The prevalence of deafness in India is fairly significant. It is the second most common cause of disability. Approximately 63 million people (6.3%) in India suffer from significant auditory loss.1 Rehabilitation of hearing impaired children in India remains a challenging task. Early detection and intervention are the mainstay of this initiative. This article does not purport to detail the clinical aspects and surgical management of hearing handicapped children.We discuss here the resources and options available in India for the education of deaf children and the role of the Government bodies in rehabilitation. Awareness abouteducation and rehabilitation of hearing handicapped is low among the general public and even among the medical fraternity.

Naik, Mahendra S

Naik, Sulabha M

Sharma, Akriti

English

Otolaryngology online journal

 
Volume 3 Issue 1 2013                                                                              ISSN: 2250-0359 
 
Rehabilitation of hearing impaired children in India – An update 
                     *Sulabha M Naik   *Mahendra S Naik   *Akriti Sharma 
*M.M.Institute of Medical Sciences & Research,Mullana,Ambala 
 
Introduction: 
The prevalence of deafness in India is fairly significant. It is the second most common 
cause of disability. Approximately 63 million people (6.3%) in India suffer from 
significant auditory loss.1  
Rehabilitation of hearing impaired children in India remains a challenging task. Early 
detection and intervention are the mainstay of this initiative. This article does not purport 
to detail the clinical aspects and surgical management of hearing handicapped children. 
We discuss here the resources and options available in India for the education of deaf 
children and the role of the Government bodies in rehabilitation. Awareness about 
education and rehabilitation of hearing handicapped is low among the general public and 
even among the medical fraternity.  
 
 
 
 Definitions and Terms 
The Rehabilitation Council of India Act,19922, has defined "hearing handicapped" as - 
hearing impairment of 70 decibels and above, in better ear or total loss of hearing in both 
ears. 
 
The legal definition of “hearing disability” in India as per the Persons with Disability 
Act3 (PWD), 1995 is – “a hearing disabled person is one who has the hearing loss of 60 
decibels or more in the better ear for conversational range of frequencies”. 
 
The latter definition is at variance with the former. There exists a need to clarify which of 
the two is a valid definition. 
 
The term ‘deaf’ is being replaced by the term ‘hearing impaired’.4 ‘Hearing challenged’ 
is an alternate appropriate term. An individual who is hard of hearing since birth was 
earlier termed ‘deaf and dumb’.In today’s age of political correctness, these individuals 
have been redesignated as “congenitally deaf”. 
 
The word ‘deaf,’ when spelt with a small‘d’ refers to hearing loss and when spelt with a 
capital ‘D’,refers to the Deaf Community4. The Deaf Community is an invisible minority 
community worldwide, as deaf persons can only be identified after personal interaction 
with them. 
 
Habilitation is a process by which persons born with impairments learn life skills5.   
Rehabilitation refers to a process by which persons readapt to society after acquiring 
impairment. 
 
Deaf Community in India 
 
Deaf persons live scattered worldwide. The Deaf Community in India is not an organized 
entity. They lack a sense of common identity. 
 
