Hearing screening: considerations for implementation

HEARING SCREENING CONSIDERATIONS FOR IMPLEMENTATION

HEARING SCREENING CONSIDERATIONS FOR IMPLEMENTATION Hearing screening: considerations for implementation ISBN 978-92-4-003276-7 (electronic version) ISBN 978-92-4-003277-4 (print version) © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Designed by Inis Communication HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION CONTENTS iii Acknowledgements v Abbreviations vi Introduction 1 1 Hearing screening in newborns and infants 7 1.1 Need and rationale 7 1.2 Current status and practices 8 1.3 Guiding principles for newborn hearing screening 8 1.4 Target group and aims 9 1.5 Screening protocol 11 1.6 Age and time frame for screening 12 1.7 Screening tests 13 1.8 Human resources 14 1.9 Follow-up 14 1.10 Diagnostic assessment 15 1.11 Intervention 15 1.12 Red flags for referral 16 1.13 Alternative screening pathways 16 References 17 2 School-based ear and hearing screening 21 2.1 Need and rationale 21 2.2 Guiding principles of school-based hearing screening 22 2.3 Target group and aims 22 2.4 Age for screening and frequency 23 2.5 Site of screening 24 2.6 Screening tests 24 2.7 Human resources 26 2.8 Referral criteria 27 2.9 Diagnostic assessment 28 2.10 Intervention 28 2.11 Hearing health promotion 29 2.12 Data management 29 2.13 Prerequisites for establishing school-based ear and hearing screening 30 2.14 Use of telemedicine for school-based screening 30 References 31 HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATIONiv 3 Hearing screening in older people 35 3.1 Need and rationale 35 3.2 Screening practices around the world 36 3.3 Guiding principles of hearing screening in older people 36 3.4 Target group and aims 37 3.5 Age for screening and frequency 37 3.6 Site of screening 37 3.7 Screening tests 38 3.8 Follow-up 40 3.9 Human resources 42 3.10 Diagnostic assessment 42 3.11 Intervention 42 3.12 Hearing health promotion 44 References 44 ANNEX 1 Components of a training programme for newborn hearing screening 47 ANNEX 2 Distraction test for identifying hearing loss In children 50 ANNEX 3 Whispered voice test 52 ANNEX 4 Management of conflict of interest 53 HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATIONHEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION v ACKNOWLEDGEMENTS This Handbook, Hearing screening considerations for implementation, is the outcome of a consultative process led by the World Health Organization. It was drafted by Shelly Chadha under the guidance of Alarcos Cieza and Bente Mikkelsen. Members of the technical working groups and external reviewers who contributed to the development and review of this Handbook include Arun Kumar Agarwal (Director Professor (retired), Maulana Azad Medical College, India); Xingkuan Bu (Medical Director and Professor of ENT Department, Nanjing Medical University, China); Patricia Castellanos (Audiologist, Medical Director of CEDAF, Guatemala); Teresa Ching (Head of Communication Sciences Department, National Acoustic Laboratories, Australia; Honorary Senior Research Fellow, Macquarie University, Australia); Jackie Clark (Co-chair, Coalition for Global Hearing Health; Professor of Audiology, University of Texas, United States of America); Adrian Davis (Visiting Professor of Audiology and ENT, Imperial College London, United Kingdom of Great Britain and Northern Ireland); Susan Emmett (Assistant Professor of Surgery and Global Health, Duke University School of Medicine, USA); Jean-Pierre Gagné (Professor, School of Speech-Language Pathology, University of Montreal, Canada); Norberto Martinez (Professor, Department ORL- HNS, University of Santo Tomas, Philippines); Catherine McMahon (Professor of Audiology, Macquarie University, Australia); Serah Ndwega (Audiologist, University of Nairobi, Kenya); Katrin Neumann (Professor of Phoniatrics and Pedaudiology, and otolaryngologist, University Clinic of Münster, Germany); Carrie Nieman (Assistant Professor, Department OHSN, Johns Hopkins University, USA); Bolajoko Olusanya Bolajoko Olusanya (Director, Centre for Healthy Start Initiative, Nigeria); Kathleen Pichora-Fuller (Professor Emeritus, Department of Psychology, University of Toronto, Canada); James Saunders (Professor and Co-chairperson, Coalition for Global Hearing Health; Professor of Otology / Neurotology, Dartmouth-Hitchcock Medical Center, USA); De Wet Swanepoel (Professor of Audiology, University of Pretoria, South Africa); George Tavartkiladze (Professor and Director of the National Research Centre for Audiology and Hearing Rehabilitation, Russian Federation); Peter Thorne (Professor of Hearing Science, University of Auckland, New Zealand); Kelly Tremblay (Professor (retired), University of Washington, USA, Adjunct Professor, Dalhousie University, Canada); and Christine Yoshinaga- Itano (Research Professor, University of Colorado, USA). Support in compilation and drafting was provided by Sowmya Rao. The background research work was facilitated by Chitra Chander (Public health specialist, India); Ivy Chilingulo (Researcher in public health, Lund University, Sweden); Carmen Kung (Senior research scientist, National Acoustics Laboratories, Australia); Vivienne Marnane (Research project coordinator, National Acoustics Laboratories, Australia); Katherine Wallis (Researcher in public health, Lund University, Sweden); and Angela Wong (Research audiologist, National Acoustics Laboratories, Australia). The following WHO staff members contributed to the technical content and its review: Rajiv Bahl, Jean-Marie Dangou, Karen Margaret Edmond, Carolina Hommes, Kaloyan Kamenov, Satish Mishra, Elick Narayan, Patanjali Nayar, Karen Reyes, David Ross, Ritu Sadana, Hala Sakr, and Yuka Sumi. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATIONvi ABBREVIATIONS AABR automated auditory brainstem response ABR auditory brainstem response ASSR auditory steady-state response dB decibel dBA A-weighted decibel dBHL decibels hearing level EHC ear and hearing care ENT ear, nose and throat FM frequency modulation HHIE hearing handicap inventory for the elderly ICOPE integrated care for older people IPC-EHC integrated people-centred ear and hearing care JCIH Joint Committee on Infant Hearing kHz kilohertz MPANL maximum permissible level NICU neonatal intensive care unit OAE otoacoustic emission PPV positive predictive value PTA pure-tone audiometry SCN special care nursery TWG technical working group UNHS universal newborn hearing screening USA United States of America WHO World Health Organization HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 1 INTRODUCTION In the World report on hearing, the World Health Organization (WHO) estimates that by 2050 nearly 2.5 billion people will be living with some degree of hearing loss, at least 700 million of whom will require rehabilitation services. Currently, this number is 430 million, which includes people with moderate or higher grades of hearing loss who are most likely to benefit from hearing rehabilitation services. The vast majority of these people live in low- and middle-income countries, where access to ear and hearing care (EHC) is often limited. The sizeable gap in the need for, and access to, EHC services is indicated by the fact that only 17% of those who could benefit from a hearing aid, actually access or use one. Unaddressed hearing loss is costly in terms both of the health and well-being of the people affected, and the financial losses arising from their exclusion from communication, education and employment. Each year, nearly 1 trillion International dollars are lost due to unaddressed hearing loss. The World report on hearing outlines innovative, cost–effective technological and clinical solutions that can improve the lives of most individuals with hearing loss. Millions are already benefitting from these developments. Combining the power of technology with sound public health strategies, can ensure that these benefits reach all populations, thereby advancing the global vision of universal health coverage. Towards this end, the World report on hearing recommends integrated people-centred ear and hearing care (IPC-EHC) within national health systems, and outlines a set of H.E.A.R.I.N.G. interventions (Box 1), that ensure that people with hearing loss or ear diseases receive the care and rehabilitation services they need. Box 1 H.E.A.R.I.N.G. set of interventions Hearing screening across the life course Ear disease prevention and management Access to technologies Rehabilitation services Improved communication Noise reduction Greater community engagement HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION2 Early intervention is critical to successful rehabilitation outcomes in people with hearing loss, as delays have a negative impact on language development, communication, social well-being and cognition. Since hearing loss is invisible, it commonly remains undetected, both in children and adults. For this reason, it is important that special measures are put in place to screen for hearing loss at different stages across the life course (Figure 1). Those most likely at risk include: O newborns and infants; O children, especially in pre-school and school settings; O older people; and O those who are exposed to noise, ototoxic chemicals and ototoxic medicines and are thus at greater risk of hearing loss. Figure 1 Identifying hearing loss across the life course ACROSS THE LIFE COURSE: Screening for hearing loss Symptomatic testing NEWBORN: Newborn hearing screening CHILDREN: Pre-school and school ear and hearing checks ADULTS: Hearing screening in high risk occupations OLDER ADULTS: Regular hearing screening HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 3 The rationale for systematic hearing screening, and the benefits and challenges of implementation are provided in the World report on hearing, along with detailed information on the costs and potential financial benefits of implementing such screening and early intervention services. The report shows that increasing hearing screening and early intervention coverage during the next 10 years requires an additional annual per capita investment of US$ 1.33. The resulting health gain during the 10-year period would avert nearly 130 million DALYs (disability adjusted life years), benefit 1.4 billion people and yield a return of nearly US$ 16 for each 1 dollar invested. The World report on hearing recommends that WHO Member States take urgent and evidence-based policy action to prevent, identify and rehabilitate hearing loss. This handbook provides the technical guidance to support Member States in developing and implementing screening strategies for early identification and intervention to address hearing loss and related ear diseases in newborns and infants, children at pre-school facilities and at school, and older people. PURPOSE OF THE HANDBOOK This handbook, HEARING screening: considerations for implementation is intended for use by anyone planning to implement a national or subnational level hearing screening programme. This includes EHC coordinators or focal points within ministries of health; public health planners; and nongovernmental organizations or civil society entities providing ear and hearing care. The handbook provides practical information for facilitating screening and early intervention for hearing loss and related ear diseases in newborns and infants, pre- school children and school students, and older people. DEVELOPMENT OF THE HANDBOOK Hearing screening: considerations for implementation has been developed through a consultative and evidence-based approach. It forms three sections: hearing screening in newborns and infants; school-based hearing screening; and hearing screening in older people. The process of developing each section involved: O setting up three technical working groups (TWGs), one for each screening group; O preparing a list of questions to be addressed with respect to each screening group; O undertaking a scoping review of existing guidelines for each screening group; O assessing the guidelines that fitted the predetermined inclusion criteria for their quality through application of the AGREE-II tool;1 1 See: https://www.agreetrust.org/resource-centre/agree-ii/agree-ii-instructions/. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION4 O reviewing in detail the high quality guidelines and, in response to pre-identified questions, extracting the data from these; O conducting a 2-stage Delphi survey (where considered relevant by the TWGs) to support the data extraction process; O developing each section based on the evidence reviewed and expert inputs; O a review of drafts (by the TWGs) and provision of feedback; and O undertaking an internal review prior to finalization. USE OF THE HANDBOOK The handbook provides guidance on important factors to be considered when developing a hearing screening programme; examples include who should be screened, the aim of the programme, the frequency of screening, the tools to be used, etc. Each of the three sections considers these and other relevant questions that must be answered during the planning phase. In addition, the sections give evidence-based options and discuss the advantages and disadvantages of the different options, so that countries can implement those which best suit their local context. Countries must set up a national or local stakeholder group and plan their programmes after due consideration of the recommendations outlined in this handbook, along with the epidemiology of hearing loss and ear diseases within the country/region, availability of the health workforce, referral pathways, equipment and financial resources. Further technical assistance in adaptation and implementation of hearing screening can be sought from WHO. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION

HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 7 1 HEARING SCREENING IN NEWBORNS AND INFANTS 1.1 NEED AND RATIONALE Unaddressed hearing loss, including congenital hearing loss, constitutes a serious obstacle to a child’s development, education, and social integration (1, 2). The impact of unaddressed hearing loss extends beyond adverse speech and language outcomes, especially in low- and middle countries (3). A key mitigating factor is the age at which intervention (amplification or enrolment in educational programmes) is initiated (4, 5). There is a significant body of research demonstrating that children whose hearing loss is identified at an early stage and who receive early intervention have better outcomes than those with later detection and treatment (4, 6–11) (see section 1.11). Literature shows that children who are born deaf or who acquire hearing loss very early in their life and who are identified and receive appropriate interventions within 6 months of age are on a par with their hearing peers in terms of language development by the time they are 5 years of age (12–15). Early identification and intervention in newborns is made possible through newborn hearing screening (NHS) (1, 15). When followed by prompt and suitable rehabilitation, hearing screening of newborns brings significant advantages both in terms of reducing the age of diagnosis and intervention and of improved language and cognitive development (4, 10, 16–19). These advantages translate into improved social and educational outcomes for infants who receive timely and suitable care (2). Cost–effectiveness studies have further demonstrated the financial benefits of universal newborn hearing screening (UNHS) in high-income, lower-middle-income and middle-income countries (2, 20). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION8 1.2 CURRENT STATUS AND PRACTICES Successful newborn hearing screening programmes have been implemented in several countries using a variety of screening methods, protocols, and linkages to existing health care, social and educational systems (21). It is estimated that nearly one third of the world’s population, living mainly in high-income regions, is fully or nearly fully covered by newborn hearing screening programmes (22). The degree of implementation and coverage of such programmes varies substantially across the world. A recent publication shows that screening coverage is closely associated with average living standards and economic well-being (22). The lack of relevant policies, human resources, equipment and financial resources for NHS are challenges very commonly faced in low- and middle- income countries. These challenges are further aggravated by a low awareness about hearing loss and its associated stigma. These factors and potential solutions are further elaborated in the World report on hearing (2). There is also variation in how NHS is currently implemented worldwide. However, most guidelines adopted are based on the underlying principles of the position statement of the Joint Committee on Infant Hearing ( JCIH) (1, 23), as outlined in section 1.3. While each country must develop its screening protocol based on several factors, such as the nature and severity of the hearing loss to be identified, the screening tools available, legislative support, the availability of qualified personnel and competent audiology services, cultural diversity, resources available and cost value (1, 16, 24–26), the principles underpinning the JCIH recommendations form a strong basis for UNHS (1). 1.3 GUIDING PRINCIPLES FOR NEWBORN HEARING SCREENING • Newborn hearing screening, where practicable, should be based on the “1–3–6” principle (23, 27) (Box 1.1). – All infants should undergo hearing screening within the first month of life. – All infants whose initial screening and subsequent re-screening warrant diagnostic testing, should have appropriate audiologic evaluation by no later than 3 months of age to confirm the infant’s hearing status. – Once hearing loss has been diagnosed, the infant and family should have immediate access to early intervention service. This should begin as soon as possible after diagnosis, and no later than 6 months of age. Box 1.1 The 1–3–6 principle SCREEN BY 1 MONTH OF AGE DIAGNOSE BY 3 MONTHS OF AGE INTERVENE BY 6 MONTHS OF AGE HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 9 • In places where infants are predominantly born outside of hospital settings or where access to health care is limited and where it is not feasible to achieve the 1–3–6 timeline, the NHS programmes should strive to remedy this over time. • Wherever feasible, the NHS programme should be integrated with, or linked to, existing health-care, educational or social systems, and the procedures and outcomes documented and reported (28). • The programme should adopt a family-centred approach, with infant and family rights and privacy guaranteed through informed and shared decision-making, and family consent in accordance with state and national guidelines (29). • Interventions, including provision of hearing technology and rehabilitation services, must reflect the family’s preferences and goals for their child. • Regardless of the outcome of their newborn hearing screening, all infants and children should be routinely monitored with respect to: hearing, cognitive development, communication, attainment of educational milestones, general health and well-being. 1.4 TARGET GROUP AND AIMS Newborn hearing screening should be universal, and all infants (in the area or facility where screening is implemented) should be covered and assessed to identify hearing loss. However, in countries where the number of annual births is large and where resource limitations do not allow for universal screening, countries may choose to start a screening programme using selective (or targeted) screening only (3), for example by including only infants considered “at-risk”; geographical subsets; or infants in a special care nursery (SCN) or neonatal intensive care unit (NICU) (see Figure 1.1). Countries should, however, plan to expand selective screening to universal screening over time. Testing only infants considered “at risk” is likely to miss approximately 50% who have no apparent cause for hearing loss (2, 24, 30). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION10 Figure 1.1 Setting up a newborn hearing screening programme *AABR: automated auditory brainstem response; NICU: neonatal intensive care unit; OAE: otoacoustic emission. The aim of any hearing screening programme is to diagnose hearing loss in infants at the earliest possible stage and to enrol them in timely intervention. Countries should decide the level and nature of hearing loss on which to focus, based on the capacity of their health system. The ear and hearing programmes of many countries focus on early intervention of infants with moderate or higher grade of hearing loss (i.e. above 35 dBHL) in the better hearing ear (1). However, where resources permit, mild hearing loss and unilateral hearing loss should also be addressed due to the impact these have on language development and education (31,32). OR Determine the target population Specify the type of hearing loss being targeted by the screening programme Establish how many times the newborn and infant will be screened Determine what screening equipment will be used and at which stage Unilateral Establish the screening protocol Screening OAE* Pass Ongoing surveillance communication development during well-child visits Referral to Diagnostic Audiology Pass Screening OAE* AABR* Refer AABR Refer 1 2 3 UNIVERSAL TARGETED OR ALL new born babies and infants Geographical subsets At risk babies and infants only (e.g. NICU)* Bilateral HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 11 1.5 SCREENING PROTOCOL A two-stage screening protocol is important to ensure a lower rate of false positives or higher specificity of the screening programmes (see Figure 1.2). This involves: • First-stage screening, which is best performed soon after birth. • Second-stage screening for all infants who fail the first stage screening. • Referral for diagnostic audiology for infants who fail both the first and second stages of screening. Note: Some screening programmes add an additional screening stage to reduce the number of false-positive test results requiring diagnostic audiology (24, 33). While multiple stage screening is more costly and may cause delay in establishing a diagnosis and starting intervention, it yields higher specificity and thus reduces the number of false referrals for specialized and costly diagnostic audiology. Figure 1.2 Two-stage screening protocol 1st screen Review if concerns arise PASS result in both ears No risk factor Risk factor Monitoring PASS result in both ears 2nd screen REFER result in one or two ears REFER result in one or two ears Referral to Diagnositic Audiology HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION12 1.6 AGE AND TIME FRAME FOR SCREENING • First-stage screening: ideally this should take place within 1 month of age and should be conducted before the infant is discharged. First-stage screening can be performed as close to hospital discharge as possible, but there should be the possibility for a potential second-stage screening prior to discharge, if needed. When birth takes place outside of a hospital setting or where the screening programme is, for example, linked with immunization visits or well-baby clinic visits, it may not be possible to screen during the recommended 1 month period. In this case, first-stage screening should take place no later than 6 weeks of age. • Second-stage screening: infants who fail the first-stage screening, should undergo a second-stage screening. This can occur either while still in hospital, and following a gap of at least several hours from the first screening to decrease the false-positive test result due to transient newborn conditions; or as soon as possible after being discharged. • Alternative arrangements must be made for completing the hearing screening of infants for whom it is not medically advisable or practical to do so in a timely manner, for example infants in an NICU, or on ventilators, or with severe life-threatening conditions. If screening is delayed, the procedure should be ensured once the infant is medically stable. Note: Where a large number of infants are born outside of the hospital setting or formal health-care system, screening at the time of first vaccination is a possible strategy to increase coverage (34). An example of this is outlined in the newborn hearing screening guidelines of South Africa (35). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 13 1.7 SCREENING TESTS As far as possible, physiological screening measures should be applied in preference to behavioural screening. Sensitive screening tests are commonly used and include automated auditory brainstem response (AABR) or otoacoustic emission (OAE) screening. There is no clear advantage of one technology over the other. For the well-infant population, first and second screening can be performed using either AABR or OAE technologies. With certain screening programmes, and where costs permit, AABR may be preferred; for infants in an NICU, AABR screening is recommended. These and other considerations for selecting the screening testing method are outlined in Box 1.2. Box 1.2 Considerations in selection of screening test • Screening with OAE alone will not detect infants with auditory neuropathy, which constitutes approximately 10% of congenital hearing loss. • The incidence of auditory neuropathy, detected by AABR, is significantly higher among infants admitted to an NICU. • When using OAE, transient-evoked OAE (TEOAE) has greater sensitivity, as it can detect hearing levels as low as 30dBHL. • Both OAE and AABR screening demonstrates high sensitivity and specificity, although specificity may be marginally higher with AABR. • AABR may be more costly than OAE. However, it is to be noted that while the initial investment is higher for AABR, the follow-up costs may be greater for OAE due to higher “refer” diagnoses and false-positive rates. • AABR is likely to take slightly longer to record than OAE. • OAE is more sensitive to background noise levels than AABR. • A combined OAE and AABR screening protocol has been reported as providing the best positive predictive value (PPV). However, the cost of purchasing both types of screening equipment may be prohibitive for many countries. Note: While the most effective approach is universal physiological screening using OAE testing or AABR, in cases where such programmes are not possible because of financial considerations or because appropriate equipment and personnel are unavailable (or because of a need to start in a more limited way and work towards universal physiological screening), other approaches that integrate behavioural tests can be used as interim measures (21). Further details are provided in section 1.13. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION14 1.8 HUMAN RESOURCES Inpatient and outpatient screening can be conducted by paediatric audiologists, audiometrists, audiological or other technicians, primary care physicians, nurses, or nursing assistants. The decision regarding the screening personnel may vary depending on human resources available at each screening location. Where screening is performed outside the hospital setting, health workers and other cadres providing childcare services at primary health-care level can be engaged. Note: All screening personnel should undergo training irrespective of any prior qualifications. Training should focus on screening equipment to be used and the standard operating procedures of the programme including documentation of results, data collection and management (see Annex 1 for training requirements). Regular supervision of personnel in training is important for quality control and troubleshooting. 1.9 FOLLOW-UP “Refer” result: All infants who have a “refer” result after first screening should be followed up to ensure that they have a second screening. Infants who fail both first and second screenings should be referred for diagnostic testing and be followed up. Follow-up must be carried out systematically by a designated person to ensure that the required screening or diagnostic testing is completed. The steps in the follow-up pathway should be mapped out and a system established to facilitate family attendance at follow-up to ensure maximum compliance. “Pass” result: Parents/caregivers should be provided with information about the usual hearing and language milestones (30) anticipated in the course of a child’s development. In situations where these milestones are not met, or where hearing loss is suspected, the child should undergo a hearing screening test, irrespective of previous test outcomes. This is important because hearing loss can develop at any time after birth, or be progressive in nature, which becomes apparent as the child grows. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 15 1.10 DIAGNOSTIC ASSESSMENT All infants failing both stages of screening should undergo diagnostic audiology to confirm their hearing status by 3 months of age. Tests should include: • Objective assessment of brainstem responses to sound stimulus for diagnosis of hearing loss through: – Auditory brainstem response (ABR) testing – the standard measure used to make a diagnosis of the nature and degree of hearing loss in each ear to ensure appropriate management (e.g. amplification, signing). – Auditory steady-state response (ASSR) – this can be used in addition to ABR in order to gain frequency specific threshold estimates. • Tympanometry to assess the middle ear function. • Acoustic reflex to test middle ear function and integrity of auditory brainstem pathways. • Otoacoustic emissions – when combined with an ABR test, this provides critical information for the differential diagnosis of auditory neuropathy spectrum disorder and sensorineural hearing loss. • Medical evaluation to determine the aetiology of hearing loss. Diagnostic testing should be undertaken by a professional who has knowledge and experience of testing infants; who follows evidence-based protocols; and who has the necessary equipment for timely and comprehensive diagnosis. 1.11 INTERVENTION In line with the principles outlined in section 1.3, intervention should ideally be initiated by the time an infant with hearing loss reaches 6 months of age. All countries should strive to achieve this. However, where this is not realistic immediately, countries can start with a more flexible goal to start management by 1 year of age. Decisions regarding management should be made through a consultative family-based approach. Options for interventions include rehabilitative therapy to support the development of language skills, along with: • hearing technology use (hearing aids or cochlear implantation); • sign language learning; or • a combination of the above. In addition, parents should be directed to enrol their child in a suitable early education programme. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION16 1.12 RED FLAGS FOR REFERRAL Infants identified with any concurrent illness should be referred for the required treatment, in accordance with the best available standard of care. The following conditions, if identified, should lead to immediate referral for diagnostic audiology: • Congenital cytomegalovirus • Meningitis • Congenital abnormalities of head and neck (e.g. unilateral or bilateral malformations of the ear, face or head) • Significant head injury • Syndromes associated with hearing loss • Neonatal jaundice requiring exchange transfusion. 1.13 ALTERNATIVE SCREENING PATHWAYS In community settings where newborn screening is planned and where physiological assessment is not feasible – either because of limitations in resources (financial, workforce or infrastructure), or because a large number of infants are born outside of health facilities and are thus not available for this approach – behavioural assessment can be used as an alternative first step in the screening process (36). However, this must be undertaken with the understanding that the specificity and sensitivity of behavioural observation is not well-established and that the proportion of false-negatives and false-positives may be higher using this approach. The processes for behavioural assessment involve: • First screening – Time frame: At first contact with the health system, for example a first visit to a health centre for vaccination (34). – Method: Behavioural screening using validated measures for behavioural screening (see Annex 2). – Workforce: Health workers trained to undertake behavioural observation. – Referral: Infants who show an equivocal response should be referred for a second screening at a health facility where hearing tests are available. • Second screening – Time frame: As soon as possible after the first screening – Method: Use of OAE or AABR (see section 1.7) – Workforce: See Human resources (section 1.8) HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 17 – Referral: Infants who fail the physiological test should be referred for diagnostic testing, followed by early intervention if diagnosis of hearing loss is confirmed. • Diagnosis and intervention: – Options for diagnosis and intervention are described in sections 1.10 and 1.11. REFERENCES 1. Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. DMCN. Jan 2021; 63(1):16–21 (https://doi.org/10.1111/dmcn.14694, accessed 18 May 2021). 2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 3. Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: an overview. Arch Dis Child. 2012 Jul;97(7):654–9 (doi: 10.1136/archdischild-2012-301786, accessed 10 May 2021). 4. Nelson HD, Bougatsos C, Nygren P, 2001 US Preventive Services Task Force. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008 Jul;122(1):e266–76. doi: 10.1542/peds.2007–1422. Erratum in: Pediatrics. 2008 Sep;122(3):689. 5. Patel H, Feldman M. Universal newborn hearing screening. Paediatr Child Health. 2011 May;16(5):302–305. 6. Ching TY, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications. Int J Audiol. 2018;57(sup2):S105–S111 (https://doi.org/10.1080/14992027.2017.1385865, accessed 18 May 2021). 7. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, Watkin, Worsfold S, Yuen HM, Stevenson J. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354:2131–2141. doi:10.1056/NEJMoa054915. 8. Yoshinaga-Itano C, Coulter D, Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology. 2001 Dec;6(6):521–529. 9. Dettman SJ, Pinder D, Briggs RJS, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing. 2007 April;28(2):11S–18S. doi:10.1097/AUD.0b013e31803153f8. 10. Neumann K, Gross M, Böttcher P, Euler HA, Spormann-Lagodzinski M, Polzer M. Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatrica et Logopaedica. 2006;58(6):440–455. 11. Yoshinaga-Itano C. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years. The Volta Review. 2000;100(5):1–117. 12. WHO. Childhood hearing loss, strategies for prevention and care. 2016; Geneva: World Health Organization. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION18 13. Yoshinaga-Itano C, Seday AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161–71. 14. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3):E43. 15. Ching TYC, Dillon H, Button L, Seeto M, Van Buynder P, Marnane V, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140(3). 16. Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95:130–135. 17. Neumann K, Chadha S, Tavartkiladze G, Bu Xingkuan, White KR. Newborn and infant hearing screening facing globally growing numbers of people suffering from disabling hearing loss. Int J Neonatal Screen. 2019;5(7). doi:10.3390/ijns5010007. 18. Yoshinaga-Itano C. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord. 2004 Sep–Oct;37(5):451– 65. doi:10.1016/j.jcomdis.2004.04.008. 19. Kover AMH, Konings S, Dekker FW, Beers M, Wever CC, Frijns JHM, et al. Newborn hearing screening vs later hearing screening and development outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304(15):1701–1708. 20. Sharma R, Gu Yuanyuan, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: a systematic review and critique. Appl Health Econ Health Policy. 2019;17(3):331–357. doi:10.1007/s40258-018-00456-1. 21. Newborn and infant hearing screening, current issues and guiding principles for action. Geneva: World Health Organization; 2010. 22. Neumann K, Euler HA, Chadha S, White KR. A survey on the global status of newborn and infant hearing screening. JEHDI. 2020;5(2):63–84 (https://digitalcommons.usu.edu/cgi/viewcontent. cgi?article=1130&context=jehdi, accessed 18 May 2021). 23. JCIH. Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1–44. 24. Mishra G, Sharma Y, Mehta K, Patel G. Efficacy of distortion product oto-acoustic emission (OAE)/ auditory brainstem evoked response (ABR) protocols in universal neonatal hearing screening and detecting hearing loss in children <2 years of age. Indian J Otolaryngol Head Neck Surg. 2013;65(2):105–110. 25. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in Southern Thailand. Bull World Health Org, 2019;97:663–671 (doi: http://dx.doi.org/10.2471/BLT.18.220939 accessed 18 May 2021). 26. Shearer AE, Shen J, Amr S, Morton C, Smith RJ. A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard of hearing children. Genet Med. 2019;21(11):2614–2630. 27. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017 Aug;140(2). 28. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Research and Reports in Neonatology. 2015;5:51–64. doi:10.2147/RRN.S61862. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 19 29. Moeller MP, Carr G, Seaver L, Stredler- Brown, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Studies Deaf Edu. 2013 Oct;18(4):429–444. 30. Australian government Department of Health. National framework for neonatal hearing screening. Canberra ACT. 2013 Aug (https://www1.health.gov.au/internet/main/publishing.nsf/Content/ neonatal-hearing-screening, accessed 18 May 2021). 31. Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early onset unilateral hearing impairment in children – a systematic review. Int J Pediatr Otorhinolaryngol. 2019;120:173–183. 32. Lieu JE. Permanent unilateral hearing loss (UHL) and childhood development. Curr Otorhinolaryngol Rep. 2018;6(1):74–81 33. Berrettini S, Ghirri P, Lazzerini F, Lenzi G, Forli F. Newborn hearing screening protocol in Tuscany region. Italian J Pediatr. 2017;43:82. doi:10.1186/s13052-017-0397-1. 34. Olusanya BO, Ebuehi OM, Somefun AO. Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience. J Epidemiol Community Health. 2009 Jun;63(6):481–7. doi: 10.1136/jech.2008.082784. 35. The Health Professions Council of South Africa. Early hearing detection and intervention (EHDI), guidelines. South Africa. 2018 (https://www.hpcsa.co.za/Uploads/SLH/Guidelines%20for%20Early_ Hearing_Detection_and_Intervention_(EHDI)_2018.pdf, accessed 18 May 2021). 36. Kuki S, Chadha S, Dhingra S, Gulati A. The role of current audiological tests in the early diagnosis of hearing impairment in infant. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(3):244–50. doi: 10.1007/s12070-012-0558-x.

HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 21 2 SCHOOL-BASED EAR AND HEARING SCREENING 2.1 NEED AND RATIONALE The implementation of universal newborn hearing screening in many places has improved the ability to identify and address congenital hearing loss shortly after birth. However, globally, most newborns are not screened for hearing loss, and even when they are, those with hearing loss that is progressive or develops later in childhood often remain unidentified and therefore untreated (1). In addition, ear diseases such as otitis media are a common cause of health-care visits and morbidity among children (1). When unaddressed, these ear diseases can lead to hearing loss, and in some cases to life threatening complications. Hearing loss in a child’s formative years can have substantial consequences on speech and language development and education. Early identification of ear and hearing problems in children, and connecting them to care, is critical to avoid long-term impact on language learning, cognition, educational attainment and social development (2, 3). Given that, worldwide, the vast majority of children attend school, school (and pre-school) screening presents a unique opportunity to conduct universal hearing screening among children. When followed by prompt diagnosis and appropriate interventions, school (and pre-school) ear and hearing screening programmes serve as a useful tool for mitigating the effect of unaddressed hearing loss and ear diseases. They also provide an opportunity to educate children and teachers about healthy hearing and safe listening practices (1). School hearing screening, (including screening in pre-schools, primary and secondary schools, or at school-entry) is mandated only in some parts of the world and there is a paucity of published data on current school hearing regulations, policies and guidelines. Even in places where school hearing screening is implemented, there are differences HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION22 in the protocols, tests used, and thresholds applied for making referrals for treatment (4–12). A recently published review highlighted the urgent need for globally standardized school hearing screening protocols which would improve the robustness and potential impact of this intervention (4)). 2.2 GUIDING PRINCIPLES OF SCHOOL-BASED HEARING SCREENING School-based hearing screening programmes should consider the following points: • Diagnostic audiology and otology services must be developed prior to, or in parallel with, screening programmes and should be available to those who have been referred after participating in hearing screening programmes. • The care pathway and follow-up mechanisms should be outlined at the time of intervention planning so that children identified with hearing loss or ear diseases can receive the care they need. • Interventions, including medical and surgical services, hearing technology and rehabilitation, must be made available and recommended based on a person-centred approach, which addresses the clinical needs of the individual, respects their preferences and adapts to the cultural context and available resources. • Wherever feasible, school (and pre-school) ear and hearing screening should be part of routine school health checks or combined with other health interventions such as general physical check-up, eye screening, dental care etc. • The components of professional accountability, risk management, quality assurance, data management and programme evaluation must be developed prior to implementation of any screening programme. An advisory board may be set up to oversee the planning, implementation and evaluation. 2.3 TARGET GROUP AND AIMS Children in pre-school or school should be screened with the aim to identify the following at the earliest possible time: • Hearing loss in one or both ears (this includes both conductive or sensorineural, or a mixed type of losses).2 Ideally all hearing thresholds higher than 20 dBHL should be identified (5–11). Where environmental limitations or health system capacity for referrals poses a challenge for identification of 20 dBHL hearing levels, countries can, for example, start with a target hearing threshold of 30 dBHL or 35 dBHL cutoff in 2 Hearing screening typically includes air conduction testing only. The differentiation of the type of hearing loss (conductive, sensorineural or mixed type) is possible only on a diagnostic audiometry, which should be made available to all children who are referred at the initial hearing screening. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 23 either ear (9). Once this is well established, countries should aim to identify children with hearing thresholds higher than 20 dBHL (see Box 2.1). • Ear disease that is likely to cause hearing loss, for example: – chronic otitis media – acute otitis media – otitis media with effusion – impacted wax – malformations of the ear – foreign bodies in the ear. Box 2.1 Considerations for deciding the target hearing threshold • Ideally children with hearing loss of any grade (i.e. 20 dBHL or higher) should be identified, as even mild hearing loss is known to affect educational attainment (13, 14). This should be the aim, especially in places where testing environmental noise levels can be kept under a strict control (e.g. below 40 dBA); and health systems have sufficient capacity to manage the demand this will create. • With programmes that are being set up, it may be prudent initially to target higher thresholds such as 30 dBHL or 35 dBHL. This is because lower thresholds such as 20 dBHL or 25 dBHL: – are difficult to assess in the presence of background noise (greater than 40 dBA); – will lead to a greater number of referrals for diagnostic evaluation and hence may pose a challenge for health systems; or – may lead to a high proportion of false-positive referrals, leading to an overburdening of health systems thereby creating distrust in the screening process. 2.4 AGE FOR SCREENING AND FREQUENCY At a minimum, all children should be screened for hearing loss and ear diseases at school entry. In countries where health system capacity permits, school ear and hearing checks should be undertaken regularly (6): • upon initial entry to school; • in kindergarten; and • in school year grades 1, 2, 3, 7 and 11. The school year grades noted above are indicative and based on existing guidelines. The actual time-points for conducting pre-school or school screening will need to be decided HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION24 by each country based on the epidemiology of ear diseases and hearing loss and available resources. For example, a country could start with ear and hearing screening at school entry and at grades 1, 3 and 7 (9) only, and then, based on the development of the health system capacity, gradually increase the frequency. In addition to the above, where teachers or parents/caregivers have expressed a concern regarding the hearing status of a child, the child should be referred to a health service for an ear and hearing check-up. 2.5 SITE OF SCREENING For ease of access to students, screening is best undertaken in the school environment (5–12). A quiet location should be identified within the school premises and noise levels checked beforehand. It is important to ensure that noise levels during hearing screening do not exceed the maximum permissible levels (MPANLs) prescribed for the selected headphones and screening level. Moreover, screening should be paused when there are transient increases in ambient noise. Noise levels can be checked using a sound level meter if available, or with use of validated phone apps for noise level measurement.3 In situations where sound meters are unavailable, screeners can test the suitability of the site by checking the levels to be used for screening against their own ability to hear the signals at their known hearing threshold levels, in the test environment. 2.6 SCREENING TESTS When assessing hearing in children/students, the following testing methods should be included (Type of test, tools, and methods used are described in Table 2.1): • Pure tone air conduction hearing screening to identify if the child is able to hear the target threshold (20 dBHL/25 dBHL/30 dBHL/35 dBHL) across test frequencies (see section 2.3 on target groups and aims and Box 2.1). • Ear examination including otoscopy to detect the target ear conditions (see section 3.3). Otoscopy should be undertaken only where trained staff and decision support for examination and diagnosis of ear diseases is available (either on the spot or remotely). In situations where such staff or support is unavailable, otoscopy and tympanometry may be excluded. • Tympanometry (wherever feasible), should be undertaken as part of the ear and hearing testing protocol. 3 Examples of validated apps that can be downloaded for use: NIOSH Sound Level Meter, Sound Meter Pro, or Sound Meter and Noise Detector. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 25 Table 2.1 Tests for school ear and hearing screening (5–12) Type of test Tools used Testing method Criteria for referral Hearing testing Sweep audiometry Conventional (non-automated) screening audiometer. Both ears tested separately at three frequencies (1 kHz, 2 kHz, and 4 kHz), at a fixed dB level of 20 dBHL /25 dBHL/30 dBHL /35 dBHL. A differential approach can be adopted that raises the dB level at 1 kHz to avoid a false-positive result due to background noise. For example, if the target hearing threshold is 25 dBHL, the screening will be conducted at 25 dBHL for 2 kHz and 4 kHz, but will be conducted at 30 dBHL for 1 kHz (15, 16). Child does not respond: • at the criterion threshold level; • at one or more frequencies; • at least two out of three times. Failure to respond in either ear should be an indication for referral. Automated digital screeners (13, 14). Digits-in-noise test or speech- in-noise tests. Digit triplet-in-noise test, such as the WHO hearWHO app could be used in children aged more than 9 years of age (18). Both ears tested together. The smartphone app should be calibrated to refer subjects with speech-in-noise ratio corresponding to the target threshold level of 20 dBHL/25 dBHL/ 30 dBHL/35 dBHL. Speech recognition thresholds specified for specific age groups (17) corresponding to target hearing threshold of 20 dBHL/25 dBHL/ 30 dBHL/35 dB. Ear examination Naked eye examination of the external ear for obvious anomalies; and otoscopic examination. Otoscope (validated low cost options are available and can be used).* Both ears examined separately. • Ear discharge is observed. • Visual identification of previously undetected. structural defect(s) • Impacted cerumen or foreign objects. • Perforations or other abnormalities of the tympanic membrane are apparent. Middle ear pressure assessment (where feasible) Tympanometry. Tympanometer or hand-held tympanometer. Each ear assessed separately. Flat (type B) or type C tympanogram. *An example of a low-cost option is the Arclight scope. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041821/ HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION26 2.7 HUMAN RESOURCES Ear and hearing checks in schoolchildren can be performed by the following cadres: • Ear and hearing care clinicians (e.g. ear, nose and throat (ENT) specialists, audiologists, speech and language pathologists). • Non-hearing care clinicians (e.g. school doctor, general physician, paediatrician). • Trained health workers and nurses (e.g. clinical officers, nurses, medical assistants, technicians) (13, 14). • Trained lay health workers (e.g. community health workers) (13, 14). • Trained teachers (19). In situations where ear and hearing checks are to be performed by non-clinicians, training must be provided, followed by supervised practice and ongoing quality control and support. Following training, regular checks should be made to ensure good practice and compliance to standards and guidelines. The training requirements for non-clinicians are summarized in Box 2.2. Box 2.2 Content of training for school ear and hearing screening Clinicians, nurses and health workers who are not trained in ear and hearing care should receive training in the following: • the importance of hearing – especially for education; • the purpose and protocol of screening; • basic anatomy of the ear; • causes of hearing loss; • the basic operation of the screening programme and the process for reporting; • the role of the screener; • screening and referral methods; • screening room set-up and calibration of equipment; • equipment, including maintenance and troubleshooting if not working; • background noise measurements; • otoscopy and tympanometry (where available); and • identification of the target ear and hearing conditions. Hearing care clinicians should be sensitized to the purpose and protocol for the screening programme. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 27 2.8 REFERRAL CRITERIA As outlined in the principles (section 2.2), a school screening programme must be linked with ear and hearing services so that children identified with ear diseases or hearing loss can access the care they require. Actions to be taken for different test results are as follows: • “Pass” result: Children with a “pass” result following ear and hearing screening, and who are not identified as having “refer” criteria, should be advised to care for their ears and be provided with information on ear and hearing care.4 • “Refer” result: Children with a “refer” result following screening should undergo an ear and hearing check-up for diagnosis and management. Ideally this should be undertaken by a clinician with competence in ear and hearing care. • Red flags: Children who receive a “red flag” alert following ear and hearing screening should be referred for further assessment, irrespective of the screening outcome. Red flag alerts include: – parent/caregiver or teacher concern regarding a child’s hearing, speech and language development, inattention, learning difficulties or any ear problems (irrespective of test outcomes) (8); – ear discharge; if ear discharge is foul smelling, this should be a cause for immediate and urgent referral; – redness and painful swelling behind the ear (mastoid); and – acute pain in or around the ear. Referrals can be made to a primary care physician, trained nurse or to an ear and hearing care clinician. The decision of who should receive the referrals must be based on the local context, availability of ear and hearing clinicians and other trained health workforce. A triaged referral approach can be followed. For example, medical concerns such as ear discharge, swelling etc., can be treated by a primary care physician or trained nurse; hearing loss concerns should be referred directly to an ear and hearing care clinician. 4 Flyer on ear care (English): https://who.canto.global/s/Q2CPO HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION28 2.9 DIAGNOSTIC ASSESSMENT Diagnostic services for assessing hearing loss that are available at the referral centre should include (5–12): • diagnostic pure tone audiometry (wherever possible, this should include bone conduction testing); • otoscopic or microscopic examination; and • tympanometry or other measures of middle-ear status. The type of diagnostic test conducted should be decided by the ear and hearing care clinician following an examination. Specialized neurological or radiological tests may be required. 2.10 INTERVENTION All children identified with hearing loss or ear diseases should have rapid access to interventions. The need for such services should be based on advice by clinicians through a person-centred approach, taking into account: (1) • the nature and severity of the hearing loss; • ear diseases and possible complications; • comorbidity/ies; • family preferences for type of intervention; • available resources; and • cultural considerations. The range of services for intervention include: (1) • the medical management of ear diseases; • middle-ear surgery; • the use of hearing technologies, such as hearing aids, or other implantable devices, such as middle-ear or cochlear implants; • the use of hearing assistive technologies, such as hearing induction loops; hardwired, FM, or infrared systems; or remote microphone systems (direct auditory input devices); • rehabilitative therapy; • sign language and other means of sensory substitution, as appropriate (for example speech reading and finger spelling); or • captioning services. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 29 It is important that parents/caregivers whose children are diagnosed with ear disease or hearing loss receive proper guidance and support, for example through parent-to-parent support groups. In addition, teachers must be informed (through parents/caregivers), of the child’s needs so that in situations where certain adaptations are needed (for example, seating the child at the front of the classroom, reducing background noise levels, using loop systems etc.) these can be made. 2.11 HEARING HEALTH PROMOTION A school screening programme that addresses ear and hearing problems provides an opportunity to promote ear and hearing health. Children, their families/caregivers, teachers and school staff should be provided with information on the importance of: • hearing health; • ear care, including the “do-s and don’t-s” for healthy hearing;5 and • safe listening, including use of hearing protection, safe listening practices and available tools such as safe listening apps. 2.12 DATA MANAGEMENT The principles of data management should be outlined clearly in the implementation guidelines as a requirement, and a reporting mechanism and quality control process defined. Data management protocol should consider: • The notification of test results to parents and teachers. • Confidentiality of results. • The recording of results and maintaining a database that includes: – screening data with date/s (e.g. screening outcome for each frequency, noise levels of the screening environment); – recommendations made; – personnel conducting follow-up; and – monitoring of outcomes in children referred under the programme. • Regular reporting to address questions such as: – What percentage of the target population was screened? – Of those screened, what percentage was referred for further ear and hearing assessment? 5 Flyer on ear care (English): https://who.canto.global/s/Q2CPO HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION30 – Of those referred, what percentage received a professional ear and hearing assessment? – What percentage of those screened was found to have an ear disease or hearing problem? – What types of ear diseases or hearing problems were identified? • Data analysis and reporting: – to monitor trends over time; – to showcase the need for ear and hearing screening in schools; – for quality control; and – for training and feedback to testers and educators. 2.13 PREREQUISITES FOR ESTABLISHING SCHOOL-BASED EAR AND HEARING SCREENING When planning ear and hearing programmes in schools, the following factors must be considered: • Ear and hearing care services must be available for referred children, or be developed concurrently. • Noise levels at the screening site must be controlled. • Screening must be calibrated regularly (preferably at least once annually), using reliable equipment. • Consent or assent must be given by the parent/caregiver and child (active or passive, in line with local policies). • Normal asepsis measures must be established for infection control. • Management and accountability of the programme must be ensured. • Procedures must be in place for follow-up of referrals. 2.14 USE OF TELEMEDICINE FOR SCHOOL-BASED SCREENING (20) In areas that have human resource limitations, ear and hearing screening can be undertaken through the application of telemedicine services whereby trained health workers conduct examinations on-site connecting with clinicians in a remote location. 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Wolmarans J, De Sousa KC, Frisby C, Mahomed-Asmail F, Smits C, Moore DR, et al. (2021). Speech recognition in noise using binaural diotic and antiphasic digits-in-noise in children: maturation and self-test validity. J Am Acad Audiol; IN PRESS. 18. Denys S, Hofmann M, Luts H, Guérin C, Keymeulen A, Van Hoeck K, et al. School-age hearing screening based on speech-in-noise perception using the digit triplet test. Ear Hear. 2018 Nov/ Dec;39(6):1104–1115. doi:10.1097/AUD.0000000000000563. 19. Shinn JR, Jayawardena ADL, Patro A, Zuniga MG, Netterville JL. Teacher prescreening for hearing loss in the developing world. Ear Nose Throat J. 2019 Oct 13. doi:10.1177/0145561319880388. Epub ahead of print. 20. Emmett S, Robler SK, Wang NY, Labrique A, Gallo JJ, Hofstetter P. Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska. BMJ Open. 2019;9(1):e023078 (doi:10.1136/bmjopen-2018-023078, accessed 18 May 2021). 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HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 35 3 HEARING SCREENING IN OLDER PEOPLE 3.1 NEED AND RATIONALE Global Burden of Disease estimates suggest that over 65% of the global population aged over 60 years experiences some degree of hearing loss (1). Given the global demographic trends (2), the need for hearing care among older people is likely to continue rising in the coming decades (3). The consequences of unaddressed adult-onset hearing loss include social withdrawal and isolation, emotional dysfunction, threats to personal relationships, loss of productivity and wages, early retirement, and mental and physical decline including poor balance and falls (4–10). Hearing loss in older people is significantly associated with increased risk of dementia and cognitive decline. Given the high prevalence of hearing loss in older people and the degree of its association with dementia, addressing hearing loss may contribute to reducing the risk of dementia by 8% at the population level (11). Indeed, at the population level, hearing loss is the most common potentially modifiable factor for dementia among older people. Early detection of hearing loss and appropriate interventions can mitigate many of the associated adverse effects in older people (12–14). However, the onset of hearing loss is often subtle and can go unrecognized (15). Notably, people aged in their 60s with unacknowledged or unaddressed hearing loss are at increased risk of social isolation and cognitive decline (16). Despite the functional limitations associated with hearing loss (17), people typically wait as long as 10 years before seeking any hearing care (18, 19). Hence, it is important to implement systematic hearing screening in older people followed by prompt rehabilitation (such as hearing aid fitting) (4, 17, 20). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION36 Although the cost–effectiveness of hearing screening in older people has not been studied extensively, limited available literature describes how an increased use of hearing care (21) is associated with a positive improvement to the quality of life of older people, as well as economic gains to society (18, 22). 3.2 SCREENING PRACTICES AROUND THE WORLD Globally, guidelines for hearing screening in older people are limited. Where guidelines have been developed, they vary substantially in their recommendations (23–26). In some countries, hearing screening is implemented solely for those with clinical indications or concerns; in others, annual or 3-yearly screening is recommended. Age groups for screening also vary, as do methods of testing and follow-up (23, 25, 26). In 2021, the United States Preventive Services Task Force (27) concluded that at present there is insufficient evidence for screening asymptomatic adults aged 50 years and older for hearing loss. Overall, there is a lack of universal guidelines for when and how older people should be screened. The limitation in available evidence to support systematic screening for hearing loss among older people is a primary barrier to expanding hearing screening. The relative lack of evidence underlines the importance of research across diverse settings and countries. With an ageing global population, and increasing evidence of the negative ramifications of adult-onset hearing loss, action is needed. With the growing understanding of the importance of systematic hearing screening followed by intervention in older people (17, 28), the guidance outlined below provides a basis for countries to plan, implement and evaluate their own hearing screening programmes. The recommendations presented are based on current understanding and available evidence and are subject to future revision. The development of programmes for hearing screening of older people in coming years is likely to boost the available limited body of evidence, so that screening protocols can be refined and high-quality guidelines established. 3.3 GUIDING PRINCIPLES OF HEARING SCREENING IN OLDER PEOPLE The principles underpinning hearing screening programmes for older people include the following: • Diagnostic audiology services must be developed in parallel with screening programmes and should be available to those referred through screening programmes. • Interventions, including hearing technology and rehabilitation services, must be made available and recommended based on a person-centred approach; they must support the individual’s listening needs and preferences, and not be based solely on the audiological test results. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 37 • The care pathways and follow-up mechanisms should be outlined at the time of intervention planning and integrated in the comprehensive care pathway. This is essential so that people identified with hearing loss can benefit from options for person- centred care following the screening (1). • Wherever feasible, hearing screening should be part of routine health checks or combined with other health interventions (e.g. general physical check-up, eye screening, dental care etc.). The WHO ICOPE handbook recommends to screen hearing capacity in conjunction with other domains of intrinsic capacity (malnutrition, cognition, mobility, mood, vision) as well as underlying diseases. It can also be included in evaluation of people with comorbidities such as those with diabetes and cognitive impairments. • The components of professional accountability, risk management, quality assurance, and programme evaluation must be developed prior to implementation of any screening programme. 3.4 TARGET GROUP AND AIMS All older people should be screened with the aim of identifying, at the earliest possible stage, those with hearing loss who would benefit from the use of hearing technology or from non- technological interventions such as education, counselling and communication training. (The target group does not include those who are currently enrolled in workplace hearing conservation programmes for exposure to noise or chemicals. Those services are outside the scope of this document and should not be influenced or altered by age- based hearing screening.) 3.5 AGE FOR SCREENING AND FREQUENCY All adults, from the age of 50 years should be screened regularly for hearing loss. Screening may be conducted at 5-yearly intervals until the age of 64 years. From 65 years of age, the frequency of screening should be increased to every 1–3 years (23, 26). Wherever possible, hearing screening schedules should align with other health checks. 3.6 SITE OF SCREENING Screening can take place in a variety of settings including: • clinical settings: primary care centres, physician’s clinics, hospitals, audiology clinics; • community settings: public facilities such as recreation centres and libraries; or • home settings: private homes or long-term care facilities for older people. In each of the settings, tests can be administered in-person or online. The site selection should be based on local context, ease of access for older people, availability of human HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION38 resources and ability to ensure control of background noise levels during testing so that accurate test results can be obtained. Screening in home settings can be conducted during home care services visits. 3.7 SCREENING TESTS There are two stages of testing for hearing loss in older people: Step 1: All those undergoing screening should be asked about the status of their hearing and experience of hearing difficulties in day-to-day life using simple questions, examples of which are outlined in Box 3.1. As far as possible, validated questions with established psychometric properties should be used. Box 3.1 Examples of questions for screening A. Yes/No questions: • Do you have a hearing problem now? (29) • Do you have a diagnosed hearing loss? • Do you use hearing aids? B. Scaled questions: • How would you characterize your hearing (using a hearing device if you use one)? (30) – Excellent – Very good – Good – Fair – Poor C. Existing screening questionnaire • The hearing handicap inventory for the elderly (HHIE) (31). A positive response to the question or questionnaire indicates a hearing problem, and the person should be referred for audiological assessment rather than be sent for screening. If the person already has a diagnosed hearing loss or uses a hearing aid, referral for audiological assessment may be unnecessary at times. However, it may still be required if there has been no recent follow up with an ear and hearing care professional. The person may be directed directly for such consultation without having to undergo Step 2. With individuals whose response is negative (i.e. they do not report a hearing problem), a second screening test should be undertaken (Step 2). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 39 Step 2: The following tests, described in Table 3.1, are used to check for hearing loss in older people: • Detection of pure tones in both ears at a fixed decibel level. • Digit triplet-in-noise test. • Determination of air conduction thresholds through pure-tone threshold screening. • Whispered voice test. Table 3.1 Tests for screening in older people Screening test Setting Testing method Refer criteria Detection of pure tones in both ears at a fixed dB level. Most suitable when screening is undertaken in a community setting or in clinical settings other than an audiology clinic. Both ears should be tested separately, at three frequencies (1 kHz, 2 kHz and 4 kHz), at a fixed dB level of 35 dBHL. Failure to respond at 35 dBHL at one or more frequencies in either ear.* Digit triplet-in-noise test. Both ears tested together through digit triplet-in- noise test, such as the WHO hearWHO A low score that corresponds to a dB cut-off of 35 dBHL e.g. A score below 50 on the hearWHO test. Determination of air conduction thresholds through pure tone screening. Audiology clinic. Both ears tested separately for air conduction thresholds. Four frequencies (0.5 kHZ, 1 kHz, 2 kHz and 4 kHz) Hearing threshold calculated as an average of the four frequencies. An average hearing threshold below 35 dBHL. Whispered voice test This should be the preferred option only when other tests are unavailable. See Annex 3 (Whispered voice test). See Annex 3 (Whispered voice test). * Where the capacity of the health system permits, and it is considered more suitable, mild hearing loss can also be identified (i.e. a hearing level above 20 dB may be set as the criterium). When undertaking any of the above-described tests, it is important to ensure that levels of background noise are below 40 dBA (32). This can be ensured by testing with a sound level meter or with use of a validated smartphone app.6 6 Some examples of validated apps that can be downloaded for use: NIOSH Sound Level Meter, Sound Meter Pro, or Sound Meter and Noise Detector. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION40 3.8 FOLLOW-UP a) “Pass” result: All those with a “pass” result in the screening should be advised to: • care for their ears and be provided with relevant information about hearing, listening function in everyday life, and ear and hearing care;7 • undergo another screening at a specified future time point (at least after a period of 5 years or 2 years, depending on age); • seek medical care in the event of any symptom such as increased hearing difficulty, tinnitus, ear discharge etc. b) “Refer” result: All those who are referred through hearing screening should: • be asked about the presence of any “red flag” alerts (see Box 3.2); • have an ear examination to assess for wax impaction and its removal; • have a repeat hearing screening following the removal of wax. • in cases where, after wax removal and repeat screening, another “refer” result is given, undergo diagnostic testing, which, if possible, should be conducted during the same visit to minimize patient discomfort and maximize compliance. c) Red flags: All those with a “red flag” alert following screening should be referred to an ear and hearing care clinician for further assessment, irrespective of the screening outcome. Box 3.2 “Red flag” alerts A “Red flag” alert following screening indicates the need for expert attention and can result from: • a history of rapidly progressive hearing loss or unilateral hearing loss of unknown origin; • exposure to noise (at work, home or in recreational activities) or ototoxic medicines/ chemicals; • complaint of ear pain, ear discharge or dizziness; and • a pre-existing diagnosis of ear disease, such as chronic otitis media. All individuals who are referred for further assessment should be followed up to ensure that they are able to access the diagnostic services and care they need. The processes of screening, referral and follow-up are described in Figure 3.1. 7 Flyer on ear care (English): https://who.canto.global/s/Q2CPO HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 41 Figure 3.1 Steps in hearing screening and follow-up of older people* (17) Adult Hearing Screening [Adult≥ 50yrs] Screening question/s [Box 3.1] Reported hearing loss/difficulty hearing Referal to diagnostic audiology Initial Hearing Screen NO reported hearing loss/difficulty hearing Ear and Hearing care clinician YES Red Flags NO Red Flags ADVICE • care for ears • when to re-screen • access medical care if symtoms develop *Adapted from the WHO Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. See: https://apps.who.int/iris/handle/10665/326843. Otoscopic examintion for wax NO Wax present Wax present Wax removal Repeat Screen REFERPASS Red flag alerts [Box 3.2] REFERPASS HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION42 3.9 HUMAN RESOURCES Hearing screening in older people can be performed by the following cadres: • Ear and hearing care clinicians (e.g. ENT specialists, audiologists, speech and language pathologists). • Non-hearing care clinicians (e.g. family doctor, physicians). • Trained health workers (e.g. clinical officers, medical assistants, technicians, nurses, pharmacists or other allied health professionals). • Trained lay health workers (e.g. community health workers). • Others such as trained volunteers. Where hearing screening is to be performed by health workers or other non-clinicians, training should be provided initially, followed by supervision and ongoing support, the level of which will depend on the test they are trained to administer. 3.10 DIAGNOSTIC ASSESSMENT All those who obtain a “refer” result after wax removal (if this was indicated) should undergo a diagnostic hearing assessment to confirm hearing loss and establish degree and nature. This helps identify the need for rehabilitation and/or other interventions and should include at a minimum: • pure-tone audiometry (PTA): air- and bone-conduction; and • tympanometry for middle ear assessment. Wherever it is feasible to do so, speech audiometry should be undertaken as this can offer valuable information regarding everyday functioning. Basic diagnostic assessments can be conducted by an ear and hearing care professional or other trained personnel. 3.11 INTERVENTION Once a diagnosis of hearing loss has been made, the interventions must include option (a) and may include options (b) (c) or (d): (a) Basic education and counselling on hearing loss for people with hearing loss, their caregivers and families, to facilitate psychological acceptance and adjustment. This should also include communication training and adaptations in social and physical environments and peer mentoring. (b) The need for, and type of, hearing technology should be assessed and whichever technology is required (e.g. hearing aids, implant, hearing assistive technologies) should be provided and fitted by a trained professional who is authorized to do so (in line with local rules and regulations). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 43 (c) Further or more advanced testing, where this has been indicated by the nature of hearing loss or associated symptoms. (d) Repeat testing at a later date, as considered necessary. Once hearing loss is identified, it is essential that it is addressed as early as possible and in an appropriate manner to mitigate any adverse impact. Intervention strategies must adopt a person-centred approach, taking into account the individual’s communication needs and preferences, as well as available resources (1) (Figure 3.2). Intervention strategies should also address the individual’s social and physical environments (Box 3.3), including guidance regarding hearing assistive technologies (such as FM systems and hearing induction loops), captioning, speech reading and communication strategy training. Some people (and their families/caregivers) may benefit from counselling to help them accept and adjust to the hearing loss, including learning to overcome the stigmatizing attitudes of others towards hearing loss. Others may also need care for related comorbidities, such as cognitive decline or dementia. Figure 3.2 Person centred ear and hearing care AVAILABLE RESOURCES What resources are possible given the environment, health infrastructure and clinical services available CLINICAL PROFILE – WHICH INCLUDES: Otological status Audiological profile: degree; type; age of onset Other functional limitations such as visual impairment; developmental disabilities e.g. autism COMMUNICATION NEEDS – WHICH INCLUDE: Hearing difficulties experienced Communication requirements COMMUNICATION PREFERENCES – SUCH AS: Oral–aural Visual/tactile HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION44 Box 3.3 Assessing and managing social and physical environments* • Provide support and help with managing emotional distress. • Provide hearing assistive technologies around the house (e.g. vibrating or flashing telephones and doorbells). • Provide the individual and their family/caregiver with strategies to stay connected and maintain social relationships. *Adapted from the WHO Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. See: https://apps.who.int/iris/handle/10665/326843. 3.12 HEARING HEALTH PROMOTION Those who receive a “pass” result for their hearing screening test, should be provided with information regarding the prevention of hearing loss and care of ears, including: • the importance of hearing health; • ear care, including the “do-s and don’t-s” for healthy hearing;8 • noise control in the environment; ear protection at home and in the workplace; • safe listening including the importance of, and means for, safe listening practices; and • the importance of communication for maintaining participation in activities of everyday life. REFERENCES 1. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 2. United Nations Population Fund. World population trends (https://www.unfpa.org/world-population- trends, accessed 18 May 2021). 3. World Health Organization. Addressing the rising prevalence of hearing loss. 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American Speech-Language-Hearing Association. (1997). Guidelines for audiologic screening [Guidelines] (https://www.asha.org/policy, accessed 18 May 2021). 24. Alberta College of Speech-Language Pathologists and Audiologists. Hearing screening guideline preschool to adult. 2015 Sept (https://silo.tips/download/september-2015-hearing-screening- guideline-1, accessed 18 May 2021). HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION46 25. Moyer VA. Screening for hearing loss in older adults: U.S. preventative services task force recommendation statement. Clinical guidelines. 2012 Nov. (https://doi.org/10.7326/0003-4819- 157-9-201211060-00526, accessed 18 May 2021). 26. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016. 27. US Preventative Services Task Force. Screening for hearing loss in older adults. 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HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 47 ANNEX 1 COMPONENTS OF A TRAINING PROGRAMME FOR NEWBORN HEARING SCREENING IDENTIFICATION OF TRAINERS • It is recommended that training and assessment of competency be undertaken by professionals with experience in hearing screening techniques and practices (for example audiologists, otologists or experienced screening programme managers), in conjunction with training input from equipment manufacturers. • Organizing a “train-the-trainer” educational programme would help increase the numbers of trainees for screening. TRAINING PROGRAMME • Course components of a training programme should include: screening procedures and equipment use; calibrating and maintaining equipment; optimizing the screening state of the infant; explaining test procedures and results; and documenting and reporting test results. • Training should be delivered face-to-face and include practical learning experience. • Attention should be paid to infection control procedures and infant handling skills. REVISION TRAINING • It is recommended that regular educational in-service training for screeners is conducted and that screening personnel demonstrate the required competency and skills to perform the hearing screen. TRAINEES MUST COMPLETE A MINIMUM INITIAL TRAINING AND DEMONSTRATE COMPETENCY AND SKILLS IN THE FOLLOWING AREAS: • Benefits of hearing screening. • Clinical screening procedures, ensuring: – a quiet screening space; – an ideal screening state (e.g. for infants, preferably sleeping or settled); – correct preparation and set-up; HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION48 – correct probe positioning (i.e. verifying ear canal is open and patent). • How to perform the screening; equipment uses and care: – Conducting the daily probe or headphone calibration and checking to minimize errors with, for example: ‚ poor connections between probe and hardware; or ‚ problems related to debris or wax blocking the speaker or microphone ports in the probe tip. • Policies and procedures of the hospital or other health facility for hearing screening. • Risks, including psychological stress of the parents. • General care and handling of infants in hospital settings, especially NICU infants, in line with the hospital policies and procedures. • Documentation in the medical file to include: – obtaining signed consent form; – recording results (e.g. Bilateral PASS; Unilateral REFER; Incomplete; Declined screen); – screening method used (e.g. Screening TEOAE, Screening DPOAE, Screening ABR,9 whispered voice test, pure tone audiometry screening); and – making a referral – and the referral centre. • Communication of results to parents/guardian and other health professionals, to include: – explaining the screening result – e.g. what the result means, the next steps (e.g. referral to diagnostic assessment for a “Refer” result or follow-up after 6 months of age in cases where the child has been identified with a risk factor for hearing loss). – ensuring the parents/guardian understand the importance of immediate follow-up. • How best to respond if a parent/guardian declines a screening. • Reporting and data collection, keeping in mind: – confidentiality of screening data; and – relevant regulations/laws. • Required hospital and other health clinic mandatory training, such as: – infection control practices and hand hygiene; – security; and – fire safety training. • Cultural sensitivity. 9 TEOAE: transitory evoked otoacoustic emission; DPOAE: distortion product otoacoustic emission; ABR: auditory brainstem response. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 49 EXAMPLES OF TRAINING PROGRAMMES • In the United Kingdom of Great Britain and Northern Ireland: https://www.gov.uk/ government/publications/newborn-hearing-screening-programme-nhsp-operational- guidance/2-education-and-training. • In Utah, USA: http://www.infanthearing.org/nhstc/. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION50 ANNEX 2 DISTRACTION TEST FOR IDENTIFYING HEARING LOSS IN CHILDREN REQUIREMENTS: • Two people to perform the test, one as the distractor and one as the tester. • Colourful wooden blocks or similar toy (the toy should not make any noise). • A towel or sheet. • Rattle (if available). PROCEDURE: 1. Make sure you are in a quiet room. 2. The infant should sit in the lap of the parent. The parent should be asked to stay still and silent. 3. The distractor should sit in front of the infant, with the wooden blocks (or other toy). 4. The tester should sit behind and to the side of the infant, holding the rattle. The tester should be about one metre away from the infant. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 51 5. The distractor plays a game with the infant. For example, putting wooden blocks on top of each other. 6. The distractor stops playing and covers the blocks (or the toy) with a towel or sheet. 7. The tester gently shakes the rattle for five seconds. The infant should turn to the noise. 8. The tester moves to behind the other side of the infant. Steps 5 to 7 are repeated. 9. Repeat steps 5 and 6. Do not make any noise. The infant should not turn its head. This confirms that the infant is actually turning their head because of the sound. 10. If the infant does not turn, the test can be repeated with a louder sound. If there is no response the child should be sent to a specialist for further tests. Additional notes: If a rattle is not available, the tester can use their voice. A low pitch “oooo” sound and a medium pitch “eeee” sound should be used on each side. Its important to note that this method is not always reliable or validated. In case of any doubt, REFER! HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION52 ANNEX 3 WHISPERED VOICE TEST 10 Adapted from the University of California, San Francisco, United States of America (https://geriatrics.ucsf.edu/sites/geriatrics.ucsf.edu/files/2018- 06/whispertest.pdf, accessed 18 May 2021). A whispered voice test should be the preferred option only when other methods for testing are unavailable. Conducting a whispered voice test:10 Figure A1 The University of California Whisper Test With the patient sitting on an exam table or chair, stand an arm’s length away (approximately 2 ft.) behind the patient. 1 8-M-3 2-J-7 K-5-R S-4-G 2 7 8 The Whisper Test Tell the patient: “During the hearing test, I will ask you to cover the ear that is not being tested as I say the letters and numbers out loud. You will cover your ear by putting your finger over your tragus.” 3 Have the patient cover the ear that’s NOT being tested with one finger over the tragus. Have the patient slowly move the finger in a circular motion. 4 Take a deep breath and exhale fully before whispering the number-letter combination. 5 Give a number-letter-number combination (for example, 4-K-2). 6 Have the patient repeat what they hear. If the patient successfully repeats, move on to testing the other ear. Ensure that the number- letter-number combination is different for each ear. If the patient is unsuccessful, reattempt testing with a different number-letter combination. If a patient gets 3 total letters and/or numbers correct (out of 6 numbers or letters spoken for that ear) after a second attempt, it is considered a pass. 9 Remember to document the results. HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION 53 ANNEX 4 MANAGEMENT OF CONFLICT OF INTEREST All members of the technical working group (TWG) and peer reviewers completed and submitted a WHO Declaration of Interests form and signed confidentiality undertakings prior to attending any TWG meetings and review. The WHO department for Noncommunicable diseases reviewed and assessed the submitted declarations of interest and performed an internet search to identify any obvious public controversies or interests that may lead to compromising situations. If additional guidance on management of any declaration or conflicts of interest had been required, the department would have consulted with colleagues in Office of Compliance, Risk Management and Ethics. If deemed necessary, individuals found to have conflicts of interest, financial or non-financial, would have been excluded from participation on any topics where interests were conflicting. The management of conflicts of interest was reviewed throughout the process. TWG members were required to update their Declaration of Interest, if necessary, before each meeting. Declared interests of the TWG members and reviewers are summarized below. No conflict of interest was identified. Name Expertise Disclosure of interest Management of conflict of interest Arun Agarwal Community ENT None declared None identified Susan Emmett School ear and hearing screening, ENT None declared None identified Catherine Mcmahon Hearing screening in older adults Employment at Macquarie University Research funds NIH/ NIDCD None identified James Saunders ENT, school ear and hearing screening None declared None identified Christine Yoshinaga-Itano Newborn hearing screening Research funds None identified Xingkuan Bu ENT, hearing screening None declared None identified Patricia Castellanos Community audiology None declared None identified Chitra Chander Public health Paid consultancy (WHO) None identified Ivy Chilingulo Public health Paid consultancy (WHO) None identified HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION54 Name Expertise Disclosure of interest Management of conflict of interest Teresa Ching Audiology, hearing screening None declared None identified Jackie Clark Audiology None declared None identified Adrian Davis Audiology, Public health None declared None identified Kathleen Pichora-Fuller Hearing screening in older adults Research funds None identified Jean-Pierre Gagne Adult audiology None declared None identified Carmen Kung Cognitive Neuroscience Research funds None identified Arunda Malachi Public health Paid consultancy (WHO) None identified Vivienne Marnane Speech Pathology Research funds None identified Norberto Martinez ENT and audiology None declared None identified Serah Ndwega Community audiology None declared None identified Katrin Neumann Audiology, newborn screening None declared None identified Carrie Nieman Hearing screening in in older adults, community ENT Employment,- Johns Hopkins University School of Medicine, Research funds-National Institutes of Health, United States None identified Bolajako Olusanya Pediatric audiology Director, Phonics Hearing Centre, Lagos, Nigeria None identified Sowmya Rao Audiology Paid consultancy (WHO) None identified De Wet Swanepoel Audiology, hearing screening technologies Co-founder hearX digital hearing technologies None identified George Tavartkilaze Audiology None declared None identified Peter Thorne Audiology None declared None identified Kelly Tremblay Adult audiology Research funds, University of Washington None identified Katherine Wallis Public health Paid consultancy (WHO) None identified Angela Wong Audiology Research funds None identified HEARING SCREENING: CONSIDERATIONS FOR IMPLEMENTATION World Health Organization Department of Noncommunicable Diseases 20 Avenue Appia 1211 Geneva 27 Switzerland For more details refer to: https://www.who.int/health-topics/hearing-loss

