January 2020 – Agarwal Hospital and Research Institute

Cochlear implantation in children:-

How we hear?

The eardrum vibrations caused by sound waves move the chain of tiny bones (the ossicles – malleus, incus and stapes) in the middle ear transferring the sound vibrations into the cochlea of the inner ear. This is where the streams of nerve impulses are converted into meaningful sound.

Parts of ear:

Outer Ear :
Middle Ear: Converts sound waves in to vibrations.
Inner Ear (Cochlea): converts vibrations into electrical impulse. Theses electrical impulse travel to brain via nerve of hearing (Cochlear nerve)

What is cause of Hearing Loss in children?

In children hearing loss can be congenital (from birth) or acquired (after birth). Acquired can be due to various infections or trauma, etc.

Hearing loss can also be classified as per language development as follows

Pre-lingual –hearing loss developed before child could start speaking, it can be either congenital (from birth) or acquired (after birth).
Post-lingual – hearing loss developed after child started speaking. It means it is acquired.

Cause of hearing loss is any defect in the transmission of sound through the ear. It can be

Conductive – Caused by defect in middle or external part of ear. It can usually be treated by some medications. Less frequently a surgery is required to correct this type of hearing loss
Sensori-neural – Caused by defect in nerve of hearing or cochlea. Mild to moderate hearing loss can be treated by hearing aid whereas severe to profound hearing loss requires Cochlear Implant surgery

Burden of Hearing loss?

In US Significant bilateral hearing loss is present in ~1 to 3 per 1000 newborn infants in the well-baby nursery population, and in ~2 to 4 per 100 infants in the intensive care unit population.

In India, 63 million people (6.3%) suffer from significant auditory loss. Four in every 1000 children suffer from severe to profound hearing loss. The estimated prevalence of childhood onset deafness to be 2%

How to assess Hearing loss in new born and small children?

Detection of infant hearing loss requires universal screening of all infants. Screening by high-risk registry alone (eg, family history of deafness) can only identify ~50% of newborns with significant congenital hearing loss. Reliance on physician observation and/or parental recognition has not been successful in the past in detecting significant hearing loss especially in the first year of life.

Tests for screening include otoacoustic emissions (OAE) and auditory brainstem response (ABR / BERA). Both test are noninvasive, quick, and easy to perform, although each assesses hearing differently. Aim is to initiate necessary intervention by 6 months of age.

What is a Cochlear implantation?

A cochlear implant is an electronic medical device that replaces the function of the defective inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of damaged parts of the inner ear (cochlea) to send sound signals to the brain.

Most important thing is early diagnosis. Management of deaf and mute child should be started as early as possible. Success of cochlear implant is more if it is done by the age of 3years. Success rate decreases with advancement of age of child.

ROOT CANAL TREATMENT (RCT)

RCT (ROOT CANAL TREATMENT) is a common treatment in Dentistry. The objective of the treatment lies in repairing the tooth which is badly decayed or infected by foreign anomalies. RCT is a job of precision & requires a very skilled & a specialized dentist who is called Endodontist . Usually, it is carried out on a tooth which gets infected by dental decay due to lack of oral hygiene leading to severe pain, sensitivity or swelling.

WHO ALL NEED IT?

If there is a deep cavity, a cracked tooth, or broken filling in patients mouth

Symptoms – The tooth becomes sensitive to high & low temperatures leading to severe pain while drinking something cold or hot like cold water or ice cream or cold drink or tea or coffee. There may be pain while chewing, some people may have continuous, throbbing pain.

There may be pus discharge from the infected tooth.

Without treatment, the infection will spread to adjacent teeth and bone leading to severe pain & swelling. Eventually, the tooth will become loose & requires removal.

Some patients opt for tooth removal instead of undergoing RCT. However, removing a tooth may mean that the surrounding teeth start to move & become crooked. This can look unsightly, and it can make it hard to have a good bite which will lead to difficulty in eating food in future.

If the tooth cannot be saved, the next best option to replace it is a Dental Implant.

However, if possible, saving the natural tooth is best, because nothing functions as good as a natural tooth.

Adding a Crown or Filling

After RCT patient’s tooth requires a permanent crown or filling to confirm long term survival of the treated tooth. Without crown after RCT the tooth is likely to fracture.

Until the crown or filling is complete, the patient should not chew or bite on the treated tooth. Once there is a crown, the person can use the tooth as before.

RCT often takes only one appointment, but if there are curved canals, multi-canals, or large infections, this could take one or two additional appointments.

How painful is it?

One of the great fears about this kind of treatment is that it will be painful, but the treatment that is carried out by a trained & specialized dental surgeon is relatively painless.

The infected tooth is anaesthetized before starting Root Canal Treatment

The pain that is felt sometimes comes from the infection & not from the treatment. The treatment does not cause pain.

Root canal therapy saves the tooth & eliminates the pain.

How Successful is Root Canal Treatment?

Root canal treatment is highly successful; the procedure has more than a 98% success rate. Many teeth fixed with a root canal treatment can last a lifetime.

Also, because the final step of the root canal treatment procedure is application of a restoration such as tooth colored crown or a filling, it will not be obvious for anybody to make out whether any treatment was ever done in that tooth.

In vitro fertilization (IVF):-

In vitro fertilization (IVF) is a complex series of advanced procedures, which is used to overcome the fertility issues and assist couples to conceive and have a child. During this procedure, mature eggs are retrieved from ovaries and fertilized by sperm in an advanced IVF lab. Then the fertilized egg (embryo) are transferred to a uterus. One full cycle of IVF takes about three weeks. Medications increase the number of mature eggs a woman can produce at a single time. Doctors can evaluate each developed embryo to determine which ones are most likely to result in pregnancy.

