NATIONAL PROGRAM FOR

PREVENTION AND
CONTROL OF DEAFNESS

Dr. Shelesh Kumar Goel

Professor
Department of Community Medicine
Dr.BSA Medical College & Hospital
Types of Deafness
>Conductive deafness : Due to defect in the conducting
mechanism of the ear namely external and middle ear.

>Sensori-neural deafness / Perceptive deafness : Due

to lesions in the labyrinth, 8th nerve & central connections.
It includes psychogenic deafness.

>Mixed deafness : Both the above mentioned types are

present.
 DEAFNESS -INDIAN SCENARIO
• “Person with Disability” means a person suffering from not less than 40% of any disability certified by
a medical authority.

• “Hearing Impairment” as defined in the Act means loss of 60 dB or more in the better ear in the
conventional range of frequencies.

Category Type of impairment dB Level Speech discrimination % of impairment

I Mild 26-40 80-100% <40%

II Moderate 41-55 50-80% 40-50%

III Severe 56-70 40-50% 50-75%

IV a. Total deafness No hearing No discrimination 100%

b. Near Total 91 and above no discrimination 100%
c. Profound 71-90 <40% 75-100% 14
• The WHO definition of ‘deafness’ refers to the complete loss of hearing ability
in one or two ears. The cases included in this category will be those having
hearing loss more than 90 decibels in the better ear (profound impairment) or
total loss of hearing in both the ears.

• In India, by RCI Act, 1992, "hearing handicap" is defined as hearing

impairment of 70 decibels and above, in better ear or total loss of hearing in both
ears.

• A person with hearing levels of 61 to 70 decibels, (although suffering from

severe hearing impairment, as per WHO classification), is automatically
excluded in the hearing handicapped category.
4
Problem Statement
>Hearing loss is the most common sensory deficit in humans today and is
the second leading cause for ‘Years Lived with Disability (YLD)’ , the
first being depression.

>Over 5% of world’s population 360 million people (328 million adults &
32 million children have disabling hearing loss.

>As per WHO estimate, in India there are approximately 63 million

people who are suffering from significant auditory impairment.

>There are 291 persons per 1 lakh population who are suffering from
severe hearing loss.

• The estimated prevalence of adult onset deafness in India was

found to be 7.6% and childhood onset deafness to be 2%.
CAUSES OF
HEARING
IMPAIRMENT
6
Fetal life/early neonatal life

1. Rubella
2. Syphilis
3. Intake of Chloroquine during
pregnancy
4. Prematurity
5. Neonatal jaundice
7
8
9
CAUSES OF HEARING LOSS
> Aging process

> Occupational hazards (those who are working in noisy areas )

> Wax in the ear

> Chronic ear infection

> Diseases of tympanum

> A hole in tympanic membrane

> Growths and masses in the ear & bones and cancer like
diseases
>Noise is the insidious of all industrial pollutants involving every industry
and causing severe hearing loss in every country in the world.

>Occupational hearing loss includes acoustic , traumatic injury and noise

induced hearing loss.

>Noise induced hearing loss is the second most common acquired

hearing loss after age related loss.

>50% of causes of hearing impairment are preventable and can be

corrected surgically and can be rehabilitated with the use of hearing
aids , speech and hearing therapy.
• Common causes (WHO survey):
• Ear wax (15.9%),
• presbycusis (10.3%),
• middle ear infections such as chronic suppurative otitis media (5.2%)
• serous otitis media (3%),
• dry perforation of tympanic membrane (0.5%),
• bilateral genetic and congenital deafness (0.2%).

• Common causes (The NSS ): Aging process (old Age) Rural - 25%, urban- 30%
• ear discharge and other illnesses were identified as the cause by a comparatively large
proportion of persons with hearing disability.
• Also, in the same survey, nearly 1% of hearing disabled persons reported German
measles/rubella as the cause of hearing disability.
Hearing loss is the second most common cause of years lived with disability (YLD)
accounting for 4.7% of the total YLD. 12
NATIONAL PROGRAMME FOR PREVENTION
AND
CONTROL OF DEAFNESS (NPPCD)
>The Program was initiated in 2007 on pilot mode in 25
districts of 11 State/UTs.

>In first phase manner , the program was extended to 203

districts of 20 State/UTs by 2012.

>In 12th five year plan, The program is being further expanded
to additional 200 districts in a phased manner probably
covering all the states and union territories.
OBJECTIVES
LONGTERM

>To reduce the total disease burden by 25% by the end of 11th five year
plan.

