Babak saedi Assistant professor of tehran university, Imam khomeini hospital

 How the Ear Hears  Types of Hearing Loss  Amplification & Assistive Devices  Teaching Strategies

 Outer ear  The pinna is a collector of sound wave vibrations that are sent through the external ear canal.  Middle Ear  A tympanic membrane and three tiny bones, incus, malleus and stapes, move in harmony to send the vibrations into the inner ear.  Inner Ear  The vibrations are changed into electrical impulses that are sent to the brain to create what we understand as “hearing.”

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 Conductive Hearing Loss  Sensorineural Hearing Loss  Mixed Hearing Loss  Progressive Hearing Loss

 Definition  Loss of hearing that originates in the outer or middle ear.  A mild hearing loss is caused from the fluid buildup in the middle ear from a middle ear infection, or otitis media.

Healthy tympanic membrane Acute otitis media with fluid Chronic otitis media Otitis media with tympanic membrane hole or perforation Otitis media treatment - tympanic membrane hole or perforation with a ventilator tube in place

 Damage in the inner ear.  Usually causes a permanent hearing loss

 Hearing loss that involves the middle and inner ear.

Normal 0-15 Mild Moderate Severe Profound

 A gradual and increasing loss of hearing over time  Immediate medical referral and treatment is necessary

 Hearing Aids cannot fix a hearing loss  Hearing Aids only amplifies incoming sound for the child  Types of Hearing Aids

 Programmable  Computer programmed to provide some flexibility and enhanced sound quality with minimal fine tuning to the hearing loss  Digital  Computer programmed to provide maximum flexibility and exceptional sound quality with fine tuning to the hearing loss

Earmold Digital Hearing Aid Digital Hearing Aid & Earmold

 A transmitter is worn by the teacher with a microphone near the mouth, and the student hears the teacher’s voice on their personal FM receiver.  An FM receiver is worn by the student as a personal listening device allowing them to have direct listening to the teacher’s voice.

 Reduces the signal-to-noise ratio.  Brings the teacher’s voice closer to the student’s ears.

Microphones, transmitter, receiver, neckloop transducer, and external earbud.

 FM’s are flexible and ESSENTIAL for children with hearing loss  In ANY classroom or cooperative learning situation  Can be self-contained functioning as a hearing aid  Can be attached to a child’s hearing aids

 The cochlea is electrically stimulated with surgically inserted device.  Children with profound loss have a better chance of good language and literacy skills when implanted early.

Transmitter headpiece and BTE processor Transmitter headpiece with a diagram of the electrode in the cochlea.

Causes development delays for students  Academically  Socially  Vocationally

 Delays in auditory processing skills affect language skill development  Delays from auditory processing affect the receptive and expressive language skills for speech  Language developmental delays affect learning causing delays in academic development

 Delays in language could affect the child socially  Isolation is often a result of language delays and the child’s limited communication abilities

 Delays in language development can affect the child’s job skill development  Could limit the child’s long term vocational choices

 Provide better acoustics in the classrooms  Classroom strategies to aid the child’s instruction  Model and promote a positive attitude

 Normal Classroom Acoustics  Slick surfaces  Noise pollution  Low signal-to-noise ratios (voice level to noise level)

 Problems in Classroom Acoustics  Sound reflects off slick surfaces and echoes  Most surfaces are slick  Desk  Floors  Walls  Hearing aids amplify ALL sounds including noise

 Noise Pollution  Noise enters the room  Hallways  Heating and air conditioning vents  Outside noises – mowing, playground  Other classrooms  Noise inside the room  Students talking  Rustling paper  Pencil tapping  Chair movements

 Signal-to-noise ratios (teacher’s voice level to noise level)  Is not loud enough for a voices to be heard above the noise  The teacher’s voice level needs to be about dB above the noise level for understanding of words spoken

 Strategies to help students with hearing loss  Preferential seating to be able to lip-read  Face the child when speaking  Avoid moving too much around the room  Gain the child’s attention by a  Gentle touch on the shoulder  Calling their name  Monitor for comprehension  Repeat or rephrase instruction  Pre-teach vocabulary

 Keep a positive attitude and model this for other student’s benefit  Teach the class about hearing loss and the equipment used to help the loss  Don’t use exaggerated pronunciations – speak normally, but slowly and clearly  Repeat what other students say in discussions  Provide written, simple instructions  Use an overhead to provide visual information

 Improve classroom acoustics  Use an FM system  Carpeting on floors  Fabric wall hangings and cushions  Tennis balls on the bottoms of chairs  Curtains over windows  Suspended ceiling tiles

cochlea Pinna (aruricle) external ear canal Tympanic membrane malleusincusstapes Cochlea & hair cells Outer Ear Middle Ear Inner Ear

 You can’t fix a hearing loss  Any hearing loss – even MILD – impact children’s learning  Improving classroom acoustics will improve learning for hearing and hearing impaired children  If children can’t hear, they can’t learn

audiomerty Physical exam Hearing loss pathologic External ear Congenital malformation wax tumormalignan t benigninfection Middle ear com Adhesive otitis perforatio n c holestatom a normal otosclerosis Senseurineural hearing loss

chronic congenital Noise inducepresbycosisTUMOR acute SSNHLTRUMAINFECTIONOTOTOXISITY

CONGENITAL HEARING LOSS geneticsyndromenonsyndromNon geneticinfectiousdrugidiopathic