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OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. © Mandke Hearing Services Year of Publication : May 2022 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition [Hearing screening: considerations for implementation]. Geneva: World Health Organization; [2021]. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 hm AZwdmX OmJ{VH$ Amamo½¶ g§KQ>ZoÛmao Ho$bobm Zmhr. ¶m AZwdmXmMr AMyH$Vm VgoM ¶mVrb ‘OHy$a ¶mgmR>r OmJ{VH$ Amamo½¶ g§KQ>Zm O~m~Xma Zmhr. ‘yi B§J«Or/B§{½be Amd¥Îmr : Hearing screening: considerations for implementation {O{Zìhm : OmJ{VH$ Amamo½¶ g§KQ>Zm; 2021. bm¶gÝg : CC BY-NC-SA 3.0 IGO ~§YZH$maH$ Agob Am{U Añgb / A{Yà‘m{UV Amd¥Îmr Agob. ho AZwdm{XV gm{h˶ /H$m‘ CC BY-NC-SA 3.0 A§VJ©V CnbãY Amho. ‘amR>r nwpñVH$m: VÁk: S>m°. H$ë`mUr ‘m§S>Ho$, ldUemók, nwUo. ^mfm§VaH$ma: S>m°. AmZ§{XZr jragmJa, nwUo. `m ‘amR>rVrb nwpñVHo$~Ôb H$moUË`mhr ñdê$nmÀ`m e§H$m Agë`mg H¥$n`m nwT>rb B©-‘ob nÎ`mda S>m°. H$ë`mUr ‘m§S>Ho$ `m§À`mer g§nH©$ gmYmdm: kalyani.mandke@gmail.com OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 3 G$U{ZX}e g§{já ê$no àñVmdZm 1 ZdOmV A^©Ho$ d bhmZ ‘wbo `m§Mr ldU nS>Vmim MmMUr 1.1 Amdí`H$Vm d Ë`mMr H$maUo 1.2 gÚpñWVr d nÕVr 1.3 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo 1.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o 1.5 nS>Vmim MmMUrMr {Z`‘mdbr 1.6 nS>Vmim MmMUrH$[aVm d` d {ZYm©[aV H$mbmdYr 1.7 nS>Vmim MmMUr 1.8 ‘mZdr g§gmYZo 1.9 nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm 1.10 Z¡Xm{ZH$ ‘yë`‘mnZ 1.11 CnMma 1.12 nwT>rb nS>Vmim MmMUrÀ`m Amdí`H$VoMo {ZX}eH$ 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© g§X^© 2 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr 2.1 Amdí`H$Vm d Ë`mMr H$maUo 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o 2.4 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm 2.5 nS>Vmim MmMUrMo {R>H$mU 2.6 nS>Vmim MmMUr 2.7 ‘mZdr g§gmYZo 2.8 nwT>rb nS>Vmim MmMUrÀ`m Amdí`H$VoMo {ZX}eH$ 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ 2.10 CnMma 2.11 ldU Amamo½`m{df`rMm àMma 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar 2.14 Q>obr‘o{S>{gZ: emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm `mMm dmna g§X^© 3 Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr 3.1 Amdí`H$Vm d Ë`mMr H$maUo 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm 3.6 nS>Vmim MmMUrMo {R>H$mU 3.7 nS>Vmim MmMUr 3.8 nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm 3.9 ‘mZdr g§gmYZo 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ 3.11 CnMma 3.12 ldU ñdmñÏ` `m{df`rMm àMma g§X^© n[a{eï> 1 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm à{ejU H$m`©H«$‘mMo KQ>H$ n[a{eï> 2 bhmZ ‘wbm§‘Yrb ldU Xmof AmoiIÊ`mH$[aVm bj {dM{bV H$aUmar MmMUr n[a{eï> 3 Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr (Whisper Test) n[a{eï> 4 nwT>o Z‘yX Ho$boë`m g{‘Vr‘Yrb gd© gXñ`m§Mo {hVg§~§Y OnÊ`mVrb g§Kfm©Mo ........ ì`dñWmnZ (Conflitct of Interest) AZwH«$‘{UH$m OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo4 G$U{ZX}e g§{já ê$no àñVmdZm 1 ZdOmV A^©Ho$ d bhmZ ‘wbo `m§Mr ldU nS>Vmim MmMUr 1.1 Amdí`H$Vm d Ë`mMr H$maUo 1.2 gÚpñWVr d nÕVr 1.3 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo 1.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o 1.5 nS>Vmim MmMUrMr {Z`‘mdbr 1.6 nS>Vmim MmMUrH$[aVm d` d {ZYm©[aV H$mbmdYr 1.7 nS>Vmim MmMUr 1.8 ‘mZdr g§gmYZo 1.9 nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm 1.10 Z¡Xm{ZH$ ‘yë`‘mnZ 1.11 CnMma 1.12 nwT>rb nS>Vmim MmMUrÀ`m Amdí`H$VoMo {ZX}eH$ 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© g§X^© 2 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr 2.1 Amdí`H$Vm d Ë`mMr H$maUo 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o 2.4 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm 2.5 nS>Vmim MmMUrMo {R>H$mU 2.6 nS>Vmim MmMUr 2.7 ‘mZdr g§gmYZo 2.8 nwT>rb nS>Vmim MmMUrÀ`m Amdí`H$VoMo {ZX}eH$ 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ 2.10 CnMma 2.11 ldU Amamo½`m{df`rMm àMma 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar 2.14 Q>obr‘o{S>{gZ: emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm `mMm dmna g§X^© 3 Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr 3.1 Amdí`H$Vm d Ë`mMr H$maUo 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm 3.6 nS>Vmim MmMUrMo {R>H$mU 3.7 nS>Vmim MmMUr 3.8 nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm 3.9 ‘mZdr g§gmYZo 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ 3.11 CnMma 3.12 ldU ñdmñÏ` `m{df`rMm àMma g§X^© n[a{eï> 1 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm à{ejU H$m`©H«$‘mMo KQ>H$ n[a{eï> 2 bhmZ ‘wbm§‘Yrb ldU Xmof AmoiIÊ`mH$[aVm bj {dM{bV H$aUmar MmMUr n[a{eï> 3 Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr (Whisper Test) n[a{eï> 4 nwT>o Z‘yX Ho$boë`m g{‘Vr‘Yrb gd© gXñ`m§Mo {hVg§~§Y OnÊ`mVrb g§Kfm©Mo ........ ì`dñWmnZ (Conflitct of Interest) OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 5 This Handbook, Hearing screening considerations for implementation, is the outcome of a consultative process led by the World Health Organization. It was drafted by Shelly Chadha under the guidance of Alarcos Cieza and Bente Mikkelsen. Members of the technical working groups and external reviewers who contributed to the development and review of this Handbook include Arun Kumar Agarwal (Director Professor (retired), Maulana Azad Medical College, India); Xingkuan Bu (Medical Director and Professor of ENT Department, Nanjing Medical University, China); Patricia Castellanos (Audiologist, Medical Director of CEDAF, Guatemala); Teresa Ching (Head of Communication Sciences Department, National Acoustic Laboratories, Australia; Honorary Senior Research Fellow, Macquarie University, Australia); Jackie Clark (Co-chair, Coalition for Global Hearing Health; Professor of Audiology, University of Texas, United States of America); Adrian Davis (Visiting Professor of Audiology and ENT, Imperial College London, United Kingdom of Great Britain and Northern Ireland); Susan Emmett (Assistant Professor of Surgery and Global Health, Duke University School of Medicine, USA); Jean-Pierre Gagné (Professor, School of Speech-Language Pathology, University of Montreal, Canada); Norberto Martinez (Professor, Department ORLHNS, University of Santo Tomas, Philippines); Catherine McMahon (Professor of Audiology, Macquarie University, Australia); Serah Ndwega (Audiologist, University of Nairobi, Kenya); Katrin Neumann (Professor of Phoniatrics and Pedaudiology, and otolaryngologist, University Clinic of Münster, Germany); Carrie Nieman (Assistant Professor, Department OHSN, Johns Hopkins University, USA); Bolajoko Olusanya Bolajoko Olusanya (Director, Centre for Healthy Start Initiative, Nigeria); Kathleen Pichora-Fuller (Professor Emeritus, Department of Psychology, University of Toronto, Canada); James Saunders (Professor and Co-chairperson,Coalition for Global Hearing Health; Professor of Otology / Neurotology, Dartmouth-Hitchcock Medical Center, USA); De Wet Swanepoel (Professor of Audiology, University of Pretoria, South Africa); George Tavartkiladze (Professor and Director of the National Research Centre for Audiology and Hearing Rehabilitation, Russian Federation); Peter Thorne (Professor of Hearing Science, University of Auckland, New Zealand); Kelly Tremblay (Professor (retired), University of Washington, USA, Adjunct Professor, Dalhousie University, Canada); and Christine Yoshinaga-Itano (Research Professor, University of Colorado, USA). Support in compilation and drafting was provided by Sowmya Rao. The background research work was facilitated by Chitra Chander (Public health specialist, India); Ivy Chilingulo (Researcher in public health, Lund University, Sweden); Carmen Kung (Senior research scientist, National Acoustics Laboratories, Australia); Vivienne Marnane (Research project coordinator, National Acoustics Laboratories, Australia); Katherine Wallis (Researcher in public health, Lund University, Sweden); and Angela Wong (Research audiologist, National Acoustics Laboratories, Australia). The following WHO staff members contributed to the technical content and its review: Rajiv Bahl, Jean-Marie Dangou, Karen Margaret Edmond, Carolina Hommes, Kaloyan Kamenov, Satish Mishra, Elick Narayan, Patanjali Nayar, Karen Reyes, David Ross, Ritu Sadana, Hala Sakr, and Yuka Sumi. G$U{ZX}e OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo6 AABR automated auditory brainstem response ABR auditory brainstem response ASSR auditory steady-state response dB decibel dBA A-weighted decibel dBHL decibels hearing level EHC ear and hearing care ENT ear, nose and throat FM frequency modulation HHIE hearing handicap inventory for the elderly ICOPE integrated care for older people IPC-EHC integrated people-centred ear and hearing care JCIH Joint Committee on Infant Hearing kHz kilohertz MPANL maximum permissible level NICU neonatal intensive care unit OAE otoacoustic emission PPV positive predictive value PTA pure-tone audiometry SCN special care nursery TWG technical working group UNHS universal newborn hearing screening USA United States of America WHO World Health Organization g§{já ê$no OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 7 gZ 2050 n`ªV gw‘mao 2.5 AãO ì`º$s¨‘Ü`o H$mhr à‘mUmV ldUXmof {XgyZ `oB©b Agm A§XmO OmJ{VH$ Amamo½` g§KQ>ZoZo ldU{df`H$ OmJ{VH$ Ahdmbm‘Ü`o ì`º$ Ho$bm Amho. Ë`mn¡H$s {H$‘mZ 700 Xebj ì`º$s¨Zm lmì` nwZd©gZ godm§Mr Amdí`H$Vm ^mgob. gÚpñWVrV, hr g§»`m 430 Xebj AgyZ Ë`mV lmì` nwZd©gZ godm§Mm bm^ hmoÊ`mMr eŠ`Vm Agboë`m ‘Ü`‘ qH$dm Ë`mnojm A{YH$ ldUXmof Agboë`m ì`º$s¨Mm g‘mdoe Amho. `mn¡H$s ~hþg§»` ì`º$s¨Mo dmñVì` ho ‘`m©{XV lmì` gw{dYm CnbãY Agboë`m H$‘r d ‘Ü`‘-CËnÞmÀ`m Xoem§‘Ü`o Amho. ldU`§ÌmMm ’$m`Xm hmoD$ eH$Vmo Aem Ho$di 17% bmoH$m§Zm Vo àË`jmV CnbãY AgVo qH$dm Vo Ë`mMm dmna H$aVmV. `m dmñV{dH$Vodê$Z H$mZmMr d ldUXmofmMr H$miOr KoUmè¶m godm§Mr Amdí`H$Vm d Ë`m§Mr CnbãYVm `m‘Ü`o ‘moR>r V’$mdV {XgyZ `oVo. ldUXmofmH$So> Xwb©j Ho$ë`mZo bmoH$m§Mo Amamo½` VgoM gwpñWVr d g§àofU, {ejU d amoOJma `m‘YyZ Vo ~mOybm nS>VmV. Xwb©{jV ldUXmofm‘wio à{Vdfu Odinmg EH$ {Q´{b`Z Am§Vaamï´>r` S>m°bg©Mo ZwH$gmZ hmoVo. ldU{df`H$ OmJ{VH$ Ahdmb hm ZmdrÝ`nyU©, {H$’$m`Vera Vm§{ÌH$ d d¡ÚH$s` Cnm``moOZm§Mr ‘m{hVr XoVmo. Á`m§À`m‘wio ldUXmof {Z‘m©U Pmboë`m ~hþVoH$ ì`º$s¨À`m OrdZ‘mZmMm XOm© gwYmaÊ`mg ‘XV hmoD$ eH$Vo. `m Cnm``moOZm§Mm bmImo ì`º$s AmYrnmgyZM bm^ KoV AmhoV. CÎm‘ gmd©O{ZH$ Amamo½`m{df`H$ YmoaUm§g‘doV V§ÌkmZmÀ`m gm‘Ï`m©À`m ‘oi KmVë`mg Ë`mMo bm^ gdmªn`ªV nmohmoMÊ`mMr ImÌr hmoD$ eH$Vo d Ë`m`moJo gd© bmoH$m§Zm hì`m Ë`m Amamo½` godm hì`m Voìhm CnbãY hmoD$ eH$Vrb `m d¡{œH$ Ñ{ï>H$moZmbm A{YH$ àmoËgmhZ {‘iy eH$Vo. ldU{df`H$ OmJ{VH$ Ahdmb amï´>r` Amamo½` àUmbs¨‘Ü`o bmoH$-H|${ÐV H$mZ d ldUj‘Vm `m XmoÝhs¨Mm g‘mdoe AgUmè¶m XoI^mbrMr {e’$mag H$aVmo d H.E.A.R.I.N.G Cnm``moOZm§Mm (Mm¡H$Q> 1) AmamIS>m ‘m§S>Vmo Omo ldUXmof {Z‘m©U Pmboë`m qH$dm H$mZmMo {dH$ma Agboë`m ì`º$s¨Zm Amdí`H$ Vr XoI^mb d lmì` nwZd©gZ godm {‘iÊ`mMm {dœmg XoVmo. Box 1 H.E.A.R.I.N.G. set of interventions Hearing screening across the life course Am`wî`mÀ`m H$mbmdYrV ldU VnmgUr H$aV amhUo Ear disease prevention and management H$mZmÀ`m {dH$mam§Zm à{V~§Y d Ë`mda CnMma Access to technologies V§ÌkmZmMr CnbãYVm Rehabilitation services nwZd©gZ godm Improved communication gwYm[aV g§dmX Noise reduction AmOy~mOybm Agbobm Jm|JmQ> H$‘r H$aUo Greater community engagement g‘mOmMm gh^mJ àñVmdZm CnMmam§Mm g§M OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo8 ldUXmof {Z‘m©U Pmboë`m bmoH$m§Mo lmì` nwZd©gZ ` eñdrnUo hmoÊ`mH$[aVm bdH$amV bdH$a Cnm``moOZm H$aUo ‘hÎdmMo AgVo H$maU, {db§~ Pmë`mg, ^mfm {dH$mg, g§dmX, BVam§gmo~V AW©nyU© g§~§Y {dH${gV H$ê$Z Vo {Q>H${dUo d AmH$bZeº$s `mda ZH$mamË‘H$ n[aUm‘ hmoVmo. ldUXmof hm S>moù`m§Zm {XgyZ `oV Zgë`m‘wio bhmZ ‘wbo d àm¡T> ì`º$s `m§À`m‘Ü`o Ë`mMo gd©gm‘mÝ`nUo {ZXmZ hmoV Zmhr. `mH$[aVm, Am`wî`mÀ`m {d{dY Q>ßß`m§da ldUXmofmMr nS>Vmim MmMUr H$aÊ`mH$[aVm {deof Cnm``moOZm AmIUo ‘hÎdmMo Amho. (AmH¥$Vr 1) gdm©V OmñV ldU Xmof AgÊ`mMr eŠ`Vm Agboë`m ì`º$s¨‘Ü`o nwT>rb ì`º$s¨Mm g‘mdoe hmoVmo:  ZdOmV A^©Ho$ d VmÝhr ~mio;  bhmZ ‘wbo, {deofH$ê$Z ~mbdmS>rV d emioV OmUmar ‘wbo  Á`oð> ì`º$s; Am{U  Jm|JmQ>, AmoQ>moQ>m°pŠgH$ (H$mZmH$[aVm {dfmar R>aUmar) agm`Zo d AmoQ>moQ>m°pŠgH$ (Ototoxic) Am¡fYm§er g§~§Y ¶oUmè¶m d Ë`m‘wio ldUXmof {Z‘m©U hmoÊ`mMm A{YH$ YmoH$m Agboë`m ì`º$s. AmH¥$Vr 1 Am`wî`mÀ`m {d{dY Q>ßß`m§Xaå`mZ ldUXmof AmoiIUo ZdOmV A^©Ho$: bhmZ ‘wbo: àm¡T> ì`º$s: d`ñH$a àm¡T> ì`º$s: ZdOmV A^©H$mMr ldU nS>Vmim MmMUr ~mbdmS>rV d emio‘Ü`o OmUmè¶m bhmZ ‘wbm§Mr H$mZ VnmgUr d ldU nS>Vmim MmMUr ldUXmof {Z‘m©U hmoÊ`mMm ‘moR>m YmoH$m Agbobm ì`dgm` H$aUmè¶m ì`º$s¨Mr ldU nS>Vmim MmMUr {Z`{‘V ldU nS>Vmim MmMUr Am¶wî¶mÀ¶m {d{dY Q>ß߶m§da ldUXmofmH$[aVm VnmgUr bjUmË‘H$ MmMUr OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 9 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1 See: https://www.agreetrust.org/resource-centre/agree-ii/agree-ii-instructions/. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo10 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 11 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo12 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1.2 gÚpñWVr d nÕVr nS>Vmim MmMUrÀ`m {d{dY nÕVr, MmMUr H$aÊ`mÀ`m {d{dY nÕVs¨Mr ‘mJ©Xe©H$ gyMr d gÚpñWVrV CnbãY Agbobr Amamo½` godm, gm‘m{OH$ d e¡j{UH$ àUmbr ` m§À`mer g§b¾ Xwdo dmnê$Z ZdOmV A^©H$m§H$[aVm ldU nS>Vmim MmMUrMo `eñdr H$m`©H«$‘ AZoH$ Xoem§‘Ü`o am~dÊ`mV Ambo AmhoV (21). àmYmÝ`mZo OJmÀ`m bmoH$g§»`on¡H$s OmñV CËnÞ àJV Agboë`m àXoemV amhmUmè¶m OdiOdi EH$ V¥Vr`m§e bmoH$m§H$[aVm ZdOmV A^©H$m§H$[aVmMo ldU nS>Vmim MmMUr H$m`©H«$‘ nyU©nUo qH$dm Odinmg nyU©nUo CnbãY AmhoV Agm A§XmO Amho (22). Aem H$m`©H«$‘m§À`m A§‘b~OmdUrMo d ì`márMo à‘mU OJ^amV bjUr`{aË`m ~Xbobo Amho. AbrH$So> EH$m àH$m{eV boIm‘YyZ Ago Xe©{dÊ`mV Ambo Amho H$s nS>Vmim MmMUrÀ`m ì`márMm gamgar OrdZ‘mZ d Am{W©H$ gwpñWVr `m§À`mer OdiMm g§~§Y Amho (22). ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrer g§~§{YV YmoaUo, ‘mZdr g§gmYZo, CnH$aUo d Am{W©H$ g§gmYZo `m§Mm A^md hr H$‘r d ‘Ü`‘ CËnÞ Agboë`m Xoem§g‘moaMr AmìhmZo AmhoV. ldUXmof d Ë`mÀ`mer g§~§{YV H$‘rnUmMr ^mdZm `m{df`rÀ`m OmJê$H$VoMm A^md Agë`m‘wio hr AmìhmZo AmUIr dmT>br AmhoV. ho KQ>H$ d g§^mì` Cnm` ho ldU{df`H$ OmJ{VH$ AhdmbmV A{YH$ ñnï> Ho$bo AmhoV (2). OJ^amV Ho$ë`m OmUmè¶m ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUr‘Ü`o XoIrb ’$aH$ Amho. na§Vw, A‘bmV AmUbobr ~hþVoH$ ‘mJ©Xe©H$ VÎdo hr ^mJ 1.3 ‘Ü`o Z‘yX Ho$ë`mZwgma A^©H$m§Mr ldUj‘Vm `mH$[aVm Agboë`m Joint Committee on Infant Hearing - Position Statement `mÀ`m ‘yb^yV VÎdm§da AmYm[aV AmhoV (1,23). ldUXmofmMo ñdê$n d Vrd«Vm, nS>Vmim MmMUrMr gmYZo, d¡Ym{ZH$ AmYma, nmÌ H$‘©Mmar d gj‘ Z¡Xm{ZH$ ldU MmMUr godm ` m§Mr CnbãYVm, gm§ñH¥${VH$ {d{dYVm, CnbãY g§gmYZo d nS>Vmim MmMUrMm IM© Aem AZoH$ KQ>H$m§- da AmYm[aV nS>Vmim MmMUrH$[aVmMr {Z`‘mdbr {dH${gV H$aUo àË`oH$ XoemH$[aVm Amdí`H$ Amho. Ago Oar Agbo Var A^©H$m§À`m ldUj‘VoH$[aVm Joint Committee on Infant Hearing `m§À`m {e’$maes¨Zm AmYma^yV R>aUmar VÎdo hr OmJ{VH$ nmVirda H$aÊ`mV `oUmè¶m ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘hÎdmMr R>aVmV (1). 1.3 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo  ZdOmV A^©H$m§‘Yrb ldU nS>Vmim MmMUr OoWo ì`dhm`© Agob VoWo 1-3-6 `m VÎdmda AmYm[aV Agbr nm{hOo (23, 27) (Mm¡H$Q> 1.1). - gd© A^©H$m§Mr OÝ‘mZ§Va EH$m ‘{hÝ`mÀ`m AmV ldU nS>Vmim MmMUr Pmbr nm{hOo. 1.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m‘Ü`o OÝ‘OmV Agboë`m ldUXmofm~amo~aM AÝ` H$maUm§‘wio {Z‘m©U Pmboë`m ldUXmofmH$So> Xwb©j Ho$bo Va bhmZ ~mbH$m§Mm gd©gmYmaU {dH$mg, {ejU d Ë`m§Mo g‘mOm‘Ü`o {‘giUo `m‘Ü`o J§^ra ñdê$nmMm AS>Wim {Z‘m©U hmoVmo (1,2). ldUXmofmH$So> Xwb©j Ho$ë`mMm n[aUm‘ dmMm d ^mfm A{dH${gV amhÊ`mH$So> hmoVmo, {deofH$ê$Z H$‘r d ‘Ü`‘ CËnÞ JQ>mVrb {dH${gV Xoem§‘Ü`o {XgyZ `oVmo (3). Á`m d`mV CnMma (ÜdZr {ddY©Z qH$dm e¡j{UH$ H$m`©H«$‘m§‘Yrb ZmdZm|XUr) gwê$ Ho$bo OmVmV Vo d` hm Xmof H$‘r H$aÊ`mH$[aVmMm ‘hÎdmMm KQ>H$ Amho (4,5). EH$m ‘hÎdmÀ`m g§emoYZ g§ñWoZo XmIdyZ {Xbo Amho H$s Á`m bhmZ ‘wbm§Mm ldUXmof bdH$a bjmV ` oVmo d Á`m§À`mda doioda CnMma Ho$bo OmVmV Ë`m§À`m‘Ü`o C{eam {ZXmZ H$aÊ`mV Amboë`m d CnMma {‘imboë`m ‘wbm§À`m VwbZoV Mm§Jbo n[aUm‘ {XgyZ `oVmV (4,6-11) (^mJ 1.11 nhm). Aä`mgmVyZ Ago {XgyZ `oVo H$s Or bhmZ ‘wbo OÝ‘V: H$U©~{Ya AgVmV qH$dm Á`m§À`m‘Ü`o Ë`m§À`m Am`wî`mÀ`m gwédmVrÀ`m H$mimVM ldUXmof {Z‘m©U hmoVmo Am{U Á`m ‘wbm§‘Ü`o hm Xmof d`mÀ`m ghm ‘{hÝ`m§À`m AmV bjmV `oD$Z Ë`m§À`mda `mo½` Vo CnMma gwê$ Ho$bo OmVmV Vr ‘wbo nmM dfmªMr hmoB©n`ªV ^mfm {dH$mgmÀ`m ~m~VrV ldUXmof Zgboë`m gd©gm‘mÝ` ‘wbm§g‘mZ åhUOoM Ë`m§À`m g‘d`ñH$m§g‘mZM AgVmV (12-15). ZdOmV A^©H$m§‘Yrb ldUXmof bdH$a bjmV `oD$Z Ë`mda CnMma H$aUo ho ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrÛmao eŠ` Pmbo Amho (NHS) (1,15). ldUnS>Vmim MmMUr Z§Va gm‘mÝ` OrdZ ì`VrV H$aÊ`m- H$[aVm ZdOmV A^©H$mbm Ooìhm VËH$mi d `mo½` ‘XV {‘iVo Voìhm Ho$boë`m ldU nS>Vmim MmMUr‘wio øm ZdOmV A^©H$m§Zm bhmZ d`mVrb {ZXmZ d CnMma VgoM ^mfm d g§àofU {dH$mg `mVrb gwYmaUm `m XmoÝhs¨Mo ‘hÎdnyU© ’$m`Xo {‘iVmV (4,10, 16-19). Á`m A^©H$m§Mr doioda d `mo½` XoI^mb Ho$br OmVo Ë`m§À`m‘Ü`o gwYm[aV gm‘m{OH$ d e¡j{UH$ n[aUm‘ {XgyZ `oÊ`mH$[aVm ho ’$m`Xo Cn`wº$ R>aVmV (2). øm gd© àJVrgmR>r `oUmè¶m IMm©À`m n[aUm‘H$maH$Vo{df`r Ho$boë`m Aä`mgm§Zr nwT>o OmD$Z àJV, ‘Ü`‘ Am{U H$‘r àJV Xoem§‘Ü`o OmJ{VH$ nmVirda Ho$ë`m OmUmè¶m ZdOmV A^©H$m§‘Yrb ldU nS>Vmim MmMUrMo Am{W©H$ ’$m`Xo XmIdyZ {Xbo AmhoV. 1 ZdOmV A^©Ho$ d bhmZ ‘wbo `m§Mr ldU nS>Vmim MmMUr - gd© ZdOmV A^©Ho$ Á`m§Mr gwédmVrMr nS>Vmim MmMUr d Ë`mZ§Va Ho$br OmUmar nS>Vmim MmMUr `m‘YyZ Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm AmT>iyZ Amë`mg, A^©H$mÀ`m ldU pñWVrMr ImÌr H$aÊ`mH$[aVm 3 ‘{hÝ`m§À`m AmV Ë`mMo `mo½` Ago ldUj‘VoMo {ZXmZ H$aUmao ‘yë`m§H$Z Ho$bo nm{hOo. - EH$Xm H$m ldUXmofmMo {ZXmZ Pmbo H$s ZdOmV A^©H$ d Ë`mMo Hw$Qw>§~r` `m§Zm bdH$amV bdH$a CnMma CnbãY Pmbo nm{hOoV. {ZXmZ Pmë`mda eŠ` {VVŠ`m bdH$a Am{U 6 ‘{hÝ`m§À`m AmV CnMma gwê$ Pmbo nm{hOoV.  Ooìhm ZdOmV A^©H$m§Mm OÝ‘ àm‘w»`mZo é½Umb`mì`{V[aº$ BVa {R>H$mUr qH$dm OoWo Amamo½` godm ‘`m©{XV ñdê$nmV CnbãY Amho qH$dm OoWo MmMUrMr 1-3-6 H$mb‘`m©Xm nmiUo eŠ` Zmhr Aem {R>H$mUr hmoVmo, Aem doir ZdOmV A^©H$m§H$[aVmÀ`m OmJ{VH$ nmVirdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§Zr `mda Cnm` emoYÊ`mMm à`ËZ Ho$bm nm{hOo.  ZdOmV A^©H$m§H$[aVmÀ`m OmJ{VH$ nmVirdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo gÚpñWVrV CnbãY Agboë`m Amamo½`godm, e¡j{UH$ qH$dm gm‘m{OH$ àUmbr `m§À`mgmo~V EH${ÌH$aU qH$dm g§b¾rH$aU Pmbo nm{hOo d H$m`©nÕVr VgoM n[aUm‘ `m§Mo XñVEodOrH$aU H$ê$Z Ë`m§Mr ‘m{hVr gdmªZm {Xbr Jobr nm{hOo (28). hr H$m`©àUmbr OoWo eŠ` Agob VoWo bmJy H$amdr.  amÁ` Am{U amï´>r` ‘mJ©Xe©H$ VÎdm§Zwgma Hw$Qw>§~mMr g§‘Vr KoÊ`mÛmao ZdOmV A^©H$ d Ë`mMo Hw$Qw>§~ `m§Mo h¸$ VgoM JmonZr`Vm `m§Mr h‘r XoUmam Hw$Qw>§~-H|${ÐV Ñ{ï>H$moZ `m H$m`©H«$‘m§Zr Adb§~bm nm{hOo (29).  ldU V§ÌkmZ d lmì` nwZd©gZ Aem gm‘mÝ` OrdZ OJÊ`mg gmhmæ`H$ R>aUmè¶m godm§À`m VaVwXs¨Mm g‘mdoe hmoUmè¶m CnMmam§‘Ü`o Hw$Qw>§~mMr ‘wbmàVr Agbobr àmYmÝ`o d Ü`o`o {XgyZ Ambr nm{hOoV.  ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrMo n[aUm‘ {dMmamV Z KoVm gd© ZdOmV A^©Ho$ VgoM bhmZ ‘wbo `m§À`mda ldU, g§kmZmË‘H$ {dH$mg, g§dmX, e¡j{UH$ Q>ßno JmR>Uo, EH§$Xa Amamo½` d gwpñWVr Aem Jmoï>s¨H$[aVm {Z`{‘VnUo bj R>odbo nm{hOo. 1.4 {dMmamV KoVbm OmUmam JQ> Am{U C{Ôï>o ZdOmV A^©H$m§Mr ldU nS>Vmim MmMUr gd©Ì CnbãY Agbr nm{hOo Am{U gd© ZdOmV A^©H$m§Zm (Á`m ^mJmV qH$dm gw{dYo‘Ü`o nS>Vmim MmMUr Ho$br OmVo VoWrb) VoWrb gw{dYm§‘Ü`o gm‘mdyZ KoVbo nm{hOo d ldUXmof AmoiIÊ`mH$[aVm Ë`m§Mr nS>Vmim MmMUr Pmbr nm{hOo. na§Vw, Á`m Xoem§‘Ü`o dm{f©H$ àOZZ Xa OmñV Amho d {OWo g§gmYZm§À`m ‘`m©Xo‘wio gmd©{ÌH$ nS>Vmim MmMUr hmoD$ eH$V Zmhr, Vo Xoe {ZdS>H$ (qH$dm {dMmamV KoVboë`m) nS>Vmim MmMUrMm n`m©` {ZdSy>Z nS>Vmim MmMUr H$m`©H«$‘ gwê$ H$ê$ eH$VmV (3) CXmhaUmW©, ldU Xmof AgÊ`mMr eŠ`Vm A{YH$ (High Risk) Agbobr ZdOmV A^©Ho$, ^m¡Jmo{bH$ ñVamdarb CnJQ> qH$dm {deof XjVm KoVbr OmUmè¶m XdmImÝ`mV (ñnoeb Ho$Aa Zg©ar) XmIb H$aÊ`mV Ambobr A^©Ho$ qH$dm ZdOmV A^©H$m§H$[aVmÀ`m A{VXjVm {d^mJmV Agbobr ZdOmV A^©Ho$ `m§MmM Ho$di g‘mdoe H$ê$Z Ë`m§Mr ldU nS>Vmim MmMUr H$amdr (AmH¥$Vr 1.1 nhm). ‘mÌ, Aem Xoem§Zr H$mbm§VamZo {ZdS>H$ nS>Vmim MmMUrMm {dñVma gdmªZm bmJy H$aVm `oB©b Aem nS>Vmim MmMUrn`ªV H$aÊ`mMm {dMma Ho$bm nm{hOo. Ho$di ldU Xmof AgÊ`mMr eŠ`Vm A{YH$ Agboë`m ZdOmV A^©H$m§Mr nS>Vmim MmMUr Ho$ë`m‘wio Á`m A^©H$m§Zm ldUXmof {Z‘m©U hmoÊ`mMo H$moUVohr gwñnï> H$maU ZgVo Aem A§XmOo 50% ZdOmV A^©H$m§Zm nS>Vmim MmMUrMr g§Yr Z {‘iÊ`mMr eŠ`Vm Amho. (2,24,30). ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 13 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1.2 gÚpñWVr d nÕVr nS>Vmim MmMUrÀ`m {d{dY nÕVr, MmMUr H$aÊ`mÀ`m {d{dY nÕVs¨Mr ‘mJ©Xe©H$ gyMr d gÚpñWVrV CnbãY Agbobr Amamo½` godm, gm‘m{OH$ d e¡j{UH$ àUmbr ` m§À`mer g§b¾ Xwdo dmnê$Z ZdOmV A^©H$m§H$[aVm ldU nS>Vmim MmMUrMo `eñdr H$m`©H«$‘ AZoH$ Xoem§‘Ü`o am~dÊ`mV Ambo AmhoV (21). àmYmÝ`mZo OJmÀ`m bmoH$g§»`on¡H$s OmñV CËnÞ àJV Agboë`m àXoemV amhmUmè¶m OdiOdi EH$ V¥Vr`m§e bmoH$m§H$[aVm ZdOmV A^©H$m§H$[aVmMo ldU nS>Vmim MmMUr H$m`©H«$‘ nyU©nUo qH$dm Odinmg nyU©nUo CnbãY AmhoV Agm A§XmO Amho (22). Aem H$m`©H«$‘m§À`m A§‘b~OmdUrMo d ì`márMo à‘mU OJ^amV bjUr`{aË`m ~Xbobo Amho. AbrH$So> EH$m àH$m{eV boIm‘YyZ Ago Xe©{dÊ`mV Ambo Amho H$s nS>Vmim MmMUrÀ`m ì`márMm gamgar OrdZ‘mZ d Am{W©H$ gwpñWVr `m§À`mer OdiMm g§~§Y Amho (22). ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrer g§~§{YV YmoaUo, ‘mZdr g§gmYZo, CnH$aUo d Am{W©H$ g§gmYZo `m§Mm A^md hr H$‘r d ‘Ü`‘ CËnÞ Agboë`m Xoem§g‘moaMr AmìhmZo AmhoV. ldUXmof d Ë`mÀ`mer g§~§{YV H$‘rnUmMr ^mdZm `m{df`rÀ`m OmJê$H$VoMm A^md Agë`m‘wio hr AmìhmZo AmUIr dmT>br AmhoV. ho KQ>H$ d g§^mì` Cnm` ho ldU{df`H$ OmJ{VH$ AhdmbmV A{YH$ ñnï> Ho$bo AmhoV (2). OJ^amV Ho$ë`m OmUmè¶m ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUr‘Ü`o XoIrb ’$aH$ Amho. na§Vw, A‘bmV AmUbobr ~hþVoH$ ‘mJ©Xe©H$ VÎdo hr ^mJ 1.3 ‘Ü`o Z‘yX Ho$ë`mZwgma A^©H$m§Mr ldUj‘Vm `mH$[aVm Agboë`m Joint Committee on Infant Hearing - Position Statement `mÀ`m ‘yb^yV VÎdm§da AmYm[aV AmhoV (1,23). ldUXmofmMo ñdê$n d Vrd«Vm, nS>Vmim MmMUrMr gmYZo, d¡Ym{ZH$ AmYma, nmÌ H$‘©Mmar d gj‘ Z¡Xm{ZH$ ldU MmMUr godm ` m§Mr CnbãYVm, gm§ñH¥${VH$ {d{dYVm, CnbãY g§gmYZo d nS>Vmim MmMUrMm IM© Aem AZoH$ KQ>H$m§- da AmYm[aV nS>Vmim MmMUrH$[aVmMr {Z`‘mdbr {dH${gV H$aUo àË`oH$ XoemH$[aVm Amdí`H$ Amho. Ago Oar Agbo Var A^©H$m§À`m ldUj‘VoH$[aVm Joint Committee on Infant Hearing `m§À`m {e’$maes¨Zm AmYma^yV R>aUmar VÎdo hr OmJ{VH$ nmVirda H$aÊ`mV `oUmè¶m ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘hÎdmMr R>aVmV (1). 1.3 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo  ZdOmV A^©H$m§‘Yrb ldU nS>Vmim MmMUr OoWo ì`dhm`© Agob VoWo 1-3-6 `m VÎdmda AmYm[aV Agbr nm{hOo (23, 27) (Mm¡H$Q> 1.1). - gd© A^©H$m§Mr OÝ‘mZ§Va EH$m ‘{hÝ`mÀ`m AmV ldU nS>Vmim MmMUr Pmbr nm{hOo. 1.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m‘Ü`o OÝ‘OmV Agboë`m ldUXmofm~amo~aM AÝ` H$maUm§‘wio {Z‘m©U Pmboë`m ldUXmofmH$So> Xwb©j Ho$bo Va bhmZ ~mbH$m§Mm gd©gmYmaU {dH$mg, {ejU d Ë`m§Mo g‘mOm‘Ü`o {‘giUo `m‘Ü`o J§^ra ñdê$nmMm AS>Wim {Z‘m©U hmoVmo (1,2). ldUXmofmH$So> Xwb©j Ho$ë`mMm n[aUm‘ dmMm d ^mfm A{dH${gV amhÊ`mH$So> hmoVmo, {deofH$ê$Z H$‘r d ‘Ü`‘ CËnÞ JQ>mVrb {dH${gV Xoem§‘Ü`o {XgyZ `oVmo (3). Á`m d`mV CnMma (ÜdZr {ddY©Z qH$dm e¡j{UH$ H$m`©H«$‘m§‘Yrb ZmdZm|XUr) gwê$ Ho$bo OmVmV Vo d` hm Xmof H$‘r H$aÊ`mH$[aVmMm ‘hÎdmMm KQ>H$ Amho (4,5). EH$m ‘hÎdmÀ`m g§emoYZ g§ñWoZo XmIdyZ {Xbo Amho H$s Á`m bhmZ ‘wbm§Mm ldUXmof bdH$a bjmV ` oVmo d Á`m§À`mda doioda CnMma Ho$bo OmVmV Ë`m§À`m‘Ü`o C{eam {ZXmZ H$aÊ`mV Amboë`m d CnMma {‘imboë`m ‘wbm§À`m VwbZoV Mm§Jbo n[aUm‘ {XgyZ `oVmV (4,6-11) (^mJ 1.11 nhm). Aä`mgmVyZ Ago {XgyZ `oVo H$s Or bhmZ ‘wbo OÝ‘V: H$U©~{Ya AgVmV qH$dm Á`m§À`m‘Ü`o Ë`m§À`m Am`wî`mÀ`m gwédmVrÀ`m H$mimVM ldUXmof {Z‘m©U hmoVmo Am{U Á`m ‘wbm§‘Ü`o hm Xmof d`mÀ`m ghm ‘{hÝ`m§À`m AmV bjmV `oD$Z Ë`m§À`mda `mo½` Vo CnMma gwê$ Ho$bo OmVmV Vr ‘wbo nmM dfmªMr hmoB©n`ªV ^mfm {dH$mgmÀ`m ~m~VrV ldUXmof Zgboë`m gd©gm‘mÝ` ‘wbm§g‘mZ åhUOoM Ë`m§À`m g‘d`ñH$m§g‘mZM AgVmV (12-15). ZdOmV A^©H$m§‘Yrb ldUXmof bdH$a bjmV `oD$Z Ë`mda CnMma H$aUo ho ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrÛmao eŠ` Pmbo Amho (NHS) (1,15). ldUnS>Vmim MmMUr Z§Va gm‘mÝ` OrdZ ì`VrV H$aÊ`m- H$[aVm ZdOmV A^©H$mbm Ooìhm VËH$mi d `mo½` ‘XV {‘iVo Voìhm Ho$boë`m ldU nS>Vmim MmMUr‘wio øm ZdOmV A^©H$m§Zm bhmZ d`mVrb {ZXmZ d CnMma VgoM ^mfm d g§àofU {dH$mg `mVrb gwYmaUm `m XmoÝhs¨Mo ‘hÎdnyU© ’$m`Xo {‘iVmV (4,10, 16-19). Á`m A^©H$m§Mr doioda d `mo½` XoI^mb Ho$br OmVo Ë`m§À`m‘Ü`o gwYm[aV gm‘m{OH$ d e¡j{UH$ n[aUm‘ {XgyZ `oÊ`mH$[aVm ho ’$m`Xo Cn`wº$ R>aVmV (2). øm gd© àJVrgmR>r `oUmè¶m IMm©À`m n[aUm‘H$maH$Vo{df`r Ho$boë`m Aä`mgm§Zr nwT>o OmD$Z àJV, ‘Ü`‘ Am{U H$‘r àJV Xoem§‘Ü`o OmJ{VH$ nmVirda Ho$ë`m OmUmè¶m ZdOmV A^©H$m§‘Yrb ldU nS>Vmim MmMUrMo Am{W©H$ ’$m`Xo XmIdyZ {Xbo AmhoV. - gd© ZdOmV A^©Ho$ Á`m§Mr gwédmVrMr nS>Vmim MmMUr d Ë`mZ§Va Ho$br OmUmar nS>Vmim MmMUr `m‘YyZ Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm AmT>iyZ Amë`mg, A^©H$mÀ`m ldU pñWVrMr ImÌr H$aÊ`mH$[aVm 3 ‘{hÝ`m§À`m AmV Ë`mMo `mo½` Ago ldUj‘VoMo {ZXmZ H$aUmao ‘yë`m§H$Z Ho$bo nm{hOo. - EH$Xm H$m ldUXmofmMo {ZXmZ Pmbo H$s ZdOmV A^©H$ d Ë`mMo Hw$Qw>§~r` `m§Zm bdH$amV bdH$a CnMma CnbãY Pmbo nm{hOoV. {ZXmZ Pmë`mda eŠ` {VVŠ`m bdH$a Am{U 6 ‘{hÝ`m§À`m AmV CnMma gwê$ Pmbo nm{hOoV.  Ooìhm ZdOmV A^©H$m§Mm OÝ‘ àm‘w»`mZo é½Umb`mì`{V[aº$ BVa {R>H$mUr qH$dm OoWo Amamo½` godm ‘`m©{XV ñdê$nmV CnbãY Amho qH$dm OoWo MmMUrMr 1-3-6 H$mb‘`m©Xm nmiUo eŠ` Zmhr Aem {R>H$mUr hmoVmo, Aem doir ZdOmV A^©H$m§H$[aVmÀ`m OmJ{VH$ nmVirdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§Zr `mda Cnm` emoYÊ`mMm à`ËZ Ho$bm nm{hOo.  ZdOmV A^©H$m§H$[aVmÀ`m OmJ{VH$ nmVirdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo gÚpñWVrV CnbãY Agboë`m Amamo½`godm, e¡j{UH$ qH$dm gm‘m{OH$ àUmbr `m§À`mgmo~V EH${ÌH$aU qH$dm g§b¾rH$aU Pmbo nm{hOo d H$m`©nÕVr VgoM n[aUm‘ `m§Mo XñVEodOrH$aU H$ê$Z Ë`m§Mr ‘m{hVr gdmªZm {Xbr Jobr nm{hOo (28). hr H$m`©àUmbr OoWo eŠ` Agob VoWo bmJy H$amdr.  amÁ` Am{U amï´>r` ‘mJ©Xe©H$ VÎdm§Zwgma Hw$Qw>§~mMr g§‘Vr KoÊ`mÛmao ZdOmV A^©H$ d Ë`mMo Hw$Qw>§~ `m§Mo h¸$ VgoM JmonZr`Vm `m§Mr h‘r XoUmam Hw$Qw>§~-H|${ÐV Ñ{ï>H$moZ `m H$m`©H«$‘m§Zr Adb§~bm nm{hOo (29).  ldU V§ÌkmZ d lmì` nwZd©gZ Aem gm‘mÝ` OrdZ OJÊ`mg gmhmæ`H$ R>aUmè¶m godm§À`m VaVwXs¨Mm g‘mdoe hmoUmè¶m CnMmam§‘Ü`o Hw$Qw>§~mMr ‘wbmàVr Agbobr àmYmÝ`o d Ü`o`o {XgyZ Ambr nm{hOoV.  ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrMo n[aUm‘ {dMmamV Z KoVm gd© ZdOmV A^©Ho$ VgoM bhmZ ‘wbo `m§À`mda ldU, g§kmZmË‘H$ {dH$mg, g§dmX, e¡j{UH$ Q>ßno JmR>Uo, EH§$Xa Amamo½` d gwpñWVr Aem Jmoï>s¨H$[aVm {Z`{‘VnUo bj R>odbo nm{hOo. 1.4 {dMmamV KoVbm OmUmam JQ> Am{U C{Ôï>o ZdOmV A^©H$m§Mr ldU nS>Vmim MmMUr gd©Ì CnbãY Agbr nm{hOo Am{U gd© ZdOmV A^©H$m§Zm (Á`m ^mJmV qH$dm gw{dYo‘Ü`o nS>Vmim MmMUr Ho$br OmVo VoWrb) VoWrb gw{dYm§‘Ü`o gm‘mdyZ KoVbo nm{hOo d ldUXmof AmoiIÊ`mH$[aVm Ë`m§Mr nS>Vmim MmMUr Pmbr nm{hOo. na§Vw, Á`m Xoem§‘Ü`o dm{f©H$ àOZZ Xa OmñV Amho d {OWo g§gmYZm§À`m ‘`m©Xo‘wio gmd©{ÌH$ nS>Vmim MmMUr hmoD$ eH$V Zmhr, Vo Xoe {ZdS>H$ (qH$dm {dMmamV KoVboë`m) nS>Vmim MmMUrMm n`m©` {ZdSy>Z nS>Vmim MmMUr H$m`©H«$‘ gwê$ H$ê$ eH$VmV (3) CXmhaUmW©, ldU Xmof AgÊ`mMr eŠ`Vm A{YH$ (High Risk) Agbobr ZdOmV A^©Ho$, ^m¡Jmo{bH$ ñVamdarb CnJQ> qH$dm {deof XjVm KoVbr OmUmè¶m XdmImÝ`mV (ñnoeb Ho$Aa Zg©ar) XmIb H$aÊ`mV Ambobr A^©Ho$ qH$dm ZdOmV A^©H$m§H$[aVmÀ`m A{VXjVm {d^mJmV Agbobr ZdOmV A^©Ho$ `m§MmM Ho$di g‘mdoe H$ê$Z Ë`m§Mr ldU nS>Vmim MmMUr H$amdr (AmH¥$Vr 1.1 nhm). ‘mÌ, Aem Xoem§Zr H$mbm§VamZo {ZdS>H$ nS>Vmim MmMUrMm {dñVma gdmªZm bmJy H$aVm `oB©b Aem nS>Vmim MmMUrn`ªV H$aÊ`mMm {dMma Ho$bm nm{hOo. Ho$di ldU Xmof AgÊ`mMr eŠ`Vm A{YH$ Agboë`m ZdOmV A^©H$m§Mr nS>Vmim MmMUr Ho$ë`m‘wio Á`m A^©H$m§Zm ldUXmof {Z‘m©U hmoÊ`mMo H$moUVohr gwñnï> H$maU ZgVo Aem A§XmOo 50% ZdOmV A^©H$m§Zm nS>Vmim MmMUrMr g§Yr Z {‘iÊ`mMr eŠ`Vm Amho. (2,24,30). Mm¡H$Q> 1.1 1-3-6 VÎd OÝ‘mZ§Va 1 ‘{hÝ`mÀ`m AmV VnmgUr OÝ‘mZ§Va 3 ‘{hÝ`m§À`m AmV {ZXmZ OÝ‘mZ§Va 6 ‘{hÝ`m§À`m AmV CnMma ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo14 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1.2 gÚpñWVr d nÕVr nS>Vmim MmMUrÀ`m {d{dY nÕVr, MmMUr H$aÊ`mÀ`m {d{dY nÕVs¨Mr ‘mJ©Xe©H$ gyMr d gÚpñWVrV CnbãY Agbobr Amamo½` godm, gm‘m{OH$ d e¡j{UH$ àUmbr ` m§À`mer g§b¾ Xwdo dmnê$Z ZdOmV A^©H$m§H$[aVm ldU nS>Vmim MmMUrMo `eñdr H$m`©H«$‘ AZoH$ Xoem§‘Ü`o am~dÊ`mV Ambo AmhoV (21). àmYmÝ`mZo OJmÀ`m bmoH$g§»`on¡H$s OmñV CËnÞ àJV Agboë`m àXoemV amhmUmè¶m OdiOdi EH$ V¥Vr`m§e bmoH$m§H$[aVm ZdOmV A^©H$m§H$[aVmMo ldU nS>Vmim MmMUr H$m`©H«$‘ nyU©nUo qH$dm Odinmg nyU©nUo CnbãY AmhoV Agm A§XmO Amho (22). Aem H$m`©H«$‘m§À`m A§‘b~OmdUrMo d ì`márMo à‘mU OJ^amV bjUr`{aË`m ~Xbobo Amho. AbrH$So> EH$m àH$m{eV boIm‘YyZ Ago Xe©{dÊ`mV Ambo Amho H$s nS>Vmim MmMUrÀ`m ì`márMm gamgar OrdZ‘mZ d Am{W©H$ gwpñWVr `m§À`mer OdiMm g§~§Y Amho (22). ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrer g§~§{YV YmoaUo, ‘mZdr g§gmYZo, CnH$aUo d Am{W©H$ g§gmYZo `m§Mm A^md hr H$‘r d ‘Ü`‘ CËnÞ Agboë`m Xoem§g‘moaMr AmìhmZo AmhoV. ldUXmof d Ë`mÀ`mer g§~§{YV H$‘rnUmMr ^mdZm `m{df`rÀ`m OmJê$H$VoMm A^md Agë`m‘wio hr AmìhmZo AmUIr dmT>br AmhoV. ho KQ>H$ d g§^mì` Cnm` ho ldU{df`H$ OmJ{VH$ AhdmbmV A{YH$ ñnï> Ho$bo AmhoV (2). OJ^amV Ho$ë`m OmUmè¶m ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUr‘Ü`o XoIrb ’$aH$ Amho. na§Vw, A‘bmV AmUbobr ~hþVoH$ ‘mJ©Xe©H$ VÎdo hr ^mJ 1.3 ‘Ü`o Z‘yX Ho$ë`mZwgma A^©H$m§Mr ldUj‘Vm `mH$[aVm Agboë`m Joint Committee on Infant Hearing - Position Statement `mÀ`m ‘yb^yV VÎdm§da AmYm[aV AmhoV (1,23). ldUXmofmMo ñdê$n d Vrd«Vm, nS>Vmim MmMUrMr gmYZo, d¡Ym{ZH$ AmYma, nmÌ H$‘©Mmar d gj‘ Z¡Xm{ZH$ ldU MmMUr godm ` m§Mr CnbãYVm, gm§ñH¥${VH$ {d{dYVm, CnbãY g§gmYZo d nS>Vmim MmMUrMm IM© Aem AZoH$ KQ>H$m§- da AmYm[aV nS>Vmim MmMUrH$[aVmMr {Z`‘mdbr {dH${gV H$aUo àË`oH$ XoemH$[aVm Amdí`H$ Amho. Ago Oar Agbo Var A^©H$m§À`m ldUj‘VoH$[aVm Joint Committee on Infant Hearing `m§À`m {e’$maes¨Zm AmYma^yV R>aUmar VÎdo hr OmJ{VH$ nmVirda H$aÊ`mV `oUmè¶m ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘hÎdmMr R>aVmV (1). 1.3 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo  ZdOmV A^©H$m§‘Yrb ldU nS>Vmim MmMUr OoWo ì`dhm`© Agob VoWo 1-3-6 `m VÎdmda AmYm[aV Agbr nm{hOo (23, 27) (Mm¡H$Q> 1.1). - gd© A^©H$m§Mr OÝ‘mZ§Va EH$m ‘{hÝ`mÀ`m AmV ldU nS>Vmim MmMUr Pmbr nm{hOo. 1.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m‘Ü`o OÝ‘OmV Agboë`m ldUXmofm~amo~aM AÝ` H$maUm§‘wio {Z‘m©U Pmboë`m ldUXmofmH$So> Xwb©j Ho$bo Va bhmZ ~mbH$m§Mm gd©gmYmaU {dH$mg, {ejU d Ë`m§Mo g‘mOm‘Ü`o {‘giUo `m‘Ü`o J§^ra ñdê$nmMm AS>Wim {Z‘m©U hmoVmo (1,2). ldUXmofmH$So> Xwb©j Ho$ë`mMm n[aUm‘ dmMm d ^mfm A{dH${gV amhÊ`mH$So> hmoVmo, {deofH$ê$Z H$‘r d ‘Ü`‘ CËnÞ JQ>mVrb {dH${gV Xoem§‘Ü`o {XgyZ `oVmo (3). Á`m d`mV CnMma (ÜdZr {ddY©Z qH$dm e¡j{UH$ H$m`©H«$‘m§‘Yrb ZmdZm|XUr) gwê$ Ho$bo OmVmV Vo d` hm Xmof H$‘r H$aÊ`mH$[aVmMm ‘hÎdmMm KQ>H$ Amho (4,5). EH$m ‘hÎdmÀ`m g§emoYZ g§ñWoZo XmIdyZ {Xbo Amho H$s Á`m bhmZ ‘wbm§Mm ldUXmof bdH$a bjmV ` oVmo d Á`m§À`mda doioda CnMma Ho$bo OmVmV Ë`m§À`m‘Ü`o C{eam {ZXmZ H$aÊ`mV Amboë`m d CnMma {‘imboë`m ‘wbm§À`m VwbZoV Mm§Jbo n[aUm‘ {XgyZ `oVmV (4,6-11) (^mJ 1.11 nhm). Aä`mgmVyZ Ago {XgyZ `oVo H$s Or bhmZ ‘wbo OÝ‘V: H$U©~{Ya AgVmV qH$dm Á`m§À`m‘Ü`o Ë`m§À`m Am`wî`mÀ`m gwédmVrÀ`m H$mimVM ldUXmof {Z‘m©U hmoVmo Am{U Á`m ‘wbm§‘Ü`o hm Xmof d`mÀ`m ghm ‘{hÝ`m§À`m AmV bjmV `oD$Z Ë`m§À`mda `mo½` Vo CnMma gwê$ Ho$bo OmVmV Vr ‘wbo nmM dfmªMr hmoB©n`ªV ^mfm {dH$mgmÀ`m ~m~VrV ldUXmof Zgboë`m gd©gm‘mÝ` ‘wbm§g‘mZ åhUOoM Ë`m§À`m g‘d`ñH$m§g‘mZM AgVmV (12-15). ZdOmV A^©H$m§‘Yrb ldUXmof bdH$a bjmV `oD$Z Ë`mda CnMma H$aUo ho ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrÛmao eŠ` Pmbo Amho (NHS) (1,15). ldUnS>Vmim MmMUr Z§Va gm‘mÝ` OrdZ ì`VrV H$aÊ`m- H$[aVm ZdOmV A^©H$mbm Ooìhm VËH$mi d `mo½` ‘XV {‘iVo Voìhm Ho$boë`m ldU nS>Vmim MmMUr‘wio øm ZdOmV A^©H$m§Zm bhmZ d`mVrb {ZXmZ d CnMma VgoM ^mfm d g§àofU {dH$mg `mVrb gwYmaUm `m XmoÝhs¨Mo ‘hÎdnyU© ’$m`Xo {‘iVmV (4,10, 16-19). Á`m A^©H$m§Mr doioda d `mo½` XoI^mb Ho$br OmVo Ë`m§À`m‘Ü`o gwYm[aV gm‘m{OH$ d e¡j{UH$ n[aUm‘ {XgyZ `oÊ`mH$[aVm ho ’$m`Xo Cn`wº$ R>aVmV (2). øm gd© àJVrgmR>r `oUmè¶m IMm©À`m n[aUm‘H$maH$Vo{df`r Ho$boë`m Aä`mgm§Zr nwT>o OmD$Z àJV, ‘Ü`‘ Am{U H$‘r àJV Xoem§‘Ü`o OmJ{VH$ nmVirda Ho$ë`m OmUmè¶m ZdOmV A^©H$m§‘Yrb ldU nS>Vmim MmMUrMo Am{W©H$ ’$m`Xo XmIdyZ {Xbo AmhoV. - gd© ZdOmV A^©Ho$ Á`m§Mr gwédmVrMr nS>Vmim MmMUr d Ë`mZ§Va Ho$br OmUmar nS>Vmim MmMUr `m‘YyZ Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm AmT>iyZ Amë`mg, A^©H$mÀ`m ldU pñWVrMr ImÌr H$aÊ`mH$[aVm 3 ‘{hÝ`m§À`m AmV Ë`mMo `mo½` Ago ldUj‘VoMo {ZXmZ H$aUmao ‘yë`m§H$Z Ho$bo nm{hOo. - EH$Xm H$m ldUXmofmMo {ZXmZ Pmbo H$s ZdOmV A^©H$ d Ë`mMo Hw$Qw>§~r` `m§Zm bdH$amV bdH$a CnMma CnbãY Pmbo nm{hOoV. {ZXmZ Pmë`mda eŠ` {VVŠ`m bdH$a Am{U 6 ‘{hÝ`m§À`m AmV CnMma gwê$ Pmbo nm{hOoV.  Ooìhm ZdOmV A^©H$m§Mm OÝ‘ àm‘w»`mZo é½Umb`mì`{V[aº$ BVa {R>H$mUr qH$dm OoWo Amamo½` godm ‘`m©{XV ñdê$nmV CnbãY Amho qH$dm OoWo MmMUrMr 1-3-6 H$mb‘`m©Xm nmiUo eŠ` Zmhr Aem {R>H$mUr hmoVmo, Aem doir ZdOmV A^©H$m§H$[aVmÀ`m OmJ{VH$ nmVirdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§Zr `mda Cnm` emoYÊ`mMm à`ËZ Ho$bm nm{hOo.  ZdOmV A^©H$m§H$[aVmÀ`m OmJ{VH$ nmVirdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo gÚpñWVrV CnbãY Agboë`m Amamo½`godm, e¡j{UH$ qH$dm gm‘m{OH$ àUmbr `m§À`mgmo~V EH${ÌH$aU qH$dm g§b¾rH$aU Pmbo nm{hOo d H$m`©nÕVr VgoM n[aUm‘ `m§Mo XñVEodOrH$aU H$ê$Z Ë`m§Mr ‘m{hVr gdmªZm {Xbr Jobr nm{hOo (28). hr H$m`©àUmbr OoWo eŠ` Agob VoWo bmJy H$amdr.  amÁ` Am{U amï´>r` ‘mJ©Xe©H$ VÎdm§Zwgma Hw$Qw>§~mMr g§‘Vr KoÊ`mÛmao ZdOmV A^©H$ d Ë`mMo Hw$Qw>§~ `m§Mo h¸$ VgoM JmonZr`Vm `m§Mr h‘r XoUmam Hw$Qw>§~-H|${ÐV Ñ{ï>H$moZ `m H$m`©H«$‘m§Zr Adb§~bm nm{hOo (29).  ldU V§ÌkmZ d lmì` nwZd©gZ Aem gm‘mÝ` OrdZ OJÊ`mg gmhmæ`H$ R>aUmè¶m godm§À`m VaVwXs¨Mm g‘mdoe hmoUmè¶m CnMmam§‘Ü`o Hw$Qw>§~mMr ‘wbmàVr Agbobr àmYmÝ`o d Ü`o`o {XgyZ Ambr nm{hOoV.  ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrMo n[aUm‘ {dMmamV Z KoVm gd© ZdOmV A^©Ho$ VgoM bhmZ ‘wbo `m§À`mda ldU, g§kmZmË‘H$ {dH$mg, g§dmX, e¡j{UH$ Q>ßno JmR>Uo, EH§$Xa Amamo½` d gwpñWVr Aem Jmoï>s¨H$[aVm {Z`{‘VnUo bj R>odbo nm{hOo. 1.4 {dMmamV KoVbm OmUmam JQ> Am{U C{Ôï>o ZdOmV A^©H$m§Mr ldU nS>Vmim MmMUr gd©Ì CnbãY Agbr nm{hOo Am{U gd© ZdOmV A^©H$m§Zm (Á`m ^mJmV qH$dm gw{dYo‘Ü`o nS>Vmim MmMUr Ho$br OmVo VoWrb) VoWrb gw{dYm§‘Ü`o gm‘mdyZ KoVbo nm{hOo d ldUXmof AmoiIÊ`mH$[aVm Ë`m§Mr nS>Vmim MmMUr Pmbr nm{hOo. na§Vw, Á`m Xoem§‘Ü`o dm{f©H$ àOZZ Xa OmñV Amho d {OWo g§gmYZm§À`m ‘`m©Xo‘wio gmd©{ÌH$ nS>Vmim MmMUr hmoD$ eH$V Zmhr, Vo Xoe {ZdS>H$ (qH$dm {dMmamV KoVboë`m) nS>Vmim MmMUrMm n`m©` {ZdSy>Z nS>Vmim MmMUr H$m`©H«$‘ gwê$ H$ê$ eH$VmV (3) CXmhaUmW©, ldU Xmof AgÊ`mMr eŠ`Vm A{YH$ (High Risk) Agbobr ZdOmV A^©Ho$, ^m¡Jmo{bH$ ñVamdarb CnJQ> qH$dm {deof XjVm KoVbr OmUmè¶m XdmImÝ`mV (ñnoeb Ho$Aa Zg©ar) XmIb H$aÊ`mV Ambobr A^©Ho$ qH$dm ZdOmV A^©H$m§H$[aVmÀ`m A{VXjVm {d^mJmV Agbobr ZdOmV A^©Ho$ `m§MmM Ho$di g‘mdoe H$ê$Z Ë`m§Mr ldU nS>Vmim MmMUr H$amdr (AmH¥$Vr 1.1 nhm). ‘mÌ, Aem Xoem§Zr H$mbm§VamZo {ZdS>H$ nS>Vmim MmMUrMm {dñVma gdmªZm bmJy H$aVm `oB©b Aem nS>Vmim MmMUrn`ªV H$aÊ`mMm {dMma Ho$bm nm{hOo. Ho$di ldU Xmof AgÊ`mMr eŠ`Vm A{YH$ Agboë`m ZdOmV A^©H$m§Mr nS>Vmim MmMUr Ho$ë`m‘wio Á`m A^©H$m§Zm ldUXmof {Z‘m©U hmoÊ`mMo H$moUVohr gwñnï> H$maU ZgVo Aem A§XmOo 50% ZdOmV A^©H$m§Zm nS>Vmim MmMUrMr g§Yr Z {‘iÊ`mMr eŠ`Vm Amho. (2,24,30). ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 15 nwT>rb VnmgUrH$[aVm nmRdm OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. AmH¥$Vr 1.1 ZdOmV A^©H$m§H$[aVm ldU nS>Vmim MmMUr H$m`©H«$‘ V`ma H$aUo *AABR: automated auditory brainstem response; NICU: neonatal intensive care unit; OAE: otoacoustic qH$dm {dMmamV KoVbobr bmoH$g§»`m {Z{üV H$aUo VnmgUr H$m`©H«$‘mÛmao {dMmamV KoÊ`mV `oUmè¶m ldUXmofmMm àH$ma gm§Jm ZdOmV ~mbH$m§Mr d A^©H$m§Mr {H$Vr doim VnmgUr Ho$br OmB©b ho {Z{üV H$am VnmgUrMo H$moUVo CnH$aU H$moUË`m Q>ßß`mda dmnabo OmB©b Vo {Z{üV H$am EH$m H$mZmVrb Xmof nS>Vmim MmMUrMr {Z`‘mdbr R>adm ‘wbmÀ`m ^oQ>s¨Xaå`mZ g§dmXmÀ`m {dH$mgmda gmVË`mZo XoIaoI H$aUo Z¡Xm{ZH$ ldU VnmgUrH$[aVm nmR>dm `eñdr `eñdrScreening OAE Screening OAE AABR* AABR nwT>rb VnmgUrH$[aVm nmR>dm 1 2 3 OmJ{VH$ nmVirda bpú`V qH$dm gd© ZdOmV ~mbHo$ d A^©Ho$ ^m¡Jmo{bH$ ñVamdarb CnJQ> ldUXmof {Z‘m©U hmoÊ`mMm A{YH$ YmoH$m Agbobr ~mbHo$ d ZdOmV A^©Ho$ (CXm. A{VXjVm {d^mJmVrb ZdOmV A^©Ho$) XmoÝhr H$mZm§Vrb Xmof A^©H$m§‘Yrb ldUXmofmMo bdH$amV bdH$a {ZXmZ H$aUo qH$d Ë`m§Zm doioda CnMma XoÊ`mH$[aVm Ë`m§Mr ZmdZm|XUr H$aUo ho H$moUË`mhr ldU nS>Vmim MmMUr H$m`©H«$‘mMo C{Ôï> AgVo. Xoem§Zr Ë`m§À`m Amamo½` ì`dñWoÀ`m j‘VoZwgma Á`m ldUXmofmÀ`m à‘mUmda d àH$mamda bj H|${ÐV H$am`Mo Amho Vo {Z{üV H$amdo. AZoH$ Xoem§‘Yrb H$mZmer g§~§{YV d ldUj‘Vm{df`H$ H$m`©H«$‘ ho Mm§Jbr ldU j‘Vm Agboë`m H$mZm‘Ü`o (1) ‘Ü`‘ qH$dm A{YH$ à‘mUmVrb ldUXmof (åhUOoM 35 dBHL da) Agboë`m ZdOmV A^©H$m§darb bdH$a CnMma H$aÊ`mda bj H|${ÐV H$aVmV. na§Vw, Á`m {R>H$mUr g§gmYZo CnbãY AgVrb Ë`m {R>H$mUr ^mfm {dH$mg d {ejU `mda n[aUm‘ H$aUmam gm¡å` ldUXmof d EH$mM H$mZm‘Ü`o Agbobm ldUXmof `m§da XoIrb CnMma Pmbo nm{hOoV (31,32). 16 ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. n{hbr MmMUr H$mhr qMVm dmQ>ë`mg AmT>mdm ¿`m XmoÝhr H$mZm§H$[aVm YmoH$m Zmhr YmoH$m Amho {ZarjU H$aUo XmoÝhr H$mZm§H$[aVm CÎmsU© Agm {ZîH$f© Xwgar VnmgUr EH$m qH$dm XmoÝhr H$mZm§H$[aVm nmR>dm Agm {ZîH$f© EH$m qH$dm XmoÝhr H$mZm§H$[aVm nmR>dm Agm {ZîH$f© Z¡Xm{ZH$ ldU VnmgUrH$[aVm nmR>dm 1.5 nS>Vmim MmMUrMr {Z`‘mdbr MwH$sMo g§Ho$V XoUmè¶m (False Positive) {ZîH$fmªMo H$‘r Agbobo à‘mU qH$dm nS>Vmim MmMUr H$m`©H«$‘m§Mr Cƒ {d{eï>Vm `m XmoÝhs¨Mr ImÌr hmoÊ`mH$[aVm XmoZ-Q>ßß`m§Mm g‘mdoe Agbobr nS>Vmim MmMUrMr {Z`‘mdbr ‘hÎdmMr Amho (AmH¥$Vr 1.2 nhm). `m‘Ü`o `mMm g‘mdoe hmoVmo:  n{hë`m Q>ßß`mV Ho$br OmUmar nS>Vmim MmMUr Or OÝ‘mZ§Va bJoMM CÎm‘ àH$mao Ho$br OmVo.  n{hë`m Q>ßß`mVrb nS>Vmim MmMUr AZwÎmsU© Pmboë`m gd© ZdOmV A^©H$m§H$[aVm Xwgè¶m Q>ßß`mVrb nS>Vmim MmMUr H$aUo  n{hë`m VgoM Xwgè¶m Q>ßß`mVrb VnmgÊ`m AZwÎmsU© Pmboë`m ZdOmV A^©H$m§Zm nwT>rb Z¡Xm{ZH$ ldU MmMUrH$[aVm nmR>{dUo gyMZm: Z¡Xm{ZH$ ldU MmMUrMr Amdí`H$Vm {Z‘m©U H$aUmè¶m MwH$sMo g§Ho$V XoUmè¶m {ZîH$fmªMr g§»`m H$‘r H$aÊ`mH$[aVm nS>Vmim MmMUrÀ`m H$mhr H$m`©H«$‘m§‘Ü`o EH$ A{V[aº$ nS>Vmim MmMUr Ho$br OmVo (24,33). EH$mnojm A{YH$ Q>ßno Agbobr nS>Vmim MmMUr Oar OmñV I{M©H$ Agbr Am{U {ZXmZ hmoD$Z CnMma gwê$ H$aÊ`mg {db§~ hmoV Agbm Var hr nÕVr Cƒ {dœmgmh©Vm XmI{dVo d `m {deof (Ho$di `mM H$maUmH$[aVm Ho$ë`m OmUmè¶m) VgoM I{M©H$ Aem Z¡Xm{ZH$ ldU MmMUr H$[aVm MwH$sZo nwT>o nmR>{dbo OmUmè¶m§Mr g§»`m H$‘r H$aVo. AmH¥$Vr 1.2 Xwgè¶m Q>ßß`mVrb nS>Vmim MmMUrMr {Z`‘mdbr ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 17 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1.6 nS>Vmim MmMUrH$[aVm d` d {ZYm©[aV H$mbmdYr  n{hë`m Q>ßß`mVrb nS>Vmim MmMUr: dmñV{dH$ nmhmVm hr OÝ‘mZ§Va EH$ ‘{hÝ`mÀ`m AmV Pmbr nm{hOo qH$dm ZdOmV A^©H$mbm é½Umb`mVyZ Kar gmoS>Ê`mnydu Vr Ho$br Jobr nm{hOo. n{hë`m Q>ßß`mVrb nS>Vmim MmMUr hr eŠ`Vmo é½Umb`mVyZ Kar gmoS>Ê`mÀ`m gw‘mamg Ho$br OmD$ eH$Vo, na§Vw é½Umb`mVyZ Kar gmoS>Ê`mnydu Amdí`H$Vm dmQ>ë`mg, Xwgè¶m Q>ßß`mVrb g§^mì` nS>Vmim MmMUrMr eŠ`Vm {dMmamV KoVbobr Agbr nm{hOo. é½Umb`mì`{V[aº$ BVa {R>H$mUr àgyVr hmoVo Aem {R>H$mUr qH$dm {OWo nS>Vmim MmMUr H$m`©H«$‘ Am`mo{OV Ho$bobm Amho Aem {R>H$mUr, CXmhaUmW©, bgrH$aUmH$[aVm {Xë`m OmUmè¶m ^oQ>r qH$dm ~mimÀ`m Amamo½` nS>Vmim MmMUrH$[aVm {Xë`m OmUmè¶m ^ oQ>r ` m§À`mdoiog, Voìhm {e’$mag Ho$ë`mà‘mUo OÝ‘mZ§Va EH$ ‘{hÝ`mÀ`m AmV nS>Vmim MmMUr hmoUo H$Xm{MV eŠ` hmoV Zmhr. Aem gd© n[apñWVrV n{hë`m Q>ßß`mVrb nS>Vmim MmMUr hr A^©H$mÀ`m d`mÀ`m ghm AmR>dS>çm§À`m AmV Pmbr nm{hOo.  Xwgè¶m Q>ßß`mVrb nS>Vmim MmMUr: Á`m ZdOmV A^©H$m§Mr n{hë`m Q>ßß`mVrb nS>Vmim MmMUr hmoD$ eH$V Zmhr Ë`m§Mr Xwgè¶m Q>ßß`mVrb nS>Vmim MmMUr Ho$br nm{hOo. hr nS>Vmim MmMUr é½Umb`mV AgVmZm d OÝ‘mZ§Va {Z‘m©U hmoUmè¶m VmËnwaË`m n[apñWVs¨‘wio {‘iUmè¶m MwH$sÀ`m g§Ho$Vm§À`m {ZîH$fm©Mo à‘mU H$‘r H$aÊ`mH$[aVm n{hë`m Q>ßß`mVrb nS>Vmim MmMUrZ§Va {H$‘mZ H$mhr Vmgm§À`m AdYrZo qH$dm é½Umb`mVyZ Kar gmoS>ë`mZ§Va eŠ` {VVŠ`m bdH$a hmoD$ eH$Vo.  