Cochlear implant: Silence to sound

Renu Sud Sinha

Chandigarh-based Omisha Gupta (6) was over two years old when her parents finally realised that she was born with total hearing impairment. “She was such an active and responsive child that it never occurred to us,” says her mother Shweta, a banker. “At 15 months, while going for her vaccination, we did ask a child specialist about her slow speech development, but the paediatrician said that sometimes children start speaking late. We would periodically consult doctors about her delayed speech, but no one ever said anything about a hearing impairment because she would understand whatever we said, communicate about her needs through actions and even dance,” adds Shweta.

Finally, when Omisha was around two-and-a-half years old, her father, Avnish, suspected that the problem may be related to hearing. “I suggested performing a simple task. We switched on some music, turned the volume to maximum and kept the speaker away so that she couldn’t see its blinking light. I suspected that’s how she could dance when it was on. Omisha did not show any response to the loud music. It was the evening of Independence Day in 2020, and we found an ENT specialist the next day after a lot of effort. After some basic hearing tests, she confirmed my fears. We opted to go to PGI for an exact diagnosis and treatment options,” says Avnish.

Omisha’s parents spent the next couple of months consulting specialists at the PGI’s ENT department. Doctors at the institute conducted advanced tests, trying out hearing aids for a month, a standard procedure, before Dr Naresh K Panda, HoD, Otolaryngology (ENT), operated upon the child, performing a bilateral cochlear implant (CI) surgery. A bilateral CI surgery can be done simultaneously (both ears together) or sequentially (one ear each, six months to a year apart). The PGI, till date, has performed 30-40 bilateral CI surgeries; nearly 60 per cent of these have been sequential.

Dr Panda, instrumental in starting CI surgery in PGI 20 years back, while recalling his journey, says, “Earlier, when patients with hearing disability would come to us for treatment, I’d get frustrated as we could only prescribe hearing aids. A majority would not respond to these aids in case of a profound hearing loss. This frustration acted as a motivation and my colleague, Dr Anu Nagarkar, and I went to Australia to learn about cochlear implant surgery at the Bionic Institute in Melbourne in October 2002.”

A cochlear implant is a small, electronic device surgically placed inside the skin behind the ear. It provides a sense of sound to a profoundly deaf person. The implant consists of an external portion that sits behind the ear and a second portion that is surgically implanted under the skin. Cochlear implants are designed for people with moderate to severe sensorineural hearing loss (due to damage in the inner ear) who have difficulty in interpreting speech even with a hearing aid.

As per WHO estimates, India has approximately 6.36 crore people suffering from significant auditory impairment. A 2018 review article in the ‘National Medical Journal of India’, however, put these numbers at 10 crore. Another article in the ‘Indian Journal of Otology’ says that over one lakh babies are born with hearing deficiency every year, while four in every 1,000 children suffer from severe to profound hearing loss. Of these, a large percentage is children between the ages of 0 and 14 years. Hearing impairment, if left undiagnosed, can lead to long-lasting effects on speech, language, cognition and psycho-social development that impacts educational and vocational achievements.

According to Dr Panda, as per the National Programme for Prevention and Control of Deafness (NPPCD), every newborn at the PGI is screened for hearing disability under the Universal Neonatal Hearing Screening Programme; it is also offered by all major hospitals across India. “The earliest the hearing loss is detected, the better it is because a child with a profound hearing disability cannot develop speech and language.”

The possibility of hearing loss is more in high-risk categories, which include pre-mature and low-birth babies, those who had severe jaundice after birth, new-borns who experienced a lack of oxygen to the brain before or shortly after birth and in case of a family history of deafness, adds Dr Panda. Omisha’s case, however, was idiopathic (cause unknown).

The CI implants can be expensive. The cost can vary from Rs 5 lakh to Rs 15 lakh based on the quality of the device used. Three FDA-approved imported implants are being used in CI surgeries at PGI — MED-EL (Austria), Cochlear (Australia) and Advanced Bionics (US), Dr Panda adds. “The waiting period is usually one to two months.”

The DRDO is also developing an indigenous CI device. Government programmes, such as the ADIP (Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances) scheme, provide free CI devices to those with minimum 40 per cent disability and income under Rs 15,000 per month, while those earning between Rs 15,000 and Rs 20,000 are given 50 per cent cost of aid/appliance. The PGI has performed 45-50 such surgeries. Private hospitals like Fortis, Max and Shalby also offer CI surgeries at their various centres, including Mohali.

For Omisha and her parents, life has definitely taken a turnaround, though challenges exist. Her speech and language development is a little slow because of her complete hearing loss in the initial years. After her surgery, her parents initially opted for professional speech therapy, but soon realised that she was more responsive in a homely atmosphere.

Their hard work has paid off. Omisha is now a student of Class I at Carmel Convent. “The school authorities have been quite supportive, providing a special counsellor for her in the initial years.” For Shweta, the fact that her daughter studies along with other ‘normal’children is a huge pay-off for the efforts she and her husband have been putting in after the surgery. “She even participates in singing and dance programmes with the rest of her class during school functions,” adds the proud mother.

Two decades of CI surgery at PGI

The first-ever cochlear transplant surgery was performed by Dr NK Panda and his team on an adult patient on April 3, 2003, under the mentorship of Padma Shri awardee Dr Mohan Kameshwaran, MD, Madras ENT Research Foundation. Since then, over 600 such surgeries have been performed on children and adults. Mostly performed on infants, toddlers and children, the CI surgery can also be performed on adults and elderly who suffer from hearing loss due to various medical and/or age-related issues. The PGI has done around 75 such surgeries on adults, the oldest being a 78-year-old patient from Ambala. The youngest patient was an 11-month-old from Kaithal.

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