IMMEDIATE

>Early identification, diagnosis and treatment of ear problems

responsible for hearing loss and deafness.

> To prevent the avoidable hearing loss on account of the

disease/injury.
> To medically rehabilitate persons of all age groups

suffering with deafness.

> To strengthen the existing intersectoral linkage for

continuity of the rehabilitation program.

> To develop institutional capacity for ear care

services by

providing support for equipment, material and training

personnel.
STRATEGIE
S
> To strengthen the service delivery including rehabilitation.

> To develop human resources for ear care.

> To promote out reach activities and public awareness

through innovative and effective IEC strategies with special

emphasis on prevention of deafness.

ORGANISATIONAL STRUCTURE
 Health Minister

Secretary Health & Family Director General of

Welfare Health Services

Additional Secretary Central Coordination

Committee

Additional Director
Joint Secretary General

Director (Public Health) Deputy Director General

Under Secretary(Public Health) Chief Medical Officer

Program Manager
COMPONENTS OF THE PROGRAM
1) Training of all the
manpower

2) Infrastructure Building

3) Service provision

4) IEC activities
0
CENTRAL
LEVEL
> Central Coordination Committee will be constituted at the central
level.

>This will consist of following members :

Representative of DGHS -2

Representative of WHO -1

ENT specialists and experts - 2

Audiologists and speech therapists -

2 Public Health expert - 1

Representative of Rehabilitation
> This Committee will evaluate and monitor the

implementation plan for program .

> Central Cell will be set up at the central level in the DGHS to

provide necessary leadership, technical support to the State

and District level functionaries.

STATE LEVEL
> State Health Society and Program Committee is placed
under

NRHM

> It will function for ….

- Preparation of district plans for implementation of NPPCD ,

- Monitoring and supervise implementation of program ,

- Release and Monitoring of flow of funds to the District Health

Societies.
> State Technical Committee will have

State Nodal Officer ; ENT Specialist / Surgeon

Audiologist -1

to provide technical guidance and expertise to the State

Health Society
DISTRICT LEVEL
> At the district level , the District Health Society and Program

Committee will function for …..

- Planning and Implementation of the program ,

- Financial and material management ,

- Social mobilization and public awareness ,

- Orientation of various functionaries of health ,

- Arrangement for Screening camps and monitoring the

> District Hospital will post …

District Nodal Officer ; ENT Surgeon -

1 Audiologist - 1

and they will be the key persons for the implementation of the

program in the district.

> They can also employ additional staff:

Teacher for young hearing impaired – on contractual basis, to look

after the therapy and training of young hearing impaired children

at district level.
PROGRAM IMPLEMENTATION
> Center of Excellence – The State Medical College – which

supports the program

> Main Focus of Activity of the Program - The District Hospital

> The program will be strengthened through training of …

- ENT doctors - Audiologist

> They would be provided with equipment for proper diagnostic,

therapeutic, & rehabilitation activities.

> The doctors at PHC & CHC will also be given training as well as the basic

diagnostic equipment to enable them to diagnose, treat & refer

the patients requiring treatment.

> The Multipurpose workers at the sub central level and

the gross level functionaries (AWWs, ASHA), including Mahila Mandals

will be sensitized about the program which would facilitate in creating

awareness and mobilizing the communities.

> The School Health system will play a very important role in the program.

The ear check up will be done by the PHC or CHC doctors

SCREENING TESTS
1) Audiometry BERA ( Brainstem Evoked Response Audiometry)

- Simple

- Automated

- Reliable

But COST is prohibiting factor to make it available in all

the places
2) Behavioral Observation Audiometry (BOA)

> Assess the baby’s response to different frequency intensity

and duration of sounds presented

> Respond to 70db noise :-

i) a new born baby – eye blink , eye widening or

startle

ii) between age of 6 – 16 weeks – arousal , eye blink or

eye shift can be useful to detect to indicate hearing

impairment in early life

ACHIEVEMENTS
>Modules of training of doctors , multipurpose workers and

technicians have been developed.

>In some places such as Delhi, training of trainers has been

started.

>In many districts, hearing aids are distributed to poor

children.

> This program is integrated with the NRHM

LIMITATION
>Once again loading the information about deafness and

burden of detection and mobilization of deafness on ASHA

and AWWs indicates poor planning.

>These part time workers cannot be the pillars of the health

who are neither the permanent health staff nor skilled enough to

handle.
>Once again a series of training program will start for
all levels of health professionals without identifying the
impact factors of previous trainings on other subjects

>In 12th Five Year Plan not much emphasis is given

on this program.

> Similarly in NRHM, it is low priority.