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Deafness, its effects and solutions

For someone uninitiated into the world of hearing loss and mutism, deafness is just another disability that one faces every day, and yet turns away in mock pity. But deafness is much more than that; it is a social embarrassment, a financial hurdle, an emotional block and even a career breaker.

Also, for many people, deafness is someone who cannot hear at all- no one cares for the millions who suffer from varying forms and severity of hearing loss. Not to hear the melodies of a favourite song, not to hear a loved one's voice, always to ask someone to repeat what was said and to silently suffer in the middle of a group conversation is just a few examples of what these unfortunate patients go through in everyday life.

The organs of hearing are one of man's most sophisticated senses. Fully mature and functional before a child is born, these exquisite organs perform so perfectly, and all the time, that we are so unaware of its great ability. Sounds set up vibrations in the air that are picked up by the delicate tympanic membrane or the "ear drum". This sets in motion little, delicately articulated bones of the middle ear called the Malleus, Incus and stapes. Due to the lever effect of these bones, sounds are amplified and fed to the inner ear via a membrane called the oval window. Vibrations further pass into the coiled, snail like structure in the inner ear called the cochlea. This is a marvel of architecture- a tube 35 mm long and 2 mm wide, broad at the base and narrow at the tip, and a delicate membrane suspended between three fluid-filled channels. The membrane consists of rows of tiny filaments called hair cells. When the membrane is set into vibration because of the sound waves, the hair cells move and due to a special arrangement where the base of the cochlea responding to high frequency sounds and the apex to low frequency sounds, electrical impulses are generated, which travel to the brain and are perceived as sounds.

Sadly, things can go wrong anywhere in this sophisticated chain of events. Small children are especially prone to infections of the middle ear and fluid can collect there, leading to repeated ear pain and hearing loss. Since they hearing loss is usually of a mild degree, most parents are unaware and the child could just be a poor performer in school. But the real danger is the fact that untreated fluid collection in the middle ear could lead to ear disease and progressive hearing loss. A simple surgical procedure called a myringotomy, taking just a few minutes and painless, is a solution for children suffering from this condition. Though hundreds of myringotomies are performed every day in developed countries, even in an educated state like Kerala, the awareness is low and this accounts for the high incidence of discharging ears and hearing loss among the people. It is a sad fact, and something that the health authorities should note, that most of today's ear surgeries could have been avoided had middle ear fluid collection been identified early. Many children who suffer just are poor students and it is shocking to note that lives for these children would have changed if parents take children who suffer from ear pain for a simple test called a tympanometry or impedance audiometry.

Sadly, ear surgeries are on the rise today due to this simple protocol not being adapted. Ear surgery, contrary to a few years ago, has become sophisticated and safe, with a vast majority of patients getting a dry ear and improved hearing. Patients do not realise that poor results from ear surgery is not a fault of surgery; it is due to delay in performing surgery. A simple ear drum perforation (hole) would cause only a 30dB loss. But surgical results are so much better now, instead of when the bones of the middle ear are destroyed by disease when the hearing loss is 50-60dB, when hearing conversation is affected. Ironically, patients go to doctors only when they have this kind of disability, and sometimes get poor hearing results after surgery. It is important to realise that an ear drum perforation of more than three months duration is unlikely to heal by medical methods and the earlier surgery is done, better are the results. Modern ENT operation theatres have skilled surgeons, sophisticated microscopes and high-speed drill systems to make surgery faster, safer and more painless than ever before. In our Institute, most patients leave hospital on the same day of the surgery and are back to work the next day!

There is yet another kind of deafness called Otosclerosis that can be effectively treated surgically, but fear of further hearing loss has scared away some patients from surgery. Yes, there is a very slight chance that surgery could result in further hearing loss, but the chance of this happening in good hands is so slight that it is probably foolishness to avoid a painless, day-care procedure that can give one instant, good hearing on the day of surgery. Since most patients with otosclerosis can hear themselves quite well, they are acutely aware of hearing loss and do not mix with people and avoid conversations. This can lead to great social embarrassment, and for almost all of them, life changes completely for the better after stapedotomy, the surgery for this condition. Doctors gently remove the smallest bone of the middle ear called the stapes; drill a very fine precise hole using a micro drill at the base of the bone and insert prosthesis, scarcely 5mm long and .6mm wide. Due to the precision of the surgery, patients can go home the same day and return to normal activity immediately. In good hands, 99 % of patients can achieve good results after surgery. Again, surgical results become poorer if the disease is neglected, when the inner ear is affected.

