1. Hearing Impairment : Deafness
By Catherine Hansford

2. How do we hear??

3. Air travels through the ear canal
Sound waves makes the eardrum vibrate
Ear ossicles vibrate
Cochlear vibrates
Disturbing hairs which detect the sound
Auditory nerve
Information is transferred to the brain

5. Hearing impairments
Any damage at any stage along this process, will cause a loss of hearing.
Sometimes children may be able to hear sounds, but not distinguish speech.
Often the higher sounds e.g. sssss, shhhh are harder to distinguish than /m/ and /a/. Or the sounds deleted from the ends of words

6. 2 types of hearing impairment
1. Conductive hearing impairment - outer or middle ear. It is often medically or surgically treatable. e.g. ear infection/ glue ear
2. Sensorineural hearing impairment - a problem with the inner ear, or, occasionally with the hearing nerve. It is usually permanent and requires rehabilitation such as the use of a hearing aid.

7. What causes hearing impairment?
During pregnancy or birth:
- Mother using ototoxic drugs (antibiotic Gentamicin during pregnancy)
- Rubella during pregnancy
- Jaundice (during pregnancy), which can damage the hearing nerve in a newborn baby
- Birth asphyxia
- Premature birth
- Genetic - hereditary

8. After birth: - Meningitis - Measles - Mumps - Chronic ear infections
- Exposure to excessive noise
- Head and ear injury
- Wax or foreign bodies blocking the ear canal
- Ageing – constant exposure to noise and other factors may lead to deafness or hearing impairment

9. Glue Ear - Fluid present in the middle ear
- Ossicles can not easily move to transmit sound signals.
- Very common in children
- Eustachian tube (usually drains the ear) – in children the tube is smaller, shorter and less angled in so it more regularly blocks

10. Why is hearing so important?
- If we cannot hear words clearly it is difficult to learn to speak
- They cannot understand what people want so regularly get frustrated
- Poor behaviour
- Feeling lonely and forgotton
- Exchange of information is very important for any child's development
- The early years (1-5) are important for a child to learn communication

11. What do we need to do?
Where are there hearing impairment schools available?
How are they currently communicating? Is it enough?
Is there any residual hearing, that could be used for communciation? If so encourage assessment in a near by centre! What sounds can't they hear?
Are they likely to attend school, how will they communicate there?

12. Sign How can they increase the amount of sign that they are using?
Encourage them to use sign to communicate all of their needs
New signs may need to be taught repeatedly and in different contexts
Who understands them, is alternative communication needed for outside the home?

13. - They can then understand everybody all of the time
Lip reading
- They can then understand everybody all of the time
- Speak in a normal way, over-exaggerated movements are not normal life
- Ensure that they are looking at your face when labelling or talking about objects

14. If patients have some hearing, they may attempt to speak
Speech
If patients have some hearing, they may attempt to speak
The speech may not be clear, as it can be difficult for them to work out how to produce sound, and they cannot hear the sounds that they make,
With practice and feedback from listeners some deaf people are able to speak relatively clearly

15. Reading and writing
- Some patients can communicate by writing and reading
- Carry a notebook and pen around to speak with others
- First they need to learn how too! Match the words with pictures or the objects

16. Environmental considerations
Do they find it difficult in group situations?
Don't exclude them from interactions
How can you reduce the amount of background noise?
Turn off the TV!
Make sure you communicate face to face wherever possible

17. Summary - 2 different types of hearing impairment
- Early identification is important for development
- Some patients can hear some sound, how can we help them hear more?
- Give them a way to communicate as much as possible
- Help people understand that they are clever people – that can live an independent life