 
Early diagnosis and intervention for rehabilitation of deaf children 
Early identification & timely intervention with appropriate support from the family and 
community is the key to management. Early diagnosis and suitable amplification is 
mandatory for speech training. Shortly after birth, every neonate should be screened by 
OAE (otoacoustic emission) testing. All cases detected by OAE testing should be tested 
further by BERA (Brainstem Evoked Response Audiometry) testing. Speech training 
should  be initiated as early as two years of age with an amplification device such as  
bone conduction hearing aid. Surgery, where indicated should be performed after careful 
assessment of each case. Cochlear implant surgery has evolved in recent years and many 
centres in India are conducting this operation with fairly good outcomes. However, the 
cost of the implant being prohibitive, not many can afford to avail of this facility. 
 Indian Sign Language 
The ability to communicate is the essence of human existence. The mother tongue is 
easily learnt by hearing children. In India, almost every state has it’s own language which 
is the mother tongue of a hearing child. The deaf child fails to learn the mother tongue. 
Thus there exists a lacuna in the early speech development at home for the child born 
with hearing impairment. 
 Sign language is the equivalent of oral language for those who are deaf .Gestural 
communication develops at home which is a type of self developed sign language. This 
form of communication in the home environment takes the place of the mother tongue 
and this has given rise to the term “homesign” language.6 
A homesign language was developed in Botswana for preschoolers. It was designed 
with the motive of improving deaf education as it facilitates the learning of the second 
sign language formally taught in the classroom. It is based on the theory that learning a 
second sign system is additive to the mother tongue. In Botswana, deaf children begin 
communication in the school by use of homesign. In school, they are then  taught  
Botswana sign language, which is based on  English. 
For several years there was no uniform Indian Sign Language (ISL). Vasishta et al.7, 
reported that ISL is a language in its own right and is indigenous to the Indian 
subcontinent. Earlier ISL was not included as part of the curriculum in teacher training 
programmes. Ironically, teachers of the Deaf had to resort to learning sign language from 
their own students for the purpose of communication. Courses and teaching aids for ISL 
instruction were not available, nor were there any avenues for training ISL instructors. The Indian sign language is based on an English platform. English is not the lingua franca 
in most homes in India. There is no sign language based on any regional Indian language. 
The problem of how to provide access to Indian Sign Language for deaf people in rural 
areas of the Indian subcontinent8 is difficult to tackle, given the magnitude of the task. 
Special schools vs Inclusive schooling 
A special school for the deaf has the following advantages4: 
1.  It provides a venue for free communication and social interactions between deaf 
persons. 
2.  It is a “home away from home” for deaf children and provides a comfort zone. 
3.  It inculcates a sense of identity. 
4.  It provides role models for deaf children. 
5.  It provides the opportunity to participate in sports and other activities among 
peers.  
Inclusive schooling or mainstream schooling, seeks to address the learning needs of all, 
with a specific focus on those who are vulnerable to marginalization and exclusion. It 
implies all young learners, with or without disabilities, should be able to learn together 
through access to common schools with an appropriate network of support services 
It is postulated that a child with disability can be educated in a general school only and 
not in special school. Even those children who .are admitted to special schools for 
training in plus curriculum skills should be transferred to general schools once they 
acquire daily living skills. Research has shown that inclusive education results in improved social development and 
academic outcomes for all learners9. It leads to the development of social skills and better 
social interactions because learners are exposed to real environment in which they have 
to interact with other learners each one having unique characteristics, interests and 
abilities. The non-disabled peers adopt positive attitudes and actions towards learners 
with disabilities as a result of studying together in an inclusive classroom. Thus, inclusive 
education lays the foundation to an inclusive society accepting, respecting and 
celebrating diversity.  
 
Initiatives by the Government of India 
The last decade has seen the passing of many a legislation on disability by the 
Government of India.  
  The Rehabilitation Council of India Act(1992)2 
A  Rehabilitation Council of India was set up to promote and regulate training of 
rehabilitation professionals in the country  
  Persons with Disability Act (1995)3 
The Persons with Disabilities Act, 1995 includes hearing impairment in the list of 
disabilities covered and defines hearing impairment (vide supra). The Act endeavors to 
promote the integration of learners with disabilities in mainstream schools. It includes a 
section dealing with reduced syllabus for disabled people and issuing a concession of a 
single language for the hearing impaired student. It has set up the Ali Yavar Jung 
National Institute of Hearing Handicapped (NIHH) 10.  
Among the several facilities at this institute, the following are noteworthy: (i)Training of Personnel at NIHH 
It was only as late as 2001, when a proposal for starting ISL classes and an interpreter 
training programme at NIHH was initiated. In March 2001, the first national workshop 
on sign language in India, sponsored by the Rehabilitation Council of India was held. An 
ISL Cell was established at NIHH, in May 2001 and subsequently, sign language training 
commenced in formal manner on a ongoing basis. 
(ii)Facility of Hearing aid sale at the Institute has been provided. 
(iii)A Directory of Rehabilitation Resources for persons with hearing impairment in India 
– consisting of details of Schools for the Deaf, Acts, Concessions, Schemes of the 
Government of India, is available at the Institute. 
 
