The most complex systems in nature appear deceptively simple ! Across the world technologists are trying to decipher how speech is understood and processed.

Narendhran Omprakash, our next pathbreaker, is a Speech Language Pathologist and Audiologist, clinically assisting patients with speech and hearing problems and providing appropriate treatments.

Narendhran talks to  Shyam Krishnamurthy  from The Interview Portal about his decision to pursue a career in healthcare, focused on unraveling how the brain works along with the sensory organs to hear, process and interpret signals into speech and communication, which led him to become an Audiologist and  Speech Language Pathologist

For students interested in healthcare , SLP/Audiology is a great career in exploring the neural and auditory pathways that result in communication

Narendhran, tell us about your initial years?

I grew up in Madurai and did all my schooling till class 12 in Madurai. I wasn’t really inclined to any specific career. I used to think of becoming a doctor especially a cardiothoracic surgeon with the intention of curing heart disease, because I thought it was one of the leading causes of death.

How did you end up in such an offbeat, unconventional and uncommon career?

At the time I was in class 12, one of my uncle’s son was working as an Audiologist and Speech Language pathologist. He recommended that i pursue a degree in Audiology and Speech Language Pathology. He was the one who exposed me to this career. He explained the scope and importance of speech and hearing professionals for the society, and since i was earlier inclined to join a healthcare related profession, Audiology and SLP seemed interesting. I decided to take it up.

What did you study?

I joined Faculty of Allied health sciences at Pondicherry for a Bachelors degree in Audiology and Speech-Language Pathology. I also did a masters degree (Audiology and Speech Language Pathology) from Manipal college of Health Professionals, MAHE, Manipal.

Admission for the bachelors degree in Manipal College is based only on marks obtained in 12th standard

Tell us about your career path

During my bachelors, I didn’t pay much attention to the course when I joined initially. But the turning point was when my father fell ill with a heart attack and as a result, I had to take responsibility for my family since I was the only son. And being away from home was also a bit of a strain. So that’s when I started paying attention to learn as much as possible in Audiology and Speech Language Pathology.

During our course we used to be involved in academic and clinical work where we had to observe patients who were visiting the hospital due to hearing loss, Speech and Language problems and record our observations. That gave us good exposure to patients suffering from Speech and hearing problems from a real world perspective. But my real learning came when i used to visit the clinics where our seniors and relatives were practicing as Audiologists and Speech Language Pathologists after their graduation. I used to go there during my college vacations and sit there, observing them treat children who had speech issues as well as counsel their parents. As i observed the frustration and inability of children who couldn’t communicate their thoughts and the anxiety on parent’s faces unable to understand what their child wanted i could really feel the need for SLP practitioners and their treating capability both clinically and psychologically.

In the final year of our bachelor’s degree, we are supposed to do a 6 months internship within our college hospital and 6 months outside. For my internship outside I worked at NipMed (National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan)), a residential school run by the government for people with disabilities. My internship there was an eye-opener.

At NipMed we had to work with a team of Counsellors, Psychologists, Occupational Therapists, Physical Therapists and other Rehabilitation professionals to identify the challenges faced by children and try to make their lives better. It seemed to be a truly multi-dimensional and multi-disciplinary profession. Working there I could see the challenges from multiple perspectives and SLP from a bigger context of things. It strengthened my belief in the challenges SLP could solve or aspire to address.

I also worked at Meenakshi Missions hospital, Madurai. As the hospital has several disciplines we used to get a referral from various departments. I gained my knowledge in assessing, diagnosing and treating patients with speech problems caused by head trauma, and neurological impairments. I gained experience in observing and taking cases under the area of neurological speech and language impairments such as Aphasia (impairment of language, affecting the areas of the brain production or comprehension of speech and the ability to read or write.), Dysarthria (Difficulty in Articulating speech sounds due to damage in the damage to areas in the brain) and Dysphagia (Difficulty or impairment in swallowing due to brain damage). MMHRC has Department of Smile train, where multiple professionals such as ENT surgeons, Plastic surgeons, Dentists, Clinical nutritionists, Audiologists and SLPs treat children. I observed them treating many children with anomalies (Cleft lip and Palate).

