Transcript [EN]: Every new parent should know this | Episode 6 | Second Opinion with Dr. Sid ft. Dr. Shruti Bansal

How big of a problem is hearing loss in children in India? In India, the incidence is much higher which comes to around 8 to 10 per thousand life birth. In a country like India, some 70,000 children are born each day. Around 700 children each day who are born with some form of an hearing impairment. I think people have trouble understanding compounding. So in those first 2 3 months the difference might only be one or two words. It compounds. It compounds. So the less words you know the less words you can know. Correct. And so that difference just keeps on on growing. You can pick up a hearing loss in a newborn baby like a child that's less than 24 hours old. I think people can empathize more with not seeing. Yes. But they cannot even imagine not hearing. I don't think that's possible for somebody to imagine what must it be like to live in a world without sound. So blindness is a handicap that attracts empathy but deafness is a handicap that attracts mockery. Wow. There is an emergency happening in this country and it has to do with children's hearing. More than 700 children are born each day with hearing loss and there is something that all of us should be doing to prevent it. In today's episode of second opinion with Dr. Sid, I have with me Dr. Shi Bansil. She's an ENT consultant who specializes in pediatric hearing loss that is hearing loss in children. Shi, a pleasure to have you here. Thank you so much. Thank you so much Siddhhat. This is this is my pleasure to be on your podcast today. How big of a problem is hearing loss in children in in India? Uh okay. So first of all um uh the western data that always comes and it has been quoted in every presentation possible that I've attended it's like four to six per thousand children that are born live births but in India the incidence is much higher which comes to around 8 to 10 per thousand live births. And when we talk about live births, it may sound like just 8 per thousand or 6 per thousand. But understand in a country like India, some 70,000 children are born each day. And when you do the calculation and maths, you realize there is around 700 children each day who are born with some form of an hearing impairment. A lot of this hearing impairment is pretty manageable. Just you know early intervention or early diagnosis is what is all needed. Yeah. Why is it so important to pick it up early? So um understand one thing. Child actually starts hearing while he's in the womb of the mother. Your hearing system apparatus develops by 18 weeks and by 24 25 weeks child starts recognizing the sound. So when a child is born he's already developed some audiary stimulation right? So if a child I mean if you're not doing a hearing evaluation at birth or if you're not picking up until the age of one or two years and waiting for child to respond you're losing on so much time already. So there are there is a there are a lot of datas that have come up especially I would I would want to just quote more of Indian data because you know that's the reality check for all of us that there there is a data from IP which says that a child that is born with a normal hearing and if you check the vocabulary of that child at the age of 3 years it is on an average 700 to 900 words. Okay. Now if a child is born with a hearing loss which means he has lost the audiary stimulation from the womb till birth and you intervene or you restore the hearing by some means in first month of life the vocabulary of this child at the age of 3 years will be somewhere around 500 to 700 pretty close to what he should have but not really 900 words. However, if you delay the diagnosis and intervention for 6 months, for example, if you are intervening at the age of 6 months and you check the vocabulary of this child at 3 years, it will drop down to 150 to 300 words which is like a significant drop and even worse is if you intervene at 2 years of life which is the best case scenario in India like we all are aiming that we should be able to intervene or do you know cockar implants or pick up all these things before 2 years or by 2 years of age and vocabulary of this child even if it intervened at 2 years at the age of 3 years will be less than 50 words. Wow. So you we don't realize what we are missing on we are you know because of the underlying neurological pruning that happens lack of audiary stimulation to the audiary cortex you even if you're giving the best of the treatment to this child at the age of 1 year or 2 year or 3 year you are never going to get back what is lost you know so that is why we keep on saying that it's a kind of a neurological urgency if not emergency but you must know that you're not going to get it back this is so important because people don't really understand how language or knowledge is built in the brain. Right? So for you to learn anything, you first need to learn the abstract concepts inside it. Correct? Right? So if I have to teach you that uh this is a phone, you need to first understand what this is a phone means. Those words, right? And if you cannot hear me, if you're not able to hear those words, you will not form any structure of meaning in your in your in your head. And so what you might form is a very visual kind of world representation. Correct. But you cannot communicate, right? And this leads to a significant um impairment in the way that these kids will Yes. Yes. Certainly. Just navigate through life. Very true. Very true. So when I say that when when you lose on auditory stimulation or when you lose on hearing you're just not losing uh the ability to acquire a language or speech you it it comes with lot of cognitive abilities it comes with lot of emotions like for example I always tell um my you know young parents who come like for example have you seen a baby when you he's crying the mother is saying oh my baby please calm down cutie That is such a soothing voice. Yeah. And if you have to use the same words in a different jargon, calm down. Yeah. Don't don't cry. That becomes a different. So it's the words are same, the language is same, the vocabulary is same. But what comes with the speech or the communication is also the emotion which gives so much of you know it's just more than the emotional stability. It gives the whole personality or you know the the existence of a child. So a child that is born in a family which is full of lot of attention and love and good conversation or you know rich language environment will be a much smarter child overall and in much stable child as a human being compared to somebody who's coming from a family where these emotional components were not there and speech is a very important part of our emotion you know so they are losing on that thing you know shi one thing that I've noticed is you see some people who are socially awkward. Right? So that means that they are in society, somebody says something to them, they don't really know how to respond. Correct? So that skill of being able to listen to someone's voice, understand is this sarcasm, are they angry, are they upset, those soft skills can only be picked up through communication. Correct? So I feel like maybe kids who've grown up in a joint family, right? with lots of conversation going around, lot of people, you know, maybe arguing, laughing, um, discussing things, their understanding of society would be better than a child growing up with just mom and dad, both of them going to work, the child is on the phone all day. There's nobody to talk to, right? Their social skills might get affected because those language centers are not getting developed. So on that note uh Siddhhat uh I don't know if you have heard about this word called virtual autism or a digital autism that is coming into picture is exactly because now uh both parents are working smaller families children are spending most of the time with nannies who are not communicating they are always on the digital media it is causing a kind of a I always say it's like a language