Deafness and Hearing Loss

Dickey-LaMoure Special Education Unit

Special Thanks to Lisa Krueger

The Prevalence and Incidence of Hearing Loss in the United States

About 28 million people have a hearing loss Of these, 80% have an irreversible hearing loss.
(NIDCD, 1989)
Service, 1990)

Over 1 million children have a hearing loss.

Health and Human Services, 1991)

(U.S. Public Health (US Dept of

5% of children 18 and under have hearing loss.

1 in every 1,000 infants has severe/profound hearing loss. (NIDCD, 1989) 83 of every 1,000 children have an educationally significant hearing loss. (U.S. Public Health Service, 1990)

The Prevalence and Incidence of Hearing Loss in the United States

7 of every 1000 school-age students bilateral hearing loss; 16-19 of every 1000 have unilateral hearing loss These may significantly interfere with education. (Berg,
F.H. 1985)

9 of every 1000 school age children experience severe to profound hearing loss, (Schein, J., and Delk, M. 1974) 10 in 1000 school age students have permanent sensorineural hearing loss. (American Speech-Language-Hearing
Association, 1993)

Approximately 30% of children who are hard of hearing have a disability in addition to a hearing loss
(Wolff, A.B., & Harkins, J.E. 1986)

Anatomy of the Ear

*Sound waves collect in the outer ear and move down the ear canal. *The eardrum vibrates; these vibrations pass along to the bones of the middle ear to the fluid in the inner ear.

*The vibrating fluid moves the nerve cells in the cochlea, which converts the vibrations into nerve signals. *These signals are then passed to the auditory (cochlear) nerve, and on to the brain which interprets the sound.

The Audiogram
An audiogram is a picture of your hearing. It is a graph of the softest sounds you can hear. The yellow banana shows where all the speech sounds are heard when speaking at a normal level.

The Audiogram
The softest sound you are able to hear is called your threshold. 0-15 dB Normal 16-25 dB Slight 26-40 dB Mild 41-55 dB Moderate 56-70 dB Mod-Sev 71-90 dB Severe 91dB or > Profound

The Audiogram
Xs mark hearing in the left ear.
Os mark hearing in the right ear. By comparing the speech banana to this persons hearing loss, we can get some information regarding this person's ability to hear speech.

Types of Hearing Loss

Conductive Hearing Loss
A problem in the outer or middle ear. May be caused by: Excessive ear wax A perforated eardrum Broken ossicle (middle ear bone) Middle ear infection Malformed or misshaped ear Most are medically or surgically treatable
(most common)

Conductive Hearing Loss Sensori-Neural Hearing Loss

A problem in the inner ear or auditory nerve. May be caused by: Maternal or postnatal diseases Rh factor Genetic Syndromes Heredity Exposure to loud noises Losses are permanent but are helped by hearing aids or cochlear implants

Types of Hearing Loss

Conductive Hearing Loss Sensori-Neural Hearing Loss

A combination of the two.

Types of Hearing Loss

Mixed Hearing Loss

Levels of Hearing Loss

Unilateral Mild Moderate Severe Profound
Hearing loss in one ear.

Symptoms:
Difficulty locating the source of sounds, Problems understanding speech in some situations
(distant speech or with background noise).

Levels of Hearing Loss

Unilateral Mild Moderate Severe Profound
May cause you to miss 2540% of the speech signal Problems with clarity. Symptoms: Problems understanding someone farther away than a normal distance for conversation

Problems understanding with background noise. Problems understanding weak voices

Levels of Hearing Loss

Unilateral Mild Moderate Severe Profound
May cause you to miss 5075% of the speech signal. Symptoms: May hear at short distances and face-toface, but problems if distance or visual cues changed. Problems hearing normal conversations Problems hearing consonants in words.

Levels of Hearing Loss

Unilateral Mild Moderate Severe Profound
Difficulty hearing in all situations. Speech is heard only if the speaker is talking loudly or at close range.

May cause you to miss up to 100% of the speech signal. Symptoms: Inability to converse except under ideal circumstances (i.e., face-toface, in quiet, and accompanied with speech reading).

