SUNDAY, NOVEMBER 29, 2015 (PAGE-4)

PERSONALITY NATURE Hearing loss in Children A study of Chatlam Conservation Reserve Sajad-ul- Akbar Wani1, Shehla Ishaque Dr. Sohit Paul Kanotra, Assistant Professor in Otolaryngology-Head and Neck Surgery, Louisiana State University, and Khursheed Ahmad New Orleans, USA, was invited to conduct a continuing medical education on ‘Pediatric Deafness and implantable The present study was carried out during 2012-2015 to assess hearing devices’ on Children’s day, 14th Nov. 2015,at Government Medical College Jammu with the object of the current status, distribution and conservation issues of water sensitizing the pediatricians, ENT specialists and audiologists on the topic of childhood hearing loss. On this birds in Chatlam-Fushkoori Wetland Conservation Reserve and associated wetlands of Pampore, Srinagar, Kashmir. The regular occasion talks were presented by Dr. Kanotra on Newborn hearing screen, evaluation of hearing loss in children surveys were carried out following the point count method in the and Cochlear implants and other devices for restoring hearing in children wetland in different time periods of the day in all the four seasons. Prior to September 2014 floods, overall 56 species of birds belong- IN CONVERSATION WITH EXCELSIOR, ing to 15 families including 14 species of migratory waterfowl EC. What is the magnitude of the hearing loss in were recorded. This was compared to a record number of 90 dif- children? ferent species of birds belonging to 30 families including 20 SPK: Deafness in newborn and children is fairly common species of migratory waterfowl that were observed in the pampore with 1-3/1000 live births having severe to profound hearing wetlands especially in Chatlam-Fushkoori wetland Conservation loss and another 1-2/1000 having mild and one sided hearing Reserve during 2015 winter. loss.In the developing countries its prevalence is higher due to The most dominant waterfowl families recorded during the ascertained further . Also, sighting of 07 individuals of Great lack of immunization, greater exposure to ototoxic agents, study period in the peak winter time was Anatidae followed by Crested Grebe which has never before been reported visiting malnutrition, consanguinity etc..About 50% of the causes of Ardeidae and Rallidae.The population of waterfowl which start Kashmir wetlands was for the first time sighted in Chatlam Wetland on first week of February 2015 as a passage migrant and disabling hearing loss worldwide are preventable. their arrival usually in mid November from Siberia and Central stayed here for two weeks. EC. How does hearing loss affect child’s develop- Asia to Kashmir Valley peaks to around more than 30,000-50,000 In Chatlam wetland we observed breeding of many water-birds ment? in pampore Wetlands during the last week of February and starts like Mallards, Common Poachards, Gadwall, Northern Shoveler, SPK: Profound hearing loss has lifelong consequences not declining as the temperature in the valley rises before their return Pheasant tailed jacana, Common Coot, Common Moorhen, Little only for the child but also his family .A profoundly deaf child migration during early spring (late March). The wetlands of Grebe, Indian Pond Heron, Grey Heron and so on. However, this will not be able to develop any speech and eventually end up Pampore are under various anthropogenic pressures owing to fish- of any rehabilitative measure. Most important thing is the fact ing, encroachments of land for saffron cultivation,seting up of year for the first time we observed overstaying of Gray Lag Goose, ‘Deaf and Mute’. Without any oral communication ,his learn- that children born deaf can become near normal members of Poultry Farms cattle rearing and human disturbance with incessant Ruddy Shelduck, Ferrogineous Poachard,Tufted Duck, Garganey, ing abilities are affected compromising his educational the society if their hearing loss is diagnosed before a critical waste disposal by locals into the wetland of Chatlam-Fushkoori Northern Pintail, Common Teal, Eurasian Wigeon and a single achievements and later his employment opportunities. With period. Universal new born hearing screening programs are CR. There is a serious problem with the breeding behavior of Common Shelduck in Chatlam Conservation Reserve. During con- lesser degrees of hearing loss the speech does develop but will based on the 1-3-6 rule according to which, a new born should migratory birds at Chatlam-Fushkoori CR as their peak period of tinued and regular monitoring of the species, we could record this be defective.In fact ,the commonest cause of delayed or defec- be screened for hearing loss by 1 month of age by OAE and if breeding activity coincides with the peak time period of catching year for the first time the unusual breeding of Gadwall and tive speech in children is