Hearing Loss and Communication

Alison King, MSP, CCC-SLP, LSLS Cert.AVT

Objectives• Gain a better understanding of the unique

role that medical and educational facilities have in assisting students who have a hearing loss

• Gain an understanding of hearing loss as a medical diagnosis

• Learning to recognize the unique speech and language characteristics of students who have a hearing loss based on communication methodologies

• Learn how to find other resources which may be beneficial for you as a professional to best serve your student’s needs

Deb Roy –Birth of a Word

• http://www.ted.com/talks/deb_roy_the_birth_of_a_word.html

Universal Newborn Hearing Screening & 1-3-6

• In 2005, 91.5% of the nearly 4 million babies born in the US had their hearing screened prior to leaving the hospital (CDC).

• Early Hearing Detection and Intervention (EHDI) laws or voluntary hearing screening programs are in place in all 50 states and the District of Columbia (ASHA, n.d.).

• 1 month=  All infants are screened for hearing loss prior to discharge from birthing/neonatal facilities, or within one month of birth.

• 3 months=  All infants referred from the screening process complete diagnostic audiological evaluation.

• 6 months=  All infants with diagnosed hearing loss receive appropriate interventions including amplification and Early Intervention.

Medical vs. Educational Diagnosis

• Medical definition – clinical measure (arbitrary) used to determine eligibility for federal benefits

• Educational definition – considers the impact of hearing loss on educational performance

Hearing Impairment and Deafness

• "Deafness" means a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects the child’s educational performance. 34 CFR § 300.7 (c) (3)

• "Hearing Impairment" means an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but that is not included under the definition of deafness in this section. 34 CFR § 300.7 (c) (5)

Hearing Impairment and Deafness

Virginia DOE Statistics2010 Child Count Data

There were 1,473 students between the ages of 0-22+ that had the label of Hearing Impairment and 25 who had the label of Deaf-Blindness.

http://www.doe.virginia.gov/special_ed/reports_plans_stats/child_count/

Hearing Impairment and Deafness

There were 357 students provided services in state operated programs.

111 students provided services at VSDB Staunton. – HI – 71 (under 5% of total population)– VI – 35– DB – 5

Etiology of Hearing Loss

• Congenital – hearing loss is present at birth– Genetic– Prenatal infections (ex. CMV)

• Acquired – hearing loss after birth– Progressive hearing loss (hereditary)– Trauma (Turn down your earbuds!)– Ototoxic medications– Otitis Media (ear infections)

Important to note that it is estimated that 90-95% of all children born with a hearing loss are both to parents with normal hearing. (White, 2006).

Types of Hearing Loss

• Conductive -Occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones of the middle ear. This type of hearing loss can often be corrected medically or surgically.

• Sensorineural - (SNHL) occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected.

• Mixed – Combination of both conductive and sensorineural 

How We Hear

Cochleahttp://www.medel.com/blog/photographic-tour-of-the-cochlea

Cochleahttp://www.medel.com/blog/photographic-tour-of-the-cochlea

Hearing Impairment and Deafness

The Audiogram!

dB (decibels) – loudness level

Hz (hertz) – frequency (pitch)

Degrees of Hearing Loss

http://www.asha.org/public/hearing/Degree-of-Hearing-Loss/

Degree of hearing loss Hearing loss range (dB HL)

Normal –10 to 15

Slight 16 to 25

Mild 26 to 40

Moderate 41 to 55

Moderately severe 56 to 70

Severe 71 to 90

Profound 91+

Most Common Amplification

Options• Hearing aids – Selected and

programmed based on an individual’s loss (dB and frequency)

• Cochlear implants – Does NOT restore hearing! Used for sensorineural hearing loss or auditory neuropathy

Cochlear Implants

• How Cochlear Implants Work

• http://www.youtube.com/watch?v=Poyj7U2wzhQ

Communication Options

• ASL (American Sign Language) – bilingual approach which uses American Sign Language and English; ASL has it’s own distinct grammar and linguistic principles.

