Hearing Impairment

1. Hearing Impairment By: Rochelle Davies

2. Definition • Hearing impairment is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance." • Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification.“ NAPCSE, 2007

3. History of the first deaf-blind school • In 1856, Amos Kendall, donated two acres of his estate in northeast Washington, D.C. to establish housing and a school for 12 deaf and six blind students. • The following year Kendall persuaded Congress to incorporate the new school, which was called the Columbia Institution for the Instruction of the Deaf and Dumb and Blind. From such modest beginnings evolved Gallaudet, a prestigious University of international importance. • Edward Miner Gallaudet-son of Thomas Hopkins Gallaudet, founder of the first school for deaf students in the United States-became the new school's first superintendent. Gallaudet, 2009

4. Classifications/Types • There are three major classification for hearing impairment: conductive, sensorineural, and mixed hearing impairments. • A conductive hearing impairment refers to an interference with the transfer of sound along the conductive pathway of the middle or outer ear. • A sensorineural hearing impairment involves problems in the inner ear. • A mixed hearing impairment is a combination of the two. Hallahan, Kauffman, Pullen, 2009

5. Hearing Impairment and the Outer Ear • Several conditions of the outer ear can cause a person to be hard of hearing. In some children, for example, the external auditory canal does not form, resulting in a condition known as atresia. Children may also develop external otitis, or “swimmer’s ear,” an infection of the skin of the external auditory canal. Tumors of the external auditory canal are another source of hearing impairment. Hallahan, Kauffman, Pullen, 2009

6. Causes of Conductive Hearing Loss • middle ear infections • head injury that damages middle ear bones  • birth defects • disease such as otosclerosis • A disease in which a bone grows abnormally in the middle ear preventing structures within the ear from working properly and causing hearing loss. Hearing Loss Education Center, 2009

7. Hearing Impairment and the Inner Ear • The inner ear is the most severe of most hearing impairments. There are problems with hearing sensitivity, a person with inner-ear hearing impairment can have additional problems, such as sound distortion, balance problems, and roaring or ringing in the ears. Hallahan, Kauffman, Pullen, 2009

8. Causes of Sensorineural Hearing Loss • Fiction: Deafness cannot be inherited. • Fact: If one or both parents or a relative is born deaf, there is a higher risk that a child will be born deaf. Hearing Loss Education Center, 2009

9. Causes of Sensorineural Hearing Loss • heredity/genetics • too much loud noise • head injury • certain medications (damage inner ear hair cells) • diseases (measles, mumps, meningitis, Menieres) • normal aging process • birth defects Hearing Loss Education Center, 2009

10. Causes of Sensorineural Hearing Loss • Hearing impairment may also be caused by problems during pregnancy and childbirth. These include: • premature birth; • conditions during birth in which a baby lacks enough oxygen to breathe; • rubella, syphilis or certain other infections in a woman during pregnancy; • inappropriate use of ototoxic drugs (a group of more than 130 drugs, such as the antibiotic gentamicin) during pregnancy; and • jaundice, which can damage the hearing nerve in a newborn baby. World Hearing Organization, 2010

11. Hearing Impairment and the Middle Ear • Otitis media is an infection of the middle ear, which is located behind the eardrum. There are two main types of otitis media. In the first, called acute otitis media (AOM), parts of the ear are infected and swollen, and fluid and mucus are trapped inside the ear. AOM can be quite painful. In the second type, called otitis media with effusion (fluid), or OME, fluid and mucus remain trapped within the ear after the infection is over, making it more difficult for the ear to fight off new infections. This fluid may adversely affect a child's hearing. Health of Children, 2010

12. Causes of Mixed Hearing Loss • a combination of damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve system Hearing Loss Education Center, 2009

13. Prevalence • The U.S. Department of Education’s statistics indicate that the public schools identify about 0.13 percent of the population from six to seventeen years of age as deaf or heard of hearing. • An important statistic is that close to 25% of students who are deaf in the U.S. come from Hispanic-speaking homes. Hallahan, Kauffman, Pullen, 2009

14. Identification • Depending on the characteristics of the examinee and the use to which the results will be put, the audiologist may choose to give any number of tests from any one or a combination of these four categories. There are four general types of hearing tests: • Screening test • Pure-tone audiometry • Speech audiometry • Specialized test Hallahan, Kauffman, Pullen, 2009