hearing impairement.The earlier the he fails this test, by 3 months , a complete evaluation should fishes by local people. Besides, cattle rearing and other agricultur- Northern Shoveler within Indian Limits at Chatlam-Manibugh hearing loss occurs in a child’s life,the more serious are the be done by a trained audiologist and by 6 months some sort of al activities nearby saffron fields by locals too coincides with the Wetland. This is the first breeding record of Gadwall and Northern effects on the child’s development.Similarly,the earlier the rehabilitation in the form of hearing aid should be given. The time period of breeding , thus creating disturbances to birds to a Shoveler in the Indian Subcontinent which needs further extensive problem is identified and intervention begun,the less serious earlier the problem is identified and intervention begun, the great extent. research. Keeping in view the above mentioned research work, the ultimate impact. A profoundly deaf child will not be able less serious the ultimate impact These activities were seen least in winter months when Icy Chatlam-Fushkoori Conservation Reserve assumes a great ecolog- to develop any speech and eventually end up ‘Deaf and mute’. EC: Is this newborn hearing screen being used period (Chillaikalan) hit the Kashmir Valley. Although,in 2014 an ical and biodiversity significance in the Indian sub-continent and The socioeconomic impact of ‘Deaf mutism’ is immense as they here. unusual breeding of 01 pair of Gray Lag Goose was also recorded long term conservation planning of the wetland is imperative. cannot contribute to the society in a productive way as normal SPK: No. However ,during the deliberations of the pro- in Fushkoori Wetland CR in April-May months which needs to be hearing individuals. gramme, there was a lot of enthusiasm among the participants EC. Does one sided deafness affect the child’s and it was decided to pursue the matter with the authorities development? HEALTHLINES and implement the programme at the earliest. SPK: One sided deafness in children is often undiagnosed EC. What are the rehabilitative measures? and undertreated. For optimal hearing,binaural meaning SPK: Various rehabilitative options available for hearing hearing from both the ears is essential. Children with one sided loss in children include hearing aids and cochlear implants. Surgically Correctable Hypertension deafness have difficulty in hearing in a noisy environment like The technology for cochlear implants has advanced a lot in classroom, which affects their academic performance. Also, recent years. Usually hearing aids are reserved for children Dr Arvind Kohli Pregnancy-induced hypertension has an incompletely one sided deafness leads to difficulty in localizing sounds who have moderate to severe hearing loss. Children who have understood neurohumoral mechanism (possibly initiated which can be problematic for the child. Hypertension may be primary or idiopathic which may profound hearing loss , don’t get much benefit from hearing by inadequate establishment of blood supply to the devel- EC. What are the causes of deafness in children? develop as a result of environmental or genetic causes, or aids and require cochlear implants. oping placenta) and occasionally can develop in the imme- SPK: The most common cause of newborn hearing loss is secondary hypertension which is elevated blood pressure EC. What is a difference between a hearing aid and diate postpartum period. genetic and this is commoner in case of consanguineous mar- that results from an underlying, identifiable, often cor- a cochlear implant? Primary hyperaldosteronism is defined as overproduc- riages.If a pregnant mother develops certain infections,is rectable cause, which has multiple etiologies, includng SPK: A hearing aid is a sound amplification device which tion of aldosterone independent of its usual regulator, the exposed to ototoxic drugs like gentamycin etc.,is suffering renal, vascular, and endocrine causes. Primary or essential renin-angiotensin system. The resulting retention of excess from diabetes,hypothyroidism or malnutrition,the child can can be worn in the ear or behind the ear and offers augmen- hypertension accounts for 90-95% of adult cases, and sec- salt and water suppresses renin levels (as opposed to ele- be born with deafness.Difficulties during birth causing tation of moderate to severe hearing loss. Cochlear implants ondary hypertension accounts for 2-10% of cases. Sec- vating renin levels, which causes secondary hyperaldostero- asphyxia i.e, prolonged lack of oxygen associated with convul- are devices which are implanted by surgery and directly stim- ondary hypertension is amenable to surgical correction. nism). Increased urinary excretion of potassium signals sions or coma can cause the child to be born deaf. Newborns ulate the hearing nerve