Earlier, inner ear deafness was called nerve deafness and was deemed "impossible" to treat. Children born with severe to profound hearing loss were detected early, treatment delayed and distraught parents run from clinic to clinic in search of an elusive solution. These unfortunate children develop abnormal speech or in very severe case no speech at all. It is a sad fact that even some doctors are unaware that hearing loss should be identified before three months of age for normal speech to develop. To say that "wait for some more time, your child will be ok" is a gross mistake. Nowadays, hearing can be accurately and quickly tested immediately after the child is born. Not even the most educated of parents can identify hearing loss at this young age and as 4 out of a thousand normally born children have hearing loss, most countries in the developed world consider it compulsory to test all children for hearing loss in the new born period. Since India has even reached the moon, it would be incorrect not to consider us developed, so it is time we follow suit and try and prevent "deaf and dumb" people in the society.

Cochlear implantation has now come of age. If children are identified to have severe to profound hearing loss at a young age, and if hearing aids do not provide enough benefit, cochlear implants would help them to develop near normal, if not completely normal speech and language. Fear of surgery is what keeps many a parent delay intervention. Often the realisation comes when they meet parents of an earlier implanted child, and by then sadly, "deaf speech" would have set in and nothing, not even cochlear implants can provide normal speech. Over 200 children have been implanted in our Institute, many of them young and now almost fully integrated into the hearing world. For the others who have not had implants when very young, it provides useful hearing sensation to compensate to some extent to the handicap. Not one has experienced a major complication, making cochlear implants one of the safest surgeries today. It is expensive, yes, but for a lifestyle change, not too expensive. The Government of Andrapradesh, with infinite maturity has started an "aryogyasree" campaign where children younger than 6 years of age below the poverty line get free cochlear implants! For this government, like many abroad realises that it makes more financial sense to make a deaf child a productive member of the society than to support a deaf and dumb individual throughout life. We hope that more State governments follow suit, and finally some day, deaf children never will have to grow up dumb.

Technological advances ensure that almost every form of hearing loss can be now treated- There are now bone anchored hearing aids (BAHA), implantable hearing aids and more. Institutes like Dr. Manoj's Super specialty Institute and Research centre bring you sophisticated technology, surgical skill and modern diagnostic methods to ensure that deafness and hearing loss need not be necessarily endured, but overcome. But none of this is effective unless treated early and the message is – if you have a hearing problem, treat it now; tomorrow maybe too late!

 
 
Otology Master Class
From the Organizing desk

Dear friends,

MESIARC CME is here again. We have always strived to bring you the best in Otology, over the past 10 years, Our live surgery workshops, have focused on cutting edge surgery, detailed teaching, scientific deliberations of the highest order and top class video coverage from one of the most advanced otological theatre suites in the world this time, we are focusing on the enigma of budding otologists - cholesteatoma and Otosclerosis. Two very diverse conditions, but requiring surgical expertise of the highest order to deliver good results. The two-day surgical workshops will feature both myself and a luminary in Otology, Dr. Ashesh Bhumker from Thane, Mumbai and we would be demonstrating in detail the finer aspects of surgical techniques that can be adapted by a keen otologist to sustain good results over time.

We have lined up an array of diverse cases- and the techniques that we intend to demonstrate include minimal access stapedotomy, Laser stapes surgery, stapes surgery with stapes head amputation for tendon preservation, bone obliteration technique for cholesteatoma, a variety of grafting techniques, intact canal wall tympanoplasty for limited cholesteatoma and a series of revision surgeries.

Do send in your registrations early as we have to limit attendance to 70 seats. A smaller crowd is ideal for active discussions which is something so characteristic of MESIARC CME programs and we do not want to deviate from that agenda.


Yours truly,

Manoj MP  
Organizing chairman

Otology in Perspective Live Surgery 2015
From the Organizing desk

Mesiarc brings you a unique live surgical workshop- a demonstration of both endoscopic and microscopic otologic skills.

Otologic surgery is special for its intricate anatomy, extreme precision and attention to detail. Traditionally done with the operating microscope, and now in some centers across the world with the endoscope, the repetoire of the art is widening.

Confusion persists. Advocates of endoscopic work claim that the microscope is passe, and traditional surgeons laugh off the ability of the one handed

The truth lies somewhere in between; there are specific conditions that require either of both of the techniques. Dogmatism, they say, is the end of science.

Mesiarc brings you a unique live surgical workshop- a demonstration of both endoscopic and microscopic otologic skills.

MESIARC has always stood for dissipation of knowledge and the live surgical workshops are not pubilicity events, nor are they grandiose. We have just one agenda- to educate.

This workshop with a difference aims to demonstrate both endoscopic and microsopic skills in otologic surgery, while attempting to define which is more suitable for what. Do come and enjoy!


Yours truly,

Manoj MP  
Organizing chairman

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