robbery that is happening you know they have they don't know how to express all their attention and emotions are going into something which is so unreal and the we all have seen there is a increase in autism postco because during covid they were most affected because they they lost on the all the form of stimulations they were getting whether it was going out talking to 10 other people understanding things so what in all this I'm trying to what I'm trying to say is a child that is born with a hearing impairment is just not born with the impaired hearing He is getting deprived of so many things in life. You know, for him to become a normal mainstream individual, you need to get them back on track and give them their at least this is the basic right that they should be coming to. One misunderstanding that parents have is that a child who is a good student is somebody who learns, right? So they only focus on the input that the child is getting. As long as the child is able to absorb things, that's a good child. Correct. But language doesn't work like that. Languages take, give, take back, give back, take back, give back. So it is a constant cycle back and forth. Right. And that I feel is happening less and less with today's children. Right. Right. Certainly there's only intake. There's only intake. Intake and they are just expected to you know perform, read, see digital videos and just perform. What we are looking at is our responsibilities just more than uh you know diagnosing and treating children with with with if they're born with lesser sense one's lesser uh sense is you know more responsibility towards society because we have to live imagine a you know in a in a if 700 children are born every day with some form of a hearing impairment and they are not really taken care of and this data is very very superficial because we all know how the data maintenance happen here. So, um I think we are looking for a bigger problem in the future than what we are already facing. Let's take a deeper dive into hearing loss. If there is a parent uh who comes to you with a child who they suspect has a hearing problem on on average how old would that child be when the parents bring the child? So um the a if you know a child actually starts responding or speaking few words by the time he's one year old. Parents still wait and between 1 to two years is when they you know realize that something is not right. I would not uh I mean I would say that the age is coming down. We would get these children initially at the age of 4 years then came down to 2 years. Now children are coming between you know at at around 1 year of age because there is an awareness which is spreading but more than that I would say even if they pick up that the child is not hearing they really don't come up to find a solution they just want us a reassurance because they have already come from a background where the family the relatives the society or even their GPS and in some cases even their pediatricians have said it's okay father and they are just not ready for us to you know say that no so the the fact is I tell them that with all due respect I want to be wrong I I wish I'm wrong when I say that your child is not going to hear but get me a hearing test if you're now we have such good aiological services such good test available that there are chances of false positive is just not there if your hearing test says that you have a severe to profound hearing loss loss which is not sufficient for the child to acquire language. You have a hearing loss. You wait for one year, you wait for 2 years, you you're just wasting on that time, right? And as we just discussed that time is very precious, right? Because waiting for two hearing loss for those two years at the age of 1 2 and three is very different from hearing loss at the age of 13 14 15. Correct. Because it's like if you imagine a building is being built those first three years is foundation. Yeah. Yeah. Correct. If that foundation has come, everything the entire building will be shaken. Yes. Yes. So in I you know I had a very um interesting and a very heart touching thing. There were two families both the parents. So one parent were from a smaller town called Ratnagiri and they came from a religious background where it was believed that if God has given you some uh handicap you're supposed to live with it. But then this parent had seen another child who had received a cockar implant and he said no I want an implant for my child. They came the child was I think 9 10 months 11 months old and I counseledled them that you know earlier we do better it is we have already lost precious time and that father was very determined and he said let's start the process and even Siddhhat unfortunately even if you know you come up with all the resources all the test everything everything is done within 5 days the child is not eligible to get implanted for good a month two months because there is a lot of things that need to be done before that Right. So, but that this family was very good. They did everything. On the same day, uh another family had come and their child was much younger, 6-month-old, belonged to a very good family from Jaipur or somebody very affording and everything came with the grandparents and grandparents kept looking at me as if I'm trying to you know just don't say such things and girl child don't say such things and they said no no we'll wait for some time we'll wait. I kept on telling them but they decided to wait. Finally this child got implanted at the age of one year the first child. The second child continued waiting and taking some treatment going to some you know other things. Now again after 3 years this child came up the the child who had got implanted and this child girl was talking like a absolutely normal. She was reciting poems. She was talking to me. And this family had come down and they said very proudly they said that we want to go for the highest end implant. You know this family we helped them through funding they got a basic implant they were doing. So I mean when we talk about these basic implants and high-end implants these are like dig it's like a phone good phone extensive phone but the phone will do the function. It will give you hearing. So they were very proudly standing outside we want a bilateral implant and a child second family and we want her this thing and when they looked at this girl when who they had met on day one this child was talking and then they looked at their granddaughter she was still you know so dependent on the family and I told them and I could see that regret in their eyes that now when you see both these children at 6 years of age you will realize that that girl is actually six year of aological age. Yeah, but that is what I keep telling all the parents that it's not about the resources. It's not just the do not get into this trap. You're missing on that important time. I think people have trouble understanding compounding whether it's in stock market or whether it's in mutual funds. Very nicely put. And whether it's in year ear damage or language development. Yes. So in those first 2 three months the difference might only be one or two words. Correct. Right. It compounds. It compounds. So the less words you know the less words you can know. Correct. And so that difference just keeps on growing. And and the and the sad part is in in this area unlike stocks uh once you cross that age of 5 years 6 years you are I mean you are not going to acquire language. We come we come across a lot of children who are seven years 8 years. they want to do it and we coun that we will be able to give you a perception of sound like he'll be able to differentiate between that sound is loud this sound is not loud but language acquisition I mean that's not going to happen I have to ask you a question that we had not discussed previously between vision loss and hearing loss what is the more profound impact okay that's very very interesting question. uh as I said uh so first of all I believe that all the sense organs given to you by God