A cochlear implant (Bionic Ear) is an artificial hearing device, designed to produce useful hearing sensations by electrically stimulating nerves inside the inner ear. The Bionic Ear was pioneered in 1978 by Professor Graeme Clark and his team.
The present day multi-channel cochlear implants consist of 2 main components: 1) the cochlear implant package and electrode array (or receiver-stimulator) and 2) the speech processor and headset.
For most people, the ears are self-cleansing. Presence of ear wax does not mean your ears are dirty. Wax is a normal component of the ear canal manufactured by specialized glands in the outer ear. Its function is to protect the delicate skin of the ear canal. Massage of the ear canal by talking and chewing tends to naturally propel wax out of the ear canal. Those who have normal ears (with no hole in the ear drum or other ear disease) can safely use an over-the-counter ear wax softening solution. People with very small ear canals and whose wax tends to be very dry and mixed with a lot of dry skin should have their ears cleaned periodically by a professional. Inserting a bud or pin into the ear has to be avoided because it actually pushes wax further down into the canal. It can also puncture the ear drum or cause more serious injuries.
If you have disease or obstruction in your external or middle ear, your conductive hearing may be impaired. Medical or surgical treatment can probably correct this.
An inner ear problem, however, can result in a sensorineural impairment or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. Severe sensorineural hearing loss cannot be corrected with medicines, it can be treated only with a cochlear implant.
Implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be 12 months of age or older (unless childhood meningitis is responsible for deafness).
Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, though not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The evaluation will be done by an implant team (an otolaryngologist, audiologist, nurse, and others) that will give you a series of tests:
Ear (otologic) evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormality precludes the implant surgery.
Hearing (audiologic) evaluation: The audiologist performs an extensive hearing test to find out how much you can hear with and without a hearing aid.
X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear bone.
Psychological evaluation: Some patients may need a psychological evaluation to learn if they can cope with the implant.
Physical examination: Your otolaryngologist also gives a physical examination to identify any potential problems with the general anesthesia needed for the implant procedure.
Implant surgery is performed under general anesthesia and lasts two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure usually requires a stay in hospital for 2-3 days, depending on the device used and the anatomy of the inner ear.
About one month after surgery, your team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant. Some implants take longer to fit and require more training. Your team will probably ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.
Cochlear implants do not restore normal hearing, and benefits vary from one individual to another. Most users find that cochlear implants help them communicate better through improved lipreading, and over half are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including:
how long a person has been deaf,
the number of surviving auditory nerve fibers, and
a patient?s motivation to learn to hear.
Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. A few patients do not benefit from implants.
It is an inflammation of the membrane lining of the paranasal sinuses. In acute sinusitis, facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, fever and cough may occur. It is generally treated with antibiotics and decongestants.
In chronic sinusitis, facial pain/pressure, facial congestion/ fullness, nasal obstruction, nasal/ postnasal discharge, diminished sense of smell, fever, headache, bad breath and cough may be present. The symptoms are usually present for 12 weeks or more.
An endoscope is an instrument for the examination of the nose and sinus drainage areas. The patient?s nasal cavity is anesthetized with a local anesthetic and diagnostic nasal endoscopy is done. Signs of obstruction, nasal polyps hidden from routine nasal examination are visualized. Structural abnormalities that cause recurrent sinusitis are identified.
Nasal spray / nose drops, decongestants, antibiotics in patients with bacterial infection, antihistamines for treatment of nasal allergies are usually prescribed. Patients are advised to refrain from smoking.
Mucus is formed in the nose and acts as a lubricant. In the sinus cavities this lubricant is moved across mucous membrane linings towards the opening of each sinus by millions of cilia (mobile extensions of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking sinus movement. Endoscopic sinus surgery may be required to correct this problem. The natural opening of the sinuses is enlarged and areas of obstruction are removed to allow the normal flow of mucus. This procedure is highly effective in restoring the normal function of the sinuses.
The basic endoscopic surgical procedure is performed under general / local anesthesia. The patient returns to normal activities within four days and full recovery takes about 4 weeks.
Not seeking treatment of sinusitis leads to pain and discomfort. In rare circumstances, meningitis, brain abscess, loss of vision, infection of the bone, etc may occur.
Snoring is a social problem and may be associated with significant sleep disturbances, waking episodes etc. Individuals who snore may also be suffering from OSAS. OSAS is characterized by significant and prolonged interruptions of breathing (airway obstruction) during sleep. These episodes of cessation of breathing may be associated with substantial decrease in blood oxygen levels, irregularities in the heart?s normal beating pattern (cardiac arrythmias), high blood pressure, and even sudden death. OSAS is a serious disorder. Symptoms of sleep apnoea include excessive day time tiredness / sleepiness, a feeling of dullness or napping during work hours, falling asleep while driving, headaches etc.
