Hearing Assessment Centres

APPS is establishing centers in Karachi, Lahore, Peshawar and Quetta.  The aim is  to diagnose deafness among children as soon as possible and rehabilitate them with instruments.


In countries where care of newborn is poor and consanguinity (cousin marriages) is practiced, the incidence of bilateral moderate to profound hearing loss is 7/1000 birth as compared to UK (1/1000 birth)

Further 7/1000 children will develop a significant loss in both ears by the age of 5.

Bilateral mild hearing loss and unilateral loss accounts for 20/1000 births by the age of 5.


Phase 1

Developing a ‘Hearing Centre’ to diagnose Deafness among children as soon as possible and rehabilitate them with instruments.

Phase 2

Introduce Targeted Newborn Hearing Screening as some children are at higher risk of developing hearing loss (Family history of hearing loss, Mother suffering with CMV, Toxoplasmosis, HIV and Herpes infection in first trimester, Non-immune mother to Rubella, Evidence of hypoxia in neonate and administration of ototoxic medication)

Why in two phases?

Screening should only take place when a child diagnosed after screening can be rehabilitated. It would be a medical crime to tell parents that a child with fail outcome cannot have diagnostic tests and rehabilitation when required.

Room Requirement:

Two rooms centrally air-conditioned (noise is absent)

Room 1

Diagnostic tests for children with hearing loss in view of suspicion of:

Hearing impairment
Speech delay
Comprehension problem
Poor educational progress
Behavioural problems
Balance disorder

Those children with no concern but when there is:

> Family history of hearing loss in parents, siblings & up to first cousins                    
> History of CMV virus
> Mother with non-immune status to Rubella
> Down's syndrome, Cleft palate
> Meningitis
> All babies with history of bacterial meningitis

Room 2

Hearing aid provision

A hearing aid analysis machine will be provided.

Hearing aids will be available at 20% of the cost in market due to bulk buying.


Two Audiologists working together, one who has done MSc in Audiology

Salary of Audiologists: Rs 40000 and Rs 20000 = Rs 60,000 in stage 1


On site by Audiologists from UK and Pakistan (Dr Nadeem Mukhtar)

Cost of Instruments:

VRA =                         £4000

Computer =                  £500

Audiometre=                £2000

Tympanometre=           £6000 (normal and newborn)

Otoscope=                    Donated- no cost

Hearing aid machine:   £4000

Audiometer for older children= Donated-no cost

Screening AABR= Donated but needs calibration £500

Total cost of immediate plan: £ 17,000

Staff cost for first years:      Rs 720,000

In second year local stakeholders and Government of Pakistan will be asked to takeover this project in terms of staff and equipment cost.


Monitoring: Internet CCTV cameras in the room will allow APPSUK to monitor the test at any time and listen to the history taking.

Experts in UK will provide advice and will visit the centre with proper planning during their holidays (No money will be paid to doctors doing special clinics).

We estimate that in year one the centre will fit  hearing aids to 50 babies (learning curve) and from year 2 onwards the number will increase progressively to 200/year by year 5.

APPS UK will provide 50 hearing aids free for year 1 to avoid any problem of rehabilitation and slowly we will introduce charge for the hearing aid unless a long term sponsor can be found.

Zanfha Inititiative has kindly pledged to raise £10,000 for this project. Please click here for more details about Zanfha: http://zanfha.org/projects/the-disability-you-dont-see/hearing-assessment-centre-appsuk

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APPS UK Foundation Reg No: 1163957