Welcome to HARMEET ENT & SPECIALITY CLINICS

(I) Company

1. About

ENT health care has not received the attention it deserves in India. Morbidity health care / wellness are incomplete without ENT care. To fulfill this requirement, HARMEET ENT CLINIC under HARMINDER HEALTHCARE SOLUTIONS was promoted and incorporated in May 2002 as a Private limited company. The team at HHS strives to provide world class ENT health care. The first ENT centre of HHS was inaugurated at AMRITSAR, the HOLY CITY OF GOLDEN TEMPLE (HARMANDIR SAHIB), in 2002. 

Our Chief consultant in ENT is Dr HARMEET SINGH MS [ENT]. He is also the Managing Director of HARMEET ENT & SPECIALITY CLINICS under HARMINDER HEALTHCARE SOLUTIONS. 

The experience and expertise gained over the years help us to expand and spread quality care in the society. In addition to running our own ENT center, we also offer technical support, guidance and help to establish and run ENT centers under our Brand. 

We aim to provide quality ENT care, maintaining high ethical standards, to reach the maximum, at reasonable cost. Our top priority is prevention of dumbness. 

2. Our Chief Consultant

Dr HARMEET SINGH MS [ENT] is the chief consultant and founder & also the Managing Director of HARMEET ENT CLINIC under HARMINDER HEALTHCARE SOLUTIONS. He did his MBBS [Bachelors degree] and MS [Masters in Surgery] in ENT at GMC, AMRITSAR which is rated, by various rating agencies among the top medical colleges in India since 18th century IN British rule when Lahor and Amritsar were in same PUNJAB before partion. 

He served in INDIA and ABROAD as HEAD ENT DEPARTMENT, SEBHA, LIBYA. He has over 17 years experience as an ENT surgeon. Post MS he had his higher training in Micro Ear surgeries, Nasal surgeries including Cosmetic surgery and Endoscopic surgery [FESS], Pediatric otology and Hearing aid fitting. Now he is associated with HARMEET ENT CLINIC under HARMINDER HEALTHCARE SOLUTIONS since its onset besides that he is Consultant ENT Surgeon Fortis Escorts Amritsar. He has special interest in and works for the prevention of dumbness. 

People now desire quality life and seek the same. ENT is a specialty of morbidity rarely mortality. Wellness driven senses of hearing, voice, smell, taste and balance come under the care of the ENT surgeons. Which other specialty to visit, for wellness and quality life. 

1. Hearing Aid fitting

It is indeed unfortunate, that many patients, who visit the physicians with nerve deafness, are still told “there is nothing that can be done to offer them relief”. It is a fact that at present we cannot cure nerve deafness. But today, excellent hearing aids are available. If fitted properly it can well compensate the hearing loss and help you hear well. Patient need not live with the handicap of hearing loss and can lead a normal life. 

In the management of hearing loss most of the energy is expended in the diagnostic process. The same effort is not seen to be made in the treatment process. Correct diagnosis without correct treatment is futile. 

Good hearing aids are complex devises and costly too. The Hearing health care centre should have experts to address this issue. Hearing is a subjective feeling and patient should be the decision maker. Patient should have an understanding of the hearing aids to help him make an adequate selection. Prior to purchase, hearing aid trial should be taken in normal setting, not sound proof room. Bin aural fitting should be tried, in all case prior to the decision making. 

2. Early detection Programme

Early detection should be done in all ENT / Pediatric centers. It aims to identify hearing impairment if present at birth, in order to affect appropriate intervention as early as possible. 

Incidence of Hearing loss is higher than the incidence of all other screen able disease put together (Thyroid disorder, sickle cell anemia, phenyl ketonuria etc). There is no standard methodology followed at present for early detection of hearing loss. In USA, UK and many other countries routine hearing screening in new born is made compulsory. 

HHS follow the three - stage process of Universal detection of hearing loss in newborn recommended by Aidan [Aidan et al Ann Otol Rhino Laryngol 1999 Jun 108]. We recommend the same for all centers. It consists of : 

Birth admission screening - All Neonates are referred for the first test OAE, before discharge from hospital. 

Follow - up screening - Those who fail the birth admission OAE screening, are screened after 1 month [4 to 6 weeks]. Those who do not pass the second - stage screening are referred for a final OAE screening at 3 months. 

On failure at all three tests to detect OAE emission, the child is then referred for “Early Intervention”. 