have their own duty and own importance but when it comes to hearing loss as we said you are just not losing on speech or you are losing on lot of other things which are essential for your well-being for your communicate I mean you know for you to exist for you to able to talk and I Sedhhat you don't I don't know if you know but this is the only technology in the world cockar implant that has been able to restore a sense organ that has been lost right so if you're born without a vision you cannot restore a vision if you're lost without know you're born with loss of sensation over the skin this is the only sense organ or the only sensation that can be restored so that's a beautiful revolution that has happened in the industry that this is the only thing that can be restored. So uh I mean I would still say I mean both vision and hearing is lost but you know sometimes we come across patients who are syndroic who are going to eventually lose their v vision and they are going to have or they have a hearing loss and we emphasize please restore their hearing because vision is something that he can still manage he can still manage you know with other things but this thing is very important for his confidence for him to just work his life through. Yeah. So blindness is a is a handicap that attracts empathy but deafness is a handicap that attracts mockery. Wow. And another thing is that you know u your blindness separates you from things environment but deafness separates you from people from the environment like so it's a vision loss is more of a thing materialistic detachment that you are getting because you're not able to see you're not able to touch you know no you're not able to but deafness you are just cut off and this is a very very you know this is thing that we have really realized that I I have so many of my colleagues or people I know who have hearing loss and they don't want to show up because it they will be mocked for it. They will be called names. But if you are blind or if you have this, people want to help you. People are more empathet empathetic towards you. Yeah. I think people can empathize more with not seeing. Yes. But they cannot even imagine not hearing. Right. Right. I don't think that's possible for somebody to imagine what must it be like to live in a world without sound from birth. From birth, right? Because what what is it like to not know what sound is? I don't think you can imagine. Whereas blindness, you can imagine it because you can close your eyes. Yes. You can you go off to sleep. You go to sleep. You're in a dark. You're scared of the dark. You play games where you know you just put a blindfold and see how it feels because you it's it's kind of you know it's an experience but you can't uh you know for that matter uh when when some patients come to me especially those who have conductive loss and they're like n we don't want to do anything I just tell them okay sit across me let's talk just close your ears just let's just talk you'll still be able to hear me you'll still be able to but try and understand that it's so so difficult or what I do is especially for my older patients sometimes when they come is when they come I keep talking to them and I keep scratching something like a really you know something which means that it's a constant thing which they're not able to and they're like can you stop it can you I said that's how your child is hearing you know there's a constant irritation irritation and he's he's understanding that you're talking to him he understand that you're talking about this subject but he can't make out like you know he can't make out what you're trying to say so uh this This is a very frustrating feeling like a hearing loss comes with lot of frustration because you are just not able to understand what people are saying to you right you know you're not able to connect with them at any level and ear ear problems are such that I always feel that ear and tooth problems they are so close to you yes you know like if my hand is hurting I can still somehow put some distance yes say that okay my hand is hurting but when I have a earache earachche Yes. Or when I have a toothache, I just feel like there is no gap between me and the pain. It's just so intense. And it's so close. And in fact, a very funny thing is before I took ENT as a subject, I always thought people don't have ENT issues. And even if how can that be distressful? But now when I'm deep into it, I realize like when a patient comes to me with ear ache or sometimes, you know, when they have a blocked ear because they've taken a flight or they have gone for scuba diving, I'm very empathetic towards them because I tell them that you have no idea how painful and distressing that is because you feel that pain deep inside somewhere in your brain and you can't even press it or you know you can't console yourself. Nowhere to hide. Nowhere to hide. It's a really and I I make sure that you know I give a emergency treatment to these patients because now I know that it's a very distressful situation to be in. Um I I I do a lot of diving. Uh I'm I've completed 90 dives so far and in 2 months I'll finish my 100th. Um so I have a lot of diving friends. So I want to put this message out there. So if somebody has equalizing problems, correct? Right. they go down, pressure, they're trying to equalize and it's not happening. Are there things that they can do beforehand to make equalizing easier? So, u I'll tell you something. It's basically in a very simple word. It's a tube that connects the middle part of the ear to the back of your throat or back of your nose. The purpose of that tube is to equalize the pressures. Right? If you're not able to equalize the pressure because the external pressure is here is higher. All that you need to technically do is basically it's like a muscular tube. Ustation tube is a cartilagynous muscular tube. You need to exercise that tube well. So lot of these val salva maneuvers there are devices which you can do basically to exercise that so that whenever you want to really do it your muscles there are strong. In fact now we see lot of uh patients old age stress related they come with these issues where you know their ears are getting blocked they have and it typically very distressed looking patients very irritable with life because they're not able to tell what's happening with them and for that matter this thing when it comes to children are not even able to tell when they have a blocked tubes which is very common they tend to develop fluid in the they don't know they are hearing but they are hearing as if they are hearing underwater because now your middle ear is filled with water and then they develop infection so these are I mean with children now that's why I mean I have a very special interest in pediatric ent because children are very different they are not many adults their problems are different their way of expressing that is different their way of the way they feel it is very different so it has to be treated differently Today we are all living with gadgets. Uh children especially I think from the age of 2 years they have an iPad, they have a phone. So they are listening to a lot of sound which is really close by. Yes. Maybe they're also using headphones. Correct. What is the harm in this? So um especially when you're using earbuds you are so basically you are kind of um occluding your ear canal. You are giving a high very high intensity sound which is directly stimulating your eard drum. It was not supposed to be stimulated that closely because when God gave us this crevices and shape of the ear, it was very strategic. The you know the ears are just not placed like just lagadia. It was very strategic where should they be placed at what height they should be placed? What should be the shape of the ear? Because the sounds which are coming they are filtered. They are kind of you know focused and then there is the whole mechanism in your ears to dampen that sound. So that sound that actually reaches your inner ear is nonharmful. You are taking away