IVF is the most effective form of assisted reproductive technology (ART). The procedure can be done using your own eggs and your partner’s sperm. Or if there is a problem in eggs or sperm then IVF can be done with eggs, sperm or embryos from an anonymous donor. In some cases, a gestational carrier (GC), also called a surrogate is an arrangement where a woman carries and delivers a child for another couple (intended parents). Chances of having a baby using this procedure depend on many factors, such as your age and the cause of infertility.

Overall, IVF can help some patients experience pregnancy and parenthood who otherwise would not be able to. This includes couples struggling to conceive due to ovulatory problems, body structure issues or any other cause of infertility.

Total Laparoscopic Hysterectomy (TLH):-

Hysterectomy can be carried out vaginally, abdominally, laparoscopically or in a combination of these. Total Laparoscopic Hysterectomy (TLH) is an advanced surgical technique which involves removing the uterus and cervix using keyhole (laparoscopic) surgery. Ovaries and fallopian tubes may or may not be removed depending on the reason for surgery. This procedure may be combined with other procedures, such as repair of a prolapse, etc.

TLH surgery could be the best option for women dealing with heavy or painful periods, pelvic pain, endometriosis, fibroids, prolapse, endometrial or cervical problems.

TLH is normally carried out under a general anaesthesia. After you have been given a general anaesthetic and you are asleep, a catheter (a tube for urine drainage) is inserted into your bladder. A small cut about 1 cm is made near your navel (belly button). The abdomen is filled with gas and an optical instrument, called a laparoscope, is inserted to allow the internal organs to be viewed before three further small cuts, about 0.5 cm each, are made on your abdomen. These cuts are for other instruments to be used during the surgery. In most cases the uterus and cervix are removed through the vagina. If the uterus is too large to remove vaginally, or the vagina is too narrow, then uterus is cut in pieces and removed vaginally.

The procedure takes about 1 to 2 hours, but you can expect to be in theatre and recovery for about 3 hours.

TLH reduces your recovery period (including hospital stay), reduces the pain and discomfort after your surgery.

Some benefits of TLH are:-

Less pain after surgery than having ‘open’ (traditional) surgery.
Fewer wound complications.
Less disruption to bowel and bladder function.
Lower risk of Deep Vein Thrombosis (DVT).
Shorter recovery period (including hospital stay) compared to other forms of hysterectomy surgery.
Lesser discomfort after your surgery compared to other forms of hysterectomy surgery.

Cosmetic Gynecology : The conditions in which we live nowadays contribute to the exposure of our bodies to harmful factors such as UV radiation, pollution, smoking, poor eating habits, low physical activity, stress, which thereafter lead to the acceleration of skin aging process and health diseases.

Various research have proved how the hormonal loss influences a woman’s body, the functionality of the tissues and her aesthetic look. Over time, age and events such as pregnancy and birth can affect the internal and external structure of the vagina, causing changes in both its appearance and physical response to stimulus. Cosmetic gynecology aims to make improvements to the physical appearance and function of both the vagina and labia simultaneously. The results of cosmetic gynecology can improve the genitals to make the body appear younger, graceful or more aesthetically-pleasing. Cosmetic gynecology is a quickly-growing field of cosmetic surgery throughout the world.

Vaginoplasty

A Vaginoplasty procedure focuses on reducing the width of the vagina and tissue injuries that may have occurred during sex or childbirth. The tissues of the vagina can lose elasticity over time, particularly following multiple childbirths. During a Vaginoplasty, surgeons’ uses techniques such as tightening the perineal muscles or making repairs to the rear vaginal wall, reducing the overall width of the vagina and tightening the tissues.

Labiaplasty

This procedure focuses on the size and shape of the labia and the folds of skin that frame the opening of the vagina. A lot of women pursue this procedure because they have a natural excess of skin that may either cause them discomfort when wearing tight-fitting clothing and to get back in physique after childbirth. Thus, a Labiaplasty procedure can remove excess skin from both the sides of the labia to reduce the overall size.

Hymenoplasty

Also known as “Virginity Surgery”, Hymenorrhaphy or hymen reconstruction surgery. The term comes from the Greek words hymen meaning “membrane”, and raphḗ meaning “suture”. Hymenoplasty is the reconstruction of the hymen, resulting in the dissolution of any evidence of trauma. The purpose of a hymenoplasty is to repair and reconstruct the hymen, a thin membrane that partially covers the opening to the vagina, to a “pre-sexual” state. Any complication from hymen repair is very rare.

O Shot

The O–Shot® is a safe and non-surgical treatment that uses the revolutionary technology of PRP (Platelet Rich Plasma) to help treat women experiencing urinary incontinence, vaginal dryness, or sexual dysfunction. The O–Shot, a new, non-invasive treatment that aims to alleviate female sexual dysfunction by extracting PRP, from a woman’s own blood and injecting it directly into the vaginal area. If you are one of the many women who suffer from low sexual desire and loss of vaginal sensitivity, the O–Shot may be just the thing you need.

Cochlear implantation for children

Root Canal Therapy

How painful is it?

How Successful is Root Canal Treatment?

In vitro fertilization

Total Laparoscopic Hysterectomy (TLH)

Cosmetic Gynecology in a Nutshell

NABH Accredited Hospitals

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