TEOAE is simple, non - invasive, quick and reliable objective audiological screening test to administer in clinical practice. Can be done in a non - acoustically shielded room by a semi - trained person too [should be under direct supervision of a clinician]. False positive test is not reported. 

The only disadvantage is - False negative is high [Appx 15%] and can lead to false alarm. Probe mechanics / EAC /Anatomy may give trouble. 

3.Early Intervention

Children who fail the OAE screening test are referred for the intervention program. It is the treatment process. In the intervention program we confirm the hearing loss, quantify the hearing loss, treat / compensate the hearing loss and start the habilitation process by AVT [Auditory Verbal Therapy]. Intervention should only be undertaken in a specialized ENT centers. HHS follows the following module for the intervention program. 

Diagnostic audiological evaluation - Once a child fails all 3 OAE screening, Threshold BERA [ABR] study is conducted to confirm and quantify the hearing loss. Followed by impedance [Immitance] studies, and behavioral audiological evaluation to identify the type and quantum of hearing loss. 

Hearing aid fitting - In children with Nerve deafness Hearing aid fitting is done.  

Follow - up / diagnosis / Habilitation - Habilitation is the process of training the child post hearing aid fitting. AVT [Auditory Verbal Therapy] is given. Auditory - Verbal approach for aural habilitation [training to listen] should be undertaken. Speech develops as a result of good auditory training, naturally. The classical Auditory - Oral approach of speech - reading [Speech therapy / lip - reading] should be discouraged. AVT is given in normal setting of the child [Normal school, inclusive education] under guidance of the Therapist / Special educator. Since it is a slow long drawn out process Supervision should be by the family doctor [General physician / Pediatrician / ENT specialist]. 

Word of Caution - Success rate varies with different tests and centres. There is failure to correct evaluation even in best of hands and centres. Parents / guardians / family doctor / therapists / educators involved in the habilitation process, have to keep this in mind and a periodic evaluation process should be made, based on the Childs progress. 

4. ENT Cancer detection

Most diseases including cancers if detected early can be cured. The Upper respiratory Tract [Nose, Throat, Oral cavity and Ear] is the most easily approachable area in our body by Endoscopy. Cancers of ENT hence can be easily detected at an early stage. It is complacency that results in tragedy. Routine endoscopy study is recommended to help in early detection. 

Fiber optic endoscopy - It is a very simple and useful investigation in expert hands. An instrument with lens and light at its tip called the endoscope is used to study the non visible parts of the nose and throat. We at HHS do the studies under local anesthesia and the procedure takes only a few minutes. 

The present teaching is “No ENT examination is complete unless an endoscopy examination is done”. In addition to early cancer detection, some of the symptoms / conditions where Endoscopy study is useful to arrive at a diagnosis are enumerated. 

Anosmia, mucosal oedema, polyps, adhesions, growths, posterior DNS, bleeding site, spread of tumors of nose / PNS / Nasopharynx and in Post operative evaluation. To evaluate the Nasopharynx [Back of the nose] and study the Eustachian tube orifice. In snoring and sleep apnea. To study the dynamic function of the larynx in voice disorders, unexplained cough investigation, unexplained stridor, unexplained wheezing etc. 

5. Hearing Conservation

School Children 

All Pre School and primary school children [Upto Standard 3] to be screened every year for hearing. ENT check up to rule out, Wax ears, secretory otitis media and ASOM / CSOM is a must. 

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Suspect a hearing loss 

If response of the child is not appropriate. Never blame the child when they have difficulty with language / speech. When the child is Lazy, Inattentive or Naughty the possibility of borderline deafness. 

Prevention of hearing loss 

Do not beat them on the head or on the ears. See that the children also do not engage in such activities. Prevent Child falling and hurting his head. 

Tell the children not to shout into each other’s ears and not to listen to loud noise / music. Very loud noise damages hearing. 

See that the children with infectious diseases, such as mumps, which are known to cause hearing loss, do not come to class and pass it on to others children. 

If the child is absent from school for many days or weeks, find out the reason. If he has had disease that are known to cause hearing loss, such as typhoid, mumps, high fever, advice the parents to take him for a hearing test. 

Encourage the children to develop listening habits, when you take them for picnics and excursions. 

We suggest that you have a hearing test for yourself so that you can tell the children what a hearing test is and how simple it is. 