all that benefit by putting something here and constantly listening to that thing and you're just taking away all the benefits that God actually gave you. So when I when these patients come to me, I always tell them if if at all you want to wear, you wear those over the year over the year ones at least you know something is getting distributed evenly. Don't put anything inside. And for that matter we are coming across lot of children with these noise induced hearing losses which is a very typical losses you know high frequency losses that typically at one frequency they'll just the hair cells are damaged. So understand it's because of inner ear inner ear yeah inside the body inside if you're using very high frequency for a very long time your hair cells are so hair cells are like they are like machinery which are which is functioning they have to convert the sound signals into electrical signals. If you're com constantly bombarding them with signal, they are just going to get exhausted and then they die off. Okay. Right. So, um I mean this is a very um I always say that technology comes with lot of uh side effects which which you will not see immediately. You'll see the good part of it like benefits of it immediately. Side effects. It's so ironic that we are using noiseancelling earbuds. Yeah. while putting noise directly into your ears. So your cat so what is happening is everybody is trying to shut the external noises in our life you don't understand what is happening inside you know and that is the main thing at different levels and I'm just not talking about the noise from the noise point of view it's like children generally when we were talking about smaller families when we were talking about social isolation you know like when we were kids we would go and play in neighbor's house So that was kind of giving us a kind of a social security. Now people are just becoming so they're cancelelling out everything outside but internally the damage that is happening is at a bigger level. So Shi a parent has come with a child with a hearing loss. What are the options that that parent has to help the child? So um first and foremost is we need to a confirm that the child has a hearing loss. Then second is what is the type of hearing loss. When I say type of hearing loss, the hearing loss can be a simple hearing loss where the problem can be conduction of a sound from your eardrum to the innermost part of your ear. Okay. Another type of a hearing loss is a sensory neural. We should we should show that. So if you look at this diagram, so this is the outer ear and middle ear. So the sound waves get you enter the sound waves are amplified. These are the oicles and then this is the inner ear. Once they reach the inner ear, this is the hair which is known as now if there is a problem from here to here. It's called a conductive hearing loss. This can happen due to any obstruction in the external canal. More commonly if there is anything in the middle ear it can be an infection, it can be fluid or it can be a simpler thing. Right? Then comes the innermost part of the ear. This is known as a coccia. Okay. This this whole thing is coccia. Correct. The function of coccia is the whatever sound waves reaches the coccia. It converts the sound signals into electrical signal. Correct? This yellow thing that you see is the nerve fibers. Okay. So then those electrical signals are given to this nerve fibers and then they are carried to the brain to the part of a brain that so now if there is a problem from here to here it's a conductive loss. If there is a problem from here to anywhere here suppose if it is not able to convert or if it is not able to carry the sound then becomes a sensory neural losses. The treatment for the two are absolutely different. Yeah. Now a conductive loss can be treated with so hearing loss ultimately means uh there is sound reaching till there is sound reaching till the ear but our brain is not able to hear it. Correct. So somewhere between the ear and the brain there is some issue. Yes. Yes. So that issue could either be conductive which is uh from the outer ear up to the coccia. Correct. And sensory which is coccia onwards. Correct. Right. So huh. Now you're telling me the treatment for the outer part. Yes. So now what can be the problem? Suppose if you have a child is born without a proper formation of an external canal. It's called microchia. Okay. So the ears are not formed. Now when you the ear is not formed, you have to see whether just the pina is not formed or whether this is also not formed. Whether half of this is not formed. the inner part is also not formed. Now when the problem is with the conduction you can give a simple hearing aid. Now the hearing aids can be now if your pina is formed and there is a problem in conduction within you can put a hearing aid. Hearing aid does a simple job of amplifying giving a louder sound. It's like a loudspeaker louder sounds. So that whatever function this pina was doing now it is happening here. It's a simple thing. Now if you suppose a pina is al only not formed or this external ear is not formed then where will you put a hearing aid? Then comes something known as a bone conduction hearing it. I don't know if you've all realized you don't only hear from your ears you also hear from your skull. Yeah. Okay. Your skull plays a very important role. So especially I don't know you because you dive if your ears ever get blocked you kind of feel a eco. Absolutely. It's more like you know those are internal sounds now which are now conducted by your bone or the skull to your cockia. Right. But I I heard something very recently that was so interesting. Most people when they hear their own voice on video Yes. they'll find that this is odd. Yes. And the reason is that when we speak we are hearing our own voice through mainly bone conduction. Whereas when we hear it on video, it's through air conduction and that sounds different. So you don't realize how you sound until you see your own video. True. True. So air conduction is better or more than bone conduction. The moment anything obstructs your air conduction, you can utilize your bone conduction to here. But the best is to restore your air conduction. Now there can be surgeries which can be done for your middle ear like a maringottomy groom. When the fluid gets filled here, what you do is take a small nick, just suck out all the fluid and put a small tube so that the fluid can it's a simple small procedures which can be done as a daycare and you can restore the hearing and these things are very very common in children especially early schoolgoing children because of the underlying enlarged tonsils adenoids. So when your tonsil adenoids are big, this is the tube. Okay, this is your ustation tube. It opens into the middle ear. This end of the tube is blocked by tonsils and adenoids. What happens that secretions are not able to drain. It gets filled with fluid. Very simple thing. It's filled with fluid. So your child is not hearing well and because of that his cholestic performance is going down. You simply either you remove the tonsoids or you take out the fluid and put a tube here. Very simple thing to do. Now the main thing which is more troublesome or thing which is not picked up is the sensory neural hearing loss. Mostly children are either you know it's a conjunctal hearing loss which the children are born with or they may acquire a hearing loss like especially children who are who stay in NICU for a very long time children who have a very high jaundice you know requiring blood transfusions children who are on lot of oxygen therapy in NICU. So that's why these children are known as high-risk children. Certain drugs like autototoxic drugs which can damage the hair cells and this can happen even you know a lot of TB medications are known to cause damage the hair cells. So that is where this part of your thing is not functioning right and then when you have problem here then the treatment option is if you have milder degree. So another thing is first find out what is the type of