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Video-BasedAural Rehabilitation Guide
Enhancing Listening and Spoken Language in Children and Adults
Linda L. Daniel, MS, MA, FAAA, CCC-A
Sneha V. Bharadwaj, PhD, CCC-SLP
5521 Ruffin RoadSan Diego, CA 92123
e-mail: [email protected]: https://www.pluralpublishing.com
Copyright © 2021 by Plural Publishing, Inc.
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Library of Congress Cataloging-in-Publication Data: Names: Daniel, Linda L., author. | Bharadwaj, Sneha V., author. Title: Video-based aural rehabilitation guide : enhancing listening and spoken language in children and adults / Linda L. Daniel, Sneha V. Bharadwaj. Description: San Diego, CA : Plural Publishing, Inc., [2021] | Includes bibliographical references and index. Identifiers: LCCN 2019029143| ISBN 9781635501124 (paperback) | ISBN 1635501121 (paperback) | ISBN 9781635501131 (ebook) Subjects: | MESH: Correction of Hearing Impairment--methods | Persons With Hearing Impairments--rehabilitation | Education of Hearing Disabled Classification: LCC RF300 | NLM WV 276 | DDC 617.8/9--dc23 LC record available at https://lccn.loc.gov/2019029143
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n Contents
Preface xiAcknowledgments xiiiContributors xv
1 Overview of Aural Rehabilitation 1Sneha V. Bharadwaj, Linda L. Daniel, and Susan G. AllenIntroduction 1Brief Anatomy and Physiology of the Auditory System
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1Types of Hearing Loss
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5Etiology of Hearing Loss
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6Diagnosis of Hearing Loss
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7Severity of Hearing Loss and Access to the Speech Spectrum
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8Treatment of Hearing Loss
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11Deaf Culture
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11Effects of Hearing Loss on the Perception and Production of Spoken Language
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12Impact of Hearing Loss on the Individual: The International Classification of 14
Functioning, Disability, and Health
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Effects of Auditory Deprivation Due to Hearing Loss
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15Aural Rehabilitation
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Advocacy
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20Spotlight on a Family of Four with Hearing Loss: Parental Advocacy
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21Summary 22References 22Recommended Readings 24Recommend Internet Sites for Further Learning 24Study Questions 26Answer Key 28Appendix 1–1: The Principles of Auditory-Verbal Therapy 29Appendix 1–2: The Principles of Auditory-Verbal Education 30See Appendix I at the end of the book for the background information on individuals featured in Chapter 1 videos: Harry, Jerry, Aanya, Samuel, Gerald, Jaxson, Caleb, Amanda, Rebecca and Bruce, Aliza, and Bruce Jr.
2 Hearing Aids and Hearing Assistive Technology Systems 31Amyn M. Amlani and Sneha V. Bharadwaj
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Introduction 31
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Hearing Aid Candidacy and Selection 31
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Hearing Aid Pre-Fitting Considerations 33
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Hearing Aid Styles 34
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Ear Molds 35
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Components of a Hearing Aid 35
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Procedures for Hearing Aid Fitting and Verification 40
Look for this icon indicating there are related videos on the companion website
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Video-Based Aural Rehabilitation Guidevi
Counseling and Education 41Universal Newborn Hearing Screening 41Challenges with Hearing Aids
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42Need for Daily Care and Troubleshooting
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43Hearing Assistive Technology Systems
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43Special Considerations in Hearing Aid Fitting
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47Over-the-Counter/Direct-to-Consumer Devices
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51Spotlight on Roberta: Audiological Consultation
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51Summary 52References 53Recommended Readings 54Recommended Internet Sites for Further Learning 54Study Questions 55Answer Key 57See Appendix I at the end of the book for the background information on individuals featured in Chapter 2 videos: Jerry and Roberta.