Levels of Hearing Loss

Unilateral Mild Moderate Severe Profound
Most extreme hearing loss. May not hear loud speech or any speech at all. Forced to rely on visual cues instead of hearing as your main method of communication.

May include sign-language and/or speech reading (also

commonly referred to as "lip reading").

Hearing Aid Styles

Behind-the-Ear (BTE) for users with a mild to a profound loss.
In-the-Ear (ITE) for a variety of losses but not recommended for children.

In-the-Canal (ITC) for users w/ mild to moderate loss but not for children.

Completely-in the-Canal (CIC) for users w/ mild to moderate loss but not for children.

Analog

Hearing Aid Types

Amplifies all sound, including background noise; User has a volume control to adjust the amount of amplification

Programmable Digital

Amplifies all sounds, but make soft sounds louder and loud sounds softer. Most automatically adjust volume. Can be precisely programmed to match the patient's individual hearing loss, sometimes at each specific frequency/pitch. Better clarity, less circuit noise, faster processing of sound, and improved listening in noise. Adjusts volume automatically.

Fact vs. Myth?

Hearing aids will restore hearing to normal.
Hearing aids are designed to aid a person's hearing that is still intact. Hearing aids cannot restore hearing nor can they cure your hearing problem. They help to get the most out of the hearing that is left and are only part of hearing rehabilitation. Hearing aids may need to be supplemented by auditory training.

Effects of Hearing Loss on Communication

and the

Educational Impacts

Effect on Communication

Educational Impact

Vocabulary develops Word meanings need to more slowly be taught (especially multiple meanings) Concrete words ("cat" or Reading & writing skills "jump) are easier than abstract words ("before develop more slowly or "after) Limited comprehension due to difficulty with Function words ("the or inferences/deductions "an) are difficult. The gap widens with age Words with multiple meanings are hard Children with hearing ("bank" can be a place to put loss dont catch up money or the edge of a stream). without intervention.

Effect on Communication
Sentence Structure
Children comprehend and produce shorter, simpler sentences;

Educational Impact
Teacher should expand on what the student says (e.g. medicineyou got

Have difficulty understandsome medicine for your cold?) ing and writing complex sentences (The teacher whom I Peer comments and PA
have for math was sick today. );

announcements need to be repeated. Often cant hear word endings ("-s" or "-ed) and Frequent checks for misunderstand or misuse verb tense, plurals, subject- understanding.
verb agreement, and possessives.

Effect on Communication

Educational Impact

Speaking Delayed Spoken Language Often cant hear quiet Lost listening time (past sounds ("s," "f," "t") & dont use and present) results in them. Quiet sounds carry delayed speech, poor up to 90% of word meanings intelligibility and voice (tense, plurals, possessives). quality. Speech may be difficult to Missed or Confused Sounds understand. or Words May not hear their own voice; May speak too loudly or softly; Student may act as if he May use a high pitch; understands but doesnt Speech may sound mumbled realize he missed critical because of poor stress, sounds when words sound inflection, or rate of speaking. alike (vacation, invitation)

Lack of Incidental Learning Language acquisition is most critical between 0 - 6 years; Most children with hearing loss are identified by age 2. 90% of learning is incidental (absorbed or over- heard from the environment). Children with hearing loss miss out on much information

Effect on Communication

Educational Impact
Academic Achievement Difficulty with all academic areas (esp. reading & math). Achievement is related to
parent involvement, and quantity, quality, and timing of support services received.

Without intervention:
Children with mild-moderate loss achieve 1-4 grade levels lower than peers. Children with severe-profound loss usually achieve skills no higher than 3rd-4th grade level.

Effect on Communication

Educational Impact

Social Functioning Delayed Social Skills and Language delays are tied to Decreased Self-Esteem delays in social skills. Student may feel Children with severedifferent because she profound loss feel isolated, wears hearing aids. without friends, unhappy in Social skills need to be school (esp. if interaction with taught. other children with hearing loss is limited). Increased Fatigue Social problems are more The effort of listening and frequent in children with watching results in fatigue. mild-moderate hearing loss This can lead to irritability than in those with severeor behavior problems. profound loss.