the hearing loss then you find out what is the degree of the hearing loss whether it is mild whether it is moderate whether it is severe whether it is profound. For children with mild to moderate loss you even if it is a hearing loss here you can still use a hearing aid which means again whatever leftover hair cells or leftover apparatus is working you are trying to overstimulate it by giving a hearing aid. So cockar implants are not meant for every child born with a sensory neurolog. Right? So in the first sentence we said that around 700 kids are born with hearing loss each day but not all of them will want a implant. Not all of them will need a cockar implant. Our job is to find out who are these children because then we need to cater to them on priority right because they are the ones. So children with severe to severe to profound hearing loss or men I the best thing to say is the children who are not benefited with the hearing aid are the candidates for cockar implant but that would mean wasting a little bit more time though I would say wasting or utilize you need to be like little proactive with them you can't that's what I'm saying you can't uh do the evaluation and decide tomorrow that okay he's a candidate for cockar implant but these are the children that are really requiring more attention from our side understood Right now out of 700 on an average how many kids are actually eligible for uh hearing aid versus how many of them need to go for surgery need implants. See I would uh difficult to give you a data like that but I would say like for example if there are 700 children I would say around 350 of them would be with a simple conductive losses which can be treated with bare medical treatment or rest 350 I would say 150 of them will benefit from hearing aid actually needing implant will be 150 only but I mean even that is a big number that is every child is equally important and we you know what what I don't see when we say hearing loss is not a visible disability you can use this term as a very victimizing term or you can use it to your advantage is that these children are actually otherwise normal they are absolutely normal they don't have any other handicap the if you can restore or give back them the you know hearing they can become a normal individual they are not somebody who needs uh you know handicapped criteria or they you need to take care of them all throughout life you when when when this thing comes up that what is oh the cost of cockar implant is very high you know uh it's a very uh the the process is very tedious I always say like you know when we mentioned about stock look at the returns don't look at the investment if the return is good which means if you are able to convert a child who is always going to be dependent on you because he'll be deaf and mute to a child who can be a normal individual do do go to a normal school get graduated as a professional earn his own income and give back to the society it's a much bigger return right can you talk about the investment part a little bit which is how expensive is it to go for something like this so um I would say that cockar implants are expensive the the average cost of an implant in India uh starts from somewhere around six six and a half lakhs and goes up to 19 20 lakhs and this I'm talking about one side implant you have a bilateral hearing loss so you have to multiply it with two so on an average of parents end up spending some 10 to 12 lakh for getting a bilateral implant to up to 40 lakhs but um so I always had this thing with the company I kept on saying that why your implants are expensive why are you not reducing the rate it has been in industry for such a long time only when when I visited their facility in Australia And I realized that these people are working so hard on the research. Their their mindfulness is 20 years ahead of us. Which means the implants that they are making are forward compatible. Which means even the implant that is done today will be eligible for a technology which will come 15 20 years down the line. And uh do these people have to the patients who undergo this do they have to get another one later or one implant lasts a lifetime? No that's a very tricky question uh Sadhhat but I will say since since it's an electronic gadget the um the guarantee warranty that comes with an electronic device worldwide could cannot be more than 10 years. Having said that or the the patients that we implanted 20 years back are still using the same implant and they are able to upgrade the processor which means I'll tell you in a very layman language there are two components of implant. One is an external component one is an internal component. Internal component is one which is surgically implanted by a surgeon. Okay. That is just the that's just an implant that will work what the cockia was doing. Right. M and that's the one you were saying was as thin as a strand of hair. Yes, it's as thin as a strand of hair. It's that thin and trust me when I tell this I saw how they do it. You know, every person who works in that facult facility for cockar implant they do that manually. They sit there and manually do it. they wear very high this thing magnifying glasses and every two hours they have to take a break and they have to like you know they're always in that PP kit because of the sterility and the hygiene part is at another level. So that's what I'm saying when we say about the cost it's not it's just not a money-m business we are talking about because it's it's the kind of technology it's the only technology that has been able to restore your hearing you know so much goes into the research so uh what what happens is the so the external component external component is called a processor that you wear outside it is the thing it it acts like like your pina it picks up the sound it converts the sound and it gives that sound via magnet magnet to the internal component which is then carried by the electrode which is implanted in the coccia and the function happens the external processor is upgradeable it's almost like you know how iPhone updates so that is updatable you can still have the best of the technology even 15 year down the line with the same internal component because when the company made those implants they thought of it that maybe 10 year 15 year down the line we'll be able to come come up with something you know. Yeah. So that's really impressive. I have never really I mean I don't think most MBBS or MD students learn about this. This is a very niche thing. But um the more I talk about it I realize that it's very important that people know that a early hearing loss detection is important. Correct. And b that there is hope. Yes. So once you know that there is hope uh I feel the urgency of it somehow even becomes more more you know because somewhere I feel that with vision loss for example even if you pick it up early with certain degenerative vision loss cases what can you do what can you do so it's almost like okay early detection would maybe of course you can take care of things a little bit more but ultimately there's no way to solve it right but um in this case that's not the case. Yes. So those few years are so precious few years or I I would have started coming to months now that first few months of life uh are very very important. In fact WH and the whole society that works initially they used to say the criteria was 136 which means you pick up a hearing loss by 1 month confirm it by 3 months and intervene by 6 months which has now come down to 1 2 3. Oh. So 1 month you know confirm your hearing loss by 2 months and by 3 months you intervene and with a better technology better anesthesia better you know this thing we are able to do the surgeries in much younger children like in Australia they have they have implanted a child as young as 6 month old. Okay. Yeah. Now we are in the realm of um science fiction but is there a way to pick up hearing loss when the child is still inside the womb? No. No, not yet. Not yet. But that would be it is coming up. It is coming up. But um