and are used for cases which cannot Diagnosis of Secondary Hypertension hyperal-dosteronism, which should be suspected in all who are admitted to the intensive care unit due to immaturi- be fully rehabilitated by hearing aid. The cochlear implant can Accuracy hypertensive patients with unprovoked (i.e not diuretic- ty and other causes or those who develop jaundice or menin- cost as much as 6-8 lac rupees while the hearing aid costs only The first, most practical step in evaluating an elevated induced) hypokalemia. gitis(Brain Fever) ,measles mumps etc. after birth are very a fraction of that. blood pressure reading is to investigate its accuracy. White- Pheochromocytoma is another endocrine cause of much prone to develop hearing loss. In older children, recur- EC: What is the ideal age of doing a cochlear coat hypertension (blood pressure that is elevated in the hypertension. The classic-symptoms include headache, rent ear infections manifesting as ear pain and pus discharge implant? physician’s office but normal at other times) accounts for diaphoresis, palpitations, and praxoysmal hypertension. if neglected can lead to hearing loss. Some children born with SPK: The earlier the child is identified and rehabilitated for about 20 percent of patients with elevated readings. Ambu- The syndrome can vary depending on the types of cate- defects of ear,nose,throat or face have associated deafness. hearing loss the better the results are. If identified earlier the latory blood pressure monitoring has become important cholamines being produced, the amount and frequency of EC. How do we diagnose hearing loss in children? child can have a cochlear implant as early as 1 year of age. Deaf diagnostic aid in identifying Secondary Hypertension. their release into the circulation, and other factors. The usu- SPK: In older children, suspicion of hearing loss can be children who are fitted cochlear implants by 2 years of age will Apnea Obstructive sleep apnea (OSA), a repetitive al screening test has been urinary measurement of cate- made by parents when the child does not respond to normal develop speech and hearing almost like normal children. mechanical obstruction of the upper airway during sleep, cholamine metabolites (vanillylmandelic acid, sounds or tends to increase the volume of the TV.In the class, EC: It is not possible for most people to afford the is an independent risk factor inattentiveness or decreased performance can be an indicator high cost of a cochlear implant. for Hypertension at least one of hearing loss and this can be confirmed by the hearing test SPK: During my interaction with the local specialists, it was half of patients with OSA called audiometry.. A high index of suspicion is required for heartening to learn that the Government of India is providing have hypertension. Treat- diagnosing one-sided hearing loss in older children. . In new- free cochlear implants to all children below 5 years of age ment of OSA with surgery or borns, hearing testing is done by using 2 methods namely otoa- through the National Health Mission . nasal continuous positive air coustic emissions (OAE’s) and auditory brainstem response EC: What can be done to prevent hearing loss in way pressure reduces hyper- audiometry (ABR) testing. In the absence of these modalities, children? tension in these patients. A responses of the newborn to various sound stimuli like blink- SPK: Avoiding marriages among close relatives, ensuring formal sleep study usually is ing,cessation of activity or head turning to locate the source of good health of the expectant mother, proper immunization of needed for diagosis of OSA sound can tell us about the integrity of child’s hearing.In devel- both the mother and child, making sure the deliveries are per- and determination of correc- oped countries, Universal Newborn Hearing Screen is used for formed under the supervision of trained personnel, treating tive interventions. all live births. ear infections timely, avoiding exposure to loud noise are some Bruits Renovascular EC: Tell us about this Universal Newborn Hearing of the measures to prevent hearing loss in children. Early diag- hypertension is defined as Screen? nosis by using the Universal newborn hearing screen and ear- Hypertension resulting from SRK: It has been shown that earlier the child is detected ly use of rehabilitative measures as outlined above will go a compromised arterial supply with hearing loss and intervention begun, the better the results long way in reducing the deafness related disability. to the kidneys. About 65 per- cent of renovascular disease is secondary to athersclero- -BUZZ sis in the renal arteries, usu- allly seen after age 50 in patients at risk of arterial compromise (e.g smokers, Yesterday once more patients with diabetes, patients with known atherosclerot- metanephrines, normetanephrines). Determination