Age Appropriate Speech in Children

Noisy breathing and Snoring in children

Job versus Career: Does it apply to medical profession?

“You can apply for a job, but you cannot apply for a career.”

A job is a specific occupational position within a business or organisation. When we complete medical school, doctors are taught that our career means pursuing a post-graduation. Is it so?

Let’s take a simple example of a vocational career like teaching. We want the people who are teaching our children to think of it as a career, not just a job. We want them to have an interest in our children and care about the success of our children.

Same applies to us as doctors! The patient assesses the technical quality of medical care indirectly by evidence of the interest and concern of professionals with their health and wellbeing. Such evidence is perceived through empathy. To achieve this, we need to love our jobs.

Jobs can help people start careers in many ways – experience, knowledge, learning about what they like and dislike. Eventually though, striving for a career is a very positive step because it means you want more out of the work you do than a paycheck.

I can share my own journey of a job to career. When I worked as an ENT Surgeon dealing with deaf children, I knew to perform surgeries to improve their hearing. I was one of the few surgeons in the country performing the cochlear implant surgery. However, performing surgery was a job and I knew that outcome of the surgery was dependent on post implantation habilitation. There was a dearth of well-trained habilitationists. I needed to strengthen my team and improve my surgical outcomes. This started the journey of my career.

First, I went for further training in cochlear implantation by the best surgeons in the world. I learnt performing cochlear implantation in anomalous cochlea by the surgeon who gave the classification of vestibular cochlear malformation to us. It was a lifetime experience to see his involvement with the deaf children and the outcomes of his implantees.

Next step was to strengthen the habilitation of my implantees and lead a strong team. We not only trained our staff but I did a deaf educator course and certificate course in early intervention in children with disabilities.

As I went looking for options to upgrade my skills, I realised they were unlimited. I completed various courses on Edx and Coursera platforms ranging from “Medical ethics” to “how to become a resilient person”. I am pleased to inform that many of these courses are free. I am now a mentor for Coursera and would recommend everyone reading this article to take at least one course.

Whether a job or career is the right fit for you will depend on your stage of life. Jobs can help people start careers in many ways – experience, knowledge, learning about what they like and dislike. In addition, earning potential is much higher in a career than in a job in most cases.

There is a lot of unrest amongst doctors these days. Doctors are stuck between good medical practices and economics of getting that paycheck. I personally feel that the balance can be struck if we develop our jobs into careers. Every specialty has something to add to the quality of patient’s life than just treating a disease.

So as you can see, while one can work very hard at a job and even be paid well to work a job, a career takes much more motivation and forward-thinking effort than a job

 “A job is given to you, but a career is made by you”

Dr Sheelu Srinivas

Consultant ENT and Cochlear Implant Surgeon

Columbia Asia Hospitals, Sarjapur, Bangalore

Sheelu.S@columbiaasia.com

9902846770

“Disability is not just a health problem”

“Disability is not just a health problem”

On International Day of persons with Disabilities 3rd December, this is the only message I would like to convey to public and professionals alike.

Theme for IDPD 2017: “Transformation towards sustainable and resilient society for all”

Disability has extensive generic meaning. It may refer to any state of existence that limits an individual to perform effectively and efficiently in her/his routines. In India, approximately 10% of population suffers from disabilities related to locomotion, vision, hearing and intellect as per the NSSO 2010 report.

The Rights of persons with Disabilities Bill- 2016 replaced the Persons with Disability act 1995 (India). This new bill has defined disability based on an evolving and dynamic concept. The types of disabilities have been increased from 7 to 21. Speech and Language disability and specific learning disability have been added for the first time in the 2016 bill. Following link gives a nutshell information http://pib.nic.in/newsite/PrintRelease.aspx?relid=155592

Speech and language delay lead to communication disability. 
Communication delays can be due to primary presenting symptom of other physical, sensory or mental disability, commonest example being sensorineural deafness. However, it can also be associated with other forms of disabilities like Autism. Now with Speech and Language included as a separate disability, an ENT specialist and the team of audiologists and speech therapist cater for almost 40 % of the disabilities.

Children who suffer from speech, language and communication disorders in early childhood may face difficulty with language learning, education, social interaction, employment and beyond.

Let’s pledge that we work towards the early diagnosis and habilitation of these children and be a supportive society.

And for the professionals, let’s have an approach of treating disability and not a disease.

Where did I start and where am I led to..in my professional journey.

Looking back at my professional life  ....I create this profile.
However it is definitely incomplete as it does not lists the beautiful souls I have met and exchanged so much of joy in working with them.It does not lists my colleagues, hospital staff, my team members, mentors, teachers and family and extended families of patients who have been my strength.That particular list of my support pillars is very exhaustive and I can only say that I am here because of them.

