Understanding Hearing Loss

Compiled by the North Dakota School for the Deaf/ Resource Center for Deaf and Hard of Hearing’s Outreach Department (3/2013)

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Typical Hearing

Drawing from SKI*HI

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Conductive Hearing Loss• An obstruction in

the outer and/or middle ear blocks the transmission of sound.

• Medical and/or surgical treatment may reduce or eliminate this type of hearing loss. Drawing taken from www.thehearingfix.com

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Causes of Conductive Hearing Loss

• The ear canal is missing or occluded (obstructed).

• Allergies• The bones in the ossicular chain are

broken or calcified.

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Sensorineural Hearing Loss• Are commonly a

result of a damaged cochlea and/or auditory nerve.

• May improve with hearing aids or cochlear implants.

• Require auditory training.

Drawing taken from www.thehearingfix.com

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Causes of Sensorineural Hearing Loss• Diseases during pregnancy• Heredity• Childhood diseases (mumps, measles,

chicken pox)• Viral infections (meningitis, encephalitis) • Prolonged high fever• Physical damage to head or ear• Exposure to excessive or intense noise

(loud music, gunfire, etc.)

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Mixed Hearing Loss

• A combination of conductive and sensorineural components:• Blockage in the outer or middle ear

AND

• Damaged inner ear (cochlea) or auditory nerve

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Warning Signs for InfantsBirth to 4 months: •awakens or startles at loud noises? •calm at the sound of a familiar voice?

9 to 15 months: •babble a lot of different sounds? •respond to his/her name? •respond to changes in your tone of voice? •say "ma-ma" or "da-da"?•understand simple requests? •repeat some sounds you make? •use his/her voice to attract attention?

4 to 9 months: •turn eyes toward source of sounds? •notice rattles and other sound-making toys? •cry differently for different needs? •make babbling sounds? •seem to understand simple word/hand motions such as "bye-bye" with a wave?

15-24 months: •point to familiar objects when they are named? •listen to stories, songs and rhymes? •follow simple commands? •use several different words? •point to body parts when asked? •name common objects? •put two or more words together?

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Warning Signs for Preschool & Older ChildrenDoes the child: •need the TV volume to be excessively high?•respond inappropriately to questions? •fail to reply /respond when called? •watch others to imitate what they are doing? •have articulation problems or speech/language delays? •have problems academically? •complain of earaches, ear pain or head noises? •have difficulty understanding what people are saying? •seem to speak differently from their same age peers?

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Audiologic Assessments

• Otoacoustic Emissions Test (OAE)• Auditory Brainstem Response Test

(ABR or BAER)• Conventional Behavior Tests• Tympanometry

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Otoacoustic Emissions (OAE) Test

 

photo from Cataract Foundation Philipines, Inc.

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Conventional Behavioral Hearing Tests

photo from www.allianceaudiologyllc.com/index.php/hearing-information

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Auditory Brainstem Response (ABR) Test

photo from http://www.bradingrao.com/abr.htm

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Tympanometry

photo from http://www.entassociates.com/services.htm

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Understanding Audiograms

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FREQUENCY IN CYCLES PER SECOND (HZ)

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LOUDLOUD

SOFTSOFT

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Average Loudness Levels

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Drawing from http://www.jtc.org

Audiogram symbols

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Bone Conduction

Audiogram from http://www.merckmanuals.com

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Degree of Hearing Loss

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Amplification

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Photo from www.impactlab.net

Photo from besthearingaidsguide.info

Photo from Advanced Bionics

Hearing Aids

• Amplify sounds• Allow sound to travel the “normal”

route through the ear

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Hearing Aids CANNOT Restore sound’s natural quality

(sounds may be perceived as “mechanical’ or “tinny”) -which will affect listening to music

Improve hearing when background noise is present or with simultaneous conversations

Amplify only what a child wants to hear

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Hearings Aids Can Make soft sounds louder, make listening to

speech more comfortable and easier to understand

Improve hearing in social situations that were previously difficult (church, social groups, etc.)

Improve hearing at high pitches (promoting

an awareness of environmental sounds and increased understanding of speech)

Improve comfort with social interactions and events

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How a Hearing Aid works

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What do Hearing Aids look like?

photo from http://www.americanhearingbenefits.com/styles.jsp

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Cochlear Implants

photo from http://www.ssc.education.ed.ac.uk/courses/deaf/dfeb08ii.html

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What is involved with CIs?

