Padmashree awardee Prof. (Dr) J. M. Hans,is honorary ENT Consultant to Prime Minister of India. He has done pioneering work in the field of cochlear implant surgery and had a invaluable record of doing more than 1000 cochlear implants in his center, centers around the country and also in SAARC countries. He is the Founder Member of the Cochlear Implant Group of India.
Providing a ray of hope for millions of deaf people in the country, Indian defense scientists have developed a low-cost cochlear implant that will enable them hear again. In conversation with Ekta Srivastava
Please tell us something about your expertise and services?
I have my expertise in two core areas that are Cochelar Implantation, Auditory Brain Stem Implantation, other than that I used to see patients who come for surgery for deafness and do routine ENT check-ups.
Cochlear Implantation and Auditory Brain stem Implantation, are the two different things. So, how these technologies are helping patients across India?
The cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing due to loss of sensory hair cells in their cochlea.
Nearly a million people in need of cochlear implants every year were till now forced to use imported cochlear implants, which came at a steep price of Rs 7 lakh to Rs 10 lakh. The Indian version will cost about Rs 1 lakh.
Minimal Invasive Technique (VERIA) for Cochlear Implantation
The conventional or the classic technique uses a mastoidectomy & posterior tympanotomy approach to the middle ear & the cochlea. Though it is a successful technique it is more time consuming & prone to various complications specially in small children with a small Facial Recess, anomalies of the cochlea, cochlear rotation, etc. In the era of Minimal invasive techniques & need for better accessibility (of the cochlea in this case) the Trans-canal or the Veria Technique is very helpful. This technique is almost becoming essential now, since the time cochlear implantation has been started in children
In this case a Trans-canal Tunnel is created with a special “Perforator” in the cortex of the posterior canal wall, which enters the middle ear through the facial recess. A tympano-meatal flap is elevated to do the Cochleostomy & insertion of the electrode in the scala-tympani.
I have done over 1000 cases by this technique, in my centre and in centers around India and SAARC countries including Pakistan & Bangladesh, with no surgical complications till date and withvery good post-op results, in patients ranging from 9 months to 79 years, both pre-lingual & post lingual.
Varity of cases with Middle ear cleft anomalies like dehiscent high jugular bulb, anteriorly placed sigmoid sinus; Cochlear anomalies like Mondini & Single cavity cochlea; Cochlear dystrophies (osteogenesis imperfecta); Cochlear ossification etc. were done. Situations like Intra-op CSF Gusher’s were dealt with ease.
Auditory Brain Stem Implant Surgery
An Auditory Brain Stem Implant (ABI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf, due to profound hearing impairment (due to illness or injury damaging the cochlea or auditory nerve, and so precluding the use of a cochlear implant). The auditory brain stem implant uses similar technology as the cochlear implant, but instead of electrical stimulation being used to stimulate the cochlea, it is instead used to stimulate the brain stem of the recipient.
1st Auditory brainstem implant (ABI) was performed on a two-and-half-year old girl from Ladakh, who was born with hearing impairment by me and my team in June 2009. Since then Ten such children have been operated by the team successfully.
Tsesal is the first child of an ABI in India and second in Asia. ABI is a technique in which a small chip is placed in the brain stem (The auditory nuclei located in the fourth ventricle) to restore hearing sensation.
It takes at least two months before the brain starts responding to the chip. It was only a matter of time, with the appropriate auditory and speech training that Tsesal began to hear normally. Me, with a team of doctors comprising of ENT Surgeon and Neuro-Surgeon has conduct the surgery
What you think is the major difference between government and corporate hospitals?
I deal in government for almost 30 years. I think the major difference is that in government hospital nobody wants to work and you can’t even work because of the paucity of the facilities, while in private set-up the cost is so high which sometimes become unaffordable for the patient, unfortunately making out of pocket expenses . So, there should be something in between the lines of not being very costly but with good quality. A very normal example is the only way to measure the hearing of a person with cochlear implant is with an instrument called electrical BERA or “brainstem evoked response audiometry”, which is not available in any government hospital. The government ought to allow the test, which is available in the private sector, to be used by candidates. Even the rich in the country, they have the most luxurious car but they won’t spend on technology. They take health for granted; in a very critical situation they give thought to their health.
What is the need of the medico-legal rights awareness among medical professionals?
Let’s take an example, If a very sick patient would come and you will start thinking of the medico-legal aspect, then you cannot treat the patient. Though there are very rare people in this field but it would be better if you do your job perfectly and let them do there. Medicine cannot be done medico-legally and that is the main loophole in our country. The reason being some of the very prominent doctors avoid of their duties due to such thing, they don’t want to take challenge or any risk even if the patient is very sick.
When government talks about the technology, how you think these technologies will help rural areas where there is lack of basic amenities?
Medicine, when attached to the scientific technology becomes very costly, making an extra pressure on the patients. In primary and tertiary areas, if you have even a good medical practioner, al lot can be achieved. With the help of telemedicine, patient’s case can be discussed in any big set-up through that medical practioner. When you talk about the lack of power, one can use telephones because they don’t need any electricity, but just the main thing is the will to do the things and carry on the responsibilities that everybody avoid to do.
What is your message for the society?
I think, we need to be aware of that prevention is the best cure for any disease. Diagnose the disease properly than the treatment will be perfect and curable.
Presently Dr Hans is Director, Adiva Dr. Hans centre for ENT & Cochlear Implant, Chairman Department of ENT & Cochlear Implant Rockland Group of Hospitals (Qutub, Dwarka, Manaser), Chairman Department of ENT, Cochlear Implant & Auditory Brain Stem Implant, Moolchand Mediciti & Assoc. Hospitals and visiting Cochlear Implant Surgeon, Fortis Hospital, Noida