1. Working With Children With Hearing Loss Stephanie Morrison, Lindsay Tucker, Au.D

2. How do we learn language? Exposure: We see language. We hear language. We use language to communicate. We process the world around us through language. Hearing loss creates a barrier to natural language learning. 90% of deaf children are born to hearing parents Hearing parents generally do not know sign language We live in a hearing world. Education is successfully tailored to meet the hearing child’s educational needs. What about the child with hearing loss? How do they learn language? How are they educated? Visual language and or hearing assistive technology can help.

3. Effects of hearing loss Researchers (e.g., Luckner, Slike, & Johnson, 2012) identified the following five potential consequences of hearing loss: 1) Language, Vocabulary, and Literacy Delays 2) Gaps in Background and Domain Knowledge 3) Inadequate Knowledge and Use of Learning Strategies 4) Social Skills Deficits 5) Reliance on Assistive Technology.

4. Quick Facts About 2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears. 1 1 More than 90 percent of deaf children are born to hearing parents. 2 2 One in eight people in the United States (13 percent, or 30 million) aged 12 years or older has hearing loss in both ears, based on standard hearing examinations. 4 4 As of December 2012, approximately 324,200 cochlear implants have been implanted worldwide. In the United States, roughly 58,000 devices have been implanted in adults and 38,000 in children. 9 9 Five out of 6 children experience ear infection (otitis media) by the time they are 3 years old. 10 10 The U.S. Food and Drug Administration (FDA) first approved cochlear implant devices for adults in 1985 and for children in 1990. According to the National Institute on Deafness and Other Communication Disorders, as of December 2010 approximately 70,000 individuals—over half of whom were children—had received cochlear implants in the United States. More than 219,000 individuals have received cochlear implants worldwide.

5. Early Detection of Hearing Impairment (EDHI) Newborn Hearing Screening and Diagnosis In 2013, Centers for Disease Control and Prevention (CDC) data showed that over 97% of newborns in the United States were screened for hearing loss. [Data table] –Of those who were screened, 1.6% did not pass the final or most recent hearing screening. [Data table] Of those babies not passing the hearing screening, 69.0% were diagnosed as either having or not having a hearing loss before 3 months of age. [Data table] There was an increase in the number of infants screened for hearing loss from 2006 (95.2%) to 2012 (96.6%). [Progress in Identifying Infants with Hearing Loss]Progress in Identifying Infants with Hearing Loss

6. Degree of hearing loss. Speech sounds occurs between 20-55 decibels. Normal hearing is 0 to 15 decibels As the degree of loss increases so does the adverse affect on education and language access. A moderate loss equates to missing out on 50% of speech (41 dB to 55 dB) A person is classified as deaf when they have a profound loss (71+ dB)

8. Technology Utilized Hearing Aids Cochlear Implants Bone Anchored Hearing Appliances FM System

9. Continued

10. Bone Anchored Hearing Appliances Conductive Hearing Loss Single Sided Deafness Mixed Losses

11. FM systems Understanding wireless technology FM technology refers to a type of wireless system that helps people better understand speech in noisy situations. FM systems commonly work together with a user’s hearing aids, although systems are also available for those with otherwise normal hearing (such as people who suffer from APD, ADHD etc.). An FM system works like this: The person speaking wears or holds a transmitter microphone, or the transmitter is placed in the middle of the group (picking up speech from all around). Using harmless radio waves, the FM system sends speech signal(s) to the listener, who wears a tiny FM receiver behind the ear.

12. FM Systems and Sound Field Systems Increase signal to noise ratio Benefits all children Repeat answers Classroom systems Personal FMs –directly to child

13. Differences between hearing aids and cochlear implants Although cochlear implants (CI) and hearing aids (HA) serve the same purpose (providing access to sound) there are differences between them. Hearing aids deliver amplified sound to the damaged cochlea. A hearing aid can be programmed to shape the amplification of sound to match the loss. Sound is still being delivered to damaged nerves, so HAs are limited in ability to aid severe and profound loss beyond environmental sounds and vowels in speech. The signal is still processed by the damaged cochlea and sent to the brain with its added distortion. Even with substantial amplification, you may not hear very much, and you become tired and strained due to the loud sounds being presented to your ear.

