Key Procedures: Otorhinolaryngology-Head and Neck Surgery

• Myringotomy with Tubes: Placing tiny tubes in the eardrum to drain fluid and prevent recurrent ear infections.
• Septoplasty: Correcting a deviated nasal septum to improve breathing.
• Functional Endoscopic Sinus Surgery (FESS): Minimally invasive surgery to open sinus passages and restore drainage.
• Tonsillectomy and Adenoidectomy: Removal of the tonsils and/or adenoids.
• Thyroidectomy: Removal of the thyroid gland.
• Micro-laryngeal Surgery: Precise surgery on the vocal cords.

Part 2: Cochlear Implants

A cochlear implant (CI) is a sophisticated electronic medical device that is designed to provide a sense of sound to a person with severe to profound sensorineural hearing loss who receives limited benefit from powerful hearing aids.

How is it different from a hearing aid?

• Hearing Aid: Amplifies sound. It is useful for people with residual hearing. It makes sounds louder but cannot fix damaged inner ear (cochlear) cells.
• Cochlear Implant: Bypasses the damaged parts of the inner ear and directly stimulates the auditory nerve. It is not a “cure” for deafness but a prosthetic substitute for hearing.

Who is a Candidate?

Candidates are evaluated by a multidisciplinary team and typically include:

• Adults: with progressive hearing loss who find hearing aids increasingly ineffective.
• Children: (as young as 9-12 months) with severe to profound hearing loss in both ears, aimed at allowing them to develop speech and language skills.
• Criteria: Limited benefit from appropriately fitted hearing aids, no medical contraindications, and high motivation (for adults) or strong family support (for children) for the rehabilitation process.

Components of a Cochlear Implant:

1. External Component (Worn behind the ear):
   • Microphone: Picks up sound from the environment.
   • Speech Processor: Selects and arranges sounds picked up by the microphone.
   • Transmitter: Sends the processed sound signals to the internal implant.
2. Internal Component (Surgically implanted):
   • Receiver/Stimulator: Receives signals from the transmitter and converts them into electric impulses.
   • Electrode Array: A bundle of electrodes that is threaded into the cochlea. It collects the impulses from the stimulator and sends them to the auditory nerve.

The Cochlear Implant Process:

1. Comprehensive Evaluation: A thorough assessment by an ENT surgeon, audiologist, speech therapist, and sometimes a psychologist. Includes hearing tests, MRI/CT scans of the inner ear, and speech testing.
2. The Surgery: Performed under general anesthesia. It takes 2-4 hours.
   • The surgeon makes a small incision behind the ear, creates a bony well for the implant, and carefully threads the electrode array into the cochlea.
   • It is considered a safe procedure with minimal visible scarring.
3. Activation: About 3-4 weeks after surgery, once the swelling has subsided, the external device is fitted and activated by the audiologist.
4. Auditory (Aural) Rehabilitation: This is the most critical phase.
   • The brain needs to learn to interpret the new electrical signals as meaningful sound.
   • For children, this involves intensive speech and language therapy to develop listening and speaking skills.
   • For adults, it involves training to recognize new sounds and speech.

Cost of Cochlear Implant in India

India is a major center for cochlear implants due to its expertise and cost-effectiveness.

• Estimated Total Cost (Surgery + Device): ₹ 6,00,000 to ₹ 15,00,000 (approx. $7,200 to $18,000 USD)

What influences the cost?

• Cost of the Implant Device: This is the single biggest cost factor. Different brands (e.g., Cochlear, Advanced Bionics, MED-EL) and their latest models have varying prices.
• Hospital and Surgeon’s Fees: Costs are higher in premium private hospitals in metro cities with highly experienced surgeons.
• Diagnostic Tests: Pre-operative MRI/CT scans and audiological tests.
• Post-Implant Therapy: The cost of long-term speech and auditory rehabilitation therapy is a significant, ongoing expense.

Government Support: In India, several government schemes (like the ADIP Scheme and various state government initiatives) provide financial assistance for cochlear implants for children from economically weaker sections, significantly reducing the cost.

Best Hospitals for ENT & Cochlear Implants in India

Several hospitals have dedicated departments for Audiology and Cochlear Implant Programs with excellent multidisciplinary teams.

1. All India Institute of Medical Sciences (AIIMS), New Delhi: A pioneer and leader in the field, known for its high volume of surgeries and excellent outcomes, often at subsidized costs.
2. Christian Medical College (CMC), Vellore: Renowned for its comprehensive ENT and audiology services, with a strong focus on cochlear implants and rehabilitation.
3. Apollo Hospitals, Chennai: Has a advanced cochlear implant program with experienced surgeons and a full team for rehabilitation.
4. Sir Ganga Ram Hospital, New Delhi: Known for its robust ENT department and successful cochlear implant program.
5. Medanta – The Medicity, Gurugram: Offers advanced technology and a skilled team for complex ENT surgeries, including cochlear implants.
6. PGIMER (Postgraduate Institute of Medical Education and Research), Chandigarh: A premier government institute with a strong reputation in ENT and cochlear implantation.

Conclusion

ENT is a vast specialty managing a wide range of conditions. The cochlear implant is one of its most remarkable achievements—a neuroprosthetic device that can literally restore the sense of hearing and, for young children, open the door to the world of sound and spoken language. The process requires a lifelong commitment to rehabilitation but offers life-changing results.