Communication Approaches
Auditory-Oral Approach - trains the
student to use speech and hearing abilities. Total Communication - uses combinations of speech, hearing, vision, speech-reading, signing, fingerspelling, reading, & writing. Sign Language - trains the student to use a visual mode of communication. Cued Speech - uses 8 different hand shapes (cues) to help the listener distinguish between sounds that look alike on the lips.

DO Speak normally

Communication Dos and Donts

Face the person so he can read your lips

Speak more slowly

Use shorter sentences Confirm the message by repeating, rephrasing or writing it down

DONT Exaggerate your words Shout or mumble Look the other way Move around while speaking Talk too quickly Cover your mouth or speak with your mouth full Change the subject without warning Talk in noisy or dark areas

Techniques for Increasing Reading Comprehension

Define new vocabulary; Provide a variety of reading material on similar subjects; Send the book home to review; Role play or act out the story; Provide hands-on activities using objects in the story; Discuss vocabulary/concepts prior to reading; Teach cognitive/language strategies to help understand the text; Outline major points of the story.

Language Remediation Techniques

Give synonyms; use them in a sentence with parentheses (e.g.: What effect (outcome) will this red stain have Use negative definition (e.g.: coldnot hot); Use general terms to give specific meaning (e.g.: a type of walktrot); Rewrite at a lower level to explain vocabulary context; Correctly model the students incorrect syntax; Use pictures or illustrations to show meaning; Put vocabulary in sentences to show its context; Dramatize the meaning of a concept.
on my mothers white sofa?);

Classroom Tips
Use preferential seating: near the front; better ear toward the teacher; away from noise; to the side (better view of classmates); light to their back; semicircle for group work;
Get students attention before addressing him;

Dont talk while walking around the room;

Identify student speakers;

Classroom Tips
Repeat peer comments & PA announcements;

Use visual supports

(pictures, charts, diagrams);

Write announcements, instructions, vocabulary, assignments, on the board;

Check for understanding by asking questions;

Use captioned videos;

Use transition phrases

(Lets move on, Any questions?).

when the mind hears. The one true deafness, the incurable deafness, is that of the mind.
Victor Hugo to Ferdinand Berthier, November 25, 1845

"What matters deafness of the ear,

For more information, click on one of the following links:

Cochlear Implants Encouraging Young Children to Use Language Assistive Listening Devices

Deaf Culture / Sign Language

Bibliography

End Show

Cochlear Implants
What are they?
Electrodes that are surgically implanted into the cochlea or inner ear with an external sound processor to stimulate the hearing (auditory) nerve with electrical current.

Cochlear Implants
What are they? How do they work?
Hearing aids amplify sound; Cochlear implants compensate for damaged or non-functional parts of the inner ear.

Cochlear Implants
What are they? How do they work? What can they do?
Cochlear implants do not restore or create normal hearing. They provide a sense of sound, give some auditory understanding of the environment, and help patients understand speech.

Sign Language
American Sign Language
a manual language distinct from spoken English; Conceptual; Has its own syntax and grammar.

Signed English
a manual language that follows English uses signing or spells out each spoken word, including word endings.

Deaf Culture
Deaf culture vs. deaf
A capital "D" indicates a person who follows Deaf culture A lowercase "d" refers to the physical nature of deafness

Deaf disabled
It is a different way of being.

Deaf Culture
People who are deaf forming a community Highlighted by a fierce sense of pride in a hard-won ability to overcome adversity. Positive Values:
Fluency in ASL, Ability to tell stories well Very strong sense of group loyalty Speech; Thinking like a hearing person

Not necessarily geographical; Held together by a common language: American Sign Language; People with shared experiences and common interests.

Negative values:

Deaf Culture
Members of the American Deaf community tend to intermarry; Many wish for a deaf child so they can pass on their heritage, values, and culture.

Encouraging Young Children to Use Language

Encourage turn-taking:
Pause after you say something give the child an opportunity to respond

Describe what you and the child see, hear, & do as you engage in different activities; Use short, simple phrases; Talk about what will happen in the future. Label & explain objects or activities (You have an apple; you have a red apple.).