3 Cochlear Implants for Children and Adults with Hearing Loss 59Sneha V. Bharadwaj, Linda L. Daniel, B. Robert Peters, and Kristin KingIntroduction 59Cochlear Implant: Parts and Function 60Candidacy 61Interprofessional Collaborations
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63Surgical Considerations 63Choice of Hearing Technologies 64Reimbursement
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65Cochlear Implant Surgery
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65Intraoperative Testing 66Cochlear Implant Programming
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67Aural Rehabilitation Following Cochlear Implantation
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68Spotlight on Tucker: Early Identification and Intervention
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69Summary 70References 70Recommended Readings 72Recommended Internet Sites for Further Learning 72Study Questions 73Answer Key 75See Appendix I at the end of the book for the background information on individuals featured in Chapter 3 videos: Terri, Liam, Annabelle, and Tucker.
4 Auditory Brainstem Implants for Children and Adults with Hearing Loss 77Sneha V. Bharadwaj, Linda L. Daniel, and B. Robert PetersIntroduction 77The Auditory Brainstem Implant Device 77A Brief History of the Auditory Brainstem Implant 78Candidacy
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79Surgery and Risks 80Interprofessional Collaborations 81A Case Presentation: 5-Year-Old Justine 81
viiContents
Communication Outcomes in Individuals with an ABI
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82Spotlight on Aanya: A Child with an ABI
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84Summary 85References 85Recommended Readings 86Recommended Internet Sites for Further Learning 87Study Questions 88Answer Key 90See Appendix I at the end of the book for the background information on the individual featured in Chapter 4: Aanya
5 Intervention After Early Diagnosis of Hearing Loss: A Listening and 91 Spoken Language ApproachLinda L. Daniel and Christina PerigoeIntroduction
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91Overview of the Listening and Spoken Language Approach 93Evidence-Based Practice
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93Diagnostic Approach to Intervention 95Principles of Auditory-Verbal Therapy
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Spotlight on Josiah: Establishing a Foundation of Listening and Spoken Language
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106Summary 107References 107Recommended Readings 110Recommended Internet Sites for Further Learning 110Study Questions 112Answer Key 114Appendix 5–1: Auditory Checklists, Hierarchies, and Developmental Scales 115Appendix 5–2: Sample Lesson Plan for Hiti 116See Appendix I at the end of the book for the background information on individuals featured in Chapter 5 videos: Kelsey, Samuel, Liam, Charlie, Tucker, Caroline, Landon, Hiti, Jaxson, Amari, Clara, Thomas, Josiah, Landon, Caleb, and Harry.
6 Factors Affecting Intervention and Outcomes of Children 119 with Hearing LossLinda L. Daniel, Ellen A. Rhoades, and Sneha V. BharadwajIntroduction
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119Hearing Loss
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120Hearing Technologies and Related Factors
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121Language Environment
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123Family
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127Community
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129Cultural and Linguistic Diversity
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130Additional Disorders
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132Spotlight on Jaxson: A Child with CHARGE Syndrome
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137Summary 138References 138Recommended Readings 143Recommended Internet Sites for Further Learning 145Study Questions 146
Video-Based Aural Rehabilitation Guideviii
Answer Key 148See Appendix I at the end of the book for the background information on individuals featured in Chapter 6 videos: Charlie, Rebecca, Aliza, Maggie, Caleb, Meghana, Amanda, Amari, Hiti, Cade, Caleb, Landon, and Jaxson.
7 Educational Supports for Students with Hearing Loss: Primary 149 Through Post-Secondary SettingsSarah D. Wainscott and Sneha V. BharadwajIntroduction 149Supporting a Continuum of Communication Approaches
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150Facilitating Decisions Regarding Educational Placement
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151Identifying and Implementing Communication-Related Accommodations
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154Interprofessional Collaborations
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158Teaching Strategies
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160Providing Ongoing Communication Supports
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160Promoting Transition Planning and Advocacy
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Facilitating Self-Identity and Self-Determination 170Spotlight on the Oklahoma School for the Deaf and Sunshine Cottage School 171
for the Deaf: Two Educational Philosophies
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Summary 173References 173Recommended Readings 177Recommended Internet Sites for Further Learning 178Study Questions 180Answer Key 182See Appendix I at the end of the book for the background information on individuals featured in Chapter 7 videos: Aanya, Cade, Meghana, Maggie, and Rhegan.
