Ali Yavar Jung
Ali Yavar Jung
National Institute For The Hearing Handicapped
(Under the Ministry of Social Justice and Empowerment, Government of india, New Delhi)
K.C. Marg, Bandra Reclamation, Bandra (West), Mumbai – 400 050.

Activities and Services

Guidelines

I. Guidelines for EIP and PIP enrollment

  1. Early Intervention programme is for children with hearing impairment from 0 years to 5 years without having any other associated disability.
  2. Parents are empowered to handle their children with special needs
  3. Parents/caregivers are to accompany the child with hearing impairment for session at least once a week to the center and do the follow up of the activities taken, at home
  4. Parents/caregiver need to come out of the initial stage of shock and depression to be equal partners in the child's progress with the professionals.
  5. Parent/caregiver need to have knowledge about their child's hearing loss, hearing aids used by him/her and care and maintenance of the same.
  6. Parents/caregiver are to provide stimulating and nurturing environment to the child
  7. Parent/caregiver are to seek opportunities to give meaningful language to their child with hearing impairment.
  8. Parents/caregiver need to tune themselves and environment to fulfill their child's need and to include him/her in all home activities.
  9. Parents/caregiver need to be positive and motivated to play a pivotal role in child's development.

II. Guidelines for Issue of Hearing Disability Certificate (for Centers recognised by appropriate authority)

Hearing disability certificate is issued as per the definition of hearing disability published in Persons with Disability Act. (PWD) 1995 which says that the hearing disabled person is one who has the hearing loss of 60 dB HL or more in the better ear for conversational range of frequencies.

For implementation of PWD Act 1995, Government of India published a Gazette in 2001. This Gazette has provided the guidelines for issue of Disability Certificate. These guidelines are as follows:

Hearing Disablity

  1. Definition of Hearing: A persons with hearing impairment having difficulty of various degrees in hearing sounds is an impaired person.
  2. Categories of Hearing Impairment

    Information about the various types of impairment
    Category Type of Impairment dB Level Word Recognition Score(Speech discrimination) Percentage(%) of Impairment
    I Mild hearing impairment 26 – 40 dBHL in better ear 80 to 100% % in better ear Less than 40%
    II a) Moderate hearing impairment 41 to 60 dB in better ear 50 to 80% in better ear 40% to 50%
    II b) Severe hearing impairment 61 to 70 dB in better 40 to 50 % in better ear 71 % to 100%
    III a)Profound hearing Impairment 71 to 90 dB Less than 40% in better ear 100%
    c) Total deafness 91 dB and above in better ear Very poor discrimination
  1. Pure tone average of hearing in 500 – 4000 Hz by (Air conduction and bone conduction) should be taken as basis for certification of disability.
  2. When there is only an island of hearing present in one or two frequencies in better ear then it should be considered as total loss of hearing.
  3. Whenever there is no response as any of the four frequencies (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) then it should be considered as equivalent to 100 dB loss for the purpose of classification of disability.

Criteria for Hearing Disability Certificate

Thus the two criteria for issue of hearing disability certificate are as follows:

  1. Person should have hearing loss of 60 dB HL or more in the better ear for conversational range of frequencies.
  2. Word recognition score (Speech discrimination) should be less than 50% in better ear.

Tests for Certification

The following two tests are mandatory for issue of Hearing Disability Certificate.

  1. Pure tone audiometry
  2. Speech audiometry

Method for calculation of Percentage of Hearing Disability:

For calculation of percentage of hearing disability, pure tone average of four frequencies (500 Hz, 1000 Hz, 2000 Hz and 4000 Hz) is considered as base.

Monaural & Binaural Percentage of Hearing Disability is calculated by using the following formula.

Step 1 Monaural percentage of hearing disability = PTA – 25 X 1.5.

Step 2 Binaural percentage of hearing disability = (Better ear % X 5 ) + Poorer ear % 6.

