From the Audiologist to ENT Specialist

April 3 - April 10.

So we now had a report from the audiologist (they are not doctors but healthcare professionals trained in audiology) which clearly indicated severe to profound hearing impairment for in both ears. What next?

The audiologist (at Hiranandani Hospital) suggested we follow-up the BERA test with an ASSR test, which would tell us specifically at which frequencies he could hear more (or less) and hence provide indications for an appropriate hearing aid.

We quickly googled and read through some information on the Internet - and basically figured that we needed an opinion from an ENT specialist, preferably someone who had experience with sensorineural hearing loss. We also called our Paediatrician in Powai, who referred us to get an appointment with Dr. M Kirtane at Hinduja. Ironically, this doctor had asked us to wait some more time when we had asked about NI's (my son) hearing a few months back. Now, of course, he conveniently asked why we waited for so long - and that we should really focus on getting him help asap. Every 15-days period mattered. So we were a little psyched.

We couldn't get an appointment with Dr. Kirtane (waiting time was over a month), so we instead took an appointment with the other ENT specialist at Hinduja (Dr. Shukla) for Thursday. In parallel, my mom found out about Dr. Rajesh Vishwakarma, the head of ENT at Civil hospital (an ex-student and parent of current student at her school) - and spoke to him. He recommended we come down for a consultation - so we booked tickets to Ahmedabad to meet him on Friday.

At Hinduja, Dr. Shukla examined NI and said he had a bit of fluid in his middle ear. Though he seemed to agree with the BERA test report, he suggested that we first drain the fluid (through a procedure called Myringotomy) and check if there is an improvement in the hearing before considering a cochlear implant. He mentioned that this may not drastically change the test results - but it was better we did this before going further down the path. He convinced us of doing this quickly and we even got a pre-authorization request initiated with the Insurance company and booked the Operation to happen in 10 days. The one thing we were though irritated about was how the Doctor (seemingly a senior guy in the Hospital) and his staff were totally insensitive to having a kid in the room and ward. NI is a very active kid, and he still doesn't know much - so if he is going to make noise and run around a bit (and make one of us run behind him), one would really expect the likes of Doctors and teachers to be a bit more tolerant and sensitive. Keep wondering if there is really a sense of thinking about people as people - and not another customer from whom you want to make money as efficiently as possible.

Anyway, we pretty much gave up on Dr. Shukla's recommendation after we met Dr. Rajesh. He was so much more patient and really explained to us the entire structure of the ear, asked us a few questions to find potential causes, and then walked us through the solution (cochlear implants = CI) and how we would have to go about it. He basically referred us back to the audiologist to do a few more tests to be followed with an MRI and CT scan. While the audiologist tests (BERA, ASSR) would give him a better idea of the hearing impairment, the MRI and CT scan would provide an indication of NI's eligibility to get a CI, based on whether the auditory nerve was fine or not.

Wrap: From diagnosis to understanding causes and potential treatment options - is a very uncertain phase. My takeaway is that it always helps to get more than one independent opinion and preferably speak to a Doctor who is known. Doing this quickly makes sense in my mind, because the sooner you can confirm the diagnosis and causes, the earlier you can start on the path toward treatment.

NI continues to have no clue about this. It was just a little hard for us to sedate him again for the tests (and confirm his hearing impairment) and then again for the MRI and CT Scan. MRI and CT Scan was a bit of a bad experience - with the doctors just shouting at us because they let him sleep for 1 hour after sedation before taking him in for a scan (and he woke up because the untrained attendant lifted him in a bedsheet - seriously > healthcare competencies - we have a long way to go beyond our Medical colleges).

NI - I am determined to whatever it takes to get you the best solution possible.

Next: Cochlear Implant > dealing with the choices and thinking about the money.

Results from the BERA and the World Cup Final

Saturday - April 2, 2011 > A momentous day for more than a billion Indians even before the match was played. Simply because the final match of the ICC cricket world cup held the dream of a nation of haves and have nots, old and young, fathers and sons, rickshaw-walas and car-walas, desis and NRIs - a dream to win the world cup again. And India did win - thanks to our heroes (who will be so for a long time to come) include MSD, SRT and YS.

Saturday - April 2, 2011 > Like any other Saturday, we woke up thinking about the weekend - how could we possibly make it more interesting than the usual boring ones (especially since this was a long weekend - Monday being Ugadi, but a holiday for us in Mumbai because my company has 10000 people in Hyderabad). We were determined to get the BERA test done, didn't want to procrastinate on it any more. So off we were to Hiranandani Hospital. A process of about 3 hours - delivered the bad news > NI has bilateral hearing impairment or simply put he wasn't hearing anything (I still struggle with calling him deaf)

What is BERA - Brainstem Evoked Response Audiometry. Basically, it is a machine-based test that reveals if the brain is responding to the sounds that the ear is getting. For children, they are sedated (mildly) - so that the audiologist can stick the plates on the forehead and beehind the ears, and plug in headphones that will convey the sounds.

Wrap > This was still sinking in. We were having guests over for the match - no point in avoiding that. NI was his normal self - he hasn't realized it. Need to think about options - and if we need to come back for the other test (ASSR) the audiologist recommended.

Next: From the Audiologist to the ENT Specialist