8 Aural Rehabilitation for Adults with Hearing Loss 183Linda L. Daniel, Kristin King, Linda Thibodeau, and Carol CokelyIntroduction 183Aural Rehabilitation with a Heterogeneous Population
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183Quality of Life for Persons with Hearing Loss, Their Families, and 184
Communication Partners
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Assessment of Aural Rehabilitation Needs
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185Aural Rehabilitation to Improve Communication
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190Factors Affecting Aural Rehabilitation Goals, Procedures, and Outcomes
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194Hearing Assistive Technology Systems
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196Spotlight on Cindy: Self-Determination and Self-Advocacy
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199Summary 200References 200Recommended Readings 204Recommended Internet Sites for Further Learning 206Study Questions 207Answer Key 209Appendix 8–1: TELEGRAM Assessment Tool 210See Appendix I at the end of the book for the background information on individuals featured in Chapter 8 videos: Jerry, Rebecca, Amanda, Roberta, Gerald, Annabelle, Cindy, Brittany, and Terri.
ixContents
9 Fundamentals of Assessing Communication Skills in Children and 213 Adults with Hearing LossSneha V. Bharadwaj and Jill DuncanIntroduction 213Interprofessional Collaboration
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213Objectives of Assessment
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214Types of Assessment
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215Accommodations and Modifications 221Cultural and Linguistic Diversity 222A Case Presentation: Five-Year-Old Hiti
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223Special Considerations in the Assessment of Children and Adults with Hearing Loss 224Spotlight on Silas: A Child with Social Communication Needs
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227Summary 228References 228Recommended Readings 230Recommended Internet Sites for Further Learning 231Study Questions 232Answer Key 234See Appendix I at the end of the book for the background information on individuals featured in Chapter 9 videos: Silas, Josiah, Landon, Clara, Liam, Harry, Jaxson, Bruce Jr, Annabel, Terri, Meghana, Jerry, and Hiti.
10 Quality of Life, Counseling, and Advocacy for Children and Adults with 235 Hearing LossLinda L. Daniel, Andrea D. Warner-Czyz, and Roshini KumarIntroduction 235Effects of Hearing Loss on Quality of Life
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236Counseling Individuals with Hearing Loss
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243Advocacy
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Spotlight on Kim: Advocacy for People with Deaf-Blindness
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253Summary 254References 254Recommended Readings 258Recommended Internet Sites for Further Learning 259Study Questions 260Answer Key 262See Appendix I at the end of the book for the background information on individuals featured in Chapter 10 videos: Kelsey, Aliza, Bruce, Amanda, Charlie, Jaxson, Landon, and Silas.
Appendix I: Background Information on Persons with Hearing Loss Featured in the Videos 263Appendix II: A Brief History of Aural Rehabilitation 297Index 299
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n Preface
This video-based textbook was conceived as a for-mat in which to present over 200 captioned videos that illustrate aural rehabilitation (AR) practices to enhance listening and spoken language in individ-uals who have hearing loss, ranging from infants to older adults. It is intended to educate undergradu-ate university students in speech-language pathol-ogy, audiology, and education of the deaf and hard of hearing; enhance the knowledge and skills of practicing professionals; and assist persons with hearing loss, their families, and communication partners in understanding hearing loss and aural rehabilitation. The extensive videos also serve as a resource for graduate students who are enrolled in an aural rehabilitation practicum or those who are involved in student teaching.
