Mrs. Char has the unusual qualification of being both an audiologist and teacher of the deaf, thereby integrating her knowledge of acoustics with the practice of classroom teaching. Her post-graduate work in the USA involved clinical experience with infants and pre-school children.

Mrs. Char has been an audiologist at Naad since its inception. She specializes in pediatric audiology working with both hearing aided and cochlear implanted children and their families. She has been instrumental in developing a booklet for guiding and informing parents and families about the implant procedure. This booklet is being used by various cochlear implant centres in India.

Mrs. Char is regularly invited to present at conferences and supervises trainees of Nair Hospital who come to Naad as part of their graduate programme.

In addition, she regularly participates in continuing education programmes.

Ms Shefali Shah
Diploma in the Education of the Deaf (India)
M Ed Smith College, Mass (USA)
Special Educator and Director, MAITRI

Mrs. Shah is particularly interested in the development of children below five years. She took additional courses in Infant Development during her Masters programme in the USA. After returning to India in 1986, she worked exclusively with pre-school children at The Central School for the Deaf, Mumbai.

In 2002 she set up Naad, an early intervention centre for hearing impaired infants and babies. She is currently Director of the programme and is actively involved in teaching the children who come to Naad.

Shefali is invited to present papers and to chair sessions on Pre-school Education for Deaf children by several professional organizations, including the Ali Yavar Jung Institute for the Hearing-Impaired, MUMBAI.

Mrs. Shah is involved with evaluating in-coming infants in coordination with the Audiologist and Counselor for eligibility into Naad’s programme. She then begins Auditory-Verbal Therapy on an individual basis in English and Marathi along with active parent participation and on-going guidance. She formulates an age-appropriate individualized curriculum for children under 3 years of age.

Mrs. Shah also conducts teacher training workshops for teachers of the deaf with special emphasis on early intervention. She also has regular workshops for parents of the children at Naad. These cover a wide variety of topics ranging from Talking to your Child to Parenting to Reading to your Child etc.

Mrs. Shah is invited to address seminars and conferences on early intervention and habilitation for the deaf in Mumbai and other parts of the country.

Malashri Patel
Diploma in Education of the Physically Handicapped (University of Bombay)
Diploma in the Education of the Deaf (India)
Assistant Special Educator, MAITRI

Malashri did her initial training in the education of the physically handicapped from the Spastic Society of India. After which she taught at the school run by the Society.

In 1985 she started her training in the Education of the Deaf at The Central Institute for Teachers of the Deaf (CITD), Mumbai. She has been at Naad since its inception. She has recently taken over as programme coordinator for I Hear Foundation’s various projects and programmes — teacher training workshops, infant hearing screening etc.

parents’ blessings

the six alumni!

Mrs Isaacs and the graduating class

The graduating class

Graduation day was celebrated at Naad’s premises in Colaba, Mumbai.

Mrs Isaacs lights the lamp

Our partners from the Rotary Club

Naad is joint program of IHF and


supported by

These early beginnings are vital to the child’s development of spoken language. Early identification, appropriate amplification and family participation allow the child to develop age-appropriate speech and language skills.

Early intervention allows infants to commence auditory living and gives them opportunities to listen, to learn and to enjoy life. It gives them the freedom of choice.

It allows them to grow up with sound.

Knowing the benefits of early intervention, IHF established Naad: a centre for early intervention.

At Naad we believe that infants born with a hearing loss are similar to hearing infants in more ways than they are different from them. This is the basic principle on which our entire educational programme is based.

In our work with you, we will encourage you to behave and talk with your hearing impaired child as though he were a hearing baby, making certain adjustments that would ensure more effective communication for both of you. This would generate spontaneous conversation between you and your child, which is fundamental to our aural habilitation method. The development of good listening habits in your child is a process that you will be actively involved in. It is important that as your child grows he develops clear speech and a natural speech rhythm.

