Deafness and Hearing Loss

1
Deafness andHearing Loss
Dickey-LaMoure Special Education Unit Special
Thanks to Lisa Krueger
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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)
• Over 1 million children have a hearing loss.
  (U.S. Public Health Service, 1990)
• 5 of children 18 and under have hearing loss.
  (US Dept of Health and Human Services, 1991)
• 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)

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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)

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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.
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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.
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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 gt Profound
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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.
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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 infection¹ Malformed
or misshaped ear Most are medically or surgically
treatable
¹ (most common)
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Types of Hearing Loss

• 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
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Types of Hearing Loss

• Conductive Hearing Loss

Sensori-Neural Hearing Loss
Mixed Hearing Loss
A combination of the two.
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Levels of Hearing Loss

• Hearing loss in one ear.
• Symptoms
• Difficulty locating the source of sounds,
• Problems understanding speech in some situations
  (distant speech or with background noise).

• Unilateral
• Mild
• Moderate
• Severe
• Profound

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Levels of Hearing Loss

• Unilateral
• Mild
• Moderate
• Severe
• Profound

• May cause you to miss 25-40 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

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Levels of Hearing Loss

• Unilateral
• Mild
• Moderate
• Severe
• Profound

• May cause you to miss 50-75 of the speech
  signal.
• Symptoms
• May hear at short distances and face-to-face,
  but problems if distance or visual cues changed.
• Problems hearing normal conversations
• Problems hearing consonants in words.

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Levels of Hearing Loss

• 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-to-face, in quiet, and
  accompanied with speech reading).

• Unilateral
• Mild
• Moderate
• Severe
• Profound

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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").

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

• Analog
• Programmable
• Digital

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

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Effects of Hearing Loss on Communicationand
the Educational Impacts
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Effect on Communication
Educational Impact

• Vocabulary develops more slowly
• Concrete words ("cat" or "jump) are easier than
  abstract words ("before or "after)
• Function words ("the or "an) are difficult.
• Words with multiple meanings are hard ("bank" can
  be a place to put money or the edge of a stream).
  

• Word meanings need to be taught (especially
  multiple meanings)
• Reading writing skills develop more slowly
• Limited comprehension due to difficulty with
  inferences/deductions
• The gap widens with age
• Children with hearing loss dont catch up without
  intervention.

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Effect on Communication
Educational Impact

• Sentence Structure
• Children comprehend and produce shorter, simpler
  sentences
• Have difficulty understand-ing and writing
  complex sentences (The teacher whom I have for
  math was sick today. )
• Often cant hear word endings ("-s" or "-ed) and
  misunderstand or misuse verb tense, plurals,
  subject-verb agreement, and possessives.

• Teacher should expand on what the student says
  (e.g. medicineyou got some medicine for your
  cold?)
• Peer comments and PA announcements need to be
  repeated.
• Frequent checks for understanding.

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Effect on Communication
Educational Impact

• Speaking
• Often cant hear quiet sounds ("s," "f," "t")
  dont use them. Quiet sounds carry up to 90 of
  word meanings (tense, plurals, possessives).
• Speech may be difficult to understand.
• May not hear their own voice
• May speak too loudly or softly
• May use a high pitch
• Speech may sound mumbled because of poor stress,
  inflection, or rate of speaking.

• Delayed Spoken Language
• Lost listening time (past and present) results
  in delayed speech, poor intelligibility and voice
  quality.
• Missed or Confused Sounds or Words
• Student may act as if he understands but doesnt
  realize he missed critical sounds when words
  sound alike (vacation, invitation)

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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.

• 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

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Effect on Communication
Educational Impact

• Social Functioning
• Language delays are tied to delays in social
  skills.
• Children with severe-profound loss feel isolated,
  without friends, unhappy in school (esp. if
  interaction with other children with hearing loss
  is limited).
• Social problems are more frequent in children
  with mild-moderate hearing loss than in those
  with severe-profound loss.

• Delayed Social Skills and Decreased Self-Esteem
• Student may feel different because she wears
  hearing aids.
• Social skills need to be taught.
• Increased Fatigue
• The effort of listening and watching results in
  fatigue.
• This can lead to irritability or behavior
  problems.

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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.

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Communication Dos and Donts

• DO
• Speak normally
• 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

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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.

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Language Remediation Techniques

• Give synonyms use them in a sentence with
  parentheses (e.g. What effect (outcome) will
  this red stain have on my mothers white sofa?)
• 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.

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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

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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?).

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"What matters deafness of the ear, when the mind
hears. The one true deafness, the incurable
deafness, is that of the mind. Victor Hugo to
Ferdinand Berthier, November 25, 1845
For more information, click on one of the
following links
Cochlear Implants
Encouraging Young Children to Use Language
Deaf Culture / Sign Language
Assistive Listening Devices
End Show
Bibliography
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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.
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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.

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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.
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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.

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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.

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Deaf Culture

• People who are deaf forming a community
• Not necessarily geographical
• Held together by a common language American Sign
  Language
• People with shared experiences and common
  interests.
• 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
• Negative values
• Speech
• Thinking like a hearing person

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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.

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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.).

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Encouraging Young Children to Use Language

• 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
• 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).

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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,
  (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
  joking!
• Begin conversations at or slightly above the
  childs level.

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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).

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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.

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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

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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.).

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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

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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

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Captioning

• Closed-Captioning
• Prerecorded programs
• Real-time Captioning
• Presentations/lectures and live telecasts
• CART
• Computer-Aided Real-time Translation
• Personal Captioning
• Palm or Clip-On Captioning Display

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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.ht
  ml
• 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