Papers by Mohan Kameswaran
Indian Journal of Otolaryngology and Head & Neck Surgery, Oct 16, 2013
Indications for cochlear implantation have expanded today to include very young children and thos... more Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioral responses may be tedious for audiologists in such cases, wherein matching an effective MAP and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed, (a) to study the trends in multi-modal electrophysiological tests and behavioral responses sequentially over the first year of implant use, (b) to generate normative data from the above, (c) to correlate the multi-modal electrophysiological thresholds levels with behavioral comfort levels, and (d) to create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. This prospective study included ten profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, Impedance Telemetry, Neural Response Imaging, Electrically Evoked Stapedial Response Telemetry and Electrically Evoked Auditory Brainstem Response tests at 1, 4, 8 and 12 months of implant use, in conjunction with behavioral Mapping. Trends in electrophysiological and behavioral responses were analyzed using paired t test. By Karl Pearson's correlation method, electrode-wise correlations were derived for NRI thresholds versus Most Comfortable Levels (M-Levels) and offset based (apical, mid-array and basal array) correlations for EABR and ESRT thresholds versus M-Levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-Levels were compared with the behaviorally recorded M-Levels among the cohort, using Cronbach's Alpha Reliability test method for confirming the efficacy of this method. NRI, ESRT and EABR thresholds showed statistically significant positive correlations with behavioral M-Levels, which improved with implant use over time. These correlations were used to derive predicted M-Levels using regression analysis. Such predicted M-Levels were found to be in proximity to the actual behavioral M-Levels recorded among this cohort and proved to be statistically reliable. When clinically applied, this method was found to be successful among subjects of our study group. Although there existed disparities of a few clinical units, between the actual and predicted comfort levels among the subjects, this statistical method was able to provide a working MAP, close to the behavioral MAP used by these children. The results help to infer that behavioral measurements are mandatory to program cochlear implantees, but in cases where they are difficult to obtain, this study method may be used as reference for obtaining additional inputs, in order to set an optimal MAP. The study explores the trends
Otolaryngology, Apr 8, 2015
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2013
Polish annals of medicine, 2018
Journal of Laryngology and Otology, Nov 1, 1993
A case of neurobrucellosis presenting to the otologist with sensorineural hearing loss (SNHL) as ... more A case of neurobrucellosis presenting to the otologist with sensorineural hearing loss (SNHL) as the predominant clinical feature is reported. The diagnostic features and treatment options are discussed and the need for prolonged combination treatment to prevent relapse and further deterioration of hearing stressed. SNHL in neurobrucellosis has hitherto been reported principally in neurology literature as something of an incidental finding and so escapes the attention of otologists. It is hoped that this report will alert otologists in areas where brucellosis is endemic to the need to include tests for brucellosis in the routine diagnostic screening for SNHL. Practitioners in other locations should also consider this possibility when dealing with patients who have visited or lived in endemic regions.
Journal of Laryngology and Otology, May 1, 2016
the diagnosis and treatment of ear disease as well as the longer term aim to identify and train a... more the diagnosis and treatment of ear disease as well as the longer term aim to identify and train a Malawian otologist. The project has also raised awareness of deafness in Malawi and has highlighted the significant public health issues relating to the aetiology of ear disease and deafness in 3 rd world countries. As well as addressing the practical and ethical issues relating to the project the presentation will outline future plans in developing both implant and otological surgery in Malawi and southern Africa.
Indian journal of ophthalmology, 2023
Journal of neurological surgery, Jun 17, 2014
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2013
Indian Journal of Medical Research, 2018
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2013
Cochlear Implants International, Jul 12, 2023
Current Opinion in Otolaryngology & Head and Neck Surgery, Jun 1, 2019
Purpose of review The Indian healthcare industry, one of the largest in the world, caters for 1.3... more Purpose of review The Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society. Recent findings Technological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country.
Journal of hearing science, Jun 30, 2015
Backround: Rehabilitation centres for cochlear implant (CI) recipients act as gateways for increa... more Backround: Rehabilitation centres for cochlear implant (CI) recipients act as gateways for increasing auditory perception and developing speech and language. In the case of children, such centres must strive not only to get the best outcomes in terms of hearing and speech, but they must also provide satisfaction to both CI recipients and their parents. To gauge the quality of service, we have divided the range of services offered into four areas and have assessed the specific and overall satisfaction levels of parents of CI children towards these services. Material and methods: This was a prospective, randomized, cross-sectional study based on a questionnaire provided to CI users of rehabilitation centers in Tamil Nadu, India. The parents of 100 CI recipients younger than 6 years were asked to fill in a questionnaire using a 5-point rating scale. The education level of the caretaker and the time spent with the child at home were also ascertained, and these factors were correlated with CI performance outcomes (categories of auditory performance, CAP, and speech intelligibility rating, SIR). Results: The overall satisfaction level of the parents was reasonably high (mean=3.9, SD=0.44). There was a positive correlation of satisfaction score with rehabilitation outcomes (r=0.80 for CAP; 0.29 for SIR). The level of education of the parents had no correlation with the outcome either for CAP (r=0.15) or SIR (r=0.07). Time spent by the parents with the CI recipient at home gave r-values of 0.31 for CAP and 0.39 for SIR. Conclusions: The general level of satisfaction of parents towards the services provided by the rehabilitation centres was good. In terms of best CI outcome, the time spent by the parents with their child was more important than the parents' education level.
International Journal of Otorhinolaryngology and Head and Neck Surgery, Sep 26, 2022
Background: Spontaneous cerebrospinal fluid (CSF) rhinorrhoea is encountered as a diagnosis of ex... more Background: Spontaneous cerebrospinal fluid (CSF) rhinorrhoea is encountered as a diagnosis of exclusion in clinical practice once all other aetiologies have been meticulously ruled out and can mostly present from preformed pathways due to benign intracranial hypertension (BIH) over time. Such leaks need to be clearly located for planning appropriate repair along with adequate control of CSF pressure to avoid recurrence. Thus, the aim of our study was to review the efficacy and outcomes of a combined endoscopic multilayered repair along with simultaneous thecoperitoneal shunting (TPS) for patients with spontaneous CSF rhinorrhoea in the background of BIH. Methods: Retrospective observational study analyzing the clinical presentations, surgical techniques and the immediate / long term outcomes of this combined approach. Results: The 46 patients who had endoscopic CSF repair with TPS done between 2008-2019 were reviewed. The mean opening CSF pressure in these cases were >25 cm H2O. The commonest site of leak was from cribriform plate followed by fovea ethmoidalis. Multilayered closure was done with autologous grafts along with TPS simultaneously. The 92% were successful, 6% had shunt problems needing revision shunts and 2% also needed revision endoscopic repair. Conclusions: Overall outcomes shows that the combined approach was safe and effective in arresting the CSF leak in 98% patients. Therefore, the rationale for a combined approach for the management of spontaneous CSF leaks in the background of BIH stands proven based on our Institutional experience.
Current Opinion in Otolaryngology & Head and Neck Surgery, Jun 1, 2018
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Papers by Mohan Kameswaran