The chapters and videos represent information regarding professional practices in AR used with a heterogeneous group of children and adults with hearing loss. The importance of interprofessional practice and collaboration is integrated into each chapter, to provide optimal patient care. Videos feature audiologists, speech pathologists, listening and spoken language specialists, teachers of the deaf and hard of hearing, early interventionists, otologists, and occupational therapists practicing in settings such as clinics, private practice, schools, hospitals, and the community. The discussions of personal hearing devices and other hearing assis-tive technologies along with strategies to enhance listening and communication are presented with the intention of optimizing communication func-tions of persons with hearing loss for greater par-ticipation in the hearing-speaking mainstream. Topics covered in the text of the chapters and vid-eos include hearing technologies, AR procedures for children and adults with hearing loss and their families, factors that affect outcomes, fundamen-tals of assessment, education, and the psychoso-cial well-being of persons with hearing loss. Some topics appear in more than one chapter, as they are integral to the focus of that chapter. Similarly,
a small number of videos are presented in more than one chapter, as they support a wide range of topics.
The framework of AR presented in this video-based book focuses primarily on the use of lis-tening and spoken language (i.e., Auditory-Verbal communication) for children and adults with hearing loss. In addition to listening and spoken language, other modes of communication are discussed and demonstrated in videos as is the communication philosophy of individuals who identify with the Deaf culture. Taken together, the approaches included in the chapters emphasize how to improve communication function in chil-dren and adults with hearing loss while respect-ing client and family choices. With improved communication, individuals can enjoy expanded opportunities and more fulfilling experiences in socialization, education, employment, and recre-ation. Whereas verbal communication underlies most social interactions, the roles of family, friends, coworkers, and other communication partners are discussed and their involvement in the AR process is illustrated in the videos.
As an introductory teaching guide, the chapters in this video-based textbook provide background knowledge on a number of topics, and the videos illustrate the application of this knowledge to AR services. While a wide range of topics and current issues are addressed in this textbook, they are not intended to be exhaustive. The activities demon-strated in the videos are for illustrative purposes. The activities and practices presented in each video were selected for the individual seen in the video and may or may not be applicable to another child or adult with hearing loss. All AR services should be completely individualized and tailored to meet the needs of the individual and family. It is our hope that this video-based book will inspire students and practicing professionals to assist people with hearing loss in improving their communication function and expanding their opportunities in life.
Video-Based Aural Rehabilitation Guide8
n Severity of Hearing Loss and Access to the Speech Spectrum
As mentioned earlier, hearing loss may be congeni-tal or acquired. Hearing loss can also be stable, fluctuating, progressive, or sudden. It can occur at any point in life and can change throughout life. Hearing loss severity can be minimal, mild, moderate, moderately severe, severe, or profound
(Table 1–3). In addition, hearing sensitivity may not be uniform across the speech frequencies and can be described with greater detail. For example, hearing loss can be within normal limits in the low to mid frequencies and severe to profound in the high frequencies.
Figure 1–4 shows audiograms depicting vary-ing severity of hearing loss, configurations of hearing loss, as well as the speech banana, which indicates the general area of the audiogram which
Table 1–2. Descriptions of Tests Commonly Used to Identify Hearing Loss
Hearing Tests Description
Auditory brainstem response
An electrophysiological response to sound from the brainstem, measured by electrodes placed on the scalp. It can provide an estimate of frequency-specific thresholds.
Otoacoustic emission
Low-intensity sound generated as a result of vibrations of the hair cells in the cochlea in response to a sound stimulus. Measured with a sensitive microphone placed in the ear canal.
Auditory steady-state response
ASSR consists of neural potentials in response to modulated auditory stimuli measured via surface electrodes. It is used to estimate frequency-specific thresholds.
Tympanometry This test provides information concerning the mobility of the tympanic membrane and status of the middle ear transmission system.
Acoustic reflex measure
The acoustic reflex is an involuntary contraction of middle ear muscles in response to loud sounds. This measure is helpful in identifying whether retrocochlear pathology is present.
Visual reinforcement audiometry
A child is conditioned to make a head turn toward visual reinforcers (e.g., lights, mechanical toys) in response to sound.
