Assignment

on

Auditory Disability

Submitted to: Submitted by :

Prof. Shalini Agarwal Ritul Singh
MSc II year

DEPARTMENT OF HUMAN DEVELOPMENT AND

FAMILY STUDIES

SCHOOL OF HOME SCIENCE

BABASAHEB BHIMRAO AMBEDKAR UNIVERSITY), LUCKNOW
Vidya Vihar Raebareli Road, Babasaheb Bhim Rao Ambedkar University,
Lucknow, Uttar Pradesh 226025
2024-2025
Purpose of the Assignment

The purpose of this assignment is to develop a comprehensive understanding of auditory

disability, including its medical definition, classification, causes, assessment methods, and its
impact on individuals’ communication, social interaction, and quality of life. This assignment
aims to explore how auditory impairments are identified, graded, and managed both clinically
and through public health interventions, particularly in the Indian context. It will also analyze
the policies, guidelines, and tools used for screening, certification, and rehabilitation of
individuals with hearing loss, such as the Government of India Hearing Disability
Guidelines (2018), WHO grading, and standardized assessment instruments like the
HHIA/HHIE. By engaging with current research, national protocols, and real-world
applications, the assignment seeks to enhance students’ awareness and sensitivity towards the
challenges faced by persons with hearing disabilities, while also emphasizing the importance
of early intervention and inclusive practices in education, healthcare, and social systems.

Auditory Disability

Auditory disability, also commonly referred to as hearing impairment or hearing loss, is a

condition characterized by partial or total inability to hear sound in one or both ears. It affects
the individual's ability to detect, interpret, and respond to sound stimuli in their environment,
which can significantly impact communication, language development, education, social
interaction, and overall quality of life.

1. Classification of Auditory Disability

Auditory disability can be classified based on the degree, type, and timing of hearing loss:

A. Degree of Hearing Loss (as per WHO and Indian standards):

 Mild (26–40 dB loss): Difficulty hearing faint or distant speech.

 Moderate (41–60 dB loss): Trouble following speech without hearing aids.
 Severe (61–80 dB loss): Needs amplification to hear normal conversation.
 Profound (81 dB and above): Cannot hear even amplified speech; often relies on
visual cues or sign language.
B. Type of Hearing Loss:

 Conductive Hearing Loss: Caused by problems in the outer or middle ear (e.g., wax
build-up, infections, ossicular chain dysfunction). Usually treatable with medication or
surgery.
 Sensorineural Hearing Loss: Results from damage to the inner ear (cochlea) or
auditory nerve; typically permanent and not medically treatable, but manageable with
hearing aids or cochlear implants.
 Mixed Hearing Loss: A combination of both conductive and sensorineural loss.

C. Timing of Onset:

 Congenital: Present at birth, often due to genetic factors, infections during pregnancy
(like rubella), or birth complications.
 Acquired: Develops after birth due to infections (e.g., meningitis), noise exposure,
aging, trauma, or ototoxic drugs.

2. Impact of Auditory Disability

Auditory disability has a profound influence on:

 Speech and language development in children.

 Cognitive and academic performance due to reduced classroom engagement.
 Social-emotional development, often resulting in isolation or behavioural issues.
 Employment opportunities, especially when communication is key.

3. Legal and Medical Recognition in India

Under the Rights of Persons with Disabilities Act, 2016 (India), hearing impairment is
legally recognized as a specified disability. The act defines hearing impairment as:

“Deaf” means persons having 70 DB hearing loss in speech frequencies in both ears;
“Hard of hearing” means persons having 60 DB to 70 DB hearing loss in speech frequencies
in both ears.

Assessment and certification are conducted by authorized medical boards using tools like Pure
Tone Audiometry (PTA) and Speech Audiometry.
4. Causes of Auditory Disability

 Genetic factors (autosomal dominant or recessive inheritance)

 Prenatal and perinatal complications
 Infections (otitis media, measles, meningitis)
 Exposure to loud noise (occupational or recreational)
 Aging (presbycusis)
 Ototoxic medications (e.g., certain antibiotics and chemotherapy drugs)
 Injuries or trauma to the head or ear

5. Assessment and Diagnosis

Common diagnostic tools include:

 Pure Tone Audiometry (PTA) – to determine hearing thresholds across frequencies.

