Cochlear implant in a 2nd & 3 tier city

1. Cochlear implant in a
2nd & 3tier city
Dr. N. Murali Chand MS (ENT) DLO
Fellowship in HIV medicine [ FHM ]
www.skullbase360.in
Bikaner
19-2-17

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

3. Let us discuss this topic in 5 headings
1. Neonatal screening & case detection
2. Surgery & CI centres
3. Programming / Mapping of CI implant
4. AVT therapy
5. Insurance to CI implant & accessories

4. Neonatal screening & Case
detection

5. 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

6. Surgery & CI centres

7. - Is CI surgery a difficult surgery?
- How much Otological experience is sufficient
for CI surgery?

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

9. 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

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

11. 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

12. • 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 .

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

14. 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

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

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

17. Prof. M.V.Appa Rao , Retired HOD of Vizag medical college
wishing
1. Every ENT centre be a CI centre
2. Every ENT Surgeon be a CI surgeon

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

19. - 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?

20. - what is the incidence of SN loss
&
can current number of CI Surgeons
are enough to surgery for all of
them.

21. How much money for surgeon in
aarogyasri CI programme

22. • ONLY ONE YOUNG CI surgeon in seemandhra

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

24. CI hospital infrastructure under
Aarogyasri scheme in Andhra Pradesh

25. What about bulk purchase order by
the state & central government &
reduced price can be used for
insurance of the implant

26. • 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.

29. • 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

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

31. 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

32. 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.

33. • People before to do something they think what is the benifit I have. Untill this is gone
We as a doctor's or Indians
Can 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.

35. System should be beyond
TRUST
Answer : National registry
with website monitored by
all the professionals in CI
science

36. Laminar flow OT in Narasaraopet town by
Dr. Jagan Mohan Reddy MS(ENT) DLO
Narasaraopet – Chilakaluripet are like twin towns

37. What about indigenous CI

38. What about indigenous CI

39. MAPPING

40. Distant mapping

41. AVT

42. 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 ??

43. 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

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

45. e-Rehabilitation

46. e-Rehabilitation

47. INSURANCE