Conditioned play audiometry
The child is taught to perform an action with a toy upon hearing a sound presented by the audiologist.
Conventional audiometry
Also known as pure-tone audiometry. Pure tones are presented at various frequencies and intensities to a person, who indicates when the sound is heard.
Speech detection threshold
A measure used to determine the lowest hearing level at which a patient can detect the presence of speech on 50% of the test trials.
Speech recognition threshold
A measure designed to find the lowest hearing level that a patient can identify or repeat words on 50% of the test trials. The most common stimuli used are two-syllable words with equal stress on each syllable (i.e., spondees).
Suprathreshold speech recognition
A measure of the percentage of single syllable words and sentences correctly identified or repeated at various loudness levels. Tests are available for children and adults.
1. Overview of Aural Rehabilitation 9
encompasses the speech frequencies. Audiogram A shows mild hearing loss with a cookie bite con-figuration; audiogram B shows a moderate hearing loss with a rising configuration; audiogram C shows a severe hearing loss with a flat configuration; and audiogram D shows a profound hearing loss with a sloping configuration. As seen in Figure 1–4, the severity of hearing loss impacts speech rec-ognition performance. Word discrimination scores generally become poorer with increased severity of hearing loss. The speech banana depicted in each audiogram illustrates which phonemes (vow-els and consonants) will be difficult to detect, dis-criminate, or identify given the configuration and severity of hearing loss. Thus, knowing the degree
Table 1–3. Hearing Loss Severity
Degree of Hearing Loss (Severity)
Hearing Loss Range (dB HL)
Normal −10 to 15 dB
Slight/Minimal 16 to 25 dB
Mild 26 to 40 dB
Moderate 41 to 55 dB
Moderately severe 56 to 70 dB
Severe 71 to 90 dB
Profound >90 dB
Source: Adapted from ASHA, 2015.
Figure 1–4. Audiometric configurations, severity of hearing loss, and the speech banana.
Video-Based Aural Rehabilitation Guide10
to which a PHL has access to the speech spectrum will assist the audiologist in counseling, helping the individual understand how the hearing loss relates to their difficulties in speech recognition, and in explaining the expected benefits of hearing technologies. These concepts are explained by a clinical audiologist in Video 1–6.
The effects of severity of hearing loss on speech recognition can also be conceptualized from a familiar sounds audiogram (Figure 1–5).
VIDEO
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The familiar sounds audiogram provides examples of phonemes and environmental sounds that may not be heard or misunderstood by a PHL based on configuration of the listener’s hearing loss and benefit from hearing technology.
Individuals may have symmetrical or asym-metrical hearing. The same type, degree, and con- figuration of hearing loss in both ears is a sym-metrical hearing loss. In asymmetrical hearing loss, the degree of hearing loss is different in each
FREQUENCY IN HERTZ (Hz)
Figure 1–5. Familiar sounds audiogram. From Hearing in Children, Sixth Edition by Jerry L. Northern and Marion P. Downs. Copyright ©2014 Plural Publishing, Inc.
1. Overview of Aural Rehabilitation 11
ear. If one ear has normal hearing and the other has a profound hearing loss, it is referred to as single-sided deafness (SSD). Another example of asymmetrical hearing is a mild hearing loss in one ear and a severe hearing loss in the other.
n Treatment of Hearing Loss
Hearing loss may be treated with medication, sur-gery, and/or hearing technologies. For example, medication may be prescribed to treat serous oti-tis media. Surgery may be needed to correct con-ductive hearing loss resulting from a perforated tympanic membrane or disarticulated ossicular chain. Hearing technologies can improve hearing in most individuals with unilateral or bilateral hearing loss. The vast majority of PHL can benefit significantly from hearing aids. For those whose hearing loss is too severe to derive necessary ben-efit from hearing aids for speech recognition, a cochlear implant may be an option. In Video 1–7, Harry’s mother discusses how the asymmetry, severity, and configuration of her son’s hearing loss led to his use of two different types of hearing technologies.