 Impedance Audiometry – to assess middle ear function.
 Otoacoustic Emissions (OAE) – used in newborn hearing screening.
 Brainstem Evoked Response Audiometry (BERA) – for objective hearing threshold
detection.

6. Management and Rehabilitation

 Medical or Surgical Treatments (for some conductive losses).

 Hearing Aids: Amplify sound for mild to severe sensorineural loss.
 Cochlear Implants: Surgically implanted devices for profound sensorineural loss.
 Speech and Language Therapy: Essential for children with delayed communication.
 Special Education: Inclusive or specialized schooling.
 Sign Language and Visual Communication: For non-verbal individuals.
 Assistive Devices: FM systems, vibrating alarms, captioning tools.

7. Social Inclusion and Rights

 Reservation in education and jobs under Indian disability laws.

 Concession in exams and employment (use of scribes, extended time).
 Provision of assistive devices and training under government schemes like ADIP.
 Inclusive education and accessibility under RTE and NEP 2020.
  Support from NGOs and national programs such as the National Programme for
Prevention and Control of Deafness (NPPCD).

The Different Scales of Auditory Disability

A) Government of India Hearing Disability Guidelines (2018): A

Detailed and Practical Overview

1. Legal Framework and Background

In alignment with the Rights of Persons with Disabilities (RPwD) Act, 2016, the Ministry of
Social Justice and Empowerment, in collaboration with the Ministry of Health and Family
Welfare, introduced a revised set of guidelines in 2018 to standardize how hearing disability is
assessed and certified in India. These updated norms aim to create uniformity in identifying
individuals who qualify as having a “benchmark disability” and thereby ensure their
entitlement to various legal and social benefits (Ministry of Social Justice & Empowerment,
2018).

2. What Constitutes a Hearing Disability?

According to the 2018 guidelines, a person is categorized as having a hearing disability if there
is a hearing loss of 60 decibels (dB) or more in the better-hearing ear, measured across speech
conversation frequencies—namely 500, 1000, 2000, and 4000 Hz. This level of impairment
must be present in both ears to qualify.

Two specific categories are identified:

 Deaf: Individuals with a hearing loss of 70 dB or more in both ears.

 Hard of Hearing: Individuals with a hearing loss between 60–70 dB in both ears.

These definitions are directly tied to the provision of disability certification and access to state-
sponsored rehabilitation services (Government of India, 2018).
3. Calculating the Percentage of Disability

To assess the severity of hearing loss, the Government of India follows a standardized formula
based on Pure Tone Audiometry (PTA). The PTA is calculated by averaging the hearing
thresholds (in decibels) at four key speech frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 4000
Hz for both ears.

The percentage of hearing disability is calculated using the following formula:

Disability % = (5 × PTA of Better Ear + 1 × PTA of Worse Ear) / 6

Once the percentage is computed, it is matched against a benchmark grid:

Less than 40%: Not considered a benchmark disability (ineligible for government disability
benefits).

40% or more: Recognized as a benchmark disability, qualifying the individual for state-
supported benefits such as assistive devices, education and job reservations, and financial
support.

This data-driven approach helps in ensuring objectivity, transparency, and fairness in the
certification process. A study by Sharma, Kacker, and Baisakhiya (2019) supported this
alignment, highlighting that India's use of WHO-recommended classification for hearing loss
not only standardizes diagnosis but also facilitates early detection and efficient public health
intervention across diverse populations.