15. Characteristics • Individuals who are hearing impaired can have profound consequences for some aspects of a person’s behavior and little or no effect on other characteristics. • Consider this question: If you where forced to choose, which would you rather be – blind or deaf? • Deaf, right? Probably because most people rely for mobility and because many of the beauties of nature of visual. But in terms of functioning in an English language-oriented society, the person who is deaf is at a much great disadvantage than someone who is blind. Hallahan, Kauffman, Pullen, 2009

16. Literature Article Review(s)

17. Classrooms for Children with Developmental Disabilities • This was a study to see if using sound-field (SF) amplification systems or public address (PA) systems could achieve acceptable classroom speech-to-noise (SNR) standards. • Eight classrooms in four primary schools for children with developmental disabilities were used for data collection. • All schools were densely populated areas, close to busy roads, and constructed of concrete within the past 30 years. • All classrooms were selected randomly. Leung, S. & McPherson, B. (2006). Classrooms for Children with Developmental Disabilities. International Journal of Disability, Development and Education, 53, 287-299.

18. Findings • The sound-field (SF) amplification system and the public address (PA) system could provide adequate SNR for classroom speech reception. • The SF amplification system provided consistently greater SNR that the PA amplification system, and met the recommended guidelines in all classrooms. • The PA system failed to meet the SNR criterion in two of the eight classrooms. Leung, S. & McPherson, B. (2006). Classrooms for Children with Developmental Disabilities. International Journal of Disability, Development and Education, 53, 287-299.

19. Multiple benefits of personal FM system use by children with auditory processing disorder (APD) • Ten children (eight male, two female) with a positive diagnosis of APD were recruited as subjects to complete a trial of FM use in the classrooms. • The mean age was 11 years, 8 months. • All children were fitted with Phonak EduLink FM systems and the microphone was situated approximately 1 to 1.5 inches from the mouth of the speaker. • Students and parents were instructed in the use of the FM system at the initial fitting. • Thirteen children were recruited as a control group. The mean age was 10 years, 6 months. These children had normal hearing sensitivity, function, and processing. Johnston, K., John, A., Kreisman, N., Hall, J., & Crandell, C. (2009). Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48, 371-383.

20. Findings • There was no longer a significant different between the control group and APD group. • Significant differences were noted for several situations. For the APD group questions 1, 3, and 5, which relate to the following classroom situations: teacher talking in front of room, teacher talking with back turned, and other students making noise. • For question 6, results for the APD group showed increased risk for problems in the classroom situation with a student answering during a discussion. • The APD group showed greater rick than the control group for problems with word recognition during a test or directions. Johnston, K., John, A., Kreisman, N., Hall, J., & Crandell, C. (2009). Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48, 371-383.

21. Johnston, K., John, A., Kreisman, N., Hall, J., & Crandell, C. (2009). Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48, 371-383.

22. This figure is pre-fit of the APD. This figure is post-fit of the APD. • Johnston, K., John, A., Kreisman, N., Hall, J., & Crandell, C. (2009). Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48, 371- 383.

23. Amplification Considerations for Children With Minimal or Mild Bilateral Hearing Loss and Unilateral Hearing Loss • The American Academy of Audiology (AAA) Pediatric Amplification Protocol addresses fitting of amplification on children with Mild Bilateral Hearing Loss (MBHL) and Unilateral Hearing Loss (UHL). • A personal FM system or sound-field amplification for use in school. • The decision to fit a child with unilateral hearing loss should be made on an individual basis, taking into consideration the child’s or family’s preference as well as audiologic, developmental, communication, and educational factors. McKay, S., Gravel, J., & Tharpe, A. (2008). Amplification Considerations for Children With Minimal or Mild Bilateral Hearing Loss and Unilateral Hearing Loss. Trends in Amplification. 12(1), 43-54.

24. Findings • 150 surveys were sent out to families of children with either MBHL or UHL and had a return of 40%. • Of 27 children with UHL who were fit with amplification, 26% wore it all the time, 4% only in school, and 50% never wearing it. • Of the 36 children with mild hearing loss, 44% wore it all of the time, 3% only in school, 25% never wearing it. McKay, S., Gravel, J., & Tharpe, A. (2008). Amplification Considerations for Children With Minimal or Mild Bilateral Hearing Loss and Unilateral Hearing Loss. Trends in Amplification. 12(1), 43-54.

