and quarterly growth. Doctors are stuck between good medical practices and economics of getting that paycheck.

This is beautifully sum up in an article http://www.forbes.com/sites/susanadams/2012/04/27/why-do-so-many-doctors-regret-their-job-choice/.Though it's in American context,some applies to us as well.
"The transformation of the field from independence and professionalism to being commoditized and feeling like you’re just another worker is disheartening to some,” says Howard Forman, a professor at the Yale School of Management who researches diagnostic radiology, health policy and healthcare leadership.

I myself had a successful job at a corporate hospital for ten years. My passion for pediatric ENT took me to Spastics Society of Karnataka and Indira Institute of Child Health,working as an Honarary.

I started doing ground work on pediatric deafness when I started the pilot of Universal hearing screening at K C General Hospital in 2013.I worked with NRHM .(National Rural Health Mission)

Finally the decision of leaving a corporate OPD practice came and it was not easy. I still need to go to a corporate to operate as I perform high end surgeries like Cochlear Implantation.I also perform Endoscopic Sinus surgery and do Base of skull work with Neurosurgeons.

Within 6 months of leaving corporate and starting our Anganwadi and government school screenings,we were rolling.We were the finalists in the prestigious BMJ South Asia Award in Healthcare Advocacy Category.

There is a long road ahead..

I want to see a day where Newborn hearing screening is made Mandatory in India nad every child is screened regularly till age 6 years.

Along with above,I wish to support as many under privileged hearing challenged children as I can and help them to be mainstreamed.

All of above is only possible with the support of my team and well wishers