4. Step-by-Step Assessment and Certification Process

Step 1: Clinical Evaluation

 Conducted by a certified ENT specialist or audiologist in a government-approved

medical institution.
 Diagnostic tests include:
o Pure Tone Audiometry (PTA)
o Speech Audiometry
o Impedance Audiometry (if necessary)
o Otoacoustic Emissions (OAE) or Brainstem Evoked Response Audiometry
(BERA) for non-cooperative individuals or young children.
Step 2: Disability Calculation

 PTA is calculated for both ears by averaging thresholds at 500, 1000, 2000, and 4000
Hz.
 The formula mentioned above is used to determine the percentage of hearing disability.

Step 3: Certification

If the hearing disability is ≥40%, a disability certificate is issued. It includes:

 The individual's name, photograph, and demographic details

 Diagnosis, cause of hearing loss, and percentage of disability
 Seal and signature of the medical board or competent authority

Step 4: Review or Renewal

 If the hearing loss is permanent and stable, no reassessment is required.

 For progressive conditions (e.g., age-related hearing loss), periodic reviews may be
mandated.

5. Rights, Benefits, and Entitlements

Individuals certified with benchmark hearing disability (≥40%) are entitled to multiple welfare
benefits under Indian law, including:

 4% reservation in education and public employment under the RPwD Act.

 Free or subsidized hearing aids under the ADIP Scheme (Assistance to Disabled
Persons for Aids and Appliances).
 Scholarships, concessions in travel fares, and priority housing schemes.
 Inclusive education, sign language training, and interpreter services for the hearing-
impaired.
 Tax deductions under Section 80U of the Income Tax Act, 1961.

These benefits are not just monetary in nature but are designed to foster social inclusion and
autonomy.
6. Worked Example: Understanding the Calculation

Let’s consider the case of a 16-year-old student undergoing a hearing test.

Frequency (Hz) Right Ear (dB) Left Ear (dB)

500 65 75
1000 70 80
2000 65 85
4000 70 90

 PTA Right Ear (Better Ear) = (65 + 70 + 65 + 70) / 4 = 67.5 dB

 PTA Left Ear (Worse Ear) = (75 + 80 + 85 + 90) / 4 = 82.5 dB

Apply the formula:

Disability % = (5 × 67.5 + 1 × 82.5) / 6
= (337.5 + 82.5) / 6
= 420 / 6 = 70%

Interpretation: This student has a 70% hearing disability, is classified as “Deaf”, and qualifies
for a benchmark disability certificate, thus making them eligible for all related benefits.

B) Hearing Handicap Inventory for Adults/Elderly (HHIA/HHIE)

1. Introduction and Purpose

The Hearing Handicap Inventory for Adults (HHIA) and its senior-focused version, the
Hearing Handicap Inventory for the Elderly (HHIE), are clinically validated tools designed to
understand how hearing loss affects a person’s daily emotional health and social functioning.
These questionnaires are more than just diagnostic tools; they provide a window into how
individuals perceive their hearing challenges in real-life contexts.

They are especially useful for:

 Routine screenings in hospitals, clinics, and community outreach programs.

 Going beyond pure-tone audiometry to capture psychosocial consequences.
 Monitoring changes over time, particularly before and after hearing aid fitting.
  Identifying rehabilitation needs in individuals struggling with social participation due
to hearing difficulties (Newman et al., 1990).

2. Versions and Structure

A. HHIA (for individuals under 65 years)

 Contains 25 questions, divided into:

o 13 Emotional Subscale items
o 12 Social/Situational Subscale items

B. HHIE (for individuals aged 65 and above)

 Also includes 25 questions, with a similar division:

o 13 Emotional items
o 12 Social/Situational items

C. HHIE-S (Short Version)

 A brief 10-item version of HHIE used for rapid community screening in older adults,
especially during field health camps or house-to-house surveys
(Ventry & Weinstein, 1982).