25. Recommendations Including Pros and Cons of Inclusion

26. Be patient (Hallahan, Kauffman & Pullen, 2009) • It takes awhile to learn about a hearing impaired child. • During class discussions, allow only one person to speak at a time (Friend & Bursuck, 2006) • Signal who is talking so the student with hearing impairment know where to look. • Noise has a detrimental effect on the listening abilities of all students, but particularly students with hearing impairments (Friend & Bursuck, 2006) • A classroom’s acoustical environment can be immediately improved by reducing or eliminating noise sources. • Work closely with colleagues and specialists (Lewis & Doorlag, 2003). • This will ensure that students with hearing impairments are provided with appropriate experiences in the general education classroom.

27. Why be inclusive? Pros Cons • Students with hearing impairments do exceptionally well in a general education classroom. • Classmates normally do not even know the student is hearing impaired (depending on severity). • Teachers can learn a lot from a hearing impaired student, such as their exceptionality. • Hearing impaired students can hear at a lower level but they can also read lips (and maybe sign language). Thus making them especially adaptable to any circumstance. • Teacher must wear an FM system or monitor hearing impaired student to ensure comprehension of study. • Must have special accommodations/modifications for hearing impairment which can hinder a general education teacher’s educational time. • Loss of equipment can become a determent to a hearing impaired student because it takes months to order and therefore this student would need one-on-one. • There is a lack of support when training teachers on the FM system, hearing aids, how to put batteries in, etc (which takes more time).

28. Applications To the Classroom

29. Encourage students with hearing impairments to use their hearing aids at all times. • This is an important factor when it comes to a classroom setting. • Find the best seating position for the student to speech read. • This will allow for the student to read the teachers verbal presentations. • Talk in full sentences. • Avoid the use of single words, and rephrase the entire sentence if it was not understood; content and meaning are easier to grasp in context. • The academic problems of many students are related to their impairments, not to a lack of intelligence. • Closely monitor their achievement.

30. Question students with hearing impairment to determine whether they understand information presented in class. • Do not assume that students understand the material. • Cleary explain concepts being taught. Use visual examples whenever possible, and keep terminology consistent. • This will allow the student with a hearing impairment more visual aides. • Teachers and students should speak naturally, use natural gestures, and maintain face-to-face contact when speaking to a student with a hearing impairment. • It would be like speaking to a person without looking at them. Would you do that?

31. References • Friend, M., & Bursuck, W. (2006). Including Students With Special Needs. (4th Edition). Boston, MA: Allyn & Bacon. • Gallaudet University. (2009). History of Gallaudet University. Retrieved from http://aaweb.gallaudet.edu/About_Gallaudet/History_of_the_University.html. • Hallahan, D. P., Kauffman, J. M., & Pullen, P. C. (2008). Exceptional Learners Introduction to Special Education (11th Edition). Boston, MA: Allyn & Bacon. • Hearing Loss Education Center. (2009). Types and Causes of Hearing Loss. Retrieved from http://www.hearinglosseducation.com/Hearing/types-causes-hearing-loss.asp. • Health of Children. (2010). Otitis Media. Retrieved from http://www.healthofchildren.com/N-O/Otitis-Media.html. • Johnston, K., John, A., Kreisman, N., Hall, J., & Crandell, C. (2009). Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48, 371-383. • Leung, S. & McPherson, B. (2006). Classrooms for Children with Developmental Disabilities. International Journal of Disability, Development and Education, 53, 287-299. • Lewis, R., & Doorlag, D. (2003). Teaching Special Students in General Education Classrooms.(6th Edition). Columbus, OH: Merrill Prentice Hall. • McKay, S., Gravel, J., & Tharpe, A. (2008). Amplification Considerations for Children With Minimal or Mild Bilateral Hearing Loss and Unilateral Hearing Loss. Trends in Amplification. 12(1), 43-54. • National Association of Parents with Children in Special Education. (2007). Introduction to NAPCSE’s Hearing Impairments Page. Retrieved from http://www.napcse.org/exceptionalchildren/hearingimpairments.php. • World Health Organization. (2010). Causes of Deafness and Hearing Impairments. Retrieved from http://www.who.int/mediacentre/factsheets/fs300/en/index.html.