 Repeat what the child says; give a more acceptable way to say it or expand on it.
Dont correct a child in the middle of sharing an exciting experience

Encouraging Young Children to Use Language

If the child says me go circus, say You went to a circus! Where was the circus? What did you see?

Watch the child; show interest in what they say.

Play. Act out situations. Encourage the child to use imaginative settings (the moon, a bridge, in a car).

Suggestions for Encouraging Young Children to Use Language

Say things that keep a conversation going Give the child a part of an task and encourage them to ask for the rest (crayons but no paper, hat & mittens but no coat). Use silly situations to encourage responses,
joking!
(e.g., put their shoe on your foot, make pudding and stir in the box, give silly responses to their questions), but be sure they know youre

Begin conversations at or slightly above the childs level.

Suggestions for Encouraging Young Children to Use Language

Encourage the child to use puppets to act out conversations in different situations; Dont assume the correct response when using pictures to encourage responses.

Ask questions to find out what the child is thinking;

Create situations where the child needs assistance (e.g. put toys on a high shelf).

Suggestions for Encouraging Young Children to Use Language

Ask questions using appropriate facial expression.
Begin with yes/no questions Then what, where, who Why & how come later

Play games that encourage the child to ask questions.

Suggestions for Encouraging Young Children to Use Language

Encourage discussion of pictures when reading to the child.
Model and expand on their utterances Older children can read to younger children

Write.
Younger children practice scribbling Then letters & words Older children can write stories

Assistive Listening Devices

FM Listening System
Teachers use a hand-held mike Voice is transmitted via radio waves Signal captured by a receiver worn by the student.

Infrared System
Sound is carried on an infrared beam of light
Transmitter and receiver closely resemble the FM system (Most popular in movie theatres.).

Assistive Listening Devices

Loop System
A loop of wire circles room near ceiling or floor Input received from a mike Sound transmitted by creating a magnetic field Hearing aid or earpiece receives sound

Sound-Field System
Another FM system
Signal travels to speakers throughout the room Everyone in the room benefits

Why use FM Systems?

They boost the Signal to Noise ratio
Improves academic achievement (esp. for younger students) Decreases distractibility; increases on-task behavior Focuses attention on verbal instruction & activities Increases sentence recognition Increases language growth Improves quality of students voice when speaking Reduces vocal strain and fatigue for teachers Increases mobility for teachers

Captioning
Closed-Captioning
Prerecorded programs

Real-time Captioning
Presentations/lectures and live telecasts

CART
Computer-Aided Realtime Translation

Personal Captioning
Palm or Clip-On Captioning Display

Bibliography
Normal Auditory Development by Ellen Goldman, Communication Skill Builders, 1990. http://www.aidb.org/asd/deaf-info.asp http://www.cdc.gov/ncbddd/dd/ddhi.htm http://www.velocity.net/~lrose/deaf/asl.html http://clerccenter.gallaudet.edu/Literacy/index.html http://www.agbell.org/ http://www.emedicine.com/ent/topic478.htm http://www.audiologynet.com/hearing-aids.html http://www.hearpro.com/id21.htm http://www.entcolumbia.org/hearaid.htm http://www.listen-up.org/haid/hear-aid.htm http://www.hearingaidhelp.com/ http://www.nidcd.nih.gov/health/hearing/hearingaid.asp http://www.amhear.com/ http://www.searshearing.com/products/technology http://deafness.about.com/od/cochlearimplants/ http://www.entcolumbia.org/cochimp.htm http://clerccenter2.gallaudet.edu/KidsWorldDeafNet/e-docs/CI/index.html http://www.listen-up.org/edu/assist.htm http://www.beginningssvcs.com/assistive_technology/about_alds.htm http://www.deafservices.utah.gov/hh/devices.php http://deafness.about.com/cs/educationgeneral/a/fmsystems.htm?terms=deaf+voice http://www.audiologynet.com/anatomy-of-the-ear.html http://www.earinfo.com/howread1.html http://www.pacificaudiology.com/audiogram/uya.html http://www.deafbiz.com/links/captioning.html http://www.asha.org/public/hearing/disorders/effects.htm The Bridge to the Future Language Arts Curriculum by the North Dakota School for the Deaf