• Surgery and an overnight hospital stay

• A healing period before the external devices are connected

• Numerous follow up appointments • To map and program the device• To receive extensive auditory training

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Parts of an implantInternal part – C. Electrodes

External Parts – A. Speech Processor B. Transmitting Coil

Image from Cochlear, Ltd.

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How an implant works

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Eligibility Criteria for Cochlear Implant

• No benefit from hearing aids• At least one year of age• Family and educational support• Absence of medical restrictions• Cochlea and auditory nerve are

present

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Bone Conduction Hearing Aid

photo from www.medicalhomeportal.org

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Bone Anchored Hearing Aid (Baha)

Image from www.feelbetterri.com

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Vibro-tactile Aid

photo from http://hearingtherapyaustralia.com Nor

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Assistive Listening Device (ALD)

A child with a hearing loss may benefit from an Assistive Listening Device (ALD). The ALD increases the child’s ability to hear sounds in an auditorium or classroom by

Reducing background noise.

Making faraway sounds seem closer.

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Assistive Listening Devices

Personal FM System

• Delivers speech from a speaker’s microphone to the ears of the person with a hearing loss

Soundfield FM System

• Delivers speech from a speaker’s microphone to speakers placed strategically throughout the room N

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Educational Implications

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Communication Options

• Auditory Oral • Auditory Verbal • Cued Speech• Total Communication• American Sign Language

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Auditory-Oral Programs

•GOAL: To encourage speech

Auditory-Oral programs combine:

residual hearing, lip reading, hearing aids, cochlear implant (s) and/or other amplification devices.

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Auditory Verbal Programs

GOAL: To teach listening and speaking using hearing aids, cochlear implant and/or other amplification devices. No use or emphasis of sign language or speech reading. Parents training: methods incorporating listening and language use within daily routines.

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Cued SpeechGOAL: To teach speaking through the use of amplification, lip-reading and cues from the hand shape system.

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Total Communication

GOAL: To teach speech using all modes of communication: speech, sign language, auditory training, speech reading finger spelling.

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American Sign Language (ASL) (Bilingual/Bicultural) GOAL: To teach a visual languageUsed by persons defined as culturally

Deaf in the United States and Canada. Has a distinct grammar and word order.

(Often English is learned as a second language).

Incorporates eyes, hands, facial expressions and body movements.

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Accommodations NOISE CONTROL

• Use draperies on windows• Use low, acoustically controlled ceilings• Reduce noise from lights, fans, heaters, etc.• Use carpeting on floors and walls to absorb

sound • Use auditory training equipment to enhance

the child’s listeningLIGHTING CONTROL• Use draperies to control sun glare• Provide adequate ceiling lights

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Accommodations SEATING ARRANGEMENTS

• Ensure a clear view of the speaker’s face – essential to following discussions and lectures

• Allow seating changes as activities change• Seat with the better ear turned toward the

speaker VISUAL AIDS• Make language and information visible-Use

chalkboard, overhead projector, written labels, captioned films, etc.

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Communication Tips

• Choose a quiet environment. • Get the child’s attention before speaking. • Do not cover mouth when speaking. • Look directly at communication partner.• Maintain eye contact. • State the topic of discussion at the

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Communication Tips• Speak clearly, at a normal pace. • Do not shout. • When spoken words are not heard

• Repeat statements, then • Re–phrase

• Be patient- take time to communicate.• Be aware of fatigue.

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for more educational strategies…

Contact the North Dakota School for the Deaf in Devils Lake1401 College Drive N., Devils Lake, ND 58301 or (701) 665-4400

or one of their outreach offices listed below.

MinotMemorial Building500 W. University AvenueMinot, ND 58701(701) 858-3357

Grand Forks1401 College Drive N.Devils Lake, ND 58301(701) 665-4420

Bismarck418 East BroadwaySuite 228-BBismarck, ND 58501(701) 328-3987

Fargo1510 12th Avenue N.P.O. Box 5036Fargo, ND 58105(701) 231-6036

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Resources• North Dakota School for the Deaf

(NDSD) www.nd.gov/ndsd/

• North Dakota Interagency Project for Assistive Technology (IPAT) www.ndipat.org

• Described and Captioned Media (DCMP) www.dcmp.org

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