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HEARING DISORDERS
DR. ASHOK KUMAR SINHA
DIRECTOR
ALI YAVAR JUNG NATIONAL INSTITUTE OF SPEECH AND
HEARING DISABILITIES MUMBAI
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THE RIGHTS OF PERSONS WITH DISABILITIES ACT, 2016
• 2016: WINTER SESSION
• MSJE: 19.4.17
• RULES : 15.6.17
• GUIDELINES: 05.1. 18
• 21 CATEGORIES
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A : LOCOMOTOR DISABILITY
• LEPROSY CURED/ CEREBRAL PALSY
• DWARFISM/ MUSCULAR DYSTROPHY
• ACID ATTACK VICTIM
B: VISUAL IMPAIRMENT
• BLINDNESS/ LOW VISION
1. PHYSICAL DISABILITY
C. HEARING IMPAIRMENT
• DEAF/ HOH
D: SPEECH AND LANGUAGE DISABILITY • LARYNGECTOMY / APHASIA
RPWD ACT, 2016
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2. INTELLECTUAL DISABILITY
• SPECIFIC LEARNING DISABILITY,
• AUTISM SPECTRUM DISORDERS
3. MENTAL BEHAVIOUR: MENTAL ILLNESS
RPWD ACT, 2016
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4. CHRONIC NEUROLOGICAL CONDITIONS
• MULTIPLE SCLEROSIS • PARKINSON'S DISEASE
BLOOD DISORDERS • HAEMOPHILIA/ THALASSEMIA • SICKLE DISEASE
5. MULTIPLE DISABILITIES : DB
6. ANY OTHER
RPWD ACT, 2016
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LEARNING TO SPEAK
n DYNAMIC PROCESS
n PREREQUISITE: WITHIN CHILD
n ENVIRONMENTAL FACTOR
n VOCAL PLAY/ FIRST WORD
n ADULT-LIKE SPEECH: 5 YEARS
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EAR
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COCHLEA
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AUDITORY NERVE
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AUDIOLOGY
n CONDUCTIVE/ SENSORINEURAL
n MIXED/ RETROCHLEAR PATHOLOGIES: CAPD/ AN
n MALINGERING
n BALANCE DISORDERS/ TINNITUS
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DIAGNOSIS
n SUBJECTIVE:
n TUNING FORK/ DISTANCE
n PURETONE/ NOSIE/ SPEECH
n OBJECTIVE:
n IMMETANCE/ ABR/ ASSR/ OAE
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GOLDEN TEST
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AUDIOMETER
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IMMITTANCE AUDIOMETERS
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INSTRUMENTATION
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NORMAL TYMPANOGRAM
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ABR/ ASSR
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OAE
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IMPACT
o LANGUAGE AND SPEECH DEVELOPMENT
o EDUCATION/SOCIAL AND EMOTIONAL
o VOCATIONAL
o FUNCTION BELOW POTENTIALS
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ELIMINATION OF COMMUNICATION BARRIER
n RULE 1 - 3 - 6
n AUTOMATED
n UHSP
n INTERVENTION
n SUCCESS
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MANAGEMENT
n PERSONAL HEARING AIDS
n COCHLEAR IMPLANTS
n ASSITIVE LISTENING DEVICES
n CLASSROOM DEVICES
n SIGN LANGUAGE
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PHA
n BODY WORN HEARING AIDS/ MOULDS
n BTE/ ITC/ CIC/ RIC
n CROS
n DIGITAL
n PROGRAMMABLE/ TRIMMER
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ADIP n BWHA
n BTE
n < 15000/ PER MONTH
n DISABILITY CERTIFICATE
n 125000 PER ANNUM
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GWR
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COCHLEAR IMPLANTS
n 1980: SURGICAL PROCEDURE
n SINGLE ELECTRODE
