Division

• Cochlear Implants
• Rhinology
• Otology
• Laryngology
• Pediatric otolaryngology
• Head and oncology
• Audiology and speech therapy
• Baha

Cochlear Implants

Cochlear implants for children

What is a cochlear implant?

A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of damaged parts of the inner ear (cochlea) to send sound signals to the brain.

Cochlear implants have helped over one hundred thousand people hear again or for the first time.

Who can they help?

Cochlear implants can help children who:

• Have severe to profound sensorineural (inner ear) hearing loss in both ears
• Receive no real hearing benefit from hearing aids
• Are not making progress in developing speech
• Have parents and families dedicated to their child learning speech and being part of the hearing world

How do they work?

Many people suffer hearing loss because they have damage to hair cells in the inner ear or (or cochlea). If some hearing nerves still work, a cochlear implant can allow you to hear.

What are the benefits of a cochlear implant?

Many parents of children with cochlear implants report that their child:

• Speaks at normal hearing level, Speech and language has developed at the right level for their age.
• Has greater confidence in social situations, Communicate better with family, friends and teachers.
• Hears clearly in noisy environments, In classrooms, playgrounds and other loud, busy places.
• Enjoys a world of new sounds, Parents and friend’s voices, music, birds singing, rain outside the house.
• Feel safer in the world, Know the direction sounds come from such as voices and approaching vehicles.
• Talk on the phone
• Enjoy music

What factors can affect hearing outcomes?

Hearing is uniquely different for everyone - like a fingerprint. There are many factors that can affect how well your child will hear and talk with a cochlear implant. These include:

• How long your child has had hearing loss.
• The condition of their inner ear.
• Other medical conditions.
• The level of habilitation after receiving the cochlear implant.
• Practice hearing with their cochlear implant.

• A sound processor worn behind the ear or on the body, captures sound and turns it into digital code. The sound processor has a battery that powers the entire system.
• The sound processor transmits the digitally-coded sound through the coil to the implant.
• The implant converts the digitally-coded sound into electrical impulses and sends them along the electrode array placed in the cochlea (the inner ear).
• The implant's electrodes stimulate the cochlea's hearing nerve, which then sends the impulses to the brain where they are interpreted as sound.

Rhinology

The rhinology division provides advanced care for patients with chronic sinusitis, nasal polyposis, fungal sinusitis, nasal obstruction, and tumors of the nasal cavity and anterior skull base. Minimally invasive endoscopic techniques are available for patients with complex nasal and sinus disease. Some common problems that are treated include :

• Allergies
• Sinusitis
• Nasal polyps
• Deviated nasal septums

Often collaboration with neurosurgery, neurology, ophthalmology, allergy/immunology and radiology specialists is needed to provide the most comprehensive multidisciplinary care possible for our patients, including difficult cases that have failed previous medications or surgery.

The commonest surgical procedures done in the division include endoscopic sinus surgery and septoplasty.

Endoscopic sinus surgery

Endoscopic sinus surgery is a surgical procedure used to remove blockages / diseases in the sinuses. These blockages can cause sinusitis, and other conditions, in which the sinuses swell and become blocked, causing pain and impaired breathing along with repeated infections.

The surgery is performed under general anesthesia. An endoscope (telescope) along with a camera is introduced through the nostril for visualization and magnification of nasal and sinus tissues. Specialized instruments are used to safely and effectively removed causes of sinus or nasal blockage. The septum may also be straightened if needed. Endoscopic sinus surgery does not involve any skin or face cuts and is done entirely through the nostrils. Most patients can be discharged on the same day or after overnight stay in the hospital. The aims of the surgery are to removed airflow blockages in the nose and to improve drainage and aeration of the sinuses. Endoscopic sinus surgery is used to treat not only sinusitis, nasal polps, deviated septums but also more complex disorders like dacrocystitis, nasal and skull base tumors.

Septoplasty

Septoplasty is performed to straighten a deviated or crooked nasal septum. patients who benefit from a septoplasty those who have a significant abnormality of the septum and blocked nasal breathing. There may be secondary benefits in nasal discharge and post nasal dripping.

The operation is done under general anesthesia. An incision is made inside the nostril (not in the visible part of the face) and the lining (mucosa) covering the septum is elevated. The deviated portions of the cartilage or bone that may up the septum are removed or reshaped. Enough tissues is left behind to support the natural shape of the nose. The incision is then stitched close.

Otology

We provide comprehensive care to patients who have diseases of the ear, including hearing loss, infections and dizziness. This division is concerned with the entire scope of otologic and neurotologic surgery, including tympanoplasty and mastoidectomy for chronic otitis media, surgery for hearing loss including ossiculoplaty and stapedectomy, vertigo and facial nerve paralysis. Ear surgery is mostly done under general anesthesia but can be done under local anesthesia. The procedure is performed under an operating microscope. Patients are discharged on the same or the following day. Postoperative care is simple and includes avoidance of water entry into the ear and routine ear cleanings in the clinic. Restoration of hearing may take upto six months for the benefit to appear.

Laryngology

The Laryngology division provides evaluation and treatment for disorders of the larynx and associated structures. This includes voice, swallowing, and breathing problems, and encompasses both benign and malignant diseases. The division specializes in care of the professional voice, phonosurgery for vocal cord nodules and polyps, laser surgery of laryngeal lesions, rehabilitation of the paralyzed vocal cord, and management of upper airway obstruction and gastroesophageal reflux disorders (GERD). The division maintains a special interest in reconstruction of the larynx and trachea for stenosis including tracheal resections and anastamosis.