3. Administration Process

The HHIA/HHIE tools are easy to administer and require minimal training:

 They can be self-completed or read aloud by a clinician or caregiver for patients with
literacy or vision difficulties.
 The setting should be quiet to help respondents focus.
 Each questionnaire takes about 10 to 15 minutes to complete.
 Instructions clearly state that respondents should answer based on their current hearing
status without factoring in the use of hearing aids.
4. Scoring System and Interpretation

Each response is scored using the following format:

 Yes = 4 points
 Sometimes = 2 points
 No = 0 points

The maximum possible score is 100. Based on the total score, hearing handicap is categorized
as:

 0–16: No significant hearing handicap

 18–42: Mild to moderate handicap
 Over 42: Severe handicap requiring intervention (Weinstein & Ventry, 1983)

5. What the Inventory Measures

The HHIA/HHIE evaluates two core domains:

 Emotional Subscale: Addresses how hearing loss impacts self-esteem, frustration,

anxiety, and depression.
 Social/Situational Subscale: Captures challenges in group interactions, telephone
conversations, and social withdrawal due to hearing problems.

These scales highlight not just how well a person hears, but how much hearing loss affects their
emotional and social life.

6. Sample Items

To give you an idea of what’s asked:

 Emotional Domain: “Does your hearing difficulty cause you to feel embarrassed when
meeting new people?”
 Social Domain: “Does your hearing problem lead you to avoid attending religious
services or social events?”

These questions help start important conversations between clinicians and patients about the
impact of hearing loss.
7. Example Case

Case Study: A 68-year-old retired school teacher visits an audiology clinic.

 Tool used: HHIE – Full version

 Responses:
o Yes to 10 questions → 10 × 4 = 40 points
o Sometimes to 7 questions → 7 × 2 = 14 points
o No to 8 questions → 8 × 0 = 0 points
 Total Score = 40 + 14 + 0 = 54

Interpretation: A score of 54 indicates a significant hearing handicap. This individual likely

needs audiological intervention, possibly a hearing aid, and may benefit from counselling or
communication strategy training.

8. Clinical and Community Use

 In ENT and Audiology clinics, the HHIA/HHIE is used before and after treatment to
assess progress or the psychological impact of hearing loss.
 In community health programs, especially for older adults, the HHIE-S helps in early
detection.
 In Human Development and Family Studies (HDFS) and rehabilitation settings, it helps
evaluate how hearing loss affects quality of life, emotional health, and interpersonal
relationships.

9. Key Advantages

 Quick and simple to use, even for large-scale screening.

 Captures emotional and social dimensions often missed by pure-tone testing.
 Encourages self-awareness and motivates patients to seek help.
 Clinicians can use the scores to tailor counselling, hearing aid recommendations, and
rehabilitation strategies.
C) All India Institute of Speech and Hearing (AIISH)
AIISH Protocol: Overview

The term "AIISH Protocol" encompasses a set of standardized procedures and guidelines
developed by AIISH to ensure consistency and quality in the assessment, diagnosis, and
rehabilitation of individuals with communication disorders. These protocols are grounded in
evidence-based practices and are tailored to address the diverse linguistic and cultural needs of
the Indian population.

Key Components of the AIISH Protocol

1. Assessment Procedures:
o Audiological Evaluations: Utilization of advanced audiological equipment to
conduct tests such as Pure Tone Audiometry, Speech Audiometry, and
Immittance Audiometry.
o Speech and Language Assessments: Comprehensive evaluations to determine
speech and language abilities, employing both standardized tests and informal
assessments.
2. Intervention Strategies:
o Individualized Therapy Plans: Development of personalized intervention
plans based on assessment outcomes, focusing on the specific needs of each
client.
o Use of Technology: Integration of technological tools, such as the i-Cry system
for infant cry analysis, to aid in early detection and intervention.
3. Ethical Guidelines:
o Research Ethics: AIISH has established an Ethics Committee to oversee
research activities, ensuring that studies involving human subjects adhere to
ethical standards.
o Clinical Ethics: Protocols emphasize informed consent, confidentiality, and the
right to receive appropriate care.
4. Telepractice Services:
o Remote Consultations: Provision of speech and hearing services through
telecommunication technologies, expanding access to care for individuals in
remote areas.
 o Digital Resources: Development of online materials and tools to support
remote therapy sessions and client education.