The process of developing good language and speech skills in your child is a slow one and its pace is set by your child. Every child has his own pace of growth and will give you clear signals when he is ready for the next step. We will help you recognise these signals but to push your child too hard in an effort to make him learn faster is a bad mistake which both of you will later regret. Allow your child the joys of a happy, relaxed childhood and help him make a successful transition to life with his hearing friends, when he is ready for it.

Every child is special in his own way and we believe that our hearing impaired infants are special too. What sets each child apart is not his intelligence or speech skills but the extent to which he is a complete personality. Our work with your child is aimed at helping him achieve this potential, through the combined efforts of our Counsellor, Audiologist and Special Educator. We work together so that your child grows up into a happy, healthy, well-rounded young person.

Naad devotes itself to empowering parents to play a pivotal role in the effective habilitation of their hearing impaired babies. They are provided with the tools which will enable them to become their child’s first teacher of language. Naad emphasises parent-child and extended family-child interaction as a way to create a listening and language rich environment for the child.

The success of the programme is the educational partnership formed with parents and their active involvement in the child’s learning.

A hearing impaired child needs to be immersed in his mother tongue for all his waking hours in order to understand language as an older child. The home environment must be able to provide an enriched language input complete with the finer nuances of language. At Naad we recommend that the language of instruction chosen by the family be one in which the parents are fluent. Naad offers a choice of English or Marathi.

Naad aims:

1. To foster a nurturing environment for all babies and their families who participate in Naad’s programme
2. To facilitate early diagnosis and fitting of appropriate amplification to provide access to spoken language.
3. To provide effective early intervention that will promote the development of age-appropriate listening and speech skills.
4. To work in partnership with parents in a natural and stimulating learning environment.
5. To offer a service that allows families to make an informed choice in the effective audiological and educational habilitation of their child.
6. To place children appropriately in learning environments that best suit their needs.

Facilities @ Naad include

• Lending library for the children which includes books, jigsaws, puzzles, videos
• Kitchenette where cooking as a means of expanding language is done with the children.
• Counseling room
• Center is very well equipped with stimulating teaching aids for children from birth to five years
• Sound treated therapy rooms with high chairs for the babies
• Videos and CDs for parent and professional training
• On-going documentation of our work. This is also used for parent and professional training
• Audiology booths equipped with the latest equipment
• MAPping facilities for cochlear implanted children
• Computer used for making teaching aids

• 
• 
• Bernard Van Leer Foundation, Netherlands
• Mahalaxmi Temple Charities
• Babulnath Mandir Charities

A complete list of our donors is available on request.

IHF’s program is intensive and expensive. It costs Rs. 63,000/- per year to educate a child at IHF’s early intervention programme Naad. A single cochlear implant can cost as much as Rs.800,000 (US $1700) and a good hearing-aid costs about Rs.25,000 (US $530). There are many families with us who simply cannot afford these costs. IHF tries to help them in every way possible including, in appropriate cases, with waivers of its already-low tuition fees.

IHF requires donations:

• To maintain a common fund on which we can draw to get hearing-aids and equipment for parents who cannot afford them;
• To meet part of our operational expenses;
• To improve and upgrade our facilities and increase our staff strength.
• To the corpus of I Hear Foundation so that it can expand its activities to include an infant-screening programme and set up an ear-mould laboratory.

Your support will give children with a hearing loss the chance to listen and speak and communicate with confidence in a hearing world. Donations to I hear Foundation are exempt from tax under Section 80G of the Income Tax Act, 1961.

A donation form can be is available for download in PDF format or as a zip file.

Volunteers

IHF is more than happy to take on volunteers at its Naad Centre. Our volunteers help us in

• Fund raising
• Illustrating books for children
• Coordinating the Awareness program
• Coordinating the Infant Screening Program
• Filming and editing video footage for documentation
• Window displays
• Preparing teaching material
• Assisting at teacher-training seminars and sessions

• You are a parent and would like to have your child assessed.
• You wish to make a donation;
• You would like to volunteer your services

Our office hours are all working days, Monday through Friday, 8:30 am to 2:00 pm.