14. Hearing Aid = mini microphone

15. Hearing Aids and Language Access Increase signal to noise ratio Half back Digital technology –amplify signal 3-6 feet optimal range

16. Hearing Loss Fatigue Putting puzzle together all day Academically demanding classes at the first of the day Less demanding classes at the end Reduce Fatigue Increase signal to noise ratio Visuals represent key concepts Clear concise presentation Outline or organizers Processing time

17. Continued Cochlear implants operate very differently than hearing aids. A cochlear implant bypasses the damaged hair cells by delivering electrical current directly to the cochlear, or auditory, nerve. A cochlear implant presents a wide range of frequencies, regardless of the pre-implantation hearing loss. People who transition from HAs to CIs generally find that compensation techniques such as lip-reading become easier. With hearing aids, many people try to increase the volume as much as possible. Cochlear implants provide plenty of sound, so that you don’t need to have high volumes blasted into your ear just to get those sounds. Your job is to learn how to interpret them so that it becomes second nature.

18. Cochlear Implant = computer processor

19. Advantages of Hearing Aids Advantages of Hearing Aids: It is easy to try different hearing aids to see which works best for you You can take advantage of new technology as it becomes available (improved earmolds, tubing, telecoils, digital/analog programming strategies) Retain residual hearing for possible future technology or medical improvements May provide better low frequency sounds, such as those in vowels. Does not require surgery

20. Advantages of CI Advantages of Cochlear Implants: Eliminates earmolds, their acoustic feedback issues and irritation of the ear bowl Can enable you to hear conversation and thus learn spoken language with relative ease, particularly for those with severe-profound hearing loss May enable you to use a regular telephone Easier high- frequency speech component perception ( /sh/, /s/, /f/, /t/, /k/, /p/, /h/) Better overall hearing at high frequencies Distance hearing is likely better than with hearing aids May enable you to overhear conversations and other environmental sounds Better feedback which may help improve your voice quality May be the only option when a hearing aid is insufficient. May help with auditory neuropathy

21. What is a Cochlear Implant? A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain.

23. More about cochlear implants Profoundly deaf Hearing aids use would not allow access to speech Must learning to listen Implant off = profoundly deaf Mini expensive computers Damaged by dampness, heat, static electricity Use sign language interpreter

24. Cochlear Implant Manufacturers Med- El Advanced Bionics Cochlear Corporation

25. Med-El

26. https://www.youtube.com/watch?v=qxnqJI 1e8So&index=11&list=PLT_-- N4wea5Dsb48603HI8obw53bCUZ0e

27. Advacned Bionics Works with Phonak Easy FM capabilities

28. https://www.youtube.com/watch?v=szAtDQ 9sJOU

29. Cochlear Corporation Works with Resound Hearing Aids Direct FM capability

31. Trouble Shooting If no sound is heard Visually inspect the cable for any damage or breakage and verify it is firmly attached to the headpiece and sound processor. Remove any materials (hat, scarf, headband, etc.) that may be covering the microphone. Unaided listeners may perform a listening check of the microphones as described in the Replace the cable. Replace the headpiece. Remove the battery cartridge. Reattach the battery cartridge.

32. Continued If static or distorted sounds are heard, try the following troubleshooting steps: Remove any materials (hat, scarf, headband, etc.) that may be covering your microphone. Visually inspect the cable for any damage or breakage. If any problems are noted, replace cable. Verify that the cable is firmly attached to the headpiece and sound processor and that the headpiece is positioned properly on the head. If the input is from the headpiece microphone and the static or distorted sounds persist, replace the headpiece cable. Visually inspect the microphones for signs of debris or wear. If available, replace the headpiece and/or headpiece Color Cap. Clean the battery contacts on the processor. Replace the Microphone Cover.

33. LING 6 Sound Check

34. Why are Ling Sound important?

35. What can you do improve language access? Increase signal to noise ratio Listening Checks/ assistive technology working Use visuals and more visuals Use Close Captioning Outlines and organizers Model thinking Establish one at a time talking … point Role play Allow for processing time Get the students attention when addressing them Keep face uncovered to allow for lip reading and facial cues Allow TOD and interpreters to be part of your team Seek to understand Be flexible, approachable, and teachable

36. Resources http://www.nidcd.nih.gov/health/statistics/p ages/quick.aspx http://www.cdc.gov/ncbddd/hearingloss/eh di-data2013.html