n FOR ADULTS ONLY
n CHILDREN BELOW ONE YEAR
n ONLY FOUR MANUFACTURES
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INTERNAL DEVICE
n Casing of the receiver: titanium/ceramic
n Length and structure of electrode array/ current flow: 25mm/Bipolar
n Channels: 12-22
n Dimensions :30mm
n Weight:10g/ Frequency band:63
n Speed of stimulation: 24000 pps
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EXTERNAL COMPONENT
• MICROPHONE
• SPEECH PROCESSOR: Sp. Coding
Strategies(formants/compressed
analog/neural firing
• CONNECTING CABLES
• TRANSMITTER COIL
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COST
n PRE OPERATIVE: ASSESSMENT
n COCHLEAR IMPLANT
n MEDICAL AND SURGICAL
n POST OPERATIVE REHABILITATION
n MAINTENANCE
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PRESENT STATUS
• PRIVATE
• SPONSORED
• STATE GOVERNMENT
• DEFENCE
• MSJE-DEPwD- ADIP
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ADIP
n NODAL AGENCY
n TARGET: 500/ 1000
n ASSISTANCE: 6.00 LAKHS/ CHILD
n PRE AND POST INTERVENTION
n CI PROCUREMENT: ALIMCO
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CANDIDACY
n BILATERAL SEVERE TO PROFOUND
n UPTO 5 YEARS
n NO ASSOCIATED DEVELOPMENTAL DELAYS
n NO MENTAL RETARDATION/ UNILATERAL IMPLANTATION
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LAUNCH
n 3RD DECEMBER 2014
n ASHOK D RANSHUR : 2.1 Yrs / Male
n BYL NAIR HOSPITAL, MUMBAI
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HospitalsEmpanelledforCochlearImplantSurgery
Telangana
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ADIP CI
n 172 HOSPITALS
n FIVE ZONES/ 1050 CI SURGERY
n POST OPERATIVE REHABILITATION
n AICs / ZCs
n www.adipcochlearimplant.in
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CSR
• PFCL
• AAI
• SBI
• MDSL
• OTHERS
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POR
n AIC (POR) / ZCS
n SWITCH ON/ MAPPING/ THERAPY
n TELEPHONIC/ E MAIL/ POST
n PROGRESS FORMAT/ FEEDBACK
n TRAINING OF PARENTS
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OUTCOMES
n AUDITORY AWARENESS/ PERCEPTION OF SOUND
n COMPREHENSION OD SIMPLE COMMANDS
n EXPRESSION: 1/2 WORDS SENTENCES
n PARENTS SATISFACTION
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OUTCOMES n NEW SET UPS/ SURGEONS
n REHAB PROFESSIONALS
n LOWERING OF COST
n STATE PARTICIPATION
n NATIONAL STRATEGY
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CHALLENGES • DISTRICT
• HOME BASED THERAPY
• ACCESSORIES/ UPGRADATION
• BATTERY/ LOST PROCESSOR
• ICT/ TELE- REHAB/ MAPPING
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BACKGROUND ROOM NOISE
n AUDITORY DISTURBANCES
n SNR
n +15dB SNRs OR GREATER n < 35 dB A n NO STANDARDS
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REVERBERATION
o PROLONGATION OF SOUND
o DEGRADES SPEECH PERCEPTION
o RT > 1.0 SECOND
o SNHL < 0.4 TO 0.5 SECOND
o NOISE AND REVERBERATION
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DISTANCE
n DECREASE IN SOUND
n INVERSE SQUARE LAW: 6 dB SPL
n EARLY SOUND REFLECTION: 50msec
n CRITICAL DISTANCE: 6- 12 FEET
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ACOUSTIC MODIFICATION
n SNR >15 dB, AMBIENT NOISE < 35dBA
n ACOUSTIC TILES/CARPETING THE FLOORS/
n ACOUSTIC FURNITURE TREATMENT
n COST/ STANDARD/LEGISLATION
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SNR-ENHANCING TECH.