Implementation Process

1. Initial Screening: Clients undergo preliminary assessments to identify potential

communication disorders.
2. Comprehensive Evaluation: Detailed assessments are conducted using standardized
tools and protocols to diagnose specific conditions.
3. Intervention Planning: Based on evaluation results, individualized therapy plans are
formulated, incorporating client goals and preferences.
4. Therapy and Monitoring: Clients receive therapy sessions, either in-person or via
telepractice, with ongoing monitoring to track progress and make necessary
adjustments.
5. Outcome Evaluation: Post-intervention assessments are conducted to evaluate the
effectiveness of the therapy and to plan for any further needs.

Example: Application of AIISH Protocol

Case: A 3-year-old child presents with delayed speech development.

 Assessment: The child undergoes audiological evaluations to rule out hearing

impairments, followed by speech and language assessments to determine specific
delays.
 Intervention: An individualized therapy plan is developed, focusing on enhancing
expressive and receptive language skills through play-based activities.
 Monitoring: Progress is tracked through regular sessions, with adjustments made to
the therapy plan as needed.
 Outcome: Post-therapy assessments indicate significant improvements in the child's
communication abilities, demonstrating the effectiveness of the AIISH protocol.
D) The Speech Handicap Index (SHI)
The Speech Handicap Index is a self-administered questionnaire designed to assess how
speech difficulties affect an individual's quality of life, particularly focusing on psychosocial
aspects. Originally developed by (Rinkel et al. 2008), the SHI was created to address the lack
of speech-specific assessment tools for patients with oral and pharyngeal cancers

Structure of the SHI

The SHI comprises 30 items divided into two subscales:

 Speech Function Subscale: Evaluates the physical aspects of speech production.

 Psychosocial Function Subscale: Assesses the emotional and social impact of speech
difficulties.

Each item is rated on a 5-point Likert scale, with higher scores indicating greater perceived
handicap.

Validation and Reliability

The SHI has undergone extensive validation across various languages and cultures. A
scoping review by identified its adaptation into eight languages, including Dutch, English,
French, Korean, Chan et al. (2021) Simplified Chinese, Lithuanian, Italian, and European
Portuguese These studies consistently reported high internal consistency and test-retest
reliability.

For instance, Dwivedi et al. (2011) validated the English version of the SHI in native
English-speaking patients with head and neck cancer, confirming its reliability and validity

Short-Form Version: SHI-15

To enhance clinical efficiency, a 15-item short-form version (SHI-15) was developed. This
version maintains the original's psychometric properties while reducing administration time.
Wee et al. (2018) demonstrated that the SHI-15 is a reliable and valid tool for assessing
speech-related quality of life in tongue cancer patients
Clinical Application

The SHI serves as a valuable tool for clinicians to

 Identify the extent of speech-related handicaps.

 Monitor changes over time or in response to interventions.
 Facilitate discussions about treatment goals and expectations.

E) WHO Hearing Impairment Grading (Adapted in India)

The World Health Organization (WHO) has established a global standard for grading
hearing impairment, which has been widely adopted and adapted by many countries, including
India. This classification system allows healthcare professionals to assess the severity of
hearing loss based on the Pure Tone Average (PTA) of the better ear at frequencies 500 Hz,
1000 Hz, 2000 Hz, and 4000 Hz. The system ensures uniformity in diagnosis, helps track the
burden of hearing loss across populations, and facilitates timely intervention.

WHO Grading of Hearing Loss: Classification

According to the WHO's revised guidelines (2019), the grading system for hearing loss is as
follows:

Hearing Threshold (dB

Hearing Grade Functional Description
HL)

Normal ≤ 20 dB Hears whispers; no perceived difficulty.

May struggle with soft speech, especially in

Mild 21–34 dB
noise.

Moderate 35–49 dB Difficulty hearing normal conversation.