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Industrial Workers 

For Permanent and temporary industrial workers who are exposed to noise. 

Suspect a hearing loss 

If difficulty in communicating by speech while in noise is felt. Head noises or ringing in the ears after working in the noise for several hours. 

A temporary loss of hearing that has the effect of muffling speech and changing the quality of other sounds after several hours of exposure to noise. 

How to avoid / limit the damage 

Continuous exposure to sound should be for a maximum of 8 hours. 

16 hours complete rest should follow prolonged sound exposure.

Personal hearing protection, like earplugs, ear muffs mandatory.

Yearly screening of hearing loss [4 K dip is the first sign] by audiogram.

(III) Awareness

Studies done in developed countries show approximately 2% of the children have hearing loss needing attention. It should be higher in our country. Sociology defines “Man is a social animal”. To be social we need verbal communication. Hearing loss hinders verbal communication. Thus the need to create awareness on deafness and the handicap due to the same. 

Severe and profound hearing loss in childhood leads to dumbness. If hearing loss is detected [Early detection program] and corrective measures give in time, dumbness is preventable. 

Even a mild hearing loss can affect the child’s learning capabilities as they can miss out on a percentage of classroom instructions. This handicap due to hearing loss should be of grave concern to educators, school teachers and parents alike. Majority of these children can be bought to the main stream by correct evaluation and management for hearing loss. 

Parents / teachers / elderly and the society in general needs to be made aware of this correctable disability. 

1. For Parents

Incidence of deafness [Hearing loss] is very high, compared to other preventable screenable diseases. Hearing loss cannot be overtly seen hence has to be looked for by the parents. Most of these children do not have any other disability. Majority of these children with timely correct evaluation and management for hearing loss can be bought to the main stream. They should be sent to normal schools. 

Children with severe to profound deafness, if not detected and treated in time become dumb. Dumbness is preventable. Majority of us are not aware of the same. Children with profound hearing loss, if intervention is done by 6 months, do develop adequate spoken language. 

So ideally all new born should be screened for hearing. Hearing loss may be suspected, if response of your child is not appropriate. When the child is Lazy, Inattentive or Naughty. When there is delay in speech development. When suspected get the child examined in an ENT centre for hearing. 

Some of the common correctable conditions are, Secretory otitis media, Impacted wax both ears, CSOM etc 

2. Childhood hearing loss is a common problem in schools. Profound hearing loss is easily detected. It is children with mild hearing loss, who are missed and have to be identified and help rendered. 

Even a mild hearing loss can affect the child’s learning capabilities as he can miss out on 10% or more of classroom instructions. Mild hearing loss in the child’s formative years can have dramatic consequence. 

Handicap commonly seen in undetected / untreated children with mild hearing loss are, Inadequate Speech / communicative skills, Backward child, A language learning deficit (ALLD), Problematic child, Learning disability [LD], Mentally challenged, etc. 

Handicap due to hearing loss should be of grave concern to educators, school teachers and parents alike. Teachers have to take special interest to identify and help these children. 

Suspecting the problem Hearing loss may be suspected 

If a child’s response to verbal commands is not appropriate. 

When the child is Lazy, Inattentive, naughty, restless, impatient or forgetful. 

Hearing some people more clearly than others. 

Difficulty in understanding words off and on. 

Sudden dip in performance level in the class, without an obvious reason. 

Performs better when made to sit in the front row in the classroom. 

Turning one ear towards a speaker in order to hear better. 

Hears conversation but has difficulty in understanding words 

Children showing errors in the form, content, and the use of language. 

Labeled socially inappropriate. 

Turning up the TV or radio louder than others prefer. 

If any of you notice the above in your children, never blame the child, get the child checked by an ENT specialist. Remedial measures suggested should be adhered to, religiously, as results are gradual. Ideally all children in the primary school level should be screened by an ENT specialist at least once a year. 

3. For Adults

Hearing impairment is very common disability in our society. It is the third most prevalent chronic disorder [after arthritis and hypertension] in the United States. Handicap due to hearing loss is also known as the silent handicap as hearing loss is not overtly seen. Hence the society too is insensitive to understand the handicap of deafness the elderly suffers. Which is most unfortunate. 

Hearing handicap will vary, depending on the attitude and perception of the affected person. Handicap generally noticed in adults are:

Auditory [hearing] deprivation [Deaf Sentence].

Communication breakdown, Self isolation.

Cut of from individuals, withdrawal from family and society.

