deafness and hearing loss dickey-lamoure special education unit special thanks to lisa krueger

Deafness and

Hearing LossDickey-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)

• 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)

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 AudiogramAn 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 AudiogramThe 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

X’s mark hearing in the left ear.

O’s mark hearing in the right ear.

By comparing the speech banana to this person’s hearing loss, we can get some information regarding this person's ability to hear speech.

Types of Hearing Loss

Conductive Hearing LossA 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 earMost are medically or surgically treatable¹ (most common)

Types of Hearing LossConductive Hearing Loss

Sensori-Neural Hearing LossA problem in the inner ear or auditory nerve. May be caused by: ° Maternal or postnatal diseases ° Rh factor ° Genetic Syndromes ° Heredity ° Exposure to loud noisesLosses are permanent but are helped by hearing aids or cochlear implants

Types of Hearing LossConductive Hearing Loss

Sensori-Neural Hearing Loss

Mixed Hearing Loss

A combination of the two.

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).



• 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



• 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.



• 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).



• 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.

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.

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 Communicat

ionVocabulary 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).

Educational Impact

•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 don’t catch up without intervention.

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 can’t hear word endings ("-s" or "-ed“) and misunderstand or misuse verb tense, plurals, subject-verb agreement, and possessives.


ion

Educational Impact

•Teacher should expand on what the student says (e.g. “medicine—you got some medicine for your cold?”)

•Peer comments and PA announcements need to be repeated.

•Frequent checks for understanding.


ion

Educational Impact

Speaking• Often can’t hear “quiet”

sounds ("s," "f," "t") & don’t 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 doesn’t realize he missed critical sounds when words sound alike (vacation, invitation)

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.


ion

Educational Impact

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


ion

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.

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.

Communication Do’s and Don’ts

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

DON’T• 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 on my mother’s white sofa?);

• Use negative definition (e.g.: cold—not hot);• Use general terms to give specific meaning

(e.g.: a type of walk—trot);• Rewrite at a lower level to explain vocabulary

context;• Correctly model the student’s incorrect syntax;• Use pictures or illustrations to show meaning;• Put vocabulary in sentences to show its

context;• Dramatize the meaning of a concept.

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 student’s attention before addressing him;

• Don’t 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 (“Let’s move on,” “Any

questions?”).

"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

Cochlear ImplantsEncouraging Young Children

to Use Language

End ShowBibliography

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

Deaf Culture / Sign Language Assistive Listening Devices

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 LanguageAmerican Sign Language

– a manual language distinct from spoken English;

– Conceptual;– Has its own syntax and grammar.

• Signed EnglishSigned 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

– 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

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.”).

Encouraging Young Children

to Use Language• Repeat what the child says; give a more acceptable way to say it or expand on it.

– Don’t 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).

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 you’re joking!

• Begin conversations at or slightly above the child’s level.


Young Children to Use Language• Encourage the child to use puppets to act out

conversations in different situations;

• Don’t 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).


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.


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 student’s 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 Real-

time 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

deafness and hearing loss dickey-lamoure special education unit special thanks to lisa krueger

Documents

unilateral hearing loss

incidence of hearing

extreme hearing loss

hearing loss wolff

severeprofound hearing

significant hearing

irreversible hearing

hearing aids