Dr Firoza Bhabha

MD Paediatrics, DCH

Child Specialist

Mrs Anupam Anand

Mr Gautam Patel

Advocate, High Court, Bombay

IHF’s flagship program,

Naad, was set up between August 2002 and April 2003 with extensive support from the Rotary Club of Bombay. Today, it is a joint program of IHF and the Rotary Club of Bombay in association with Reuters Foundation.

Naad is a unique early intervention program for babies and young children born with a hearing loss and their families. It is founded on the principle that if hearing-impaired infants are to be brought into a world of sound, they must receive assistance as early as possible. At Naad, we believe that it is essential to teach these children to listen and speak clearly so that they can fully participate in our hearing world and make informed choices. Naad offers a comprehensive range of services—audiology, therapy and counselling—in one integrated facility.

In a very short time, IHF’s Naad program has received nation-wide and even international recognition. It is arguably the only program of its kind in the country today. There are 35 children enrolled at Naad today and they came from as far away as Surat, New Delhi and even Assam.

IHF & Hearing-Impaired Babies

The human ear is a marvellously balanced mechanism: With equal ease, it hears a pin drop and copes with the thunder of a jet. Sound and speech are fundamental to our daily communications; we take for granted the entire process of listening.

But when this delicate balance is upset, the consequences are far-reaching and frequently misunderstood. A crying three-month old baby is comforted by her mother’s voice; a hearing-impaired infant cannot hear her mother and becomes frantic.

As she grows, the hearing-impaired child does not comprehend spoken language and speech appropriate to her age. She is regarded as a low-functioning child. The family finds it difficult to understand the dimensions of the impairment. It needs appropriate guidance. The infant needs an effective early-intervention programme. She needs a customised hearing-aid. She must be taught to listen and to develop intelligible speech and age-appropriate language skills.

We are committed to providing just such early, effective and age-appropriate intervention so that hearing-impaired infants and their families may become confident participants in our hearing society. The Foundation’s technologically advanced audiological facility and individualized educational and counselling services make it a forerunner in early identification and effective management of very young hearing-impaired children in India.

I Hear Foundation uses a model developed indigenously over the last three years for effectively rehabilitating hearing-impaired babies. Infants gain placement in kindergarten classes of regular schools for hearing children. The hearing-impaired children are appropriately amplified, have good listening and speech skills and even participate in class singing sessions.

IHF’s Work

Over the past two years, IHF has

• set up a comprehensive centre in South Bombay from where it runs its early-intervention program;
• conducted a workshop for teachers of the deaf from other schools and centres;
• facilitated continuing education for its own staff;
• developed a library of materials and case-studies, including extensive videography, for further research;
• prepared teaching aids and materials of its own;
• assisted parents in obtaining appropriate hearing-amplification, including raising support for expensive Cochlear Implants;
• graduated its first students who will now be integrated into mainstream primary and secondary schools;

What we offer:

• An Auditory-verbal program which offers children who are hearing impaired the opportunity to listen, speak and communicate in the world of sound. Focus on listening, leading to the natural development of speech and language.
• Warm, friendly, family environment.
• Diverse team of qualified, experienced professionals including teachers, audiologists, counsellor, ENT surgeons, paediatricians.
• Early intervention program, Naad, for hearing aid users and implanted children from diagnosis to age of school entry
• A comprehensive Cochlear Implant (CI) program

Our Cochlear Implant program offers:

• evaluation of suitability for CI including a trial of hearing aids
• Preparation for CI surgery
• Activation or ‘switch on’ of CI
• Post-implant therapy
• Audiological management including MAPping and audiological assessment
• Support and counselling for parents and families
• an individualized short-term plan that addresses audiological and therapy goals, and family needs.
• Regular assessment to monitor and facilitate the child’s progress

Looking Ahead

Recently, IHF received accredition from the Alexander Graham Bell Association for the Deaf and Hard of Hearing in America.