Á`m ZdOmV A^©H$m§Mr ldU nS>Vmim MmMUr doioV H$aUo d¡ÚH$s`Ñï²>`m `mo½` qH$dm ì`mdhm[aH$ Zmhr Aem A^©H$m§Mr nS>Vmim MmMUr H$aÊ`mH$[aVm n`m©`r ì`dñWm H$aUo Amdí`H$ Amho, CXmhaUmW© A{VXjVm {d^mJmVrb qH$dm ìh|{Q>boQ>ada Agbobr qH$dm {Odmbm YmoH$m Agboë`m J§^ra n[apñWVrVrb ZdOmV A^©H$m§À`m nS>Vmim MmMUrbm H$mhr H$maUm§Zr Cera Pmë`mg, Aem gd© ZdOmV A^©H$mMr pñWVr d¡ÚH$s`Ñï²>`m pñWa Pmë`mda Ë`m§Mr ldU nS>Vmim MmMUr Ho$br OmB©b `mMr ImÌr Ho$br nm{hOo. gyMZm: é½Umb`mì`{V[aº$ BVa {R>H$mUr qH$dm {OWo Zoh‘rMr Amamo½` godm àUmbr CnbãY ZgVo Aem {R>H$mUr AZoH$ A^©H$m§Mm OÝ‘ hmoVmo Voìhm Aem ZdOmV A^©H$m§Zm gm‘mdyZ KoÊ`mH$[aVm n{hbo bgrH$aU OoWo Ho$bo OmVo Ë`m {R>H$mUr nS>Vmim MmMUr H$aUo ho g§^mì` YmoaU Amho (34). `mMo CXmhaU X{jU Am{’«$Ho$À`m ZdOmV A^©H$m§Mr ldU nS>Vmim MmMUr `mH$[aVmÀ`m ‘mJ©Xe©H$ VÎdm§‘Ü`o XoÊ`mV Ambo Amho (35). ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo18 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1.7 nS>Vmim MmMUr dV©UwH$sda AmYm[aV ldU nS>Vmim MmMUrbm àmYmÝ` XoÊ`mnojm eŠ`Vmo eara{dkmZ (Physiological) nS>Vmim MmMUrÀ`m Cnm``moOZm§Mm dmna Ho$bm nm{hOo. øm nÕVr‘Ü`o AË`§V gyú‘ ’$aH$mMr Zm|X KoUmè¶m nS>Vmim MmMÊ`m gd©gm‘mÝ`nUo dmnaë`m OmVmV d Ë`m‘Ü`o (AABR) qH$dm (OAE) nS>Vmim MmMUrMm g‘mdoe hmoVmo. øm nS>Vmim MmMUr nÕVr‘Ü`o H$moUVohr EH$ V§ÌkmZ Xwgè¶m V§ÌkmZmnojm nojm A{YH$ Mm§Jbo Amho Ago Zmhr. ZdOmV A^©H$m§Mo Amamo½` Mm§Jbo amhmÊ`mH$[aVm, ABR qH$dm OAE V§ÌkmZ dmnê$Z n{hbr d Xwgar nS>Vmim MmMUr Ho$br OmD$ eH$Vo. H$mhr nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o Am{U {OWo nS>Vmim MmMUrbm ` oUmam IM© nadSy> eH$Vmo Aem {R>H$mUr AABR bm àmYmÝ` {Xbo OmD$ eH$Vo; A{VXjVm {d^mJmVrb A^©H$m§H$[aVm AABR nS>Vmim MmMUrMr {e’$mag H$aÊ`mV Ambr Amho. `m d {dMmamV KoÊ`mÀ`m BVa ~m~r Mm¡H$Q> 1.2 ‘Ü`o {Xë`m AmhoV. Mm¡H$Q> 1.2 nS>Vmim MmMUrMr {ZdS> H$aVmZm {dMmamV KoÊ`mMo ‘wÔo  Ho$di OAE À`m gmhmæ`mZo Ho$boë`m nS>Vmim MmMUr‘wio ZdOmV A^©H$m§‘Yrb ldU{df`H$ Ý`yamon°WrMm (Auditory Neuropathy) Ìmg AmoiIVm `oUma Zmhr, Aem OÝ‘OmV ldUXmofmMo à‘mU A§XmOo 10% EdT>oM AgVo.  AABR À`m gmhmæ`mZo {ZXmZ Pmboë`m A{VXjVm {d^mJmVrb ZdOmV A^©H$m§‘Yrb ldU{df`H$ Ý`yamon°WrÀ`m (Auditory Neuropathy) XmofmMr CXmhaUo bjUr`[aË`m OmñV AmhoV.  OAE Mm dmna H$aV AgVmZm, Transient-evoked OAE (TEOAE) Mr g§doXZerbVm (AË`§V gyú‘ ’$aH$mMr Zm|X KoÊ`mMr j‘Vm) A{YH$ AgVo, H$maU hr MmMUr 30 dBHL BVH$s H$‘r ldU nmVir emoYy eH$Vo.  OAE AABR `m XmoÝhr VnmgÊ`m Cƒ g§doXZerbVm (AË`§V gyú‘ ’$aH$mMr Zm|X KoÊ`mMr j‘Vm) d {d{eï>Vm Xe©{dVmV.  OAE nojm AABR A{YH$ I{M©H$ Agy eH$Vo. ‘mÌ AABR MmMUrH$[aVmMr àma§^rMr Jw§VdUyH$ Oar OmñV Agbr Var "nwT>rb VnmgUrH$[aVm nmR>dm' Ago {ZXmZ d MwH$sMo gH$mamË‘H$ {ZîH$f© `m§À`m Iyn OmñV à‘mUm‘wio OAE H$[aVmÀ`m AmH¥$Vr~§Y nmR>nwamì`mMm IM© H$Xm{MV A{YH$ Agy eH$Vmo.  OAE nojm AABR MmMUrMm {ZîH$f© Zm|X{dÊ`mg WmoS>m OmñV doi bmJÊ`mMr eŠ`Vm AgVo.  MmMUr H$aÊ`mÀ`m {R>H$mUr g^modVmbÀ`m AmdmOmÀ`m nmViràVr OAE hr AABR nojm A{YH$ g§doXZerb AgVo.  OAE d AABR `m§Mr EH${ÌV {Z`‘mdbr hr ldUXmofmMr gdm}Îm‘ gH$mamË‘H$ gyMH$Vm Xe©{dVo. na§Vw, nS>Vmim MmMUrMr XmoÝhr CnH$aUo {dH$V KoÊ`mMm IM© AZoH$ Xoem§H$[aVm AmdmŠ`m~mhoaMm Agy eH$Vmo. gyMZm: OAE qH$dm AABR MmMUrÀ`m gmhmæ`mZo ZdOmV A^©H$m§Mr eara{dkmZ nÕVrZo (physiological) nS>Vmim MmMUr H$aUo hr gdm©V n[aUm‘H$maH$ nÕV Agbr Var Am{W©H$ H$maUm§‘wio qH$dm `mo½` CnH$aUo d H$‘©Mmar CnbãY Zgë`m‘wio Ago H$m`©H«$‘ OoWo eŠ` ZgVrb (qH$dm A{YH$ ‘`m©{XV ‘mJm©Zo gwédmV H$ê$Z gdmªMr emar[aH$ VnmgUr H$aÊ`mMo Ü`o` R>odyZ H$m‘ H$aÊ`mMr Amdí`H$Vm Agë`m‘wio) Aem {R>H$mUr dV©UwH$ser g§~§{YV MmMÊ`m§Mm g‘mdoe H$aUmè¶m BVa nÕVr VmËnwaË`m Cnm``moOZm åhUyZ dmnaë`m OmD$ eH$VmV (21). ^mJ 1.13 ‘Ü`o A{YH$ Vnerb XoÊ`mV Ambo ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 19 OmJ{VH$ Ahdmbm‘Ü`o nÕVera ldU nS>Vmim MmMUr H$aÊ`m‘mJrb H$maUo d Vr H$aÊ`mMo ’$m`Xo Am{U Ë`m‘Yrb AmìhmZo {Xbr AmhoV. VgoM Ë`mgmo~V Aer nS>Vmim MmMUr d bdH$a Ho$boë`m Cnm``moOZm `m§Zm `oUmam IM© Am{U g§^mì` Am{W©H$ bm^ `m§Mr Vnerbdma ‘m{hVr {Xbr Amho. nwT>rb 10 dfmª‘Ü`o dmT>Ë`m à‘mUmV Ho$br OmUmar ldU nS>Vmim MmMUr d bdH$amV bdH$a Cnm``moOZm CnbãY H$ê$Z XoUmè¶m godm§Mr ì`már `mH$[aVm 1.33 A‘o[aH$Z S>m°bg©Mr A{V[aº$ dm{f©H$ XaS>moB© Jw§VdUyH$ Amdí`H$ Amho Ago øm AhdmbmV Z‘yX Ho$bo Amho. `m‘wio hmoUmè¶m n[aUm‘m§‘wio 10 dfmªÀ`m H$mbmdYrV àmá hmoUmao Amamo½`{df`H$ ’$m`Xo ho An§JËdmer OwidyZ KoV AgVmZm Am`wî`mVrb dm`m Jobobr Odinmg 130 Xebj df} (DALYs) ‘mJo Q>mH$Vrb. øm gd© godm ‘Ü`o 1.4 AãO ì`º$s¨Zm ` mMm ’$m`Xm hmoB©b d Jw§VdUyH$ Ho$boë`m àË`oH$s EH$ S>m°bagmR>r OdiOdi 16 `yEg S>m°bg©Mm naVmdm {‘iob. OmJ{VH$ Amamo½` g§KQ>ZoMo gXñ` Agboë`m amï´>m§Zr ldUXmofmbm à{V~§Y H$aÊ`mH$[aVm, Vmo AmoiIÊ`mH$[aVm d Vmo Zmhrgm H$ê$Z ldUXmof Agboë`m ì`º$s¨Mo lmì` nwZd©gZ H$aÊ`mH$[aVm Ëd[aV d nwamì`mda AmYm[aV YmoaUmË‘H$ H¥$Vr H$amdr Aer {e’$mag ldU {df`H$ OmJ{VH$ Ahdmbm‘Ü`o Ho$br Amho. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o d emioV OmUmar bhmZ ‘wbo Am{U Á`oð> ì`º$s `m§À`m‘Yrb ldUXmof d Ë`mg§~§{YV AgUmao H$mZmMo {dH$ma bdH$a AmoiIÊ`mH$[aVm ‘mJ©Xe©Z H$aVo VgoM Ë`mda Cnm` H$aÊ`mH$[aVm nS>Vmim MmMUrMr YmoaUo {dH${gV H$aÊ`mgmR>r d Vr A‘bmV AmUÊ`mgmR>r gXñ` amï´>m§Zm ‘XV ìhmdr åhUyZ Vm§{ÌH$ ‘mJ©Xe©Z CnbãY H$ê$Z XoVo. nwpñVHo$Mm CÔoe "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' hr nwpñVH$m amï´>s` ñVamda qH$dm Ë`mÀ`m ImbÀ`m ñVamda ldU nS>Vmim MmMUr H$m`©H«$‘ am~{dÊ`mMr `moOZm AmIV Agboë`m H$moUË`mhr ì`º$sZo dmnaÊ`mH$[aVm Amho. `m‘Ü`o H$mZ d ldU XoI^mb `mH$[aVm Amamo½` ‘§Ìmb`mVrb g‘Ýd`H$ qH$dm ho H$m‘ H$aUmar H|$Ðo; gmd©O{ZH$ Amamo½` {Z`moOH$; Am{U ñd`§godr g§ñWm qH$dm ZmJar g§ñWm `m§Mm g‘mdoe hmoVmo. hr nwpñVH$m ZdOmV A^©Ho$ d VmÝhr ~mio, ~mbdmS>r‘Ü`o OmUmar bhmZ ‘wbo d emioVrb {dÚmWu VgoM Á`oð> ì`º$s `m§À`mVrb ldUXmof d Ë`mg§~§{YV H$mZmMo {dH$ma ` m§Mr nS>Vmim MmMUr d bdH$amV bdH$a H$aVm ` oUmè¶m Cnm``moOZm `mH$[aVm ì`mdhm[aH$ ‘m{hVr CnbãY H$ê$Z XoVo. nwpñVHo$Mr {Z{‘©Vr "ldU nS>Vmim MmMUr: {dMmamV KoÊ`mMo ‘wÔo' `m nwpñVHo$Mr {Z{‘©Vr hr g„m‘gbVrÀ`m d nwamì`mda AmYm[aV Ñ{ï>H$moZmÀ`m ‘mÜ`‘mVyZ Pmbr Amho. `m‘Ü`o nwT>rb VrZ ^mJm§Mm g‘mdoe Amho: ZdOmV A^©Ho$ d VmÝhr ~mio `m§Mr ldU nS>Vmim MmMUr, emim ñVamda Ho$br OmUmar ldU nS>Vmim MmMUr d Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr. àË`oH$ ^mJmÀ`m {dH$gZ à{H«$`o‘Ü`o nwT>rb ~m~s¨Mm g‘mdoe hmoVmo:  nS>Vmim MmMUrÀ`m àË`oH$ JQ>mH$[aVm EH$ `mà‘mUo VrZ Vm§{ÌH$ H$m`© JQ> ñWmnZ H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mbm g§~mo{YV H$aÊ`mH$[aVm àým§Mr `mXr V`ma H$aUo;  àË`oH$ nS>Vmim MmMUr JQ>mgmR>r gÜ`m CnbãY Agboë`m ‘mJ©Xe©H$ VÎdm§À`m ì`márMo àmW{‘H$ ‘yë`m§H$Z hmVr KoUo;  nyd©{ZYm©[aV g‘mdoeZ {ZH$fm§‘Ü`o AMyH$nUo ~gUmè¶m ‘mJ©Xe©H$ VÎdm§Mo Ë`m§À`m JwUdÎmoH$[aVm ‘yë`m§H$Z H$aUo (AGREE-II `m gmYZmÀ`m gmhmæ`mZo)1;  Cƒ XOm©À`m ‘mJ©Xe©H$ VÎdm§Mo Vnerbdma nwZamdbmoH$Z H$aUo d `mnyduM {Z{üV Ho$boë`m àýmdbr‘YyZ ‘m{hVr àmá H$aUo;  ‘m{hVr {‘i{dÊ`mÀ`m à{H«$`og ‘XV hmoÊ`mH$[aVm XmoZ Q>ßno Agbobo Delphi survey (OoWo TWGs Ûmao àg§Jmo{MV ‘mZbo OmVo) Am`mo{OV H$aUo;  nwZamdbmoH$Z Ho$bobo nwamdo d VÁkm§Zr {Xboë`m ‘m{hVrÀ`m AmYmao àË`oH$ ^mJmMr {Z{‘©Vr H$aUo;  ‘gwÚm§Mo nwZamdbmoH$Z (TWGs Ûmao) d A{^àm`mMr VaVyX; Am{U  A§{V‘ ñdê$n XoÊ`mnydu A§VJ©V H$m‘ H$aUmè¶m§Zr `mMo nwZamdbmoH$Z H$aUo nwpñVHo$Mm Cn`moJ ldU nS>Vmim MmMUr H$m`©H«$‘ {dH${gV H$aVmZm {dMmamV KoÊ`mÀ`m ‘hÎdmÀ`m KQ>H$m§{df`r hr nwpñVH$m ‘mJ©Xe©Z H$aVo; nwpñVHo$V H$moUmMr nS>Vmim MmMUr Ho$br Omdr, H$m`©H«$‘mMo C{Ôï>, nS>Vmim MmMUrMr dma§dm[aVm, dmnaÊ`mV `oUmar gmYZo BË`mXs¨Mm CXmhaUm§‘Ü`o g‘mdoe hmoVmo. VrZ ^mJm§n¡H$s àË`oH$ ^mJm‘Ü`o `m d BVa g§~§{YV àým§Mm {dMma H$aÊ`mV Ambm Amho, Ë`m àým§Mr CÎmao {Z`moOZmÀ`m Q>ßß`mda {Xbr Jobr nm{hOoV. `m ì`{V[aº$, `m ^mJm§‘Ü`o nwamì`mda AmYm[aV n`m©` {Xbobo AmhoV d {d{dY n`m©`m§Mo ’$m`Xo Am{U VmoQ>o `mda MMm© H$aÊ`mV Ambr Amho, OoUoH$ê$Z `mMm dmna H$aUmao Xoe Ë`m§À`m ñWm{ZH$ g§X^m©g AZwHy$b Agbobo n`m©` am~dy eH$Vrb. nwpñVHo$Mm dmna H$aUmè¶m Xoem§Zr amï´>s` qH$dm ñWm{ZH$ ^mJYmaH$m§Mm JQ> ñWmnZ Ho$bm nm{hOo Am{U Ë`m§Zr `m nwpñVHo$‘Ü`o {Xboë`m {e’$maes¨Mm VgoM Ë`m XoemVrb ldUXmof d H$mZmMo {dH$ma `m§Mo dJuH$aU, ldUXmofm§Mo àH$ma d {ZYm©aH$ KQ>H$ `mM~amo~a VoWrb Amamo½` H$‘©Mmar, ldUMmMUr, nwT>rb VnmgUrH$[aVm ’o$ag„m KoÊ`mÀ`m nÕVr, CnH$aUo d Am{W©H$ g§gmYZo `m gdmªÀ`m CnbãYVo{df`r `mo½` {dMma H$ê$Z Ë`m§À`m H$m`©H«$‘m§Mo {Z`moOZ Ho$bo nm{hOo. ldU nS>Vmim MmMUrMo AZwHy$bZ d {VMr A§‘b~OmdUr `mH$[aVm bmJUmè¶m A{YH$ Vm§{ÌH$ gmhmæ`mH$[aVm OmJ{VH$ Amamo½` g§KQ>Zobm {dZ§Vr Ho$br OmD$ eH$Vo. 1.8 ‘mZdr g§gmYZo é½Umb`mV XmIb Agboë`m é½Um§Mr VgoM ~møé½Um§Mr nS>Vmim MmMUr hr bhmZ ‘wbm§Mo Am°{S>Amobm°{OñQ>, Am°{S>Amo‘o{Q´ñQ²g, Am°{S>Amobm°{OH$b qH$dm BVa V§Ìk, àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a, n[aMm[aH$m qH$dm é½Ugodm H$aUmè¶m (Z{gªJ) ghmæ`H$m§Ûmao Ho$br OmD$ eH$Vo. nS>Vmim MmMUr H$aÊ`mÀ`m àË`oH$ {R>H$mUr CnbãY Agboë`m ‘mZdr g§gmYZm§Zwgma nS>Vmim MmMUr H$‘©Mmè¶m§g§~§YrÀ`m {ZU©`mV ~Xb hmoD$ eH$Vmo. Ooìhm é½Umb`mì`{V[aº$ AÝ` {R>H$mUr nS>Vmim MmMUr Ho$br OmVo Voìhm àmW{‘H$ Amamo½`-godm ñVamda ~mb g§JmonZ godm àXmZ H$aUmao Amamo½` H$‘©Mmar Am{U BVa H$m`©H$V} `m§Zm `m‘Ü`o gh^mJr H$ê$Z KoVbo OmD$ eH$Vo. 1.9 nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm nS>Vmim MmMUrMm nwT>rb VnmgUrH$[aVm nmR>dm {ZîH$f©: n{hë`m nS>Vmim MmMUrZ§Va nwT>rb VnmgUrH$[aVm nmR>dm Agm {ZîH$f© àmá Pmboë`m gd© ZdOmV A^©H$m§Mr Xwgar nS>Vmim MmMUr Ho$br OmÊ`mMr ImÌr H$aÊ`mH$[aVm AmH¥${V~§Y nmR>nwamdm Ho$bm nm{hOo. n{hbr d Xwgar Aem XmoÝhr VnmgÊ`m hmoD$ Z eH$boë`m ZdOmV A^©H$m§Zm Z¡Xm{ZH$ MmMUrH$[aVm nmR>{dbo nm{hOo d Ë`m§Mm AmH¥${V~§Y nmR>nwamdm Ho$bm nm{hOo. Amdí`H$ Vr nS>Vmim MmMUr qH$dm Z¡Xm{ZH$ MmMUr nyU© Pmbr Amho `mMr ImÌr H$aÊ`mH$[aVm {Z`wº$ Ho$boë`m ì`º$sÛmao nÕVeranUo AmH¥${V~§Y nmR>nwamdm Ho$bm Jobm nm{hOo. AmH¥${V~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr‘Yrb Q>ßno {Z{üV H$ê$Z KoVbo nm{hOoV d OmñVrV OmñV AZwnmbZ ìhmdo åhUyZ AmH¥${V~§Y nmR>nwamdm H$aVmZm Hw$Qw>§~mVrb ì`º$sZo CnpñWV amhmdo `mMr ì`dñWm Z¸$s Ho$br nm{hOo. nS>Vmim MmMUrMm CÎmsU© {ZîH$f©: bhmZ ‘wbmÀ`m {dH$mgm‘Yrb Ano{jV Agboë`m ldU d ^mfm{df`H$ àJVrÀ`m Q>ßß`m§{df`r (30) nmbH$/XoI^mbH$V} `m§Zm ‘m{hVr {Xbr nm{hOo. H$mhr doim Ooìhm ho Q>ßno gmÜ` Ho$bo OmV ZmhrV qH$dm ldUXmofmMr e§H$m `oD$ bmJVo Voìhm nyduÀ`m MmMUrMo {ZîH$f© {dMmamV Z KoVm bhmZ ‘wbmMr nwÝhm ldU nS>Vmim MmMUr Ho$br nm{hOo. ho ‘hÎdmMo Amho H$maU ldUXmof hm OÝ‘mZ§Va Ho$ìhmhr CØdy eH$Vmo qH$dm dmT>V OmUmam Agy eH$Vmo, hm Xmof ‘yb OgOgo ‘moR>o hmoV OmVo VgVgm ñnï>nUo {XgyZ `oVmo. gyMZm : nS>Vmim MmMUr H$aUmè¶m gd© H$‘©Mmè¶m§Zr nyduMr H$moUVrhr Ah©Vm Agbr VargwÜXm à{ejU KoVbo nm{hOo. dmnaë¶m OmUmè¶m nS>Vmim MmMUrÀ¶m CnH$aUm§da Am{U {ZîH$f©, ‘m{hVr g§H$bZ Am{U ì¶dñWmnZ (à{ejU Amdí¶H$Vm§gmR>r n[a{eð> 1 nhm) ¶mÀ¶m XñVEodOrH$aUmgh H$m¶©H«$‘mÀ¶m ‘mZH$ H$m¶©àUmbtda à{ejUm‘ܶo bj H|${ÐV H$aʶmV Ambo nm{hOo. JwUdÎmm {Z¶§ÌU Am{U g‘ñ¶m{ZdmaU ¶mH$[aVm à{ejUmVrb H$‘©Mmè¶m§da {Z¶{‘V XoIaoI R>odUo ‘hÎdmMo Amho. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo20 1.10 Z¡Xm{ZH$ ‘yë`‘mnZ ldUpñWVr {Z{üV g‘OÊ`mH$[aVm nS>Vmim MmMUrMo XmoÝhr Q>ßno nyU© Z Ho$boë`m gd© ZdOmV A^©H$m§Mr Ë`m§À`m d`mÀ`m {Vgè¶m ‘{hÝ`mn`ªV Z¡Xm{ZH$ ldU nS>Vmim MmMUr Ho$br nm{hOo. nS>Vmim MmMUr‘Ü`o ` mMm g‘mdoe Agbm nm{hOo:  `m MmMÊ`m§À`m ‘mÜ`‘mVyZ ldUXmofmMo {ZXmZ hmoÊ`mH$[aVm ÜdZr MoVH$màVr ‘|XyH$Sy>Z {Xë`m à{VgmXm§Mo dñVw{Zð> ‘yë`‘mnZ: - Auditory Brainstem Response (ABR) Test :- `mo½` XoI^mb ìhmdr `mMr ImÌr H$aÊ`mH$[aVm àË`oH$ H$mZmVrb ldUXmofmÀ`m ñdê$nmMo d à‘mUmMo {ZXmZ H$aÊ`mH$[aVm dmnabobm ‘mZH$ Cnm` (ÜdZr {ddY©Z, gm§Ho${VH$ IwUm§Mm dmna) - Auditory steady-state response (ASSR) Test :- dma§dm[aVm-{d{eï> Aem à{VgmXmMm (EImÚm Jmoï>rMr {dembVm qH$dm Vrd«Vm) A§XmO àmá H$aÊ`mH$[aVm `mMm ABR gmo~V dmna Ho$bm OmD$ eH$Vmo.  ‘Ü`H$Um©À`m H$m`m©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zm°‘oQ´r (Tympanometry)  ‘Ü` H$Um©Mo H$m`© Am{U Auditory Brainstem Pathways (Am§VaH$Um©nmgyZ ~«oZñQ>o‘n`ªVMo lmì` n¥ÏWH$aUmMo ‘mJ©) VnmgyZ nhmÊ`mH$[aVm AH$m°pñQ>H$ [aâboŠg (Acoustic reflex).  Otoacoustic Emissions (OAE) - ABR MmMUrg‘doV `mMm dmna Ho$ë`mda, ho Am°{S>Q>ar Ý`yamon°Wr ñnoŠQ´‘ {S>gAm°S©>a (auditory neuropathy spectrum disorder) Am{U g§doXZr ldUXmof (sensorineu- ral hearing loss) `mVrb {^ÞVm AmoiIÊ`mÀ`m {ZXmZmH$[aVm ‘hÎdnyU© ‘m{hVr àXmZ H$aVmV.  ldUXmofmMr H$maUo {Z{üV H$aÊ`mH$[aVm d¡ÚH$s` ‘yë`‘mnZ Z¡Xm{ZH$ MmMUr EImÚm VÁk ì`º$sZo Ho$br nm{hOo {OÀ`mH$So> ZdOmV A^©H$m§Mr MmMUr H$aÊ`mMo kmZ d AZw^d Amho; Aer ì`º$s nwamì`mda AmYm[aV {Z`‘mdbs¨Mo nmbZ H$aVo; Am{U {OÀ`mH$So> doioV d gd©g‘mdoeH$ {ZXmZ H$aÊ`mH$[aVm Amdí`H$ CnH$aU Amho. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 21 1.11 CnMma ^mJ 1.3 ‘Ü`o {Xboë`m VÎdm§Zwgma, dmñV{dH$ nhmVm ldUXmof Agbobo ZdOmV A^©H$ Ooìhm 6 ‘{hÝ`m§Mo hmoVo Voìhm Ë`mÀ`mda CnMma gwê$ Pmbo nm{hOoV. ho gmÜ` H$aÊ`mH$[aVm gd© Xoem§Zr à`ËZm§Mr namH$mð>m Ho$br nm{hOo. na§Vw, {OWo ho àË`jmV KS>dyZ AmUUo bJoM eŠ` Zgob Ago Xoe d`mÀ`m EH$ dfm©n`ªV eŠ` hmoB©b Voìhm XoI^mb gwê$ H$aÊ`mMo Ü`o` R>ody eH$VmV. ZdOmV A^©H$ XoI^mbrg§~§YrMo {ZU©` H$m¡Qw>§{~H$ nmVirda {dMma H$ê$Z KoVbo nm{hOoV. nwT>rb Jmoï>s¨~amo~aM, CnMmam§À`m n`m©`m§‘Ü`o ^mfm H$m¡eë`m§À`m {dH$mgmg ‘XV H$aÊ`mH$[aVm lmì` nwZd©gZ CnMma nÕVrMm g‘mdoe hmoVmo.  ldU V§ÌkmZmMm dmna (ldU `§Ìo qH$dm H$m°pŠbAa àË`mamonU);  gm§Ho${VH$ ^mfm {eH$Uo qH$dm  darb XmoÝhr Jmoï>s¨Mm EH${ÌV dmna H$aUo `m ì`{V[aº$, nmbH$m§Zm Ë`m§À`m ‘wbmMr ~mbH$‘§{XamVrb `mo½` Aem e¡j{UH$ H$m`©H«$‘mV ZmdZm|XUr H$aÊ`mH$[aVm ‘mJ©Xe©Z Ho$bo nm{hOo. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo22 1.12 nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ EH$mM doir Xwgè¶m EImÚm AmOmamMo {ZXmZ Pmboë`m ZdOmV A^©H$m§Zm Amdí`H$ CnMmam§H$[aVm, gdm}Îm‘ XoI^mb CnbãY Agboë`m {R>H$mUr nmR>{dbo nm{hOo. nwT>rb H$moUVmhr AmOma {XgyZ Amë`mg, Z¡Xm{ZH$ ldU MmMUrH$[aVm Ëd[aV nmR>{dbo nm{hOo:  OÝ‘mnmgyZ Agbobm gm`Q>mo‘oJ°bmoìhm`ag (Cytomegalovirus)Mm g§gJ©  ‘|XyÁda  S>moHo$ d ‘mZ `mg§~§YrÀ`m OÝ‘OmV {dH¥$Vr (CXmhaUmW©, H$mZ, Moham qH$dm S>moHo$ `m§À`m EH$m ~mOybm qH$dm XmoÝhr ~mOy§Zm Agbobr {dH¥$Vr)  S>moŠ`mbm Pmbobr ‘moR>r XwImnV  ldUXmofmgh bjU g‘wƒ` pñWVr (Syndroms associated with hearing loss)  ZdOmV A^©H$m‘Ü`o {XgyZ `oUmar (aº$g§H«$‘U H$aÊ`mMr Amdí`H$Vm Agbobr) H$mdri 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© nS>Vmim MmMUr à{H«$`oVrb n`m©`r n{hbm Q>ßnm åhUyZ dV©UyH${df`H$ ‘yë`‘mnZmMm dmna nwT>rb n[apñWVrV Ho$bm OmD$ eH$Vmo: 1. d¡ÚH$s` godm XoUo hm àmW{‘H$ CÔoe Zgboë`m {R>H$mUr ZdOmV A^©H$m§À`m nS>Vmim MmMUrMo H$aÊ`mV Ambobo {Z`moOZ. 2. g§gmYZm§Mr ‘`m©Xm (Am{W©H$, H$‘©Mmar dJ© qH$dm nm`m^yV gw{dYm), qH$dm Amamo½` gw{dYm§ì`{V[aº$ AÝ` {R>H$mUr ‘moR>çm g§»`oZo OÝ‘mbm Ambobr ZdOmV A^©Ho$. 3. emar[aH$ ldU ‘yë`‘mnZ eŠ` ZgUo (36). ho bjmV KoVbo nm{hOo H$s dV©UyH${df`H$ {ZarjUmMr {d{eï>Vm Am{U g§doXZerbVm `mo½` àH$mao {gÕ Pmbobr Zgë`mZo ` m nÕVrMm dmna Ho$ë`mZo MwH$sMo ZH$mamË‘H$ (False negative) d MwH$sMo gH$mamË‘H$ (False positive) g§Ho$V XoUmè¶m {ZîH$fmªMo à‘mU A{YH$ Agy eH$Vo. dV©UyH${df`H$ ‘yë`‘mnZmÀ`m à{H«$`m§‘Ü`o `m§Mm g‘mdoe hmoVmo:  n{hbr nS>Vmim MmMUr - H$mbmdYr: Amamo½` `§ÌUoer n{hë`m§Xm Amboë`m g§nH$m©Xaå`mZ, CXmhaUmW© bgrH$aUmgmR>r Amamo½` H|$Ðmbm {Xbobr àW‘ ^oQ> (34). - nÕV: d¡Y Cnm``moOZm§Mm dmna H$ê$Z dV©UyH${df`H$ VnmgUr (n[a{eï> 2 nhm). - H$‘©Mmar dJ©: Amamo½` H$‘©Mmè¶m§Zm dV©UyH${df`H$ {ZarjU H$aÊ`mH$[aVm {Xbobo à{ejU. - g§X^©: Or ZdOmV A^©Ho$ A{Z{üV à{VgmX Xe©{dVmV Ë`m§Zm Xwgè¶m nS>Vmim MmMUrH$[aVm ldU{df`H$ MmMÊ`m CnbãY Agboë`m Amamo½` H|$Ðm‘Ü`o nmR>{dbo nm{hOo.  Xwgar nS>Vmim MmMUr - H$mbmdYr: n{hë`m nS>Vmim MmMUrZ§Va eŠ` {VVŠ`m bdH$a - nÕV: OAE qH$dm AABRMm dmna (^mJ 1.7 nhm) - H$‘©Mmar dJ©: ‘mZdr g§gmYZm§darb ^mJ nhm (^mJ 1.8) - g§X^©: emar[aH$ (Physiological) ldU MmMUrV A`eñdr Pmboë`m ZdOmV A^©H$m§Zm Z¡Xm{ZH$ MmMUrH$[aVm nmR>{dbo nm{hOo, Ë`mZ§Va ldUXmofmÀ`m {ZXmZmMr ImÌr Pmë`mg bdH$amV bdH$a CnMma H$aÊ`mH$[aVm nmR>{dbo nm{hOo.  {ZXmZ d CnMma: - ^mJ 1.10 d 1.11‘Ü`o {ZXmZ d CnMma `mgmR>rÀ`m n`m©`m§Mr ‘m{hVr XoÊ`mV Ambr Amho. g§X^©: 1. Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. DMCN. Jan 2021; 63(1):16–21 (https://doi.org/10.1111/ dmcn.14694,accessed 18 May2021). 2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 3. Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: an overview. Arch Dis Child. 2012 Jul;97(7):654–9 (doi: 10.1136/archdischild-2012- 301786, accessed 10 May 2021). 4. Nelson HD, Bougatsos C, Nygren P, 2001 US Preventive Services Task Force. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008 Jul;122(1):e266–76. doi: 10.1542/peds. 2007–1422. Erratumin: Pediatrics. 2008 Sep;122(3):689. 5. Patel H, Feldman M. Universal newborn hearing screening. Paediatr Child Health. 2011 May;16(5):302–305. 6. Ching TY, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications. Int J Audiol. 2018;57(sup2):S105–S111 (https://doi.org/10.1080/ 14992027. 2017.1385865, accessed 18 May 2021). 7. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, Watkin, Worsfold S, Yuen HM, Stevenson J. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354:2131–2141. doi:10.1056/ NEJMoa054915. 8. Yoshinaga-Itano C, Coulter D, Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology. 2001 Dec;6(6):521–529. 9. Dettman SJ, Pinder D, Briggs RJS, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing.2007 April;28(2):11S–18S. doi:10.1097/ AUD.0b013e31803153f8. 10. Neumann K, Gross M, Böttcher P, Euler HA, Spormann-Lagodzinski M, Polzer M. Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatrica et Logopaedica. 2006;58(6):440–455. 11. Yoshinaga-Itano C. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years. The Volta Review. 2000;100(5):1–117. 12. WHO. Childhood hearing loss, strategies for prevention and care. 2016; Geneva: World Health Organization. 13. Yoshinaga-Itano C, Seday AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161–71. 14. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3):E43. 15. Ching TYC, Dillon H, Button L, Seeto M, Van Buynder P, Marnane V, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140(3). 16. Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95:130–135. 17. Neumann K, Chadha S, Tavartkiladze G, Bu Xingkuan, White KR. Newborn and infant hearing screening facing globally growing numbers of people suffering from disabling hearing loss. Int J Neonatal Screen. 2019;5(7). doi:10.3390/ijns5010007. 18. Yoshinaga-Itano C. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord. 2004 Sep–Oct;37(5):451– 65. doi:10.1016/j.jcomdis.2004.04.008. 19. Kover AMH, Konings S, Dekker FW, Beers M, Wever CC, Frijns JHM, et al. Newborn hearing screening vs later hearing screening and development outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304(15):1701–1708. 20. Sharma R, Gu Yuanyuan, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: a systematic review and critique. Appl Health Econ Health Policy. 2019;17(3):331–357. doi:10.1007/s40258- 018-00456-1. 21. Newborn and infant hearing screening, current issues and guiding principles for action. Geneva: World Health Organization; 2010. 22. Neumann K, Euler HA, Chadha S, White KR. A survey on the global status of newborn and infant hearing screening. JEHDI. 2020;5(2):63–84 (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1130&context=jehdi, accessed 18 May 2021). 23. JCIH. Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1–44. 24. Mishra G, Sharma Y, Mehta K, Patel G. Efficacy of distortion product oto-acoustic emission (OAE)/ auditory brainstem evoked response (ABR) protocols in universal neonatal hearing screening and detecting hearing loss in children <2 years of age. Indian J Otolaryngol Head Neck Surg.2013;65(2):105–110. 25. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in Southern Thailand. Bull World Health Org, 2019;97:663–671 (doi:http://dx.doi.org/10.2471/BLT.18.220939 accessed 18 May 2021). 26. Shearer AE, Shen J, Amr S, Morton C, Smith RJ. A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard of hearing children. Genet Med. 2019;21(11):2614–2630. 27. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017 Aug;140(2). 28. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Research and Reports in Neonatology. 2015;5:51–64. doi:10.2147/RRN.S61862. 29. Moeller MP, Carr G, Seaver L, Stredler- Brown, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Studies Deaf Edu. 2013 Oct;18(4):429–444. 30. Australian government Department of Health. National framework for neonatal hearing screening. Canberra ACT. 2013 Aug (https://www1.health.gov.au/internet/ main/publishing.nsf/Content/neonatal-hearing-screening, accessed 18 May 2021). 31. Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early onset unilateral hearing impairment in children – a systematic review. Int J Pediatr Otorhinolaryngol. 2019;120:173–183. 32. Lieu JE. Permanent unilateral hearing loss (UHL) and childhood development. Curr Otorhinolaryngol Rep. 2018;6(1):74–81 33. Berrettini S, Ghirri P, Lazzerini F, Lenzi G, Forli F. Newborn hearing screening protocol in Tuscany region. Italian J Pediatr. 2017;43:82. doi:10.1186/s13052-017-0397-1. 34. Olusanya BO, Ebuehi OM, Somefun AO. Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience. J Epidemiol Community Health. 2009 Jun;63(6):481–7. doi: 10.1136/jech.2008.082784. 35. The Health Professions Council of South Africa. Early hearing detection and intervention (EHDI), guidelines. South Africa. 2018 (ht tps : / /www.hpcsa .co.za/Uploads/SLH/Guidel ines%20for%20Early_ Hearing_Detection_and_Intervention_(EHDI)_2018.pdf, accessed 18 May 2021). 36. Kuki S, Chadha S, Dhingra S, Gulati A. The role of current audiological tests in the early diagnosis of hearing impairment in infant. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(3):244–50. doi: 10.1007/s12070-012-0558-x. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 23 1.12 nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ EH$mM doir Xwgè¶m EImÚm AmOmamMo {ZXmZ Pmboë`m ZdOmV A^©H$m§Zm Amdí`H$ CnMmam§H$[aVm, gdm}Îm‘ XoI^mb CnbãY Agboë`m {R>H$mUr nmR>{dbo nm{hOo. nwT>rb H$moUVmhr AmOma {XgyZ Amë`mg, Z¡Xm{ZH$ ldU MmMUrH$[aVm Ëd[aV nmR>{dbo nm{hOo:  OÝ‘mnmgyZ Agbobm gm`Q>mo‘oJ°bmoìhm`ag (Cytomegalovirus)Mm g§gJ©  ‘|XyÁda  S>moHo$ d ‘mZ `mg§~§YrÀ`m OÝ‘OmV {dH¥$Vr (CXmhaUmW©, H$mZ, Moham qH$dm S>moHo$ `m§À`m EH$m ~mOybm qH$dm XmoÝhr ~mOy§Zm Agbobr {dH¥$Vr)  S>moŠ`mbm Pmbobr ‘moR>r XwImnV  ldUXmofmgh bjU g‘wƒ` pñWVr (Syndroms associated with hearing loss)  ZdOmV A^©H$m‘Ü`o {XgyZ `oUmar (aº$g§H«$‘U H$aÊ`mMr Amdí`H$Vm Agbobr) H$mdri 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© nS>Vmim MmMUr à{H«$`oVrb n`m©`r n{hbm Q>ßnm åhUyZ dV©UyH${df`H$ ‘yë`‘mnZmMm dmna nwT>rb n[apñWVrV Ho$bm OmD$ eH$Vmo: 1. d¡ÚH$s` godm XoUo hm àmW{‘H$ CÔoe Zgboë`m {R>H$mUr ZdOmV A^©H$m§À`m nS>Vmim MmMUrMo H$aÊ`mV Ambobo {Z`moOZ. 2. g§gmYZm§Mr ‘`m©Xm (Am{W©H$, H$‘©Mmar dJ© qH$dm nm`m^yV gw{dYm), qH$dm Amamo½` gw{dYm§ì`{V[aº$ AÝ` {R>H$mUr ‘moR>çm g§»`oZo OÝ‘mbm Ambobr ZdOmV A^©Ho$. 3. emar[aH$ ldU ‘yë`‘mnZ eŠ` ZgUo (36). ho bjmV KoVbo nm{hOo H$s dV©UyH${df`H$ {ZarjUmMr {d{eï>Vm Am{U g§doXZerbVm `mo½` àH$mao {gÕ Pmbobr Zgë`mZo ` m nÕVrMm dmna Ho$ë`mZo MwH$sMo ZH$mamË‘H$ (False negative) d MwH$sMo gH$mamË‘H$ (False positive) g§Ho$V XoUmè¶m {ZîH$fmªMo à‘mU A{YH$ Agy eH$Vo. dV©UyH${df`H$ ‘yë`‘mnZmÀ`m à{H«$`m§‘Ü`o `m§Mm g‘mdoe hmoVmo:  n{hbr nS>Vmim MmMUr - H$mbmdYr: Amamo½` `§ÌUoer n{hë`m§Xm Amboë`m g§nH$m©Xaå`mZ, CXmhaUmW© bgrH$aUmgmR>r Amamo½` H|$Ðmbm {Xbobr àW‘ ^oQ> (34). - nÕV: d¡Y Cnm``moOZm§Mm dmna H$ê$Z dV©UyH${df`H$ VnmgUr (n[a{eï> 2 nhm). - H$‘©Mmar dJ©: Amamo½` H$‘©Mmè¶m§Zm dV©UyH${df`H$ {ZarjU H$aÊ`mH$[aVm {Xbobo à{ejU. - g§X^©: Or ZdOmV A^©Ho$ A{Z{üV à{VgmX Xe©{dVmV Ë`m§Zm Xwgè¶m nS>Vmim MmMUrH$[aVm ldU{df`H$ MmMÊ`m CnbãY Agboë`m Amamo½` H|$Ðm‘Ü`o nmR>{dbo nm{hOo.  Xwgar nS>Vmim MmMUr - H$mbmdYr: n{hë`m nS>Vmim MmMUrZ§Va eŠ` {VVŠ`m bdH$a - nÕV: OAE qH$dm AABRMm dmna (^mJ 1.7 nhm) - H$‘©Mmar dJ©: ‘mZdr g§gmYZm§darb ^mJ nhm (^mJ 1.8) - g§X^©: emar[aH$ (Physiological) ldU MmMUrV A`eñdr Pmboë`m ZdOmV A^©H$m§Zm Z¡Xm{ZH$ MmMUrH$[aVm nmR>{dbo nm{hOo, Ë`mZ§Va ldUXmofmÀ`m {ZXmZmMr ImÌr Pmë`mg bdH$amV bdH$a CnMma H$aÊ`mH$[aVm nmR>{dbo nm{hOo.  {ZXmZ d CnMma: - ^mJ 1.10 d 1.11‘Ü`o {ZXmZ d CnMma `mgmR>rÀ`m n`m©`m§Mr ‘m{hVr XoÊ`mV Ambr Amho. g§X^©: 1. Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. DMCN. Jan 2021; 63(1):16–21 (https://doi.org/10.1111/ dmcn.14694,accessed 18 May2021). 2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 3. Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: an overview. Arch Dis Child. 2012 Jul;97(7):654–9 (doi: 10.1136/archdischild-2012- 301786, accessed 10 May 2021). 4. Nelson HD, Bougatsos C, Nygren P, 2001 US Preventive Services Task Force. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008 Jul;122(1):e266–76. doi: 10.1542/peds. 2007–1422. Erratumin: Pediatrics. 2008 Sep;122(3):689. 5. Patel H, Feldman M. Universal newborn hearing screening. Paediatr Child Health. 2011 May;16(5):302–305. 6. Ching TY, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications. Int J Audiol. 2018;57(sup2):S105–S111 (https://doi.org/10.1080/ 14992027. 2017.1385865, accessed 18 May 2021). 7. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, Watkin, Worsfold S, Yuen HM, Stevenson J. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354:2131–2141. doi:10.1056/ NEJMoa054915. 8. Yoshinaga-Itano C, Coulter D, Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology. 2001 Dec;6(6):521–529. 9. Dettman SJ, Pinder D, Briggs RJS, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing.2007 April;28(2):11S–18S. doi:10.1097/ AUD.0b013e31803153f8. 10. Neumann K, Gross M, Böttcher P, Euler HA, Spormann-Lagodzinski M, Polzer M. Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatrica et Logopaedica. 2006;58(6):440–455. 11. Yoshinaga-Itano C. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years. The Volta Review. 2000;100(5):1–117. 12. WHO. Childhood hearing loss, strategies for prevention and care. 2016; Geneva: World Health Organization. 13. Yoshinaga-Itano C, Seday AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161–71. 14. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3):E43. 15. Ching TYC, Dillon H, Button L, Seeto M, Van Buynder P, Marnane V, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140(3). 16. Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95:130–135. 17. Neumann K, Chadha S, Tavartkiladze G, Bu Xingkuan, White KR. Newborn and infant hearing screening facing globally growing numbers of people suffering from disabling hearing loss. Int J Neonatal Screen. 2019;5(7). doi:10.3390/ijns5010007. 18. Yoshinaga-Itano C. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord. 2004 Sep–Oct;37(5):451– 65. doi:10.1016/j.jcomdis.2004.04.008. 19. Kover AMH, Konings S, Dekker FW, Beers M, Wever CC, Frijns JHM, et al. Newborn hearing screening vs later hearing screening and development outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304(15):1701–1708. 20. Sharma R, Gu Yuanyuan, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: a systematic review and critique. Appl Health Econ Health Policy. 2019;17(3):331–357. doi:10.1007/s40258- 018-00456-1. 21. Newborn and infant hearing screening, current issues and guiding principles for action. Geneva: World Health Organization; 2010. 22. Neumann K, Euler HA, Chadha S, White KR. A survey on the global status of newborn and infant hearing screening. JEHDI. 2020;5(2):63–84 (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1130&context=jehdi, accessed 18 May 2021). 23. JCIH. Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1–44. 24. Mishra G, Sharma Y, Mehta K, Patel G. Efficacy of distortion product oto-acoustic emission (OAE)/ auditory brainstem evoked response (ABR) protocols in universal neonatal hearing screening and detecting hearing loss in children <2 years of age. Indian J Otolaryngol Head Neck Surg.2013;65(2):105–110. 25. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in Southern Thailand. Bull World Health Org, 2019;97:663–671 (doi:http://dx.doi.org/10.2471/BLT.18.220939 accessed 18 May 2021). 26. Shearer AE, Shen J, Amr S, Morton C, Smith RJ. A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard of hearing children. Genet Med. 2019;21(11):2614–2630. 27. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017 Aug;140(2). 28. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Research and Reports in Neonatology. 2015;5:51–64. doi:10.2147/RRN.S61862. 29. Moeller MP, Carr G, Seaver L, Stredler- Brown, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Studies Deaf Edu. 2013 Oct;18(4):429–444. 30. Australian government Department of Health. National framework for neonatal hearing screening. Canberra ACT. 2013 Aug (https://www1.health.gov.au/internet/ main/publishing.nsf/Content/neonatal-hearing-screening, accessed 18 May 2021). 31. Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early onset unilateral hearing impairment in children – a systematic review. Int J Pediatr Otorhinolaryngol. 2019;120:173–183. 32. Lieu JE. Permanent unilateral hearing loss (UHL) and childhood development. Curr Otorhinolaryngol Rep. 2018;6(1):74–81 33. Berrettini S, Ghirri P, Lazzerini F, Lenzi G, Forli F. Newborn hearing screening protocol in Tuscany region. Italian J Pediatr. 2017;43:82. doi:10.1186/s13052-017-0397-1. 34. Olusanya BO, Ebuehi OM, Somefun AO. Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience. J Epidemiol Community Health. 2009 Jun;63(6):481–7. doi: 10.1136/jech.2008.082784. 35. The Health Professions Council of South Africa. Early hearing detection and intervention (EHDI), guidelines. South Africa. 2018 (ht tps : / /www.hpcsa .co.za/Uploads/SLH/Guidel ines%20for%20Early_ Hearing_Detection_and_Intervention_(EHDI)_2018.pdf, accessed 18 May 2021). 36. Kuki S, Chadha S, Dhingra S, Gulati A. The role of current audiological tests in the early diagnosis of hearing impairment in infant. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(3):244–50. doi: 10.1007/s12070-012-0558-x. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo24 1.12 nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ EH$mM doir Xwgè¶m EImÚm AmOmamMo {ZXmZ Pmboë`m ZdOmV A^©H$m§Zm Amdí`H$ CnMmam§H$[aVm, gdm}Îm‘ XoI^mb CnbãY Agboë`m {R>H$mUr nmR>{dbo nm{hOo. nwT>rb H$moUVmhr AmOma {XgyZ Amë`mg, Z¡Xm{ZH$ ldU MmMUrH$[aVm Ëd[aV nmR>{dbo nm{hOo:  OÝ‘mnmgyZ Agbobm gm`Q>mo‘oJ°bmoìhm`ag (Cytomegalovirus)Mm g§gJ©  ‘|XyÁda  S>moHo$ d ‘mZ `mg§~§YrÀ`m OÝ‘OmV {dH¥$Vr (CXmhaUmW©, H$mZ, Moham qH$dm S>moHo$ `m§À`m EH$m ~mOybm qH$dm XmoÝhr ~mOy§Zm Agbobr {dH¥$Vr)  S>moŠ`mbm Pmbobr ‘moR>r XwImnV  ldUXmofmgh bjU g‘wƒ` pñWVr (Syndroms associated with hearing loss)  ZdOmV A^©H$m‘Ü`o {XgyZ `oUmar (aº$g§H«$‘U H$aÊ`mMr Amdí`H$Vm Agbobr) H$mdri 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© nS>Vmim MmMUr à{H«$`oVrb n`m©`r n{hbm Q>ßnm åhUyZ dV©UyH${df`H$ ‘yë`‘mnZmMm dmna nwT>rb n[apñWVrV Ho$bm OmD$ eH$Vmo: 1. d¡ÚH$s` godm XoUo hm àmW{‘H$ CÔoe Zgboë`m {R>H$mUr ZdOmV A^©H$m§À`m nS>Vmim MmMUrMo H$aÊ`mV Ambobo {Z`moOZ. 2. g§gmYZm§Mr ‘`m©Xm (Am{W©H$, H$‘©Mmar dJ© qH$dm nm`m^yV gw{dYm), qH$dm Amamo½` gw{dYm§ì`{V[aº$ AÝ` {R>H$mUr ‘moR>çm g§»`oZo OÝ‘mbm Ambobr ZdOmV A^©Ho$. 3. emar[aH$ ldU ‘yë`‘mnZ eŠ` ZgUo (36). ho bjmV KoVbo nm{hOo H$s dV©UyH${df`H$ {ZarjUmMr {d{eï>Vm Am{U g§doXZerbVm `mo½` àH$mao {gÕ Pmbobr Zgë`mZo ` m nÕVrMm dmna Ho$ë`mZo MwH$sMo ZH$mamË‘H$ (False negative) d MwH$sMo gH$mamË‘H$ (False positive) g§Ho$V XoUmè¶m {ZîH$fmªMo à‘mU A{YH$ Agy eH$Vo. dV©UyH${df`H$ ‘yë`‘mnZmÀ`m à{H«$`m§‘Ü`o `m§Mm g‘mdoe hmoVmo:  n{hbr nS>Vmim MmMUr - H$mbmdYr: Amamo½` `§ÌUoer n{hë`m§Xm Amboë`m g§nH$m©Xaå`mZ, CXmhaUmW© bgrH$aUmgmR>r Amamo½` H|$Ðmbm {Xbobr àW‘ ^oQ> (34). - nÕV: d¡Y Cnm``moOZm§Mm dmna H$ê$Z dV©UyH${df`H$ VnmgUr (n[a{eï> 2 nhm). - H$‘©Mmar dJ©: Amamo½` H$‘©Mmè¶m§Zm dV©UyH${df`H$ {ZarjU H$aÊ`mH$[aVm {Xbobo à{ejU. - g§X^©: Or ZdOmV A^©Ho$ A{Z{üV à{VgmX Xe©{dVmV Ë`m§Zm Xwgè¶m nS>Vmim MmMUrH$[aVm ldU{df`H$ MmMÊ`m CnbãY Agboë`m Amamo½` H|$Ðm‘Ü`o nmR>{dbo nm{hOo.  Xwgar nS>Vmim MmMUr - H$mbmdYr: n{hë`m nS>Vmim MmMUrZ§Va eŠ` {VVŠ`m bdH$a - nÕV: OAE qH$dm AABRMm dmna (^mJ 1.7 nhm) - H$‘©Mmar dJ©: ‘mZdr g§gmYZm§darb ^mJ nhm (^mJ 1.8) - g§X^©: emar[aH$ (Physiological) ldU MmMUrV A`eñdr Pmboë`m ZdOmV A^©H$m§Zm Z¡Xm{ZH$ MmMUrH$[aVm nmR>{dbo nm{hOo, Ë`mZ§Va ldUXmofmÀ`m {ZXmZmMr ImÌr Pmë`mg bdH$amV bdH$a CnMma H$aÊ`mH$[aVm nmR>{dbo nm{hOo.  {ZXmZ d CnMma: - ^mJ 1.10 d 1.11‘Ü`o {ZXmZ d CnMma `mgmR>rÀ`m n`m©`m§Mr ‘m{hVr XoÊ`mV Ambr Amho. g§X^©: 1. Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. DMCN. Jan 2021; 63(1):16–21 (https://doi.org/10.1111/ dmcn.14694,accessed 18 May2021). 2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 3. Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: an overview. Arch Dis Child. 2012 Jul;97(7):654–9 (doi: 10.1136/archdischild-2012- 301786, accessed 10 May 2021). 4. Nelson HD, Bougatsos C, Nygren P, 2001 US Preventive Services Task Force. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008 Jul;122(1):e266–76. doi: 10.1542/peds. 2007–1422. Erratumin: Pediatrics. 2008 Sep;122(3):689. 5. Patel H, Feldman M. Universal newborn hearing screening. Paediatr Child Health. 2011 May;16(5):302–305. 6. Ching TY, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications. Int J Audiol. 2018;57(sup2):S105–S111 (https://doi.org/10.1080/ 14992027. 2017.1385865, accessed 18 May 2021). 7. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, Watkin, Worsfold S, Yuen HM, Stevenson J. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354:2131–2141. doi:10.1056/ NEJMoa054915. 8. Yoshinaga-Itano C, Coulter D, Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology. 2001 Dec;6(6):521–529. 9. Dettman SJ, Pinder D, Briggs RJS, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing.2007 April;28(2):11S–18S. doi:10.1097/ AUD.0b013e31803153f8. 10. Neumann K, Gross M, Böttcher P, Euler HA, Spormann-Lagodzinski M, Polzer M. Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatrica et Logopaedica. 2006;58(6):440–455. 11. Yoshinaga-Itano C. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years. The Volta Review. 2000;100(5):1–117. 12. WHO. Childhood hearing loss, strategies for prevention and care. 2016; Geneva: World Health Organization. 13. Yoshinaga-Itano C, Seday AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161–71. 14. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3):E43. 15. Ching TYC, Dillon H, Button L, Seeto M, Van Buynder P, Marnane V, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140(3). 16. Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95:130–135. 17. Neumann K, Chadha S, Tavartkiladze G, Bu Xingkuan, White KR. Newborn and infant hearing screening facing globally growing numbers of people suffering from disabling hearing loss. Int J Neonatal Screen. 2019;5(7). doi:10.3390/ijns5010007. 18. Yoshinaga-Itano C. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord. 2004 Sep–Oct;37(5):451– 65. doi:10.1016/j.jcomdis.2004.04.008. 19. Kover AMH, Konings S, Dekker FW, Beers M, Wever CC, Frijns JHM, et al. Newborn hearing screening vs later hearing screening and development outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304(15):1701–1708. 20. Sharma R, Gu Yuanyuan, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: a systematic review and critique. Appl Health Econ Health Policy. 2019;17(3):331–357. doi:10.1007/s40258- 018-00456-1. 21. Newborn and infant hearing screening, current issues and guiding principles for action. Geneva: World Health Organization; 2010. 22. Neumann K, Euler HA, Chadha S, White KR. A survey on the global status of newborn and infant hearing screening. JEHDI. 2020;5(2):63–84 (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1130&context=jehdi, accessed 18 May 2021). 23. JCIH. Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1–44. 24. Mishra G, Sharma Y, Mehta K, Patel G. Efficacy of distortion product oto-acoustic emission (OAE)/ auditory brainstem evoked response (ABR) protocols in universal neonatal hearing screening and detecting hearing loss in children <2 years of age. Indian J Otolaryngol Head Neck Surg.2013;65(2):105–110. 25. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in Southern Thailand. Bull World Health Org, 2019;97:663–671 (doi:http://dx.doi.org/10.2471/BLT.18.220939 accessed 18 May 2021). 26. Shearer AE, Shen J, Amr S, Morton C, Smith RJ. A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard of hearing children. Genet Med. 2019;21(11):2614–2630. 27. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017 Aug;140(2). 28. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Research and Reports in Neonatology. 2015;5:51–64. doi:10.2147/RRN.S61862. 29. Moeller MP, Carr G, Seaver L, Stredler- Brown, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Studies Deaf Edu. 2013 Oct;18(4):429–444. 30. Australian government Department of Health. National framework for neonatal hearing screening. Canberra ACT. 2013 Aug (https://www1.health.gov.au/internet/ main/publishing.nsf/Content/neonatal-hearing-screening, accessed 18 May 2021). 31. Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early onset unilateral hearing impairment in children – a systematic review. Int J Pediatr Otorhinolaryngol. 2019;120:173–183. 32. Lieu JE. Permanent unilateral hearing loss (UHL) and childhood development. Curr Otorhinolaryngol Rep. 2018;6(1):74–81 33. Berrettini S, Ghirri P, Lazzerini F, Lenzi G, Forli F. Newborn hearing screening protocol in Tuscany region. Italian J Pediatr. 2017;43:82. doi:10.1186/s13052-017-0397-1. 34. Olusanya BO, Ebuehi OM, Somefun AO. Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience. J Epidemiol Community Health. 2009 Jun;63(6):481–7. doi: 10.1136/jech.2008.082784. 35. The Health Professions Council of South Africa. Early hearing detection and intervention (EHDI), guidelines. South Africa. 2018 (ht tps : / /www.hpcsa .co.za/Uploads/SLH/Guidel ines%20for%20Early_ Hearing_Detection_and_Intervention_(EHDI)_2018.pdf, accessed 18 May 2021). 36. Kuki S, Chadha S, Dhingra S, Gulati A. The role of current audiological tests in the early diagnosis of hearing impairment in infant. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(3):244–50. doi: 10.1007/s12070-012-0558-x. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 25 1.12 nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ EH$mM doir Xwgè¶m EImÚm AmOmamMo {ZXmZ Pmboë`m ZdOmV A^©H$m§Zm Amdí`H$ CnMmam§H$[aVm, gdm}Îm‘ XoI^mb CnbãY Agboë`m {R>H$mUr nmR>{dbo nm{hOo. nwT>rb H$moUVmhr AmOma {XgyZ Amë`mg, Z¡Xm{ZH$ ldU MmMUrH$[aVm Ëd[aV nmR>{dbo nm{hOo:  OÝ‘mnmgyZ Agbobm gm`Q>mo‘oJ°bmoìhm`ag (Cytomegalovirus)Mm g§gJ©  ‘|XyÁda  S>moHo$ d ‘mZ `mg§~§YrÀ`m OÝ‘OmV {dH¥$Vr (CXmhaUmW©, H$mZ, Moham qH$dm S>moHo$ `m§À`m EH$m ~mOybm qH$dm XmoÝhr ~mOy§Zm Agbobr {dH¥$Vr)  S>moŠ`mbm Pmbobr ‘moR>r XwImnV  ldUXmofmgh bjU g‘wƒ` pñWVr (Syndroms associated with hearing loss)  ZdOmV A^©H$m‘Ü`o {XgyZ `oUmar (aº$g§H«$‘U H$aÊ`mMr Amdí`H$Vm Agbobr) H$mdri 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© nS>Vmim MmMUr à{H«$`oVrb n`m©`r n{hbm Q>ßnm åhUyZ dV©UyH${df`H$ ‘yë`‘mnZmMm dmna nwT>rb n[apñWVrV Ho$bm OmD$ eH$Vmo: 1. d¡ÚH$s` godm XoUo hm àmW{‘H$ CÔoe Zgboë`m {R>H$mUr ZdOmV A^©H$m§À`m nS>Vmim MmMUrMo H$aÊ`mV Ambobo {Z`moOZ. 2. g§gmYZm§Mr ‘`m©Xm (Am{W©H$, H$‘©Mmar dJ© qH$dm nm`m^yV gw{dYm), qH$dm Amamo½` gw{dYm§ì`{V[aº$ AÝ` {R>H$mUr ‘moR>çm g§»`oZo OÝ‘mbm Ambobr ZdOmV A^©Ho$. 3. emar[aH$ ldU ‘yë`‘mnZ eŠ` ZgUo (36). ho bjmV KoVbo nm{hOo H$s dV©UyH${df`H$ {ZarjUmMr {d{eï>Vm Am{U g§doXZerbVm `mo½` àH$mao {gÕ Pmbobr Zgë`mZo ` m nÕVrMm dmna Ho$ë`mZo MwH$sMo ZH$mamË‘H$ (False negative) d MwH$sMo gH$mamË‘H$ (False positive) g§Ho$V XoUmè¶m {ZîH$fmªMo à‘mU A{YH$ Agy eH$Vo. dV©UyH${df`H$ ‘yë`‘mnZmÀ`m à{H«$`m§‘Ü`o `m§Mm g‘mdoe hmoVmo:  n{hbr nS>Vmim MmMUr - H$mbmdYr: Amamo½` `§ÌUoer n{hë`m§Xm Amboë`m g§nH$m©Xaå`mZ, CXmhaUmW© bgrH$aUmgmR>r Amamo½` H|$Ðmbm {Xbobr àW‘ ^oQ> (34). - nÕV: d¡Y Cnm``moOZm§Mm dmna H$ê$Z dV©UyH${df`H$ VnmgUr (n[a{eï> 2 nhm). - H$‘©Mmar dJ©: Amamo½` H$‘©Mmè¶m§Zm dV©UyH${df`H$ {ZarjU H$aÊ`mH$[aVm {Xbobo à{ejU. - g§X^©: Or ZdOmV A^©Ho$ A{Z{üV à{VgmX Xe©{dVmV Ë`m§Zm Xwgè¶m nS>Vmim MmMUrH$[aVm ldU{df`H$ MmMÊ`m CnbãY Agboë`m Amamo½` H|$Ðm‘Ü`o nmR>{dbo nm{hOo.  Xwgar nS>Vmim MmMUr - H$mbmdYr: n{hë`m nS>Vmim MmMUrZ§Va eŠ` {VVŠ`m bdH$a - nÕV: OAE qH$dm AABRMm dmna (^mJ 1.7 nhm) - H$‘©Mmar dJ©: ‘mZdr g§gmYZm§darb ^mJ nhm (^mJ 1.8) - g§X^©: emar[aH$ (Physiological) ldU MmMUrV A`eñdr Pmboë`m ZdOmV A^©H$m§Zm Z¡Xm{ZH$ MmMUrH$[aVm nmR>{dbo nm{hOo, Ë`mZ§Va ldUXmofmÀ`m {ZXmZmMr ImÌr Pmë`mg bdH$amV bdH$a CnMma H$aÊ`mH$[aVm nmR>{dbo nm{hOo.  {ZXmZ d CnMma: - ^mJ 1.10 d 1.11‘Ü`o {ZXmZ d CnMma `mgmR>rÀ`m n`m©`m§Mr ‘m{hVr XoÊ`mV Ambr Amho. g§X^©: 1. Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. DMCN. Jan 2021; 63(1):16–21 (https://doi.org/10.1111/ dmcn.14694,accessed 18 May2021). 2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 3. Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: an overview. Arch Dis Child. 2012 Jul;97(7):654–9 (doi: 10.1136/archdischild-2012- 301786, accessed 10 May 2021). 4. Nelson HD, Bougatsos C, Nygren P, 2001 US Preventive Services Task Force. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008 Jul;122(1):e266–76. doi: 10.1542/peds. 2007–1422. Erratumin: Pediatrics. 2008 Sep;122(3):689. 5. Patel H, Feldman M. Universal newborn hearing screening. Paediatr Child Health. 2011 May;16(5):302–305. 6. Ching TY, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications. Int J Audiol. 2018;57(sup2):S105–S111 (https://doi.org/10.1080/ 14992027. 2017.1385865, accessed 18 May 2021). 7. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, Watkin, Worsfold S, Yuen HM, Stevenson J. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354:2131–2141. doi:10.1056/ NEJMoa054915. 8. Yoshinaga-Itano C, Coulter D, Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology. 2001 Dec;6(6):521–529. 9. Dettman SJ, Pinder D, Briggs RJS, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing.2007 April;28(2):11S–18S. doi:10.1097/ AUD.0b013e31803153f8. 10. Neumann K, Gross M, Böttcher P, Euler HA, Spormann-Lagodzinski M, Polzer M. Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatrica et Logopaedica. 2006;58(6):440–455. 11. Yoshinaga-Itano C. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years. The Volta Review. 2000;100(5):1–117. 12. WHO. Childhood hearing loss, strategies for prevention and care. 2016; Geneva: World Health Organization. 13. Yoshinaga-Itano C, Seday AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161–71. 14. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3):E43. 15. Ching TYC, Dillon H, Button L, Seeto M, Van Buynder P, Marnane V, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140(3). 16. Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95:130–135. 17. Neumann K, Chadha S, Tavartkiladze G, Bu Xingkuan, White KR. Newborn and infant hearing screening facing globally growing numbers of people suffering from disabling hearing loss. Int J Neonatal Screen. 2019;5(7). doi:10.3390/ijns5010007. 18. Yoshinaga-Itano C. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord. 2004 Sep–Oct;37(5):451– 65. doi:10.1016/j.jcomdis.2004.04.008. 19. Kover AMH, Konings S, Dekker FW, Beers M, Wever CC, Frijns JHM, et al. Newborn hearing screening vs later hearing screening and development outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304(15):1701–1708. 20. Sharma R, Gu Yuanyuan, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: a systematic review and critique. Appl Health Econ Health Policy. 2019;17(3):331–357. doi:10.1007/s40258- 018-00456-1. 21. Newborn and infant hearing screening, current issues and guiding principles for action. Geneva: World Health Organization; 2010. 22. Neumann K, Euler HA, Chadha S, White KR. A survey on the global status of newborn and infant hearing screening. JEHDI. 2020;5(2):63–84 (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1130&context=jehdi, accessed 18 May 2021). 23. JCIH. Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1–44. 