We care for anyone who has concerns about voice or swallowing, however people with vocally demanding jobs are at particularly high risk for vocal pathologies. Such groups include teachers, lawyers, sales executives, business presenters, singers and those who habitually speak in a loud volume. These people are particularly prone to problems like vocal nodules, polyps and cysts which are treated by endoscopic removal under a microscope. The operation is normally done as a day care procedure and does not involve any cuts on the neck or face skin. Voice Therapy services are also offered

Pediatric Otolaryngology

The Division of Pediatric Otolaryngology evaluates and treats disorders of the ear, nose and throat in children. All aspects of pediatric disorders are seen, with special emphasis placed upon communicative disorders, airway problems, infectious diseases, neoplasms, congenital anomalies and paranasal sinus disorders. All aspects of medical and surgical therapy are covered, including tympanostomy or grommet insertion, mastoidectomy, detailed airway procedures, airway reconstruction, pharyngeal flaps and major soft tissue surgery. Complete medical and surgical care is provided to infants and children with complex and often rare diseases and conditions.

Common procedures are also provided for children like adenoidectomy and tonsillectomy. Adenoidectomies are often done using endoscopes and specially designed microdebriders. We believe this is safer and offers more comprehensive removal of the adenoids as compared with the traditional ‘blind’ curettage method. Some examples of pediatric ear problems include otitis media, cholesteatoma, hearing loss, and birth defects (atresia). Pediatric diseases are tackled in a comprehensive manner including participation from pediatricians and special care before, during and after surgery to make the hospital admission a less traumatic experience for a child.

Head and Neck Oncology

In coordination with our cancer center we diagnose, manage and provide rehabilitation for patients with benign and malignant neoplasms of the head and neck. We have expertise in treating mouth, throat and voice box cancers, and use a multidisciplinary approach to provide state-of-the-art care.

Audiology and Speech Therapy

Basic Services In addition to providing routine hearing assessment and hearing aid evaluation services, we conduct a number of highly specialized audiologic, electrophysiologic and neurodiagnostic procedures. The services include: audiometry, tympanometry, BERA, hearing aid trial, hearing aid fitting and auditory rehabilitation. The division is staffed by academically trained audiologists.

Speech therapy
In addition to diagnostic services and intervention based on the provision of hearing devices, audiologists provide guidance and treatments for patients and families on the following:

• How language is learned and spoken
• Speech therapy for patients following operations and strokes
• Speech therapy for children with speech disorders and misarticulation
• Lip reading and sign language techniques

Hearing aid fitting

Hearing ability is very important for understanding speech and for a wide variety of other functions such as detecting warning alarms and listening to music. When the abnormal or damaged auditory system is not directly reparable through surgical or medical means, a wide variety of advanced hearing devices is available that can improve these functions, very often quite dramatically.

With the proper selected, fitted and adjusted hearing device, patients with any degree of hearing loss from very mild to total deafness can achieve hearing functions that were not attainable previously. Because these devices generally do not restore the underlying abnormal auditory structures, the sense of hearing is not restored to its natural normal state. However, these devices can optimize or even replace the remaining hearing function and improve hearing ability such that significant life style changes often occur.

Patients who were deaf now can detect sounds and understand speech once again.  Others whose hearing has deteriorated sufficiently to prevent them from easily communicating with others, in particular, family members, now rejoin the world of easy and natural communication often restoring communication ability to its previous functional state. Virtually everyone with a permanent hearing deficit may benefit from the use of an advanced hearing device. If it has been determined that you are not able to hear sounds within the normal range needed to fully hear and understand speech in normal conversational situations, you should consider being evaluated for the benefits of new, high technology advanced hearing devices

Hearing aid prices vary depending upon the style and the circuitry that would best accommodate your hearing loss. Conventional hearing aids are less expensive but they are limited in the features. The digital hearing aids are more expensive but they offer features that would benefit you the most. Discuss the financial aspects of your hearing aids with your dispensing audiologist. Remember, you are purchasing your hearing aids to enhance your hearing and your enjoyment of day-to-day communication with your family and friends.

Baha

What is a bone conduction implant?

Most people with hearing loss use standard hearing aids which make sounds louder and send them through the ear canal and middle ear to the inner ear (cochlea) where the hearing nerves are.

But some people may not be able to hear via this process. There may be problems with the outer or middle ear, or one ear may not function at all. In these instances, sound needs to take a different path to the inner ear in order to bypass these hearing roadblocks.

And that’s where bone conduction plays such a vital role.

For people with outer or middle ear trouble, or who are deaf in one ear, a bone conduction implant such as Baha, is the most effective way to provide hearing.Instead of trying to send sound through the damaged part of the ear, a bone conduction implant uses the body’s natural ability to send sound through bone, bypassing the outer and middle ear completely. The result is a clean, clear sound without the distortion or feedback often associated with standard hearing aids.

Who can they help?

Bone conduction implants can help children with:

• Conductive hearing loss (problems with the outer or middle ear).
• Mixed hearing loss (problems with the outer/middle and inner ear).
• Single sided sensorineural deafness (total deafness in one ear).

Your child can trial Baha without having surgery

• A sound processor captures sounds and converts them into vibrations.
• A connecting abutment transfers the sound vibrations from the sound processor to the titanium implant.
• The small titanium implant is placed in the bone behind the ear where it fuses with the bone to form a very strong bond. The implant transfers the sound vibrations through the bone directly to the cochlea, bypassing the outer or middle ear completely.
• These sound vibrations cause the fluid in the inner ear to move hair cells and send sound signals to the brain. We then hear sound.

Baha Softband

Unlike other hearing implants, a Baha can be trialled before making the decision to proceed with surgery. The sound processor is connected to a test band, test rod or Baha Softband, allowing your child to instantly experience hearing via the Baha system. As a parent, you too can trial Baha to experience the quality of sound your child will be hearing.

Bone conduction implant components :