Cochlear implant in a 2nd & 3tier city

Dr. N. Murali Chand MS (ENT) DLOFellowship in HIV medicine [ FHM ]

www.skullbase360.inBikaner 19-2-17

My teachers – Dr. Satish Jain sir & Dr. Vidya Sagar sir

Let us discuss this topic in 5 headings

1. Neonatal screening & case detection2. Surgery & CI centres 3. Programming / Mapping of CI implant 4. AVT therapy 5. Insurance to CI implant & accessories

Neonatal screening & Case detection

1. can current number of CI Surgeons/Centres are enough to screen peripheal villages & tribal areas

2. If we don’t involve peripheral ENT surgeons in CI surgery programme how can few CI surgeons enough

Surgery & CI centres

- Is CI surgery a difficult surgery?

- How much Otological experience is sufficient for CI surgery?

CIGI [ www.cigi.in ] guidelines - Instead of this introduce/ recommend “ Fellowships of CI surgery ” in all Universities of INDIA

Why a DLO post-graduate can’t do CI with structured training [ most of the DLOs are in periphery ] - DGO’s doing excellent laproscopic surgeries &

running excellent IVF centres

CIGI [ www.cigi.in ] guidelines - Instead of this introduce/ recommend “ Fellowships of CI surgery ” in all Universities of INDIA

Dr. Manu ( 31 yrs ) & Dr. Satya kiran ( 37 yrs ) ... both vellore implantology fellows . ... too good ... telugu people … Students of

Prof. John Mathew sir who made gems of implantology

• Recently Prof. Mohan kameswaran sir said at hyderabad APOLLO hospital CI conference - there is NO DIFFERENCE between complications rate between 3 to 4 yrs experienced assistant professors & senior professsors .

• Junior assitatnt professors also very serious & dedicated in implantology science .

www.fogsi.org – Ob&G society of INDIA introduced training programms long back

Programme started by Prof. O.C. Abraham HOD , General

medicine , Vellore – Not recognised by MCI ,

Recognised by NACO

• 13 modules of books. like HIV & women , HIV& CHILD , HIV & TB , HIV & lung etc etc

• 1 year programme• 6 contact courses each 10

days & ward rounds to LRS TB hospital

• Theory & Practical exam• Eligeable to ART centres

medical officers along with MD(Gen ) , MD ( Chest ) MD ( Skin ) ; recognised by NACO

Only 2 CI centres in whole Seemandhra of 13 districts - VIZAG recently started - CIGICON 2017 is in VIZAG !!!!!!

• CI Science will develop if more number ENT surgeons think about it

Prof. M.V.Appa Rao , Retired HOD of Vizag medical college wishing

1. Every ENT centre be a CI centre2. Every ENT Surgeon be a CI surgeon

- If a poor patient cannot go to corporate hospital and afford their heavy bill, what is the other alternative for them?

- what is the ideal place for rehabilitation- with mother and siblings or a clinical set up?

- why not rehabilitation done at home?

- why not public rehabilitation centers?

- what is the incidence of SN loss &

can current number of CI Surgeons are enough to surgery for all of them.

How much money for surgeon in aarogyasri CI programme

• ONLY ONE YOUNG CI surgeon in seemandhra

Suppose if the parents wants to take 2nd opinion – how it is possible with few surgeons

CI hospital infrastructure under Aarogyasri scheme in Andhra Pradesh

What about bulk purchase order by the state & central government & reduced price can be used

for insurance of the implant

• Of the 65 who underwent CIs, only seven successfully underwent the rehabilitation programme, enabling them to join normal schools.

• Four patients could not be traced, 23 are still undergoing rehabilitation and 31 patients who underwent rehabilitation for a year need more ‘lessons' since they were unable to acquire sufficient language/communication skills. However, since they cannot afford to pay for the services after the one-year period, they are not attending.

• These patients hailing from below the poverty line families are also not in a position to buy external speech processor if necessary or even buy a set of rechargeable batteries costing Rs. 35,000, thus making the princely sum of Rs. 6.5 lakh spent on CI go abegging.

• Regional HOD deafness certificate to undergo CI surgery under ADIP scheme --- The minute parents get deafness certificate most of the rural parents not attending Government authorized CI private hospital .

• Reason – parents are satisfied that they will get bus & train tickets free

Southern institute / staff - They are not giving digital hearing aids -- most of these institute activities are restricted /limited to only submission of deafness certificates

No sufficient qualified staff to run peripheral AVT centres

• Regular BEd teachers AVT training by modules can be used for peripheral / rural AVT therapy staff – by Prof. Mohan Kameswaran

Dr. Duvva Shyam Kiran MS ( ENT ) UK experience ; Rajamundry

• Particularly in Andhra Pradesh.Skill/professionalism/Humanity/Trust/Quality/Empathy.

• All been removed from dictionary.• Two things remain and prevails

Cash and Community• Sorry to say this because I was at a recieving end having Established one of the best

ENT unit to do or give something back to society with all good faith• I couldn't get Arogyasri or CI implant programme• Everywhere money from application to inspection.

• I am against it they disqualified my application for 8 times.• I left it when I can survive in better way with my patient client tail I don't need any

govt initiative programme• Pity I tried to contact CI device teams in India they are purely a syndicate with deep

down arrogance• Pity having trained in UK lived up to ethical practice

No one values any thing.

• People before to do something they think what is the benifit I have. Untill this is gone We as a doctor's or IndiansCan be at par with global teams.

• Last but least comming to research before no practioner or no college or institute have provision time to develop this.

• Every one want to be recognised as super or good surgeon.Every wants to run conferences and workshops good.There are more conferences and workshops than doctors now a days.

• Please people like you and there are good hand full of teachers hope you all can come together and make not our profession big.

• Let us give the uniform care across the board.• If pt in UK/USA/DUbai/

Gets a protocol based care not treatment• Same an Indian should get.• Thank you

This is just opinion from my experience.

System should be beyond TRUST

Answer : National registry with website monitored by all the professionals in CI

science

Laminar flow OT in Narasaraopet town by Dr. Jagan Mohan Reddy MS(ENT) DLO

Narasaraopet – Chilakaluripet are like twin towns

What about indigenous CI

What about indigenous CI

MAPPING

Distant mapping

AVT

Senior CI surgeon said

40% dropout for AVT therapy in post-CI children when the CI centre in cities . Now once peripheral AVTs established only 5 % dropouts

How will you address dropouts ??

Daily this mother has to come from Vijaywada to Guntur for AVT

All the 13 districts parents has to come to guntur for AVT therapy for 1 to 2 years

e-Rehabilitation – Is it possible in INDIA with rural population / parents

e-Rehabilitation

e-Rehabilitation

INSURANCE