24. Mishra G, Sharma Y, Mehta K, Patel G. Efficacy of distortion product oto-acoustic emission (OAE)/ auditory brainstem evoked response (ABR) protocols in universal neonatal hearing screening and detecting hearing loss in children <2 years of age. Indian J Otolaryngol Head Neck Surg.2013;65(2):105–110. 25. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in Southern Thailand. Bull World Health Org, 2019;97:663–671 (doi:http://dx.doi.org/10.2471/BLT.18.220939 accessed 18 May 2021). 26. Shearer AE, Shen J, Amr S, Morton C, Smith RJ. A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard of hearing children. Genet Med. 2019;21(11):2614–2630. 27. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017 Aug;140(2). 28. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Research and Reports in Neonatology. 2015;5:51–64. doi:10.2147/RRN.S61862. 29. Moeller MP, Carr G, Seaver L, Stredler- Brown, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Studies Deaf Edu. 2013 Oct;18(4):429–444. 30. Australian government Department of Health. National framework for neonatal hearing screening. Canberra ACT. 2013 Aug (https://www1.health.gov.au/internet/ main/publishing.nsf/Content/neonatal-hearing-screening, accessed 18 May 2021). 31. Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early onset unilateral hearing impairment in children – a systematic review. Int J Pediatr Otorhinolaryngol. 2019;120:173–183. 32. Lieu JE. Permanent unilateral hearing loss (UHL) and childhood development. Curr Otorhinolaryngol Rep. 2018;6(1):74–81 33. Berrettini S, Ghirri P, Lazzerini F, Lenzi G, Forli F. Newborn hearing screening protocol in Tuscany region. Italian J Pediatr. 2017;43:82. doi:10.1186/s13052-017-0397-1. 34. Olusanya BO, Ebuehi OM, Somefun AO. Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience. J Epidemiol Community Health. 2009 Jun;63(6):481–7. doi: 10.1136/jech.2008.082784. 35. The Health Professions Council of South Africa. Early hearing detection and intervention (EHDI), guidelines. South Africa. 2018 (ht tps : / /www.hpcsa .co.za/Uploads/SLH/Guidel ines%20for%20Early_ Hearing_Detection_and_Intervention_(EHDI)_2018.pdf, accessed 18 May 2021). 36. Kuki S, Chadha S, Dhingra S, Gulati A. The role of current audiological tests in the early diagnosis of hearing impairment in infant. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(3):244–50. doi: 10.1007/s12070-012-0558-x. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo26 1.12 nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ EH$mM doir Xwgè¶m EImÚm AmOmamMo {ZXmZ Pmboë`m ZdOmV A^©H$m§Zm Amdí`H$ CnMmam§H$[aVm, gdm}Îm‘ XoI^mb CnbãY Agboë`m {R>H$mUr nmR>{dbo nm{hOo. nwT>rb H$moUVmhr AmOma {XgyZ Amë`mg, Z¡Xm{ZH$ ldU MmMUrH$[aVm Ëd[aV nmR>{dbo nm{hOo:  OÝ‘mnmgyZ Agbobm gm`Q>mo‘oJ°bmoìhm`ag (Cytomegalovirus)Mm g§gJ©  ‘|XyÁda  S>moHo$ d ‘mZ `mg§~§YrÀ`m OÝ‘OmV {dH¥$Vr (CXmhaUmW©, H$mZ, Moham qH$dm S>moHo$ `m§À`m EH$m ~mOybm qH$dm XmoÝhr ~mOy§Zm Agbobr {dH¥$Vr)  S>moŠ`mbm Pmbobr ‘moR>r XwImnV  ldUXmofmgh bjU g‘wƒ` pñWVr (Syndroms associated with hearing loss)  ZdOmV A^©H$m‘Ü`o {XgyZ `oUmar (aº$g§H«$‘U H$aÊ`mMr Amdí`H$Vm Agbobr) H$mdri 1.13 nS>Vmim MmMUrH$[aVmMo n`m©`r ‘mJ© nS>Vmim MmMUr à{H«$`oVrb n`m©`r n{hbm Q>ßnm åhUyZ dV©UyH${df`H$ ‘yë`‘mnZmMm dmna nwT>rb n[apñWVrV Ho$bm OmD$ eH$Vmo: 1. d¡ÚH$s` godm XoUo hm àmW{‘H$ CÔoe Zgboë`m {R>H$mUr ZdOmV A^©H$m§À`m nS>Vmim MmMUrMo H$aÊ`mV Ambobo {Z`moOZ. 2. g§gmYZm§Mr ‘`m©Xm (Am{W©H$, H$‘©Mmar dJ© qH$dm nm`m^yV gw{dYm), qH$dm Amamo½` gw{dYm§ì`{V[aº$ AÝ` {R>H$mUr ‘moR>çm g§»`oZo OÝ‘mbm Ambobr ZdOmV A^©Ho$. 3. emar[aH$ ldU ‘yë`‘mnZ eŠ` ZgUo (36). ho bjmV KoVbo nm{hOo H$s dV©UyH${df`H$ {ZarjUmMr {d{eï>Vm Am{U g§doXZerbVm `mo½` àH$mao {gÕ Pmbobr Zgë`mZo ` m nÕVrMm dmna Ho$ë`mZo MwH$sMo ZH$mamË‘H$ (False negative) d MwH$sMo gH$mamË‘H$ (False positive) g§Ho$V XoUmè¶m {ZîH$fmªMo à‘mU A{YH$ Agy eH$Vo. dV©UyH${df`H$ ‘yë`‘mnZmÀ`m à{H«$`m§‘Ü`o `m§Mm g‘mdoe hmoVmo:  n{hbr nS>Vmim MmMUr - H$mbmdYr: Amamo½` `§ÌUoer n{hë`m§Xm Amboë`m g§nH$m©Xaå`mZ, CXmhaUmW© bgrH$aUmgmR>r Amamo½` H|$Ðmbm {Xbobr àW‘ ^oQ> (34). - nÕV: d¡Y Cnm``moOZm§Mm dmna H$ê$Z dV©UyH${df`H$ VnmgUr (n[a{eï> 2 nhm). - H$‘©Mmar dJ©: Amamo½` H$‘©Mmè¶m§Zm dV©UyH${df`H$ {ZarjU H$aÊ`mH$[aVm {Xbobo à{ejU. - g§X^©: Or ZdOmV A^©Ho$ A{Z{üV à{VgmX Xe©{dVmV Ë`m§Zm Xwgè¶m nS>Vmim MmMUrH$[aVm ldU{df`H$ MmMÊ`m CnbãY Agboë`m Amamo½` H|$Ðm‘Ü`o nmR>{dbo nm{hOo.  Xwgar nS>Vmim MmMUr - H$mbmdYr: n{hë`m nS>Vmim MmMUrZ§Va eŠ` {VVŠ`m bdH$a - nÕV: OAE qH$dm AABRMm dmna (^mJ 1.7 nhm) - H$‘©Mmar dJ©: ‘mZdr g§gmYZm§darb ^mJ nhm (^mJ 1.8) - g§X^©: emar[aH$ (Physiological) ldU MmMUrV A`eñdr Pmboë`m ZdOmV A^©H$m§Zm Z¡Xm{ZH$ MmMUrH$[aVm nmR>{dbo nm{hOo, Ë`mZ§Va ldUXmofmÀ`m {ZXmZmMr ImÌr Pmë`mg bdH$amV bdH$a CnMma H$aÊ`mH$[aVm nmR>{dbo nm{hOo.  {ZXmZ d CnMma: - ^mJ 1.10 d 1.11‘Ü`o {ZXmZ d CnMma `mgmR>rÀ`m n`m©`m§Mr ‘m{hVr XoÊ`mV Ambr Amho. g§X^©: 1. Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. DMCN. Jan 2021; 63(1):16–21 (https://doi.org/10.1111/ dmcn.14694,accessed 18 May2021). 2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 3. Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: an overview. Arch Dis Child. 2012 Jul;97(7):654–9 (doi: 10.1136/archdischild-2012- 301786, accessed 10 May 2021). 4. Nelson HD, Bougatsos C, Nygren P, 2001 US Preventive Services Task Force. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008 Jul;122(1):e266–76. doi: 10.1542/peds. 2007–1422. Erratumin: Pediatrics. 2008 Sep;122(3):689. 5. Patel H, Feldman M. Universal newborn hearing screening. Paediatr Child Health. 2011 May;16(5):302–305. 6. Ching TY, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: summary of 5-year findings and implications. Int J Audiol. 2018;57(sup2):S105–S111 (https://doi.org/10.1080/ 14992027. 2017.1385865, accessed 18 May 2021). 7. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, Watkin, Worsfold S, Yuen HM, Stevenson J. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354:2131–2141. doi:10.1056/ NEJMoa054915. 8. Yoshinaga-Itano C, Coulter D, Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology. 2001 Dec;6(6):521–529. 9. Dettman SJ, Pinder D, Briggs RJS, Dowell RC, Leigh JR. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing.2007 April;28(2):11S–18S. doi:10.1097/ AUD.0b013e31803153f8. 10. Neumann K, Gross M, Böttcher P, Euler HA, Spormann-Lagodzinski M, Polzer M. Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatrica et Logopaedica. 2006;58(6):440–455. 11. Yoshinaga-Itano C. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years. The Volta Review. 2000;100(5):1–117. 12. WHO. Childhood hearing loss, strategies for prevention and care. 2016; Geneva: World Health Organization. 13. Yoshinaga-Itano C, Seday AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161–71. 14. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3):E43. 15. Ching TYC, Dillon H, Button L, Seeto M, Van Buynder P, Marnane V, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140(3). 16. Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95:130–135. 17. Neumann K, Chadha S, Tavartkiladze G, Bu Xingkuan, White KR. Newborn and infant hearing screening facing globally growing numbers of people suffering from disabling hearing loss. Int J Neonatal Screen. 2019;5(7). doi:10.3390/ijns5010007. 18. Yoshinaga-Itano C. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord. 2004 Sep–Oct;37(5):451– 65. doi:10.1016/j.jcomdis.2004.04.008. 19. Kover AMH, Konings S, Dekker FW, Beers M, Wever CC, Frijns JHM, et al. Newborn hearing screening vs later hearing screening and development outcomes in children with permanent childhood hearing impairment. JAMA. 2010;304(15):1701–1708. 20. Sharma R, Gu Yuanyuan, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: a systematic review and critique. Appl Health Econ Health Policy. 2019;17(3):331–357. doi:10.1007/s40258- 018-00456-1. 21. Newborn and infant hearing screening, current issues and guiding principles for action. Geneva: World Health Organization; 2010. 22. Neumann K, Euler HA, Chadha S, White KR. A survey on the global status of newborn and infant hearing screening. JEHDI. 2020;5(2):63–84 (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1130&context=jehdi, accessed 18 May 2021). 23. JCIH. Year 2019 Position Statement: Principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1–44. 24. Mishra G, Sharma Y, Mehta K, Patel G. Efficacy of distortion product oto-acoustic emission (OAE)/ auditory brainstem evoked response (ABR) protocols in universal neonatal hearing screening and detecting hearing loss in children <2 years of age. Indian J Otolaryngol Head Neck Surg.2013;65(2):105–110. 25. Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in Southern Thailand. Bull World Health Org, 2019;97:663–671 (doi:http://dx.doi.org/10.2471/BLT.18.220939 accessed 18 May 2021). 26. Shearer AE, Shen J, Amr S, Morton C, Smith RJ. A proposal for comprehensive newborn hearing screening to improve identification of deaf and hard of hearing children. Genet Med. 2019;21(11):2614–2630. 27. Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017 Aug;140(2). 28. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Research and Reports in Neonatology. 2015;5:51–64. doi:10.2147/RRN.S61862. 29. Moeller MP, Carr G, Seaver L, Stredler- Brown, Holzinger D. Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement. J Deaf Studies Deaf Edu. 2013 Oct;18(4):429–444. 30. Australian government Department of Health. National framework for neonatal hearing screening. Canberra ACT. 2013 Aug (https://www1.health.gov.au/internet/ main/publishing.nsf/Content/neonatal-hearing-screening, accessed 18 May 2021). 31. Huttunen K, Erixon E, Löfkvist U, Mäki-Torkko E. The impact of permanent early onset unilateral hearing impairment in children – a systematic review. Int J Pediatr Otorhinolaryngol. 2019;120:173–183. 32. Lieu JE. Permanent unilateral hearing loss (UHL) and childhood development. Curr Otorhinolaryngol Rep. 2018;6(1):74–81 33. Berrettini S, Ghirri P, Lazzerini F, Lenzi G, Forli F. Newborn hearing screening protocol in Tuscany region. Italian J Pediatr. 2017;43:82. doi:10.1186/s13052-017-0397-1. 34. Olusanya BO, Ebuehi OM, Somefun AO. Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience. J Epidemiol Community Health. 2009 Jun;63(6):481–7. doi: 10.1136/jech.2008.082784. 35. The Health Professions Council of South Africa. Early hearing detection and intervention (EHDI), guidelines. South Africa. 2018 (ht tps : / /www.hpcsa .co.za/Uploads/SLH/Guidel ines%20for%20Early_ Hearing_Detection_and_Intervention_(EHDI)_2018.pdf, accessed 18 May 2021). 36. Kuki S, Chadha S, Dhingra S, Gulati A. The role of current audiological tests in the early diagnosis of hearing impairment in infant. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(3):244–50. doi: 10.1007/s12070-012-0558-x. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 27 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo28 2 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 29 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. ldU nS>Vmim MmMUr‘Ü`o gm‘mÝ`V: ÜdZr H§$nZm§À`m dhZ MmMUrMm g‘mdoe AgVmo. ldUXmofmÀ`m àH$mamVrb ’$aH$ (g§dmhH$, g§doXZr qH$dm {‘{lV àH$ma) Ho$di Z¡Xm{ZH$ ldU nS>Vmim MmMUr H$ê$Z AmoiIUo eŠ` Amho. Á`m ‘wbm§Zm gwédmVrÀ`m ldU nS>Vmim MmMUr‘Ü`o XmofmMr eŠ`Vm {XgyZ `oVo Am{U Ë`m§Zm nwT>rb VnmgUrH$[aVm nmR>{dbo OmVo, Ë`m gd© ‘wbm§H$[aVm hr CnbãY Ho$br nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo30 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. Mm¡H$Q> 2.1 ldUq~Xy {Z{üV H$aÊ`mH$[aVm {dMmamV KoÊ`mMo ‘wÔo  dmñV{dH$ nmhVm H$moUË`mhr nmVirMm (åhUOoM 20 dBHL qH$dm Ë`mhÿZ A{YH$) ldUXmof Agbobr ‘wbo AmoiIVm Ambr n{hOoV, H$maU {H$aH$moi ldUXmofmMmgwÕm e¡j{UH$ H$m‘{Jarda n[aUm‘ hmoVmo. (13,14). ho C{Ôï> {deofV: Aem {R>H$mUr Agbo nm{hOo OoWo dmVmdaUmVrb AmdmOmMr nmVir VnmgÊ`m- da H$R>moa {Z`§ÌU R>odVm `oD$ eH$Vo (CXm. 40 dBHL nojm H$‘r); Am{U `m‘wio ldU MmMUrÀ`m {Z‘m©U hmoUmè¶m ‘mJUrMo ì`dñWmnZ H$aÊ`mH$[aVm Amamo½` `§ÌUm§Mr j‘Vm nwaoer AgVo.  H$m`©H«$‘m§Mo Am`moOZ H$aVmZm gwédmVrbm 30 qH$dm 35 dBHL `m§gmaIo ldUq~Xy§Mo bú` R>odUo H$Xm{MV `mo½` Agob. `mMo H$maU åhUOo 20qH$dm 25 dBHL `m§gmaIo H$‘r ldUq~Xy: - ho AmOy~mOyÀ`m AmdmOm‘Ü`o ‘yë`‘mnZ H$aÊ`mg AdKS> AgVmV (40 dB nojm A{YH$) - ho Z¡Xm{ZH$ ‘yë`‘mnZmH$[aVm A{YH$ ‘wbm§Zm nmR>{dÊ`mg ^mJ nmS>VmV d Vo Amamo½` `§ÌUm§H$[aVm AmìhmZmË‘H$ R>ê$ eH$Vo; qH$dm - MwH$sÀ`m {ZîH$fmªMo à‘mU dmT>ë`mZo nwT>rb VnmgUrH$[aVm nmR>dë`m OmUmè¶m ‘wbm§À`m g§»`oV dmT> hmoD$ eH$Vo, Á`m‘wio Amamo½` ` §ÌUm§da OmñV ^ ma nS>Vmo d Ë`m‘wio nS>Vmim MmMUr à{H«$`oda A{dœmg {Z‘m©U hmoVmo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 31 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. 3 à‘m{UV A°ßg Or dmnaÊ`mH$[aVm S>mCZbmoS> Ho$br OmD$ eH$VmV CXm.: NIOSH Sound Level Meter, Sound Meter Pro, qH$dm Sound Meter and Noise Detector ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo32 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. Vº$m 2.1 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUrH$[aVm MmMÊ`m (5-12) MmMUrMm àH$ma dmnabobr CnH$aUo MmMUrMr nÕV nwT>o nmR>{dÊ`mH$[aVm {ZH$f ldU MmMUr ñdrn Am°{S>Amo‘oQ´r (emim gwê$ hmoÊ`mnydu Ho$bobr bhmZ ‘wbmMr ldU nS>Vmim MmMUr) nma§n[aH$ (ñd`§M{bV Zgbobm) nS>Vmim MmMUrMm Am°{S>Amo‘rQ>a VrZ dma§dm[aVm§Zm (1 kHz, 2 kHz, d 4 kHz,) 20 dBHL/25 dBHL/ 30 dBHL/35 dBHL Aem {Z{üV dB nmVirbm XmoÝhr H$mZm§Mr Pmbobr ñdV§Ì MmMUr. dmVmdaUmVrb AmdmOm‘wio `oUmam MwH$sMm gH$mamË‘H$ åhUOoM False positive {ZîH$f© Q>miÊ`mH$[aVm 1 kHz bm dB Mr nmVir dmT>dUmam EH$ doJim Ñ{ï>H$moZ R>odVm `oD$ eH$Vmo. CXmhaUmW© Oa {dMmamV KoVbm OmUmam ldUq~Xy 25 dBHL Agob Va 2 kHz d 4 kHz H$[aVm 25 dBHL bm nS>Vmim MmMUr Ho$br OmB©b, na§Vw, 1 kHz H$[aVm Vr 30 dBHL bm Ho$br OmB©b (15,16) ‘yb à{VgmX XoV Zmhr:  {ZH$fmÀ`m ldUq~Xy nmVirbm;  EH$m qH$dm A{YH$ dma§dm[aVm§Zm;  VrZn¡H$s {H$‘mZ XmoZ doiobm EH$m H$mZmZo Oar à{VgmX {Xbm Zmhr Var hr nwT>rb VnmgUrH$[aVm nmR>{dÊ`mMr IyU g‘Omdr ñd`§M{bV {S>{OQ>b ñH«$sZg© (13,14) . {S>{OQ²g-BZ-Zm°BO (Digits-in-Noise) MmMUr qH$dm ñnrM-BZ- Zm°BO (Speech-in- Noise) MmMÊ`m {S>{OQ> {Q´ßboQ>-BZ-Zm°BO (Digit triplet-in-Noise) MmMUr Ogo H$s 9 dfmªnojm A{YH$ d` Agboë`m ‘wbm§H$[aVm OmJ{VH$ Amamo½` g§KQ>ZoMo WHO hear WHO app dmnaVm `oD$ eH$Vo (18) XmoÝhr H$mZm§Mr EH${ÌV MmMUr Pmbr. 20 dBHL / 25 dBHL / 30dBHL / 35 dBHL À`m {dMmamV KoVë`m OmUmè¶m ldUq~XyÀ`m nmVirer g§b¾ Agbobo ñnrM-BZ- Zm°BOMo à‘mU Agboë`m ì`º$s¨Zm nwT>rb VnmgUrH$[aVm nmR>{dÊ`mH$[aVm ñ‘mQ>©’$moZ‘Yrb A°n à‘m{UV Ho$bo nm{hOo. 20 dBHL / 25dBHL /30 dBHL /35 dBHL À`m {dMmamV KoVë`m OmUmè¶m ldUq~Xyer g§b¾ Agboë`m R>amdrH$ d`moJQ>mH$[aVm (17) {Z{üV Ho$bobo AmdmO AmoiIÊ`mMo ldUq~Xy H$mZmMr VnmgUr EImXo ghOnUo {XgyZ `oUmao ì`§J nmhÊ`mH$[aVm VgoM Am°Q>moñH$mo{nH$ VnmgUr H$[aVm ~mø H$Um©Mr CKS>çm S>moù`m§Zr Ho$bobr VnmgUr AmoQ>moñH$mon (à‘m{UV H$‘r I{M©H$ n`m©` CnbãY AmhoV d dmnaVm `oD$ eH$VmV).* XmoÝhr H$mZm§Mr ñdV§ÌnUo Ho$bobr VnmgUr.  H$mZmVyZ òmd `oV Agë`mMo {XgyZ Ambo.  nydu {ZXmZ Z Pmbobo Ñí` ñdê$nmVrb g§aMZmË‘H$ Xmof  KÅ> ‘oUmgmaIm nXmW© qH$dm ~mø dñVy  H$mZmÀ`m nS>Úmbm Agbobo {N>Ð qH$dm ghOnUo {XgyZ `oUmar {dH¥$Vr ‘Ü` H$Um©Vrb hdoÀ`m Xm~mMo ‘yë`‘mnZ (eŠ` Agob {VWo) {Q>ån°Zm°‘oQ´r ‘moR>m {Q>ån°Zmo‘rQ>a qH$dm hmVmV YaVm `oB©b Agm {Q>ån°Zmo‘rQ>a àË`oH$ H$mZmMo ñdV§ÌnUo Ho$bobo ‘yë`‘mnZ B qH$dm C {Q>ån°ZmoJ«m‘. * H$‘r {H$‘VrÀ`m n`m©`mMo CXmhaU åhUOo AmH©$bmBQ> ñH$mon. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041821/ nhm. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 33 2.7 ‘mZdr g§gmYZo emioV OmUmè¶m ‘wbm§Mr H$mZ VnmgUr d ldU nS>Vmim MmMUr nwT>rb à{e{jV ì`º$s¨À`m JQ>mÛmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ÜdZr {deofk (ldUemók), dmMm d ^mfm amoJ{ZXmZVÁk)  H$U©~{Ya ì`º$s¨Mr XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© emioVrb S>m°ŠQ>a, gm‘mÝ` S>m°ŠQ>a, ~mbamoJVÁk)  à{e{jV Amamo½` H$‘©Mmar d n[aMm[aH$m (CXmhaUmW© d¡ÚH$s` A{YH$mar, n[aMm[aH$m, d¡ÚH$s` ‘XVZrg, V§Ìk) (13,14)  à{e{jV Ago gd©gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© dñVr nmVirda H$m‘ H$aUmao Amamo½` H$‘©Mmar) (13,14)  à{e{jV {ejH$ (19) H$mZmÀ`m d ldU VnmgÊ`m EImÚm {M{H$ËgH$ Zgboë`m ì`º$sH$Sy>Z H$amì`m bmJUma AgVrb Va g§~§{YV bmoH$m§Zm à{ejU ho {XboM nm{hOo, Ë`mZ§Va Ë`m§Zr XoIaoIrImbr gamd Ho$bm nm{hOo d gmVË`mZo JwUdÎmm VnmgyZ bmJUmar ‘XV Ho$br nm{hOo. à{ejUmZ§Va, Mm§Jbm gamd d ‘mZHo$ Am{U ‘mJ©Xe©H$ VÎdo `m§Mo nmbZ hmoV Agë`mMr ImÌr H$aÊ`m- H$[aVm {Z`{‘V VnmgUr Ho$br nm{hOo. {M{H$ËgH$ Zgboë`m ì`º$s¨À`m à{ejUmH$[aVm Amdí`H$ Agboë`m Jmoï>r Mm¡H$Q> 2.2 ‘Ü`o WmoS>Š`mV {Xë`m AmhoV. Mm¡H$Q> 2.2 emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amdí`H$ KQ>H$ H$mZmMr VgoM ldUj‘VoMr H$miOr KoÊ`mH$[aVm à{e{jV Zgbobo {M{H$ËgH$, n[aMm[aH$m d Amamo½` H$‘©Mmar `m§Zr nwT>rb Jmoï>s¨‘Ü`o à{ejU KoVbo nm{hOo:  ldUmMo ‘hÎd- {deofH$ê$Z {ejUmH$[aVm;  nS>Vmim MmMUrMm CÔoe d {Z`‘mdbr;  H$mZmMr ‘yb^yV aMZm  ldUXmofmMr H$maUo;  nS>Vmim MmMUr H$m`©H«$‘mMo ‘yb^yV H$m`© d Ahdmb XoÊ`mMr à{H«$`m;  nS>Vmim MmMUr H$aUmè¶m ì`º$sMr / MmMUrH$Ë`m©Mr ^y{‘H$m;  nS>Vmim MmMUr d nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVr;  nS>Vmim MmMUr Ho$br OmUmè¶m ImobrMr aMZm d CnH$aUmMo à‘mUrH$aU;  CnH$aU, XoI^mb d H$m‘ H$aV Zgë`mg g‘ñ`m {ZdmaU `mgh;  dmVmdaUmVrb AmdmOmMr ‘moO‘mno;  Am°Q>moñH$monr d {Q>ån°Zm°‘oQ´r (OoWo CnbãY Agob VoWo) Am{U;  {dMmamV KoVbm OmUmam H$mZ d ldUj‘VoMr pñWVr AmoiIUo. ldU{df`H$ H$miOr KoUmao S>m°ŠQ>a nS>Vmim MmMUr H$m`©H«$‘mMm CÔoe d {Z`‘mdbr `màVr g§doXZerb Agbo nm{hOoV. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. 2.8 nwT>rb VnmgUrH$[aVmMo {ZH$f ‘mJ©Xe©H$ VÎdm§‘Ü`o (^mJ 2.2) Z‘yX Ho$ë`mZwgma, emim-ñVamdarb H$mZ VnmgUr H$m`©H«$‘ hm H$mZ d ldU godm `m§À`mer g§b¾ AgUo Amdí`H$ Amho. Ë`m‘Ü`o H$mZmMo {dH$ma Agbobr qH$dm ldUXmofmMo {ZXmZ Pmbobr ‘wbo Amdí`H$ Vr XoI^mb àmá H$ê$ eH$Vrb. MmMUrÀ`m doJdoJù`m {ZîH$fmªH$[aVm H$amd`mÀ`m H¥$Vr nwT>rbà‘mUo AmhoV:  CÎmsU© {ZîH$f©: H$mZ VnmgUr d ldU nS>Vmim MmMUrZ§Va CÎmsU© Agm {ZîH$f© Amboë`m d nwT>rb VnmgUrH$[aVm nmR>dm Agm eoam Z XoÊ`mV Amboë`m ‘wbm§Zm Ë`m§À`m H$mZm§Mr H$miOr KoÊ`mMm g„m {Xbm nm{hOo. Ë`m§Zm H$mZ d ldUeº$s `mMr H$miOr `m{df`r ‘m{hVr {Xbr nm{hOo.4  nwT>rb VnmgUrH$[aVm nmR>dm {ZîH$f©: ldU nS>Vmim MmMUrZ§Va nwT>rb VnmgUrH$[aVm nmR>dm Agm {ZîH$f© Amboë`m ‘wbm§Mo {ZXmZ d ì`dñWmnZ H$aÊ`mH$[aVm H$mZmMr VnmgUr d ldU MmMUr Pmbr nm{hOo. hr MmMUr H$mZ d ldUeº$sMr H$miOr KoÊ`mMr j‘Vm Agboë`m S>m°ŠQ>am§Zr Ho$br nm{hOo.  {ZX}eH$ g§Ho$V (Red Flags): H$mZmMr VnmgUr d ldU nS>Vmim MmMUrZ§Va {ZX}eH$ Agm {ZîH$f© Amboë`m ‘wbm§Zm nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var nwT>rb ‘yë`‘mnZmH$[aVm nmR>{dbo nm{hOo. {ZX}eH$m§À`m Bemè¶m§‘Ü`o `m§Mm g‘mdoe hmoVmo: - ‘wbmMo EoH$Uo, ~mobUo d ^mfm {dH$mg, Xwb©j, {eH$Ê`mVrb AS>MUr qH$dm H$mZmÀ`m H$moUË`mhr g‘ñ`m§~Ôb (nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var) H$miOr dmQ>Umao nmbH$ Am{U H$miOr KoUmè¶m ì`º$s qH$dm {ejH$ - H$mZmVyZ `oUmam òmd; Oa H$mZmVyZ `oUmè¶m òmdmbm XwJªYr `oV Agob, Va ho Ëd[aV d VmVS>rZo nwT>rb VnmgUrH$[aVm nmR>{dÊ`mMo H$maU Agbo nm{hOo; - H$mZmÀ`m ‘mJo bmbganUm Am{U doXZmXm`H$ gyO (mastoid); Am{U - H$mZm‘Ü`o qH$dm H$mZmÀ`m AdVr^dVr Vrd« doXZm àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a, à{e{jV n[aMm[aH$m qH$dm H$mZ d ldUeº$sMr H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dbo OmD$ eH$Vo. H$moUmH$So> nmR>{dbo Omdo `mMm {ZU©` ñWm{ZH$ n[apñWVr, H$mZ Am{U ldU {M{H$ËgH$m§Mr CnbãYVm d BVa à{e{jV Amamo½` H$‘©Mmar `m§À`mda Adb§~yZ AgUo Amdí`H$ Amho. àmYmÝ`H«$‘mZwgma nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVrMm Adb§~ Ho$bm OmD$ eH$Vmo. CXmhaUmW©, H$mZmVyZ òmd `oUo, gyO BË`mXs¨gma»`m d¡ÚH$s` g‘ñ`m§da àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a qH$dm à{e{jV n[aMm[aH$m `m§À`mÛmao CnMma Ho$bo OmD$ eH$VmV; ldUXmofmer g§~§{YV g‘ñ`m WoQ> H$mZ d ldU{df`H$ H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dë`m nm{hOoV. 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ ldUXmofmMo ‘yë`‘mnZ H$aÊ`mH$[aVm nmR>{dboë`m H|$Ðmda CnbãY Agboë`m Z¡Xm{ZH$ godm§‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe Agmdm (5-12):  Z¡Xm{ZH$ ewÕ ÜdZr ldU MmMUr (eŠ` Agob {VWo, `m‘Ü`o ~moZ H§$S>ŠeZ MmMUrMm g‘mdoe nm{hOo);  Am°Q>moñH$mo{nH$ (Otoscopic) qH$dm ‘m`H«$moñH$mo{nH$ (Microscopic)VnmgUr Am{U  {Q>ån°Zmo‘oQ´r (Tympanometry)qH$dm ‘Ü` H$Um©À`m pñWVrMr BVa ‘moO‘mno H$mZ d ldU H$miOr KoUmè¶m {M{H$ËgH$mZo Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm nS>Vmim MmMUrZ§Va R>a{dbr nm{hOo. ` oWo {deof ‘‚mmV§Vy{df`H$ qH$dm j-{H$aU MmMÊ`m§Mr Amdí`H$ Agy eH$Vo. 2.10 CnMma ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m gd© ‘wbm§Zm Ëd[aV CnMma {‘imbo nm{hOoV. nwT>rb Jmoï>r {dMmamV KoD$Z (1) Aem godm§Mr Amdí`H$Vm hr {M{H$ËgH$m§Zr ì`º$s-H|${ÐV Ñ{ï>H$moZmVyZ {Xboë`m g„²`mZwgma Agmdr:  ldUXmofmMo ñdê$n d Vrd«Vm;  H$mZmMo {dH$ma d g§^mì` Jw§VmJw§Vr;  ghì`mYr;  CnMmamÀ`m àH$mamH$[aVm Hw$Qw>§~mMo àmYmÝ`H«$‘;  CnbãY g§gmYZo; Am{U  g§ñH¥$Vrg§~§YmV {dMmamV KoÊ`mMo ‘wÔo CnMmamH$[aVmÀ`m godm§‘Ü`o `m§Mm g‘mdoe hmoVmo (1):  H$mZmÀ`m {dH$mam§Mo d¡ÚH$s` ì`dñWmnZ;  ‘Ü` H$Um©Mr eó{H«$`m;  ldU V§ÌkmZmMm dmna, Ogo H$s ldU`§Ì, qH$dm e§ImH¥$Vr àË`mamonU (Cochlear Implant) H$aÊ`m`mo½` BVa CnH$aUo, (‘Ü`-H$U© qH$dm H$m°pŠb`a Båßbm§Q>);  ldU ghm`H$ V§ÌkmZmMm dmna, Ogo H$s ldU B§S>ŠeZ byßg; hmS©>dm`S©>, E’$E‘ qH$dm BÝ’«$maoS> {gñQ>åg; qH$dm [a‘moQ> ‘m`H«$mo’$moZ {gñQ>råg (WoQ> ldU{df`H$ CnH$aUo);  lmì` nwZd©gZ CnMmanÕVr  hmVmÀ`m hmbMmbr d g§Ho$V `m§Mm g‘mdoe Agbobr ^mfm d g§doXr à{VñWmnZmMo BVa n`m©` (CXmhaUmW© AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY Am{U ~moQ>m§Zr Ho$bobo eãXboIZ) qH$dm {MÌn[aM` H$ê$Z XoUmè¶m godm ‘wbm§À`m H$mZmÀ`m {dH$mamMo qH$dm ldUXmofmMo {ZXmZ Pmbo Amho H$s nmbH$ Am{U H$miOr KoUmè¶m ì`º$s `m§Zm `mo½` ‘mJ©Xe©Z d ‘XV {‘iUo ‘hÎdmMo Amho, CXmhaUmW© nmbH$m§À`m ‘XV JQ>m§Ûmao. `m{edm`, {ejH$m§Zm ‘wbmÀ`m JaOm§Mr (nmbH$/ H$miOr KoUmè¶m ì`º$s¨‘m’©$V) ‘m{hVr {Xbr nm{hOo, OoUoH$ê$Z H$mhr n[apñWVs¨‘Ü`o H$amdo bmJUmao ~Xb (CXmhaUmW©, ‘wbmbm dJm©V nwT>o ~g{dUo, dmVmdaUmVrb AmdmOmMr nmVir H$‘r H$aUo, byn {gñQ>råg dmnaUo B.) H$aVm `oD$ eH$VmV. 2.11 ldU ñdmñÏ` `m{df`rMm àMma H$mZmÀ`m d ldU g‘ñ`m§da Cnm` emoYUmam emioVrb nS>Vmim MmMUr H$m`©H«$‘m‘wio H$mZ d ldU ñdmñÏ` `mMm àMma H$aÊ`mMr g§Yr CnbãY hmoVo. ‘wbo, Ë`m§À`m Hw$Qw>§~mVrb gXñ`/Ë`m§Mr H$miOr KoUmè¶m ì`º$s, {ejH$ d emioVrb H$‘©Mmar `m§Zm nwT>rb Jmoï>s¨{df`r àm‘w»`mZo ‘m{hVr {Xbr nm{hOo:  ldU Amamo½`;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mMm g‘mdoe hmoUmar H$mZmMr H$miOr5 d  ldUj‘VoÀ`m g§ajUmH$[aVm dmnamV Agbobo gwa{jV ldU, gwa{jV ldU nÕVr d gwa{jV ldU A°ßg ` mg- maIr CnbãY gmYZo 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ A§‘b~OmdUrÀ`m ‘mJ©Xe©H$ VÎdm§‘Ü`o g§H${bV ‘m{hVrÀ`m ì`dñWmnZmMr YmoaUo Amdí`H$Vm åhUyZ ñnï>nUo Z‘yX Ho$bobr AgmdrV d Ahdmb XoUmar `§ÌUm d JwUdÎmm {Z`§ÌU à{H«$`m n[a^m{fV Ho$bobr Agmdr. g§H${bV ‘m{hVrÀ`m ì`dñWmnZmÀ`m {Z`‘mdbr‘Ü`o `mMm {dMma Ho$bm Omdm:  nmbH$ d {ejH$ `m§Zm MmMUrÀ`m {ZîH$fmª{df`r ‘m{hVr  {ZîH$fmª{df`r JmonZr`Vm  {ZîH$fmªMr Zm|X H$aUo d ‘m{hVrg§J«h V`ma H$aUo Á`m‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe hmoVmo: - VmaIm§gh VnmgUr{df`H$ ‘m{hVr (CXmhaUmW©, àË`oH$ dma§dm[aVoH$[aVm VnmgUrMm {ZîH$f©, VnmgUrÀ`m {R>H$mUMr AmdmOmMr nmVir); - Ho$boë`m {e’$magr - AmH¥$Vr~§Y nmR>nwamdm H$aUmao H$‘©Mmar; Am{U - H$m`©H«$‘m§VJ©V nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§‘Yrb n[aUm‘m§da XoIaoI  nwT>rb g‘ñ`m§da Cnm` emoYÊ`mH$[aVm {Z`{‘V ‘m{hVr XoUo: - {dMmamV KoVë`m OmUmè¶m EHy$U g§»`on¡H$s {H$Vr ‘wbm§Mr nS>Vmim MmMUr Ho$br Jobr? - nS>Vmim MmMUr Ho$boë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm H$mZ d ldU ‘yë`‘mnZmH$[aVm nwT>rb VnmgUrH$[aVm nmR>{dbo? - nwT>rb VnmgUrH$[aVm nmR>{dboë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm ì`mdgm{`H$ H$mZ d ldU ‘yë`‘mnZ CnbãY Pmbo? - nS>Vmim MmMUr Pmboë`m§n¡H$s {H$Vr Q>¸o$ ‘wbm§Zm H$mZmMm {dH$ma qH$dm EoH$Ê`mMr g‘ñ`m Agë`mMo AmT>iyZ Ambo? - H$moUË`m àH$maMo H$mZmMo {dH$ma qH$dm EoH$Ê`mÀ`m g‘ñ`m bjmV Amë`m?  ‘m{hVrMo {dûcofU Am{U Ë`m{df`r ‘m{hVr XoUo: - H$mimZwgma ~XbmMo {ZarjU H$aÊ`mH$[aVm - emim§‘Ü`o H$mZ VnmgUr d ldU nS>Vmim MmMUrMr JaO Xe©{dÊ`mH$[aVm - JwUdÎmm {Z`§ÌUmH$[aVm; Am{U - MmMUrH$V} d {ejH$m/à{ejH$ `m§Zm à{ejU Am{U A{^àm` XoÊ`mH$[aVm 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar emim§‘Ü`o H$mZ d VnmgUr ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo {Z`moOZ H$aVmZm, nwT>rb KQ>H$ {dMmamV KoVbo nm{hOoV:  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§H$[aVm H$mZ d ldU `m§Mr H$miOr KoUmar godm CnbãY AgUo Amdí`H$ Amho qH$dm Ë`mM doir Vr {dH${gV H$aUo Amdí`H$ Amho  nS>Vmim MmMUrÀ`m OmJodarb AmdmOmMr nmVir {Z`§{ÌV H$aUo Amdí`H$ Amho.  ImÌrera CnH$aU dmnê$Z nS>Vmim VnmgUr gmYZ {Z`{‘VnUo (eŠ`Vmo dfm©VyZ {H$‘mZ EH$Xm) à‘m{UV H$aUo Amdí`H$ Amho.  ñWm{ZH$ YmoaUm§À`m AZwf§JmZo nmbH$/XoI^mbH$Vm© d ‘yb `m§Zr g§‘Vr qH$dm AZw‘Vr {Xbr AgbrM nm{hOo.  g§gJ© {Z`§ÌUmH$[aVm gm‘mÝ` {ZOªVwH$sH$aUmMo Cnm` dmnamV AmUUo Amdí`H$ Amho.  H$m`©H«$‘mMo ì`dñWmnZ d O~m~Xmar gw{Z{üV H$aUo Amdí`H$ Amho.  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$s¨À`m AmH¥${V~§Y nmR>nwamì`mH$[aVm H$m`©nÕVr {Z{üV Ho$boë`m AgUo Amdí`H$ Amho. 2.14 emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm Q>obr‘o{S>{gZMm dmna (20) ‘mZdr g§gmYZo ‘`m©{XV Agboë`m ^mJmV, H$mZ VnmgUr d ldU nS>Vmim MmMUr Q>o{b‘o{S>{gZ godm§À`m dmnamÛmao Ho$br OmD$ eH$Vo Á`mÛmao à{e{jV Amamo½` H$‘©Mmar S>m°ŠQ>am§er g§nH©$ gmYyZ XwJ©‘ {R>H$mUr OmJodaM VnmgÊ`m H$aVmV. B‘oOog d MmMUrMo {ZîH$f© `m§Mm AmT>mdm KoD$Z, g§^mì` {ZXmZ d XoI^mb `mH$[aVm nwT>o nmR>dÊ`mÛmao Amamo½` H$‘©Mmè¶m§Zm ‘mJ©Xe©Z H$ê$ eH$VmV. ñWm{ZH$ g§nH©$ EH$Va àË`jmV hmoD$ eH$Vmo; qH$dm {M{H$ËgH$m§Zm Z§Va AmT>mdm KoVm `mdm `mH$[aVm åhUyZ VnmgUr d B‘oOog g§J«{hV Ho$ë`m OmD$ eH$VmV d bdH$a CnMma CnbãY hmoÊ`mH$[aVm doioda A{^àm` {Xbm OmD$ eH$Vmo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo34 2.7 ‘mZdr g§gmYZo emioV OmUmè¶m ‘wbm§Mr H$mZ VnmgUr d ldU nS>Vmim MmMUr nwT>rb à{e{jV ì`º$s¨À`m JQ>mÛmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ÜdZr {deofk (ldUemók), dmMm d ^mfm amoJ{ZXmZVÁk)  H$U©~{Ya ì`º$s¨Mr XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© emioVrb S>m°ŠQ>a, gm‘mÝ` S>m°ŠQ>a, ~mbamoJVÁk)  à{e{jV Amamo½` H$‘©Mmar d n[aMm[aH$m (CXmhaUmW© d¡ÚH$s` A{YH$mar, n[aMm[aH$m, d¡ÚH$s` ‘XVZrg, V§Ìk) (13,14)  à{e{jV Ago gd©gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© dñVr nmVirda H$m‘ H$aUmao Amamo½` H$‘©Mmar) (13,14)  à{e{jV {ejH$ (19) H$mZmÀ`m d ldU VnmgÊ`m EImÚm {M{H$ËgH$ Zgboë`m ì`º$sH$Sy>Z H$amì`m bmJUma AgVrb Va g§~§{YV bmoH$m§Zm à{ejU ho {XboM nm{hOo, Ë`mZ§Va Ë`m§Zr XoIaoIrImbr gamd Ho$bm nm{hOo d gmVË`mZo JwUdÎmm VnmgyZ bmJUmar ‘XV Ho$br nm{hOo. à{ejUmZ§Va, Mm§Jbm gamd d ‘mZHo$ Am{U ‘mJ©Xe©H$ VÎdo `m§Mo nmbZ hmoV Agë`mMr ImÌr H$aÊ`m- H$[aVm {Z`{‘V VnmgUr Ho$br nm{hOo. {M{H$ËgH$ Zgboë`m ì`º$s¨À`m à{ejUmH$[aVm Amdí`H$ Agboë`m Jmoï>r Mm¡H$Q> 2.2 ‘Ü`o WmoS>Š`mV {Xë`m AmhoV. Mm¡H$Q> 2.2 emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amdí`H$ KQ>H$ H$mZmMr VgoM ldUj‘VoMr H$miOr KoÊ`mH$[aVm à{e{jV Zgbobo {M{H$ËgH$, n[aMm[aH$m d Amamo½` H$‘©Mmar `m§Zr nwT>rb Jmoï>s¨‘Ü`o à{ejU KoVbo nm{hOo:  ldUmMo ‘hÎd- {deofH$ê$Z {ejUmH$[aVm;  nS>Vmim MmMUrMm CÔoe d {Z`‘mdbr;  H$mZmMr ‘yb^yV aMZm  ldUXmofmMr H$maUo;  nS>Vmim MmMUr H$m`©H«$‘mMo ‘yb^yV H$m`© d Ahdmb XoÊ`mMr à{H«$`m;  nS>Vmim MmMUr H$aUmè¶m ì`º$sMr / MmMUrH$Ë`m©Mr ^y{‘H$m;  nS>Vmim MmMUr d nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVr;  nS>Vmim MmMUr Ho$br OmUmè¶m ImobrMr aMZm d CnH$aUmMo à‘mUrH$aU;  CnH$aU, XoI^mb d H$m‘ H$aV Zgë`mg g‘ñ`m {ZdmaU `mgh;  dmVmdaUmVrb AmdmOmMr ‘moO‘mno;  Am°Q>moñH$monr d {Q>ån°Zm°‘oQ´r (OoWo CnbãY Agob VoWo) Am{U;  {dMmamV KoVbm OmUmam H$mZ d ldUj‘VoMr pñWVr AmoiIUo. ldU{df`H$ H$miOr KoUmao S>m°ŠQ>a nS>Vmim MmMUr H$m`©H«$‘mMm CÔoe d {Z`‘mdbr `màVr g§doXZerb Agbo nm{hOoV. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. 2.8 nwT>rb VnmgUrH$[aVmMo {ZH$f ‘mJ©Xe©H$ VÎdm§‘Ü`o (^mJ 2.2) Z‘yX Ho$ë`mZwgma, emim-ñVamdarb H$mZ VnmgUr H$m`©H«$‘ hm H$mZ d ldU godm `m§À`mer g§b¾ AgUo Amdí`H$ Amho. Ë`m‘Ü`o H$mZmMo {dH$ma Agbobr qH$dm ldUXmofmMo {ZXmZ Pmbobr ‘wbo Amdí`H$ Vr XoI^mb àmá H$ê$ eH$Vrb. MmMUrÀ`m doJdoJù`m {ZîH$fmªH$[aVm H$amd`mÀ`m H¥$Vr nwT>rbà‘mUo AmhoV:  CÎmsU© {ZîH$f©: H$mZ VnmgUr d ldU nS>Vmim MmMUrZ§Va CÎmsU© Agm {ZîH$f© Amboë`m d nwT>rb VnmgUrH$[aVm nmR>dm Agm eoam Z XoÊ`mV Amboë`m ‘wbm§Zm Ë`m§À`m H$mZm§Mr H$miOr KoÊ`mMm g„m {Xbm nm{hOo. Ë`m§Zm H$mZ d ldUeº$s `mMr H$miOr `m{df`r ‘m{hVr {Xbr nm{hOo.4  nwT>rb VnmgUrH$[aVm nmR>dm {ZîH$f©: ldU nS>Vmim MmMUrZ§Va nwT>rb VnmgUrH$[aVm nmR>dm Agm {ZîH$f© Amboë`m ‘wbm§Mo {ZXmZ d ì`dñWmnZ H$aÊ`mH$[aVm H$mZmMr VnmgUr d ldU MmMUr Pmbr nm{hOo. hr MmMUr H$mZ d ldUeº$sMr H$miOr KoÊ`mMr j‘Vm Agboë`m S>m°ŠQ>am§Zr Ho$br nm{hOo.  {ZX}eH$ g§Ho$V (Red Flags): H$mZmMr VnmgUr d ldU nS>Vmim MmMUrZ§Va {ZX}eH$ Agm {ZîH$f© Amboë`m ‘wbm§Zm nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var nwT>rb ‘yë`‘mnZmH$[aVm nmR>{dbo nm{hOo. {ZX}eH$m§À`m Bemè¶m§‘Ü`o `m§Mm g‘mdoe hmoVmo: - ‘wbmMo EoH$Uo, ~mobUo d ^mfm {dH$mg, Xwb©j, {eH$Ê`mVrb AS>MUr qH$dm H$mZmÀ`m H$moUË`mhr g‘ñ`m§~Ôb (nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var) H$miOr dmQ>Umao nmbH$ Am{U H$miOr KoUmè¶m ì`º$s qH$dm {ejH$ - H$mZmVyZ `oUmam òmd; Oa H$mZmVyZ `oUmè¶m òmdmbm XwJªYr `oV Agob, Va ho Ëd[aV d VmVS>rZo nwT>rb VnmgUrH$[aVm nmR>{dÊ`mMo H$maU Agbo nm{hOo; - H$mZmÀ`m ‘mJo bmbganUm Am{U doXZmXm`H$ gyO (mastoid); Am{U - H$mZm‘Ü`o qH$dm H$mZmÀ`m AdVr^dVr Vrd« doXZm àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a, à{e{jV n[aMm[aH$m qH$dm H$mZ d ldUeº$sMr H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dbo OmD$ eH$Vo. H$moUmH$So> nmR>{dbo Omdo `mMm {ZU©` ñWm{ZH$ n[apñWVr, H$mZ Am{U ldU {M{H$ËgH$m§Mr CnbãYVm d BVa à{e{jV Amamo½` H$‘©Mmar `m§À`mda Adb§~yZ AgUo Amdí`H$ Amho. àmYmÝ`H«$‘mZwgma nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVrMm Adb§~ Ho$bm OmD$ eH$Vmo. CXmhaUmW©, H$mZmVyZ òmd `oUo, gyO BË`mXs¨gma»`m d¡ÚH$s` g‘ñ`m§da àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a qH$dm à{e{jV n[aMm[aH$m `m§À`mÛmao CnMma Ho$bo OmD$ eH$VmV; ldUXmofmer g§~§{YV g‘ñ`m WoQ> H$mZ d ldU{df`H$ H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dë`m nm{hOoV. 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ ldUXmofmMo ‘yë`‘mnZ H$aÊ`mH$[aVm nmR>{dboë`m H|$Ðmda CnbãY Agboë`m Z¡Xm{ZH$ godm§‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe Agmdm (5-12):  Z¡Xm{ZH$ ewÕ ÜdZr ldU MmMUr (eŠ` Agob {VWo, `m‘Ü`o ~moZ H§$S>ŠeZ MmMUrMm g‘mdoe nm{hOo);  Am°Q>moñH$mo{nH$ (Otoscopic) qH$dm ‘m`H«$moñH$mo{nH$ (Microscopic)VnmgUr Am{U  {Q>ån°Zmo‘oQ´r (Tympanometry)qH$dm ‘Ü` H$Um©À`m pñWVrMr BVa ‘moO‘mno H$mZ d ldU H$miOr KoUmè¶m {M{H$ËgH$mZo Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm nS>Vmim MmMUrZ§Va R>a{dbr nm{hOo. ` oWo {deof ‘‚mmV§Vy{df`H$ qH$dm j-{H$aU MmMÊ`m§Mr Amdí`H$ Agy eH$Vo. 2.10 CnMma ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m gd© ‘wbm§Zm Ëd[aV CnMma {‘imbo nm{hOoV. nwT>rb Jmoï>r {dMmamV KoD$Z (1) Aem godm§Mr Amdí`H$Vm hr {M{H$ËgH$m§Zr ì`º$s-H|${ÐV Ñ{ï>H$moZmVyZ {Xboë`m g„²`mZwgma Agmdr:  ldUXmofmMo ñdê$n d Vrd«Vm;  H$mZmMo {dH$ma d g§^mì` Jw§VmJw§Vr;  ghì`mYr;  CnMmamÀ`m àH$mamH$[aVm Hw$Qw>§~mMo àmYmÝ`H«$‘;  CnbãY g§gmYZo; Am{U  g§ñH¥$Vrg§~§YmV {dMmamV KoÊ`mMo ‘wÔo CnMmamH$[aVmÀ`m godm§‘Ü`o `m§Mm g‘mdoe hmoVmo (1):  H$mZmÀ`m {dH$mam§Mo d¡ÚH$s` ì`dñWmnZ;  ‘Ü` H$Um©Mr eó{H«$`m;  ldU V§ÌkmZmMm dmna, Ogo H$s ldU`§Ì, qH$dm e§ImH¥$Vr àË`mamonU (Cochlear Implant) H$aÊ`m`mo½` BVa CnH$aUo, (‘Ü`-H$U© qH$dm H$m°pŠb`a Båßbm§Q>);  ldU ghm`H$ V§ÌkmZmMm dmna, Ogo H$s ldU B§S>ŠeZ byßg; hmS©>dm`S©>, E’$E‘ qH$dm BÝ’«$maoS> {gñQ>åg; qH$dm [a‘moQ> ‘m`H«$mo’$moZ {gñQ>råg (WoQ> ldU{df`H$ CnH$aUo);  lmì` nwZd©gZ CnMmanÕVr  hmVmÀ`m hmbMmbr d g§Ho$V `m§Mm g‘mdoe Agbobr ^mfm d g§doXr à{VñWmnZmMo BVa n`m©` (CXmhaUmW© AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY Am{U ~moQ>m§Zr Ho$bobo eãXboIZ) qH$dm {MÌn[aM` H$ê$Z XoUmè¶m godm ‘wbm§À`m H$mZmÀ`m {dH$mamMo qH$dm ldUXmofmMo {ZXmZ Pmbo Amho H$s nmbH$ Am{U H$miOr KoUmè¶m ì`º$s `m§Zm `mo½` ‘mJ©Xe©Z d ‘XV {‘iUo ‘hÎdmMo Amho, CXmhaUmW© nmbH$m§À`m ‘XV JQ>m§Ûmao. `m{edm`, {ejH$m§Zm ‘wbmÀ`m JaOm§Mr (nmbH$/ H$miOr KoUmè¶m ì`º$s¨‘m’©$V) ‘m{hVr {Xbr nm{hOo, OoUoH$ê$Z H$mhr n[apñWVs¨‘Ü`o H$amdo bmJUmao ~Xb (CXmhaUmW©, ‘wbmbm dJm©V nwT>o ~g{dUo, dmVmdaUmVrb AmdmOmMr nmVir H$‘r H$aUo, byn {gñQ>råg dmnaUo B.) H$aVm `oD$ eH$VmV. 2.11 ldU ñdmñÏ` `m{df`rMm àMma H$mZmÀ`m d ldU g‘ñ`m§da Cnm` emoYUmam emioVrb nS>Vmim MmMUr H$m`©H«$‘m‘wio H$mZ d ldU ñdmñÏ` `mMm àMma H$aÊ`mMr g§Yr CnbãY hmoVo. ‘wbo, Ë`m§À`m Hw$Qw>§~mVrb gXñ`/Ë`m§Mr H$miOr KoUmè¶m ì`º$s, {ejH$ d emioVrb H$‘©Mmar `m§Zm nwT>rb Jmoï>s¨{df`r àm‘w»`mZo ‘m{hVr {Xbr nm{hOo:  ldU Amamo½`;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mMm g‘mdoe hmoUmar H$mZmMr H$miOr5 d  ldUj‘VoÀ`m g§ajUmH$[aVm dmnamV Agbobo gwa{jV ldU, gwa{jV ldU nÕVr d gwa{jV ldU A°ßg ` mg- maIr CnbãY gmYZo 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ A§‘b~OmdUrÀ`m ‘mJ©Xe©H$ VÎdm§‘Ü`o g§H${bV ‘m{hVrÀ`m ì`dñWmnZmMr YmoaUo Amdí`H$Vm åhUyZ ñnï>nUo Z‘yX Ho$bobr AgmdrV d Ahdmb XoUmar `§ÌUm d JwUdÎmm {Z`§ÌU à{H«$`m n[a^m{fV Ho$bobr Agmdr. g§H${bV ‘m{hVrÀ`m ì`dñWmnZmÀ`m {Z`‘mdbr‘Ü`o `mMm {dMma Ho$bm Omdm:  nmbH$ d {ejH$ `m§Zm MmMUrÀ`m {ZîH$fmª{df`r ‘m{hVr  {ZîH$fmª{df`r JmonZr`Vm  {ZîH$fmªMr Zm|X H$aUo d ‘m{hVrg§J«h V`ma H$aUo Á`m‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe hmoVmo: - VmaIm§gh VnmgUr{df`H$ ‘m{hVr (CXmhaUmW©, àË`oH$ dma§dm[aVoH$[aVm VnmgUrMm {ZîH$f©, VnmgUrÀ`m {R>H$mUMr AmdmOmMr nmVir); - Ho$boë`m {e’$magr - AmH¥$Vr~§Y nmR>nwamdm H$aUmao H$‘©Mmar; Am{U - H$m`©H«$‘m§VJ©V nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§‘Yrb n[aUm‘m§da XoIaoI  nwT>rb g‘ñ`m§da Cnm` emoYÊ`mH$[aVm {Z`{‘V ‘m{hVr XoUo: - {dMmamV KoVë`m OmUmè¶m EHy$U g§»`on¡H$s {H$Vr ‘wbm§Mr nS>Vmim MmMUr Ho$br Jobr? - nS>Vmim MmMUr Ho$boë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm H$mZ d ldU ‘yë`‘mnZmH$[aVm nwT>rb VnmgUrH$[aVm nmR>{dbo? - nwT>rb VnmgUrH$[aVm nmR>{dboë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm ì`mdgm{`H$ H$mZ d ldU ‘yë`‘mnZ CnbãY Pmbo? - nS>Vmim MmMUr Pmboë`m§n¡H$s {H$Vr Q>¸o$ ‘wbm§Zm H$mZmMm {dH$ma qH$dm EoH$Ê`mMr g‘ñ`m Agë`mMo AmT>iyZ Ambo? - H$moUË`m àH$maMo H$mZmMo {dH$ma qH$dm EoH$Ê`mÀ`m g‘ñ`m bjmV Amë`m?  ‘m{hVrMo {dûcofU Am{U Ë`m{df`r ‘m{hVr XoUo: - H$mimZwgma ~XbmMo {ZarjU H$aÊ`mH$[aVm - emim§‘Ü`o H$mZ VnmgUr d ldU nS>Vmim MmMUrMr JaO Xe©{dÊ`mH$[aVm - JwUdÎmm {Z`§ÌUmH$[aVm; Am{U - MmMUrH$V} d {ejH$m/à{ejH$ `m§Zm à{ejU Am{U A{^àm` XoÊ`mH$[aVm 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar emim§‘Ü`o H$mZ d VnmgUr ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo {Z`moOZ H$aVmZm, nwT>rb KQ>H$ {dMmamV KoVbo nm{hOoV:  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§H$[aVm H$mZ d ldU `m§Mr H$miOr KoUmar godm CnbãY AgUo Amdí`H$ Amho qH$dm Ë`mM doir Vr {dH${gV H$aUo Amdí`H$ Amho  nS>Vmim MmMUrÀ`m OmJodarb AmdmOmMr nmVir {Z`§{ÌV H$aUo Amdí`H$ Amho.  ImÌrera CnH$aU dmnê$Z nS>Vmim VnmgUr gmYZ {Z`{‘VnUo (eŠ`Vmo dfm©VyZ {H$‘mZ EH$Xm) à‘m{UV H$aUo Amdí`H$ Amho.  ñWm{ZH$ YmoaUm§À`m AZwf§JmZo nmbH$/XoI^mbH$Vm© d ‘yb `m§Zr g§‘Vr qH$dm AZw‘Vr {Xbr AgbrM nm{hOo.  g§gJ© {Z`§ÌUmH$[aVm gm‘mÝ` {ZOªVwH$sH$aUmMo Cnm` dmnamV AmUUo Amdí`H$ Amho.  H$m`©H«$‘mMo ì`dñWmnZ d O~m~Xmar gw{Z{üV H$aUo Amdí`H$ Amho.  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$s¨À`m AmH¥${V~§Y nmR>nwamì`mH$[aVm H$m`©nÕVr {Z{üV Ho$boë`m AgUo Amdí`H$ Amho. 2.14 emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm Q>obr‘o{S>{gZMm dmna (20) ‘mZdr g§gmYZo ‘`m©{XV Agboë`m ^mJmV, H$mZ VnmgUr d ldU nS>Vmim MmMUr Q>o{b‘o{S>{gZ godm§À`m dmnamÛmao Ho$br OmD$ eH$Vo Á`mÛmao à{e{jV Amamo½` H$‘©Mmar S>m°ŠQ>am§er g§nH©$ gmYyZ XwJ©‘ {R>H$mUr OmJodaM VnmgÊ`m H$aVmV. B‘oOog d MmMUrMo {ZîH$f© `m§Mm AmT>mdm KoD$Z, g§^mì` {ZXmZ d XoI^mb `mH$[aVm nwT>o nmR>dÊ`mÛmao Amamo½` H$‘©Mmè¶m§Zm ‘mJ©Xe©Z H$ê$ eH$VmV. ñWm{ZH$ g§nH©$ EH$Va àË`jmV hmoD$ eH$Vmo; qH$dm {M{H$ËgH$m§Zm Z§Va AmT>mdm KoVm `mdm `mH$[aVm åhUyZ VnmgUr d B‘oOog g§J«{hV Ho$ë`m OmD$ eH$VmV d bdH$a CnMma CnbãY hmoÊ`mH$[aVm doioda A{^àm` {Xbm OmD$ eH$Vmo. 4 Flyer on ear care (English): https://who.canto.global/s/Q2CPO ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 35 2.7 ‘mZdr g§gmYZo emioV OmUmè¶m ‘wbm§Mr H$mZ VnmgUr d ldU nS>Vmim MmMUr nwT>rb à{e{jV ì`º$s¨À`m JQ>mÛmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ÜdZr {deofk (ldUemók), dmMm d ^mfm amoJ{ZXmZVÁk)  H$U©~{Ya ì`º$s¨Mr XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© emioVrb S>m°ŠQ>a, gm‘mÝ` S>m°ŠQ>a, ~mbamoJVÁk)  à{e{jV Amamo½` H$‘©Mmar d n[aMm[aH$m (CXmhaUmW© d¡ÚH$s` A{YH$mar, n[aMm[aH$m, d¡ÚH$s` ‘XVZrg, V§Ìk) (13,14)  à{e{jV Ago gd©gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© dñVr nmVirda H$m‘ H$aUmao Amamo½` H$‘©Mmar) (13,14)  à{e{jV {ejH$ (19) H$mZmÀ`m d ldU VnmgÊ`m EImÚm {M{H$ËgH$ Zgboë`m ì`º$sH$Sy>Z H$amì`m bmJUma AgVrb Va g§~§{YV bmoH$m§Zm à{ejU ho {XboM nm{hOo, Ë`mZ§Va Ë`m§Zr XoIaoIrImbr gamd Ho$bm nm{hOo d gmVË`mZo JwUdÎmm VnmgyZ bmJUmar ‘XV Ho$br nm{hOo. à{ejUmZ§Va, Mm§Jbm gamd d ‘mZHo$ Am{U ‘mJ©Xe©H$ VÎdo `m§Mo nmbZ hmoV Agë`mMr ImÌr H$aÊ`m- H$[aVm {Z`{‘V VnmgUr Ho$br nm{hOo. {M{H$ËgH$ Zgboë`m ì`º$s¨À`m à{ejUmH$[aVm Amdí`H$ Agboë`m Jmoï>r Mm¡H$Q> 2.2 ‘Ü`o WmoS>Š`mV {Xë`m AmhoV. Mm¡H$Q> 2.2 emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amdí`H$ KQ>H$ H$mZmMr VgoM ldUj‘VoMr H$miOr KoÊ`mH$[aVm à{e{jV Zgbobo {M{H$ËgH$, n[aMm[aH$m d Amamo½` H$‘©Mmar `m§Zr nwT>rb Jmoï>s¨‘Ü`o à{ejU KoVbo nm{hOo:  ldUmMo ‘hÎd- {deofH$ê$Z {ejUmH$[aVm;  nS>Vmim MmMUrMm CÔoe d {Z`‘mdbr;  H$mZmMr ‘yb^yV aMZm  ldUXmofmMr H$maUo;  nS>Vmim MmMUr H$m`©H«$‘mMo ‘yb^yV H$m`© d Ahdmb XoÊ`mMr à{H«$`m;  nS>Vmim MmMUr H$aUmè¶m ì`º$sMr / MmMUrH$Ë`m©Mr ^y{‘H$m;  nS>Vmim MmMUr d nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVr;  nS>Vmim MmMUr Ho$br OmUmè¶m ImobrMr aMZm d CnH$aUmMo à‘mUrH$aU;  CnH$aU, XoI^mb d H$m‘ H$aV Zgë`mg g‘ñ`m {ZdmaU `mgh;  dmVmdaUmVrb AmdmOmMr ‘moO‘mno;  Am°Q>moñH$monr d {Q>ån°Zm°‘oQ´r (OoWo CnbãY Agob VoWo) Am{U;  {dMmamV KoVbm OmUmam H$mZ d ldUj‘VoMr pñWVr AmoiIUo. ldU{df`H$ H$miOr KoUmao S>m°ŠQ>a nS>Vmim MmMUr H$m`©H«$‘mMm CÔoe d {Z`‘mdbr `màVr g§doXZerb Agbo nm{hOoV. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. 2.8 nwT>rb VnmgUrH$[aVmMo {ZH$f ‘mJ©Xe©H$ VÎdm§‘Ü`o (^mJ 2.2) Z‘yX Ho$ë`mZwgma, emim-ñVamdarb H$mZ VnmgUr H$m`©H«$‘ hm H$mZ d ldU godm `m§À`mer g§b¾ AgUo Amdí`H$ Amho. Ë`m‘Ü`o H$mZmMo {dH$ma Agbobr qH$dm ldUXmofmMo {ZXmZ Pmbobr ‘wbo Amdí`H$ Vr XoI^mb àmá H$ê$ eH$Vrb. MmMUrÀ`m doJdoJù`m {ZîH$fmªH$[aVm H$amd`mÀ`m H¥$Vr nwT>rbà‘mUo AmhoV:  CÎmsU© {ZîH$f©: H$mZ VnmgUr d ldU nS>Vmim MmMUrZ§Va CÎmsU© Agm {ZîH$f© Amboë`m d nwT>rb VnmgUrH$[aVm nmR>dm Agm eoam Z XoÊ`mV Amboë`m ‘wbm§Zm Ë`m§À`m H$mZm§Mr H$miOr KoÊ`mMm g„m {Xbm nm{hOo. Ë`m§Zm H$mZ d ldUeº$s `mMr H$miOr `m{df`r ‘m{hVr {Xbr nm{hOo.4  nwT>rb VnmgUrH$[aVm nmR>dm {ZîH$f©: ldU nS>Vmim MmMUrZ§Va nwT>rb VnmgUrH$[aVm nmR>dm Agm {ZîH$f© Amboë`m ‘wbm§Mo {ZXmZ d ì`dñWmnZ H$aÊ`mH$[aVm H$mZmMr VnmgUr d ldU MmMUr Pmbr nm{hOo. hr MmMUr H$mZ d ldUeº$sMr H$miOr KoÊ`mMr j‘Vm Agboë`m S>m°ŠQ>am§Zr Ho$br nm{hOo.  {ZX}eH$ g§Ho$V (Red Flags): H$mZmMr VnmgUr d ldU nS>Vmim MmMUrZ§Va {ZX}eH$ Agm {ZîH$f© Amboë`m ‘wbm§Zm nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var nwT>rb ‘yë`‘mnZmH$[aVm nmR>{dbo nm{hOo. {ZX}eH$m§À`m Bemè¶m§‘Ü`o `m§Mm g‘mdoe hmoVmo: - ‘wbmMo EoH$Uo, ~mobUo d ^mfm {dH$mg, Xwb©j, {eH$Ê`mVrb AS>MUr qH$dm H$mZmÀ`m H$moUË`mhr g‘ñ`m§~Ôb (nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var) H$miOr dmQ>Umao nmbH$ Am{U H$miOr KoUmè¶m ì`º$s qH$dm {ejH$ - H$mZmVyZ `oUmam òmd; Oa H$mZmVyZ `oUmè¶m òmdmbm XwJªYr `oV Agob, Va ho Ëd[aV d VmVS>rZo nwT>rb VnmgUrH$[aVm nmR>{dÊ`mMo H$maU Agbo nm{hOo; - H$mZmÀ`m ‘mJo bmbganUm Am{U doXZmXm`H$ gyO (mastoid); Am{U - H$mZm‘Ü`o qH$dm H$mZmÀ`m AdVr^dVr Vrd« doXZm àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a, à{e{jV n[aMm[aH$m qH$dm H$mZ d ldUeº$sMr H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dbo OmD$ eH$Vo. H$moUmH$So> nmR>{dbo Omdo `mMm {ZU©` ñWm{ZH$ n[apñWVr, H$mZ Am{U ldU {M{H$ËgH$m§Mr CnbãYVm d BVa à{e{jV Amamo½` H$‘©Mmar `m§À`mda Adb§~yZ AgUo Amdí`H$ Amho. àmYmÝ`H«$‘mZwgma nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVrMm Adb§~ Ho$bm OmD$ eH$Vmo. CXmhaUmW©, H$mZmVyZ òmd `oUo, gyO BË`mXs¨gma»`m d¡ÚH$s` g‘ñ`m§da àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a qH$dm à{e{jV n[aMm[aH$m `m§À`mÛmao CnMma Ho$bo OmD$ eH$VmV; ldUXmofmer g§~§{YV g‘ñ`m WoQ> H$mZ d ldU{df`H$ H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dë`m nm{hOoV. 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ ldUXmofmMo ‘yë`‘mnZ H$aÊ`mH$[aVm nmR>{dboë`m H|$Ðmda CnbãY Agboë`m Z¡Xm{ZH$ godm§‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe Agmdm (5-12):  Z¡Xm{ZH$ ewÕ ÜdZr ldU MmMUr (eŠ` Agob {VWo, `m‘Ü`o ~moZ H§$S>ŠeZ MmMUrMm g‘mdoe nm{hOo);  Am°Q>moñH$mo{nH$ (Otoscopic) qH$dm ‘m`H«$moñH$mo{nH$ (Microscopic)VnmgUr Am{U  {Q>ån°Zmo‘oQ´r (Tympanometry)qH$dm ‘Ü` H$Um©À`m pñWVrMr BVa ‘moO‘mno H$mZ d ldU H$miOr KoUmè¶m {M{H$ËgH$mZo Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm nS>Vmim MmMUrZ§Va R>a{dbr nm{hOo. ` oWo {deof ‘‚mmV§Vy{df`H$ qH$dm j-{H$aU MmMÊ`m§Mr Amdí`H$ Agy eH$Vo. 2.10 CnMma ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m gd© ‘wbm§Zm Ëd[aV CnMma {‘imbo nm{hOoV. nwT>rb Jmoï>r {dMmamV KoD$Z (1) Aem godm§Mr Amdí`H$Vm hr {M{H$ËgH$m§Zr ì`º$s-H|${ÐV Ñ{ï>H$moZmVyZ {Xboë`m g„²`mZwgma Agmdr:  ldUXmofmMo ñdê$n d Vrd«Vm;  H$mZmMo {dH$ma d g§^mì` Jw§VmJw§Vr;  ghì`mYr;  CnMmamÀ`m àH$mamH$[aVm Hw$Qw>§~mMo àmYmÝ`H«$‘;  CnbãY g§gmYZo; Am{U  g§ñH¥$Vrg§~§YmV {dMmamV KoÊ`mMo ‘wÔo CnMmamH$[aVmÀ`m godm§‘Ü`o `m§Mm g‘mdoe hmoVmo (1):  H$mZmÀ`m {dH$mam§Mo d¡ÚH$s` ì`dñWmnZ;  ‘Ü` H$Um©Mr eó{H«$`m;  ldU V§ÌkmZmMm dmna, Ogo H$s ldU`§Ì, qH$dm e§ImH¥$Vr àË`mamonU (Cochlear Implant) H$aÊ`m`mo½` BVa CnH$aUo, (‘Ü`-H$U© qH$dm H$m°pŠb`a Båßbm§Q>);  ldU ghm`H$ V§ÌkmZmMm dmna, Ogo H$s ldU B§S>ŠeZ byßg; hmS©>dm`S©>, E’$E‘ qH$dm BÝ’«$maoS> {gñQ>åg; qH$dm [a‘moQ> ‘m`H«$mo’$moZ {gñQ>råg (WoQ> ldU{df`H$ CnH$aUo);  lmì` nwZd©gZ CnMmanÕVr  hmVmÀ`m hmbMmbr d g§Ho$V `m§Mm g‘mdoe Agbobr ^mfm d g§doXr à{VñWmnZmMo BVa n`m©` (CXmhaUmW© AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY Am{U ~moQ>m§Zr Ho$bobo eãXboIZ) qH$dm {MÌn[aM` H$ê$Z XoUmè¶m godm ‘wbm§À`m H$mZmÀ`m {dH$mamMo qH$dm ldUXmofmMo {ZXmZ Pmbo Amho H$s nmbH$ Am{U H$miOr KoUmè¶m ì`º$s `m§Zm `mo½` ‘mJ©Xe©Z d ‘XV {‘iUo ‘hÎdmMo Amho, CXmhaUmW© nmbH$m§À`m ‘XV JQ>m§Ûmao. `m{edm`, {ejH$m§Zm ‘wbmÀ`m JaOm§Mr (nmbH$/ H$miOr KoUmè¶m ì`º$s¨‘m’©$V) ‘m{hVr {Xbr nm{hOo, OoUoH$ê$Z H$mhr n[apñWVs¨‘Ü`o H$amdo bmJUmao ~Xb (CXmhaUmW©, ‘wbmbm dJm©V nwT>o ~g{dUo, dmVmdaUmVrb AmdmOmMr nmVir H$‘r H$aUo, byn {gñQ>råg dmnaUo B.) H$aVm `oD$ eH$VmV. 2.11 ldU ñdmñÏ` `m{df`rMm àMma H$mZmÀ`m d ldU g‘ñ`m§da Cnm` emoYUmam emioVrb nS>Vmim MmMUr H$m`©H«$‘m‘wio H$mZ d ldU ñdmñÏ` `mMm àMma H$aÊ`mMr g§Yr CnbãY hmoVo. ‘wbo, Ë`m§À`m Hw$Qw>§~mVrb gXñ`/Ë`m§Mr H$miOr KoUmè¶m ì`º$s, {ejH$ d emioVrb H$‘©Mmar `m§Zm nwT>rb Jmoï>s¨{df`r àm‘w»`mZo ‘m{hVr {Xbr nm{hOo:  ldU Amamo½`;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mMm g‘mdoe hmoUmar H$mZmMr H$miOr5 d  ldUj‘VoÀ`m g§ajUmH$[aVm dmnamV Agbobo gwa{jV ldU, gwa{jV ldU nÕVr d gwa{jV ldU A°ßg ` mg- maIr CnbãY gmYZo 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ A§‘b~OmdUrÀ`m ‘mJ©Xe©H$ VÎdm§‘Ü`o g§H${bV ‘m{hVrÀ`m ì`dñWmnZmMr YmoaUo Amdí`H$Vm åhUyZ ñnï>nUo Z‘yX Ho$bobr AgmdrV d Ahdmb XoUmar `§ÌUm d JwUdÎmm {Z`§ÌU à{H«$`m n[a^m{fV Ho$bobr Agmdr. g§H${bV ‘m{hVrÀ`m ì`dñWmnZmÀ`m {Z`‘mdbr‘Ü`o `mMm {dMma Ho$bm Omdm:  nmbH$ d {ejH$ `m§Zm MmMUrÀ`m {ZîH$fmª{df`r ‘m{hVr  {ZîH$fmª{df`r JmonZr`Vm  {ZîH$fmªMr Zm|X H$aUo d ‘m{hVrg§J«h V`ma H$aUo Á`m‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe hmoVmo: - VmaIm§gh VnmgUr{df`H$ ‘m{hVr (CXmhaUmW©, àË`oH$ dma§dm[aVoH$[aVm VnmgUrMm {ZîH$f©, VnmgUrÀ`m {R>H$mUMr AmdmOmMr nmVir); - Ho$boë`m {e’$magr - AmH¥$Vr~§Y nmR>nwamdm H$aUmao H$‘©Mmar; Am{U - H$m`©H«$‘m§VJ©V nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§‘Yrb n[aUm‘m§da XoIaoI  nwT>rb g‘ñ`m§da Cnm` emoYÊ`mH$[aVm {Z`{‘V ‘m{hVr XoUo: - {dMmamV KoVë`m OmUmè¶m EHy$U g§»`on¡H$s {H$Vr ‘wbm§Mr nS>Vmim MmMUr Ho$br Jobr? - nS>Vmim MmMUr Ho$boë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm H$mZ d ldU ‘yë`‘mnZmH$[aVm nwT>rb VnmgUrH$[aVm nmR>{dbo? - nwT>rb VnmgUrH$[aVm nmR>{dboë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm ì`mdgm{`H$ H$mZ d ldU ‘yë`‘mnZ CnbãY Pmbo? - nS>Vmim MmMUr Pmboë`m§n¡H$s {H$Vr Q>¸o$ ‘wbm§Zm H$mZmMm {dH$ma qH$dm EoH$Ê`mMr g‘ñ`m Agë`mMo AmT>iyZ Ambo? - H$moUË`m àH$maMo H$mZmMo {dH$ma qH$dm EoH$Ê`mÀ`m g‘ñ`m bjmV Amë`m?  ‘m{hVrMo {dûcofU Am{U Ë`m{df`r ‘m{hVr XoUo: - H$mimZwgma ~XbmMo {ZarjU H$aÊ`mH$[aVm - emim§‘Ü`o H$mZ VnmgUr d ldU nS>Vmim MmMUrMr JaO Xe©{dÊ`mH$[aVm - JwUdÎmm {Z`§ÌUmH$[aVm; Am{U - MmMUrH$V} d {ejH$m/à{ejH$ `m§Zm à{ejU Am{U A{^àm` XoÊ`mH$[aVm 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar emim§‘Ü`o H$mZ d VnmgUr ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo {Z`moOZ H$aVmZm, nwT>rb KQ>H$ {dMmamV KoVbo nm{hOoV:  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§H$[aVm H$mZ d ldU `m§Mr H$miOr KoUmar godm CnbãY AgUo Amdí`H$ Amho qH$dm Ë`mM doir Vr {dH${gV H$aUo Amdí`H$ Amho  nS>Vmim MmMUrÀ`m OmJodarb AmdmOmMr nmVir {Z`§{ÌV H$aUo Amdí`H$ Amho.  ImÌrera CnH$aU dmnê$Z nS>Vmim VnmgUr gmYZ {Z`{‘VnUo (eŠ`Vmo dfm©VyZ {H$‘mZ EH$Xm) à‘m{UV H$aUo Amdí`H$ Amho.  ñWm{ZH$ YmoaUm§À`m AZwf§JmZo nmbH$/XoI^mbH$Vm© d ‘yb `m§Zr g§‘Vr qH$dm AZw‘Vr {Xbr AgbrM nm{hOo.  g§gJ© {Z`§ÌUmH$[aVm gm‘mÝ` {ZOªVwH$sH$aUmMo Cnm` dmnamV AmUUo Amdí`H$ Amho.  H$m`©H«$‘mMo ì`dñWmnZ d O~m~Xmar gw{Z{üV H$aUo Amdí`H$ Amho.  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$s¨À`m AmH¥${V~§Y nmR>nwamì`mH$[aVm H$m`©nÕVr {Z{üV Ho$boë`m AgUo Amdí`H$ Amho. 2.14 emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm Q>obr‘o{S>{gZMm dmna (20) ‘mZdr g§gmYZo ‘`m©{XV Agboë`m ^mJmV, H$mZ VnmgUr d ldU nS>Vmim MmMUr Q>o{b‘o{S>{gZ godm§À`m dmnamÛmao Ho$br OmD$ eH$Vo Á`mÛmao à{e{jV Amamo½` H$‘©Mmar S>m°ŠQ>am§er g§nH©$ gmYyZ XwJ©‘ {R>H$mUr OmJodaM VnmgÊ`m H$aVmV. B‘oOog d MmMUrMo {ZîH$f© `m§Mm AmT>mdm KoD$Z, g§^mì` {ZXmZ d XoI^mb `mH$[aVm nwT>o nmR>dÊ`mÛmao Amamo½` H$‘©Mmè¶m§Zm ‘mJ©Xe©Z H$ê$ eH$VmV. ñWm{ZH$ g§nH©$ EH$Va àË`jmV hmoD$ eH$Vmo; qH$dm {M{H$ËgH$m§Zm Z§Va AmT>mdm KoVm `mdm `mH$[aVm åhUyZ VnmgUr d B‘oOog g§J«{hV Ho$ë`m OmD$ eH$VmV d bdH$a CnMma CnbãY hmoÊ`mH$[aVm doioda A{^àm` {Xbm OmD$ eH$Vmo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo36 2.7 ‘mZdr g§gmYZo emioV OmUmè¶m ‘wbm§Mr H$mZ VnmgUr d ldU nS>Vmim MmMUr nwT>rb à{e{jV ì`º$s¨À`m JQ>mÛmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ÜdZr {deofk (ldUemók), dmMm d ^mfm amoJ{ZXmZVÁk)  H$U©~{Ya ì`º$s¨Mr XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© emioVrb S>m°ŠQ>a, gm‘mÝ` S>m°ŠQ>a, ~mbamoJVÁk)  à{e{jV Amamo½` H$‘©Mmar d n[aMm[aH$m (CXmhaUmW© d¡ÚH$s` A{YH$mar, n[aMm[aH$m, d¡ÚH$s` ‘XVZrg, V§Ìk) (13,14)  à{e{jV Ago gd©gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© dñVr nmVirda H$m‘ H$aUmao Amamo½` H$‘©Mmar) (13,14)  à{e{jV {ejH$ (19) H$mZmÀ`m d ldU VnmgÊ`m EImÚm {M{H$ËgH$ Zgboë`m ì`º$sH$Sy>Z H$amì`m bmJUma AgVrb Va g§~§{YV bmoH$m§Zm à{ejU ho {XboM nm{hOo, Ë`mZ§Va Ë`m§Zr XoIaoIrImbr gamd Ho$bm nm{hOo d gmVË`mZo JwUdÎmm VnmgyZ bmJUmar ‘XV Ho$br nm{hOo. à{ejUmZ§Va, Mm§Jbm gamd d ‘mZHo$ Am{U ‘mJ©Xe©H$ VÎdo `m§Mo nmbZ hmoV Agë`mMr ImÌr H$aÊ`m- H$[aVm {Z`{‘V VnmgUr Ho$br nm{hOo. {M{H$ËgH$ Zgboë`m ì`º$s¨À`m à{ejUmH$[aVm Amdí`H$ Agboë`m Jmoï>r Mm¡H$Q> 2.2 ‘Ü`o WmoS>Š`mV {Xë`m AmhoV. Mm¡H$Q> 2.2 emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amdí`H$ KQ>H$ H$mZmMr VgoM ldUj‘VoMr H$miOr KoÊ`mH$[aVm à{e{jV Zgbobo {M{H$ËgH$, n[aMm[aH$m d Amamo½` H$‘©Mmar `m§Zr nwT>rb Jmoï>s¨‘Ü`o à{ejU KoVbo nm{hOo:  ldUmMo ‘hÎd- {deofH$ê$Z {ejUmH$[aVm;  nS>Vmim MmMUrMm CÔoe d {Z`‘mdbr;  H$mZmMr ‘yb^yV aMZm  ldUXmofmMr H$maUo;  nS>Vmim MmMUr H$m`©H«$‘mMo ‘yb^yV H$m`© d Ahdmb XoÊ`mMr à{H«$`m;  nS>Vmim MmMUr H$aUmè¶m ì`º$sMr / MmMUrH$Ë`m©Mr ^y{‘H$m;  nS>Vmim MmMUr d nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVr;  nS>Vmim MmMUr Ho$br OmUmè¶m ImobrMr aMZm d CnH$aUmMo à‘mUrH$aU;  CnH$aU, XoI^mb d H$m‘ H$aV Zgë`mg g‘ñ`m {ZdmaU `mgh;  dmVmdaUmVrb AmdmOmMr ‘moO‘mno;  Am°Q>moñH$monr d {Q>ån°Zm°‘oQ´r (OoWo CnbãY Agob VoWo) Am{U;  {dMmamV KoVbm OmUmam H$mZ d ldUj‘VoMr pñWVr AmoiIUo. ldU{df`H$ H$miOr KoUmao S>m°ŠQ>a nS>Vmim MmMUr H$m`©H«$‘mMm CÔoe d {Z`‘mdbr `màVr g§doXZerb Agbo nm{hOoV. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. 2.8 nwT>rb VnmgUrH$[aVmMo {ZH$f ‘mJ©Xe©H$ VÎdm§‘Ü`o (^mJ 2.2) Z‘yX Ho$ë`mZwgma, emim-ñVamdarb H$mZ VnmgUr H$m`©H«$‘ hm H$mZ d ldU godm `m§À`mer g§b¾ AgUo Amdí`H$ Amho. Ë`m‘Ü`o H$mZmMo {dH$ma Agbobr qH$dm ldUXmofmMo {ZXmZ Pmbobr ‘wbo Amdí`H$ Vr XoI^mb àmá H$ê$ eH$Vrb. MmMUrÀ`m doJdoJù`m {ZîH$fmªH$[aVm H$amd`mÀ`m H¥$Vr nwT>rbà‘mUo AmhoV:  CÎmsU© {ZîH$f©: H$mZ VnmgUr d ldU nS>Vmim MmMUrZ§Va CÎmsU© Agm {ZîH$f© Amboë`m d nwT>rb VnmgUrH$[aVm nmR>dm Agm eoam Z XoÊ`mV Amboë`m ‘wbm§Zm Ë`m§À`m H$mZm§Mr H$miOr KoÊ`mMm g„m {Xbm nm{hOo. Ë`m§Zm H$mZ d ldUeº$s `mMr H$miOr `m{df`r ‘m{hVr {Xbr nm{hOo.4  nwT>rb VnmgUrH$[aVm nmR>dm {ZîH$f©: ldU nS>Vmim MmMUrZ§Va nwT>rb VnmgUrH$[aVm nmR>dm Agm {ZîH$f© Amboë`m ‘wbm§Mo {ZXmZ d ì`dñWmnZ H$aÊ`mH$[aVm H$mZmMr VnmgUr d ldU MmMUr Pmbr nm{hOo. hr MmMUr H$mZ d ldUeº$sMr H$miOr KoÊ`mMr j‘Vm Agboë`m S>m°ŠQ>am§Zr Ho$br nm{hOo.  {ZX}eH$ g§Ho$V (Red Flags): H$mZmMr VnmgUr d ldU nS>Vmim MmMUrZ§Va {ZX}eH$ Agm {ZîH$f© Amboë`m ‘wbm§Zm nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var nwT>rb ‘yë`‘mnZmH$[aVm nmR>{dbo nm{hOo. {ZX}eH$m§À`m Bemè¶m§‘Ü`o `m§Mm g‘mdoe hmoVmo: - ‘wbmMo EoH$Uo, ~mobUo d ^mfm {dH$mg, Xwb©j, {eH$Ê`mVrb AS>MUr qH$dm H$mZmÀ`m H$moUË`mhr g‘ñ`m§~Ôb (nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var) H$miOr dmQ>Umao nmbH$ Am{U H$miOr KoUmè¶m ì`º$s qH$dm {ejH$ - H$mZmVyZ `oUmam òmd; Oa H$mZmVyZ `oUmè¶m òmdmbm XwJªYr `oV Agob, Va ho Ëd[aV d VmVS>rZo nwT>rb VnmgUrH$[aVm nmR>{dÊ`mMo H$maU Agbo nm{hOo; - H$mZmÀ`m ‘mJo bmbganUm Am{U doXZmXm`H$ gyO (mastoid); Am{U - H$mZm‘Ü`o qH$dm H$mZmÀ`m AdVr^dVr Vrd« doXZm àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a, à{e{jV n[aMm[aH$m qH$dm H$mZ d ldUeº$sMr H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dbo OmD$ eH$Vo. H$moUmH$So> nmR>{dbo Omdo `mMm {ZU©` ñWm{ZH$ n[apñWVr, H$mZ Am{U ldU {M{H$ËgH$m§Mr CnbãYVm d BVa à{e{jV Amamo½` H$‘©Mmar `m§À`mda Adb§~yZ AgUo Amdí`H$ Amho. àmYmÝ`H«$‘mZwgma nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVrMm Adb§~ Ho$bm OmD$ eH$Vmo. CXmhaUmW©, H$mZmVyZ òmd `oUo, gyO BË`mXs¨gma»`m d¡ÚH$s` g‘ñ`m§da àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a qH$dm à{e{jV n[aMm[aH$m `m§À`mÛmao CnMma Ho$bo OmD$ eH$VmV; ldUXmofmer g§~§{YV g‘ñ`m WoQ> H$mZ d ldU{df`H$ H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dë`m nm{hOoV. 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ ldUXmofmMo ‘yë`‘mnZ H$aÊ`mH$[aVm nmR>{dboë`m H|$Ðmda CnbãY Agboë`m Z¡Xm{ZH$ godm§‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe Agmdm (5-12):  Z¡Xm{ZH$ ewÕ ÜdZr ldU MmMUr (eŠ` Agob {VWo, `m‘Ü`o ~moZ H§$S>ŠeZ MmMUrMm g‘mdoe nm{hOo);  Am°Q>moñH$mo{nH$ (Otoscopic) qH$dm ‘m`H«$moñH$mo{nH$ (Microscopic)VnmgUr Am{U  {Q>ån°Zmo‘oQ´r (Tympanometry)qH$dm ‘Ü` H$Um©À`m pñWVrMr BVa ‘moO‘mno H$mZ d ldU H$miOr KoUmè¶m {M{H$ËgH$mZo Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm nS>Vmim MmMUrZ§Va R>a{dbr nm{hOo. ` oWo {deof ‘‚mmV§Vy{df`H$ qH$dm j-{H$aU MmMÊ`m§Mr Amdí`H$ Agy eH$Vo. 2.10 CnMma ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m gd© ‘wbm§Zm Ëd[aV CnMma {‘imbo nm{hOoV. nwT>rb Jmoï>r {dMmamV KoD$Z (1) Aem godm§Mr Amdí`H$Vm hr {M{H$ËgH$m§Zr ì`º$s-H|${ÐV Ñ{ï>H$moZmVyZ {Xboë`m g„²`mZwgma Agmdr:  ldUXmofmMo ñdê$n d Vrd«Vm;  H$mZmMo {dH$ma d g§^mì` Jw§VmJw§Vr;  ghì`mYr;  CnMmamÀ`m àH$mamH$[aVm Hw$Qw>§~mMo àmYmÝ`H«$‘;  CnbãY g§gmYZo; Am{U  g§ñH¥$Vrg§~§YmV {dMmamV KoÊ`mMo ‘wÔo CnMmamH$[aVmÀ`m godm§‘Ü`o `m§Mm g‘mdoe hmoVmo (1):  H$mZmÀ`m {dH$mam§Mo d¡ÚH$s` ì`dñWmnZ;  ‘Ü` H$Um©Mr eó{H«$`m;  ldU V§ÌkmZmMm dmna, Ogo H$s ldU`§Ì, qH$dm e§ImH¥$Vr àË`mamonU (Cochlear Implant) H$aÊ`m`mo½` BVa CnH$aUo, (‘Ü`-H$U© qH$dm H$m°pŠb`a Båßbm§Q>);  ldU ghm`H$ V§ÌkmZmMm dmna, Ogo H$s ldU B§S>ŠeZ byßg; hmS©>dm`S©>, E’$E‘ qH$dm BÝ’«$maoS> {gñQ>åg; qH$dm [a‘moQ> ‘m`H«$mo’$moZ {gñQ>råg (WoQ> ldU{df`H$ CnH$aUo);  lmì` nwZd©gZ CnMmanÕVr  hmVmÀ`m hmbMmbr d g§Ho$V `m§Mm g‘mdoe Agbobr ^mfm d g§doXr à{VñWmnZmMo BVa n`m©` (CXmhaUmW© AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY Am{U ~moQ>m§Zr Ho$bobo eãXboIZ) qH$dm {MÌn[aM` H$ê$Z XoUmè¶m godm ‘wbm§À`m H$mZmÀ`m {dH$mamMo qH$dm ldUXmofmMo {ZXmZ Pmbo Amho H$s nmbH$ Am{U H$miOr KoUmè¶m ì`º$s `m§Zm `mo½` ‘mJ©Xe©Z d ‘XV {‘iUo ‘hÎdmMo Amho, CXmhaUmW© nmbH$m§À`m ‘XV JQ>m§Ûmao. `m{edm`, {ejH$m§Zm ‘wbmÀ`m JaOm§Mr (nmbH$/ H$miOr KoUmè¶m ì`º$s¨‘m’©$V) ‘m{hVr {Xbr nm{hOo, OoUoH$ê$Z H$mhr n[apñWVs¨‘Ü`o H$amdo bmJUmao ~Xb (CXmhaUmW©, ‘wbmbm dJm©V nwT>o ~g{dUo, dmVmdaUmVrb AmdmOmMr nmVir H$‘r H$aUo, byn {gñQ>råg dmnaUo B.) H$aVm `oD$ eH$VmV. 2.11 ldU ñdmñÏ` `m{df`rMm àMma H$mZmÀ`m d ldU g‘ñ`m§da Cnm` emoYUmam emioVrb nS>Vmim MmMUr H$m`©H«$‘m‘wio H$mZ d ldU ñdmñÏ` `mMm àMma H$aÊ`mMr g§Yr CnbãY hmoVo. ‘wbo, Ë`m§À`m Hw$Qw>§~mVrb gXñ`/Ë`m§Mr H$miOr KoUmè¶m ì`º$s, {ejH$ d emioVrb H$‘©Mmar `m§Zm nwT>rb Jmoï>s¨{df`r àm‘w»`mZo ‘m{hVr {Xbr nm{hOo:  ldU Amamo½`;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mMm g‘mdoe hmoUmar H$mZmMr H$miOr5 d  ldUj‘VoÀ`m g§ajUmH$[aVm dmnamV Agbobo gwa{jV ldU, gwa{jV ldU nÕVr d gwa{jV ldU A°ßg ` mg- maIr CnbãY gmYZo 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ A§‘b~OmdUrÀ`m ‘mJ©Xe©H$ VÎdm§‘Ü`o g§H${bV ‘m{hVrÀ`m ì`dñWmnZmMr YmoaUo Amdí`H$Vm åhUyZ ñnï>nUo Z‘yX Ho$bobr AgmdrV d Ahdmb XoUmar `§ÌUm d JwUdÎmm {Z`§ÌU à{H«$`m n[a^m{fV Ho$bobr Agmdr. g§H${bV ‘m{hVrÀ`m ì`dñWmnZmÀ`m {Z`‘mdbr‘Ü`o `mMm {dMma Ho$bm Omdm:  nmbH$ d {ejH$ `m§Zm MmMUrÀ`m {ZîH$fmª{df`r ‘m{hVr  {ZîH$fmª{df`r JmonZr`Vm  {ZîH$fmªMr Zm|X H$aUo d ‘m{hVrg§J«h V`ma H$aUo Á`m‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe hmoVmo: - VmaIm§gh VnmgUr{df`H$ ‘m{hVr (CXmhaUmW©, àË`oH$ dma§dm[aVoH$[aVm VnmgUrMm {ZîH$f©, VnmgUrÀ`m {R>H$mUMr AmdmOmMr nmVir); - Ho$boë`m {e’$magr - AmH¥$Vr~§Y nmR>nwamdm H$aUmao H$‘©Mmar; Am{U - H$m`©H«$‘m§VJ©V nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§‘Yrb n[aUm‘m§da XoIaoI  nwT>rb g‘ñ`m§da Cnm` emoYÊ`mH$[aVm {Z`{‘V ‘m{hVr XoUo: - {dMmamV KoVë`m OmUmè¶m EHy$U g§»`on¡H$s {H$Vr ‘wbm§Mr nS>Vmim MmMUr Ho$br Jobr? - nS>Vmim MmMUr Ho$boë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm H$mZ d ldU ‘yë`‘mnZmH$[aVm nwT>rb VnmgUrH$[aVm nmR>{dbo? - nwT>rb VnmgUrH$[aVm nmR>{dboë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm ì`mdgm{`H$ H$mZ d ldU ‘yë`‘mnZ CnbãY Pmbo? - nS>Vmim MmMUr Pmboë`m§n¡H$s {H$Vr Q>¸o$ ‘wbm§Zm H$mZmMm {dH$ma qH$dm EoH$Ê`mMr g‘ñ`m Agë`mMo AmT>iyZ Ambo? - H$moUË`m àH$maMo H$mZmMo {dH$ma qH$dm EoH$Ê`mÀ`m g‘ñ`m bjmV Amë`m?  ‘m{hVrMo {dûcofU Am{U Ë`m{df`r ‘m{hVr XoUo: - H$mimZwgma ~XbmMo {ZarjU H$aÊ`mH$[aVm - emim§‘Ü`o H$mZ VnmgUr d ldU nS>Vmim MmMUrMr JaO Xe©{dÊ`mH$[aVm - JwUdÎmm {Z`§ÌUmH$[aVm; Am{U - MmMUrH$V} d {ejH$m/à{ejH$ `m§Zm à{ejU Am{U A{^àm` XoÊ`mH$[aVm 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar emim§‘Ü`o H$mZ d VnmgUr ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo {Z`moOZ H$aVmZm, nwT>rb KQ>H$ {dMmamV KoVbo nm{hOoV:  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§H$[aVm H$mZ d ldU `m§Mr H$miOr KoUmar godm CnbãY AgUo Amdí`H$ Amho qH$dm Ë`mM doir Vr {dH${gV H$aUo Amdí`H$ Amho  nS>Vmim MmMUrÀ`m OmJodarb AmdmOmMr nmVir {Z`§{ÌV H$aUo Amdí`H$ Amho.  ImÌrera CnH$aU dmnê$Z nS>Vmim VnmgUr gmYZ {Z`{‘VnUo (eŠ`Vmo dfm©VyZ {H$‘mZ EH$Xm) à‘m{UV H$aUo Amdí`H$ Amho.  ñWm{ZH$ YmoaUm§À`m AZwf§JmZo nmbH$/XoI^mbH$Vm© d ‘yb `m§Zr g§‘Vr qH$dm AZw‘Vr {Xbr AgbrM nm{hOo.  g§gJ© {Z`§ÌUmH$[aVm gm‘mÝ` {ZOªVwH$sH$aUmMo Cnm` dmnamV AmUUo Amdí`H$ Amho.  H$m`©H«$‘mMo ì`dñWmnZ d O~m~Xmar gw{Z{üV H$aUo Amdí`H$ Amho.  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$s¨À`m AmH¥${V~§Y nmR>nwamì`mH$[aVm H$m`©nÕVr {Z{üV Ho$boë`m AgUo Amdí`H$ Amho. 2.14 emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm Q>obr‘o{S>{gZMm dmna (20) ‘mZdr g§gmYZo ‘`m©{XV Agboë`m ^mJmV, H$mZ VnmgUr d ldU nS>Vmim MmMUr Q>o{b‘o{S>{gZ godm§À`m dmnamÛmao Ho$br OmD$ eH$Vo Á`mÛmao à{e{jV Amamo½` H$‘©Mmar S>m°ŠQ>am§er g§nH©$ gmYyZ XwJ©‘ {R>H$mUr OmJodaM VnmgÊ`m H$aVmV. B‘oOog d MmMUrMo {ZîH$f© `m§Mm AmT>mdm KoD$Z, g§^mì` {ZXmZ d XoI^mb `mH$[aVm nwT>o nmR>dÊ`mÛmao Amamo½` H$‘©Mmè¶m§Zm ‘mJ©Xe©Z H$ê$ eH$VmV. ñWm{ZH$ g§nH©$ EH$Va àË`jmV hmoD$ eH$Vmo; qH$dm {M{H$ËgH$m§Zm Z§Va AmT>mdm KoVm `mdm `mH$[aVm åhUyZ VnmgUr d B‘oOog g§J«{hV Ho$ë`m OmD$ eH$VmV d bdH$a CnMma CnbãY hmoÊ`mH$[aVm doioda A{^àm` {Xbm OmD$ eH$Vmo. 5 Flyer on ear care (English): https://who.canto.global/s/Q2CPO ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 37 2.7 ‘mZdr g§gmYZo emioV OmUmè¶m ‘wbm§Mr H$mZ VnmgUr d ldU nS>Vmim MmMUr nwT>rb à{e{jV ì`º$s¨À`m JQ>mÛmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ÜdZr {deofk (ldUemók), dmMm d ^mfm amoJ{ZXmZVÁk)  H$U©~{Ya ì`º$s¨Mr XoI^mb H$aUmao {M{H$ËgH$ (CXmhaUmW© emioVrb S>m°ŠQ>a, gm‘mÝ` S>m°ŠQ>a, ~mbamoJVÁk)  à{e{jV Amamo½` H$‘©Mmar d n[aMm[aH$m (CXmhaUmW© d¡ÚH$s` A{YH$mar, n[aMm[aH$m, d¡ÚH$s` ‘XVZrg, V§Ìk) (13,14)  à{e{jV Ago gd©gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© dñVr nmVirda H$m‘ H$aUmao Amamo½` H$‘©Mmar) (13,14)  à{e{jV {ejH$ (19) H$mZmÀ`m d ldU VnmgÊ`m EImÚm {M{H$ËgH$ Zgboë`m ì`º$sH$Sy>Z H$amì`m bmJUma AgVrb Va g§~§{YV bmoH$m§Zm à{ejU ho {XboM nm{hOo, Ë`mZ§Va Ë`m§Zr XoIaoIrImbr gamd Ho$bm nm{hOo d gmVË`mZo JwUdÎmm VnmgyZ bmJUmar ‘XV Ho$br nm{hOo. à{ejUmZ§Va, Mm§Jbm gamd d ‘mZHo$ Am{U ‘mJ©Xe©H$ VÎdo `m§Mo nmbZ hmoV Agë`mMr ImÌr H$aÊ`m- H$[aVm {Z`{‘V VnmgUr Ho$br nm{hOo. {M{H$ËgH$ Zgboë`m ì`º$s¨À`m à{ejUmH$[aVm Amdí`H$ Agboë`m Jmoï>r Mm¡H$Q> 2.2 ‘Ü`o WmoS>Š`mV {Xë`m AmhoV. Mm¡H$Q> 2.2 emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amdí`H$ KQ>H$ H$mZmMr VgoM ldUj‘VoMr H$miOr KoÊ`mH$[aVm à{e{jV Zgbobo {M{H$ËgH$, n[aMm[aH$m d Amamo½` H$‘©Mmar `m§Zr nwT>rb Jmoï>s¨‘Ü`o à{ejU KoVbo nm{hOo:  ldUmMo ‘hÎd- {deofH$ê$Z {ejUmH$[aVm;  nS>Vmim MmMUrMm CÔoe d {Z`‘mdbr;  H$mZmMr ‘yb^yV aMZm  ldUXmofmMr H$maUo;  nS>Vmim MmMUr H$m`©H«$‘mMo ‘yb^yV H$m`© d Ahdmb XoÊ`mMr à{H«$`m;  nS>Vmim MmMUr H$aUmè¶m ì`º$sMr / MmMUrH$Ë`m©Mr ^y{‘H$m;  nS>Vmim MmMUr d nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVr;  nS>Vmim MmMUr Ho$br OmUmè¶m ImobrMr aMZm d CnH$aUmMo à‘mUrH$aU;  CnH$aU, XoI^mb d H$m‘ H$aV Zgë`mg g‘ñ`m {ZdmaU `mgh;  dmVmdaUmVrb AmdmOmMr ‘moO‘mno;  Am°Q>moñH$monr d {Q>ån°Zm°‘oQ´r (OoWo CnbãY Agob VoWo) Am{U;  {dMmamV KoVbm OmUmam H$mZ d ldUj‘VoMr pñWVr AmoiIUo. ldU{df`H$ H$miOr KoUmao S>m°ŠQ>a nS>Vmim MmMUr H$m`©H«$‘mMm CÔoe d {Z`‘mdbr `màVr g§doXZerb Agbo nm{hOoV. 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. 2.8 nwT>rb VnmgUrH$[aVmMo {ZH$f ‘mJ©Xe©H$ VÎdm§‘Ü`o (^mJ 2.2) Z‘yX Ho$ë`mZwgma, emim-ñVamdarb H$mZ VnmgUr H$m`©H«$‘ hm H$mZ d ldU godm `m§À`mer g§b¾ AgUo Amdí`H$ Amho. Ë`m‘Ü`o H$mZmMo {dH$ma Agbobr qH$dm ldUXmofmMo {ZXmZ Pmbobr ‘wbo Amdí`H$ Vr XoI^mb àmá H$ê$ eH$Vrb. MmMUrÀ`m doJdoJù`m {ZîH$fmªH$[aVm H$amd`mÀ`m H¥$Vr nwT>rbà‘mUo AmhoV:  CÎmsU© {ZîH$f©: H$mZ VnmgUr d ldU nS>Vmim MmMUrZ§Va CÎmsU© Agm {ZîH$f© Amboë`m d nwT>rb VnmgUrH$[aVm nmR>dm Agm eoam Z XoÊ`mV Amboë`m ‘wbm§Zm Ë`m§À`m H$mZm§Mr H$miOr KoÊ`mMm g„m {Xbm nm{hOo. Ë`m§Zm H$mZ d ldUeº$s `mMr H$miOr `m{df`r ‘m{hVr {Xbr nm{hOo.4  nwT>rb VnmgUrH$[aVm nmR>dm {ZîH$f©: ldU nS>Vmim MmMUrZ§Va nwT>rb VnmgUrH$[aVm nmR>dm Agm {ZîH$f© Amboë`m ‘wbm§Mo {ZXmZ d ì`dñWmnZ H$aÊ`mH$[aVm H$mZmMr VnmgUr d ldU MmMUr Pmbr nm{hOo. hr MmMUr H$mZ d ldUeº$sMr H$miOr KoÊ`mMr j‘Vm Agboë`m S>m°ŠQ>am§Zr Ho$br nm{hOo.  {ZX}eH$ g§Ho$V (Red Flags): H$mZmMr VnmgUr d ldU nS>Vmim MmMUrZ§Va {ZX}eH$ Agm {ZîH$f© Amboë`m ‘wbm§Zm nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var nwT>rb ‘yë`‘mnZmH$[aVm nmR>{dbo nm{hOo. {ZX}eH$m§À`m Bemè¶m§‘Ü`o `m§Mm g‘mdoe hmoVmo: - ‘wbmMo EoH$Uo, ~mobUo d ^mfm {dH$mg, Xwb©j, {eH$Ê`mVrb AS>MUr qH$dm H$mZmÀ`m H$moUË`mhr g‘ñ`m§~Ôb (nS>Vmim MmMUrMm {ZîH$f© H$mhrhr Agbm Var) H$miOr dmQ>Umao nmbH$ Am{U H$miOr KoUmè¶m ì`º$s qH$dm {ejH$ - H$mZmVyZ `oUmam òmd; Oa H$mZmVyZ `oUmè¶m òmdmbm XwJªYr `oV Agob, Va ho Ëd[aV d VmVS>rZo nwT>rb VnmgUrH$[aVm nmR>{dÊ`mMo H$maU Agbo nm{hOo; - H$mZmÀ`m ‘mJo bmbganUm Am{U doXZmXm`H$ gyO (mastoid); Am{U - H$mZm‘Ü`o qH$dm H$mZmÀ`m AdVr^dVr Vrd« doXZm àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a, à{e{jV n[aMm[aH$m qH$dm H$mZ d ldUeº$sMr H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dbo OmD$ eH$Vo. H$moUmH$So> nmR>{dbo Omdo `mMm {ZU©` ñWm{ZH$ n[apñWVr, H$mZ Am{U ldU {M{H$ËgH$m§Mr CnbãYVm d BVa à{e{jV Amamo½` H$‘©Mmar `m§À`mda Adb§~yZ AgUo Amdí`H$ Amho. àmYmÝ`H«$‘mZwgma nwT>rb VnmgUrH$[aVm nmR>{dÊ`mÀ`m nÕVrMm Adb§~ Ho$bm OmD$ eH$Vmo. CXmhaUmW©, H$mZmVyZ òmd `oUo, gyO BË`mXs¨gma»`m d¡ÚH$s` g‘ñ`m§da àmW{‘H$ H$miOr KoUmao S>m°ŠQ>a qH$dm à{e{jV n[aMm[aH$m `m§À`mÛmao CnMma Ho$bo OmD$ eH$VmV; ldUXmofmer g§~§{YV g‘ñ`m WoQ> H$mZ d ldU{df`H$ H$miOr KoUmè¶m {M{H$ËgH$mH$So> nmR>{dë`m nm{hOoV. 2.9 Z¡Xm{ZH$ ‘yë`‘mnZ ldUXmofmMo ‘yë`‘mnZ H$aÊ`mH$[aVm nmR>{dboë`m H|$Ðmda CnbãY Agboë`m Z¡Xm{ZH$ godm§‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe Agmdm (5-12):  Z¡Xm{ZH$ ewÕ ÜdZr ldU MmMUr (eŠ` Agob {VWo, `m‘Ü`o ~moZ H§$S>ŠeZ MmMUrMm g‘mdoe nm{hOo);  Am°Q>moñH$mo{nH$ (Otoscopic) qH$dm ‘m`H«$moñH$mo{nH$ (Microscopic)VnmgUr Am{U  {Q>ån°Zmo‘oQ´r (Tympanometry)qH$dm ‘Ü` H$Um©À`m pñWVrMr BVa ‘moO‘mno H$mZ d ldU H$miOr KoUmè¶m {M{H$ËgH$mZo Z¡Xm{ZH$ MmMUrMr Amdí`H$Vm nS>Vmim MmMUrZ§Va R>a{dbr nm{hOo. ` oWo {deof ‘‚mmV§Vy{df`H$ qH$dm j-{H$aU MmMÊ`m§Mr Amdí`H$ Agy eH$Vo. 2.10 CnMma ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m gd© ‘wbm§Zm Ëd[aV CnMma {‘imbo nm{hOoV. nwT>rb Jmoï>r {dMmamV KoD$Z (1) Aem godm§Mr Amdí`H$Vm hr {M{H$ËgH$m§Zr ì`º$s-H|${ÐV Ñ{ï>H$moZmVyZ {Xboë`m g„²`mZwgma Agmdr:  ldUXmofmMo ñdê$n d Vrd«Vm;  H$mZmMo {dH$ma d g§^mì` Jw§VmJw§Vr;  ghì`mYr;  CnMmamÀ`m àH$mamH$[aVm Hw$Qw>§~mMo àmYmÝ`H«$‘;  CnbãY g§gmYZo; Am{U  g§ñH¥$Vrg§~§YmV {dMmamV KoÊ`mMo ‘wÔo CnMmamH$[aVmÀ`m godm§‘Ü`o `m§Mm g‘mdoe hmoVmo (1):  H$mZmÀ`m {dH$mam§Mo d¡ÚH$s` ì`dñWmnZ;  ‘Ü` H$Um©Mr eó{H«$`m;  ldU V§ÌkmZmMm dmna, Ogo H$s ldU`§Ì, qH$dm e§ImH¥$Vr àË`mamonU (Cochlear Implant) H$aÊ`m`mo½` BVa CnH$aUo, (‘Ü`-H$U© qH$dm H$m°pŠb`a Båßbm§Q>);  ldU ghm`H$ V§ÌkmZmMm dmna, Ogo H$s ldU B§S>ŠeZ byßg; hmS©>dm`S©>, E’$E‘ qH$dm BÝ’«$maoS> {gñQ>åg; qH$dm [a‘moQ> ‘m`H«$mo’$moZ {gñQ>råg (WoQ> ldU{df`H$ CnH$aUo);  lmì` nwZd©gZ CnMmanÕVr  hmVmÀ`m hmbMmbr d g§Ho$V `m§Mm g‘mdoe Agbobr ^mfm d g§doXr à{VñWmnZmMo BVa n`m©` (CXmhaUmW© AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY Am{U ~moQ>m§Zr Ho$bobo eãXboIZ) qH$dm {MÌn[aM` H$ê$Z XoUmè¶m godm ‘wbm§À`m H$mZmÀ`m {dH$mamMo qH$dm ldUXmofmMo {ZXmZ Pmbo Amho H$s nmbH$ Am{U H$miOr KoUmè¶m ì`º$s `m§Zm `mo½` ‘mJ©Xe©Z d ‘XV {‘iUo ‘hÎdmMo Amho, CXmhaUmW© nmbH$m§À`m ‘XV JQ>m§Ûmao. `m{edm`, {ejH$m§Zm ‘wbmÀ`m JaOm§Mr (nmbH$/ H$miOr KoUmè¶m ì`º$s¨‘m’©$V) ‘m{hVr {Xbr nm{hOo, OoUoH$ê$Z H$mhr n[apñWVs¨‘Ü`o H$amdo bmJUmao ~Xb (CXmhaUmW©, ‘wbmbm dJm©V nwT>o ~g{dUo, dmVmdaUmVrb AmdmOmMr nmVir H$‘r H$aUo, byn {gñQ>råg dmnaUo B.) H$aVm `oD$ eH$VmV. 2.11 ldU ñdmñÏ` `m{df`rMm àMma H$mZmÀ`m d ldU g‘ñ`m§da Cnm` emoYUmam emioVrb nS>Vmim MmMUr H$m`©H«$‘m‘wio H$mZ d ldU ñdmñÏ` `mMm àMma H$aÊ`mMr g§Yr CnbãY hmoVo. ‘wbo, Ë`m§À`m Hw$Qw>§~mVrb gXñ`/Ë`m§Mr H$miOr KoUmè¶m ì`º$s, {ejH$ d emioVrb H$‘©Mmar `m§Zm nwT>rb Jmoï>s¨{df`r àm‘w»`mZo ‘m{hVr {Xbr nm{hOo:  ldU Amamo½`;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mMm g‘mdoe hmoUmar H$mZmMr H$miOr5 d  ldUj‘VoÀ`m g§ajUmH$[aVm dmnamV Agbobo gwa{jV ldU, gwa{jV ldU nÕVr d gwa{jV ldU A°ßg ` mg- maIr CnbãY gmYZo 2.12 g§H${bV ‘m{hVrMo ì`dñWmnZ A§‘b~OmdUrÀ`m ‘mJ©Xe©H$ VÎdm§‘Ü`o g§H${bV ‘m{hVrÀ`m ì`dñWmnZmMr YmoaUo Amdí`H$Vm åhUyZ ñnï>nUo Z‘yX Ho$bobr AgmdrV d Ahdmb XoUmar `§ÌUm d JwUdÎmm {Z`§ÌU à{H«$`m n[a^m{fV Ho$bobr Agmdr. g§H${bV ‘m{hVrÀ`m ì`dñWmnZmÀ`m {Z`‘mdbr‘Ü`o `mMm {dMma Ho$bm Omdm:  nmbH$ d {ejH$ `m§Zm MmMUrÀ`m {ZîH$fmª{df`r ‘m{hVr  {ZîH$fmª{df`r JmonZr`Vm  {ZîH$fmªMr Zm|X H$aUo d ‘m{hVrg§J«h V`ma H$aUo Á`m‘Ü`o Imbrb Jmoï>s¨Mm g‘mdoe hmoVmo: - VmaIm§gh VnmgUr{df`H$ ‘m{hVr (CXmhaUmW©, àË`oH$ dma§dm[aVoH$[aVm VnmgUrMm {ZîH$f©, VnmgUrÀ`m {R>H$mUMr AmdmOmMr nmVir); - Ho$boë`m {e’$magr - AmH¥$Vr~§Y nmR>nwamdm H$aUmao H$‘©Mmar; Am{U - H$m`©H«$‘m§VJ©V nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§‘Yrb n[aUm‘m§da XoIaoI  nwT>rb g‘ñ`m§da Cnm` emoYÊ`mH$[aVm {Z`{‘V ‘m{hVr XoUo: - {dMmamV KoVë`m OmUmè¶m EHy$U g§»`on¡H$s {H$Vr ‘wbm§Mr nS>Vmim MmMUr Ho$br Jobr? - nS>Vmim MmMUr Ho$boë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm H$mZ d ldU ‘yë`‘mnZmH$[aVm nwT>rb VnmgUrH$[aVm nmR>{dbo? - nwT>rb VnmgUrH$[aVm nmR>{dboë`m§n¡H$s, {H$Vr Q>¸o$ ‘wbm§Zm ì`mdgm{`H$ H$mZ d ldU ‘yë`‘mnZ CnbãY Pmbo? - nS>Vmim MmMUr Pmboë`m§n¡H$s {H$Vr Q>¸o$ ‘wbm§Zm H$mZmMm {dH$ma qH$dm EoH$Ê`mMr g‘ñ`m Agë`mMo AmT>iyZ Ambo? - H$moUË`m àH$maMo H$mZmMo {dH$ma qH$dm EoH$Ê`mÀ`m g‘ñ`m bjmV Amë`m?  ‘m{hVrMo {dûcofU Am{U Ë`m{df`r ‘m{hVr XoUo: - H$mimZwgma ~XbmMo {ZarjU H$aÊ`mH$[aVm - emim§‘Ü`o H$mZ VnmgUr d ldU nS>Vmim MmMUrMr JaO Xe©{dÊ`mH$[aVm - JwUdÎmm {Z`§ÌUmH$[aVm; Am{U - MmMUrH$V} d {ejH$m/à{ejH$ `m§Zm à{ejU Am{U A{^àm` XoÊ`mH$[aVm 2.13 emim-ñVamda H$mZ VnmgUr d ldU nS>Vmim MmMUr gwê$ H$aÊ`mMr nyd©V`mar emim§‘Ü`o H$mZ d VnmgUr ldU nS>Vmim MmMUr H$m`©H«$‘m§Mo {Z`moOZ H$aVmZm, nwT>rb KQ>H$ {dMmamV KoVbo nm{hOoV:  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ‘wbm§H$[aVm H$mZ d ldU `m§Mr H$miOr KoUmar godm CnbãY AgUo Amdí`H$ Amho qH$dm Ë`mM doir Vr {dH${gV H$aUo Amdí`H$ Amho  nS>Vmim MmMUrÀ`m OmJodarb AmdmOmMr nmVir {Z`§{ÌV H$aUo Amdí`H$ Amho.  ImÌrera CnH$aU dmnê$Z nS>Vmim VnmgUr gmYZ {Z`{‘VnUo (eŠ`Vmo dfm©VyZ {H$‘mZ EH$Xm) à‘m{UV H$aUo Amdí`H$ Amho.  ñWm{ZH$ YmoaUm§À`m AZwf§JmZo nmbH$/XoI^mbH$Vm© d ‘yb `m§Zr g§‘Vr qH$dm AZw‘Vr {Xbr AgbrM nm{hOo.  g§gJ© {Z`§ÌUmH$[aVm gm‘mÝ` {ZOªVwH$sH$aUmMo Cnm` dmnamV AmUUo Amdí`H$ Amho.  H$m`©H«$‘mMo ì`dñWmnZ d O~m~Xmar gw{Z{üV H$aUo Amdí`H$ Amho.  nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$s¨À`m AmH¥${V~§Y nmR>nwamì`mH$[aVm H$m`©nÕVr {Z{üV Ho$boë`m AgUo Amdí`H$ Amho. 2.14 emim-ñVamda Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUrH$[aVm Q>obr‘o{S>{gZMm dmna (20) ‘mZdr g§gmYZo ‘`m©{XV Agboë`m ^mJmV, H$mZ VnmgUr d ldU nS>Vmim MmMUr Q>o{b‘o{S>{gZ godm§À`m dmnamÛmao Ho$br OmD$ eH$Vo Á`mÛmao à{e{jV Amamo½` H$‘©Mmar S>m°ŠQ>am§er g§nH©$ gmYyZ XwJ©‘ {R>H$mUr OmJodaM VnmgÊ`m H$aVmV. B‘oOog d MmMUrMo {ZîH$f© `m§Mm AmT>mdm KoD$Z, g§^mì` {ZXmZ d XoI^mb `mH$[aVm nwT>o nmR>dÊ`mÛmao Amamo½` H$‘©Mmè¶m§Zm ‘mJ©Xe©Z H$ê$ eH$VmV. ñWm{ZH$ g§nH©$ EH$Va àË`jmV hmoD$ eH$Vmo; qH$dm {M{H$ËgH$m§Zm Z§Va AmT>mdm KoVm `mdm `mH$[aVm åhUyZ VnmgUr d B‘oOog g§J«{hV Ho$ë`m OmD$ eH$VmV d bdH$a CnMma CnbãY hmoÊ`mH$[aVm doioda A{^àm` {Xbm OmD$ eH$Vmo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo38 13. Dawood N, Mahomed Asmail F, Louw C, Swanepoel W. Mhealth hearing screening for children by non-specialist health workers in communities. Int J Audiol. 2020 Oct 12:1–7. doi:10.1080/149920 27.2020.1829719. Epub ahead of print. 14. Manus M, van der Linde J, Kuper H, Olinger R, Swanepoel W. Community-based hearing and vision screening in schools in low-income communities using mobile health technologies. Lang Speech Hear Serv Sch. 2021 April 20;52(2):568–580. doi:10.1044/2020_LSHSS-20-00089. 15. Mahomed-Asmail F, Swanepoel DW, Eikelboom RH. Referral criteria for school-based hearing screening in South Africa: considerations for resource-limited contexts. Health SA Gesondheid. 2016; 96–102. 16. Eksteen S, Eikelboom RH, Launer S, Kuper H, Swanepoel DW. Referral criteria for preschool hearing screening in resource-constrained settings: a retrospective comparison of protocols. Lang Speech Hear Serv Sch. 2021 Jan; IN REVIEW. 17. Wolmarans J, De Sousa KC, Frisby C, Mahomed-Asmail F, Smits C, Moore DR, et al. (2021). Speech recognition in noise using binaural diotic and antiphasic digits-in-noise in children: maturation and self-test validity. J Am Acad Audiol; IN PRESS. 18. Denys S, Hofmann M, Luts H, Guérin C, Keymeulen A, Van Hoeck K, et al. School-age hearing screening based on speech-in-noise perception using the digit triplet test. Ear Hear. 2018 Nov/ Dec;39(6):1104–1115. doi:10.1097/AUD.0000000000000563. 19. Shinn JR, Jayawardena ADL, Patro A, Zuniga MG, Netterville JL. Teacher prescreening for hearing loss in the developing world. Ear Nose Throat J. 2019 Oct 13. doi:10.1177/0145561319880388. Epub ahead of print. 20. Emmett S, Robler SK, Wang NY, Labrique A, Gallo JJ, Hofstetter P. Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska. BMJ Open. 2019;9(1):e023078 (doi:10.1136/bmjopen-2018-023078, accessed 18 May 2021). 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma `m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. g§X^©: 1. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 2. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3). doi:10.1542/peds.106.3.e43. 3. Robinshaw HM. Early intervention for hearing impairment: differences in the timing of communicativeand linguistic development. Br J Audiol. 1995;29(6):315–334 (doi:10.3109/03005369509076750, accessed 18 May 2021). 4. Yong M, Panth N, McMahon C, Thorne P, Emmett S D. How the world’s children hear: a narrative review of school hearing screening programs globally. OTO Open. 2020;4(2) (doi:10.1177/2473974X20923580, accessed 18 May 2021). 5. American Academy of Audiology. (2011). American Academy of Audiology Clinical Practice Guidelines: Childhood Hearing Screening (https://audiology-web.s3. amazonaws.com/migrated/ChildhoodScreeningGuidelines.pdf_5399751c9ec216. 42663963.pdf, accessed 18 May 2021). 6. American Speech-Language-Hearing Association. (1997). Guidelines for Audiologic Screening; 1–64(www.asha.org/policy, accessed 18 May 2021). 7. Department of Health and Social Services. (2016). Hearing screening guidelines for the pre-school/ school population. Anchorage, United States. 8. Harlor AD, Bower C, Walker RD, Curry ES, Hammer LD, Laughlin JJ, et al. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics. 2009;124(4):1252–1263. 9. Mahomed F, Swanepoel DW, Ayieko, J. Open access guide to audiology and hearing aids for otolaryngologists: audiology screening: school aged hearing screening. Cape Town, South Africa; 2014 (http://www.entdev.uct.ac.za/guides/open-access-guide-to- audiology-and-hearing-aids-forotolaryngologis,accessed 18 May 2021). 10. Ministry of Health, New Zealand. (2008). The B4 School Check – a handbook for practitioners. New Zealand. 11. Tennessee Department of Education and Tennessee Department of Health. (2015). Tennessee School Health Screening Guidelines (https://www.tn.gov/content/dam/ tn/education/csh/csh_school_health_ screening_ guidelines.pdf, accessed 18 May 2021). 12. Mississippi Department of Education. (n.d.). Handbook for Speech-Language Pathologists in Mississippi Schools (https://www.mdek12.org/sites/default/files/ Offices/MDE/OAE/OSE/Info-and-Publications/Handbook_speech_lang_path.pdf, accessed 18 May 2021). ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 39 13. Dawood N, Mahomed Asmail F, Louw C, Swanepoel W. Mhealth hearing screening for children by non-specialist health workers in communities. Int J Audiol. 2020 Oct 12:1–7. doi:10.1080/149920 27.2020.1829719. Epub ahead of print. 14. Manus M, van der Linde J, Kuper H, Olinger R, Swanepoel W. Community-based hearing and vision screening in schools in low-income communities using mobile health technologies. Lang Speech Hear Serv Sch. 2021 April 20;52(2):568–580. doi:10.1044/2020_LSHSS-20-00089. 15. Mahomed-Asmail F, Swanepoel DW, Eikelboom RH. Referral criteria for school-based hearing screening in South Africa: considerations for resource-limited contexts. Health SA Gesondheid. 2016; 96–102. 16. Eksteen S, Eikelboom RH, Launer S, Kuper H, Swanepoel DW. Referral criteria for preschool hearing screening in resource-constrained settings: a retrospective comparison of protocols. Lang Speech Hear Serv Sch. 2021 Jan; IN REVIEW. 17. Wolmarans J, De Sousa KC, Frisby C, Mahomed-Asmail F, Smits C, Moore DR, et al. (2021). Speech recognition in noise using binaural diotic and antiphasic digits-in-noise in children: maturation and self-test validity. J Am Acad Audiol; IN PRESS. 18. Denys S, Hofmann M, Luts H, Guérin C, Keymeulen A, Van Hoeck K, et al. School-age hearing screening based on speech-in-noise perception using the digit triplet test. Ear Hear. 2018 Nov/ Dec;39(6):1104–1115. doi:10.1097/AUD.0000000000000563. 19. Shinn JR, Jayawardena ADL, Patro A, Zuniga MG, Netterville JL. Teacher prescreening for hearing loss in the developing world. Ear Nose Throat J. 2019 Oct 13. doi:10.1177/0145561319880388. Epub ahead of print. 20. Emmett S, Robler SK, Wang NY, Labrique A, Gallo JJ, Hofstetter P. Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska. BMJ Open. 2019;9(1):e023078 (doi:10.1136/bmjopen-2018-023078, accessed 18 May 2021). 2.1 Amdí`H$Vm d Ë`mMr H$maUo ZdOmV A^©H$m§À`m Ho$ë`m OmUmè¶m ldU nS>Vmim MmMUr‘wio AZoH$ {R>H$mUr OÝ‘OmV Agbobm ldUXmof OÝ‘mZ§Va bJoMM AmoiIyZ Ë`mda Cnm` H$aUo `m‘Ü`o gwYmaUm Pmbr Amho. na§Vw, OmJ{VH$ ñVamda, AZoH$ ZdOmV A^©H$m§Mr ldUXmofmMr nS>Vmim MmMUr Ho$br OmV Zmhr. Am{U MmMUr Ho$br Jobr Var, Z§Va dmT>V OmUmam qH$dm ~mbnUm‘Ü`o nwT>rb d`mV {dH${gV Pmbobm ldUXmof ~aoMXm AmoiIbm OmV Zmhr Am{U Ë`m‘wio Ë`mÀ`mda CnMma Ho$bo OmV ZmhrV (1). `mì`{V[aº$, ‘wbm§À`m Amamo½`mH$[aVm XdmImÝ`mV {Xë`m OmUmè¶m ^oQ>r d ‘wbm§‘Yrb amoJJ«ñVVm `mMo ‘Ü`H$U©Xmh ho gd©gm‘mÝ` H$maU Amho (1). `mH$So> Xwb©j Ho$ë`mg `m {dH$mam§Mo ê$nm§Va ldUXmofm‘Ü`o d H$mhr ~m~VrV Ordmda ~oVUmè¶m JwVm§Jw§Vs¨‘Ü`o hmoD$ eH$Vo. ‘wbmÀ`m OS>UKS>UrÀ`m H$mimVrb ldUXmofmMo ‘hÎdmMo n[aUm‘ ho dmMm d ^mfoMm {dH$mg VgoM {ejU `mda hmoD$ eH$VmV. ‘wbm§‘Yrb H$mZ d ldU g‘ñ`m bdH$a AmoiIUo d Ë`m§da Cnm` H$aUo ho ‘hÎdmMo Amho. `m‘wio ^mfm {ejU, AmH$bZ, e¡j{UH$ àJVr d gm‘m{OH$ {dH$mg `m§da hmoUmam XsK©H$mbrZ n[aUm‘ Q>miVm `oD$ eH$Vmo (2,3). OmJ{VH$ nmVirda ~hþg§»` ‘wbo emioV OmVmV. Ë`m‘wio emioV Am{U ~mbdmS>rV Ho$ë`m OmUmè¶m nS>Vmim MmMUr‘wio gd© ‘wbm§Mr ldU nS>Vmim MmMUr H$aÊ`mMr EH$ Mm§Jbr g§Yr {Z‘m©U hmoVo. emim-ñVamda KoVë`m OmUmè¶m H$mZ VnmgUr d ldU nS>Vmim MmMUr H$m`©H«$‘m§Z§Va doioda {ZXmZ d `mo½` CnMma Ho$ë`mg Xwb©j Ho$bm Jobobm ldUXmof d H$mZmMo {dH$ma ` m§Mo n[aUm‘ H$‘r H$aÊ`mH$[aVm Cn`moJr R>aVmV. Vo ‘wbm§Zm VgoM {ejH$m§Zm Mm§Jë`m d gwa{jV ldU nÕVs¨{df`r ‘m{hVrXoIrb XoVmV (1). OJmÀ`m Ho$di H$mhr ^mJm§‘Ü`oM emimñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr (~mbdmS>r, àmW{‘H$ Am{U ‘mÜ`{‘H$ emim§‘Ü`o qH$dm emim-àdoemÀ`m doir Ho$ë`m OmUmè¶m nS>Vmim MmMUrgh) ~§YZH$maH$ Amho. emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m{df`r gÜ`mMo {Z`‘, YmoaUo d ‘mJ©Xe©H$ VÎdo `m§~Ôb A{Ve` H$‘r à‘mUmV àH$m{eV ‘m{hVr CnbãY Amho. Á`m {R>H$mUr emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr Ho$br OmVo VoWoXoIrb {Z`‘mdë`m, MmMÊ`m d CnMmam§H$[aVm g§X{^©V H$aÊ`mgmR>r bmJy Ho$bobo ldUq~Xy `m§‘Ü`o ’$aH$ Amho (4-12). ZwH$Ë`mM àH$m{eV Pmboë`m narjUm‘Ü`o OmJ{VH$ ñVamda emioVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr `m§À`m à‘m{UV {Z`‘mdbs¨Mr {ZH$S>rMr Amdí`H$Vm AYmoaopIV Ho$br Jobr Amho. `m‘wio doioda Ho$ë`m OmUmè¶m CnMmam§Mo gm‘Ï`© d g§^mì` n[aUm‘ `m‘Ü`o gwYmaUm hmoB©b (4). 2.2 emim-ñVamdarb ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo emim-ñVamdarb ldU nS>Vmim MmMUr H$m`©H«$‘m§‘Ü`o nwT>rb ‘wX²Úm§Mm {dMma Pmbm nm{hOo:  nS>Vmim MmMUrÀ`m H$m`©H«$‘m§nydu qH$dm H$m`©H«$‘m§gmo~VM Z¡Xm{ZH$ ldU MmMUr d H$mZmÀ`m amoJm§Mm emór` Aä`mg `m godm {dH${gV Pmë`m nm{hOoV. nS>Vmim MmMUr H$m`©H«$‘m§‘Yrb gh^mJmZ§Va nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m ì`º$s¨Zm Ë`m CnbãY Agë`m nm{hOoV.  CnMma R>adVmZm H$miOr KoÊ`mÀ`m d AmH¥$Vr~§Y nmR>nwamdm H$aÊ`mÀ`m nÕVr ñnï>nUo gm§{JVë`m nm{hOoV. `m‘wio ldUXmofmMo qH$dm H$mZmÀ`m {dH$mam§Mo {ZXmZ Pmboë`m ‘wbm§da Ë`m§Zm Amdí`H$ Agbobo CnMma Ho$bo OmD$ eH$Vrb.  CnMmam§‘Ü`o d¡ÚH$s` Am{U eë`{M{H$Ëgm godm, ldU V§ÌkmZ d lmì` nwZd©gZ `m§Mm g‘mdoe hmoVmo. ho CnMma ì`º$sÀ`m d¡ÚH$s` JaOm nyU© H$aVmV, Ë`m§À`m àmYmÝ`m§Zm ‘hÎd XoVmV Am{U g§ñH¥$Vrbm AZwgê$Z AgVmV VgoM CnbãY g§gmYZm§er OwidyZ KoVmV. Ago CnMma g§~§{YV ì`º$sbm H|$ÐñWmZr R>odyZ CnbãY H$ê$Z {Xbo nm{hOoV d Ë`m§Mr {e’$mag Ho$br nm{hOo.  emioVrb Am{U ~mbdmS>rVrb H$mZ VnmgUr d ldU nS>Vmim MmMUr, OoWo eŠ` Agob VoWo, hr emioVrb {Z`{‘V Amamo½` VnmgUrMm ^mJ Agmdr Am{U gd©gmYmaU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr Amamo½`mer g§~§{YV BVa VnmgÊ`m§~amo~aM Vr Ho$br Omdr.  H$moUVmhr nS>Vmim MmMUr H$m`©H«$‘ KoÊ`mnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r, ‘m{hVrMo ì`dñWmnZ d H$m`©H«$‘mMo ‘yë`‘mnZ `m Jmoï>r {dH${gV Ho$ë`m nm{hOoV. {Z`moOZ, A§‘b~OmdUr d ‘yë`‘mnZ `mda XoIaoI H$aÊ`mH$[aVm g„mJma ‘§S>imMr ñWmnZm Ho$br OmD$ eH$Vo. 2.3 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o ldUXmof bdH$amV bdH$a AmoiIÊ`mÀ`m CÔoemZo ~mbdmS>rV qH$dm emioV OmUmè¶m ‘wbm§Mr VnmgUr Ho$br nm{hOo.  EH$m qH$dm XmoÝhs¨ H$mZm§‘Yrb ldUXmof (`m‘Ü`o g§dmhH$ qH$dm g§doXZr Xmof `mg§~§Yr Aem XmoÝhr qH$dm {‘l àH$maÀ`m Xmofm§Mm g‘mdoe hmoVmo)2. dmñV{dH$ nmhVm, 20 dBHL nojm A{YH$ Agbobo gd© ldUq~Xy bjmV Ambo nm{hOoV. H$mhr doiog AmOy~mOyÀ`m n[apñWVr‘wio `oUmè¶m ‘`m©Xm qH$dm Amamo½` `§ÌUoMr j‘Vm `m Jmoï>r nwT>rb VnmgUrH$[aVm nmR>{dboë`m ì`º$sÀ`m ~m~VrV 20 dBHL Mr ldU nmVir AmoiIÊ`mMo EH$ AmìhmZ {Z‘m©U H$aVmV. Voìhm, Xoem‘Ü`o nS>Vmim MmMUr Mmby H$aVmZm gwédmVrbm XmoÝhrn¡H$s EH$m H$mZmH$[aVm 30 qH$dm 35 dBHL ‘`m©XoMm ldUq~Xy R>odVm `oD$ eH$Vmo(9). EH$Xm ho R>aë`mZ§Va, 20 dBHL nojm OmñV ldUq~Xy Agbobr ‘wbo AmoiIÊ`mMo C{Ôï> Xoem§Zr R>odbo nm{hOo (Mm¡H$Q> 2.1 nhm).  ldUXmof {Z‘m©U H$aUmam H$mZmMm {dH$ma, CXmhaUmW©: - ‘Ü`H$Um©V Pmbobm XrK©H$mbrZ g§gJ© (Chronic Otitis Media) - ‘Ü`H$Um©V Pmbobm Vrd« g§gJ© (Acute Otitis Media) - ‘Ü`H$Um©V O‘m Pmbobm Ðmd (Otitis Media with Effusion) - H$mZm‘Ü`o gmR>bobm KÅ> ‘i (Impacted Wax) - H$mZmMr gXmof aMZm - ~møH$Um©V Joboë`m dñVy 2.4 nS>Vmim MmMUrH$[aVmMo d` d dma§dm[aVm {H$‘mZ, emioV àdoe KoVmZm Var gd© ‘wbm§Mr ldUXmofmH$[aVm d H$mZmÀ`m {dH$mam§H$[aVm VnmgUr Pmbr nm{hOo. Á`m Xoem§‘Ü`o Amamo½` `§ÌUm§Mr j‘Vm Amho Ë`m Xoem§‘Ü`o emim-ñVamdarb H$mZ VnmgUr d ldU nS>Vmim MmMUr {Z`{‘VnUo Ho$br nm{hOo(6).  emioV gwédmVrbm àdoe KoVmZm;  ~mbdmS>r‘Ü`o d  n{hbr, Xwgar, {Vgar, gmVdr d AH$amdr `m embo` B`Îmm§‘Ü`o daVr Z‘yX Ho$boë`m embo` B`Îmm `m gyMH$ d gÜ`mÀ`m ‘mJ©Xe©H$ VÎdm§da AmYm[aV AmhoV. àË`oH$ XoemZo H$mZmMo {dH$ma d ldUXmof {Z‘m©U hmoÊ`mMr n[apñWVr VgoM CnbãY g§gmYZo `m§À`mZwgma ~mbdmS>rVrb qH$dm emioVrb ldU nS>Vmim MmMUrÀ`m àË`jmVrb doim R>a{dUo Amdí`H$ Amho. CXmhaUmW©, EImÚm Xoem‘Ü`o emioV àdoe KoVmZm d Ho$di n{hbr, {Vgar Am{U gmVdr (9) `m B`Îmm§‘Ü`o emioVrb H$mZ d ldUXmof nS>Vmim MmMUr Ho$br OmD$ eH$Vo d Ë`mZ§Va Amamo½` `§ÌUoÀ`m dmT>Ë`m j‘VoZwgma, nS>Vmim MmMUrMr dma§dm[aVm hiyhiy dmT>dVm `oD$ eH$Vo. `m{edm`, Oa {ejH$ qH$dm nmbH$/H$miOr KoUmè¶m ì`º$s¨Zr ‘wbmÀ`m ldU pñWVr{df`r H$miOr ì`º$ Ho$br Agob, Va ‘wbmbm H$mZ VnmgUr d ldU nS>Vmim MmMUr `mH$[aVm Amamo½` godoH$So> nmR>{dbo nm{hOo. 2.5 nS>Vmim MmMUrMo {R>H$mU {dÚmÏ`mªZm ghO eŠ` ìhmdo `mH$[aVm, embo` dmVmdaUmV (5-12) CÎm‘ nS>Vmim MmMUr Ho$br OmD$ eH$Vo. emioÀ`m Amdmam‘Yrb EImXr em§V OmJm emoYyZ VoWrb AmdmOmMr nmVir AJmoXa Vnmgbr nm{hOo. ldU nS>Vmim MmMUr Xaå`mZ AmdmOmMr nmVir hr, {ZdS>bobo hoS>’$moÝg d nS>Vmim MmMUrMr nmVir `mH$[aVm {ZYm©[aV Ho$boë`m H$‘mb AZwko` nmVirnojm OmñV AgUma ZmhrV `mMr ImÌr H$aUo ‘hÎdmMo Amho. `m{edm` Ooìhm AmOy~mOyÀ`m n[agamVrb Jm|JmQ> Ooìhm VmËnwaVm dmT>Vmo Voìhm nS>Vmim MmMUr Wm§~dbr nm{hOo. AmdmOmMr nmVir, Üd{ZnmVir ‘rQ>a (Sound level meter) CnbãY Agë`mg Vmo dmnê$Z qH$dm AmdmOmMr nmVir ‘moOÊ`mH$[aVm Agbobr ’$moZdarb à‘m{UV A°ßg dmnê$Z Vnmgbr OmD$ eH$Vo3. MmMUr H$aVmZm Üd{Z‘rQ>a CnbãY ZmhrV Aer n[apñWVr Agob Va nS>Vmim MmMUrH$[aVm dmnaë`m OmUmè¶m nmVirMr MmMUrH$V} Ë`m§À`m ñdV:À`m kmV ldUq~Xy nmVirda ÜdZr EoHy$Z OmJoMr Cn`wº$Vm VnmgyZ nmhÿ eH$VmV. 2.6 nS>Vmim MmMUr {dÚmÏ`mªÀ`m/‘wbm§À`m ldUj‘VoMo ‘yë`‘mnZ H$aVmZm, nwT>rb MmMUr nÕVs¨Mm g‘mdoe Ho$bm nm{hOo (MmMUrMm àH$ma, gmYZo/CnH$aUo d dmnaboë`m nÕVr Vº$m 2.1 ‘Ü`o {Xë`m AmhoV):  ‘wbmbm MmMUrH$[aVmÀ`m dma§d[aVm§‘Ü`o ({dMmamV KoVbm OmUmam JQ> d C{Ôï>o `mdarb {d^mJ 2.3 d Mm¡H$Q> 2.1 nhm). {dMmamV KoVbm OmUmam ldUq~Xy (20 dBHL /25 dBHL /30 dBHL /35 dBHL ) EoHy$ `oVmo H$s Zmhr ho AmoiIÊ`mH$[aVm ewÕ ÜdZr nS>Vmim MmMUr  {dMmamV KoVë`m OmUmè¶m H$mZmÀ`m pñWVs¨Mo (^mJ 3.3 nhm) {ZXmZ H$aUmè¶m Am°Q>moñH$monrMm (H$mZmÀ`m aMZoMr MmMUr H$aUmar d¡ÚH$s` H$m`©nÕVr) g‘mdoe AgUmar H$mZmMr VnmgUr. Am°Q>moñH$monr Ho$di VoìhmM Ho$br nm{hOo Ooìhm à{e{jV H$‘©Mmar d H$mZmÀ`m {dH$mam§Mr nS>Vmim MmMUr Am{U {ZXmZmH$[aVm Amdí`H$ Vr ‘XV CnbãY (EH$Va Ë`m OmJoda qH$dm ñWm{ZH$ {R>H$mUr) Agob. Ago H$‘©Mmar qH$dm ‘XV CnbãY Zgob Aem n[apñWVrV Am°Q>moñH$monr qH$dm {Q>ån°Zm°‘oQ´r øm MmMÊ`m dJiVm `oD$ eH$VmV.  H$mZ d ldU nS>Vmim MmMUrÀ`m {Z`‘mdbrMm ^mJ åhUyZ {Q>ån°Zmo‘oQ´r (eŠ` Agob {VWo) Ho$br nm{hOo. g§X^©: 1. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 2. Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000;106(3). doi:10.1542/peds.106.3.e43. 3. Robinshaw HM. Early intervention for hearing impairment: differences in the timing of communicativeand linguistic development. Br J Audiol. 1995;29(6):315–334 (doi:10.3109/03005369509076750, accessed 18 May 2021). 4. Yong M, Panth N, McMahon C, Thorne P, Emmett S D. How the world’s children hear: a narrative review of school hearing screening programs globally. OTO Open. 2020;4(2) (doi:10.1177/2473974X20923580, accessed 18 May 2021). 5. American Academy of Audiology. (2011). American Academy of Audiology Clinical Practice Guidelines: Childhood Hearing Screening (https://audiology-web.s3. amazonaws.com/migrated/ChildhoodScreeningGuidelines.pdf_5399751c9ec216. 42663963.pdf, accessed 18 May 2021). 6. American Speech-Language-Hearing Association. (1997). Guidelines for Audiologic Screening; 1–64(www.asha.org/policy, accessed 18 May 2021). 7. Department of Health and Social Services. (2016). Hearing screening guidelines for the pre-school/ school population. Anchorage, United States. 8. Harlor AD, Bower C, Walker RD, Curry ES, Hammer LD, Laughlin JJ, et al. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics. 2009;124(4):1252–1263. 9. Mahomed F, Swanepoel DW, Ayieko, J. Open access guide to audiology and hearing aids for otolaryngologists: audiology screening: school aged hearing screening. Cape Town, South Africa; 2014 (http://www.entdev.uct.ac.za/guides/open-access-guide-to- audiology-and-hearing-aids-forotolaryngologis,accessed 18 May 2021). 10. Ministry of Health, New Zealand. (2008). The B4 School Check – a handbook for practitioners. New Zealand. 11. Tennessee Department of Education and Tennessee Department of Health. (2015). Tennessee School Health Screening Guidelines (https://www.tn.gov/content/dam/ tn/education/csh/csh_school_health_ screening_ guidelines.pdf, accessed 18 May 2021). 12. Mississippi Department of Education. (n.d.). Handbook for Speech-Language Pathologists in Mississippi Schools (https://www.mdek12.org/sites/default/files/ Offices/MDE/OAE/OSE/Info-and-Publications/Handbook_speech_lang_path.pdf, accessed 18 May 2021). ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo40 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 41 Á`oð> ì`º$s¨Mr ldU nS>Vmim MmMUr3 3.1 Amdí`H$Vm d Ë`mMr H$maUo ½bmo~b ~S©>Z Am°’$ {S>grO (Global Burden of Disease) `mZwgma Ago gwM{dÊ`mV `oVo H$s OJ^amV 60 dfmªnojm A{YH$ d` Agboë`m 65% nojm A{YH$ bmoH$m§‘Ü`o H$mhr à‘mUmV ldUXmof hm AgVmoM (1). OmJ{VH$ bmoH$g§»`m emór` H$b (2) bjmV KoVm `oË`m H$mhr XeH$m§V Á`oð> ì`º$s¨‘Ü`o ldUj‘VoMr H$miOr KoÊ`mMr JaO dmT>VM OmÊ`mMr eŠ`Vm Amho (3). àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmH$So> Xwb©j Ho$ë`mZo g‘mOmV Z {‘giUo d EH$Q>onUm, {~KS>bobr ^md{ZH$ AdñWm, d¡`{º$H$ ZmVog§~§Ym§Zm Agbobm YmoH$m, CËnmXH$Vm Am{U doVZ H$‘r hmoUo, bdH$a {Zd¥Îmr, ‘mZ{gH$ Am{U emar[aH$ H$‘Omoar‘wio g§VwbZmV {Z‘m©U hmoUmam {~KmS> d Vmob OmUo Aem§gmaIo n[aUm‘ hmoVmV (4-10). Á`oð> ì`º$s¨‘Yrb ldUXmof hm ñ‘¥{V^«§e Am{U AmH$bZeº$s H$‘r hmoÊ`mÀ`m dmT>Ë`m YmoŠ`mer bjUr`[aË`m g§~§{YV Amho. Á`oð> ì`º$s¨‘Yrb ldUXmofmMo dmT>Vo à‘mU Am{U Ë`mMm ñ‘¥{V^«§emer Agbobm g§~§Y bjmV KoVm, ldUXmofmda Cnm``moOZm Ho$ë`m‘wio ñ‘¥{V^«§e hmoÊ`mMm YmoH$m bmoH$g§»`m {dMmamV KoVm 8% H$‘r H$aVm `oD$ eH$Vmo (11). dmñV{dH$ nmhVm, bmoH$g§»`m {dMmamV KoVm, Á`oð> ì`º$s¨‘Ü`o ñ‘¥{V^«§emH$[aVm ldUXmof hm g§^mì` ~Xb H$aÊ`mgmaIm gdm©V gm‘mÝ` KQ>H$ Amho. ldUXmofmMo doioda Ho$bobo {ZXmZ d `mo½` CnMma `m‘wio Á`oð> ì`º$s¨‘Yrb ldUXmofmer g§~§{YV AZoH$ Xwîn[aUm‘ H$‘r hmoD$ eH$VmV (12-14). na§Vw, ldUXmofmMr gwédmV hr ~hþVoH$Xm AJXr H$‘r AgVo d Vr AmoiIy `oV Zmhr (15). {deof åhUOo, 60 dfmªÀ`m AmgnmgÀ`m ì`º$s Á`m§Mm ldUXmof bjmV Ambobm Zmhr qH$dm Ë`mda Cnm` Ho$bobo ZmhrV Ë`m§À`m‘Ü`o gm‘m{OH$ EH$Q>onUm `oÊ`mMm d AmH$bZeº$s H$‘r hmoÊ`mMm dmT>Vm YmoH$m AgVmo (16). ldUXmofmer g§~§{YV H$m`m©Ë‘H$ ‘`m©Xm `oD$Zhr (17), bmoH$ ldU{df`H$ H$moUVrhr H$miOr KoÊ`mnydu gd©gm‘mÝ`nUo 10 dfmªn`ªV dmQ> nmhVmV (18,19). åhUyZ, Á`oð> ì`º$s¨Mr nÕVera ldU VnmgUr H$aUo d Ë`mZ§Va Ë`m§Mo Ëd[aV nwZd©gZ (Ogo H$s ldU`§Ì ~gdUo) H$aUo ‘hËdmMo AgVo. Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm ` oUmè¶m IMm©À`m VwbZoV Ë`mÀ`m n[aUm‘H$maH$VoMm Oar g{dñVa Aä`mg Ho$bm Jobm Zgbm Var ‘`m©{XV à‘mUmV CnbãY Agbobr ‘m{hVr Ago gm§JVo H$s ldUXmof {ZdmaU H$aÊ`mH$[aVmÀ`m CnH$aUm§Mm dmT>Vm dmna (20) Á`oð> ì`º$s¨À`m OrdZ‘mZm‘Yrb gH$mamË‘H$ gwYmaUm, VgoM g‘mOmbm hmoUmam Am{W©H$ bm^ `m§À`mer g§~§{YV Amho (18,22). 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm OmJ{VH$ ñVamda ‘`m©{XV ‘mJ©Xe©H$ VÎdo AmhoV. Á`m {R>H$mUr ‘mJ©Xe©H$ VÎdo {dH${gV H$aÊ`mV Ambr AmhoV VoWo Ë`m§À`m {e’$maes¨‘Ü`o (23-26) ‘moR>çm à‘mUmV V’$mdV Amho. H$mhr Xoem§‘Ü`o, ldU VnmgUr hr Ho$di d¡ÚH$s` bjUo qH$dm H$miOr dmQ>V Agboë`m bmoH$m§gmR>rM Ho$br OmVo; Va AÝ` H$mhr Xoem§‘Ü`o, dm{f©H$ qH$dm 3 dfmªVyZ EH$Xm VnmgUrMr {e’$mag Ho$br OmVo. MmMUr d nmR>nwamdm H$aÊ`mÀ`m nÕVs¨à‘mUoM VnmgUrH$[aVmMo d`moJQ> XoIrb ~XbVmV (23,25,26). `wZm`Q>oS> ñQ>oQ²g {àìh|{Q>ìh gpìh©gog Q>mñH$ ’$mog©Zo (United States Preventive Services Task Force) (27) 2021‘Ü`o Agm {ZîH$f© H$mT>bm H$s gÚpñWVrV 50 df} qH$dm Ë`mhÿZ A{YH$ d`mÀ`m bjUo Zgboë`m àm¡T> ì`º$s¨Mr ldUXmofmH$[aVm VnmgUr H$aÊ`mgmR>r nwaogm nwamdm CnbãY Zmhr. EH§$XarV, Á`oð> ì`º$s¨Mr VnmgUr Ho$ìhm d H$er H$amdr `m{df`r gdmªH$[aVm Aer ‘mJ©X- e©H$ VÎdo CnbãY ZmhrV. ldUXmofmH$[aVm Á`oð> ì`º$s¨Mr nÕVera VnmgUr H$aÊ`mg g‘W©Z XoÊ`mH$[aVm CnbãY Agboë`m nwamì`mMr ‘`m©Xm hm ldU VnmgUrMr ì`már dmT>{dÊ`m‘Yrb àmW{‘H$ AS>Wim Amho. nwamì`mMm A^md hm {d{dY ì`dñWm§‘Yrb d Xoem§‘Yrb g§emoYZmMo ‘hÎd AYmoaopIV H$aVmo. Á`oð>ËdmH$So> PwH$Umè¶m OmJ{VH$ bmoH$g§»`ogh d àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmÀ`m ZH$mamË‘H$ n[aUm‘m§Mo dmT>Vo nwamdo nhmVm, Ë`m g§~§Yr H¥$Vr Amdí`H$ Amho. Á`oð> ì`º$s¨Mr (17,28) nÕVera ldU VnmgUr d Ë`mZ§VaMo CnMma `mÀ`m ‘hÎdm{df`rÀ`m dmT>Ë`m Om{Udogh Imbr {Xbobo ‘mJ©Xe©Z ho Xoem§Zm Ë`m§À`m ñdV…À`m ldU VnmgUr H$m`©H«$‘m§Mr `moOZm, A§‘b~OmdUr d Ë`m§Mo ‘yë`‘mnZ `mH$[aVm ‘hÎdmMo R>aVo. gmXa H$aÊ`mV Amboë`m {e’$maer `m gÚpñWVrVrb OmUrd d CnbãY nwamdm `mda AmYm[aV AmhoV d Ë`m‘Ü`o ^{dî`mV ’o$a~Xb Ho$bm OmD$ eH$Vo. `oË`m H$mhr dfmª‘Ü`o Á`oð> ì`º$s¨À`m ldU VnmgUrH$[aVmMo H$m`©H«$‘ {dH${gV Pmë`mda ‘`m©{XV ñdê$nmV CnbãY Agboë`m nwamì`mbm MmbZm {‘iÊ`mMr eŠ`Vm Amho, OoUoH$ê$Z VnmgUrH$[aVmÀ`m {Z`‘mdbr‘Ü`o gwYmaUm Ho$br OmD$Z Cƒ àVrMr ‘mJ©Xe©H$ VÎdo V`ma Ho$br OmD$ eH$VmV. 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo Á`oð> ì`º$s¨À`m ldU VnmgUr H$m`©H«$‘m§Zm AmYma^yV R>aUmè¶m VÎdm§‘Ü`o nwT>rb Jmoï>s¨Mm g‘mdoe hmoVmo:  Z¡Xm{ZH$ ldU MmMÊ`m `m VnmgUr H$m`©H«$‘m§gmo~VM {dH${gV Pmë`m nm{hOoV. VnmgUr H$m`©H«$‘m§‘YyZ nwT>rb VnmgUrH$[aVm nmR>{dÊ`mV Amboë`m ì`º$s¨Zm Aem d¡km{ZH$ ldUMmMʶm CnbãY Pmë`m nm{hOoV.  ldU V§ÌkmZ d nwZd©gZ godm§gh hmoUmao CnMma ` m§Mr CnbãYVm d {e’$mag ì`º$s-H|${ÐV Ñ{ï>H$moZmda AmYm[aV Agbo nm{hOo; Ë`m§Zr ì`º$sÀ`m EoH$Ê`mÀ`m JaOm d àmYmÝ`o `m§Mo g‘W©Z Ho$bo nm{hOo Am{U Vo Ho$di ldU- j‘VoMo {ZXmZ H$aUmè¶m MmMUrÀ`m {ZîH$fmªda AmYm[aV Zgmdo.  XoI^mb H$aÊ`mÀ`m nÕVr d nmR>nwamdm `§ÌUm `m§Mm AmamIS>m CnMmamMo {Z`moOZ H$aVmZm V`ma Ho$bm nm{hOo d gd©g‘mdoeH$ XoI^mb nÕVr‘Ü`o EH${ÌV Ho$ë`m nm{hOoV. ldUXmof Agboë`m ì`º$s¨Zm VnmgUrZ§Va ì`º$s-H|${ÐV XoI^mbrÀ`m n`m©`m§Mm ’$m`Xm {‘iÊ`mH$[aVm ho A{Ve` Amdí`H$ Amho.  