Social death [Professional, intellectual, social and economic handicap].

Psychosocial problems, stress, anxiety.

Depression / emotional handicap. 

Kubler-Ross’ five stages of grief - best defines the commonest reaction to adult onset hearing loss. 

The five stages being - Denial and Isolation, Anger, Bargaining, Depression, and Acceptance. 

With awareness, acceptance the last stage of Kubler - Ross’ five stages of grief can be made first and patients with hearing handicap helped. Today excellent hearing aids are available. Once fitted correctly your hearing loss can be neutralized to a large extend and you can lead a normal life. 

So why the reluctance to fit hearing aids. Do not self punish, visit the nearest hearing health care delivery centre and get hearing aid fitted. 

4. For Society

The Dog in your house is better of than a dumb child as the dog has no language but can hear, a deaf and dumb child cannot hear too. 

Just imagine the magnitude of the handicap. Making a child dumb is a great crime you commit on the child. This is due to lack of awareness and that is why we need to work to educate the society and prevent dumbness. Helen Keller once said that Deafness cuts "one off from people", whereas blindness only cuts "one off from Things". 

First convince yourself on the need for the same, only after that you can convince other. 

The foremost need in prevention of dumbness is early detection of hearing loss. Followed by correct intervention and AVT [Auditory Verbal Therapy]. 

What the society can do? 

Train Hearing health care workers. 

Raising awareness in the community and in school. 

Awareness campaign to create better understanding on hearing loss [impairment] and the disability it causes. 

Clinics to display posters on hearing impairment and ear care to create awareness. 

Healthy Ear day. 

Educate health workers / teachers / learners social / religious groups. 

Games to test for hearing in children. 

Help in forming support groups to help hearing impaired. 

(I) Medical Tourism

Medical tourism and advantages for tourists 

At HHS ENT, we are committed to providing the best quality of professional ENT care solutions to our tourist patients (medical tourists). HHS follows the philosophy of minimal hospitalisation, as healing is better when the mind and body is healthy. We achieve this by encouraging the patient to lead a normal enjoyable active life, outside the hospital setup, during the healing period. 

AMRITSAR -

For tourist and patient, which other better destination to see and get cared for. 

In ENT practice most of the surgeries/ procedures are “surgeries of perfection and not surgeries of risk”. The ideal specialty for tourist in quest for wellness.

Some of the services offered include: 

Cosmetic surgery (Nose / Ears) 

Microsurgery Ear 

Microsurgery Vocal cords (Phono - Surgery) 

FESS (Endoscopic surgery for Sinusitis) 

Correction surgery for Snoring. 

Other ENT surgeries (Adeno - tonsilectomy, Septoplasty etc.) 

Hearing Aid Fitting 

Desirous patient should send their available medical details to HHS. The details of treatment modalities and recuperation details will be finalized on case to case basis by the ENT specialist. 

(III) Specialised Services

Specialised Services [Therapeutic and Diagnostic] 

New born hearing detection [OAE]. 

Early intervention program / BERA test. 

Micro Ear and Laryngeal Surgeries. 

Cosmetic surgery of Nose etc. 

Endoscopic surgery for the sinuses [FESS]. 

Fiber - optic Endoscopy for nose, throat and larynx. 

Child hearing Evaluation and Management 

(IV) The Deaf Child

Parents / guardian / teachers and well - wishers should understand the handicap of deafness and be proactive in the management of the hard of hearing child. We spent thousands to send a child to a good school but are reluctant to spend hundreds to check our child’s hearing. May be ignorance. 

Hearing loss has considerable impact on a child’s overall development of language, cognition skills, social and emotional competence. Even mild hearing loss can significantly retard acquisition of language, speech and intellectual skills. 

Handicap seen in undetected / untreated children are- Delayed Speech, Backward child, Problematic child, A language learning deficit (ALLD), Learning disability [LD], Mentally challenged, etc. Deafness is correctable in all cases so good hearing evaluation is mandatory to rule out hearing as a cause of the above before specialized management for the above is initiated. 

Evaluation of a pre - lingual child [child without language] is a complex affair. Tests may have to be repeated number of times or a battery of tests may have to be done. The skill and experience of the examiner plays an important part in the proper evaluation and judgment. 

Profound hearing loss leads to dumbness which is preventable. See early detection / intervention program. 

© 2010 HARMEET ENT CLINIC