  National Programme for Prevention and Control of Deafness (2006)11 
National Programme for Prevention and Control of Deafness was launched with the long 
term objective to prevent and control major causes of hearing impairment and deafness, 
so as to reduce the total disease burden by 25% of the existing burden by the end of 
eleventh five year plan. The pilot project was completed in 2008.As per NSSO survey, 
currently there are 291 persons per one lakh population who are suffering from severe to 
profound hearing loss (NSSO, 2001). A large percentage of these, are children aged from 
0 to 14 years. These hearing impaired young Indians, contribute to a loss of national 
productivity. Rehabilitation programmes reaching all over the country, particularly the 
rural areas is the need of the hour. 
OBJECTIVES OF THE PROGRAMME 
 1.  To prevent the avoidable hearing loss on account of disease or injury. 2.  Early  identification,  diagnosis  and  treatment  of  ear  problems  responsible  for 
hearing loss and deafness. 
3.  To medically rehabilitate persons of all age groups, suffering with deafness. 
4.  To  strengthen  the  existing  inter-sectoral  linkages  for  continuity  of  the 
rehabilitation programme, for persons with deafness. 
5.  To develop institutional capacity for ear care services by providing support for 
equipment and material and training personnel.  
STRATEGIES 
1.  To strengthen the service delivery including rehabilitation. 
2.  To develop human resource for ear care. 
3.  To  promote  outreach  activities  and  public  awareness  through  appropriate  and 
effective IEC strategies with special emphasis on prevention of deafness. 
4.  To  develop  institutional  capacity  of  the  district  hospitals,  community  health 
centers and primary health centers, selected under the project. 
 
Components of the Programme  
1)       Manpower  training  and  development  –  For  prevention,  early  identification  and 
management of hearing impaired and deafness cases, training would be provided from 
medical college level specialists (ENT and Audiology) to grass root level workers. The 
training of PHC doctors and health functionaries would be provided by Rehabilitation 
Council of India. 
2)      Capacity building – for the district hospital, community health centers and primary 
health center in respect of ENT/ Audiology infrastructure.  3)      Service provision including rehabilitation – Screening camps for early detection of 
hearing impairment and deafness, management of hearing and speech impaired cases and 
rehabilitation (including provision of hearing aids ), at different levels of health care 
delivery system. 
 4)      Awareness generation through IEC activities – for early identification of hearing 
impaired, especially children so that timely management of such cases is possible and to 
remove the stigma attached to deafness.  
 The programme is expected to generate the following benefits: 
i.  Various  services  like  prevention,  early  identification,  treatment,  referral, 
rehabilitation  etc.  for  hearing  impairment  and  deafness  at  the  primary  health 
center / community health centers / district hospital level. 
ii.  Decrease in the magnitude of hearing impaired persons.  
iii. Decrease in the extent of ear morbidity or hearing impairment in large number of 
cases.  
iv.  Improved service network for the persons with hearing impairment in the districts.  
v.  Awareness  creation  among  the  health  workers/grassroot  level  workers  who 
function  within  the  community,  through  the  primary  health  centre  medical 
officers and district officers. 
vi.  Community  participation  to  prevent  hearing  loss  through  panchyati  raj 
institutions, mahila mandals and village bodies. 
vii. Capacity building at the district hospitals to ensure better care. 
viii. State of the art department of ENT at the medical colleges. However despite efforts by the government and the non-government sector, 
educational facilities need to be made available to a large proportion of persons with 
hearing disability. 
  Sarva Shiksha Abhiyan(SSA)12 - has been implemented by the Ministry of  
 
Human Resource Development for children with special needs (CWSN).The  
 
Emphasis is on inclusion or mainstreaming CWSN into formal elementary  
 
Schooling. SSA ensures that CWSN are provided education. All CWSN need not  
 
Be deprived of the right to education and they are taught in an environment,  
 
Which is best, as per their needs. All CWSN should be placed in schools of the   
 
neighborhood with along with provision of all necessary support services. 
 