of ic disease). The remainder of patients will demonstrate plasma free metanephrines might be the test of first choice 's Dilwale is scheduled for an all-IIndia release on Dec 18. The biggest fibromuscular dysplasia (FMD) and will tend to be younger for diagnosis of this tumor, although availability of this test attraction of the new film is that it brings back the electrically charged combine of (25 to 50 years of age) at the time of diagnosis. at hospital and reference laboratories is limited. Pheochro- About one half of patients with renovascular hyperten- mocytoma is very rare, and routine screening in hyperten- Shahrukh Khan-KKajol five years after My Name is Khan and 20 years after they set the sion will have an abdominal bruit identifiable on physical sive patients is not recommended. screen on fire with their love chemistry in Dilwale Dulhaniya Le Jaayenge. The big question examination Bruits heard in both systole and diastole are Cushing’s syndrome can cause hypertension via the min- more suggestive of renovascular hypertension than systolic eralocorticoid effects of excess glucocorticoids and is best is will this film set the screen on fire again. Shoma A. Chatterji raises the curtain a little…. bruits alone. screened for with a dexamethasone-suppression test. Bad Kidneys Surgical Treatment of Hypertension Remember that both and Shahrukh are twenty years Renal parenchymal disease can be a cause or conse- Although some patients with adrenal tumors can be older than what they were in DDLJ. Also note that they now have quence of hypertension. Progressive renal damage is caused effectively treated with medications, most patients should growing children of their own and the bloom and blush of fresh by the mechanical and humoral effects of glomerular hyper- have surgery. Excising hormonally active adrenal masses youth needs to be heavily disguised with intelligent make-up tension. The renal damage decreases the kidneys’ ability to through a relatively low-risk, minimally invasive operation and a well-fashioned beard for Shahrukh. And what does King excrete salt and excess fluid (resulting in a lwo renin state, (laparoscopic adrenalectomy) can resolve hypertention and Khan himself has to say? as opposed to the high renin state found in enovascular other health problems, including the obesity, diabetes, “Dilwale was a wonderful filmmaking experience and the hypertension), and the hypertension worsens. As renal hypertension and osteoporosis associated with Cushing’s results will show on screen. Never enjoyed myself more while damage progresses, hyperparathyroidism develops and ery- syndrome. Because the adrenal glands are situated in and shooting for a film, right from reuniting with Kajol after a long thropoietin production increases, exacerbating the hyper- around important blood vessels and other structure and gap to shooting the heavy duty action sequences, it was all a tension. Thus, a vicious cycle of worsening renal function because adrenalectromies are relatively rare procedures, delight. I'm glad to be sharing the trailer with you guys as it will and hypertension begins. patients are generally referred to a tertiary care specialist. give you a perfect taste of the fun family film that Rohit Shetty Increasingly, patients who are on multiple medications for has made!” Coarctation of the Aorta But wait. Is it only a ‘family’ entertainer? Not really because Coarctation of the aorta is a congenital narrowing of the difficult-to-control hypertension are benefitting from this the character Shahrukh plays is of a “car modifier” and perhaps aortic lumen, most often occurring just distal to the origin relatively simple laparoscopic operation. has his first, full-blown action-oriented role filled with director of the left subclavian artery. Patients with less severe forms Coarctation Of Aorta There are several surgical tech- Rohit Shetty’s signature of a line of cars jumping into the air or of the disorder may not be diagnosed until young adulthood niques to repair aortic coarctation. The options include: Khan himself on a shooting spree from a car window or just but have a high incidence of premature death, Diagnostic Resection with end-to-end anastomosis. This method straight. clues include decreased lower-extremity (femoral) pulses involves removing the narrowed segment of the aorta Rohit Shetty who has an open admiration for vehicles and with upper-extremity hypertension, dyspnea on exertion, (resection) followed by connecting the two ends of the aor- and chest radiographic findings of notched ribs (from dilat- speed and action, comes together again with Shahrukh after they Adds Kajol: “Dilwale is an extremely special film. Not only ta together (anastomosis). Subclavian flap aortoplasty. A did . Rohit says, “The great response that we for what it offers but also because