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Quality Highlights

Cochlear Implants
Cochlear implants (CI) are devices which help to restore hearing by integration of external circuitry with the nerve of hearing. They are safe and extremely effective in restoring hearing in children and adults with profound hearing loss who do not receive benefit from hearing aids. Cochlear implants detect mechanical sound energy and convert it into electrical signals which are then sent to an array of electrodes implanted surgically in the cochlea (inner ear). These signals are then delivered to the nerve of hearing, bypassing the damaged hair cells of the inner ear. Appropriate, timely intervention is extremely important for a successful outcome. After the implantation, the implantee requires prolonged and intensive habilitation. The benefits of implantation include improved understanding of speech in noise, better sound quality and better speech production.
Auditory Brainstem Implants
Auditory Brainstem Implant is an effective means of hearing rehabilitation in patients with tumours involving both the nerves of hearing and absent nerve of hearing on both sides. The implant bypasses the nerve of hearing and directly stimulates the hearing centre in the lower portion of the brain. The ABI has few side effects and allows most patients to experience improved communication as well as access to environmental sounds.
Bone Anchored Hearing Aids
Bone Anchored Hearing Aids (BAHA) are useful in patients with hearing loss due to absent outer ear canals, chronic ear infections and in those who cannot wear a conventional hearing aid. Sound is conducted through the skull bone bypassing the outer and middle ear and stimulates the inner ear.
Middle Ear Implants
Middle ear implants are used for patients with moderate to severe hearing loss and may be partially or totally implantable. They deliver sound to the inner ear by driving the middle ear bones mechanically, rather than by sound. With the totally implantable hearing device, the clarity of the sound heard by the ear is enhanced considerably. The Envoy Esteem device is a totally implantable device in which coupling of piezoelectric crystals with the bones of the middle ear is done. Clarity of sound is enhanced and much better than with a hearing aid. The implanted battery does not require recharging and lasts for 6- 8 years. After this period, the battery can be changed by making a small incision under local anesthesia similar to changing the battery of a pacemaker. The main advantage of this device is that there are no external parts. This device allows patients to live normal active lifestyles such as swimming and sports.
Video Oculography
Video oculography is Infrared imaging analysis which helps us to determine the possible causes of vertigo/ giddiness. It uses the conventional black and white camera. Eyes are illuminated with infrared light. The eye movements are recorded by an infrared video camera and converted into a digital format through a software that documents the eye movements in an accurate manner. Horizontal and vertical tracings of eye movements are produced by the camera tracking the pupil of the eye.
Balloon Sinuplasty
Balloon sinuplasty is a new technological innovation in the surgical treatment for sinusitis. This system was first introduced in 2004 by the patented manufacturer Acclarent Inc California, USA. Madras ENT Research Foundation (MERF) successfully brought this cutting- edge technology to India on 12 December 2007 when the first surgery of this kind in South and South-East Asia was performed by Prof. Mohan Kameswaran and his surgical team in Chennai. Since then, nearly 100 such surgeries have been performed in India. At MERF, 25 balloon sinuplasty surgeries have been performed so far.

Sinusitis is one of the most common health problems in our society. Symptoms may significantly affect people physically, functionally and emotionally. Common symptoms include facial pain, pressure, congestion or fullness, nasal obstruction or blockage, discharge of discolored mucus from the nose, discolored post-nasal drainage, loss of smell, bad breath, headache and fatigue.The secretions from the paranasal sinuses drain via small openings called ostia into the nasal cavity. In sinusitis, these secretions get blocked within the sinuses.

There are three management strategies in sinusitis - medical therapy, endoscopic sinus surgery with cutting instruments and balloon sinuplasty. Surgery is indicated for those patients whose symptoms and ostial obstruction persist despite medical therapy. Conventional endoscopic sinus surgery involves the draining of these blocked sinuses by removing the normal anatomical structures blocking the sinus openings within the nose. The balloon sinuplasty operation involves the use of an FDA approved Balloon Sinus Dilatational System, which is used to widen the natural opening of the paranasal sinuses with endoscopic assistance and fluoroscopic C-arm guidance. Endoscopic sinus surgery (with balloon sinuplasty technology) utilizes a small, flexible, sinus balloon that is placed into the nose to reach the sinuses. The sinus balloon is then gradually inflated to gently restructure the previously blocked sinus opening which helps to restore normal sinus drainage and function.

