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Early communication is the key!

What sets the human race apart from the countless thousands of species that reside on this planet is our ability to communicate verbally. And the essence of communication is hearing. It is debatable when the infant actually begins to hear- but we do get a clue from developmental studies that the cochlea or the inner ear is one of the earliest organs to develop fully and by 28 weeks in the mother’s womb, the cochlea is fully developed. The mythical story of Abhimanyu hearing about the Chakravyuh, while still unborn is evidence that our forefathers had some clue about this.

Well, now that we know that even an unborn child can “hear”, it is easy to postulate that hearing early is vital to development of language. Research has shown that if hearing loss is identified and corrected before the child is six months old, the speech development is far superior to those children who have it corrected later. Unfortunately most people, including medical professionals are unaware of this fact and try to test for hearing only when they suspect something is wrong, which is often too late. This is exactly why, in the developed countries, almost 100% of children have their hearing tested in the first few days of life and if found deficient, have hearing aids fitted by three months! We only have to look around for evidence that our failure to do this has caused so much harm.

In spite of the countless hours of tireless activity done by the teachers of the deaf, a vast majority of children in deaf schools do not develop normal speech and language and the teachers themselves complain that they are getting the children too late. Even very educated and intelligent parents do not identify deafness before the child is about a year old. By then, parts of the brain that are supposed to code for speech are already disappearing, replaced by the “visual” brain, making these children look very “smart and active”, and sadly, by two to three years, this damage is almost complete.

So, do we have an option? Yes, science has paved the way by the discovery of techniques that enable us to accurately assess the hearing of a newborn infant. Brain Stem Evoked Response Audiometry (BERA), Auditory steady state response (ASSR), Tympanometry, Pure tone / Speech Audiometry & Oto acoustic emissions (OAE) are tests used to find this out, and combined with skilled pediatric audiologists, we are able to do this with 100% accuracy. Some causes of hearing loss like fluid in the middle ear are easily correctable, but for the inner ear type of deafness, which affects 4 out of a thousand children born, making it the most common new born defect, the child may have to wear hearing aids.

Wearing hearing aids has been seen with so much taboo and that is tragic, because that happens to be the first step towards normalcy that a young child with a hearing problem can take. By early fitting of hearing aids and with a new kind of therapy that focuses on hearing as the primary modality, called Auditory-verbal habilitation, most children can learn to speak normally and go to normal school and just be normal children. A small obstacle in this story is that there are very few teachers trained in auditory verbal habilitation and though we have three, it is difficult to find more!

For those unfortunate few who cannot develop normal speech with adequate habilitation, science has again come to the rescue with a device that for the first time ever, directly communicates with the hearing centers in the brain- the Cochlear implant. Many people still believe, even after our program which is the first in Kerala and have already completed 160 implants, that cochlear implantation is too expensive and is too risky. For a well trained surgeon, this is a procedure that takes only a little more than an hour, and is one of the safest of all surgeries to perform. As to the cost, it is only as expensive as a mid size car, and considering that we are flooding our poor roads with countless such monsters, this is but a small price to pay to make a deaf child talk sing and read like a normal child, and enable him or her to pursue higher academic studies and earn well for themselves.

Prices have come down, and in our center, costs of the implant and surgery with two years of programming and medical support in one of the most sophisticated centers in India, start from Rs. 5,34,000/-. We also have done over 27 implants with local funding, where the costs are much lower, ensuring that if you are poor, this should not come in the way of your child’s ability to communicate!

How do we choose a cochlear implant center? It is important to choose a team that has been together for many years. You do not want to go back with your child after a few years and find that the team is no longer together! You also should ensure that the cochlear implant team takes time to evaluate, give a good period of hearing aid trial, talks in detail and answers all your questions, and encourage you to speak to other implantees. Compassion, empathy and care, words that are often associated with the medical profession, are most vital in the field of cochlear implantation.

Dr. M.P. Manoj
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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