1. Deafness and Hearing Loss
Dickey-LaMoure Special Education Unit
Special Thanks to Lisa Krueger

2. 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)

3. The Prevalence and Incidence of Hearing Loss in the United States
7 of every 1000 school-age students bilateral hearing loss;
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)

4. 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 eardrum (tympanic membrane), the hammer (malleus), the anvil (incus), the stirrup (stapes)
*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.

5. 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.
Frequency or pitch ranges from low sounds (125) to high sounds (8000).
Intensity or decibels ranges soft sounds (a 20dB) to loud sounds (a jet 110 dB.

6. 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

7. 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.

8. Conductive Hearing Loss
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
3 types of hearing loss: conductive, sensori-neural, and mixed.
If mother is Rh negative and the father is Rh positive, then Rh incompatibility problems. Mixing of Rh negative and Rh positive blood will make the mother's body develop antibodies against the different Rh factor.
¹ (most common)

9. Conductive Hearing Loss Sensori-Neural Hearing Loss
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
3 types of hearing loss: conductive, sensori-neural, and mixed.
If mother is Rh negative and the father is Rh positive, then Rh incompatibility problems. Mixing of Rh negative and Rh positive blood will make the mother's body develop antibodies against the different Rh factor.

10. Conductive Hearing Loss Sensori-Neural Hearing Loss
Types of Hearing Loss
Conductive Hearing Loss
Sensori-Neural Hearing Loss
Mixed Hearing Loss
A combination of the two.
3 types of hearing loss: conductive, sensori-neural, and mixed.
If mother is Rh negative and the father is Rh positive, then Rh incompatibility problems. Mixing of Rh negative and Rh positive blood will make the mother's body develop antibodies against the different Rh factor.

11. 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).
Unilateral
Mild
Moderate
Severe
Profound

12. 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

13. 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.

14. 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-to-face, in quiet, and accompanied with speech reading).
Unilateral
Mild
Moderate
Severe
Profound

15. 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").

16. 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.
ITE, ITC, and CIC are not recommended for children due to the dexterity required. CICs also may not be used with older adults for the same reason.

17. 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.
Programmable: A hearing health care professional (audiologist) connects the hearing instrument to a computer and sets a listening program in the hearing aid based upon the patient's hearing loss. These can have different "programs" for different listening environments, e.g., quiet, noisy, music listening, etc.
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.

18. Hearing aids will restore hearing to normal.
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.

19. Effects of Hearing Loss on Communication and the Educational Impacts

20. 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 don’t catch up without intervention.

21. 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 can’t 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. “medicine—you got some medicine for your cold?”)
Peer comments and PA announcements need to be repeated.
Frequent checks for understanding.

22. Effect on Communication
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)

23. Effect on Communication
Educational Impact
Lack of Incidental Learning
Language acquisition is most critical between 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
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.

24. 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.

25. 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.

26. Communication Do’s and Don’ts
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

27. 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 strategies—prediction, compare/contrast, recall, sequencing, inferencing, etc.

28. 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.

29. 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;
Get attn before addressing student—call their name so they focus in on the comment.
Make sure face/mouth is visible—this gives the opportunity for speech reading. Also, don’t chew gum, put a pencil in your mouth, or cover your mouth.

30. 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?”).
Get attn before addressing student—call their name so they focus in on the comment.
Make sure face/mouth is visible—this gives the opportunity for speech reading. Also, don’t chew gum, put a pencil in your mouth, or cover your mouth.

31. "What matters deafness of the ear, when the mind hears
"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
Bibliography
End Show

32. 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.

33. 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.

34. 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.

35. Sign Language American Sign Language Signed English
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.

36. Deaf Culture “Deaf culture” vs. “deaf” Deaf  disabled
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.
Not every deaf person adheres to the ideals of Deaf culture.

37. 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
Not every deaf person adheres to the ideals of Deaf culture.

38. 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.
Not every deaf person adheres to the ideals of Deaf culture.

39. 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.”).

40. 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).

41. 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.

42. Suggestions for Encouraging 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).

43. 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.

44. 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

45. 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.).
Infrared--There must be an unobstructed line of sight for the light beam to travel between transmitter and receiver. Also, it doesn’t work with sunlight or bright light.
Loop—student must be inside the loop. Good for small settings but fluorescent lighting can interfere with the signal.

46. 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
Infrared--There must be an unobstructed line of sight for the light beam to travel between transmitter and receiver. Also, it doesn’t work with sunlight or bright light.
Loop—student must be inside the loop. Good for small settings but fluorescent lighting can interfere with the signal.

47. 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

48. Captioning Closed-Captioning Real-time Captioning CART
Prerecorded programs
Real-time Captioning
Presentations/lectures and ‘live’ telecasts
CART
Computer-Aided Real-time Translation
Personal Captioning
Palm or Clip-On Captioning Display
CART consists of a reporter with a notebook computer and a steno keyboard, sitting next to a deaf or hard of hearing person. The CART reporter writes everything that happens, and the screen on the notebook computer is turned so that the deaf or hard of hearing person can read it. This differs from traditional court reporting in that the CART reporter is not just there to create a verbatim record, but to help the person understand the proceedings, which may mean paraphrasing, interpreting, and two-way communication.
Using wireless radio transmission the PALM CAPTIONING DISPLAY provides easy to read text captioning anywhere within a venue. The battery powered unit is held on a goose neck allowing complete flexibility in positioning. “Reading captions from a PALM CAPTIONING DISPLAY is like glancing down at the speedometer while you drive.”
A pair of glasses can now have a CLIP-ON-CAPTIONING DISPLAY attached to the frame. The text to be captioned is provided through wireless transmission and the words "float" about 18 inches in front of the eye. The captioning is always between the eye and the object being viewed.

49. Bibliography
Normal Auditory Development by Ellen Goldman, Communication Skill Builders, 1990.
“The Bridge to the Future” Language Arts Curriculum by the North Dakota School for the Deaf