  Persons with Disabilities Act, 2011. -Working Draft (9
th 
February, 2011 version) 3 
All persons with disabilities have a right to be provided aids and appliances of  
recognized quality at an affordable cost along with the requisite training to utilize it.  
Every person with disability has the right to be informed of the various rehabilitation 
options and make the final decision on the course of rehabilitation.  
There shall be constituted for the purposes of this Act, a Fund to be called the 
National Fund for Persons with Disabilities 
 
Summary 
The government has enacted legislation and set up bodies like Rehabilitation Council of 
India and institutes like NIHH for training personnel for the education and rehabilitation  
of deaf children. These measures focus on inclusive schooling as a means of integration 
of deaf children in the community. However, the advantages of special schools for deaf children cannot be ignored. The task of educating and rehabilitating deaf children is a 
formidable one. The decision whether to opt for special school or mainstream schooling 
should be left to the parents of the deaf child. Suitable counselling centres should be set 
up to advice parents to take an informed decision regarding the same. More special 
schools as well as training institutes for educators of the deaf are the need of the hour. 
Public awareness campaigns should be initiated by voluntary organizations so that 
facilities provided by the government are broadcast and thereby availed by all in need. 
   
References: 
1) Garg S, Chadha S, Malhotra S, Agarwal AK. Deafness: burden, prevention and 
control in India. National Medical Journal of India. 2009 Mar-Apr;22(2):79-81 
2. The Rehabilitation Council of India Act,1992, Ministry of Law, Justice & Company 
Affairs(1992): (No. 34 of 1992),New Delhi.(Available at-
rehabcouncil.nic.in/engweb/rciact.pdf) 
3. The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full 
Participation) Act, 1995 Ministry of Law, Justice & Company Affairs (1996): (No. 1 of 
1996),New Delhi: The Gazette of India, Page. 24(Available at-http:// 
socialjustice.nic.in/pwdact1995.php) 
4. Jafek B.,Murrow B.”ENT Secrets” Third Edition.2005.pgs 45-50.Elsevier 
5. Persons with Disabilities Act, 2011 Working Draft (9
th 
February, 2011 version) 
(Available at-http://socialjustice.nic.in/pdf/workdraftdd.pdf ) 
6. Sourav Mukhopadhyay, Waldetrudes Sison .” Natural sign language and proficiency 
in learning Setswana sign language and curriculum content among students with hearing impairment in Botswana”. Asia Pacific Disability Rehabilitation Journal Vol. 17 No. 1 
2006,pgs 61 -72  
7 Vasishta M., Woodward J, De Santis S. An Introduction to Indian Sign Language: 
Focus on Delhi. New Delhi: All India Federation of the Deaf, 1981 
8. Ulrike Zeshan, Madan M. Vasishta, Meher Sethna.”Implementation of Indian Sign 
Language in educational settings.”  Asia Pacific Disability Rehabilitation Journal Vol. 
16 No.1, 2005,pgs 16-40 
9.Department of Higher Education. Action plan for inclusive education of children and 
youth with disabilities.New Delhi:Ministry of Human Resources 
Development.2005(Available at-http://education.nic.in/inclusive.asp) 
10. Ministry of Social Justice and Empowerment 1983. Ali Yavar Jung National Institute 
of Hearing Handicapped(NIHH) (Available at-http://ayjnihh.nic.in) 
11.Directorate General of Health Services. National programme for prevention and 
control of deafness, Project proposal. New Delhi:Ministry of Health and Family 
Welfare; 2006.(Available at - http://rehabcouncil.nic.in/projects/nppcd.htm) 
12.Sarva Shiksha Abhiyan. Ministry of Human Resources Development .(Available at - 
http://ssa.nic.in/page_portletlinks?foldername=inclusive-education) 

Deafness: burden, prevention and control in India. National Medical Journal of India.

Directorate General of Health Services. National programme for prevention and control of deafness, Project proposal. New Delhi:Ministry of Health and Family Welfare; 2006.(Available at - http://rehabcouncil.nic.in/projects/nppcd.htm)

Education. Action plan for inclusive education of children and youth with disabilities.New Delhi:Ministry of Human Resources Development.2005(Available at-http://education.nic.in/inclusive.asp)

Meher Sethna.”Implementation of Indian Sign Language in educational settings.”

Sarva Shiksha Abhiyan. Ministry of Human Resources Development .(Available at -http://ssa.nic.in/page_portletlinks?foldername=inclusive-education)

Social Justice and Empowerment

The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act,

The Rehabilitation Council of India

Waldetrudes Sison .” Natural sign language and proficiency in learning Setswana sign language and curriculum content among students with hearing impairment in Botswana”. Asia Pacific Disability Rehabilitation

Rehabilitation of hearing impaired children in India – An update

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Rehabilitation of hearing impaired children in India – An update

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