Georgia State University Series: Early Intervention with Children who are Deaf and Hard of Hearing Part 1, Presentation 3 July 2001

Orientation to Hearing Loss

Aren’t all babies who have hearing loss the same? No. There are different levels of hearing loss ranging from mild to profound. In addition, two people with the same level of loss will have different hearing characteristics.

There are many variables that may effect the progress of your child. Age of onset Etiology Degree of loss Type of loss Use of amplification devices Health of the child Involvement of the family Accompanying disabilities

Etiology Unknown High Risk Factors Meningitis Congenital Infections –Congenital Rubella –CMV –Toxoplasmosis

Hearing losses can be:  Congenital or acquired  Affect one or both ears  Fluctuate or remain constant  Can be the result of developmental differences in various parts of the ear  Can be the result of illness

Degrees of Loss Minimal (Borderline): 15 to 25 dB Mild: 26 to 40 dB Moderate: 41 to 55 dB Moderate to Severe 56 to 76 dB Severe: 71 to 90 dB Profound: 90dB +

Slight Loss dB No significant speech and language delays Hearing abilities should be tested on a regular basis

Mild Loss 26-40dB Possible difficulty hearing faint /distant speech May benefit from hearing aid as loss goes toward 40dB Will not usually have difficulty in school Need vocabulary work Needs favorable seating and lighting in school May need to speech read to increase understanding of what is spoken May need speech therapy to correct mispronounced sounds

Moderate Loss 41-55dB Understands speaker face to face at 3-5 feet May miss 50% of class discussion Child referred to special education to determine support needs May have limited vocabulary Problems pronouncing some speech sounds Benefit from FM System Need favorable seating

Moderately Severe Loss dB Conversation must be loud to hear it Needs a hearing aid Difficulty in group activities Likely to be deficient in language use and comprehension Need special help in language, grammar, vocabulary, reading and writing Attends to visual and auditory situations Need resource teacher, special class or tutor

With hearing aid, Can hear: Clock ticking Liquid pouring Snapping fingers Doorbell Knock at door Radio at normal level Voices Singing conversation

Severe Loss dB May hear loud voices about 12” from the ear Speech and language development delayed Speech and language will not develop spontaneously if loss is present before age 2 May be able to discriminate vowels but not all consonants Education program needs special emphasis on language skills, concept development, speech, communication skill development May be placed in regular class part time May benefit from using sign language

With Hearing Aid, Can hear: Thunder Telephone ringing Alarm clock Piano Auto horn Radio at louder than average level Group singing Loud shots Baby crying

Profound Loss 90 dB or more May hear some loud sounds, is aware of vibrations more than tones Hearing aid is necessary Relies on vision as primary avenue for communication May need alternatives to hearing aid Continuous assessment of communication needs is required Use of sign language will be helpful Speech therapy needed for functional communication development

With hearing aid, Can hear: Organ Audience applauding Heavy objects dropped on a hard floor Banging door Large deep bell

Types of Loss Conductive : A change in hearing due to reduction in sound transmission through the outer ear, middle ear, or both (Ex. Otitis Media) Sensorineural: A change in hearing due to damage to structures within the cochlea, to the VIII cranial nerve, or to both Mixed: Conductive and sensorineural hearing loss occurring simultaneously

ABILITY TO HEAR SPEECH WITH A HEARING LOSS NORMALFreddiethoughtheshouldfindawhistle M I L DFreddiethough--e-ould-indawhi-le MODERATE-reddie-ough--e-ould-i-a-i-le PROFOUNDLOUDsoftLOUDsoft LOUDsoftLOUDsoft

The Speech Banana Most sounds associated with speech are found within the shaded area of the audiogram affectionately referred to as the speech banana.

Impact on Development Language Learning Education Cognition Social-Emotional Development Communication

Impact (continued) “Without early intervention, the deaf infant will be delayed in normal developmental processes- self confidence, intellectual curiosity, good social relations, and the ability to use language to communicate and further the learning process.” Hayes & Northern, 1996

Hearing Aid and Cochlear Implant Facts Caregivers must have realistic expectations for the hearing aid. ALL sound is amplified, not just speech. Amplification devices, including hearing aids, do not restore hearing to normal. A person with a hearing loss will never have “normal” hearing.

Facts (Continued) 92-95% of those who are deaf have SOME hearing. This is called residual hearing. The goal is to maximize your child’s use of his or her residual hearing. It is extremely important for parents to understand that hearing aid use is an ongoing process due to changes in hearing loss, growth of the ear canal and advances in technology. Children as young as 4 weeks old can be fitted with a hearing aid

The FDA has approved Cochlear Implantation for children who: Have a profound hearing loss in both ears Receive little or no benefit from hearing aids Have not other medical conditions that would make surgery risky Are involved, along with the parents, in all aspects of the informed consent process

Cochlear Implant Facts (Continued) Understand, along with the parents, his or her individual role in successful use Have, along with the parents, realistic expectations Are willing to be involved in intensive habilitation services Have support from educational programs to emphasize the development of auditory skills

P atience- teach your child how to use the sound available to them, which will require many modifications. Be patient! A ccess- amplification will give your child access to the speech signal. R elevance- make all interactions with the child meaningful. E xpectations- high, but realistic, expectations for your child are critical. N urture- provide an abundance of affection. T ime- learning speech and language through listening is an ongoing process. S uccess- what you put in is what you get out!

Glossary Assistive Listening Devices (ALDs)- refers to systems that improve the signal-to-noise ratio by transmitting amplified sound directly to the listener and transforms sound into a visual or tactile signal. Audiogram- table that summarizes how loud a sound must be at a particular frequency for an individual to hear it Bilateral- affecting both ears. Cochlea- the osseous (bony) portion of the inner ear which surrounds the organ of hearing. Decibels (dB)- used to express sound pressure.

Frequency- perceived by people as the “pitch”- low or high spectrum of sound. Inner Ear- the area beyond the bones of the middle ear space; includes the cochlea. Mastoid Bone- the lower portion of the temporal bone which lies just behind the ear. Residual Hearing- the amount of hearing that is left when a hearing loss is present. Speech Banana- an area on an audiogram (which holds the shape of a banana) that covers the frequency area in which speech sounds are produced. Unilateral- affecting one ear.