It is possible as more specialists conduct surgeries in India and states provide free implants and treatment
What happens when the silent world of a one-year-old is suddenly filled with noise from all around? She recoils in fear; screams and cries. But, instead of alarm, her cries bring a smile to the sombre faces, and tears to the eyes of her parents. She can hear now, they know. A little device fitted in her ears, when switched on, takes her to the world of sounds, and scares her. The sounds are new to her. When the device is switched off, she calms down. The cochlear implant (CI) has changed her life forever. She is one of the lucky few who will not suffer the rigours of deafness and shall gradually adapt to the world of hearing and speech like other children.
“Most importantly, she will attend a normal school and not have to learn a sign language. To hear is to get into the mainstream,” says Dr Shomeshwar Singh, who heads the department of ENT and cochlear implants at the Saket City Hospital, New Delhi. And that is the most remarkable quality of a CI. It works well when implanted at the right age, by a trained surgeon (in India there are few trained ENT surgeons who can conduct a CI surgery) and with proper post-surgery rehabilitation. While cure for deafness was unheard of in earlier times, with advancement in technology and discovery of new sophisticated devices, this is now a possibility. However, a CI works best when implanted between the ages of one and three years. “Early referral helps,” says Dr Singh, “because the brain’s ability to pick up hearing and speech will only happen in the earliest years of life. Once a child crosses the age (of three years) and she has still not picked up speech, like other children with normal hearing ability, but learns to communicate with signs, she cannot be brought into the CI paradigm.”
Still, CI can work in slightly older children as well “especially, if they have already been using hearing aids and having some benefits,” says Dr MV Kirtane, ENT surgeon and consultant at PD Hinduja National Hospital and Research Centre, and Breach Candy Hospital, Mumbai, “So individual cases have to be decided upon their merits. Then there is the other group of CI candidates that is the post-lingual group – adults who once had good hearing but lost it due to disease, trauma, toxicity, or any other reason – that can also benefit with this technique. In this case, there is no upper age limit and even the elderly can benefit under these circumstances.”
Training most important
With almost 4,00,000 children with severe to profound hearing loss and 1,00,000 born each year with significant hearing loss, there are only about 1,000 under the age of four who have received the CI. It was only around 2001 that CI surgeries began in India. In 2003, the Cochlear Implant Group of India, a Bangalore-based organisation, came into being. Despite these small steps in the direction of CI, there remained a dearth of trained surgeons in this field. “A surgeon has to be specifically trained to conduct a CI surgery. And while ear surgeries are taught in medical schools, the precise CI is not. Those who did get trained were either in the US or the UK (that have organised training programmes) and some doctors learnt from specialists who were visiting India to conduct surgeries. Opportunities for training in India are very limited,” says Dr Singh.
But ENT surgeons who are interested in training themselves for CI can certainly do so at centres where they can go and train themselves. “We have been doing such a training programme for the last eight years now, besides which I have a continuous flow of ENT surgeons coming to watch and learn (CI) surgery during a three-month fellowship, where I train fellows who can then go and start their own CI programmes,” says Dr Kirtane.
Dr Ramesh C Deka is renowned ENT specialist and one of the pioneers of CI in India. He began conducting CI at the All India Institute of Medical Sciences (AIIMS), New Delhi, way back in 1997-98, and says that special training for CI is required so that there is no damage to the facial nerve during the surgery. Dr Deka, who received training in the US and Australia, says, “Even companies which provide the cochlear device will not supply to an untrained surgeon because their reputation is at stake.” While some CI surgeons now at AIIMS have trained under him, “the CI manufacturing companies also impart some prior training to surgeons,” he says. “We have standardised the technique in AIIMS and demonstrated very satisfactory results,” he adds.
The government’s role
“The government needs to bear the complete cost of CI right up to maintenance. Otherwise, it makes no sense to give the device to people below the poverty line who cannot maintain the device later,” says Dr Singh. Some states – Andhra Pradesh, Rajasthan, Tamil Nadu, Kerala, Gujarat, Assam and Chhattisgarh – have made provisions to provide CI free of cost.
The government could waive tax on the import of CI devices to bring down the cost. In this context, a committee has recommended for such funding at least for children below three years. The union health ministry has also decided to provide funds to select patients for CI in government hospitals and establishing a private CI centre.
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