not much is known about it. They are trying to figure out. But the good thing is you can pick up a hearing loss in a newborn baby like a child that's less than 24 hours old. Tell me about that. Tell me about newborn screening. So um very stra so all developed countries have something known as a universal newborn hearing screening which means your baby will not be allowed outside the premises of the hospital until you have hearing report attached in your file and or you have and you have a baby bassinet in your car. Okay. Like they're very particular about extreme things but which is a good thing. However, in India there's nothing like that. There is nothing like a universal newborn hearing screening. Universal newborn hearing screening means you need to pick up a hearing loss in a newborn child. Very simple test. It's known as an O AE auto acoustic emissions. It's a one-click test. There are probes that goes into the child's ear. One click and you can just say whether your child is hearing or not. It comes as pass or refer. If your child pass, well and good. If it is a refer, you need to work up on that child more. And then there are more sophisticated test that can help you understand the frequency specific hearing loss like whether it's a conductive whether it is a sensitive but as a screening that's all you need to know normal hair abnormal hair correct that's it that's it and that is very doable very easy very simple okay and you in by you you'll be more so much more confident when you know that your child has passed so as an ENT specialist is it your recommendation that every single child born in India should undergo a newborn hearing screening test. Certainly certainly without a doubt it has to be a norm and it it I mean there's no second thought about it. You cannot say that no I don't want to do it and I'm sure my child is hearing. Nobody can be sure whether the child is hearing until there is a report which is attached which says your child has passed the test. Brilliant. Because I feel like one uh after listening to you, if suppose from today every newborn child gets screened, that means that every day potentially around 700 kids with hearing loss will get picked up and potentially that is 700 people who would have been disabled after 10 years, 15 years who have now a chance of living a normal life. living a normal life certainly and the price for that is in the it's incalculable but even if you try to calculate it's in millions each person will contribute so much correct correct that's what that's what I was saying that that's the concept of returns you know you you don't go and and in fact I'll tell you something very personal Shat when I started working very closely with this the only um uh limitation from my community was why would you spend this much on doing a hearing test for thousand children you're picking up six to seven children why should we uh you know screen thousand children what is the amount of money that got wasted so what I did was that for 2 years in my hospital for every child that was less than one year because newborn was not you know I couldn't see myself doing a newborn screening but we we did everything for free you know despite all of that what I realized that you know it is not one person or one community that can do it because even if you're getting picked up What next? Do we have resources? Do we have infrastructure? Now suppose if universal newborn hearing screening has come into place which is the dream for all ENT community 700 children per day. Do we have resources to cater to them? 700 like what next? Where do they go? What what kind? And then they need a high-end auditory uh you know testing. Do we have that many pediatric aiologists? Do we have that many referral units that can take care and you know actually segregate these children that which child needs to be under observation, which child needs to be put on hearing aid, which child needs to be worked up for cockar implant. We don't have that. This is so unfortunate because it's very similar to what is happening in mental health. Awareness of mental health problems is now at its peak, right? Everybody knows about anxiety, depression. But then what? Then what? When somebody says, "Okay, now what do I do?" And we say, "Oh, you should go to therapy." Do we have enough resources? Do we have enough qualified experienced therapists in the country to handle all the patients who are going through anxiety? The answer is no. No. And so it's almost as if what was the point of me knowing then? Now it's even worse in Now it's worse. Now you know that your child has a problem and now you know that you don't know what to do. Like there are a lot of patients who come from these remote areas. They have files and files of hearing test and uh investigations done and it was like you knew your child had a problem at 7 months. Why did nobody told us what next? They kept on saying wait for 1 year, we'll repeat this test after 1 month, we'll repeat this test after 2 years, this person told us to wait. And it feels so unfortunate that despite of them picking up the hearing loss, what next? So it's I think the whole community or the government needs to come together to put these things like I always say we were able to eradicate polio because we attacked at it from every possible end you know for example AKT every you you can't say we'll give you one month of AKT and now because now we have told you you have TB now we have told the medication works but then you know you had to give them the 6 months of TB treatment free that's how you were able to you control the TB. So everything that you are dealing with, you need to do it as a holistic thing and it it cannot happen just like whole all of us keep talking about universal newborn hearing screening. I feel it's just the tip of the iceberg. You know there's a much bigger problem sitting down there. I think that uh this conversation was really important. Uh in second opinion this is what we try to do. We try to take a topic and just sort of highlight all the things that doctors should be talking about but we don't we don't really and so many times in the series I have I have gotten surprised you know after 15 16 years of studying and 6 years of practice I still come across things that I'm like wait if I didn't know that yes of course no people would not so these are niche topics that are not really niche it affects everybody it affects everybody right Dr. noise pollution is one of the leading problems that is happening in the country in the world right now. So what is the damage that noise can do and also what is the difference between sound and noise? Okay, let's first talk about sound and noise. It's a beautiful thing actually. Sound is when there is different frequencies are in harmony with each other. I am trying to talk to you. Yeah. It's a sound. Yeah, I shout at you, it becomes a noise. Okay, noise is an unpleasant experience which is where one frequency or certain frequencies are more than the rest of the frequency. So noise is used for a term which is unpleasant because the frequencies are not balanced with each other. M sound or is like a balance of different frequencies where you're using different consonants and vowels to give a meaning you know which your brain can soothingly accept. So that's the difference. Yeah. Because I always thought that it was the meaning. So sound is noise that your brain can make sense of. Yes. Um so that could be like a harsh thing. So yes I mean on a lighter note we say that a wife may be just talking. It may be a sound but husbands may feel it's a noise if they are fighting. Yes. So yeah I mean so it's a but but otherwise like definition wise like noise is something that's unpleasant and it has a you know there's a more emphasis on certain frequencies which are unacceptable and not a routine thing for your ears to hear. Right. How big of a problem is noise pollution? How does it affect the hearing? Noise pollution is becoming very relevant especially because of the urbanization because of we are constantly uh you