o D-MICROPHONE/ BEAMFORMERS
o ASP TECHNOLOGY
o BILL/TILL/NR/ CROS
o CLASSROOM AMPLIFICATION DEVICES
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SOUND–FIELD FM AMPLIFICATION
n 8- 10 dB UNIFORM AMPLIFICATION n BENEFIT ALL CHILDREN
n COST EFFECTIVE
n LESSEN BURDEN ON RESOURCE ROOM
n LESS VOCAL STRESS AND STRAIN
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HARDWIRED SYSTEM
n NOT SPECIFIED AS MEDICAL DEVICE-FDA
n NO SPECIFICATION
n EAC AND REAL EAR
n RESTRICTED MOBILITY
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ELIS
n 1938
n 1999: 3 D LOOP SYSTEM n EMBEDDED IN MAT
n 30 dB REDUCTION
n US ACCESS BOARD
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ALDs
• VOICE AMPLIFIERS
• TELEPHONE HEADPHONES
• TELEPHONE/ TELEVISION ADAPTERS
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HAT
FLASHING / VIBRATING
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HAT
o LIGHT FLASHERS
o DOORBELLS
o SMOKE /FIRE ALARMS
o TTY/ TELECOMMUNICATION DEVICE FOR THE DEAF (TTD)
o SMS
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TV VIEWING
n CAPTIONED MEDIA
n CLOSED, REAL, AND OPEN
n (TELEPHONE DECODER CIRCUITRY ACT, 1990)
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COMMUNICATION STRATEGIES
n CLEAR PRONUNCIATION
n SLIGHT LOWER RATE OF SPEECH
n HIGHER INTENSITY
n FACE-TO-FACE COMMUNICATION
n LACE
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SIGN LANGUAGE RECOGNITION AND TRANSLATION
n TEXT TO SPEECH
n SPEECH TO TEXT
n SIGN TO SPEAK- SIGN
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AIC
n 24.9.15
n BUILT IN INFRASTRUCTURE
n TRANSPORTATION
n ICT
n NATIONAL PROGRAM
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LOOKING FORWARD
n BIS SPECIFICATIONS
n UNDER ADIP SCHEME
n INDIGENOUS DESIGN AND DEVELOPMENT
n ASSESSMENT AND TRIAL/ PRESCRIBTION
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NEW INITIATIVES n RPWD ACT 2016
n EARLY IDENTIFICATION
n STATE PARTICIPATION
n NATIONAL/ STATE FUNDS
n SPEECH AND LANGUAGE DISABILITY
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SPEECH
LARYNGECTOMY/
GLOSSECTOMY
BILATERAL VOCAL CORD PARALYSIS
MAXILLOFACIAL ANOMALIES
DYSARTHRIA/ APRAXIA OF SPEECH
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% OF SPEECH DISABILITY = 2 X UR OF SIA + UR OF OVCA 3 • BENCHMARK SPEECH DISABILITY: 40%
• SLP AND ENT SPECIALIST
• SPEECH SAMPLE • DIGITAL PLATFORM
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LANGUAGE DISABILITY: APHASIA
n WESTERN APHASIA BATTERY (WAB)
n INDIAN LANGUAGES/ SPONTANEOUS SPEECH/ NAMING
COMPREHENSION/ REPETITIONS/
n SLP AND ENT/ NEUROLOGIST
n APHASIA QUOTIENT (AQ)
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AQ
n MAXIMUM AQ: 99
n AQ OF 94 ONWARDS : 0% LANGUAGE DISABILITY
n AQ OF 0: 100% LANGUAGE DISABILITY
n AQ OF 56: 40% ( 1% INCREASE)
n READY RECKONER : AQ
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TENS
PLACE IN AQ
UNIT PLACE IN AQ
0 1 2 3 4 5 6 7 8 9
0 100 98.9 97.8 96.8 95.7 94.6 93.6 92.5 91.4 90.4
1 89.3 88.2 87.2 86.1 85.0 84.0 82.9 81.8 80.8 79.7
2 78.6 77.6 76.5 75.4 74.4 73.3 72.2 71.2 70.1 69.0
3 68.0 66.9 65.8 64.8 63.7 62.6 61.6 60.5 59.4 58.4
4 57.3 56.2 55.2 54.1 53.0 52.0 50.9 49.8 48.8 47.7
5 46.6 45.6 44.5 43.4 42.4 41.3 40.0 39.2 38.1 37.1
6 36.0 34.9 33.9 32.8 31.7 30.7 29.6 28.5 27.5 26.4
7 25.3 24.3 23.2 22.1 21.1 20 18.9 17.9 16.8 15.7
8 14.7 13.6 12.5 11.5 10.4 09.3 8.3 07.2 06.1 05.1
9 4.0 2.9 1.9 0.8 00.0 00.0 00.0 00.0 00.0 00.0
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ADIP SCHEME
n BTE/ CI/ ALDS/ I PAD/ ELECTRO LARYNX
n UHSP: OAE/ABR
n RESEARCH: SPEECH PROCESSORS
n MANUFACTURING
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THANKS
n HAPPY NEW YEAR 2018 n HAPPY SARASVATI PUJA n HAPPY REPUBLIC DAY
n HAPPY REPUBLIC DAY