This ‘auditory living’ is even more crucial for children born with a hearing loss. Delayed auditory stimulation results in inefficient language facilities. A baby deprived of appropriate language stimulation during the first three years of life may never fully attain optimal language function.

Early intervention uses the plasticity of the infant brain to stimulate auditory and neural pathways. Appropriate early amplification allows infants to commence auditory living and gives them opportunities they otherwise might never have—to listen, to learn, to enjoy life. It gives them the freedom of choice.

The choice of methodology is two-fold:

1. Oral Communication
2. Sign Language Communication

The main difference between these two methodologies lies in the importance given to speech. Oral communication is committed to the development of listening and speech skills in hearing impaired children. Children are encouraged to express themselves by talking and using natural gestures but they are discouraged from using any signs. There are different teaching methods within Oral Communication and these range from the development of listening skills exclusively, without the assistance of lip-reading (as in The Acoupedic Approach) to those that encourage the development of listening skills supplemented by lip-reading (as in The Auditory Oral Approach) as the means to generate language and speech in hearing impaired children.

Indian Sign Language is as full fledged a language like any spoken language however the language is visual rather than auditory. It is used by over five million deaf adults in India. Proponents of sign language believe that hearing impaired children should be allowed to express themselves through a medium that they have full access to (visual) rather than auditory since deaf people are unable to learn spoken language in the same manner as hearing people do. Proponents of sign language believe that language is a more important factor than good speech. Proponents of sign language argue that speech is only one component of language and reading and writing skills are as important. Everyday communication and education to the child is provided exclusively in sign language and speech training is taken up in special sessions with a speech therapist. Just as each country has its own spoken language, complete with its rules and grammar, so also sign language has its own characteristic vocabulary, grammar and idioms. Sign language used within India is known as Indian Sign Language or ISL. Sign language used in the USA and Canada is known as ASL.

ISL is systematized within India and its signs consist of hand shapes, hand positions and movements which can be uniformly expressed and understood within our country. It also uses space, direction, speed of movements and facial expressions to convey meaning. Proper nouns (such as names) and certain words have no specific sign and so sign language users use Finger Spelling to spell out these words.

Finger spelling can be described as writing in the air. Each letter of the alphabet has a corresponding hand shape or sign. In education, finger spelling is sometimes used as the main means of communication, together with spoken English.

When sign language users use a combination of speech, signs and finger spelling to communicate, it is known as Simultaneous Communication. The advantage of Simultaneous Communication is that it offers the benefit of seeing two forms of a message at the same time: the hearing impaired person lip reads what is being said and simultaneously reads the signs and finger spelling of the speaker. Users of Simultaneous Communication claim that this makes for easier communication.

Cued Speech was developed later as a means of combining the advantages of both Oral and Visual Communication. It seeks to remove the confusion caused in lip reading sounds that look alike on the lips (e.g. “p” and “b” or “t” and “d”) by supplementing talking with specific hand shapes and positions for these individual sounds. These cues help clarify potentially confusing look-alike words, such as “cot” and “got” thus improving overall communication.

It is important to clarify at this point, the meaning of Total Communication, which is often misunderstood. Total Communication (or TC) is a philosophy of acceptance which uses all possible methods of communication to assist a hearing impaired child acquire language and understand speech. Therefore TC does not refer to any particular teaching method but instead refers to the adoption of an open attitude in teaching hearing impaired children.

Before deciding on methodology, it is important that you read articles and books explaining some basic theory and then visit schools in your city/town that seeks to implement the method of your choice. We will be happy to give you some basic information in this regard.

Arguments about methods of teaching hearing impaired children continue among professionals but you should not allow yourself to get trapped into defending one method against another. You are not looking for “the perfect methodology”. Instead you are looking for a method of teaching which will be most suited to your child’s needs and which will allow you to participate most actively.

Our Way Of Working

At IHF we believe that infants born with a hearing loss are similar to hearing infants in more ways than they are different from them. This is the basic principle on which our entire educational programme is based.