know surrounded by uh some form of a noise for example there's a construction going on the flights like I I stay in you know that area bandra I don't want to live somewhere near that Santa Cruz du area because there's so much of sound pollution which people are not recognizing it can be damaging it's a constant high frequency sound of the planes that is going above you Then another thing of course as we talked about it that because of the earbuds that you are using it's a constant noise exposure at a relatively higher frequency than normal which is you know kind of bombarding your hair cells. Then comes a different kind of a noise pollutions like you know a bomb blast or a train accident or maybe somebody has hit you very hard. So basically one loud frequency sound which has suddenly you know kind of uh damaged your hair cell or you know kind of moved your hair cell. So now more and more people are coming up with initially the noise induced hearing loss was mainly occupational related you know people the laborers working in the train industry people working in metal beating industry those those people and they were supposed to wear those protective ear plugs and all and all but now I think we all are surrounded with some form of construction related horn related or with all that urbanization that is happening we are perpetually being you know So on that note more and more younger adults are now developing hearing loss at a earlier that age related hearing loss. So with age your hair cells also become aged. Yeah. They also become less functional and you develop something known as a press byes or an age related hearing loss. And we have seen that their overall average age is coming down. I had once done this test uh where you can hear certain frequencies and as the frequency goes up your you stop hearing it at one particular point. Yes. And uh depending on when scary it was so I'll I'll see if I can show it to you. Um so this is the these are the different frequencies the extreme ends of our here. Okay. If you can hear 8,000 hertz you're both alive and not hearing impaired. But let's keep raising this. We are alive and we're not hearing impact. 8,000 hertz everyone should be able to hear. See, we are here. 12,000 Hz, I can hear it. You can hear it. Yes. Okay. I can hear it. 15,000 Hz. I can hear it. Oh. 16,000 hertz. I can't hear it. So, we have a 20-year-old. We have a 22 year old sitting in front of us and he's doing like this so he can hear it. Can you hear it? Yeah. 17,000 Hz. I can't hear. You can. 18,000 Hz. I can't hear. 19,000 Hz. I can't hear. 18. How high could you hear? If you could hear. Okay. So this is uh very uh sobering because you realize that age is a thing and it is not just a number. You your body does keep score of how old you are. And this means that certain hair cells in my ear has stopped working. Yeah. They they are aging. They're aging. They're aging. They're aging. Yes. Yeah. So which which also brings us to this uh really uh it's a reality check that uh so that is what I was telling that you know the average age of developing an age related hearing loss is coming down and because now we are living a more fulfilling life which means the average professional age is going up for example like my 50-year-old grandmother had actually stopped doing much of work you know I mean with respect to being active she really looked 50 like now my 60-year-old mother doesn't look like a 60-year-old. She's like all up and about. People are working running marathons at 70. So the average professional age is going up because of a better understanding of life, better medical facilities that are available. So we are we are actually waiting for a kind of a big chunk of people who are going to come up especially our parents and eventually us that will develop an age related hearing loss in life you know at much earlier age and still be working and still be working and it's quite frustrating to be not and so the the funny thing about this is this kind of a hearing loss is different from what children get because they have never been exposed to sound so for them it's not that distressing for age related ated hearing loss like you know what we just saw that we were able to hear up to 12,000 but he was able to hear up to 18,000 right which means if he is trying to talk to us at a frequency between 12,000 to so he will think that why these two people are not responding they are they are not listening to me they're they're ignoring me I'm trying to make them understand so there is something known as a speech discrimination which means you we can see that he's saying something we will hear all the consonant wobbles which are less than 12,000 frequency but the moment any sentence or any word or anything that is so we will only hear parts of it and since now we are older we are wiser and we have much more egos we don't want to accept that we are not hearing what you are saying so it comes with lot of emotional and you know anxieties and kind of things which which are beyond yeah like I can imagine say a 75year-old grandfather who has always been used to having his way or you being in charge of his office or whatever at home. Now, if he's not able to hear 30% of the words that is being said, he might not admit it. He might not admit it. He might just pretend that he heard it and he might get irritated or he might just yell at the youngster saying, "You never told me." Yes. Yes. So, he might uh like, you know, divert his frustration at himself at other people. And people think that ology. So there is a whole data shat which says that hearing loss in adults have increased the chances of them developing Alzheimer's. Yeah, there is I mean this is a very scary data I mean that comes that the chances of you developing uh neurological issues like Alzheimer's and all is much more higher in patients with hearing loss and if you can reverse that or if you can take care of that your incident and even the progression of developing Alzheimer's comes down because brain I mean you are no but better person than you to tell how all the neural things are connected to each other but uh that is that is something which needs to be really really you know concentrate looked on now. So the reason that I I really like this test is that um it gives you a different marker to see your age. Yes. And ultimately degeneration happens in parallel through the body. It's unlikely that you will have extremely good hearing but very poor memory. Yes. Right. Unless something specific has damaged your memory area in the brain. If it is age related degeneration roughly speaking your body ages is around the same way uh similar for bone age similar for heart age because your body if one organ suffers then eventually others also suffer and as you said that this is such an important stimulus that is going to your brain uh your memory your conversion of your short-term into a long-term memory thing your cognition overall is m very much linked to what you are hearing you know so even so surprisingly I must tell you this cockar implants were actually devised or invented for elderly people abroad in Australia and all government gives cockar implant as an insurance scheme to elderly people much later they got approved for children but in India there is a thought process where children are considered important but the older people are not for example if you have to spend 10 lakh rupees. You'll spend it on your child health or wellbe. But you won't spend it on your 70 year old father. In fact, father will only say 70. But that's that's not what is going to happen with our generation or we would want a best life for us even at 70. Right. Of course. Of course. Um one more question about noise pollution. We are it's it feels like we are headed down this path anyway. there is no no real escaping noise. So are there things that we can do to take care of our hearing given that we are living in cities and we can't really afford to move anywhere. What can we do to take care of it to just reduce or slow down this aging process? So certain few