Moderately Struggles to follow conversations even in

50–64 dB
Severe quiet.

Severe 65–79 dB Cannot hear speech unless very loud.

 Hearing Threshold (dB
Hearing Grade Functional Description
HL)

Only loud environmental sounds may be

Profound 80–94 dB
perceived.

No hearing even with amplification; likely

Complete/Total ≥ 95 dB
deaf.

Adaptation in India
India has officially adapted the WHO grading system to frame its disability certification and
rehabilitation services. As per the Guidelines for the Assessment of Hearing Disability
(Govt. of India, 2018), a person is considered to have a benchmark hearing disability if the
hearing loss is 60 dB or more in the better ear, which corresponds with WHO’s moderately
severe to severe category.

This adaptation has been critical for:

 Certifying hearing impairment under the Rights of Persons with Disabilities Act,
2016.
 Providing benefits under the ADIP Scheme (Assistance to Disabled Persons for
Aids/Appliances).
 Implementing interventions under the National Programme for Prevention and
Control of Deafness (NPPCD).(Ministry of Social Justice & Empowerment, 2018)

Importance of the Grading System

The use of a structured grading scale:

 Enables early detection and standardized reporting of hearing loss.

 Facilitates research and policy planning based on severity-based statistics.
 Supports equitable resource allocation for those with moderate to profound loss.
 Helps clinicians decide when to refer patients for amplification devices, cochlear
implants, or speech-language rehabilitation.
A study published in the Indian Journal of Otolaryngology and Head & Neck Surgery
emphasized the importance of aligning Indian audiological services with WHO grading to
promote early intervention and reduce long-term communicative and psychosocial impact
(Sharma et al., 2019).

Conclusion
Understanding auditory disability through a multidimensional lens is essential for addressing
the medical, social, psychological, and policy-related challenges faced by individuals with
hearing loss. This assignment has explored the complex nature of auditory impairment—its
definitions, classifications, causes, and wide-ranging impact on communication, development,
education, and inclusion.

By analyzing national frameworks such as the Government of India’s Hearing Disability

Guidelines (2018) and global standards like the WHO Hearing Impairment Grading
System, it becomes clear that accurate diagnosis, standardized assessment, and fair
certification are crucial for ensuring equitable access to benefits and services. These
mechanisms enable timely identification of hearing loss and open the door to assistive
technology, inclusive education, social security schemes, and community-based rehabilitation.

Tools like the Hearing Handicap Inventory for Adults/Elderly (HHIA/HHIE) and the
Speech Handicap Index (SHI) play a key role in capturing the subjective experiences of
individuals with hearing and speech challenges. These tools not only guide clinicians in therapy
planning but also help in evaluating the psychological burden and social exclusion that often
accompany auditory disabilities.

Further, institutions like the All India Institute of Speech and Hearing (AIISH) offer
structured protocols and ethical frameworks for holistic intervention, combining technology,
therapy, and telepractice to make services more accessible, especially in remote areas.

In the Indian context, where linguistic, cultural, and socioeconomic diversity presents unique
challenges, adapting global standards and embedding them within national policies is a
commendable step. Government initiatives like the ADIP Scheme and NPPCD, along with
the legislative protection under the RPwD Act, 2016, reinforce the commitment to empower
persons with hearing loss and promote their full participation in society.
In essence, this assignment not only enhances awareness of auditory disability as a medical
condition but also highlights its broader social dimensions. Through integrated policy, early
intervention, community engagement, and sensitivity to lived experiences, we can move
toward a more inclusive and equitable society for individuals with hearing impairments