of the people I have worked ed collateral vessels) and dilation of the aorta above and portion of the left subclavian artery, the blood vessel that got from our association after Chennai Express, Mr. Khan and with here. I had a great time working on the film most special- below the constriction. delivers blood to your left arm, might be used to expand the me wanted to gift our audience something special. Dilwale is not ly with Shahrukh and of course Rohit as well and I think every- Erythropoietin narrowed area of the artery. Bypass graft repair. This tech- just another film for me and my team but a soulful journey that's Elevated erythropoetin levels can be endogenous (as in body will be bowled over as much as we were while we shot for nique involves bypassing the narrowed area by inserting a being helmed by courageous hearts to create magic on screen.” response to the chronic hypoxia of COPD) or exogenous the film." plastic tube called a graft between the portions of the aor- Remember that in DDLJ, the two of them were enough to (administered to alleviate the anemia seen in chronic renal The music for this seven-song film has been composed by ta. Patch aortoplasty. Your doctor might treat your coarcta- carry the entire film on their young shoulders in a script filled Chakraborty. The official title of the song is Gerua! It failure). High erythropoietin levels can elevate blood. tion by cutting across the narrowed area of the aorta and with exciting twists and turns of suspense with a heavy dose of goes - Rang De Tu Mohe Gerua and has been shot across Ice- Endocrine Disorders family syrup thrown in for good measure. Not one to depend on land. It is a track that brings back the crackling chemistry of the Hypothyroidism can cause decreased cardiac output then attaching a patch of synthetic material to widen the two major stars growing on in years, the very intelligent deadly SRK-Kajol combo. with a compensatory increase in vascular tone, resulting in blood vessel. Patch aortoplasty is useful if the coaractation Shahrukh Khan has ensured the eyeballs of Generation Y by rop- So it is not all about mushy love shot in beautiful locations a more prominent rise in diastolic blood pressure than in involves a long segment of the aorta. ing in two youngsters, who doubles up as in Iceland and also at the Ramoji Rao Film City in Hyderabad. systolic blood pressure. Conversely, hyperthyroidism Balloon angioplasty and stenting Balloon angioplasty is Shahrukh’s younger brother in the film and as his The trailer launch included the display a host of modified induces increased cardiac output and compensatory an option for initially treating aortic coarctation or for treat- love interest. designer cars, a concept integral to the film. decreased vascular tone, causing a greater increase in sys- ing re-narrowing (re-coarctation) that has occured after So what does Varun Dhawan has to say about his first brush Others in the cast are - , , Boman tolic blood pressure. surgery. with both the Khan and the Shetty? “I have always been a big Irani and Sanjay Mishra. Dilip Chhabria’s designer cars used in Renal Artery Stenosis Angioplasty is effective for treat- Rohit Shetty fan. But never did I expect to do a Rohit Shetty film Hyperparathyroidism (primary or secondary to chronic the film for the action scenes and air stunts were brought in dur- renal insufficiency) is a potentially reversible cause of ing renovascular hypertension associated with atheroma- with Shahrukh Sir and Kajol ma'am. They are amazing actors ing the trailer launch. The cast displayed a host of modified and to work with them is something no one has done in my gen- hypertension. Its incidence in hypertensive patients is tous lesions Bypass procedures include aortorenal, hepa- designer cars, a concept integral to the film. Dilwale is produced about 1 percent, compared with a 0.1 percent incidence in torenal, splenorenal, and ileorenal conduits constructed eration. I am really lucky to be a part of it.” jointly by and Shetty under the banner of Red Chill- His character is torn between his love for his beautiful beau the general population. However, only 30 to 40 percent of with autologous saphenous veins, autologous arteries, or ies Entertainment and Rohit Shetty Productions respectively. patients with hyperparathyroidism have hypertension, and prosthetic material. and his love for his brother who has practically brought him up. Between the two giant films releasing in December, Bajirao parathyroidectomy does not reliably resolve hypertension (The author is Consultant Cardiotoracic & Vascular Surgeon He has lot of action scenes packed into family scenes of sacri- Mastaani and Dilwale, one has to wait and watch to find out in patiens with this disorder. SSH Jammu) fice and melodrama, typical of most Shahrukh Khan films. which one wins the race. (TWF)