uh oral hygiene things that I always say is of course there are things like you know underlying diabetes, blood pressure, um general autoimmune issues that you the incidence of autoimmune is also increasing and hence your hearing losses are also increasing those things eat as healthy as possible lot of uh you know we give give a lot of nerve related uh multivitamins so that your neuronal functions are staying active much more than that I and That's purely my personal thing which I've said is you need to just calm down and you know stress has to be under control. Stress is the most distressing thing that your body can experience and it has been proven in multiple aspects whether it's your hearing or other issues. So things like you know meditation and doing lot of those calming things have go a long way and they go a long way. I mean generally just keep yourself hydrated so that all these functions they water is such an important component keep yourself hydrated manage your stress well don't be in that whole rush don't do don't go for any fancy things like wearing those earbuds and gadgets like just be as normal as you can like try to become as conventional as possible is what like use the technology to your advantage and don't you know fall for I have one doubt there are headphones that conduct sound through bone M yes. So bone conducting headphones basically are they healthier? They are definitely healthier because um there then I would say healthier in a way is because they're not directly impacting your eard drum in a way the air conduction thing is happening. But again one thing is mostly they we have seen a problem that it's a the sound is not that great as compared to the air conduction. Some companies have come up with a very nice uh technologies. But at the same time again the what we are talking about is inner hair cells. Whether you are stimulating it through the air conduction by putting them in your ear canal or you're stimulating it with your bone conduction. It is about the intensity or the you know how how high the sound is. So even a high intensity bone conduction devices are going to cause can also harm the hair sound. There are some myths around hearing that uh all a lot of people have. So I wanted to break them with you. Uh first of all say if a child cannot hear a one-year-old child a lot of parents might say is that true? No. So again there are two components of hearing. Hearing is not hearing. Hearing is for them is speech speech acquisition. So as long I I tell the parents as long as you confirm it to me that your child is hearing normally, you can wait for whatever time until there is a time you need to see a neurologist where you need to figure out whether he's able to process the information he's getting from the audiary stimulus. Hearing loss, it's a absolute myth. If your child has a hearing loss, he has a hearing loss. If it is a proven on report, there are lot of parents who say father grandfather you are h you are you know you can wait for as long as you want if you are giving me a normal hearing report so it is you need to separate these two things that hearing loss if your hearing is normal your child may be a late speaker which is a different problem altogether correct PRP or plateletri plasma is now Um I think a treatment in in fact you can count the number of things it is not a treatment in. Yes. You can grow hair. You can grow hair you can look pretty. You can have glowing skin. Your joints can get better. Your you can score well in exams. Anything. Surprisingly, there are few centers that are putting PRP in your inner ears claiming that you can reverse the hearing loss, which is such a big myth. Like it's it's that's not the treatment. There's no no study, no proven facts, nothing. Absolutely nothing. It's it's it cost patient a bomb. It more than that the loss of cost, it's the cost time that is lost because they keep on waiting. they repeat the bera after six months or they repeat the hearing test and again after one year they keep on putting that PRP it's it's absolutely okay so don't go for PRP if you can't do anything else um another myth is that cocclear surgeries are brain surgeries oh no no no coccleia surgeries are not brain surgeries they so the only thing that is close is that ear is close to your brain the cockar implants are just put in the coccia and coccia is the innermost part of the ear. So you're not fiddling, you're not opening the brain. It's like a any other ear surgery but much more advanced. When I just talk about the ear surgery part of it because now you are opening up the inner ear. You're dealing with implant that is going into your inner ear but it has no relation with your brain. You're not stimulating any part of the brain externally. You're not touching any part of the brain. So it's not a brain surgery. It's a pure ear surgery. Little more advanced than a routine ear surgery. Right? Another myth is if your child has say if you have two children and both of them have hearing loss, fix one ear of both. So unfortunately Siddha that is what is happening all across the nation. All the government programs that have come and even in Mumbai that we run most of the donors are giving implant only for one side because the aim is that you give them hearing and hence they are able to acquire language on one from one side which is not which I won't say is a myth or it's not untrue it's almost like try to hear it from one side try to see from one side there's a reason why god gave you two things so all the components that we were talking that localization of the sound, directionality of the sound, emotional component or depth of the sound, it will only come when you have hearing access from both the sides. So very typically you know what I have seen in my patients is that children who were implanted in initial like a one year old or 2 year old and they started taking therapy of course the language acquisition was brilliant because next 2 three years they're taking therapy they're always tagging along with their parents. The moment they go into the mainstream like a five-year-old child will start going to the school and there he's independent. So he's not able to hear what the teacher is saying from this side what the students are saying from this side and then we see there is a drop in his confidence his language you know he then starts to go down and then they come up with that. So it's best I mean I would really urge all the government programs all the donors and everybody who's into this thing that don't go for halfeling you know if you really want to help somebody help somebody wholeheartedly it's almost like you know you see um you know you see somebody a beggar or somebody who needs to buy food and the cost of the food is 100 bucks but you go and give them 25 rupees and say now he has 25 rupees he still can't eat food but he has some money. He's still waiting to reach there. So I mean that's that's not really a help. You are just giving them a taste of what it is to be in a hearing world. Yeah. So I would say I would still say that so if that is a situation we have come across this thing I tell them okay do one side each for both the children but within 3 months please do the other side. But that comes with of course two surgeries two you know all these things. So yeah there's no easy answer but yes there's no easy answer. I know they people keep saying the resources are limited and I don't think India has limited resources. India has immense potential, immense resources and again understand these are the people who are going to be your future. They are going to give back much more than what they are taking from you. Shi thank you so much for doing this. Um I think there will be a lot of questions that the audience will have. If so drop it in the comments we'll have Shi back. We'll do another conversation on this in the meantime. Thank you. Thank you so much. It was lovely. I I feel I could just pour my heart out and give out that message which needs to reach. Beautiful. Thank you so much. Thank you. Cheers guys.