References

1. World Health Organization. (2021). World Report on Hearing. Geneva: WHO.

Retrieved from https://www.who.int/publications/i/item/9789240030830
2. Ministry of Social Justice and Empowerment, Government of India. (2018). Guidelines
for the Assessment of Hearing Disability. Retrieved from
https://disabilityaffairs.gov.in/upload/uploadfiles/files/hearing%20disability.pdf
3. Sharma, D., Kacker, S., Baisakhiya, N., Sharma, A. (2019). WHO’s Grading of Hearing
Impairment and Its Applicability in the Indian Context. Indian Journal of
Otolaryngology and Head & Neck Surgery, 71(Suppl 1), 586–590.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796665/
4. Rinkel, R. N., Verdonck-de Leeuw, I. M., van Reij, E. J., Aaronson, N. K., &
Leemans, C. R. (2008). Speech Handicap Index in patients with oral and pharyngeal
cancer: better understanding of patients' complaints. Head & Neck, 30(7), 868–874.
https://doi.org/10.1002/hed.20795
5. Chan, H. F., Ng, M. L., Rosen, C. A., & Schneider, S. L. (2021). Cultural Adaptation
and Validation of Speech Handicap Index: A Scoping Review. American Journal of
Speech-Language Pathology, 30(2), 748–760. https://doi.org/10.1044/2020_AJSLP-
20-00236
6. Dwivedi, R. C., St. Rose, S., Roe, J. W., Chisholm, E., Elmiyeh, B., Nutting, C. M.,
Clarke, P. M., Kerawala, C. J., Rhys-Evans, P. H., Harrington, K. J., & Kazi, R.
(2011). First report on the reliability and validity of Speech Handicap Index in native
English-speaking patients with head and neck cancer. Head & Neck, 33(3), 341–348.
https://doi.org/10.1002/hed.21450
7. Wee, S. A., Choi, E. C., Cho, S. R., Choi, S. H., & Kim, H. H. (2018). Development
of short-form of The Speech Handicap Index and its application to tongue cancer
patients. Communication Sciences and Disorders, 23(1), 218–227.
https://doi.org/10.12963/csd.18471
8. AIISH Mysore. (n.d.). Department of Audiology. Retrieved from
https://aiishmysore.in/departments/audiology
9. Brüel & Kjær. (n.d.). AIISH - Developing Speech and Hearing. Retrieved from
https://www.hbkworld.com/en/knowledge/resource-center/articles/sound/aiish-
developing-speech-and-hearing
10. AIISH Mysore. (n.d.). Ethics Committee - AIISH Mysore. Retrieved from
https://aiishmysore.in/pdf/ethical_guidelines.pdf
11. Rao, P. K. S., & Yashaswini, R. (2018). Telepractice in Speech-Language Pathology
and Audiology. Journal of Indian Speech Language & Hearing Association, 32(2), 67-
72.
12. Ministry of Social Justice and Empowerment. (2018). Guidelines for the Assessment of
Hearing Disability. Government of India. Retrieved from:
https://disabilityaffairs.gov.in/upload/uploadfiles/files/hearing%20disability.pdf
13. World Health Organization. (2021). World Report on Hearing. Geneva: WHO.
Retrieved from: https://www.who.int/publications/i/item/9789240030830
14. Sharma, D., Kacker, S., & Baisakhiya, N. (2019). WHO’s Grading of Hearing
Impairment and Its Applicability in the Indian Context. Indian Journal of
Otolaryngology and Head & Neck Surgery, 71(Suppl 1), 586–590.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796665/
15. Newman, C. W., Weinstein, B. E., Jacobson, G. P., & Hug, G. A. (1990). The Hearing
Handicap Inventory for Adults: Psychometric adequacy and audiometric correlates. Ear
and Hearing, 11(6), 430–433. https://pubmed.ncbi.nlm.nih.gov/2262304/
16. Ventry, I. M., & Weinstein, B. E. (1982). The Hearing Handicap Inventory for the
Elderly: A new tool. Ear and Hearing, 3(3), 128–134.
https://doi.org/10.1044/jshd.4702.379
17. Weinstein, B. E., & Ventry, I. M. (1983). Audiometric correlates of the Hearing
Handicap Inventory for the Elderly. Journal of Speech and Hearing Disorders, 48(4),
379–384. https://doi.org/10.1044/jshd.4702.379