In our work with you, we will encourage you to behave and talk with your hearing impaired child as though he were a hearing baby, making certain adjustments that would ensure more effective communication for both of you. This would generate spontaneous conversation between you and your child. Fundamental to this aural habilitation method is the development of good listening habits in your child; a process that you will be actively involved in. It is important that your child grows he develops clear speech and natural speech rhythm.

The process of developing good language and speech skills in your child is a slow one and its pace is set by your child. Every child has his own pace of growth and will give you clear signals when he is ready for the next step. We will help you recognize these signals but to push your child too hard in an effort to make him learn faster is a bad mistake which both of you will later regret. Allow your child the joys of a happy, relaxed childhood and help him make a successful transition to life with his hearing friends, when he is ready for it.

Every child is special in his own way and we believe that our hearing impaired infants are special too. What set each child apart are not his intelligence or speech skills but the extent to which he is a complete personality. Our work with your child is aimed at helping him achieve this potential, through the combined efforts of our Counselor, Audiologist and Special Educator. We work as a team so that your child grows up into a happy, healthy, well-rounded young person.

If the auditory channel is impaired or blocked, speech and language may not develop properly. Since the first three years of life are critical for normal speech and language development, every effort should be made to identify hearing impairment during these early listening years.

Identification of hearing loss in infants and children requires careful observation, a thorough medical examination with an extensive case history, and an audiological evaluation. Help identify young children who may need a medical and/or audiological evaluation by familiarizing yourself with the facts.

When and How to Evaluate

If speech and language development begins normally and then stops, refer immediately for a hearing evaluation. A child of any age can have an audiological evaluation. The evaluation technique used depends upon the developmental age of the infant or child. Methods include Auditory Brainstem Response (ABR) and Oto Acoustic Emission (OAE) testing at any age (including premature infants), and Visual Response Audiometry (VRA), which is designed to elicit consistent and reliable responses from only a few months of age. Play Audiometry is used at around 2 1/2 years of age until the child is able to respond consistently to the conventional evaluation techniques used with adults. Our pediatric audiology team can help decide which method is best for a child. In order to obtain complete and accurate test results, children may need to be seen on more than one occasion.

Early identification and assessment are the first steps in the successful management of the hearing impaired child.

High Risk Factors

Birth - 28 days:

• Malformations of the ear, nose or throat
• Rubella during pregnancy
• Rh incompatibility
• Family history of hearing loss
• Apgar score from 0 - 3
• Severe neonatal infections
• Meningitis
• Low birth weight (under 3.3 lbs.)
• Hyperbilirubinemia
• Ototoxic medications
• Severe respiratory distress and/or prolonged mechanical ventilation (10 days or more)

29 days - 2 years

• Parent/caregiver concern regarding hearing, speech, language and/or developmental delay
• Meningitis
• Presence of neonatal risk factors
• Head trauma
• Stigmata
• Ototoxic medications
• Neurodegenerative disorders
• Childhood infectious diseases associated with hearing loss (e.g. mumps, measles)

A child who has had one or more of these conditions is considered “at risk” for a hearing impairment and should have a comprehensive audiological evaluation by a pediatric audiologist.

Milestones of Normal Development

Some babies have a significant hearing loss due to unknown factors. Use these developmental guidelines to watch for hearing and speech milestones.

0 - 4 months: Stops movement or quiets in response to speech. Startles to loud sounds. Moves eyes toward sound source. Arouses from light sleep to sudden loud noises.

4 - 7 months: Begins head turn toward sounds and voices out of sight (4 months) and turns head directly toward the sound source (7 months). Smiles in response to speech. Looks in response to own name. Babbling begins.

7 - 9 months: Turns to find a sound source out of sight. Gurgles or coos to sounds out of sight. Intonation patterns heard in speech. Comprehends “no.” Babbles in multiple syllables.

9 - 12 months: Acquires first true word. Imitates sounds. Looks at a common object when named. Responds to music. Understands simple commands.