Á`m {R>H$mUr eŠ` Agob Ë`m {R>H$mUr, ldU VnmgUr hr {Z`{‘V Amamo½` VnmgUrMm ^mJ Agbr nm{hOo qH$dm Amamo½` gwpñWVrV amhmÊ`mH$[aVm Ho$ë`m OmUmè¶m AÝ` CnMmam§gmo~V Ho$br nm{hOo. (CXmhaUmW© gd©gmY- maU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr). ldUXmofmMr VnmgUr hr BVa A§J^yV j‘Vm (Hw$nmofU, AmH$bZeº$s, J{VerbVm, ‘mZ{gH$ AdñWm, Ñï>r) VgoM {XgyZ Z `oUmao AmOma `m§À`m VnmgUr~amo~a H$aÊ`mMr {e’$mag OmJ{VH$ Amamo½` g§KQ>ZoMr ICOPE (Á`oð>m§H$[aVm EH$mpË‘H$ XoI^mb) nwpñVH$m H$aVo. ‘Yw‘oh d H$‘r AmH$bZeº$s `m§gma»`m ghì`mYr Agboë`m bmoH$m§À`m ‘yë`‘mnZmV XoIrb `mMm g‘mdoe Ho$bm OmD$ eH$Vmo.  H$moUË`mhr VnmgUr H$m`©H«$‘mÀ`m A§‘b~OmdUrnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r d H$m`©H«$‘mMo ‘yë`‘mnZ ho KQ>H$ {dH${gV Ho$bo nm{hOoV. 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o Á`m ì`º$s¨Zm ldU V§ÌkmZmÀ`m dmnamMm qH$dm {ejU, g‘wnXoeZ d g§dmX à{ejU `m§gma»`m AVm§{ÌH$ CnMmam§Mm ’$m`Xm hmoB©b Aem gd© Á`oð> ì`º$s¨Mr VnmgUr hr ldUXmof eŠ` {VVŠ`m bdH$amV bdH$a AmoiIÊ`mÀ`m hoVyZo Ho$br nm{hOo. (Jm|JmQ> qH$dm amgm`{ZH$ nXmWmªÀ`m g§nH$m©V `oV Agë`mZo H$m‘mÀ`m {R>H$mUr KoVë`m OmUmè¶m ldU g§dY©Z H$m`©H«$‘m§‘Ü`o gÜ`m Zm|XUr Ho$boë`m ì`º$s¨Mm {dMmamV KoVë`m OmUmè¶m JQ>m‘Ü`o g‘mdoe hmoV Zmhr. Ë`m godm øm nwpñVHo$À`m H$jo~mhoaÀ`m AgyZ Ë`m d`mZwgma Ho$ë`m OmUmè¶m ldU VnmgUrÛmao à^m{dV hmoD$ Z`oV qH$dm Ë`m§À`m‘Ü`o ~Xb Ho$bm OmD$ Z`o.) 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm nÞmg dfmªdarb gd© àm¡T>m§Mr ldUXmofmH$[aVm {Z`{‘VnUo VnmgUr Ho$br nm{hOo. Xa nmM dfmªZr 64 df} d`mn`ªV VnmgUr Ho$br OmD$ eH$Vo. d`mÀ`m 65 dfmªZ§Va, VnmgUrMr dma§dm[aVm Xa 1-3 df} (23,26) EdT>r dmT>{dbr nm{hOo. Á`m {R>H$mUr eŠ` Agob VoWo, ldU VnmgUr Amamo½`mÀ`m BVa VnmgÊ`m§gmo~V Ho$br nm{hOo. 3.6 nS>Vmim MmMUrMo {R>H$mU VnmgUr nwT>rb {R>H$mUr Ho$br OmD$ eH$Vo:  d¡ÚH$s` {R>H$mUo: àmW{‘H$ CnMma H|$Ðo, S>m°ŠQ>am§Mo XdmImZo, ldU MmMUr godm XoUmao XdmImZo;  dñVr‘Yrb {R>H$mUo: ‘Zmoa§OZ H|$Ðo Am{U J«§Wmb`o; qH$dm  KamgmaIr {R>H$mUo: Á`oð> ì`º$s¨Mr Kao qH$dm Á`oð> ì`º$s¨Mr XsK©H$mi XoI^mb H$aUmè¶m gw{dYm Ogo H$s d¥Õml‘ àË`oH$ {R>H$mUr, d¡`{º$H$[aË`m qH$dm Am°ZbmBZ nÕVrZo MmMÊ`m Ho$ë`m OmD$ eH$VmV. MmMUrÀ`m {R>H$mUmMr {ZdS> hr ñWm{ZH$ n[apñWVr, Á`oð> ì`º$s¨H$[aVm àdoe gwb^Vm, ‘mZdr g§gmYZm§Mr CnbãYVm d MmMUr Xaå`mZ dmVmdUmVbm Jm|JmQ>/AmdmO {Z`§{ÌV H$aÊ`mMr ImÌr `mda AmYm[aV Agbr nm{hOo `m‘wio MmMUrMo AMyH$ {ZîH$f© {‘iy eH$Vrb. Kar OmD$Z XoI^mb H$aUmè¶m godm ^oQ>s¨‘Ü`o ldU MmMUr Ho$br OmD$ eH$Vo. 3.7 nS>Vmim MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmofmÀ`m VnmgUrMo XmoZ Q>ßno AmhoV: Q>ßnm 1: VnmgUr H$aV Agboë`m gd© ì`º$s¨Zm gmÜ`m àým§Ûmao Ë`m§Mr ldU pñWVr d X¡Z§{XZ OrdZmV `oUmè¶m ldU{df`H$ AS>MUr `m{df`rÀ`m AZw^dm§~Ôb {dMmabo nm{hOo, Á`mMr CXmhaUo Mm¡H$Q> 3.1 ‘Ü`o {Xbr AmhoV. Mm¡H$Q> 3.1 VnmgUrH$[aVm {dMmaë`m OmUmè¶m àým§Mr CXmhaUo A. hmo/Zmhr àý:  Vwåhmbm AmÎmm ldU g‘ñ`m Amho H$m? (29)  Vw‘À`m ldUXmofmMo {ZXmZ Pmbo Amho H$m?  Vwåhr ldU `§Ìo dmnaVm H$m? ~. loUr {dMmaUmao àý:  Vwåhr Vw‘À`m ldUj‘VoMo dU©Z H$go H$amb (Vwåhr Oa EImXo ldU`§Ì dmnaV Agmb Va Ë`mMm dmna H$ê$Z) (30) - CËH¥$ï> - Iyn N>mZ - N>mZ - ~è¶mn¡H$s - AJXr H$‘r H$. VnmgUrH$[aVm ApñVËdmV Agbobr àýmdbr  Á`oð>m§H$[aVm {hA[a¨J h°pÊS>H°$n BÝìh|Q>ar (HHIE) (31) àý qH$dm àýmdbrbm {‘imbobm gH$mamË‘H$ à{VgmX hm ldU{df`H$ g‘ñ`m Agë`mMo gy{MV H$aVmo Am{U Aem ì`º$sbm MmMUrH$[aVm nmR>{dÊ`mEodOr ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dbo nm{hOo. Oa Ë`m ì`º$sÀ`m ldUXmofmMo AJmoXaM {ZXmZ Pmbo Agob qH$dm Vr ì`º$s ldU`§Ì dmnaV Agob, Va ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dUo ho H$mhr doiog AZmdí`H$ R>ê$ eH$Vo. na§Vw, Oa H$mZ d ldUVÁkmbm AbrH$So> ^oQ> {Xbr Zgob Va Ë`mMr Amdí`H$Vm Agy eH$Vo. Aem ì`º$sH$[aVm Q>ßnm XmoZMm g‘mdoe Z Ho$bm OmVm WoQ> g„m‘gbVrgmR>r nmR>{dbo OmD$ eH$Vo. Á`m ì`º$s¨Mm à{VgmX ZH$mamË‘H$ Amho (åhUOo Vo EoH$Ê`mÀ`m g‘ñ`oMr VH«$ma H$aV ZmhrV), Ë`m§Mr Xwgar nS>Vmim MmMUr KoVbr nm{hOo (Q>ßnm 2). Q>ßnm 2: Vº$m 3.1‘Ü`o dU©Z Ho$boë`m nwT>rb MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmof AmoiIÊ`mH$[aVm dmnaë`m OmVmV.  {Z{üV So>{g~b nmVirbm XmoÝhr H$mZm§‘Ü`o ewÕ ÜdZr emoYUo  {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUr  ewÕ ÜdZr ldUq~Xy VnmgUrÛmao EAa H§$S>ŠeZ ldUq~Xy {Z{üV H$aUo  Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo42 3.1 Amdí`H$Vm d Ë`mMr H$maUo ½bmo~b ~S©>Z Am°’$ {S>grO (Global Burden of Disease) `mZwgma Ago gwM{dÊ`mV `oVo H$s OJ^amV 60 dfmªnojm A{YH$ d` Agboë`m 65% nojm A{YH$ bmoH$m§‘Ü`o H$mhr à‘mUmV ldUXmof hm AgVmoM (1). OmJ{VH$ bmoH$g§»`m emór` H$b (2) bjmV KoVm `oË`m H$mhr XeH$m§V Á`oð> ì`º$s¨‘Ü`o ldUj‘VoMr H$miOr KoÊ`mMr JaO dmT>VM OmÊ`mMr eŠ`Vm Amho (3). àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmH$So> Xwb©j Ho$ë`mZo g‘mOmV Z {‘giUo d EH$Q>onUm, {~KS>bobr ^md{ZH$ AdñWm, d¡`{º$H$ ZmVog§~§Ym§Zm Agbobm YmoH$m, CËnmXH$Vm Am{U doVZ H$‘r hmoUo, bdH$a {Zd¥Îmr, ‘mZ{gH$ Am{U emar[aH$ H$‘Omoar‘wio g§VwbZmV {Z‘m©U hmoUmam {~KmS> d Vmob OmUo Aem§gmaIo n[aUm‘ hmoVmV (4-10). Á`oð> ì`º$s¨‘Yrb ldUXmof hm ñ‘¥{V^«§e Am{U AmH$bZeº$s H$‘r hmoÊ`mÀ`m dmT>Ë`m YmoŠ`mer bjUr`[aË`m g§~§{YV Amho. Á`oð> ì`º$s¨‘Yrb ldUXmofmMo dmT>Vo à‘mU Am{U Ë`mMm ñ‘¥{V^«§emer Agbobm g§~§Y bjmV KoVm, ldUXmofmda Cnm``moOZm Ho$ë`m‘wio ñ‘¥{V^«§e hmoÊ`mMm YmoH$m bmoH$g§»`m {dMmamV KoVm 8% H$‘r H$aVm `oD$ eH$Vmo (11). dmñV{dH$ nmhVm, bmoH$g§»`m {dMmamV KoVm, Á`oð> ì`º$s¨‘Ü`o ñ‘¥{V^«§emH$[aVm ldUXmof hm g§^mì` ~Xb H$aÊ`mgmaIm gdm©V gm‘mÝ` KQ>H$ Amho. ldUXmofmMo doioda Ho$bobo {ZXmZ d `mo½` CnMma `m‘wio Á`oð> ì`º$s¨‘Yrb ldUXmofmer g§~§{YV AZoH$ Xwîn[aUm‘ H$‘r hmoD$ eH$VmV (12-14). na§Vw, ldUXmofmMr gwédmV hr ~hþVoH$Xm AJXr H$‘r AgVo d Vr AmoiIy `oV Zmhr (15). {deof åhUOo, 60 dfmªÀ`m AmgnmgÀ`m ì`º$s Á`m§Mm ldUXmof bjmV Ambobm Zmhr qH$dm Ë`mda Cnm` Ho$bobo ZmhrV Ë`m§À`m‘Ü`o gm‘m{OH$ EH$Q>onUm `oÊ`mMm d AmH$bZeº$s H$‘r hmoÊ`mMm dmT>Vm YmoH$m AgVmo (16). ldUXmofmer g§~§{YV H$m`m©Ë‘H$ ‘`m©Xm `oD$Zhr (17), bmoH$ ldU{df`H$ H$moUVrhr H$miOr KoÊ`mnydu gd©gm‘mÝ`nUo 10 dfmªn`ªV dmQ> nmhVmV (18,19). åhUyZ, Á`oð> ì`º$s¨Mr nÕVera ldU VnmgUr H$aUo d Ë`mZ§Va Ë`m§Mo Ëd[aV nwZd©gZ (Ogo H$s ldU`§Ì ~gdUo) H$aUo ‘hËdmMo AgVo. Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm ` oUmè¶m IMm©À`m VwbZoV Ë`mÀ`m n[aUm‘H$maH$VoMm Oar g{dñVa Aä`mg Ho$bm Jobm Zgbm Var ‘`m©{XV à‘mUmV CnbãY Agbobr ‘m{hVr Ago gm§JVo H$s ldUXmof {ZdmaU H$aÊ`mH$[aVmÀ`m CnH$aUm§Mm dmT>Vm dmna (20) Á`oð> ì`º$s¨À`m OrdZ‘mZm‘Yrb gH$mamË‘H$ gwYmaUm, VgoM g‘mOmbm hmoUmam Am{W©H$ bm^ `m§À`mer g§~§{YV Amho (18,22). 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm OmJ{VH$ ñVamda ‘`m©{XV ‘mJ©Xe©H$ VÎdo AmhoV. Á`m {R>H$mUr ‘mJ©Xe©H$ VÎdo {dH${gV H$aÊ`mV Ambr AmhoV VoWo Ë`m§À`m {e’$maes¨‘Ü`o (23-26) ‘moR>çm à‘mUmV V’$mdV Amho. H$mhr Xoem§‘Ü`o, ldU VnmgUr hr Ho$di d¡ÚH$s` bjUo qH$dm H$miOr dmQ>V Agboë`m bmoH$m§gmR>rM Ho$br OmVo; Va AÝ` H$mhr Xoem§‘Ü`o, dm{f©H$ qH$dm 3 dfmªVyZ EH$Xm VnmgUrMr {e’$mag Ho$br OmVo. MmMUr d nmR>nwamdm H$aÊ`mÀ`m nÕVs¨à‘mUoM VnmgUrH$[aVmMo d`moJQ> XoIrb ~XbVmV (23,25,26). `wZm`Q>oS> ñQ>oQ²g {àìh|{Q>ìh gpìh©gog Q>mñH$ ’$mog©Zo (United States Preventive Services Task Force) (27) 2021‘Ü`o Agm {ZîH$f© H$mT>bm H$s gÚpñWVrV 50 df} qH$dm Ë`mhÿZ A{YH$ d`mÀ`m bjUo Zgboë`m àm¡T> ì`º$s¨Mr ldUXmofmH$[aVm VnmgUr H$aÊ`mgmR>r nwaogm nwamdm CnbãY Zmhr. EH§$XarV, Á`oð> ì`º$s¨Mr VnmgUr Ho$ìhm d H$er H$amdr `m{df`r gdmªH$[aVm Aer ‘mJ©X- e©H$ VÎdo CnbãY ZmhrV. ldUXmofmH$[aVm Á`oð> ì`º$s¨Mr nÕVera VnmgUr H$aÊ`mg g‘W©Z XoÊ`mH$[aVm CnbãY Agboë`m nwamì`mMr ‘`m©Xm hm ldU VnmgUrMr ì`már dmT>{dÊ`m‘Yrb àmW{‘H$ AS>Wim Amho. nwamì`mMm A^md hm {d{dY ì`dñWm§‘Yrb d Xoem§‘Yrb g§emoYZmMo ‘hÎd AYmoaopIV H$aVmo. Á`oð>ËdmH$So> PwH$Umè¶m OmJ{VH$ bmoH$g§»`ogh d àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmÀ`m ZH$mamË‘H$ n[aUm‘m§Mo dmT>Vo nwamdo nhmVm, Ë`m g§~§Yr H¥$Vr Amdí`H$ Amho. Á`oð> ì`º$s¨Mr (17,28) nÕVera ldU VnmgUr d Ë`mZ§VaMo CnMma `mÀ`m ‘hÎdm{df`rÀ`m dmT>Ë`m Om{Udogh Imbr {Xbobo ‘mJ©Xe©Z ho Xoem§Zm Ë`m§À`m ñdV…À`m ldU VnmgUr H$m`©H«$‘m§Mr `moOZm, A§‘b~OmdUr d Ë`m§Mo ‘yë`‘mnZ `mH$[aVm ‘hÎdmMo R>aVo. gmXa H$aÊ`mV Amboë`m {e’$maer `m gÚpñWVrVrb OmUrd d CnbãY nwamdm `mda AmYm[aV AmhoV d Ë`m‘Ü`o ^{dî`mV ’o$a~Xb Ho$bm OmD$ eH$Vo. `oË`m H$mhr dfmª‘Ü`o Á`oð> ì`º$s¨À`m ldU VnmgUrH$[aVmMo H$m`©H«$‘ {dH${gV Pmë`mda ‘`m©{XV ñdê$nmV CnbãY Agboë`m nwamì`mbm MmbZm {‘iÊ`mMr eŠ`Vm Amho, OoUoH$ê$Z VnmgUrH$[aVmÀ`m {Z`‘mdbr‘Ü`o gwYmaUm Ho$br OmD$Z Cƒ àVrMr ‘mJ©Xe©H$ VÎdo V`ma Ho$br OmD$ eH$VmV. 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo Á`oð> ì`º$s¨À`m ldU VnmgUr H$m`©H«$‘m§Zm AmYma^yV R>aUmè¶m VÎdm§‘Ü`o nwT>rb Jmoï>s¨Mm g‘mdoe hmoVmo:  Z¡Xm{ZH$ ldU MmMÊ`m `m VnmgUr H$m`©H«$‘m§gmo~VM {dH${gV Pmë`m nm{hOoV. VnmgUr H$m`©H«$‘m§‘YyZ nwT>rb VnmgUrH$[aVm nmR>{dÊ`mV Amboë`m ì`º$s¨Zm Aem d¡km{ZH$ ldUMmMʶm CnbãY Pmë`m nm{hOoV.  ldU V§ÌkmZ d nwZd©gZ godm§gh hmoUmao CnMma ` m§Mr CnbãYVm d {e’$mag ì`º$s-H|${ÐV Ñ{ï>H$moZmda AmYm[aV Agbo nm{hOo; Ë`m§Zr ì`º$sÀ`m EoH$Ê`mÀ`m JaOm d àmYmÝ`o `m§Mo g‘W©Z Ho$bo nm{hOo Am{U Vo Ho$di ldU- j‘VoMo {ZXmZ H$aUmè¶m MmMUrÀ`m {ZîH$fmªda AmYm[aV Zgmdo.  XoI^mb H$aÊ`mÀ`m nÕVr d nmR>nwamdm `§ÌUm `m§Mm AmamIS>m CnMmamMo {Z`moOZ H$aVmZm V`ma Ho$bm nm{hOo d gd©g‘mdoeH$ XoI^mb nÕVr‘Ü`o EH${ÌV Ho$ë`m nm{hOoV. ldUXmof Agboë`m ì`º$s¨Zm VnmgUrZ§Va ì`º$s-H|${ÐV XoI^mbrÀ`m n`m©`m§Mm ’$m`Xm {‘iÊ`mH$[aVm ho A{Ve` Amdí`H$ Amho.  Á`m {R>H$mUr eŠ` Agob Ë`m {R>H$mUr, ldU VnmgUr hr {Z`{‘V Amamo½` VnmgUrMm ^mJ Agbr nm{hOo qH$dm Amamo½` gwpñWVrV amhmÊ`mH$[aVm Ho$ë`m OmUmè¶m AÝ` CnMmam§gmo~V Ho$br nm{hOo. (CXmhaUmW© gd©gmY- maU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr). ldUXmofmMr VnmgUr hr BVa A§J^yV j‘Vm (Hw$nmofU, AmH$bZeº$s, J{VerbVm, ‘mZ{gH$ AdñWm, Ñï>r) VgoM {XgyZ Z `oUmao AmOma `m§À`m VnmgUr~amo~a H$aÊ`mMr {e’$mag OmJ{VH$ Amamo½` g§KQ>ZoMr ICOPE (Á`oð>m§H$[aVm EH$mpË‘H$ XoI^mb) nwpñVH$m H$aVo. ‘Yw‘oh d H$‘r AmH$bZeº$s `m§gma»`m ghì`mYr Agboë`m bmoH$m§À`m ‘yë`‘mnZmV XoIrb `mMm g‘mdoe Ho$bm OmD$ eH$Vmo.  H$moUË`mhr VnmgUr H$m`©H«$‘mÀ`m A§‘b~OmdUrnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r d H$m`©H«$‘mMo ‘yë`‘mnZ ho KQ>H$ {dH${gV Ho$bo nm{hOoV. 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o Á`m ì`º$s¨Zm ldU V§ÌkmZmÀ`m dmnamMm qH$dm {ejU, g‘wnXoeZ d g§dmX à{ejU `m§gma»`m AVm§{ÌH$ CnMmam§Mm ’$m`Xm hmoB©b Aem gd© Á`oð> ì`º$s¨Mr VnmgUr hr ldUXmof eŠ` {VVŠ`m bdH$amV bdH$a AmoiIÊ`mÀ`m hoVyZo Ho$br nm{hOo. (Jm|JmQ> qH$dm amgm`{ZH$ nXmWmªÀ`m g§nH$m©V `oV Agë`mZo H$m‘mÀ`m {R>H$mUr KoVë`m OmUmè¶m ldU g§dY©Z H$m`©H«$‘m§‘Ü`o gÜ`m Zm|XUr Ho$boë`m ì`º$s¨Mm {dMmamV KoVë`m OmUmè¶m JQ>m‘Ü`o g‘mdoe hmoV Zmhr. Ë`m godm øm nwpñVHo$À`m H$jo~mhoaÀ`m AgyZ Ë`m d`mZwgma Ho$ë`m OmUmè¶m ldU VnmgUrÛmao à^m{dV hmoD$ Z`oV qH$dm Ë`m§À`m‘Ü`o ~Xb Ho$bm OmD$ Z`o.) 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm nÞmg dfmªdarb gd© àm¡T>m§Mr ldUXmofmH$[aVm {Z`{‘VnUo VnmgUr Ho$br nm{hOo. Xa nmM dfmªZr 64 df} d`mn`ªV VnmgUr Ho$br OmD$ eH$Vo. d`mÀ`m 65 dfmªZ§Va, VnmgUrMr dma§dm[aVm Xa 1-3 df} (23,26) EdT>r dmT>{dbr nm{hOo. Á`m {R>H$mUr eŠ` Agob VoWo, ldU VnmgUr Amamo½`mÀ`m BVa VnmgÊ`m§gmo~V Ho$br nm{hOo. 3.6 nS>Vmim MmMUrMo {R>H$mU VnmgUr nwT>rb {R>H$mUr Ho$br OmD$ eH$Vo:  d¡ÚH$s` {R>H$mUo: àmW{‘H$ CnMma H|$Ðo, S>m°ŠQ>am§Mo XdmImZo, ldU MmMUr godm XoUmao XdmImZo;  dñVr‘Yrb {R>H$mUo: ‘Zmoa§OZ H|$Ðo Am{U J«§Wmb`o; qH$dm  KamgmaIr {R>H$mUo: Á`oð> ì`º$s¨Mr Kao qH$dm Á`oð> ì`º$s¨Mr XsK©H$mi XoI^mb H$aUmè¶m gw{dYm Ogo H$s d¥Õml‘ àË`oH$ {R>H$mUr, d¡`{º$H$[aË`m qH$dm Am°ZbmBZ nÕVrZo MmMÊ`m Ho$ë`m OmD$ eH$VmV. MmMUrÀ`m {R>H$mUmMr {ZdS> hr ñWm{ZH$ n[apñWVr, Á`oð> ì`º$s¨H$[aVm àdoe gwb^Vm, ‘mZdr g§gmYZm§Mr CnbãYVm d MmMUr Xaå`mZ dmVmdUmVbm Jm|JmQ>/AmdmO {Z`§{ÌV H$aÊ`mMr ImÌr `mda AmYm[aV Agbr nm{hOo `m‘wio MmMUrMo AMyH$ {ZîH$f© {‘iy eH$Vrb. Kar OmD$Z XoI^mb H$aUmè¶m godm ^oQ>s¨‘Ü`o ldU MmMUr Ho$br OmD$ eH$Vo. 3.7 nS>Vmim MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmofmÀ`m VnmgUrMo XmoZ Q>ßno AmhoV: Q>ßnm 1: VnmgUr H$aV Agboë`m gd© ì`º$s¨Zm gmÜ`m àým§Ûmao Ë`m§Mr ldU pñWVr d X¡Z§{XZ OrdZmV `oUmè¶m ldU{df`H$ AS>MUr `m{df`rÀ`m AZw^dm§~Ôb {dMmabo nm{hOo, Á`mMr CXmhaUo Mm¡H$Q> 3.1 ‘Ü`o {Xbr AmhoV. Mm¡H$Q> 3.1 VnmgUrH$[aVm {dMmaë`m OmUmè¶m àým§Mr CXmhaUo A. hmo/Zmhr àý:  Vwåhmbm AmÎmm ldU g‘ñ`m Amho H$m? (29)  Vw‘À`m ldUXmofmMo {ZXmZ Pmbo Amho H$m?  Vwåhr ldU `§Ìo dmnaVm H$m? ~. loUr {dMmaUmao àý:  Vwåhr Vw‘À`m ldUj‘VoMo dU©Z H$go H$amb (Vwåhr Oa EImXo ldU`§Ì dmnaV Agmb Va Ë`mMm dmna H$ê$Z) (30) - CËH¥$ï> - Iyn N>mZ - N>mZ - ~è¶mn¡H$s - AJXr H$‘r H$. VnmgUrH$[aVm ApñVËdmV Agbobr àýmdbr  Á`oð>m§H$[aVm {hA[a¨J h°pÊS>H°$n BÝìh|Q>ar (HHIE) (31) àý qH$dm àýmdbrbm {‘imbobm gH$mamË‘H$ à{VgmX hm ldU{df`H$ g‘ñ`m Agë`mMo gy{MV H$aVmo Am{U Aem ì`º$sbm MmMUrH$[aVm nmR>{dÊ`mEodOr ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dbo nm{hOo. Oa Ë`m ì`º$sÀ`m ldUXmofmMo AJmoXaM {ZXmZ Pmbo Agob qH$dm Vr ì`º$s ldU`§Ì dmnaV Agob, Va ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dUo ho H$mhr doiog AZmdí`H$ R>ê$ eH$Vo. na§Vw, Oa H$mZ d ldUVÁkmbm AbrH$So> ^oQ> {Xbr Zgob Va Ë`mMr Amdí`H$Vm Agy eH$Vo. Aem ì`º$sH$[aVm Q>ßnm XmoZMm g‘mdoe Z Ho$bm OmVm WoQ> g„m‘gbVrgmR>r nmR>{dbo OmD$ eH$Vo. Á`m ì`º$s¨Mm à{VgmX ZH$mamË‘H$ Amho (åhUOo Vo EoH$Ê`mÀ`m g‘ñ`oMr VH«$ma H$aV ZmhrV), Ë`m§Mr Xwgar nS>Vmim MmMUr KoVbr nm{hOo (Q>ßnm 2). Q>ßnm 2: Vº$m 3.1‘Ü`o dU©Z Ho$boë`m nwT>rb MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmof AmoiIÊ`mH$[aVm dmnaë`m OmVmV.  {Z{üV So>{g~b nmVirbm XmoÝhr H$mZm§‘Ü`o ewÕ ÜdZr emoYUo  {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUr  ewÕ ÜdZr ldUq~Xy VnmgUrÛmao EAa H§$S>ŠeZ ldUq~Xy {Z{üV H$aUo  Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 43 3.1 Amdí`H$Vm d Ë`mMr H$maUo ½bmo~b ~S©>Z Am°’$ {S>grO (Global Burden of Disease) `mZwgma Ago gwM{dÊ`mV `oVo H$s OJ^amV 60 dfmªnojm A{YH$ d` Agboë`m 65% nojm A{YH$ bmoH$m§‘Ü`o H$mhr à‘mUmV ldUXmof hm AgVmoM (1). OmJ{VH$ bmoH$g§»`m emór` H$b (2) bjmV KoVm `oË`m H$mhr XeH$m§V Á`oð> ì`º$s¨‘Ü`o ldUj‘VoMr H$miOr KoÊ`mMr JaO dmT>VM OmÊ`mMr eŠ`Vm Amho (3). àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmH$So> Xwb©j Ho$ë`mZo g‘mOmV Z {‘giUo d EH$Q>onUm, {~KS>bobr ^md{ZH$ AdñWm, d¡`{º$H$ ZmVog§~§Ym§Zm Agbobm YmoH$m, CËnmXH$Vm Am{U doVZ H$‘r hmoUo, bdH$a {Zd¥Îmr, ‘mZ{gH$ Am{U emar[aH$ H$‘Omoar‘wio g§VwbZmV {Z‘m©U hmoUmam {~KmS> d Vmob OmUo Aem§gmaIo n[aUm‘ hmoVmV (4-10). Á`oð> ì`º$s¨‘Yrb ldUXmof hm ñ‘¥{V^«§e Am{U AmH$bZeº$s H$‘r hmoÊ`mÀ`m dmT>Ë`m YmoŠ`mer bjUr`[aË`m g§~§{YV Amho. Á`oð> ì`º$s¨‘Yrb ldUXmofmMo dmT>Vo à‘mU Am{U Ë`mMm ñ‘¥{V^«§emer Agbobm g§~§Y bjmV KoVm, ldUXmofmda Cnm``moOZm Ho$ë`m‘wio ñ‘¥{V^«§e hmoÊ`mMm YmoH$m bmoH$g§»`m {dMmamV KoVm 8% H$‘r H$aVm `oD$ eH$Vmo (11). dmñV{dH$ nmhVm, bmoH$g§»`m {dMmamV KoVm, Á`oð> ì`º$s¨‘Ü`o ñ‘¥{V^«§emH$[aVm ldUXmof hm g§^mì` ~Xb H$aÊ`mgmaIm gdm©V gm‘mÝ` KQ>H$ Amho. ldUXmofmMo doioda Ho$bobo {ZXmZ d `mo½` CnMma `m‘wio Á`oð> ì`º$s¨‘Yrb ldUXmofmer g§~§{YV AZoH$ Xwîn[aUm‘ H$‘r hmoD$ eH$VmV (12-14). na§Vw, ldUXmofmMr gwédmV hr ~hþVoH$Xm AJXr H$‘r AgVo d Vr AmoiIy `oV Zmhr (15). {deof åhUOo, 60 dfmªÀ`m AmgnmgÀ`m ì`º$s Á`m§Mm ldUXmof bjmV Ambobm Zmhr qH$dm Ë`mda Cnm` Ho$bobo ZmhrV Ë`m§À`m‘Ü`o gm‘m{OH$ EH$Q>onUm `oÊ`mMm d AmH$bZeº$s H$‘r hmoÊ`mMm dmT>Vm YmoH$m AgVmo (16). ldUXmofmer g§~§{YV H$m`m©Ë‘H$ ‘`m©Xm `oD$Zhr (17), bmoH$ ldU{df`H$ H$moUVrhr H$miOr KoÊ`mnydu gd©gm‘mÝ`nUo 10 dfmªn`ªV dmQ> nmhVmV (18,19). åhUyZ, Á`oð> ì`º$s¨Mr nÕVera ldU VnmgUr H$aUo d Ë`mZ§Va Ë`m§Mo Ëd[aV nwZd©gZ (Ogo H$s ldU`§Ì ~gdUo) H$aUo ‘hËdmMo AgVo. Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm ` oUmè¶m IMm©À`m VwbZoV Ë`mÀ`m n[aUm‘H$maH$VoMm Oar g{dñVa Aä`mg Ho$bm Jobm Zgbm Var ‘`m©{XV à‘mUmV CnbãY Agbobr ‘m{hVr Ago gm§JVo H$s ldUXmof {ZdmaU H$aÊ`mH$[aVmÀ`m CnH$aUm§Mm dmT>Vm dmna (20) Á`oð> ì`º$s¨À`m OrdZ‘mZm‘Yrb gH$mamË‘H$ gwYmaUm, VgoM g‘mOmbm hmoUmam Am{W©H$ bm^ `m§À`mer g§~§{YV Amho (18,22). 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm OmJ{VH$ ñVamda ‘`m©{XV ‘mJ©Xe©H$ VÎdo AmhoV. Á`m {R>H$mUr ‘mJ©Xe©H$ VÎdo {dH${gV H$aÊ`mV Ambr AmhoV VoWo Ë`m§À`m {e’$maes¨‘Ü`o (23-26) ‘moR>çm à‘mUmV V’$mdV Amho. H$mhr Xoem§‘Ü`o, ldU VnmgUr hr Ho$di d¡ÚH$s` bjUo qH$dm H$miOr dmQ>V Agboë`m bmoH$m§gmR>rM Ho$br OmVo; Va AÝ` H$mhr Xoem§‘Ü`o, dm{f©H$ qH$dm 3 dfmªVyZ EH$Xm VnmgUrMr {e’$mag Ho$br OmVo. MmMUr d nmR>nwamdm H$aÊ`mÀ`m nÕVs¨à‘mUoM VnmgUrH$[aVmMo d`moJQ> XoIrb ~XbVmV (23,25,26). `wZm`Q>oS> ñQ>oQ²g {àìh|{Q>ìh gpìh©gog Q>mñH$ ’$mog©Zo (United States Preventive Services Task Force) (27) 2021‘Ü`o Agm {ZîH$f© H$mT>bm H$s gÚpñWVrV 50 df} qH$dm Ë`mhÿZ A{YH$ d`mÀ`m bjUo Zgboë`m àm¡T> ì`º$s¨Mr ldUXmofmH$[aVm VnmgUr H$aÊ`mgmR>r nwaogm nwamdm CnbãY Zmhr. EH§$XarV, Á`oð> ì`º$s¨Mr VnmgUr Ho$ìhm d H$er H$amdr `m{df`r gdmªH$[aVm Aer ‘mJ©X- e©H$ VÎdo CnbãY ZmhrV. ldUXmofmH$[aVm Á`oð> ì`º$s¨Mr nÕVera VnmgUr H$aÊ`mg g‘W©Z XoÊ`mH$[aVm CnbãY Agboë`m nwamì`mMr ‘`m©Xm hm ldU VnmgUrMr ì`már dmT>{dÊ`m‘Yrb àmW{‘H$ AS>Wim Amho. nwamì`mMm A^md hm {d{dY ì`dñWm§‘Yrb d Xoem§‘Yrb g§emoYZmMo ‘hÎd AYmoaopIV H$aVmo. Á`oð>ËdmH$So> PwH$Umè¶m OmJ{VH$ bmoH$g§»`ogh d àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmÀ`m ZH$mamË‘H$ n[aUm‘m§Mo dmT>Vo nwamdo nhmVm, Ë`m g§~§Yr H¥$Vr Amdí`H$ Amho. Á`oð> ì`º$s¨Mr (17,28) nÕVera ldU VnmgUr d Ë`mZ§VaMo CnMma `mÀ`m ‘hÎdm{df`rÀ`m dmT>Ë`m Om{Udogh Imbr {Xbobo ‘mJ©Xe©Z ho Xoem§Zm Ë`m§À`m ñdV…À`m ldU VnmgUr H$m`©H«$‘m§Mr `moOZm, A§‘b~OmdUr d Ë`m§Mo ‘yë`‘mnZ `mH$[aVm ‘hÎdmMo R>aVo. gmXa H$aÊ`mV Amboë`m {e’$maer `m gÚpñWVrVrb OmUrd d CnbãY nwamdm `mda AmYm[aV AmhoV d Ë`m‘Ü`o ^{dî`mV ’o$a~Xb Ho$bm OmD$ eH$Vo. `oË`m H$mhr dfmª‘Ü`o Á`oð> ì`º$s¨À`m ldU VnmgUrH$[aVmMo H$m`©H«$‘ {dH${gV Pmë`mda ‘`m©{XV ñdê$nmV CnbãY Agboë`m nwamì`mbm MmbZm {‘iÊ`mMr eŠ`Vm Amho, OoUoH$ê$Z VnmgUrH$[aVmÀ`m {Z`‘mdbr‘Ü`o gwYmaUm Ho$br OmD$Z Cƒ àVrMr ‘mJ©Xe©H$ VÎdo V`ma Ho$br OmD$ eH$VmV. 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo Á`oð> ì`º$s¨À`m ldU VnmgUr H$m`©H«$‘m§Zm AmYma^yV R>aUmè¶m VÎdm§‘Ü`o nwT>rb Jmoï>s¨Mm g‘mdoe hmoVmo:  Z¡Xm{ZH$ ldU MmMÊ`m `m VnmgUr H$m`©H«$‘m§gmo~VM {dH${gV Pmë`m nm{hOoV. VnmgUr H$m`©H«$‘m§‘YyZ nwT>rb VnmgUrH$[aVm nmR>{dÊ`mV Amboë`m ì`º$s¨Zm Aem d¡km{ZH$ ldUMmMʶm CnbãY Pmë`m nm{hOoV.  ldU V§ÌkmZ d nwZd©gZ godm§gh hmoUmao CnMma ` m§Mr CnbãYVm d {e’$mag ì`º$s-H|${ÐV Ñ{ï>H$moZmda AmYm[aV Agbo nm{hOo; Ë`m§Zr ì`º$sÀ`m EoH$Ê`mÀ`m JaOm d àmYmÝ`o `m§Mo g‘W©Z Ho$bo nm{hOo Am{U Vo Ho$di ldU- j‘VoMo {ZXmZ H$aUmè¶m MmMUrÀ`m {ZîH$fmªda AmYm[aV Zgmdo.  XoI^mb H$aÊ`mÀ`m nÕVr d nmR>nwamdm `§ÌUm `m§Mm AmamIS>m CnMmamMo {Z`moOZ H$aVmZm V`ma Ho$bm nm{hOo d gd©g‘mdoeH$ XoI^mb nÕVr‘Ü`o EH${ÌV Ho$ë`m nm{hOoV. ldUXmof Agboë`m ì`º$s¨Zm VnmgUrZ§Va ì`º$s-H|${ÐV XoI^mbrÀ`m n`m©`m§Mm ’$m`Xm {‘iÊ`mH$[aVm ho A{Ve` Amdí`H$ Amho.  Á`m {R>H$mUr eŠ` Agob Ë`m {R>H$mUr, ldU VnmgUr hr {Z`{‘V Amamo½` VnmgUrMm ^mJ Agbr nm{hOo qH$dm Amamo½` gwpñWVrV amhmÊ`mH$[aVm Ho$ë`m OmUmè¶m AÝ` CnMmam§gmo~V Ho$br nm{hOo. (CXmhaUmW© gd©gmY- maU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr). ldUXmofmMr VnmgUr hr BVa A§J^yV j‘Vm (Hw$nmofU, AmH$bZeº$s, J{VerbVm, ‘mZ{gH$ AdñWm, Ñï>r) VgoM {XgyZ Z `oUmao AmOma `m§À`m VnmgUr~amo~a H$aÊ`mMr {e’$mag OmJ{VH$ Amamo½` g§KQ>ZoMr ICOPE (Á`oð>m§H$[aVm EH$mpË‘H$ XoI^mb) nwpñVH$m H$aVo. ‘Yw‘oh d H$‘r AmH$bZeº$s `m§gma»`m ghì`mYr Agboë`m bmoH$m§À`m ‘yë`‘mnZmV XoIrb `mMm g‘mdoe Ho$bm OmD$ eH$Vmo.  H$moUË`mhr VnmgUr H$m`©H«$‘mÀ`m A§‘b~OmdUrnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r d H$m`©H«$‘mMo ‘yë`‘mnZ ho KQ>H$ {dH${gV Ho$bo nm{hOoV. 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o Á`m ì`º$s¨Zm ldU V§ÌkmZmÀ`m dmnamMm qH$dm {ejU, g‘wnXoeZ d g§dmX à{ejU `m§gma»`m AVm§{ÌH$ CnMmam§Mm ’$m`Xm hmoB©b Aem gd© Á`oð> ì`º$s¨Mr VnmgUr hr ldUXmof eŠ` {VVŠ`m bdH$amV bdH$a AmoiIÊ`mÀ`m hoVyZo Ho$br nm{hOo. (Jm|JmQ> qH$dm amgm`{ZH$ nXmWmªÀ`m g§nH$m©V `oV Agë`mZo H$m‘mÀ`m {R>H$mUr KoVë`m OmUmè¶m ldU g§dY©Z H$m`©H«$‘m§‘Ü`o gÜ`m Zm|XUr Ho$boë`m ì`º$s¨Mm {dMmamV KoVë`m OmUmè¶m JQ>m‘Ü`o g‘mdoe hmoV Zmhr. Ë`m godm øm nwpñVHo$À`m H$jo~mhoaÀ`m AgyZ Ë`m d`mZwgma Ho$ë`m OmUmè¶m ldU VnmgUrÛmao à^m{dV hmoD$ Z`oV qH$dm Ë`m§À`m‘Ü`o ~Xb Ho$bm OmD$ Z`o.) 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm nÞmg dfmªdarb gd© àm¡T>m§Mr ldUXmofmH$[aVm {Z`{‘VnUo VnmgUr Ho$br nm{hOo. Xa nmM dfmªZr 64 df} d`mn`ªV VnmgUr Ho$br OmD$ eH$Vo. d`mÀ`m 65 dfmªZ§Va, VnmgUrMr dma§dm[aVm Xa 1-3 df} (23,26) EdT>r dmT>{dbr nm{hOo. Á`m {R>H$mUr eŠ` Agob VoWo, ldU VnmgUr Amamo½`mÀ`m BVa VnmgÊ`m§gmo~V Ho$br nm{hOo. 3.6 nS>Vmim MmMUrMo {R>H$mU VnmgUr nwT>rb {R>H$mUr Ho$br OmD$ eH$Vo:  d¡ÚH$s` {R>H$mUo: àmW{‘H$ CnMma H|$Ðo, S>m°ŠQ>am§Mo XdmImZo, ldU MmMUr godm XoUmao XdmImZo;  dñVr‘Yrb {R>H$mUo: ‘Zmoa§OZ H|$Ðo Am{U J«§Wmb`o; qH$dm  KamgmaIr {R>H$mUo: Á`oð> ì`º$s¨Mr Kao qH$dm Á`oð> ì`º$s¨Mr XsK©H$mi XoI^mb H$aUmè¶m gw{dYm Ogo H$s d¥Õml‘ àË`oH$ {R>H$mUr, d¡`{º$H$[aË`m qH$dm Am°ZbmBZ nÕVrZo MmMÊ`m Ho$ë`m OmD$ eH$VmV. MmMUrÀ`m {R>H$mUmMr {ZdS> hr ñWm{ZH$ n[apñWVr, Á`oð> ì`º$s¨H$[aVm àdoe gwb^Vm, ‘mZdr g§gmYZm§Mr CnbãYVm d MmMUr Xaå`mZ dmVmdUmVbm Jm|JmQ>/AmdmO {Z`§{ÌV H$aÊ`mMr ImÌr `mda AmYm[aV Agbr nm{hOo `m‘wio MmMUrMo AMyH$ {ZîH$f© {‘iy eH$Vrb. Kar OmD$Z XoI^mb H$aUmè¶m godm ^oQ>s¨‘Ü`o ldU MmMUr Ho$br OmD$ eH$Vo. 3.7 nS>Vmim MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmofmÀ`m VnmgUrMo XmoZ Q>ßno AmhoV: Q>ßnm 1: VnmgUr H$aV Agboë`m gd© ì`º$s¨Zm gmÜ`m àým§Ûmao Ë`m§Mr ldU pñWVr d X¡Z§{XZ OrdZmV `oUmè¶m ldU{df`H$ AS>MUr `m{df`rÀ`m AZw^dm§~Ôb {dMmabo nm{hOo, Á`mMr CXmhaUo Mm¡H$Q> 3.1 ‘Ü`o {Xbr AmhoV. Mm¡H$Q> 3.1 VnmgUrH$[aVm {dMmaë`m OmUmè¶m àým§Mr CXmhaUo A. hmo/Zmhr àý:  Vwåhmbm AmÎmm ldU g‘ñ`m Amho H$m? (29)  Vw‘À`m ldUXmofmMo {ZXmZ Pmbo Amho H$m?  Vwåhr ldU `§Ìo dmnaVm H$m? ~. loUr {dMmaUmao àý:  Vwåhr Vw‘À`m ldUj‘VoMo dU©Z H$go H$amb (Vwåhr Oa EImXo ldU`§Ì dmnaV Agmb Va Ë`mMm dmna H$ê$Z) (30) - CËH¥$ï> - Iyn N>mZ - N>mZ - ~è¶mn¡H$s - AJXr H$‘r H$. VnmgUrH$[aVm ApñVËdmV Agbobr àýmdbr  Á`oð>m§H$[aVm {hA[a¨J h°pÊS>H°$n BÝìh|Q>ar (HHIE) (31) àý qH$dm àýmdbrbm {‘imbobm gH$mamË‘H$ à{VgmX hm ldU{df`H$ g‘ñ`m Agë`mMo gy{MV H$aVmo Am{U Aem ì`º$sbm MmMUrH$[aVm nmR>{dÊ`mEodOr ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dbo nm{hOo. Oa Ë`m ì`º$sÀ`m ldUXmofmMo AJmoXaM {ZXmZ Pmbo Agob qH$dm Vr ì`º$s ldU`§Ì dmnaV Agob, Va ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dUo ho H$mhr doiog AZmdí`H$ R>ê$ eH$Vo. na§Vw, Oa H$mZ d ldUVÁkmbm AbrH$So> ^oQ> {Xbr Zgob Va Ë`mMr Amdí`H$Vm Agy eH$Vo. Aem ì`º$sH$[aVm Q>ßnm XmoZMm g‘mdoe Z Ho$bm OmVm WoQ> g„m‘gbVrgmR>r nmR>{dbo OmD$ eH$Vo. Á`m ì`º$s¨Mm à{VgmX ZH$mamË‘H$ Amho (åhUOo Vo EoH$Ê`mÀ`m g‘ñ`oMr VH«$ma H$aV ZmhrV), Ë`m§Mr Xwgar nS>Vmim MmMUr KoVbr nm{hOo (Q>ßnm 2). Q>ßnm 2: Vº$m 3.1‘Ü`o dU©Z Ho$boë`m nwT>rb MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmof AmoiIÊ`mH$[aVm dmnaë`m OmVmV.  {Z{üV So>{g~b nmVirbm XmoÝhr H$mZm§‘Ü`o ewÕ ÜdZr emoYUo  {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUr  ewÕ ÜdZr ldUq~Xy VnmgUrÛmao EAa H§$S>ŠeZ ldUq~Xy {Z{üV H$aUo  Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo44 3.1 Amdí`H$Vm d Ë`mMr H$maUo ½bmo~b ~S©>Z Am°’$ {S>grO (Global Burden of Disease) `mZwgma Ago gwM{dÊ`mV `oVo H$s OJ^amV 60 dfmªnojm A{YH$ d` Agboë`m 65% nojm A{YH$ bmoH$m§‘Ü`o H$mhr à‘mUmV ldUXmof hm AgVmoM (1). OmJ{VH$ bmoH$g§»`m emór` H$b (2) bjmV KoVm `oË`m H$mhr XeH$m§V Á`oð> ì`º$s¨‘Ü`o ldUj‘VoMr H$miOr KoÊ`mMr JaO dmT>VM OmÊ`mMr eŠ`Vm Amho (3). àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmH$So> Xwb©j Ho$ë`mZo g‘mOmV Z {‘giUo d EH$Q>onUm, {~KS>bobr ^md{ZH$ AdñWm, d¡`{º$H$ ZmVog§~§Ym§Zm Agbobm YmoH$m, CËnmXH$Vm Am{U doVZ H$‘r hmoUo, bdH$a {Zd¥Îmr, ‘mZ{gH$ Am{U emar[aH$ H$‘Omoar‘wio g§VwbZmV {Z‘m©U hmoUmam {~KmS> d Vmob OmUo Aem§gmaIo n[aUm‘ hmoVmV (4-10). Á`oð> ì`º$s¨‘Yrb ldUXmof hm ñ‘¥{V^«§e Am{U AmH$bZeº$s H$‘r hmoÊ`mÀ`m dmT>Ë`m YmoŠ`mer bjUr`[aË`m g§~§{YV Amho. Á`oð> ì`º$s¨‘Yrb ldUXmofmMo dmT>Vo à‘mU Am{U Ë`mMm ñ‘¥{V^«§emer Agbobm g§~§Y bjmV KoVm, ldUXmofmda Cnm``moOZm Ho$ë`m‘wio ñ‘¥{V^«§e hmoÊ`mMm YmoH$m bmoH$g§»`m {dMmamV KoVm 8% H$‘r H$aVm `oD$ eH$Vmo (11). dmñV{dH$ nmhVm, bmoH$g§»`m {dMmamV KoVm, Á`oð> ì`º$s¨‘Ü`o ñ‘¥{V^«§emH$[aVm ldUXmof hm g§^mì` ~Xb H$aÊ`mgmaIm gdm©V gm‘mÝ` KQ>H$ Amho. ldUXmofmMo doioda Ho$bobo {ZXmZ d `mo½` CnMma `m‘wio Á`oð> ì`º$s¨‘Yrb ldUXmofmer g§~§{YV AZoH$ Xwîn[aUm‘ H$‘r hmoD$ eH$VmV (12-14). na§Vw, ldUXmofmMr gwédmV hr ~hþVoH$Xm AJXr H$‘r AgVo d Vr AmoiIy `oV Zmhr (15). {deof åhUOo, 60 dfmªÀ`m AmgnmgÀ`m ì`º$s Á`m§Mm ldUXmof bjmV Ambobm Zmhr qH$dm Ë`mda Cnm` Ho$bobo ZmhrV Ë`m§À`m‘Ü`o gm‘m{OH$ EH$Q>onUm `oÊ`mMm d AmH$bZeº$s H$‘r hmoÊ`mMm dmT>Vm YmoH$m AgVmo (16). ldUXmofmer g§~§{YV H$m`m©Ë‘H$ ‘`m©Xm `oD$Zhr (17), bmoH$ ldU{df`H$ H$moUVrhr H$miOr KoÊ`mnydu gd©gm‘mÝ`nUo 10 dfmªn`ªV dmQ> nmhVmV (18,19). åhUyZ, Á`oð> ì`º$s¨Mr nÕVera ldU VnmgUr H$aUo d Ë`mZ§Va Ë`m§Mo Ëd[aV nwZd©gZ (Ogo H$s ldU`§Ì ~gdUo) H$aUo ‘hËdmMo AgVo. Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm ` oUmè¶m IMm©À`m VwbZoV Ë`mÀ`m n[aUm‘H$maH$VoMm Oar g{dñVa Aä`mg Ho$bm Jobm Zgbm Var ‘`m©{XV à‘mUmV CnbãY Agbobr ‘m{hVr Ago gm§JVo H$s ldUXmof {ZdmaU H$aÊ`mH$[aVmÀ`m CnH$aUm§Mm dmT>Vm dmna (20) Á`oð> ì`º$s¨À`m OrdZ‘mZm‘Yrb gH$mamË‘H$ gwYmaUm, VgoM g‘mOmbm hmoUmam Am{W©H$ bm^ `m§À`mer g§~§{YV Amho (18,22). 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm OmJ{VH$ ñVamda ‘`m©{XV ‘mJ©Xe©H$ VÎdo AmhoV. Á`m {R>H$mUr ‘mJ©Xe©H$ VÎdo {dH${gV H$aÊ`mV Ambr AmhoV VoWo Ë`m§À`m {e’$maes¨‘Ü`o (23-26) ‘moR>çm à‘mUmV V’$mdV Amho. H$mhr Xoem§‘Ü`o, ldU VnmgUr hr Ho$di d¡ÚH$s` bjUo qH$dm H$miOr dmQ>V Agboë`m bmoH$m§gmR>rM Ho$br OmVo; Va AÝ` H$mhr Xoem§‘Ü`o, dm{f©H$ qH$dm 3 dfmªVyZ EH$Xm VnmgUrMr {e’$mag Ho$br OmVo. MmMUr d nmR>nwamdm H$aÊ`mÀ`m nÕVs¨à‘mUoM VnmgUrH$[aVmMo d`moJQ> XoIrb ~XbVmV (23,25,26). `wZm`Q>oS> ñQ>oQ²g {àìh|{Q>ìh gpìh©gog Q>mñH$ ’$mog©Zo (United States Preventive Services Task Force) (27) 2021‘Ü`o Agm {ZîH$f© H$mT>bm H$s gÚpñWVrV 50 df} qH$dm Ë`mhÿZ A{YH$ d`mÀ`m bjUo Zgboë`m àm¡T> ì`º$s¨Mr ldUXmofmH$[aVm VnmgUr H$aÊ`mgmR>r nwaogm nwamdm CnbãY Zmhr. EH§$XarV, Á`oð> ì`º$s¨Mr VnmgUr Ho$ìhm d H$er H$amdr `m{df`r gdmªH$[aVm Aer ‘mJ©X- e©H$ VÎdo CnbãY ZmhrV. ldUXmofmH$[aVm Á`oð> ì`º$s¨Mr nÕVera VnmgUr H$aÊ`mg g‘W©Z XoÊ`mH$[aVm CnbãY Agboë`m nwamì`mMr ‘`m©Xm hm ldU VnmgUrMr ì`már dmT>{dÊ`m‘Yrb àmW{‘H$ AS>Wim Amho. nwamì`mMm A^md hm {d{dY ì`dñWm§‘Yrb d Xoem§‘Yrb g§emoYZmMo ‘hÎd AYmoaopIV H$aVmo. Á`oð>ËdmH$So> PwH$Umè¶m OmJ{VH$ bmoH$g§»`ogh d àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmÀ`m ZH$mamË‘H$ n[aUm‘m§Mo dmT>Vo nwamdo nhmVm, Ë`m g§~§Yr H¥$Vr Amdí`H$ Amho. Á`oð> ì`º$s¨Mr (17,28) nÕVera ldU VnmgUr d Ë`mZ§VaMo CnMma `mÀ`m ‘hÎdm{df`rÀ`m dmT>Ë`m Om{Udogh Imbr {Xbobo ‘mJ©Xe©Z ho Xoem§Zm Ë`m§À`m ñdV…À`m ldU VnmgUr H$m`©H«$‘m§Mr `moOZm, A§‘b~OmdUr d Ë`m§Mo ‘yë`‘mnZ `mH$[aVm ‘hÎdmMo R>aVo. gmXa H$aÊ`mV Amboë`m {e’$maer `m gÚpñWVrVrb OmUrd d CnbãY nwamdm `mda AmYm[aV AmhoV d Ë`m‘Ü`o ^{dî`mV ’o$a~Xb Ho$bm OmD$ eH$Vo. `oË`m H$mhr dfmª‘Ü`o Á`oð> ì`º$s¨À`m ldU VnmgUrH$[aVmMo H$m`©H«$‘ {dH${gV Pmë`mda ‘`m©{XV ñdê$nmV CnbãY Agboë`m nwamì`mbm MmbZm {‘iÊ`mMr eŠ`Vm Amho, OoUoH$ê$Z VnmgUrH$[aVmÀ`m {Z`‘mdbr‘Ü`o gwYmaUm Ho$br OmD$Z Cƒ àVrMr ‘mJ©Xe©H$ VÎdo V`ma Ho$br OmD$ eH$VmV. 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo Á`oð> ì`º$s¨À`m ldU VnmgUr H$m`©H«$‘m§Zm AmYma^yV R>aUmè¶m VÎdm§‘Ü`o nwT>rb Jmoï>s¨Mm g‘mdoe hmoVmo:  Z¡Xm{ZH$ ldU MmMÊ`m `m VnmgUr H$m`©H«$‘m§gmo~VM {dH${gV Pmë`m nm{hOoV. VnmgUr H$m`©H«$‘m§‘YyZ nwT>rb VnmgUrH$[aVm nmR>{dÊ`mV Amboë`m ì`º$s¨Zm Aem d¡km{ZH$ ldUMmMʶm CnbãY Pmë`m nm{hOoV.  ldU V§ÌkmZ d nwZd©gZ godm§gh hmoUmao CnMma ` m§Mr CnbãYVm d {e’$mag ì`º$s-H|${ÐV Ñ{ï>H$moZmda AmYm[aV Agbo nm{hOo; Ë`m§Zr ì`º$sÀ`m EoH$Ê`mÀ`m JaOm d àmYmÝ`o `m§Mo g‘W©Z Ho$bo nm{hOo Am{U Vo Ho$di ldU- j‘VoMo {ZXmZ H$aUmè¶m MmMUrÀ`m {ZîH$fmªda AmYm[aV Zgmdo.  XoI^mb H$aÊ`mÀ`m nÕVr d nmR>nwamdm `§ÌUm `m§Mm AmamIS>m CnMmamMo {Z`moOZ H$aVmZm V`ma Ho$bm nm{hOo d gd©g‘mdoeH$ XoI^mb nÕVr‘Ü`o EH${ÌV Ho$ë`m nm{hOoV. ldUXmof Agboë`m ì`º$s¨Zm VnmgUrZ§Va ì`º$s-H|${ÐV XoI^mbrÀ`m n`m©`m§Mm ’$m`Xm {‘iÊ`mH$[aVm ho A{Ve` Amdí`H$ Amho.  Á`m {R>H$mUr eŠ` Agob Ë`m {R>H$mUr, ldU VnmgUr hr {Z`{‘V Amamo½` VnmgUrMm ^mJ Agbr nm{hOo qH$dm Amamo½` gwpñWVrV amhmÊ`mH$[aVm Ho$ë`m OmUmè¶m AÝ` CnMmam§gmo~V Ho$br nm{hOo. (CXmhaUmW© gd©gmY- maU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr). ldUXmofmMr VnmgUr hr BVa A§J^yV j‘Vm (Hw$nmofU, AmH$bZeº$s, J{VerbVm, ‘mZ{gH$ AdñWm, Ñï>r) VgoM {XgyZ Z `oUmao AmOma `m§À`m VnmgUr~amo~a H$aÊ`mMr {e’$mag OmJ{VH$ Amamo½` g§KQ>ZoMr ICOPE (Á`oð>m§H$[aVm EH$mpË‘H$ XoI^mb) nwpñVH$m H$aVo. ‘Yw‘oh d H$‘r AmH$bZeº$s `m§gma»`m ghì`mYr Agboë`m bmoH$m§À`m ‘yë`‘mnZmV XoIrb `mMm g‘mdoe Ho$bm OmD$ eH$Vmo.  H$moUË`mhr VnmgUr H$m`©H«$‘mÀ`m A§‘b~OmdUrnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r d H$m`©H«$‘mMo ‘yë`‘mnZ ho KQ>H$ {dH${gV Ho$bo nm{hOoV. 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o Á`m ì`º$s¨Zm ldU V§ÌkmZmÀ`m dmnamMm qH$dm {ejU, g‘wnXoeZ d g§dmX à{ejU `m§gma»`m AVm§{ÌH$ CnMmam§Mm ’$m`Xm hmoB©b Aem gd© Á`oð> ì`º$s¨Mr VnmgUr hr ldUXmof eŠ` {VVŠ`m bdH$amV bdH$a AmoiIÊ`mÀ`m hoVyZo Ho$br nm{hOo. (Jm|JmQ> qH$dm amgm`{ZH$ nXmWmªÀ`m g§nH$m©V `oV Agë`mZo H$m‘mÀ`m {R>H$mUr KoVë`m OmUmè¶m ldU g§dY©Z H$m`©H«$‘m§‘Ü`o gÜ`m Zm|XUr Ho$boë`m ì`º$s¨Mm {dMmamV KoVë`m OmUmè¶m JQ>m‘Ü`o g‘mdoe hmoV Zmhr. Ë`m godm øm nwpñVHo$À`m H$jo~mhoaÀ`m AgyZ Ë`m d`mZwgma Ho$ë`m OmUmè¶m ldU VnmgUrÛmao à^m{dV hmoD$ Z`oV qH$dm Ë`m§À`m‘Ü`o ~Xb Ho$bm OmD$ Z`o.) 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm nÞmg dfmªdarb gd© àm¡T>m§Mr ldUXmofmH$[aVm {Z`{‘VnUo VnmgUr Ho$br nm{hOo. Xa nmM dfmªZr 64 df} d`mn`ªV VnmgUr Ho$br OmD$ eH$Vo. d`mÀ`m 65 dfmªZ§Va, VnmgUrMr dma§dm[aVm Xa 1-3 df} (23,26) EdT>r dmT>{dbr nm{hOo. Á`m {R>H$mUr eŠ` Agob VoWo, ldU VnmgUr Amamo½`mÀ`m BVa VnmgÊ`m§gmo~V Ho$br nm{hOo. 3.6 nS>Vmim MmMUrMo {R>H$mU VnmgUr nwT>rb {R>H$mUr Ho$br OmD$ eH$Vo:  d¡ÚH$s` {R>H$mUo: àmW{‘H$ CnMma H|$Ðo, S>m°ŠQ>am§Mo XdmImZo, ldU MmMUr godm XoUmao XdmImZo;  dñVr‘Yrb {R>H$mUo: ‘Zmoa§OZ H|$Ðo Am{U J«§Wmb`o; qH$dm  KamgmaIr {R>H$mUo: Á`oð> ì`º$s¨Mr Kao qH$dm Á`oð> ì`º$s¨Mr XsK©H$mi XoI^mb H$aUmè¶m gw{dYm Ogo H$s d¥Õml‘ àË`oH$ {R>H$mUr, d¡`{º$H$[aË`m qH$dm Am°ZbmBZ nÕVrZo MmMÊ`m Ho$ë`m OmD$ eH$VmV. MmMUrÀ`m {R>H$mUmMr {ZdS> hr ñWm{ZH$ n[apñWVr, Á`oð> ì`º$s¨H$[aVm àdoe gwb^Vm, ‘mZdr g§gmYZm§Mr CnbãYVm d MmMUr Xaå`mZ dmVmdUmVbm Jm|JmQ>/AmdmO {Z`§{ÌV H$aÊ`mMr ImÌr `mda AmYm[aV Agbr nm{hOo `m‘wio MmMUrMo AMyH$ {ZîH$f© {‘iy eH$Vrb. Kar OmD$Z XoI^mb H$aUmè¶m godm ^oQ>s¨‘Ü`o ldU MmMUr Ho$br OmD$ eH$Vo. 3.7 nS>Vmim MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmofmÀ`m VnmgUrMo XmoZ Q>ßno AmhoV: Q>ßnm 1: VnmgUr H$aV Agboë`m gd© ì`º$s¨Zm gmÜ`m àým§Ûmao Ë`m§Mr ldU pñWVr d X¡Z§{XZ OrdZmV `oUmè¶m ldU{df`H$ AS>MUr `m{df`rÀ`m AZw^dm§~Ôb {dMmabo nm{hOo, Á`mMr CXmhaUo Mm¡H$Q> 3.1 ‘Ü`o {Xbr AmhoV. Mm¡H$Q> 3.1 VnmgUrH$[aVm {dMmaë`m OmUmè¶m àým§Mr CXmhaUo A. hmo/Zmhr àý:  Vwåhmbm AmÎmm ldU g‘ñ`m Amho H$m? (29)  Vw‘À`m ldUXmofmMo {ZXmZ Pmbo Amho H$m?  Vwåhr ldU `§Ìo dmnaVm H$m? ~. loUr {dMmaUmao àý:  Vwåhr Vw‘À`m ldUj‘VoMo dU©Z H$go H$amb (Vwåhr Oa EImXo ldU`§Ì dmnaV Agmb Va Ë`mMm dmna H$ê$Z) (30) - CËH¥$ï> - Iyn N>mZ - N>mZ - ~è¶mn¡H$s - AJXr H$‘r H$. VnmgUrH$[aVm ApñVËdmV Agbobr àýmdbr  Á`oð>m§H$[aVm {hA[a¨J h°pÊS>H°$n BÝìh|Q>ar (HHIE) (31) àý qH$dm àýmdbrbm {‘imbobm gH$mamË‘H$ à{VgmX hm ldU{df`H$ g‘ñ`m Agë`mMo gy{MV H$aVmo Am{U Aem ì`º$sbm MmMUrH$[aVm nmR>{dÊ`mEodOr ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dbo nm{hOo. Oa Ë`m ì`º$sÀ`m ldUXmofmMo AJmoXaM {ZXmZ Pmbo Agob qH$dm Vr ì`º$s ldU`§Ì dmnaV Agob, Va ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dUo ho H$mhr doiog AZmdí`H$ R>ê$ eH$Vo. na§Vw, Oa H$mZ d ldUVÁkmbm AbrH$So> ^oQ> {Xbr Zgob Va Ë`mMr Amdí`H$Vm Agy eH$Vo. Aem ì`º$sH$[aVm Q>ßnm XmoZMm g‘mdoe Z Ho$bm OmVm WoQ> g„m‘gbVrgmR>r nmR>{dbo OmD$ eH$Vo. Á`m ì`º$s¨Mm à{VgmX ZH$mamË‘H$ Amho (åhUOo Vo EoH$Ê`mÀ`m g‘ñ`oMr VH«$ma H$aV ZmhrV), Ë`m§Mr Xwgar nS>Vmim MmMUr KoVbr nm{hOo (Q>ßnm 2). Q>ßnm 2: Vº$m 3.1‘Ü`o dU©Z Ho$boë`m nwT>rb MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmof AmoiIÊ`mH$[aVm dmnaë`m OmVmV.  {Z{üV So>{g~b nmVirbm XmoÝhr H$mZm§‘Ü`o ewÕ ÜdZr emoYUo  {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUr  ewÕ ÜdZr ldUq~Xy VnmgUrÛmao EAa H§$S>ŠeZ ldUq~Xy {Z{üV H$aUo  Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 45 3.1 Amdí`H$Vm d Ë`mMr H$maUo ½bmo~b ~S©>Z Am°’$ {S>grO (Global Burden of Disease) `mZwgma Ago gwM{dÊ`mV `oVo H$s OJ^amV 60 dfmªnojm A{YH$ d` Agboë`m 65% nojm A{YH$ bmoH$m§‘Ü`o H$mhr à‘mUmV ldUXmof hm AgVmoM (1). OmJ{VH$ bmoH$g§»`m emór` H$b (2) bjmV KoVm `oË`m H$mhr XeH$m§V Á`oð> ì`º$s¨‘Ü`o ldUj‘VoMr H$miOr KoÊ`mMr JaO dmT>VM OmÊ`mMr eŠ`Vm Amho (3). àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmH$So> Xwb©j Ho$ë`mZo g‘mOmV Z {‘giUo d EH$Q>onUm, {~KS>bobr ^md{ZH$ AdñWm, d¡`{º$H$ ZmVog§~§Ym§Zm Agbobm YmoH$m, CËnmXH$Vm Am{U doVZ H$‘r hmoUo, bdH$a {Zd¥Îmr, ‘mZ{gH$ Am{U emar[aH$ H$‘Omoar‘wio g§VwbZmV {Z‘m©U hmoUmam {~KmS> d Vmob OmUo Aem§gmaIo n[aUm‘ hmoVmV (4-10). Á`oð> ì`º$s¨‘Yrb ldUXmof hm ñ‘¥{V^«§e Am{U AmH$bZeº$s H$‘r hmoÊ`mÀ`m dmT>Ë`m YmoŠ`mer bjUr`[aË`m g§~§{YV Amho. Á`oð> ì`º$s¨‘Yrb ldUXmofmMo dmT>Vo à‘mU Am{U Ë`mMm ñ‘¥{V^«§emer Agbobm g§~§Y bjmV KoVm, ldUXmofmda Cnm``moOZm Ho$ë`m‘wio ñ‘¥{V^«§e hmoÊ`mMm YmoH$m bmoH$g§»`m {dMmamV KoVm 8% H$‘r H$aVm `oD$ eH$Vmo (11). dmñV{dH$ nmhVm, bmoH$g§»`m {dMmamV KoVm, Á`oð> ì`º$s¨‘Ü`o ñ‘¥{V^«§emH$[aVm ldUXmof hm g§^mì` ~Xb H$aÊ`mgmaIm gdm©V gm‘mÝ` KQ>H$ Amho. ldUXmofmMo doioda Ho$bobo {ZXmZ d `mo½` CnMma `m‘wio Á`oð> ì`º$s¨‘Yrb ldUXmofmer g§~§{YV AZoH$ Xwîn[aUm‘ H$‘r hmoD$ eH$VmV (12-14). na§Vw, ldUXmofmMr gwédmV hr ~hþVoH$Xm AJXr H$‘r AgVo d Vr AmoiIy `oV Zmhr (15). {deof åhUOo, 60 dfmªÀ`m AmgnmgÀ`m ì`º$s Á`m§Mm ldUXmof bjmV Ambobm Zmhr qH$dm Ë`mda Cnm` Ho$bobo ZmhrV Ë`m§À`m‘Ü`o gm‘m{OH$ EH$Q>onUm `oÊ`mMm d AmH$bZeº$s H$‘r hmoÊ`mMm dmT>Vm YmoH$m AgVmo (16). ldUXmofmer g§~§{YV H$m`m©Ë‘H$ ‘`m©Xm `oD$Zhr (17), bmoH$ ldU{df`H$ H$moUVrhr H$miOr KoÊ`mnydu gd©gm‘mÝ`nUo 10 dfmªn`ªV dmQ> nmhVmV (18,19). åhUyZ, Á`oð> ì`º$s¨Mr nÕVera ldU VnmgUr H$aUo d Ë`mZ§Va Ë`m§Mo Ëd[aV nwZd©gZ (Ogo H$s ldU`§Ì ~gdUo) H$aUo ‘hËdmMo AgVo. Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm ` oUmè¶m IMm©À`m VwbZoV Ë`mÀ`m n[aUm‘H$maH$VoMm Oar g{dñVa Aä`mg Ho$bm Jobm Zgbm Var ‘`m©{XV à‘mUmV CnbãY Agbobr ‘m{hVr Ago gm§JVo H$s ldUXmof {ZdmaU H$aÊ`mH$[aVmÀ`m CnH$aUm§Mm dmT>Vm dmna (20) Á`oð> ì`º$s¨À`m OrdZ‘mZm‘Yrb gH$mamË‘H$ gwYmaUm, VgoM g‘mOmbm hmoUmam Am{W©H$ bm^ `m§À`mer g§~§{YV Amho (18,22). 3.2 nS>Vmim MmMUrÀ`m OmJ{VH$ ñVamdarb nÕVr Á`oð> ì`º$s¨‘Yrb ldU VnmgUrH$[aVm OmJ{VH$ ñVamda ‘`m©{XV ‘mJ©Xe©H$ VÎdo AmhoV. Á`m {R>H$mUr ‘mJ©Xe©H$ VÎdo {dH${gV H$aÊ`mV Ambr AmhoV VoWo Ë`m§À`m {e’$maes¨‘Ü`o (23-26) ‘moR>çm à‘mUmV V’$mdV Amho. H$mhr Xoem§‘Ü`o, ldU VnmgUr hr Ho$di d¡ÚH$s` bjUo qH$dm H$miOr dmQ>V Agboë`m bmoH$m§gmR>rM Ho$br OmVo; Va AÝ` H$mhr Xoem§‘Ü`o, dm{f©H$ qH$dm 3 dfmªVyZ EH$Xm VnmgUrMr {e’$mag Ho$br OmVo. MmMUr d nmR>nwamdm H$aÊ`mÀ`m nÕVs¨à‘mUoM VnmgUrH$[aVmMo d`moJQ> XoIrb ~XbVmV (23,25,26). `wZm`Q>oS> ñQ>oQ²g {àìh|{Q>ìh gpìh©gog Q>mñH$ ’$mog©Zo (United States Preventive Services Task Force) (27) 2021‘Ü`o Agm {ZîH$f© H$mT>bm H$s gÚpñWVrV 50 df} qH$dm Ë`mhÿZ A{YH$ d`mÀ`m bjUo Zgboë`m àm¡T> ì`º$s¨Mr ldUXmofmH$[aVm VnmgUr H$aÊ`mgmR>r nwaogm nwamdm CnbãY Zmhr. EH§$XarV, Á`oð> ì`º$s¨Mr VnmgUr Ho$ìhm d H$er H$amdr `m{df`r gdmªH$[aVm Aer ‘mJ©X- e©H$ VÎdo CnbãY ZmhrV. ldUXmofmH$[aVm Á`oð> ì`º$s¨Mr nÕVera VnmgUr H$aÊ`mg g‘W©Z XoÊ`mH$[aVm CnbãY Agboë`m nwamì`mMr ‘`m©Xm hm ldU VnmgUrMr ì`már dmT>{dÊ`m‘Yrb àmW{‘H$ AS>Wim Amho. nwamì`mMm A^md hm {d{dY ì`dñWm§‘Yrb d Xoem§‘Yrb g§emoYZmMo ‘hÎd AYmoaopIV H$aVmo. Á`oð>ËdmH$So> PwH$Umè¶m OmJ{VH$ bmoH$g§»`ogh d àm¡T>m§‘Yrb gwédmVrÀ`m ldUXmofmÀ`m ZH$mamË‘H$ n[aUm‘m§Mo dmT>Vo nwamdo nhmVm, Ë`m g§~§Yr H¥$Vr Amdí`H$ Amho. Á`oð> ì`º$s¨Mr (17,28) nÕVera ldU VnmgUr d Ë`mZ§VaMo CnMma `mÀ`m ‘hÎdm{df`rÀ`m dmT>Ë`m Om{Udogh Imbr {Xbobo ‘mJ©Xe©Z ho Xoem§Zm Ë`m§À`m ñdV…À`m ldU VnmgUr H$m`©H«$‘m§Mr `moOZm, A§‘b~OmdUr d Ë`m§Mo ‘yë`‘mnZ `mH$[aVm ‘hÎdmMo R>aVo. gmXa H$aÊ`mV Amboë`m {e’$maer `m gÚpñWVrVrb OmUrd d CnbãY nwamdm `mda AmYm[aV AmhoV d Ë`m‘Ü`o ^{dî`mV ’o$a~Xb Ho$bm OmD$ eH$Vo. `oË`m H$mhr dfmª‘Ü`o Á`oð> ì`º$s¨À`m ldU VnmgUrH$[aVmMo H$m`©H«$‘ {dH${gV Pmë`mda ‘`m©{XV ñdê$nmV CnbãY Agboë`m nwamì`mbm MmbZm {‘iÊ`mMr eŠ`Vm Amho, OoUoH$ê$Z VnmgUrH$[aVmÀ`m {Z`‘mdbr‘Ü`o gwYmaUm Ho$br OmD$Z Cƒ àVrMr ‘mJ©Xe©H$ VÎdo V`ma Ho$br OmD$ eH$VmV. 3.3 Á`oð> ì`º$s¨À`m ldU nS>Vmim MmMUrH$[aVm ‘mJ©Xe©H$ VÎdo Á`oð> ì`º$s¨À`m ldU VnmgUr H$m`©H«$‘m§Zm AmYma^yV R>aUmè¶m VÎdm§‘Ü`o nwT>rb Jmoï>s¨Mm g‘mdoe hmoVmo:  Z¡Xm{ZH$ ldU MmMÊ`m `m VnmgUr H$m`©H«$‘m§gmo~VM {dH${gV Pmë`m nm{hOoV. VnmgUr H$m`©H«$‘m§‘YyZ nwT>rb VnmgUrH$[aVm nmR>{dÊ`mV Amboë`m ì`º$s¨Zm Aem d¡km{ZH$ ldUMmMʶm CnbãY Pmë`m nm{hOoV.  ldU V§ÌkmZ d nwZd©gZ godm§gh hmoUmao CnMma ` m§Mr CnbãYVm d {e’$mag ì`º$s-H|${ÐV Ñ{ï>H$moZmda AmYm[aV Agbo nm{hOo; Ë`m§Zr ì`º$sÀ`m EoH$Ê`mÀ`m JaOm d àmYmÝ`o `m§Mo g‘W©Z Ho$bo nm{hOo Am{U Vo Ho$di ldU- j‘VoMo {ZXmZ H$aUmè¶m MmMUrÀ`m {ZîH$fmªda AmYm[aV Zgmdo.  XoI^mb H$aÊ`mÀ`m nÕVr d nmR>nwamdm `§ÌUm `m§Mm AmamIS>m CnMmamMo {Z`moOZ H$aVmZm V`ma Ho$bm nm{hOo d gd©g‘mdoeH$ XoI^mb nÕVr‘Ü`o EH${ÌV Ho$ë`m nm{hOoV. ldUXmof Agboë`m ì`º$s¨Zm VnmgUrZ§Va ì`º$s-H|${ÐV XoI^mbrÀ`m n`m©`m§Mm ’$m`Xm {‘iÊ`mH$[aVm ho A{Ve` Amdí`H$ Amho.  Á`m {R>H$mUr eŠ` Agob Ë`m {R>H$mUr, ldU VnmgUr hr {Z`{‘V Amamo½` VnmgUrMm ^mJ Agbr nm{hOo qH$dm Amamo½` gwpñWVrV amhmÊ`mH$[aVm Ho$ë`m OmUmè¶m AÝ` CnMmam§gmo~V Ho$br nm{hOo. (CXmhaUmW© gd©gmY- maU emar[aH$ VnmgUr, S>moù`m§Mr VnmgUr, XmVm§Mr H$miOr BË`mXr). ldUXmofmMr VnmgUr hr BVa A§J^yV j‘Vm (Hw$nmofU, AmH$bZeº$s, J{VerbVm, ‘mZ{gH$ AdñWm, Ñï>r) VgoM {XgyZ Z `oUmao AmOma `m§À`m VnmgUr~amo~a H$aÊ`mMr {e’$mag OmJ{VH$ Amamo½` g§KQ>ZoMr ICOPE (Á`oð>m§H$[aVm EH$mpË‘H$ XoI^mb) nwpñVH$m H$aVo. ‘Yw‘oh d H$‘r AmH$bZeº$s `m§gma»`m ghì`mYr Agboë`m bmoH$m§À`m ‘yë`‘mnZmV XoIrb `mMm g‘mdoe Ho$bm OmD$ eH$Vmo.  H$moUË`mhr VnmgUr H$m`©H«$‘mÀ`m A§‘b~OmdUrnydu ì`mdgm{`H$ O~m~Xmar, OmoIr‘ ì`dñWmnZ, JwUdÎmoMr h‘r d H$m`©H«$‘mMo ‘yë`‘mnZ ho KQ>H$ {dH${gV Ho$bo nm{hOoV. 3.4 {dMmamV KoVbm OmUmam JQ> d C{Ôï>o Á`m ì`º$s¨Zm ldU V§ÌkmZmÀ`m dmnamMm qH$dm {ejU, g‘wnXoeZ d g§dmX à{ejU `m§gma»`m AVm§{ÌH$ CnMmam§Mm ’$m`Xm hmoB©b Aem gd© Á`oð> ì`º$s¨Mr VnmgUr hr ldUXmof eŠ` {VVŠ`m bdH$amV bdH$a AmoiIÊ`mÀ`m hoVyZo Ho$br nm{hOo. (Jm|JmQ> qH$dm amgm`{ZH$ nXmWmªÀ`m g§nH$m©V `oV Agë`mZo H$m‘mÀ`m {R>H$mUr KoVë`m OmUmè¶m ldU g§dY©Z H$m`©H«$‘m§‘Ü`o gÜ`m Zm|XUr Ho$boë`m ì`º$s¨Mm {dMmamV KoVë`m OmUmè¶m JQ>m‘Ü`o g‘mdoe hmoV Zmhr. Ë`m godm øm nwpñVHo$À`m H$jo~mhoaÀ`m AgyZ Ë`m d`mZwgma Ho$ë`m OmUmè¶m ldU VnmgUrÛmao à^m{dV hmoD$ Z`oV qH$dm Ë`m§À`m‘Ü`o ~Xb Ho$bm OmD$ Z`o.) 3.5 nS>Vmim MmMUrH$[aVm d` d dma§dm[aVm nÞmg dfmªdarb gd© àm¡T>m§Mr ldUXmofmH$[aVm {Z`{‘VnUo VnmgUr Ho$br nm{hOo. Xa nmM dfmªZr 64 df} d`mn`ªV VnmgUr Ho$br OmD$ eH$Vo. d`mÀ`m 65 dfmªZ§Va, VnmgUrMr dma§dm[aVm Xa 1-3 df} (23,26) EdT>r dmT>{dbr nm{hOo. Á`m {R>H$mUr eŠ` Agob VoWo, ldU VnmgUr Amamo½`mÀ`m BVa VnmgÊ`m§gmo~V Ho$br nm{hOo. 3.6 nS>Vmim MmMUrMo {R>H$mU VnmgUr nwT>rb {R>H$mUr Ho$br OmD$ eH$Vo:  d¡ÚH$s` {R>H$mUo: àmW{‘H$ CnMma H|$Ðo, S>m°ŠQ>am§Mo XdmImZo, ldU MmMUr godm XoUmao XdmImZo;  dñVr‘Yrb {R>H$mUo: ‘Zmoa§OZ H|$Ðo Am{U J«§Wmb`o; qH$dm  KamgmaIr {R>H$mUo: Á`oð> ì`º$s¨Mr Kao qH$dm Á`oð> ì`º$s¨Mr XsK©H$mi XoI^mb H$aUmè¶m gw{dYm Ogo H$s d¥Õml‘ àË`oH$ {R>H$mUr, d¡`{º$H$[aË`m qH$dm Am°ZbmBZ nÕVrZo MmMÊ`m Ho$ë`m OmD$ eH$VmV. MmMUrÀ`m {R>H$mUmMr {ZdS> hr ñWm{ZH$ n[apñWVr, Á`oð> ì`º$s¨H$[aVm àdoe gwb^Vm, ‘mZdr g§gmYZm§Mr CnbãYVm d MmMUr Xaå`mZ dmVmdUmVbm Jm|JmQ>/AmdmO {Z`§{ÌV H$aÊ`mMr ImÌr `mda AmYm[aV Agbr nm{hOo `m‘wio MmMUrMo AMyH$ {ZîH$f© {‘iy eH$Vrb. Kar OmD$Z XoI^mb H$aUmè¶m godm ^oQ>s¨‘Ü`o ldU MmMUr Ho$br OmD$ eH$Vo. 3.7 nS>Vmim MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmofmÀ`m VnmgUrMo XmoZ Q>ßno AmhoV: Q>ßnm 1: VnmgUr H$aV Agboë`m gd© ì`º$s¨Zm gmÜ`m àým§Ûmao Ë`m§Mr ldU pñWVr d X¡Z§{XZ OrdZmV `oUmè¶m ldU{df`H$ AS>MUr `m{df`rÀ`m AZw^dm§~Ôb {dMmabo nm{hOo, Á`mMr CXmhaUo Mm¡H$Q> 3.1 ‘Ü`o {Xbr AmhoV. Mm¡H$Q> 3.1 VnmgUrH$[aVm {dMmaë`m OmUmè¶m àým§Mr CXmhaUo A. hmo/Zmhr àý:  Vwåhmbm AmÎmm ldU g‘ñ`m Amho H$m? (29)  Vw‘À`m ldUXmofmMo {ZXmZ Pmbo Amho H$m?  Vwåhr ldU `§Ìo dmnaVm H$m? ~. loUr {dMmaUmao àý:  Vwåhr Vw‘À`m ldUj‘VoMo dU©Z H$go H$amb (Vwåhr Oa EImXo ldU`§Ì dmnaV Agmb Va Ë`mMm dmna H$ê$Z) (30) - CËH¥$ï> - Iyn N>mZ - N>mZ - ~è¶mn¡H$s - AJXr H$‘r H$. VnmgUrH$[aVm ApñVËdmV Agbobr àýmdbr  Á`oð>m§H$[aVm {hA[a¨J h°pÊS>H°$n BÝìh|Q>ar (HHIE) (31) àý qH$dm àýmdbrbm {‘imbobm gH$mamË‘H$ à{VgmX hm ldU{df`H$ g‘ñ`m Agë`mMo gy{MV H$aVmo Am{U Aem ì`º$sbm MmMUrH$[aVm nmR>{dÊ`mEodOr ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dbo nm{hOo. Oa Ë`m ì`º$sÀ`m ldUXmofmMo AJmoXaM {ZXmZ Pmbo Agob qH$dm Vr ì`º$s ldU`§Ì dmnaV Agob, Va ldUj‘Vm{df`H$ ‘yë`m§H$ZmH$[aVm nmR>{dUo ho H$mhr doiog AZmdí`H$ R>ê$ eH$Vo. na§Vw, Oa H$mZ d ldUVÁkmbm AbrH$So> ^oQ> {Xbr Zgob Va Ë`mMr Amdí`H$Vm Agy eH$Vo. Aem ì`º$sH$[aVm Q>ßnm XmoZMm g‘mdoe Z Ho$bm OmVm WoQ> g„m‘gbVrgmR>r nmR>{dbo OmD$ eH$Vo. Á`m ì`º$s¨Mm à{VgmX ZH$mamË‘H$ Amho (åhUOo Vo EoH$Ê`mÀ`m g‘ñ`oMr VH«$ma H$aV ZmhrV), Ë`m§Mr Xwgar nS>Vmim MmMUr KoVbr nm{hOo (Q>ßnm 2). Q>ßnm 2: Vº$m 3.1‘Ü`o dU©Z Ho$boë`m nwT>rb MmMÊ`m Á`oð> ì`º$s¨‘Yrb ldUXmof AmoiIÊ`mH$[aVm dmnaë`m OmVmV.  {Z{üV So>{g~b nmVirbm XmoÝhr H$mZm§‘Ü`o ewÕ ÜdZr emoYUo  {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUr  ewÕ ÜdZr ldUq~Xy VnmgUrÛmao EAa H§$S>ŠeZ ldUq~Xy {Z{üV H$aUo  Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. Vº$m 3.1 Á`oð> ì`º$s¨‘Yrb nS>Vmim MmMÊ`m nS>Vmim MmMUr {R>H$mU MmMUrMr nÕV g§X^© {ZH$f {Z{üV So>{g~b nmVirbm XmoÝhr H$mZm§‘Ü`o ewÕ ÜdZr à{VgmX emoYUo Ooìhm VnmgUr dñVr nmVirda OmD$Z qH$dm ldUMmMUr H$aUmao pŠb{ZH$ gmoSy>Z AÝ` d¡ÚH$s` H|$Ðm§da Ho$br OmUma AgVo Voìhm gdm©{YH$ Cn`wº$ 35 dBHLÀ`m {Z{üV nmVirbm XmoÝhr H$mZm§Mr VnmgUr VrZ dma§dm{aVm§Zm (1 kHz, 2 kHz, d 4 kHz,) ñdV§ÌnUo Pmbr nm{hOo XmoÝhrn¡H$s EH$m H$mZmMm EH$m qH$dm Ë`mhÿZ A{YH$ dma§dm{aVm§Zm 35 dBHL bm à{VgmX {‘imbm Zmhr. {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUr {S>{OQ> {Q´ßboQ>-BZ-Zm°BO MmMUrÛmao XmoÝhr H$mZm§Mr EH${ÌV VnmgUr Pmbr Ogo H$s WHO hear WHO 35 dBHL À`m dB ‘`m©XoEdT>m H$‘r à{VgmX CXmhaUmW©, hear WHO MmMUr‘Ü`o 50 nojm H$‘r à{VgmX ewÕ ÜdZr ldUq~Xy VnmgUrÛmao EAa H§$S>ŠeZ ldUq~Xy {Z{üV H$aUo ldUMmMUr H$aUmao pŠb{ZH$ EAa H§$S>ŠeZ ldUq~Xy H$[aVm XmoÝhr H$mZm§Mr ñdV§ÌnUo VnmgUr Pmbr. Mma dma§dm[aVm (0.5 kHz, 1 kHz, 2 kHz d 4 kHz) Mma dma§dm[aVm§Mr gamgar åhUyZ ldUq~Xy ‘moObm OmVmo gamgar ldUq~Xy 35 dBHL nojm H$‘r. Hy$O~yOV ~mobbobo EoH$Ê`mMr MmMUr Oa BVa MmMÊ`m CnbãY ZgVrb VaM Ho$di `m n`m©`mMm {dMma H$amdm n[a{eï> 3 nhm (Hy$O~yOV ~mobbobo EoH$Ê`mMr MmMUr) n[a{eï> 3 nhm (Hy$O~yOV ~mobbobo EoH$Ê`mMr MmMUr) * Á`m {R>H$mUr Amamo½` `§ÌUoMr j‘Vm ho H$aÊ`mMr nadmZJr XoVo, d Vr A{YH$ `mo½` ‘mZbr OmVo Ë`m {R>H$mUr {H$aH$moi ldUXmof XoIrb AmoiIVm `oD$ eH$Vmo (åhUOoM {ZH$f åhUyZ 20 dB nojm A{YH$ ldU nmVir R>odVm `oD$ eH$Vo). darbn¡H$s H$moUË`mhr MmMÊ`m H$aVmZm dmVmdaUmVrb AmdmOmMr nmVir 40 dB (32) nojm H$‘r Agë`mMr ImÌr H$aUo Amdí`H$ Amho. ÜdZrMr nmVir ‘rQ>aZo VnmgyZ nmhÿZ qH$dm à‘m{UV ñ‘mQ>©’$moZ A°n dmnê$Z `mMr ImÌr Ho$br OmD$ eH$Vo.6 6 à‘m{UV A°ßg Or dmnaÊ`mH$[aVm S>mCZbmoS> Ho$br OmD$ eH$VmV CXm.: NIOSH Sound Level Meter, Sound Meter Pro, qH$dm Sound Meter Am{U Noise Detector ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo46 3.8 nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm A) {ZîH$f© CÎmrU©: VnmgUr‘Ü`o CÎmsU© {ZîH$f© Amboë`m gd© ì`º$s¨Zm nwT>rb g„m {Xbm nm{hOo:  Ë`m§À`m H$mZm§Mr H$er H$miOr ¿`mdr d ldU, X¡Z§{XZ OrdZmVrb EoH$Ê`mMo H$m`© d H$mZ Am{U ldU{df`H$ H$miOr `m{df`rMr ‘m{hVr {Xbr nm{hOo;7  ^{dî`mV {Z{X©ï> Ho$boë`m doir (d`mZwgma {H$‘mZ 5 df} qH$dm 2 df} H$mbmdYrZ§Va,) Xwgar VnmgUr Ho$br nm{hOo;  ldUXmofmV dmT> hmoUo, H$U©ZmX, H$mZmVyZ ómd `oUo BË`mXr H$moUVrhr bjUo AmT>ië`mg d¡ÚH$s` ‘XV KoVbr nm{hOo. ~) {ZîH$f© nwT>rb VnmgUrH$[aVm nmR>dm: ldU nS>Vmim MmMUrÛmao nwT>rb VnmgUrH$[aVm nmR>{dë`m Joboë`m gd© ì`º$s¨Zm:  nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ {XgyZ `oV AmhoV H$m `m{df`r {dMmabo nm{hOo (Mm¡H$Q> 3.2 nhm)  ‘oUmgmaIm ‘i gmRy>Z am{hbm Agë`mg Vmo H$mTy>Z Q>mH$Ê`mH$[aVm H$mZmMr VnmgUr Ho$br nm{hOo;  ‘oUmgmaIm ‘i H$mT>ë`mZ§Va nwÝhm ldU nS>Vmim MmMUr Ho$br nm{hOo;  Á`m ì`º$s¨À`m ~m~VrV ‘oUmgmaIm ‘i H$mTy>Z Q>mH$ë`mZ§Va d nwÝhm MmMUr Ho$ë`mZ§Va nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo, Ë`m ì`º$s¨Mr Z¡Xm{ZH$ MmMUr Ho$br nm{hOo. é½UmMr AñdñWVm H$‘r H$aÊ`mH$[aVm Z¡Xm{ZH$ MmMUr eŠ` Agë`mg Ë`mM ^oQ>rXaå`mZ Ho$br nm{hOo. H$) nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$: VnmgUrZ§Va nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ {XgyZ Amboë`m gd© ì`º$s¨Zm, VnmgUrMm {ZîH$f© H$mhrhr Ambm Var nwT>rb ‘yë`m§H$ZmH$[aVm H$mZ d ldU VÁkm§H$So> nmR>{dbo nm{hOo. z 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. 