Following my learning at Meenakshi missions hospital, I worked as a student clinician at Affordable hearing aid project centre (AHAP), Madurai as a part of my internship program, where i learnt assessing and diagnosing patients with various hearing problems. I also learnt the nuances of counselling the parents of hearing impaired children and patients with hearing problems related to treatment using hearing aids, cochlear implants and assistive listening devices. I focused on how a professional breaks the diagnosis to the patients in a professional way and makes them understand the problems the patients face and the available treatment options. In AHAP, we mainly focused on prescribing hearing aids for patients. I also got a chance to visit a special school organised by AHAP where, various professionals like Special educators, Audiologists, Psychologists and SLPs work together through a multidisciplinary approach in the treatment and management of post hearing aid fitting and cochlear implant surgery for children. I learnt the importance of different therapeutic approaches as the most necessary part of the treatment.

During the end of my internship I had already decided I wanted to pursue my masters in Audiology and SLP to gain deeper knowledge. I chose Manipal for my masters, which is pretty well known in the areas of Audiology and SLP, both in clinical and research expertise.

At Manipal, we learnt everything in-depth, knowing the reasons for the interrelations among causes, symptoms and treatment procedures. As a part of our curriculum, we used to take up clinical diagnosis and treatment procedures of several patients on a daily basis with appropriate guidance and supervision. Our role was to monitor and teach juniors doing clinical diagnosis and then prepare patient reports regarding each diagnosis to our professors. During my masters the focus was more in-depth. Manipal has Kasturiba Hospital, which is popular around Manipal. I got exposed to work as a student clinician in different departments in health care. I spent most of my clinical hours in Hearing assessments, Electrophysiological assessments, Hearing aid trials and fitting and Cochlear implants. Neurobiology and Neurolinguistics play a major role in Speech, Language and hearing profession because our brain is the control centre for all our body parts. Our brain has 4 different lobes which control different functions of our body. Although it has a different role in controlling all the structures, the brain always works together as a whole. Hearing and speech mechanisms are controlled by different areas in the left temporal lobe and other lobes in our brain, sub cortical structures and cerebellum have their important role in the comprehension of hearing, understanding speech and process in and production of speech. Speech is considered as one of the easiest ways in communication and Language is considered as a tool for communication. But the way of hearing and speech production is a complex phenomenon.

I used to wonder how nature has such complex creations within our body. When I started understanding the normal and abnormal mechanisms, i wanted to learn more in depth and i  am still learning and unravelling the secrets inside our brain.

As a part of our Post-graduation curriculum I got a chance to do dissertations in the field.

How did you get your first, break?

After completion of my post-graduation, I returned to Madurai in search of a career in the field. I decided that my profession would have to be service-oriented. I attended job interviews at different hospitals in and around Madurai. Since the vacancies were less, i had to search for jobs in clinical settings. I had a conversation with my seniors who work as Audiologists and SLPs. They referred me to Astra hearing care, where I work as an Audiologist and Speech Language pathologist in a regular job. They initially did not have any vacancy at Madurai branch, I had to go to Chennai to start my career. After a few months, i shifted to Madurai.

Where do you work now? 

 I work for Astra hearing care, Madurai. Here I focus on assessing, diagnosing, counselling and treating patients with hearing loss and other ear-related problems.

What are the skills required for this career? Can you tell us the difference between an Audiologist and Speech-Language Pathologist?