13 - 18 months: Uses sentence-like intonation. Perceives emotions of others. Uses 3 - 20 words. Uses all vowels and consonants in jargon.

19 - 24 months: Uses more words than jargon. Asks question by rising intonation at end of phrase. Comprehends about 300 words. Uses about 50 words. Produces animal sounds. Combines 2 words into phrases. Listens to simple stories.

An infant’s hearing is usually ‘screened’ by one or both of the following methods:

• Auditory Brainstem Response (ABR) test, or
• Oto Acoustic Emission (OAE) test.

Both tests are effective and accurate. Importantly, neither test requires an invasive procedure or even an observable response from the infant. The two tests differ in the way they measure hearing.

The OtoAcoustic Emission (OAE) Test

In this test, a small microphone and speaker device is fitted into the infant’s ear. A sound is played into the speaker and the test measures the response that is produced by the cochlea (in the inner ear: see our page on Hearing Loss: The Facts ).

Throughout, the infant is resting quietly undisturbed. As we know, in the human body, sound is passed from the cochlea by an electrical stimulus into the brain. But there is also a second sound that does not travel to the brain at all but bounces back out into the ear canal. This is called an otoacoustic emission. The microphone in the infant’s ear records this secondary sound that has been bounced back into the ear canal and this recording is then analyzed by the audiologist on a computer. Essentially, the audiologist sees which sound has generated an emission and how strong that emission is. Some sounds are essential to understanding speech. If those sounds yield an emission, the infant has passed the test.

The Auditory Brainstem Response (ABR) Test

This test measures the brain’s response to a sound stimulus. In this test, the infant is fitted with a pair of small earphones and several electrodes on its head. A spectrum of sound is fed through the earphones. These sounds are stimuli which are received by the infant’s ear and travel to the infant’s brain. As all of this nerve-activity is essentially electrical, the audiologist can measure it through the electrodes. A computer representation of this electrical activity is analysed by the audiologist. The audiologist determines the softest sound audible to the infant — ie, the least sound that generates an acceptable level of electrical activity. In actuality, while screening an infant, only one type of sound is used (known as a “click”) but it is applied at a loud level and at a low level, split into groups. Depending on the results, the audiologist determines the quality of the infant’s hearing.

Which test is right for my baby?

The OAE is easy and inexpensive but the ABR is frequently more accurate. For a truly proper scrutiny and maximum accuracy, both tests should be used together.

My infant failed the initial screening test. Is my infant deaf?

Not necessarily. This may be the result of a number of factors in newborn infants—for example, if there is still amniotic fluid in the ear canal, blocking the sound path; a middle-ear infection; etc. Often, a re-screen is ordered after a few days—which the baby passes.

Remember, too, that both tests record very minute sounds. If the baby makes too much noise or movement during the test, it’s possible that the test results will be negative. That’s why these tests are done when the baby is quiet or sleeping (for example, just after a feed).

My infant does have a hearing loss. What do I do next?

A full diagnostic exam must be done to determine the type and amount of hearing loss.

What is a diagnostic test? How is it different from a hearing screen? Does it involve surgery?

The diagnostic test does not require surgery. It is a longer session (sometimes over an hour) and there is more participation with the baby. In diagnostics, both the above tests (the ABR and the OAE) are re-used. The ABR is usually the principal test and a variety of testing sounds are administered. The OAE is used to cross-verify the results. A diagnostic test harvests a huge amount of information and can report if there is really a hearing loss and, if so, if it is permanent or reversible/correctable.

What is the sequence of testing I should follow?

It is important to follow this sequence:

1. initial screen (ABR or OAE or both);
2. re-screen if initial screen failed (after a few days);
3. full diagnostic if re-screen fails.

How can IHF help me?

IHF has a close association with major hospitals in Bombay which provide facilities for both these tests. We routinely refer infants to these hospitals (Nair Hospital and Hinduja Hospital) for screening and diagnostics. IHF plans to offer both screen tests in-house in the near future.