25 dB HL is considered as lower fence while 95 dB HL is considered as higher fence.

For time saving and avoiding calculation error, we have prepared the Ready Reckoner which act as ready reference chart for determination of binaural percentage of disability.

Suggestion and Recommendation for Issue of Hearing Disability Certificate

  1. Hearing Disability Certificates should be given to all those having hearing loss of 60 dB HL or more in the better ear as PWD act 1995.
  2. Speech discrimination levels do help in categorizing disability especially in clients with mixed hearing loss. Even though most of the certifying agencies do not take into account speech discrimination ability, as on today, it is worth while to start doing it as it will help in identifying the needy more validly.
  3. The calculation of percentage of disability (especially of > 40%) is not misleading if one takes into account the better ear threshold alone. The Ready Reckoner prepared by us will be helpful in such cases.
  4. In the proposed criteria, 40% disability is kept as minimum to be called as “Partially Deaf” though as per PWD Act only those above 53 % (60 dB HL above) become eligible for social benefits.
  5. Partially Deaf are those whose hearing loss in the better ear is 43 to 70 dB HL in the better ear and binaural percentage of hearing disability is 40 % to 68 %
  6. Partially Deaf are those whose hearing loss in the better ear is 43 to 70 dB HL in the better ear and binaural percentage of hearing disability is 40 % to 68 %
  7. As per the definition of hearing impairment in PWD Act., groups following in the above two categories may be considered accordingly as eligible to avail the benefits reserved for person with disabilities.

III. Facility of Hearing aid sale at the Institute

The following are the points to be considered for the implementation of provision of hearing aid sale at the Institute.

  1. The patients who are not eligible for SADP hearing aid or those who would like to purchase better–suited hearing aids inspite of their eligibility to SADP hearing aids, will undergo a trial with the available trial hearing aids at the Audio clinic.
  2. The client will be sent to stores with a Hearing Aid Prescription form for request of procurement.
  3. Stores will collect 100% deposit of the cost of the hearing aid by DD in favour of Director, AYJNIHH, Mumbai or cash and will place the order for the hearing aid. They will deposit the money in Accounts Section.
  4. The manufacturers will be requested to deliver the hearing aids to the Institute at the earliest and not later than 2 weeks.
  5. The case will collect the hearing aid from Stores by signing a receipt slip and will report to the Audiology Clinic for its/their analysis. Once the aid is found to be ok, the same will be handed over to the case. In case the aid is not found to be satisfactory (in terms of EAC & Physical Characteristics) the same will be sent back to the Stores to take further necessary action.
  6. The ‘unsatisfactory’ aids will be sent for replacement. In case any make/model delivered is found to be unsatisfactory more than once, the same will be intimated to the manufacturer and will be considered for ‘blacklisting’ by the higher authorities.

Flowchart for prescribing Hearing Aids Not covered under ADIP Scheme

  1. HA Trial: Using those hearing aids for which we have the dealer price list and trial pieces are available in the clinic.
  2. HA prescription: Explain the procedure terms & Conditions for procuring HA From the Institute
  3. HA Prescription Form: Fill in duplicate
  4. Mention:
    1. Number of HA's prescribed
    2. Procure dealer' price list from RRJ or HOD
    3. Calculate total price (dealer' price as per list + 3% Institute's overhead charges)
    4. Fill form & sign
    5. HOD's sign
  5. Cashier: Direct client to the casher with Prescription form in duplicate where he/she will pay cash and Procure receipt and prescription form back.
  6. Stores: Client shows prescription form (in duplicate) with receipt & thus places orders for HAs. Stores retain one copy of the prescription form & the client brings back the duplicate to the clinic for filing. Stores places order by calling the company & asking them to deliver the aid by courier within 48 hours
  7. Delivery: Within 48 hours, client picks up HA from stores
  8. EAC: Client gets HA + file for EAC to the Department
  9. HA counseling + Service Center list to be provided in the Audio Clinic.