If conventional hearing aids are not appro-priate, implantable hearing technologies may be considered. Implantable devices, including bone anchored hearing aids, cochlear implants, and auditory brainstem implants (ABIs), may be rec-ommended following comprehensive hearing testing and medical evaluation. Hearing aids and cochlear implants are highly effective in providing access to the speech spectrum, which includes the frequencies that are necessary for understanding speech. Many children and adults with hearing aids and cochlear implants have achieved positive outcomes in speech recognition. In special cases, such as a child with absent cochleae or an adult with absent auditory nerves due to acoustic neu-romas, an ABI may be an option. An ABI does not provide the sound quality of hearing aids and cochlear implants. However, with ongoing, inten-sive auditory-based intervention, some individuals with an ABI may acquire awareness and recogni-tion of environmental sounds, prosodic patterns,
VIDEO
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and segmental features leading to some speech recognition (Allen & Daniel, 2016). Video 1–8 shows Aanya in an assessment session with her AV therapist probing her auditory skills for discrimina-tion of prosodic and segmental features.
Hearing aids, cochlear implants, and ABIs are discussed in detail in Chapters 2, 3, and 4. It should be noted that some PHL do not elect to use hearing technologies due to personal preference or factors such as finances and cosmetics. Individuals who identify with the Deaf culture may not choose to use hearing technologies.
n Deaf Culture
People who identify themselves with the Deaf cul-ture use American Sign Language (ASL) as their primary mode of communication. They consider being Deaf to be their cultural and linguistic iden-tity, take pride in their history, and prefer to use a visual-spatial mode of communication. Deaf culture perspective maintains that deafness is a difference, not a disability, and therefore, hearing technology is not necessary. Deaf culture perspec-tive also maintains that Deaf people do not focus on their physical difference, but instead, capitalize on their strengths in visual communication, use of ASL, and sense of belonging within a linguistic-cultural minority (Marschark, Zettler, & Dammeyer, 2017). Deaf people may rely on visual technolo-gies such as closed captioning, texting, Internet-based face-to-face communication technologies, and devices that use vision and touch for access-ing environmental sounds. Examples of visual and tactile devices are flashing lights that signal the doorbell and a vibrating alarm clock, respectively. Many members of Deaf culture support residential schools for children with hearing loss and edu-cational programs that promote a bilingual ASL-English approach to teaching communication and literacy. Deaf culture is discussed in further detail in Chapter 7. Video 1–9 shows a university profes-sor explaining Deaf culture. In Video 1–10, the principal of an elementary program at a school for the Deaf discusses the role of the Deaf community in the lives of individuals who are Deaf.
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Video-Based Aural Rehabilitation Guide12
n Effects of Hearing Loss on the Perception and Production of Spoken Language
A PHL may have difficulty understanding face-to-face conversations, overhearing conversations of others, hearing at a distance, and understanding speech in noise. The degree to which a PHL has access to the acoustic properties of speech will affect detection, discrimination, and identifica-tion of certain phonemes, which, in turn, impact speech recognition and comprehension of spoken language. Speech perception, in turn, is inextri-cably tied to speech acquisition and monitoring through auditory feedback.
Speech Acoustics
An understanding of speech acoustics and its rela-tionship to speech perception helps an AR prac-titioner determine which speech features a PHL may hear or have difficulty in perceiving. Speech comprises suprasegmental (e.g., intonation, word emphasis, syllable stress, juncture) and segmental (vowel and consonants) elements. Suprasegmental (i.e., prosodic) aspects of speech are conveyed by varying intensity, frequency, and duration across syllables or longer units of speech. Suprasegmen-tal aspects are conveyed primarily in the low fre-quencies and are used to express emotions and meaning. Vowels differ from each other in terms of tongue height and placement. Similarly, consonants differ from each other in terms of voicing, manner of articulation, and place of articulation. These production differences are reflected in acoustic differences (e.g., intensity, frequency, temporal information). In general, vowels are more salient (i.e., louder), longer, and lower in frequency than consonants. In contrast, consonants are primarily in the higher frequency range, have less power (i.e., are softer), and are shorter in duration. The acous-tic cues that are important in perception of vowels include formant frequencies (e.g., F1, F2), formant trajectories of the syllable nucleus, formant band-width and amplitude, vowel spectrum, vowel dura-tion, and fundamental frequency (see Kent & Read, 2002 for basic descriptions). The acoustic cues that may be important for consonant perception
include: burst frequency, noise intervals, formant transitions, voice onset times, and nasal murmur (see Kent & Read, 2002 for basic descriptions).