However, IHF also has a high-quality audiological facility soundproofed to well below 18db. This is used for in-depth testing of hearing in slightly older babies (not infants), preparatory to fitting them with appropriate hearing aids.

Soon after birth your baby will begin making sounds of his/her own. She/he will start responding to sound around her/him. This is the beginning of learning to talk. Babies must be able to hear in order to learn to speak. If they don’t hear, they won’t be able to imitate the sounds to produce speech.

The following guidelines are designed to help you become aware of your baby’s hearing and speech development. As mentioned, these are guidelines and children grow at different rates and are unique in their developmental patterns. Your baby may show differences that are not unusual or alarming.

If you answer YES to all the questions, your baby’s hearing is probably normal.

If you answer NO to any of these questions, or you suspect a hearing problem, DO NOT WAIT. Talk to your doctor immediately. He may refer you to an audiologist, who is a specialist in testing hearing.

With a hearing loss, we cannot adopt the “wait and see” attitude or think that the child will grow out of it. The first three years are the most important for speech and language development, specifically the first year of life.

Any child, including a newborn baby, can be tested for hearing – accurately, painlessly, un-intrusively and comfortably; even while asleep.

Download table: PDF | zip file

For more information, please contact us: or CALL:
+91-22-2202-1006/+91-22-2202-1038

• the outer ear
• the middle ear and
• the inner ear

The Outer Ear includes the visible parts, the pinna and the ear canal.

The Middle Ear consists of the eardrum and three tiny bones: the hammer-anvil-stirrup or, in technical terms, the malleus, incus and stapes.

The Inner Ear includes the cochlea, semi-circular canals and the hearing nerve.

As we know, sound travels in waves. Normally, these sound waves are picked up by the outer ear, conducted into the ear canal where they strike the eardrum (also called the tympanic membrane). This makes the eardrum and three bones in the middle ear to vibrate. The vibration of these three bones agitates or moves the cochlear fluid in the inner ear. This in turn makes hair cells in the cochlea bend. These hair cells convert the mechanical energy of their bending movements into tiny electrical pulses which are then sent down the auditory nerve and on to a specific region of the brain which decodes them first into sound and then into intelligible or recognizable sound.

Of course, the human body being the marvelous piece of engineering that it is, all this hearing activity happens incredibly quickly—down to the ‘decoding’ so that we can distinguish a voice from an engine roar, a male voice from a female, and even different types of voices, accents, pronunciations.

Different Types Of Hearing Loss

There are three different types of hearing loss:

1. Conductive Hearing Loss—outer/middle ear damage;
2. Sensori-neural Hearing Loss—inner ear damage, outer and middle ears all right;
3. Mixed Hearing Loss—damage to outer/middle and inner ear structures

Conductive Hearing Loss may result from obstructions or abnormalities in or damage to the outer or middle ears. Impacted wax, a perforated eardrum, fluid in the middle ear, may all cause conductive hearing loss.

Sensori-neural Hearing Loss occurs when the inner ear is damaged or obstructed, but the outer and middle ear structures are otherwise all right. Damaged or dead hair cells in the cochlea, a missing or deformed cochlea, etc, typically cause this kind of hearing loss.

Mixed Hearing Loss_is a result of damage to the outer/middle ear structures _and _also to the inner ear. This is, thus, a combination of the previous two. Examples include wax in the canal _and damaged hair cells in the cochlea; fluid in the middle ear and dead hair cells within the cochlea, etc.

Treatment and Procedures

It may be possible to treat a conductive hearing loss with surgical or medical procedures. Similarly, in cases of a mixed hearing loss, outer/middle ear damage may be amenable to treatment.

The only option for sensori-neural hearing loss, however, is appropriate amplification: hearing aids or cochlear implants.