We are very well trained in treating patients with both speech and hearing problems. Audiologists are hearing specialists, work on diagnosing and treating hearing, balance, tinnitus (ringing inside the ear without any external stimuli) and other ear disorders that cause damage to the ear and hearing. Audiologists work along with ENTs, Paediatricians, Neurologists and Neurosurgeons. Beyond the routine clinical jobs, Audiologists will also work with ENT surgeons through an intra operative monitor during cochlear implant surgery. We also focus on creating awareness regarding hearing protection and conservation for public population, Industrial employees who work with machinery, and some doctors and dentists who work with occupational noise exposure. Audiology is a field that came into existence after the 2nd World war, when soldiers were suffering from noise induced hearing loss from warfare technologies. Since then, the field of audiology has been growing and functioning as an interdisciplinary approach.

The main focus for a SLP is assessing and treating children, adults and elderly populations with speech and communication difficulties. We work on children with symptoms of various syndromes and disorders related to delayed speech, language and motor development problems, patients with abnormal voice, articulation and Speech fluency problems, neurological speech, communication and impaired swallowing problems. We also deal with school going children with dyslexia (difficulty in reading and writing) which is a neurological and learning problem. SLPs can work along with ENTs, Head and neck surgeons, Neurosurgeons, Paediatricians in a multi disciplinary team.

Here let me explain the interrelations between Audiology and Speech-language pathology. Hearing is essential for speech and communication. Without properly hearing the concept, communication cannot be initiated. Our ear is described as Outer, middle and inner ear. Outer ear works as a funnel by collecting all the sounds from our environment along with speech sounds as a sound pressure, makes the ear drum vibrate and then conducts the vibrations to the middle ear, which is an air filled cavity consisting of 3 tiny bones (Malleus, Incus and stapes). The vibrations are sent to the inner part of the ear (Cochlea), which is a bony and membranous structure and fluid filled cavity. Here all the sounds are separated based on different frequencies which stimulate the tiny cells inside the inner ear where the vibrations are converted as electric impulses. The stimulation makes the Auditory nerve to conduct the electrical impulses to the auditory cortex in the brain located in the left temporal lobe where the sounds are processed. Our brain has the capacity to differentiate the signals from environmental noises to speech sounds and make us perceive what is spoken. Our brain has a very special linguistic capacity in learning any language at any time. Once the sounds are processed and the speech is separated, speech comprehension area (Broca’s area) plays a major role in understanding what is spoken by comparing with past experience with the language, speech, word or a sound is stored in our memory. Once the concept is understood, the speech expression area (Wernicke’s area) starts sending signals to the cranial nerves which supplies info to the muscles of the peripheral speech production system (muscles innervates the vocal cords in the Larynx (voice box) mouth, tongue, palate and resonatory system). Hence the communication is completed.

 What do you love about your job?

My ability to rehabilitate what a person lost due to damage to the brain or other organs and help a person communicate, is what i love. Proper and appropriate counselling is a very crucial part in treatment. I love counselling people to make them understand the normal mechanism and abnormal mechanism and different treatment options available.

How does your work benefit society? 

As in the proverb “Prevention is better than cure” we strive to create awareness among all populations to protect themselves from noise pollution and conserve their hearing. As a part of annual health check-up, hearing assessment should also be a part in check-up programme.

Early identification, detection and early treatment are essential for the part of the treatment program. We create awareness among parents, teachers and other health care professionals.

Tell us an example of a specific memorable work you did that is very close to you!

Every positive response from a patient is memorable to me.

Tinnitus (hearing ringing, roaring buzzing, hissing, whistling or ticking sounds inside the ear without any external stimuli) is one of the symptoms a person with or without having hearing loss would experience. It is irritable and frustrating that results in patients being anxious, having poor concentration, sleeplessness and sometimes suicidal tendencies in severe cases. Tinnitus can be treated through different treatment procedures, one among them is using hearing aids. Most of my patients come to my clinic with reduced hearing along with the symptom of Tinnitus. I give proper and appropriate counselling to the needy and prescription of good quality and appropriate hearing aids. It helps me save patients from all the symptoms caused by tinnitus.

Your advice to students based on your experience?

Educating parents about the health care courses beyond engineering and Medicine (MBBS). Students should also think of choosing their career in rehabilitation and treating people with loss in hearing and communication.