The main investigation required is a polysomnogram (sleep study) which is an overnight test usually performed in a sleep laboratory where one simply falls asleep for a number of hours. During this sleeping time, important processes including ECG, blood oxygen levels, number and duration of apnoeic spells are monitored. A sleep MRI is also essential to identify the level of obstruction.
The treatment can be nonsurgical (weight loss, CPAP etc) or surgical (e.g. LAUP). Continuous positive airway pressure (CPAP) - pressurized air is administered by way of a face mask which is worn during sleep. This maintains adequate pressure to overcome airway obstruction. In Laser assisted uvulopalatopharyngoplasty (LAUP), a laser beam is utilized to reduce the redundant tissue in the back of the throat.
A cholesteatoma is a serious infection which affects the ear. The skin of the ear drum grows into the middle ear and becomes a cholesteatoma. This looks like an onion peel of white skin formed into a ball. It can destroy the bones of hearing as it grows. Symptoms include hearing loss, recurring ear discharge which may be foul smelling. It tends to actively erode bone and may cause nerve deafness, imbalance and dizziness. The thin plate of bone that separates the roof of the ear from the brain can also be eroded by cholesteatoma. This exposes the covering of the brain. In extreme situations, it can lead to brain infection and other serious complications. Cholesteatoma is a serious condition and when diagnosed requires prompt treatment. Polyps (growth of inflamed tissue) are often present in the ear with cholesteatoma. The treatment required for cholesteatoma is micro ear surgery.
Structures of the ear are very small. The surgery is usually performed with an operating microscope which enlarges the view of the ear structures sufficiently so the surgeon can perform the delicate tasks needed. The incision is made behind or in front of the ear. The wall separating the middle ear from the mastoid (bone behind the ear) is removed. Disease clearance is done. Hearing reconstruction is then done. The surgery results in a so called open cavity which requires long term follow-up.
Head and neck cancers actually include many different malignancies. The way a particular cancer behaves depends on the site it arises (primary site). The main parts of the head and neck include oral cavity, oropharynx, nasal cavity, nasopharynx, paranasal sinuses, hypopharynx, larynx, thyroid and salivary gland. Most common types of cancers in the head and neck is squamous cell carcinoma, the others being lymphoma, sarcoma, salivary gland tumours etc. Typical symptoms include a lump or sore that does not heal, a sore throat that does not go away, difficulty in swallowing or breathing, and a change or hoarseness in the voice. Diagnosis of head and neck cancers is by a complete physical examination, CT/MRI scan, endoscopy and tissue biopsy. The three main types of treatment for head and cancers are surgery, radiotherapy (high energy X-ray to kill cancer cells) and chemotherapy (anti-cancer drugs). Surgical treatment consists of removal of cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed. Optimal combination of the three treatment modalities for a patient with a particular head and neck cancer depends on the site of the cancer, extent of the disease and medical condition of the patient. Rehabilitation and regular follow-up care are important part of the treatment.
It is a surgical procedure that maintains, restores or enhances the human voice. Phonosurgery includes phonomicrosurgery (microsurgery of the vocal folds done through an endoscope), laryngoplastic phonosurgery (open neck surgery that restructures the cartilaginous framework of the larynx - voice box), soft tissue laryngeal injection (injection into the larynx of medications as well as synthetic and organic biologic substances) and reinnervation (restoration of the nerve supply) of the larynx. Use of the microscope during laryngeal surgery enhances precision. The results of surgery are excellent but have to be followed up with voice rest, hygiene and rehabilitation to get good long-term results of voice improvement.
The laser has proved to be a valuable tool in ENT due to its precision, blood less dissection with minimal damage to surrounding tissues, and its ability to produce minimal postoperative edema, pain and scarring. The CO2 laser has been the workhorse of ENT surgery for many years. It is a good cutting tool but a poor coagulator. The KTP /532 laser cuts nerve endings smoothly, hence decreases postoperative pain. Its precision, with decreased damage to surrounding structures leads to decreased postoperative edema, pain and scarring. It is an ideal laser for ENT and Head and Neck surgery. In the ear, the laser can be used to treat disorders of the outer ear such as stenosis (narrowing) and benign tumors, removal of disease in the middle ear, stapedotomy (an operation done in patients with a fixed bone in the middle ear causing hearing loss). In the nose, the laser can be used to remove disease from the nose and sinuses, tumors, etc. In the throat, it has many applications such as tonsillectomy, LAUP (removal of redundant tissue in the back of the throat in patients with snoring and sleep apnoea), tumors ? both benign and malignant, cysts, narrowing in the windpipe etc. With the introduction of lasers in ENT, a majority of ENT surgeries have become day care procedures.