Profile: Dr Sheelu Srinivas, M.S.ENT, DORL (Mumbai), DLO (RCS, London)

Dr. Sheelu Srinivas is an ENT Surgeon with over 17 years of experience. She studied ENT at K.E.M. Medical College, Mumbai and underwent further training in Otolaryngology in the U.K. She pursued her further surgical training in Otology and Pediatric ENT in France, Turkey and Switzerland. Her interest in deafness and communication disorders in children has led her to successfully complete hands on training and certificate courses on deaf education as well as early intervention in children with Autism and other communication disorders.

Dr. Sheelu Srinivas was the Director and Coordinator - ENT Department at Fortis Hospitals, Bannerghetta Road for a decade where she developed tertiary ENT unit along with Cochlear Implant and Pediatric Airway Programs. She also worked as Honorary Consultant at Indira Gandhi Institute of Child Health and Spastics Society of Karnataka. She runs her own ENT Diagnostic Center along with Pediatric hearing and Speech Rehabilitation Unit.

Her surgical expertise includes Otology, Cochlear Implantation, Endoscopic Sinus Surgery and Pediatric ENT Surgeries. She is known for her thorough clinical diagnosis and a holistic approach towards patients including the little ones.

Dr. Sheelu is a regular speaker and presenter at various national and international conferences including WHO Symposium on deafness at IFOS Seoul.

She has been involved in starting the newborn hearing screening and deafness habilitation programs in private and public sectors. She ran the first pilot project of Universal Hearing Screening in babies at K.C. General Hospital, Bangalore and went on to introduce Anganwadi projects for screening hearing and speech disorders in the young.

She has been advisor to National Program for Prevention and Control of Deafness, Karnataka and Member of State Cochlear Implant Committee. Her comprehensive work in this field from diagnosis to habilitation led her team to be the finalists of BMJ South Asia Awards 2015 in Healthcare Advocacy category. She is the member of Association of Otolaryngologists of India, Indian Association of Pediatric Otolaryngologists, Indian Academy of Pediatrics, Allergy Chapter and Interamerican Association of Pediatric Otorhinolaryngology.

Importance of the nasal breathing in children

Babies are nasal breathers and do not know how to breath through the mouth when they are born.
At birth, human babies are obligate nasal breathers.

Breathing through the nose enables adequate facial growth and proper positioning of the teeth. It also leads to calm and restoring sleep.

Noisy breathing or snoring is not normal in children. The commonest cause of nose block is allergic rhinitis. A child with blocked nose leads may have bad breath and suffer with sinusitis more frequently. Also these children are less interested in eating as they cannot smell food and hence enjoy it.
Another common cause of mouth breathing in children is Adenoid hypertrophy or Adenoid enlargement. These are lymphoid tissues like tonsils in the space at the back of the nose. The size of adenoids is usually confirmed with a nasoendoscopy.

Breathing through the mouth can cause the following

• Unexpressive face; 
• Changes in positioning of the teeth; 
• Dental caries; 
• Aesthetic facial alterations (elongated face, hypotonic lips);
• Gritting or grinding of teeth (bruxism); 
• Sleep disorders (superficial or restless sleep); 
• Attention deficit or learning disorder; 
• Mood swings.

Read more on allergies,sinusitis and adenoids in the following links:

http://sheelusrinivas-entpractice.blogspot.in/2013/01/allergen-avoidance-is-it-worthwhile.html

http://sheelusrinivas-entpractice.blogspot.in/2017/01/sinusitis-in-children.html

http://sheelusrinivas-entpractice.blogspot.in/2015/05/removal-of-adenoids-and-tonsilswhich.html

When to consult an ENT Doctor for my child?

"Your child's Pediatrician is the primary care provider and incharge of your child's health."

Parents should consult a Pediatric ENT only if the child's Pediatrician has suggested them to do so.

Pediatric otolaryngologists are concerned with treatment of medical and surgical ENT disorders in children. They have been trained to take care of children from newborn period to teenage years.

Children are not just small adults.The disease presentations and management can differ from adults.Right from the clinical approach for diagnosis differs in children.It needs specialised training and experience in working with children to keep them comfortable while examining them.

A child will not always be cooperative and will not be able to answer medical questions or express their problems. Sometimes they have their own ways of expressing concerns. I cannot forget a 3 year old telling me her ears are "singing" and we did go ahead and found a cause.

If we learn to interact with kids, they are also capable of giving information.They may not answer direct questions or get overwhelmed with questioning.

Interaction with the child is a must for a pediatric otolaryngologists as child is the one who needs attention.This is especially useful in diagnosing social and communication disabilities.Many times parents are in denial or do not know age appropriate behaviours,in these situations direct interaction with the child is a must.

All of the above requires experience,skill and judgement with the team including the primary treating pediatrician.

Finally be a child with the child....and the doctor for the family.