7 Flyer on ear care (English): https://who.canto.global/s/Q2CPO ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 47 Mm¡H$Q> 3.2 nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ VnmgUrZ§Va nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ Aer gyMZm, VÁkmH$So> OmÊ`mMr Amdí`H$Vm Xe©{dVo d Ë`mMo n[aUm‘ Ago Agy eH$VmV:  doJmZo dmT>V OmUmè¶m ldUXmofmMr nyd©‘m{hVr qH$dm H$maU ‘mhrV ZgVmZm EH$m H$mZmV ldUXmof {Z‘m©U hmoUo;  AmdmO/Jm|JmQ >(H$m‘mÀ`m {R>H$mUr, Kar qH$dm ‘Zmoa§OZmË‘H$ H$m`©H«$‘m§‘Ü`o) qH$dm AmoQ>moQ>m°pŠgH$ (H$mZmda {dfmar n[aUm‘ H$aUmar) Am¡fYo/amgm`{ZH$ nXmW© `m§À`mer Ambobm g§nH©$;  H$mZm‘Ü`o doXZm, H$mZmVyZ òmd `oUo qH$dm M¸$a `oUo Aem VH«$mar Am{U  H$mZmÀ`m AmOmamMo nyduM Pmbobo {ZXmZ, Ogo H$s XsK©H$minmgyZ Agbobm ‘Ü`H$U©Xmh. nwT>rb ‘yë`‘mnZmH$[aVm nmR>{dÊ`mV Amboë`m gd© ì`º$s Z¡Xm{ZH$ godm d XoI^mb `m§Mm bm^ KoD$ eH$V AmhoV Zm `mMr ImÌr H$aÊ`mH$[aVm Ë`m§Mm nmR>nwamdm Ho$bm nm{hOo. nwT>rb VnmgUrH$[aVm nmR>{dUo Am{U AmH¥${V~§Y nmR>nwamdm `m H$m`©nÕVs¨Mo dU©Z AmH¥$Vr 3.1 ‘Ü`o Ho$bo Amho. 7 Flyer on ear care (English): https://who.canto.global/s/Q2CPO 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo48 nS>Vmim MmMUrMm(Mo) àý Mm¡H$Q> 3.1 Á¶oð>m§‘Yrb ldU nS>Vmim MmMUr [Á¶oð> ≥ 50 df}]≥ nS>Vmim MmMUrMm(Mo) àý Mm¡H$Q> 3.1 ldUXmof/ EoHy$ `oÊ`mV AS>MU Z¡Xm{ZH$ ldU Aä`mg godm§H$[aVm nmR>{dUo gwédmVrMr ldU nS>Vmim MmMUrldUXmof ZgUo H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a nwT>rb VnmgUrMr Amdí`H$Vm Amho nwT>rb VnmgUrMr Amdí`H$Vm Zmhr g„m • H$mZm§Mr H$miOr KoUo • nS>Vmim MmMUr nwÝhm H$Yr H$am`Mr Vo gm§JUo • bjUo AmT>iyZ Amë`mg d¡ÚH$s` XoI^mb àmá H$aUo. H$mZmVrb ‘i nmhÊ`mH$[aVm Am°Q>moñH$mo{nH$ VnmgUr ‘i Zmhr ‘i Amho ‘i H$mT>Uo nwÝhm VnmgUr H$aUo nwT>rb VnmgUrH$[aVm nmR>{dUo CÎmsU© nwT>rb VnmgUrH$[aVm nmR>dmCÎmsU© *Adapted from the WHO Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. See: https://apps.who.int/iris/handle/10665/326843. nwT>rb VnmgUrÀ`m Amdí`H$VoMo {ZX}eH$ Mm¡H$Q> 3.2 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 49 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo50 AmH¥$Vr 3.2 H$mZ d ldU `mMr ì`º$s-H|${ÐV XoI^mb CnbãY g§gmYZo n`m©daU, Amamo½`mer g§~§{YV nm`m^yV gw{dYm d CnbãY d¡ÚH$s` godm {dMmamV KoVm H$moUVr g§gmYZo eŠ` AmhoV. d¡ÚH$s` ‘m{hVr Á`m‘Ü`o `m§Mm g‘mdoe hmoVmo: H$mZmÀ`m aMZoMr Am{U XmofmMr pñWVr ldU{df`H$ ‘m{hVr: à‘mU, àH$ma, gwê$ Pmë`mMo d` BVa H$m`m©Ë‘H$ ‘`m©Xm Ogo H$s H$‘Omoa Ñï>r; {dH$mgmË‘H$ Aj‘Vm CXm. AmË‘H|$ÐrnUm g§àofUmÀ`m JaOm- Á`m‘Ü`o `m§Mm g‘mdoe hmoVmo: EoHy$ `oÊ`m‘Ü`o Ìmg Pmë`mMm AZw^d Ambm. g§àofUmMr Amdí`H$Vm g§àofUmMr àmYmÝ`o- Ogo H$s: EoHy$Z ~mobUo Ñî` Am{U ñne© nÕVr 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 51 g§X^©: 1. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 2. United Nations Population Fund. 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JAMA 2021 March;325(12):1196–1201 (https://www.uspreventiveservicestaskforce.org/uspstf/recomendation/hearing- loss-in-older-adults-screening, accessed 18 May 2021). 28. Thiyagarajan JA, Araujo de Carvalho I, Peña-Rosas JP, Chadha S, Mariotti SP, Dua T, et al. (2019). Rede- signing care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care. PLoS Med 16(10):e1002948 (https://doi.org/10.1371/jour- nal.pmed.1002948, accessed 18 May 2021). 29. Gates GA, Murphy M, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. J Fam Pract. 2003 Jan;52(1):56–62. 30. Hämäläinen A, Pichora-Fuller MK, Wittich W, Phillips NA, Mick P. Self-report measures of hearing and vision in older adults participating in the Canadian Longitudinal Study of Aging are explained by behavioral sensory measures, demographic, and social factors. Ear Hear. March 19 2021.doi:10.1097/AUD.0000000000000992 (https://journals.lww.com/ear-hearing/Abstract/9000/Self_re- port_Measures_of_Hearing_and_Vision_in.98530.asx, accessed 18 May 2021). 31. Ventry IM, Weinstein BE. The hearing handicap inventory for the elderly: a new tool. Ear Hear. 1982 May–Jun;3(3):128–34. doi:10.1097/00003446-198205000-00006. 32. WHO. Ear and hearing survey handbook. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. *Adapted from the WHO Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. See: https://apps.who.int/iris/handle/10665/326843. 8 Flyer on ear care (English): https://who.canto.global/s/Q2CPO ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo52 g§X^©: 1. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 2. United Nations Population Fund. World population trends (https://www.unfpa.org/world-populationtrends, accessed 18 May 2021). 3. World Health Organization. Addressing the rising prevalence of hearing loss. Geneva: World Health Organi- zation; 2018 (https://apps.who.int/iris/handle/10665/260336, accessed 18 May 2021). 4. Mulrow CD, Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, et al. Quality of-life changes and hearing impairment. A randomized trial. Ann Intern Med. 1990;113(3):188–94. 5. Gates GA, Mills JH. Presbycusis. Lancet. 2005;366:1111–20. 6. Huddle MG, Goman AM, Kernizan FC, Foley DM, Price C, Frick KD, et al. The economic impact of adult hearing loss: a systematic review. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1040–8. 7. Lawrence BJ, Jayakody DMP, Bennett RJ, Eikelboom RH, Gasson N, Friedland PL. Hearing loss and depression in older adults: a systematic review and meta-analysis. Gerontologist.2020;60(3):e137–e54. 8. Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech Hear Res.1982;25:593–9. 9. Carabellese C, Appollonio I, Rozzini R, Bianchetti A, Frisoni GB, Frattola L, et al. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc. 1993;41:401–7. 10. Vas VF. The biopsychosocial impact of hearing loss on people with hearing loss and their communication partners: University of Nottingham; 2017. 11. Livingtson G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug;396:413–446. 12. Barker AB, Leighton P, Ferguson MA. Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners.Int J Audiol. 2017;56(5):297–305. 13. Gaylor JM, Raman G, Chung M, Lee J, Rao M, Lau J, et al. Cochlear implantation in adults: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2013;139(3):265–72. 14. Ferguson MA, Kitterick PT, Chong LY, Edmondson-Jones M, Barker F, Hoare DJ. Hearing aids for mild to moderate hearing loss in adults. The Cochrane Database Syst Rev. 2017;9(9):Cd012023. 15. Howarth A, Shone GR. Ageing and the auditory system. Postgrad Med J. 2006 Mar;82(965):166–171. 16. Mick P, Pichora-Fuller MK. Is hearing loss associated with poorer health in older adults who might benefit from hearing screening? Ear Hear. 2016 May–Jun;37(3):e194–201. doi:10.1097/AUD.0000000000000267. 17. World Health Organization. Integrated care for older people. Guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017 https://www.who.int/age- ing/publications/guidelines-icope/en/, accessed 18 May 2021). 18. Davis A, Smith P, Ferguson M, Stephens D, Gianopoulos I. Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. Health Technology Assessment. 2007;11(42). 19. Simpson AN, Matthews LJ, Cassarly C, Dubno JR. Time from hearing aid candidacy to hearing aid adoption: a longitudinal cohort study. Ear Hear. 2019;40(3):468–76. 20. Yueh B, Souza PE, McDowell JA, Collins MP, Loovis CF, Hedrick SC, et al. Randomized trial of amplifica- tion strategies. Arch Otolaryngol Head Neck Surg. 2001;127(10):1197–204. 21. Yueh B, Piccirillo JF. Screening for hearing loss in older adults: insufficient evidence does not mean insuffi- cient benefit. JAMA. 2021;325(12):1162–1163. doi:10.1001/jama.2021.2020. 22. Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, et al. Long-term effectiveness of screen- ing for hearing loss: the screening for auditory impairment– which hearing assessment test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 2010;58(3):427–34. 23. American Speech-Language-Hearing Association. (1997). Guidelines for audiologic screening [Guidelines] (https://www.asha.org/policy, accessed 18 May 2021). 24. Alberta College of Speech-Language Pathologists and Audiologists. Hearing screening guideline preschool to adult. 2015 Sept (https://silo.tips/download/september-2015-hearing-screeningguideline-1, accessed 18 May 2021). 25. Moyer VA. Screening for hearing loss in older adults: U.S. preventative services task forcerecommendation statement. Clinical guidelines. 2012 Nov. (https://doi.org/10.7326/0003-4819-157-9-201211060-00526, accessed 18 May 2021). 26. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016. 27. US Preventative Services Task Force. Screening for hearing loss in older adults. JAMA 2021 March;325(12):1196–1201 (https://www.uspreventiveservicestaskforce.org/uspstf/recomendation/hearing- loss-in-older-adults-screening, accessed 18 May 2021). 28. Thiyagarajan JA, Araujo de Carvalho I, Peña-Rosas JP, Chadha S, Mariotti SP, Dua T, et al. (2019). Rede- signing care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care. PLoS Med 16(10):e1002948 (https://doi.org/10.1371/jour- nal.pmed.1002948, accessed 18 May 2021). 29. Gates GA, Murphy M, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. J Fam Pract. 2003 Jan;52(1):56–62. 30. Hämäläinen A, Pichora-Fuller MK, Wittich W, Phillips NA, Mick P. Self-report measures of hearing and vision in older adults participating in the Canadian Longitudinal Study of Aging are explained by behavioral sensory measures, demographic, and social factors. Ear Hear. March 19 2021.doi:10.1097/AUD.0000000000000992 (https://journals.lww.com/ear-hearing/Abstract/9000/Self_re- port_Measures_of_Hearing_and_Vision_in.98530.asx, accessed 18 May 2021). 31. Ventry IM, Weinstein BE. The hearing handicap inventory for the elderly: a new tool. Ear Hear. 1982 May–Jun;3(3):128–34. doi:10.1097/00003446-198205000-00006. 32. WHO. Ear and hearing survey handbook. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 53 g§X^©: 1. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 2. United Nations Population Fund. World population trends (https://www.unfpa.org/world-populationtrends, accessed 18 May 2021). 3. World Health Organization. Addressing the rising prevalence of hearing loss. Geneva: World Health Organi- zation; 2018 (https://apps.who.int/iris/handle/10665/260336, accessed 18 May 2021). 4. Mulrow CD, Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, et al. Quality of-life changes and hearing impairment. A randomized trial. Ann Intern Med. 1990;113(3):188–94. 5. Gates GA, Mills JH. Presbycusis. Lancet. 2005;366:1111–20. 6. Huddle MG, Goman AM, Kernizan FC, Foley DM, Price C, Frick KD, et al. The economic impact of adult hearing loss: a systematic review. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1040–8. 7. Lawrence BJ, Jayakody DMP, Bennett RJ, Eikelboom RH, Gasson N, Friedland PL. Hearing loss and depression in older adults: a systematic review and meta-analysis. Gerontologist.2020;60(3):e137–e54. 8. Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech Hear Res.1982;25:593–9. 9. Carabellese C, Appollonio I, Rozzini R, Bianchetti A, Frisoni GB, Frattola L, et al. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc. 1993;41:401–7. 10. Vas VF. The biopsychosocial impact of hearing loss on people with hearing loss and their communication partners: University of Nottingham; 2017. 11. Livingtson G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug;396:413–446. 12. Barker AB, Leighton P, Ferguson MA. Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners.Int J Audiol. 2017;56(5):297–305. 13. Gaylor JM, Raman G, Chung M, Lee J, Rao M, Lau J, et al. Cochlear implantation in adults: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2013;139(3):265–72. 14. Ferguson MA, Kitterick PT, Chong LY, Edmondson-Jones M, Barker F, Hoare DJ. Hearing aids for mild to moderate hearing loss in adults. The Cochrane Database Syst Rev. 2017;9(9):Cd012023. 15. Howarth A, Shone GR. Ageing and the auditory system. Postgrad Med J. 2006 Mar;82(965):166–171. 16. Mick P, Pichora-Fuller MK. Is hearing loss associated with poorer health in older adults who might benefit from hearing screening? Ear Hear. 2016 May–Jun;37(3):e194–201. doi:10.1097/AUD.0000000000000267. 17. World Health Organization. Integrated care for older people. Guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017 https://www.who.int/age- ing/publications/guidelines-icope/en/, accessed 18 May 2021). 18. Davis A, Smith P, Ferguson M, Stephens D, Gianopoulos I. Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. Health Technology Assessment. 2007;11(42). 19. Simpson AN, Matthews LJ, Cassarly C, Dubno JR. Time from hearing aid candidacy to hearing aid adoption: a longitudinal cohort study. Ear Hear. 2019;40(3):468–76. 20. Yueh B, Souza PE, McDowell JA, Collins MP, Loovis CF, Hedrick SC, et al. Randomized trial of amplifica- tion strategies. Arch Otolaryngol Head Neck Surg. 2001;127(10):1197–204. 21. Yueh B, Piccirillo JF. Screening for hearing loss in older adults: insufficient evidence does not mean insuffi- cient benefit. JAMA. 2021;325(12):1162–1163. doi:10.1001/jama.2021.2020. 22. Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, et al. Long-term effectiveness of screen- ing for hearing loss: the screening for auditory impairment– which hearing assessment test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 2010;58(3):427–34. 23. American Speech-Language-Hearing Association. (1997). Guidelines for audiologic screening [Guidelines] (https://www.asha.org/policy, accessed 18 May 2021). 24. Alberta College of Speech-Language Pathologists and Audiologists. Hearing screening guideline preschool to adult. 2015 Sept (https://silo.tips/download/september-2015-hearing-screeningguideline-1, accessed 18 May 2021). 25. Moyer VA. Screening for hearing loss in older adults: U.S. preventative services task forcerecommendation statement. Clinical guidelines. 2012 Nov. (https://doi.org/10.7326/0003-4819-157-9-201211060-00526, accessed 18 May 2021). 26. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016. 27. US Preventative Services Task Force. Screening for hearing loss in older adults. JAMA 2021 March;325(12):1196–1201 (https://www.uspreventiveservicestaskforce.org/uspstf/recomendation/hearing- loss-in-older-adults-screening, accessed 18 May 2021). 28. Thiyagarajan JA, Araujo de Carvalho I, Peña-Rosas JP, Chadha S, Mariotti SP, Dua T, et al. (2019). Rede- signing care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care. PLoS Med 16(10):e1002948 (https://doi.org/10.1371/jour- nal.pmed.1002948, accessed 18 May 2021). 29. Gates GA, Murphy M, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. J Fam Pract. 2003 Jan;52(1):56–62. 30. Hämäläinen A, Pichora-Fuller MK, Wittich W, Phillips NA, Mick P. Self-report measures of hearing and vision in older adults participating in the Canadian Longitudinal Study of Aging are explained by behavioral sensory measures, demographic, and social factors. Ear Hear. 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Licence: CC BY-NC-SA 3.0 IGO. 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo54 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. n[a{eï> 1 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVmÀ`m à{ejU H$m`©H«$‘mMo KQ>H$ à{ejH$m§Mr AmoiI  à{ejU Am{U H$m`©j‘VoMo ‘yë`‘mnZ `m{df`rÀ`m à{ejUmMr ‘m{hVr CnH$aUmÀ`m CËnmXZH$Ë`mªZr Úmdr. ho à{ejU ldU nS>Vmim MmMUrMr V§Ìo d àUmbr `m§Mm AZw^d Agboë`m ì`mdgm{`H$m§Zr hmVr ¿`mdo Aer {e’$mag Ho$br OmVo (CXmhaUmW© Am°{S>Amobm°{OñQ²g åhUOoM ÜdZr {deofVÁk, Am°Q>mobm°{OñQ²g åhUOoM ZmH$ H$mZ Kgm VÁk qH$dm nS>Vmim MmMUr H$m`©H«$‘m§Mo AZw^dr ì`dñWmnH$).  Q´oZ-X-Q´oZa `m e¡j{UH$ H$m`©H«$‘mMo Am`moOZ Ho$ë`m‘wio nS>Vmim MmMUrH$[aVmÀ`m à{ejUmWsªÀ`m g§»`o‘Ü`o dmT> hmoÊ`mg ‘XV hmoB©b. à{ejU H$m`©H«$‘  à{ejU H$m`©H«$‘mÀ`m Aä`mgH«$‘m‘Ü`o `mMm g‘mdoe Agbm nm{hOo: nS>Vmim MmMUr à{H«$`m Am{U CnH$aUmMm dmna; CnH$aUmMo à‘mUrH$aU Am{U XoI^mb; A^©H$mÀ`m nS>Vmim MmMUrÀ`m dmVmdaUmMo AZwHy$bZ; MmMUrÀ`m H$m`©nÕVr Am{U {ZîH$f© g‘OmdyZ gm§JUo; Am{U MmMUrÀ`m {ZîH$fmªMr {bpIV ‘m{hVr R>odUo d Vr BVam§Zm XoUo.  à{ejU àË`jmV {Xbo Jobo nm{hOo Am{U Ë`m‘Ü`o ì`mdhm[aH$ {ejUmÀ`m AZw^dmMm g‘mdoe Agbm nm{hOo.  g§gJ© {Z`§ÌU à{H«$`m Am{U A^©H$m§Zm hmVmiÊ`mMr H$m¡eë`o `mH$So> bj {Xbo Jobo nm{hOo. COiUr à{ejU  nS>Vmim MmMUr Ho$br OmUmè¶m ì`º$s¨gmR>r {Z`{‘V e¡j{UH$ godm§VJ©V à{ejU Am`mo{OV Ho$bo Omdo Am{U MmMUr KoUmè¶m ì`º$sH$So> ldU nS>Vmim MmMUr H$aÊ`mH$[aVm Amdí`H$ Vr j‘Vm d H$m¡eë`o AgmdrV Aer {e’$mag Ho$br OmVo. à{ejUmWsªZr {H$‘mZ àmW{‘H$ à{ejU nyU© H$aUo Am{U nwT>rb joÌm§‘Ü`o j‘Vm d H$m¡eë`o Xe©{dUo Amdí`H$ Amho :  ldU nS>Vmim MmMUrMo ’$m`Xo.  d¡ÚH$s` MmMUr H$m`©nÕVs¨‘Ü`o nwT>rb Jmoï>s¨Mr ImÌr H$aUo: - nS>Vmim MmMUrH$[aVm EH$ em§V OmJm; - nS>Vmim MmMUr H$aÊ`mH$[aVm A^©H$mMr gw`mo` pñWVr (CXm. A^©H$m§gmR>r, eŠ`Vmo Pmonbobr qH$dm pñWa{MÎm ~mbHo$); - MmMUrgmR>r `mo½` V`mar Am{U ‘m§S>Ur - H$mZmV Kmbm`Mr Z{bH$m ì`dpñWV R>odUo (åhUOo H$U© Z{bH$m CKS>r Am{U ñnï>nUo {XgVo Amho ho VnmgyZ nhmUo).  nS>Vmim MmMUr H$er H$amdr; CnH$aUm§Mm dmna Am{U Ë`m§Mr H$miOr: - àmo~ qH$dm hoS>’$moZ XaamoO à‘m{UV H$aUo Am{U ÌwQ>r H$‘rV H$‘r `oVrb H$miOr KoUo, CXmhaUmW©:  àmo~ d hmS©>doAa `m§À`m‘Yrb Iam~ OmoS>Ê`m; qH$dm  H$Mam qH$dm H$mZmVrb ‘i `m‘wio àmo~À`m Q>moH$mbm Agbobm ñnrH$a qH$dm ‘m`H«$mo’$moZ nmoQ>© `m‘Ü`o `oUmam AS>Wim Xya H$aUo  ldU nS>Vmim MmMUrH$[aVm é½Umb` qH$dm AÝ` Amamo½` gw{dYm H|$ÐmMr YmoaUo Am{U H$m`©nÕVr.  nmbH$m§À`m ‘mZ{gH$ VUmdmgh Agbobo BVa YmoHo$ ømMr OmUrd.  é½Umb`mÀ`m YmoaUm§À`m Am{U H$m`©nÕVs¨À`m AZwf§JmZo é½Umb`m‘Ü`o, A^©H$m§Mr gd©gm‘mÝ` H$miOr Am{U hmVmiUr, {deofV: A{VXjVm {d^mJmVrb A^©H$m§H$[aVm.  d¡ÚH$s` ’$mBb‘Yrb {bpIV ‘m{hVr‘Ü`o `mMm g‘mdoe Agbm nm{hOo: - ñdmjar Ho$bobo g§‘Vr nÌ {‘i{dUo; - {ZîH$fmªMr Zm|X H$aUo (CXm. XmoÝhr H$mZm§Mr MmMUr CÎmsU©; EH$m H$mZmMr- MmMUr nwT>o nmR>{dUo; AnyU©; A`eñdr MmMUr; Unilateral REFER; Incomplete; Declined screen); - MmMUrH$[aVm dmnabobr nÕVr (CXm.: nS>Vmim MmMUr Q>rB©AmoEB© (TEOE), nS>Vmim MmMUr S>rnrAmoEB© (DPOE), nS>Vmim MmMUr E~rAma (ABR), Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr, ewÕ ÜdZr ldU MmMUr); Am{U - nwT>rb VnmgUrH$[aVm nmR>{dUo - Am{U Ë`mgmR>rMo VnmgUr H|$Ð  nmbH$ qH$dm XoI^mb H$aUmè¶m ì`º$s¨Zm Am{U BVa Amamo½`H$‘sªZm {ZîH$f© gm§JVmZm nwT>rb Jmoï>s¨Mm g‘mdoe H$amdm: - nS>Vmim MmMUrMm {ZîH$f© g‘OmdyZ gm§JUo - CXm. {ZîH$fm©Mm AW© H$m` Amho, nwT>rb H¥$Vr (CXm. nwT>rb VnmgUrH$[aVm nmR>{dUo Aem {ZîH$fm©H$[aVm Z¡Xm{ZH$ ‘yë`‘mnZmH$[aVm nmR>{dUo qH$dm Oa bhmZ ‘wbmbm ldUXmof {Z‘m©U hmoÊ`mMm YmoH$m bjmV Ambm Agob Va ghm ‘{hÝ`m§Zr nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm H$aUo) - nwZV©nmgUrH$[aVm VËH$mb AmH¥${V~§Y nmR>nwamdm H$aÊ`mMo ‘hÎd nmbH$ qH$dm XoI^mb H$aUmè¶m ì`º$s¨Zm g‘Obo Amho `mMr ImÌr H$aUo  nmbH$ Am{U XoI^mb H$aUmè¶m ì`º$s nS>Vmim MmMUrbm ZH$ma XoV AgVrb Va Ë`m§Zm Mm§Jë`m àH$mao H$go g‘OmdyZ gm§Jmdo/Ë`mda `mo½` à{V{H«$`m H$er Úmdr.  nwT>rb Jmoï>r bjmV KoD$Z ‘m{hVr XoUo d Vr g§H${bV H$aUo: - nS>Vmim MmMUrÀ`m ‘m{hVrMr JmonZr`Vm; Am{U - g§~§{YV {Z`‘/H$m`Xo  é½Umb` d BVa XdmImÝ`mH$[aVm Amdí`H$ Ago A{Zdm`© à{ejU, Ogo H$s: - g§gJ© {Z`§ÌU nÕVr d hmVmMr ñdÀN>Vm; - gwajm; Am{U - A{¾gwajm à{ejU  gm§ñH¥${VH$ g§doXZerbVm à{ejU H$m`©H«$‘m§Mr CXmhaUo  In the United Kingdom of Great Britain and Northern Ireland: https://www.gov.uk/ government/publications/newborn-hearing-screening-programme-nhsp-operationalguida nce/2-education-and-training.  In Utah, USA: http://www.infanthearing.org/nhstc/. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 55 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. n[a{eï> 1 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVmÀ`m à{ejU H$m`©H«$‘mMo KQ>H$ à{ejH$m§Mr AmoiI  à{ejU Am{U H$m`©j‘VoMo ‘yë`‘mnZ `m{df`rÀ`m à{ejUmMr ‘m{hVr CnH$aUmÀ`m CËnmXZH$Ë`mªZr Úmdr. ho à{ejU ldU nS>Vmim MmMUrMr V§Ìo d àUmbr `m§Mm AZw^d Agboë`m ì`mdgm{`H$m§Zr hmVr ¿`mdo Aer {e’$mag Ho$br OmVo (CXmhaUmW© Am°{S>Amobm°{OñQ²g åhUOoM ÜdZr {deofVÁk, Am°Q>mobm°{OñQ²g åhUOoM ZmH$ H$mZ Kgm VÁk qH$dm nS>Vmim MmMUr H$m`©H«$‘m§Mo AZw^dr ì`dñWmnH$).  Q´oZ-X-Q´oZa `m e¡j{UH$ H$m`©H«$‘mMo Am`moOZ Ho$ë`m‘wio nS>Vmim MmMUrH$[aVmÀ`m à{ejUmWsªÀ`m g§»`o‘Ü`o dmT> hmoÊ`mg ‘XV hmoB©b. à{ejU H$m`©H«$‘  à{ejU H$m`©H«$‘mÀ`m Aä`mgH«$‘m‘Ü`o `mMm g‘mdoe Agbm nm{hOo: nS>Vmim MmMUr à{H«$`m Am{U CnH$aUmMm dmna; CnH$aUmMo à‘mUrH$aU Am{U XoI^mb; A^©H$mÀ`m nS>Vmim MmMUrÀ`m dmVmdaUmMo AZwHy$bZ; MmMUrÀ`m H$m`©nÕVr Am{U {ZîH$f© g‘OmdyZ gm§JUo; Am{U MmMUrÀ`m {ZîH$fmªMr {bpIV ‘m{hVr R>odUo d Vr BVam§Zm XoUo.  à{ejU àË`jmV {Xbo Jobo nm{hOo Am{U Ë`m‘Ü`o ì`mdhm[aH$ {ejUmÀ`m AZw^dmMm g‘mdoe Agbm nm{hOo.  g§gJ© {Z`§ÌU à{H«$`m Am{U A^©H$m§Zm hmVmiÊ`mMr H$m¡eë`o `mH$So> bj {Xbo Jobo nm{hOo. COiUr à{ejU  nS>Vmim MmMUr Ho$br OmUmè¶m ì`º$s¨gmR>r {Z`{‘V e¡j{UH$ godm§VJ©V à{ejU Am`mo{OV Ho$bo Omdo Am{U MmMUr KoUmè¶m ì`º$sH$So> ldU nS>Vmim MmMUr H$aÊ`mH$[aVm Amdí`H$ Vr j‘Vm d H$m¡eë`o AgmdrV Aer {e’$mag Ho$br OmVo. à{ejUmWsªZr {H$‘mZ àmW{‘H$ à{ejU nyU© H$aUo Am{U nwT>rb joÌm§‘Ü`o j‘Vm d H$m¡eë`o Xe©{dUo Amdí`H$ Amho :  ldU nS>Vmim MmMUrMo ’$m`Xo.  d¡ÚH$s` MmMUr H$m`©nÕVs¨‘Ü`o nwT>rb Jmoï>s¨Mr ImÌr H$aUo: - nS>Vmim MmMUrH$[aVm EH$ em§V OmJm; - nS>Vmim MmMUr H$aÊ`mH$[aVm A^©H$mMr gw`mo` pñWVr (CXm. A^©H$m§gmR>r, eŠ`Vmo Pmonbobr qH$dm pñWa{MÎm ~mbHo$); - MmMUrgmR>r `mo½` V`mar Am{U ‘m§S>Ur - H$mZmV Kmbm`Mr Z{bH$m ì`dpñWV R>odUo (åhUOo H$U© Z{bH$m CKS>r Am{U ñnï>nUo {XgVo Amho ho VnmgyZ nhmUo).  nS>Vmim MmMUr H$er H$amdr; CnH$aUm§Mm dmna Am{U Ë`m§Mr H$miOr: - àmo~ qH$dm hoS>’$moZ XaamoO à‘m{UV H$aUo Am{U ÌwQ>r H$‘rV H$‘r `oVrb H$miOr KoUo, CXmhaUmW©:  àmo~ d hmS©>doAa `m§À`m‘Yrb Iam~ OmoS>Ê`m; qH$dm  H$Mam qH$dm H$mZmVrb ‘i `m‘wio àmo~À`m Q>moH$mbm Agbobm ñnrH$a qH$dm ‘m`H«$mo’$moZ nmoQ>© `m‘Ü`o `oUmam AS>Wim Xya H$aUo  ldU nS>Vmim MmMUrH$[aVm é½Umb` qH$dm AÝ` Amamo½` gw{dYm H|$ÐmMr YmoaUo Am{U H$m`©nÕVr.  nmbH$m§À`m ‘mZ{gH$ VUmdmgh Agbobo BVa YmoHo$ ømMr OmUrd.  é½Umb`mÀ`m YmoaUm§À`m Am{U H$m`©nÕVs¨À`m AZwf§JmZo é½Umb`m‘Ü`o, A^©H$m§Mr gd©gm‘mÝ` H$miOr Am{U hmVmiUr, {deofV: A{VXjVm {d^mJmVrb A^©H$m§H$[aVm.  d¡ÚH$s` ’$mBb‘Yrb {bpIV ‘m{hVr‘Ü`o `mMm g‘mdoe Agbm nm{hOo: - ñdmjar Ho$bobo g§‘Vr nÌ {‘i{dUo; - {ZîH$fmªMr Zm|X H$aUo (CXm. XmoÝhr H$mZm§Mr MmMUr CÎmsU©; EH$m H$mZmMr- MmMUr nwT>o nmR>{dUo; AnyU©; A`eñdr MmMUr; Unilateral REFER; Incomplete; Declined screen); - MmMUrH$[aVm dmnabobr nÕVr (CXm.: nS>Vmim MmMUr Q>rB©AmoEB© (TEOE), nS>Vmim MmMUr S>rnrAmoEB© (DPOE), nS>Vmim MmMUr E~rAma (ABR), Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr, ewÕ ÜdZr ldU MmMUr); Am{U - nwT>rb VnmgUrH$[aVm nmR>{dUo - Am{U Ë`mgmR>rMo VnmgUr H|$Ð  nmbH$ qH$dm XoI^mb H$aUmè¶m ì`º$s¨Zm Am{U BVa Amamo½`H$‘sªZm {ZîH$f© gm§JVmZm nwT>rb Jmoï>s¨Mm g‘mdoe H$amdm: - nS>Vmim MmMUrMm {ZîH$f© g‘OmdyZ gm§JUo - CXm. {ZîH$fm©Mm AW© H$m` Amho, nwT>rb H¥$Vr (CXm. nwT>rb VnmgUrH$[aVm nmR>{dUo Aem {ZîH$fm©H$[aVm Z¡Xm{ZH$ ‘yë`‘mnZmH$[aVm nmR>{dUo qH$dm Oa bhmZ ‘wbmbm ldUXmof {Z‘m©U hmoÊ`mMm YmoH$m bjmV Ambm Agob Va ghm ‘{hÝ`m§Zr nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm H$aUo) - nwZV©nmgUrH$[aVm VËH$mb AmH¥${V~§Y nmR>nwamdm H$aÊ`mMo ‘hÎd nmbH$ qH$dm XoI^mb H$aUmè¶m ì`º$s¨Zm g‘Obo Amho `mMr ImÌr H$aUo  nmbH$ Am{U XoI^mb H$aUmè¶m ì`º$s nS>Vmim MmMUrbm ZH$ma XoV AgVrb Va Ë`m§Zm Mm§Jë`m àH$mao H$go g‘OmdyZ gm§Jmdo/Ë`mda `mo½` à{V{H«$`m H$er Úmdr.  nwT>rb Jmoï>r bjmV KoD$Z ‘m{hVr XoUo d Vr g§H${bV H$aUo: - nS>Vmim MmMUrÀ`m ‘m{hVrMr JmonZr`Vm; Am{U - g§~§{YV {Z`‘/H$m`Xo  é½Umb` d BVa XdmImÝ`mH$[aVm Amdí`H$ Ago A{Zdm`© à{ejU, Ogo H$s: - g§gJ© {Z`§ÌU nÕVr d hmVmMr ñdÀN>Vm; - gwajm; Am{U - A{¾gwajm à{ejU  gm§ñH¥${VH$ g§doXZerbVm à{ejU H$m`©H«$‘m§Mr CXmhaUo  In the United Kingdom of Great Britain and Northern Ireland: https://www.gov.uk/ government/publications/newborn-hearing-screening-programme-nhsp-operationalguida nce/2-education-and-training.  In Utah, USA: http://www.infanthearing.org/nhstc/. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo56 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. n[a{eï> 1 ZdOmV A^©H$m§À`m ldU nS>Vmim MmMUrH$[aVmÀ`m à{ejU H$m`©H«$‘mMo KQ>H$ à{ejH$m§Mr AmoiI  à{ejU Am{U H$m`©j‘VoMo ‘yë`‘mnZ `m{df`rÀ`m à{ejUmMr ‘m{hVr CnH$aUmÀ`m CËnmXZH$Ë`mªZr Úmdr. ho à{ejU ldU nS>Vmim MmMUrMr V§Ìo d àUmbr `m§Mm AZw^d Agboë`m ì`mdgm{`H$m§Zr hmVr ¿`mdo Aer {e’$mag Ho$br OmVo (CXmhaUmW© Am°{S>Amobm°{OñQ²g åhUOoM ÜdZr {deofVÁk, Am°Q>mobm°{OñQ²g åhUOoM ZmH$ H$mZ Kgm VÁk qH$dm nS>Vmim MmMUr H$m`©H«$‘m§Mo AZw^dr ì`dñWmnH$).  Q´oZ-X-Q´oZa `m e¡j{UH$ H$m`©H«$‘mMo Am`moOZ Ho$ë`m‘wio nS>Vmim MmMUrH$[aVmÀ`m à{ejUmWsªÀ`m g§»`o‘Ü`o dmT> hmoÊ`mg ‘XV hmoB©b. à{ejU H$m`©H«$‘  à{ejU H$m`©H«$‘mÀ`m Aä`mgH«$‘m‘Ü`o `mMm g‘mdoe Agbm nm{hOo: nS>Vmim MmMUr à{H«$`m Am{U CnH$aUmMm dmna; CnH$aUmMo à‘mUrH$aU Am{U XoI^mb; A^©H$mÀ`m nS>Vmim MmMUrÀ`m dmVmdaUmMo AZwHy$bZ; MmMUrÀ`m H$m`©nÕVr Am{U {ZîH$f© g‘OmdyZ gm§JUo; Am{U MmMUrÀ`m {ZîH$fmªMr {bpIV ‘m{hVr R>odUo d Vr BVam§Zm XoUo.  à{ejU àË`jmV {Xbo Jobo nm{hOo Am{U Ë`m‘Ü`o ì`mdhm[aH$ {ejUmÀ`m AZw^dmMm g‘mdoe Agbm nm{hOo.  g§gJ© {Z`§ÌU à{H«$`m Am{U A^©H$m§Zm hmVmiÊ`mMr H$m¡eë`o `mH$So> bj {Xbo Jobo nm{hOo. COiUr à{ejU  nS>Vmim MmMUr Ho$br OmUmè¶m ì`º$s¨gmR>r {Z`{‘V e¡j{UH$ godm§VJ©V à{ejU Am`mo{OV Ho$bo Omdo Am{U MmMUr KoUmè¶m ì`º$sH$So> ldU nS>Vmim MmMUr H$aÊ`mH$[aVm Amdí`H$ Vr j‘Vm d H$m¡eë`o AgmdrV Aer {e’$mag Ho$br OmVo. à{ejUmWsªZr {H$‘mZ àmW{‘H$ à{ejU nyU© H$aUo Am{U nwT>rb joÌm§‘Ü`o j‘Vm d H$m¡eë`o Xe©{dUo Amdí`H$ Amho :  ldU nS>Vmim MmMUrMo ’$m`Xo.  d¡ÚH$s` MmMUr H$m`©nÕVs¨‘Ü`o nwT>rb Jmoï>s¨Mr ImÌr H$aUo: - nS>Vmim MmMUrH$[aVm EH$ em§V OmJm; - nS>Vmim MmMUr H$aÊ`mH$[aVm A^©H$mMr gw`mo` pñWVr (CXm. A^©H$m§gmR>r, eŠ`Vmo Pmonbobr qH$dm pñWa{MÎm ~mbHo$); - MmMUrgmR>r `mo½` V`mar Am{U ‘m§S>Ur - H$mZmV Kmbm`Mr Z{bH$m ì`dpñWV R>odUo (åhUOo H$U© Z{bH$m CKS>r Am{U ñnï>nUo {XgVo Amho ho VnmgyZ nhmUo).  nS>Vmim MmMUr H$er H$amdr; CnH$aUm§Mm dmna Am{U Ë`m§Mr H$miOr: - àmo~ qH$dm hoS>’$moZ XaamoO à‘m{UV H$aUo Am{U ÌwQ>r H$‘rV H$‘r `oVrb H$miOr KoUo, CXmhaUmW©:  àmo~ d hmS©>doAa `m§À`m‘Yrb Iam~ OmoS>Ê`m; qH$dm  H$Mam qH$dm H$mZmVrb ‘i `m‘wio àmo~À`m Q>moH$mbm Agbobm ñnrH$a qH$dm ‘m`H«$mo’$moZ nmoQ>© `m‘Ü`o `oUmam AS>Wim Xya H$aUo  ldU nS>Vmim MmMUrH$[aVm é½Umb` qH$dm AÝ` Amamo½` gw{dYm H|$ÐmMr YmoaUo Am{U H$m`©nÕVr.  nmbH$m§À`m ‘mZ{gH$ VUmdmgh Agbobo BVa YmoHo$ ømMr OmUrd.  é½Umb`mÀ`m YmoaUm§À`m Am{U H$m`©nÕVs¨À`m AZwf§JmZo é½Umb`m‘Ü`o, A^©H$m§Mr gd©gm‘mÝ` H$miOr Am{U hmVmiUr, {deofV: A{VXjVm {d^mJmVrb A^©H$m§H$[aVm.  d¡ÚH$s` ’$mBb‘Yrb {bpIV ‘m{hVr‘Ü`o `mMm g‘mdoe Agbm nm{hOo: - ñdmjar Ho$bobo g§‘Vr nÌ {‘i{dUo; - {ZîH$fmªMr Zm|X H$aUo (CXm. XmoÝhr H$mZm§Mr MmMUr CÎmsU©; EH$m H$mZmMr- MmMUr nwT>o nmR>{dUo; AnyU©; A`eñdr MmMUr; Unilateral REFER; Incomplete; Declined screen); - MmMUrH$[aVm dmnabobr nÕVr (CXm.: nS>Vmim MmMUr Q>rB©AmoEB© (TEOE), nS>Vmim MmMUr S>rnrAmoEB© (DPOE), nS>Vmim MmMUr E~rAma (ABR), Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr, ewÕ ÜdZr ldU MmMUr); Am{U - nwT>rb VnmgUrH$[aVm nmR>{dUo - Am{U Ë`mgmR>rMo VnmgUr H|$Ð  nmbH$ qH$dm XoI^mb H$aUmè¶m ì`º$s¨Zm Am{U BVa Amamo½`H$‘sªZm {ZîH$f© gm§JVmZm nwT>rb Jmoï>s¨Mm g‘mdoe H$amdm: - nS>Vmim MmMUrMm {ZîH$f© g‘OmdyZ gm§JUo - CXm. {ZîH$fm©Mm AW© H$m` Amho, nwT>rb H¥$Vr (CXm. nwT>rb VnmgUrH$[aVm nmR>{dUo Aem {ZîH$fm©H$[aVm Z¡Xm{ZH$ ‘yë`‘mnZmH$[aVm nmR>{dUo qH$dm Oa bhmZ ‘wbmbm ldUXmof {Z‘m©U hmoÊ`mMm YmoH$m bjmV Ambm Agob Va ghm ‘{hÝ`m§Zr nwZV©nmgUrH$[aVm AmH¥${V~§Y nmR>nwamdm H$aUo) - nwZV©nmgUrH$[aVm VËH$mb AmH¥${V~§Y nmR>nwamdm H$aÊ`mMo ‘hÎd nmbH$ qH$dm XoI^mb H$aUmè¶m ì`º$s¨Zm g‘Obo Amho `mMr ImÌr H$aUo  nmbH$ Am{U XoI^mb H$aUmè¶m ì`º$s nS>Vmim MmMUrbm ZH$ma XoV AgVrb Va Ë`m§Zm Mm§Jë`m àH$mao H$go g‘OmdyZ gm§Jmdo/Ë`mda `mo½` à{V{H«$`m H$er Úmdr.  nwT>rb Jmoï>r bjmV KoD$Z ‘m{hVr XoUo d Vr g§H${bV H$aUo: - nS>Vmim MmMUrÀ`m ‘m{hVrMr JmonZr`Vm; Am{U - g§~§{YV {Z`‘/H$m`Xo  é½Umb` d BVa XdmImÝ`mH$[aVm Amdí`H$ Ago A{Zdm`© à{ejU, Ogo H$s: - g§gJ© {Z`§ÌU nÕVr d hmVmMr ñdÀN>Vm; - gwajm; Am{U - A{¾gwajm à{ejU  gm§ñH¥${VH$ g§doXZerbVm à{ejU H$m`©H«$‘m§Mr CXmhaUo  In the United Kingdom of Great Britain and Northern Ireland: https://www.gov.uk/ government/publications/newborn-hearing-screening-programme-nhsp-operationalguida nce/2-education-and-training.  In Utah, USA: http://www.infanthearing.org/nhstc/. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 57 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. n[a{eï> 2 bhmZ ‘wbm§‘Yrb ldU Xmof AmoiIÊ`mH$[aVm bj {dM{bV H$aÊ`mMr MmMUr Amdí`H$ ~m~r:  MmMUr H$aÊ`mH$[aVm XmoZ ì`º$s, EH$ bj {dM{bV H$aUmar åhUyZ Am{U EH$ MmMUr H$aUmar åhUyZ.  a§Jr~oa§Jr bmH$S>r R>moH$io qH$dm VËg‘ IoiUo (H$moUË`mhr àH$maMm AmdmO H$aUmar IoiUr KoD$ Z`oV).  Q>m°dob qH$dm MmXa.  IwiIwim (CnbãY Agë`mg) H$m`©nÕVr: 1. Vwåhr EImÚm em§V ImobrV AmhmV `mMr ImÌr H$am. 2. A^©H$mbm nmbH$m§À`m Hw$erV/‘m§S>rda ~gmdo. nmbH$m§Zm pñWa Am{U em§V amhmÊ`mg gm§{JVbo nm{hOo. 3. bj {dM{bV H$aUmè¶m ì`º$sZo bmH$S>r R>moH$io (qH$dm AÝ` IoiUo) KoD$Z A^©H$mg‘moa ~gmdo. 4. MmMUr H$aUmè¶m ì`º$sZo IwiIwim KoD$Z Ë`m A^©H$mÀ`m ‘mJo Am{U ~mOybm A^©H$mnmgyZ gw‘mao EH$ ‘rQ>a A§Vamda ~gbo nm{hOo. 5. bj {dM{bV H$aUmar ì`º$s A^©H$m~amo~a Ioi IoiVo. CXmhaUmW©, bmH$S>r R>moH$io EH$‘oH$m§da R>odUo. 6. bj {dM{bV H$aUmar ì`º$s IoiUo Wm§~dVo Am{U R>moH$io (qH$dm IoiUo) Q>m°dob qH$dm MmXarZo PmH$Vo. 7. MmMUr H$aUmar ì`º$s hiwdmanUo nmM goH§$XmgmR>r IwiIwim dmOdVmo. A^©H$mZo AmdmOmÀ`m {XeoZo dibo nm{hOo. 8. MmMUr H$aUmar ì`º$s A^©H$mÀ`m Xwgè`m ~mOybm ‘mJo OmVmo. H¥$Vr 5 Vo 7 `m nwÝhm Ho$ë`m OmVmV. 9. H¥$Vr 5 Am{U 6 nwÝhm H$am. Hw$R>bmhr AmdmO H$ê$ ZH$m. A^©H$mZo Ë`mMo S>moHo$ di{dVm H$m‘m Z`o. `m‘wio ho ñnï> hmoVo H$s A^©H$ AmdmO EoHy$ZM S>moHo$ di{dV Amho. 10. Oa A^©H$mZo diyZ nm{hbo Zmhr, Va MmMUr ‘moR>çm AmdmOmV nwÝhm Ho$br OmD$ eH$Vo. Oa H$moUVmhr à{VgmX Zgob Va ‘wbmbm/~mbH$mbm nwT>rb MmMÊ`m§gmR>r VÁkmH$So> nmR>{dbo nm{hOo. ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo58 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. n[a{eï> 2 bhmZ ‘wbm§‘Yrb ldU Xmof AmoiIÊ`mH$[aVm bj {dM{bV H$aÊ`mMr MmMUr Amdí`H$ ~m~r:  MmMUr H$aÊ`mH$[aVm XmoZ ì`º$s, EH$ bj {dM{bV H$aUmar åhUyZ Am{U EH$ MmMUr H$aUmar åhUyZ.  a§Jr~oa§Jr bmH$S>r R>moH$io qH$dm VËg‘ IoiUo (H$moUË`mhr àH$maMm AmdmO H$aUmar IoiUr KoD$ Z`oV).  Q>m°dob qH$dm MmXa.  IwiIwim (CnbãY Agë`mg) H$m`©nÕVr: 1. Vwåhr EImÚm em§V ImobrV AmhmV `mMr ImÌr H$am. 2. A^©H$mbm nmbH$m§À`m Hw$erV/‘m§S>rda ~gmdo. nmbH$m§Zm pñWa Am{U em§V amhmÊ`mg gm§{JVbo nm{hOo. 3. bj {dM{bV H$aUmè¶m ì`º$sZo bmH$S>r R>moH$io (qH$dm AÝ` IoiUo) KoD$Z A^©H$mg‘moa ~gmdo. 4. MmMUr H$aUmè¶m ì`º$sZo IwiIwim KoD$Z Ë`m A^©H$mÀ`m ‘mJo Am{U ~mOybm A^©H$mnmgyZ gw‘mao EH$ ‘rQ>a A§Vamda ~gbo nm{hOo. 5. bj {dM{bV H$aUmar ì`º$s A^©H$m~amo~a Ioi IoiVo. CXmhaUmW©, bmH$S>r R>moH$io EH$‘oH$m§da R>odUo. 6. bj {dM{bV H$aUmar ì`º$s IoiUo Wm§~dVo Am{U R>moH$io (qH$dm IoiUo) Q>m°dob qH$dm MmXarZo PmH$Vo. 7. MmMUr H$aUmar ì`º$s hiwdmanUo nmM goH§$XmgmR>r IwiIwim dmOdVmo. A^©H$mZo AmdmOmÀ`m {XeoZo dibo nm{hOo. 8. MmMUr H$aUmar ì`º$s A^©H$mÀ`m Xwgè`m ~mOybm ‘mJo OmVmo. H¥$Vr 5 Vo 7 `m nwÝhm Ho$ë`m OmVmV. 9. H¥$Vr 5 Am{U 6 nwÝhm H$am. Hw$R>bmhr AmdmO H$ê$ ZH$m. A^©H$mZo Ë`mMo S>moHo$ di{dVm H$m‘m Z`o. `m‘wio ho ñnï> hmoVo H$s A^©H$ AmdmO EoHy$ZM S>moHo$ di{dV Amho. 10. Oa A^©H$mZo diyZ nm{hbo Zmhr, Va MmMUr ‘moR>çm AmdmOmV nwÝhm Ho$br OmD$ eH$Vo. Oa H$moUVmhr à{VgmX Zgob Va ‘wbmbm/~mbH$mbm nwT>rb MmMÊ`m§gmR>r VÁkmH$So> nmR>{dbo nm{hOo. A{V[aº$ gyMZm: Oa IwiIwim CnbãY Zgob, Va MmMUr H$aUmar ì`º$s Vm|S>mZo AmdmO H$mTy>Z MmMUr H$ê$ eH$VmV. ImbÀ`m nÅ>rVrb AmoAmo Am{U ‘Yë`m nÅ>rVrb B©B©B© Ago AmdmO àË`oH$ ~mOybm Ho$bo nm{hOoV. ho bjmV KoUo ‘hÎdmMo Amho H$s hr nÕV Zoh‘rM {dœmgmh© qH$dm à‘m{UV ZgVo. H$moUË`mhr ~m~VrV e§H$m Agë`mg MmMUrgmR>r nwT>o nmR>dm åhUOoM REFER!! ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 59 3.9 ‘mZdr g§gmYZo Á`oð> ì`º$s¨‘Yrb ldU nS>Vmim MmMUr nwT>rb bmoH$m§Ûmao Ho$br OmD$ eH$Vo:  H$mZ d ldU XoI^mb H$aUmao S>m°ŠQ>a (CXmhaUmW© H$mZ, ZmH$ d Kgm (B©EZQ>r) VÁk, ldUVÁk, dmMm d ^mfm amoJ{ZXmZVÁk)  ldU j‘VoMr XoI^mb Z H$aUmao S>m°ŠQ>a (CXmhaUmW© Zoh‘rMo S>m°ŠQ>a, {’${O{e`Z)  à{e{jV Amamo½` H$‘©Mmar (CXmhaUmW© d¡ÚH$s` A{YH$mar, d¡ÚH$s` ‘XVZrg, V§Ìk, n[aMm[aH$m, Am¡fY{dH«o$Vm qH$dm BVa g§~§{YV Amamo½` ì`mdgm{`H$)  à{e{jV gm‘mÝ` Amamo½` H$‘©Mmar (CXmhaUmW© g‘mOmV H$m‘ H$aUmao Amamo½` H$‘©Mmar).  BVa Ogo H$s à{e{jV ñd`§godH$. ldU nS>Vmim MmMUr Ooìhm Amamo½` H$‘©Mmè¶mH$Sy>Z qH$dm EImÚm S>m°ŠQ>a Zgboë`m ì`º$sH$Sy>Z Ho$br OmVo Voìhm Ë`m§Zm gwédmVrbm à{ejU ho {XboM nm{hOo, Ë`m§À`mda XoIaoI R>odbr nm{hOo d Ë`m§Zm gmVË`mZo ‘XV Ho$br nm{hOo. ho gd© Ë`m§Zr Ë`m§Zr KoVboë`m MmMUr à{ejUmda Adb§~yZ amhrb. 3.10 Z¡Xm{ZH$ ‘yë`‘mnZ H$mZmVyZ ‘i H$mT>ë`mZ§Va (ho gy{MV Ho$bo Agë`mg) Á`m ì`º$s¨Mm nwT>rb VnmgUrH$[aVm nmR>{dUo Agm {ZîH$f© `oVmo Ë`m gd© ì`º$s¨Mm ldUXmof d Ë`mMo à‘mU Am{U ñdê$n `mMr ImÌr H$aÊ`mH$[aVm Z¡Xm{ZH$ ldU ‘yë`‘mnZ Ho$bo nm{hOo. `m‘wio nwZd©gZ d BVa CnMma H$aÊ`mMr JaO AmoiIÊ`mg ‘XV hmoVo d `m‘Ü`o {H$‘mZ `m Jmoï>s¨Mm g‘mdoe Agbm nm{hOo:  ewÕ ÜdZr ldU MmMUr: EAa d ~moZ H§$S>ŠeZ Am{U  ‘Ü` H$Um©Mo ‘yë`‘mnZ H$aÊ`mH$[aVm {Q>ån°Zmo‘oQ´r Á`m {R>H$mUr H$aUo eŠ` Agob Ë`m {R>H$mUr ñnrM Am°{S>Amo‘oQ´r (^mfm ldU MmMUr) Ho$br nm{hOo H$maU `m‘wio X¡Z§{XZ ^mfm AmH$bZm{df`r ‘hÎdmMr ‘m{hVr {‘iy eH$Vo. àmW{‘H$ Z¡Xm{ZH$ ‘yë`‘mnZo H$mZ d ldU VÁkm§Ûmao qH$dm BVa à{e{jV H$‘©Mmè¶m§Ûmao Ho$br OmD$ eH$VmV. 3.11 CnMma EH$Xm ldUXmofmMo {ZXmZ Pmbo H$s, CnMmam§‘Ü`o (A) n`m©`mMm g‘mdoe Ho$bmM nm{hOo Am{U (~) (H$) qH$dm (S>) `m§Mm g‘mdoe H$Xm{MV Ho$bm OmD$ eHo$b: (A) ldUXmof Agbobo bmoH$, Ë`m§Mo XoI^mbH$V} d Hw$Qw>§~r` `m§Mr ‘mZ{gH$ ñdrH¥$Vr Am{U g‘m`moOZ gwb^ H$aÊ`mH$[aVm ‘yb^yV {ejU d g‘wnXoeZ. `m‘Ü`o g§dmX à{ejU VgoM gm‘m{OH$ d emar[aH$ dmVmdaUmVrb ~Xb Am{U g‘d`ñH$ ì`º$s¨Mo ‘mJ©Xe©Z `m§Mm XoIrb g‘mdoe Agmdm. (~) ldU V§ÌkmZmMr JaO d àH$ma `m§Mo ‘yë`‘mnZ Ho$bo Omdo Am{U Oo V§ÌkmZ Amdí`H$ Agob (CXm. ldU`§Ì, Båßbm§Q>, ldU gmhmæ`H$ V§ÌkmZ) Vo Ë`mMr A{YH¥$V nadmZJr Agboë`m à{e{jV ì`mdgm{`H$mZo CnbãY H$ê$Z Úmdo d ~gdmdo (ñWm{ZH$ {Z`‘ d AQ>s¨Zwgma). (H$) OoWo ldUXmofmMo ñdê$n qH$dm g§~§{YV bjUo `mÛmao gy{MV Ho$bo Amho VoWo nwT>rb qH$dm A{YH$ àJV MmMUr H$amdr (S>) Amdí`H$VoZwgma, Z§VaÀ`m VmaIobm nwÝhm MmMUr H$amdr. EH$Xm H$m ldUXmof bjmV Ambm H$s H$moUVmhr Xwîn[aUm‘ H$‘r H$aÊ`mH$[aVm eŠ` {VVŠ`m bdH$a Am{U `mo½` arVrZo Ë`mda Cnm` H$aUo Amdí`H$ Amho. ì`º$sÀ`m g§dmXmÀ`m JaOm d àmYmÝ`o VgoM CnbãY g§gmYZo (1) (9) (AmH¥$Vr 3.2) {dMmamV KoD$Z CnMmam{df`rÀ`m YmoaUm§‘Ü`o ì`º$s-H|${ÐV Ñ{ï>H$moZmMm Adb§~ Ho$bm nm{hOo. CnMma{df`H$ YmoaUm§Zr ì`º$sÀ`m gm‘m{OH$ d emar[aH$ (Mm¡H$Q> 3.3) g‘ñ`m§Mo {ZamH$aU Ho$bo nm{hOo. `m‘Ü`o ldU gmhmæ`H$ V§ÌkmZm{df`r (Ogo H$s E’$E‘ {gñQ>råg d {hA[a¨J BÝS>ŠeZ byßg) ‘mJ©Xe©Z, {MÌn[aM` H$ê$Z XoUmam ‘OHy$a, AmoR>m§À`m hmbMmbs¨dê$Z hmoUmam AW©~moY d g§àofU YmoaUm§Mo à{ejU `m§Mm g‘mdoe hmoVmo. ldUXmof ñdrH$mê$Z Ë`mÀ`mer OwidyZ KoÊ`m{df`r g‘wnXoeZ Ho$ë`m‘wio H$mhr bmoH$m§Zm (Am{U Ë`m§Mo Hw$Qw>§~r`/XoI^mbH$V}) ldUXmofmH$So> nmhmÊ`mÀ`m ZH$mamË‘H$ Ñ{ï>H$moZmda ‘mV H$aÊ`mg ‘XV hmoD$ eH$Vo. ldU~m{YV ì`º$s¨Zm `mg§~§{YV ghì`mYs¨H$[aVm XoIrb XoI^mbrMr Amdí`H$ Agy eH$Vo, Ogo H$s AmH$bZeº$s H$‘r hmoUo qH$dm ñ‘¥{V^«§e. Mm¡H$Q> 3.3 gm‘m{OH$ d emar[aH$ g‘ñ`m§Mo ‘yë`‘mnZ d ì`dñWmnZ*  AmYma XoUo d ^md{ZH$ VmU ghZ H$aÊ`mg ‘XV H$aUo  Kam‘Ü`o ldU gmhmæ`H$ V§ÌkmZ CnbãY H$ê$Z XoUo (CXm. H§$n nmdUmam qH$dm Ñî` g§Ho$V XoUmam XyaÜdZr d Xmam daMr K§Q>m)  ì`º$s d Ë`mMo Hw$Qw>§~r`/Ë`mMm XoI^mbH$Vm© `m§Zm g§b¾ amhmÊ`mH$[aVm d gm‘m{OH$ g§~§Y {Q>H$dyZ R>odÊ`m H$[aVm V§ÌH$m¡eë`o {eH${dUo 3.12 ldU Amamo½`m{df`rMm àMma Á`m ì`º$s¨Zm Ë`m§Mr ldU nS>Vmim MmMUr Ho$ë`mZ§Va CÎmsU© Agm {ZîH$f© àmá hmoVmo, Ë`m§Zm nwT>rb Jmoï>s¨À`m g‘m- doemgh ldUXmofmbm à{V~§Y H$aÊ`m{df`r d H$mZm§À`m H$miOr{df`r ‘m{hVr {Xbr Omdr.  ldU Amamo½`mMo ‘hÎd;  Amamo½`nyU© ldUmH$[aVm H$m` H$am d H$m` H$ê$ ZH$m `mÀ` g‘mdoemgh H$mZmMr XoI^mb 8;  dmVmdaUmVrb AmdmO {Z`§ÌUmV R>odUo, Kar d H$m‘mÀ`m {R>H$mUr H$mZmMo ajU H$aUo;  gwa{jV ldU nÕVs¨Mo ‘hÎd d gmYZo `mgh gwa{jV ldU Am{U;  X¡Z§{XZ OrdZmVrb H$m`©H«$‘m§‘Yrb gh^mJ H$m`‘ R>odÊ`mH$[aVm g§àofUmMo ‘hÎd. n[a{eï> 3 Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr Ooìhm MmMUrH$[aVm BVa nÕVr CnbãY ZgVmV VoìhmM Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr ` m n`m©`mMr {ZdS> Ho$br nm{hOo Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr:10 AmH¥$Vr A 1 H°${b’$mo{Z©`m {dÚmnrR>mMr Hw$O~yOV ~mobbobo EoH$Ê`mMr MmMUr é½U MmMUr H$aÊ`mÀ`m Q>o~bda qH$dm IwMuda ~gbobm AgVmZm, é½UmÀ`m ‘mJo EH$ hmV bm§~ (A§XmOo 2 ’y$Q>) C^o amhm. 1 8-M-3 2-J-7 K-5-R S-4-G 2 7 8 The Whisper Test é½Umbm gm§Jm: ldU MmMUrXaå`mZ, ‘r Ajao Am{U AmH$So> ‘moR>çm AmdmOmV åhUV AgVmZm Á`m H$mZmMr MmMUr H$am`Mr Zmhr Vmo H$mZ ‘r Vwåhmbm ~§X H$aÊ`mg gm§JoZ. Vwåhr Vw‘À`m Q´°Jgda (~møH$U© a§Y«mOdi Agbobm Hw$M}Mm bhmZ C§MdQ>m) EH$ ~moQ> R>oD$Z H$mZ ~§X H$amb. 3 Á`m H$mZmMr MmMUr H$am`Mr Zmhr Vmo H$mZ é½Umbm Q´°Jgda EH$ ~moQ> R>oD$Z ~§X H$ê$ Úm. é½Umbm hiyhiy ~moQ> JmobmH$ma hbdy Úm. 4 Ajao Am{U AmH$So> EH${ÌVarË`m Hw$O~yOÊ`mnydu EH$ XsK© œmg ¿`m Am{U œmg nyU©nUo gmoS>m. 5 Ajao Am{U AmH$So> EH${ÌVarË`m Úm.(CXmhaUmW©, 4-K-2) 6 é½Umbm EoH$bobo nwÝhm åhUÊ`mg gm§Jm. Oa é½UmZo `eñdr[aË`m nwZamd¥Îmr Ho$br Va Xwgè¶m H$mZmMr MmMUr H$am. àË`oH$ H$mZmgmR>r Ajao Am{U AmH$S>çm§Mo EH$ÌrH$aU {Zamio Agë`mMr ImÌr H$am. é½U A`eñdr Pmë`mg, Ajam§À`m Am{U AmH$S>çm§À`m {Zamù`m EH$ÌrH$aUmgh nwÝhm MmMUr H$aÊ`mMm à`ËZ H$am. Xwgè¶m à`ËZmZ§Va é½U Oa EHy$U 3 Ajao Am{U/qH$dm AmH$So> ~amo~a (Ë`m H$mZmgmR>r ~mobboë`m 6 Ajao qH$dm AmH$S>çm§n¡H$s) gm§Jy eH$bm, Va Vmo CÎmsU© Pmbm Ago ‘mZbo OmVo. 9 {ZîH$f© {bhÿZ R>odÊ`mMo bjmV R>odm. 10 Adapted from the University of California, San Francisco, United States of America (https://geriatrics.ucsf.edu/sites/geriatrics.ucsf.edu/files/2018-06/whispertest.pdf, accessed 18 May 2021). ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo60 n[a{eï> 4 nwT>o Z‘yX Ho$boë`m g{‘Vr‘Yrb gd© gXñ`m§Mo {hVg§~§Y OnÊ`mVrb g§Kfm©Mo ì`dñWmnZ Vm§{ÌH$ H$m`©H$mar JQ>mÀ`m gd© gXñ`m§Zr Am{U ~amo~arÀ`m g‘rjH$m§Zr Vm§{ÌH$ H$m`©H$mar JQ>mÀ`m H$moUË`mhr ~¡R>H$s¨Zm d g‘rjobm CnpñWV amhmÊ`mnydu OmJ{VH$ Amamo½` g§KQ>ZoMm {hVg§~§Y OnÊ`m{df`rMo KmofUm nÌ nyU© ^abo d gmXa Ho$bo Am{U JmonZr`Vm h‘rnÌmda ñdmjar Ho$br hmoVr. OmJ{VH$ Amamo½` g§KQ>ZoÀ`m Ag§gJ©OÝ` AmOmam§/{dH$mam§À`m {d^mJmZo gmXa Ho$boë`m {hVg§~§Y OnÊ`m {df`rMo KmofUmnÌmMm AmT>mdm KoVbm Amho. Ë`m§Zr Ë`mMo ‘yë`‘mnZ Ho$bo AgyZ VS>OmoS> H$aÊ`mMr n[apñWVr {Z‘m©U hmoD$ eH$Vo Ago H$moUVohr gmd©O{ZH$ dmX qH$dm {hVg§~§Y ho AmoiIÊ`mgmR>r B§Q>aZoQ>da emoY KoVbm Amho. Oa H$moUË`mhr KmofUmnÌmÀ`m qH$dm {hVg§~§Y OnÊ`mVrb ì`dñWmnZmÀ`m ~m~VrV A{V[aº$ ‘mJ©Xe©ZmMr Amdí`H$Vm AgVr Va {d^mJmZo AZwnmbZ, OmoIr‘ ì`dñWmnZ Am{U Zr{Vemó ~KUmè¶m H$m`m©b`mVrb ghH$m`mªer g„m‘gbV Ho$br AgVr. Amdí`H$ dmQ>ë`mg Am{W©H$ qH$dm {~Ja Am{W©H$ {hVg§~§Ym§~m~V g§Kf© Agboë`m ì`º$s¨Zm Aem H$moUË`mhr {df`m§darb gh^mJmVyZ dJibo Jobo AgVo. g§nyU© à{H«$`oXaå`mZ {hVg§~§Y OnÊ`mVrb g§Kfm©À`m ì`dñWmnZmMm AmT>mdm KoVbm Jobm AgyZ Vm§{ÌH$ H$m`©H$mar JQ>mÀ`m gXñ`m§Zr Amdí`H$Vm dmQ>ë`mg àË`oH$ ~¡R>H$snydu Ë`m§Mr {hVg§~§Y OnÊ`m{df`rMr KmofUm nÌ AÚ`mdV H$aUo Amdí`H$ hmoVo. Vm§{ÌH$ H$m`©H$mar JQ>gXñ` Am{U g‘rjH$ `m§Mo Kmo{fV {hVg§~§Y Imbr WmoS>Š`mV {Xbo AmhoV. {hVg§~§Y OnÊ`m{df`rMm Name Expertise Disclosure of Management of interest conflict of interest Arun Agarwal Community ENT None declared None identified Susan Emmett School ear and hearing None declared None identified screening, ENT Catherine Mcmahon Hearing screening Employment at None identified in older adults Macquarie University Research Funds NIH/NIDCD James Saunders ENT, school ear and None declared None identified hearing screening Christine Yoshinaga-Itano Newborn hearing Research Fuds None identified screening Xingkuan Bu ENT, hearing screening None declared None identified Patricia Castellanos Community audiology None declared None identified Chitra Chander Public health Paid consultancy None identified (WHO) Name Expertise Disclosure of Management of interest conflict of interest Ivy Chillingulo Public health Paid consultancy None identified Teresa Ching Audiology, None declared None identified hearing screening Jackie Clark Audiology None declared None identified Adrian Davis Audiology, Public Health None declared None identified Kathleen Pichora-Fuller Hearing screening Research Funds None identified in older adults Jean-Pierre Gagne Adult audiology None declared None identified Carmen Kung Cognitive Neuroscience Research Funds None identified Arunda Malachi Public health Paid consultancy None identified (WHO) Vivienne Marnane Speech Pathology Research Funds None identified Norberto Martinez ENT and audiology None declared None identified Serah Ndwega Coommunity audiology None declared None identified Kartin Neumann Audiology, newborn None declared None identified screening Carrie Nieman Hearing screening Employment – Johns None identified in older adults, Hopkins University community ENT School of Medicine, Research Funds – National Institutes of Health, United States Bolajako Olusanya Pediatric audiology Director, Phonics None identified Hearing Centre, Lagos, Nigeria Sowmya Rao Pediatric audiology Paid consultancy None identified (WHO) De Wet Swanepoel Audiology Co-founder hearX None identified digital hearing technologies George Tavartkilaze Audiology None declared None identified Peter Thorne Audiology None declared None identified Kelly Tremblay Adult audiology Research funds, None identified University of Washington Katherine Walls Public health None declared None identified Angela Wong Audiology Research funds None identified ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo 61 Name Expertise Disclosure of Management of interest conflict of interest Arun Agarwal Community ENT None declared None identified Susan Emmett School ear and hearing None declared None identified screening, ENT Catherine Mcmahon Hearing screening Employment at None identified in older adults Macquarie University Research Funds NIH/NIDCD James Saunders ENT, school ear and None declared None identified hearing screening Christine Yoshinaga-Itano Newborn hearing Research Fuds None identified screening Xingkuan Bu ENT, hearing screening None declared None identified Patricia Castellanos Community audiology None declared None identified Chitra Chander Public health Paid consultancy None identified (WHO) Name Expertise Disclosure of Management of interest conflict of interest Ivy Chillingulo Public health Paid consultancy None identified Teresa Ching Audiology, None declared None identified hearing screening Jackie Clark Audiology None declared None identified Adrian Davis Audiology, Public Health None declared None identified Kathleen Pichora-Fuller Hearing screening Research Funds None identified in older adults Jean-Pierre Gagne Adult audiology None declared None identified Carmen Kung Cognitive Neuroscience Research Funds None identified Arunda Malachi Public health Paid consultancy None identified (WHO) Vivienne Marnane Speech Pathology Research Funds None identified Norberto Martinez ENT and audiology None declared None identified Serah Ndwega Coommunity audiology None declared None identified Kartin Neumann Audiology, newborn None declared None identified screening Carrie Nieman Hearing screening Employment – Johns None identified in older adults, Hopkins University community ENT School of Medicine, Research Funds – National Institutes of Health, United States Bolajako Olusanya Pediatric audiology Director, Phonics None identified Hearing Centre, Lagos, Nigeria Sowmya Rao Pediatric audiology Paid consultancy None identified (WHO) De Wet Swanepoel Audiology Co-founder hearX None identified digital hearing technologies George Tavartkilaze Audiology None declared None identified Peter Thorne Audiology None declared None identified Kelly Tremblay Adult audiology Research funds, None identified University of Washington Katherine Walls Public health None declared None identified Angela Wong Audiology Research funds None identified ldU nS>Vmim MmMUr : {dMmamV KoÊ`mMo ‘wÔo62