Effects of Hearing Loss on Speech Perception and Production
Many factors affect speech perception and speech production. These include: severity and configura-tion of hearing loss, the degree to which a PHL has access to the speech spectrum through the hearing technologies (e.g., hearing aid, cochlear implant, ABI), background noise, associated audi-tory disorders, and cognitive status. A PHL typi-cally has more difficulty hearing and identifying consonants than vowels. Significant hearing loss in the lower frequencies may lead to confusions in vowel identification, voicing (e.g., /b / vs. /p/), and perception of suprasegmental features (e.g., perception of unstressed syllables). Hearing loss in the mid and higher frequencies is often associ-ated with difficulties in perceiving cues related to manner of articulation (e.g., bee vs. see), place of articulation (e.g., call vs. tall), and either detect-ing or distinguishing between less salient con-sonants (e.g., /f/, /s/, /th/) (Nerbonne, Schow, & Blaiser, 2018).
Hearing loss, even with appropriately fitted hearing technologies, may result in an individual hearing an impoverished (i.e., degraded) represen-tation of spoken language. During the acquisition of spoken language, impoverished auditory input and auditory feedback typically are reflected in speech production errors. Audio 1–1 and Audio 1–2 illustrate speech production differences in 3½-year-old twin girls. One of the twins has typical hearing and the other has congenital, moderate hearing loss and has worn hearing aids for 1½ years. Audio 1–1 is a short speech sample of the twin who has typi-cal hearing, and Audio 1–2 is a speech sample of the twin with moderate hearing loss. As can be noted from these speech samples, the twin with hearing loss demonstrates atypical resonance and articulation errors. The waveform and spectrogram shown in Figure 1–6 demonstrate that the twin who has typical hearing was able to produce the phrase “I like juice” in a developmentally appropri-ate manner, whereas the sibling with hearing loss demonstrated omission of final consonant as well as phoneme substitutions.
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1. Overview of Aural Rehabilitation 13
Speech production characteristics of individu-als with hearing loss vary depending on the degree of hearing loss, access to the speech spectrum, age of intervention, and quality of intervention. Some of the suprasegmental and segmental charac-teristics of the speech of PHL may include: higher F0; limited F0 ranges; longer durations of vow-els, consonants, syllables, and phrases; abnormal resonance; deviant voice quality; restricted formant frequency ranges (often described as constricted vowel spaces); omission, distortion, or substitution of consonants; and abnormal voice-onset times
(e.g., Bharadwaj & Assmann, 2013; Bharadwaj & Graves, 2008; Ertmer & Goffman, 2010; Osberger, 1987; Serry & Blamey, 1999; Tobey et al., 1991; Uchanski & Geers, 2003; Waldstein, 1990).
It is not uncommon for individuals with sig-nificant hearing loss to present with deficits in vocabulary, morphology, syntax, phonology, prag-matics, and world knowledge (e.g., Salas-Provance, Spencer, Nicholas, & Tobey, 2014; Tomblin et al., 2015; Walker et al., 2015). The effects of hearing-related language errors permeate the individual’s receptive language, expressive language, reading,
Figure 1–6. Production of the phrase “I like juice” by twins. Waveform and spectrogram on the top panel show productions by a 3.5-year-old with typical hearing and the bottom panel shows the production by the 3.5-year-old sibling with hearing loss.