The main advantage of this surgical technique over the conventional endoscopic sinus surgery is the preservation of the normal anatomy of the most vital area of the nose called the osteo-meatal complex. This sophisticated surgical technique enables complete clearance of disease within the blocked sinuses with no blood loss and painless post operative period. Most of our patients were able to resume their normal routines within 24 hours. Hence, this system has proved to be an efficient tool in the armamentarium of the endoscopic sinus surgeons. The procedure can be effectively performed only in certain type of sinus problems and is not indicated in cases of extensive sinonasal polyps, growths and malignancies.
Laser Surgeries
The laser is an intense collimated (parallel) beam of pure monochromatic coherent light. The laser can cut, coagulate and vaporize tissue. At MERF two types of lasers are used in the management of various ENT and Head and Neck diseases. Carbondioxide laser is used in Tonsillectomy. KTP/ 532 laser is widely used in Tonsillectomy, Uvulopalatopharyngoplasty for Obstructive Sleep Apnoea Syndrome, Recurrent respiratory papillomatosis, Early vocal cord malignancies, Vocal cord Keratosis and other microlaryngeal surgeries. KTP /532 laser is a very useful tool in the management of inferior turbinate hypertrophy in chronic allergic rhinitis and also in dealing with septal spurs. KTP/532 laser is also widely used in the treatment of early malignant and keratotic lesions of oral cavity. It is extremely useful in the management of oral submucous fibrosis and to debulk tongue base tumours and sinonasal malignancies. Laser arytenoidectomy is done to enhance the airway in bilateral abductor type of vocal cord paralysis. Laser has become an indispensable tool in the treatment of laryngeal and tracheal stenosis.

In the contact mode, it has an incisional effect. In the near contact mode (2 – 4 mm from tissue) it vaporizes. In the noncontact mode it coagulates blood vessels. It is delivered by a hand held probe. The optical fibre is small and light weight and provides excellent access to difficult to reach areas. It is easy to manoeuvre, provides tactile feedback and allows precise bloodless dissection. Its precision, with decreased damage to surrounding structures leads to decreased postoperative edema and scarring. It cuts peripheral nerve endings smoothly and hence decrease postoperative pain.

Advantages of KTP/532 laser include Mucosal preservation, Precision with very less collateral damage during surgery, Minimal or absent intraoperative bleeding, Reduced postoperative Pain, Edema and Crusting.

Electro-Acoustic Stimulation
The Individuals with good low-frequency hearing and severe-to-profound high-frequency hearing loss can experience significant difficulty in everyday communication, particularly in noisy backgrounds, where low-frequency information alone is not sufficient to allow high levels of speech understanding. One of the latest applications of implantable hearing technology, combines electric and acoustic stimulation (EAS) into a hybrid device designed for individuals with binaural low-frequency residual hearing and severe-to-profound high-frequency hearing loss 'ski-slope audiograms'. The addition of electrical stimulation via a cochlear implant to such patients with existing residual low frequency hearing can provide clear speech recognition in background noise and better appreciation of musical notes. The EAS system consists of two parts: a cochlear implant with a soft and flexible electrode array for preservation of residual low frequency hearing, and a speech processor which combines the cochlear implant component with conventional acoustic stimulation in one comfortable and compact device. This kind of Implant surgery involves employing a soft surgical technique which includes a smaller cochleostomy or round window insertion performed gently with a thinner electrode array which contributes to the preservation of residual hearing. The hybrid device uses a shortened cochlear implant electrode array that is inserted into the cochlea, covering the basal 2/3rd of the cochlea. A successful surgical outcome allows for electric stimulation of the basal cochlea for high-frequency information without damaging apical cochlear structures that transmit low-frequency acoustic information via the hearing aid attached to the 'Duet' speech processor. Madras ENT Research Foundation is one of the first implant centers in this part of the world, to successfully perform the EAS implantation for 2 patients in 2011.