Causes /High Risk Factors For Hearing Loss

1. Family history of hearing loss
2. Rh incompatibility
3. Hyperbilirubinemia
4. Meningitis
5. Septicemia
6. Head Trauma
7. Infectious diseases or illness during pregnancy (rubella, syphilis, etc.)
8. Alcohol/nicotine intake by the mother during pregnancy
9. Ototoxic drugs
10. Exposure to X-rays
11. Difficulty breathing at birth
12. Mechanical ventilation at birth
13. Low APGAR score, no birth cry
14. Admission into NICU
15. Premature birth and Low Birth Weight
16. Abnormalities of the Head/Neck/Face
17. Children with neuro-degenerative diseases/other syndromes known to include a Sensori-neural or Conductive hearing loss.
18. Genetic disorders
19. Consanguinity

Factors Affecting Optimal Use Of Residual Hearing

• Age at onset of deafness
• Duration of deafness
• Age at providing appropriate amplification (hearing aids/cochlear implants)
• Consistent use of functioning amplification devices
• Listening environment at home
• Educational program

Recommending Amplification Involves The Family And—

• an ENT surgeon
• an audiologist
• a teacher for the hearing-impaired, and, possibly
• a social worker/counselor and
• a psychologist

• Developing age-appropriate auditory skills and clear speech in very young hearing impaired children.
• Providing individualized therapy that will stimulate the child’s audition, language and cognition.
• Developing age-appropriate social skills so that young hearing-impaired children grow up to have hearing friends.
• Providing a well-balanced extra curricular programme to enhance motoric development of young hearing-impaired children, as also their skills in singing, music, art and craft.
• Providing continued support through therapy to hearing-impaired children who have been integrated into the educational mainstream.

Enrolment

I Hear Foundation runs an early-intervention programme. It focuses on working with pre-lingual, hearing-impaired babies below eighteen months of age with mild, severe or profound hearing loss and their families whose environmental language is English or Marathi.

Children below 18 months of age are considered for enrolment at the Foundation on the merits of their individual situations.

Today, 35 children from across the country, including as far away as Surat, New Delhi and Assam, attend IHF’s early-intervention program.

Religion, caste and sex are not criteria for admission at the I Hear Foundation

Why Early Intervention

Human beings are pre-programmed for speech. The human ear responds to sounds in-utero at 20 weeks. Every newborn possesses this hearing and speech potential. This does not necessarily mean that they grow into high-functioning children. For the auditory area of the brain to develop, children must receive systematic auditory stimulation through direct and meaningful experiences.

This ‘auditory living’ is even more crucial for children born with a hearing loss. Delayed auditory stimulation results in inefficient language facilities. A baby deprived of appropriate language stimulation during the first three years of life may never fully attain optimal language function.

Early intervention uses the plasticity of the infant brain to stimulate auditory and neural pathways. Appropriate early amplification allows infants to commence auditory living and gives them opportunities they otherwise might never have—to listen, to learn, to enjoy life. It gives them the freedom of choice.

Difference between Language and Speech

Language is a code consisting of symbols ordered in a particular sequence for the purpose of conveying information. Language development is not dependent on speech development.

“Language deals with understanding a means of communication, whether spoken, written, signed or finger spelled. “Speech” by contrast refers specifically to the clear production of a spoken message. By definition, therefore, development of language precedes that of speech, as there needs to be a foundation of comprehension, from which a spoken message can emerge.”

Speech is an audible manifestation of language. Speech development is dependent on language development.

Language is different from speech. Language is a code made up of a group of rules that include:

• What words mean
• How to make new words (friend, friendly, unfriendly)
• How to combine words together (“Peg walked to the new store.” Not “Peg walk store new”)
• What word combinations are best in what situations (“Would you mind moving your foot?” could quickly change to “Get off my foot, please!” if the first request got no results.)

When a person cannot understand the language code, then there is a receptive problem. If a person does not know enough language rules to share thoughts, ideas, and feelings completely, then there is an expressive problem. One problem can exist without the other, but often they occur together in both children and adults.

The language code can be correct, but if the right body parts are not moved at the right time, then the message will not sound right. Children who stutter, and people whose voices sound rough, hoarse or nasal all have speech problems.