• http://www.youtube.com/watch?v=5-fwQpCylW4

Communication Options

• Auditory-Verbal- Emphasis of developing spoken language through listening

• http://www.youtube.com/watch?v=v6UQBX8sNPY

• http://www.youtube.com/watch?v=6yNPTFjNyzI

Communication Options

• Auditory-Oral - An approach that teaches a child to use his/her remaining hearing through amplification and the use of speechreading/natural gestures/visual cues to aid the child’s understanding of language.

Communication Options

• Cued Speech - An auditory-visual communication approach with the use of hand cues with the natural mouth movements of speech, specifying each sound (phoneme) of spoken language clearly

• http://www.youtube.com/watch?v=QFStsUmrwUQ

Communication Options

• Simultaneous Communication- an educational philosophy that uses spoken language and sign language simultaneously.  The sign is English-based.

• http://www.youtube.com/watch?v=MeGSIixY4jc

Communication Strategies

• Dependent communication methodology being used

• Have a clear understanding of where the child is with regards to auditory, speech, and language or sign development

• Sit on the side of the “better” ear• Best practice = personal FM systems• Best to say it again in the same way – child

is still processing how you said it the first time

• Have child repeat back directions• Have high expectations• Never Assume!

Things to Remember:

• The first seven years of life are critical for learning verbal language. Past those 7 years, it becomes much more difficult to acquire verbal language and the window of opportunity slowly closes neurologically (Lillard & Erisir, 2011).

• Demographic data suggests that 40% of all students with a hearing loss have a secondary disability (Wiley & Moeller, 2007). Due to UNHS, hearing loss is identified prior to many of these disabilities (i.e. autism, learning disabilities).

Things to Remember:

• Yoshinago-Itano (2003) found that early identification of hearing loss and early amplification by either the use of hearing aids or cochlear implants have positive effects on the language, speech, and social-emotional development of children.

• As professionals, we must support parental choices!

Impact of HL on Language

• Families have options. If they choose for their child to use sign, then they must learn sign at a faster rate than the child.

• The development of sign language does not equate exactly to the development of spoken language.

• Auditory skills are developmental and coincide with language and speech development.

Impact of HL on Articulation/Voic

e• Without access to sound, a child with a

hearing loss will not develop articulation and vocal quality the same as their hearing peers – physiologically impossible.

• However, with early and appropriate amplification, a child with a hearing loss can develop articulation and voice commensurate to their hearing peers.

Assistive Technology

Personal FM systems – connects directly to the HA or CI • Decreases the “distance”

factor• Provides the best opportunity

for the child to hear and not miss important information from

the teacher.Soundfield amplification – speakers in the classroom

IFSP/IEP Development

• Things to consider…– History– Communication modality– How long they have been

hearing– Parental choices– LRE (?)

It is all about LANGUAGE!

What’s Important?

• Early Identification– UNHS

• Early Amplification– Parental decision

• Early Intervention – Communication methodology can

change over time based on the child/family needs

– Language learning is the key!

Let’s Discuss….

Who decides what (or if) amplification should be used?

Who decides what communication option should be used?

When are these decisions made?

What is the role of EI providers and Early Childhood Educators?

Take Aways

What are 3 important items that we need to take away from tonight?

Additional Resources

AG Bell Association for the Deaf and Hard of Hearinghttp://listeningandspokenlanguage.org/

National Cued Speech Associationhttp://www.cuedspeech.org

National Association of the Deafhttp://www.nad.org

VCU Cochlear Implant Program http://www.vcu.edu/ent/cicenter/

References• American Speech-Language Hearing Assocaition. (n.d.). Early

Hearing Detection and Interventon (EHDI). Retrieved from: http://www.asha.org/advocacy/federal/ehdi/.

• Lillard, A. & Erisir, A. (2011). Old dogs learning new tricks: Neuroplasticity beyond the juvenile period. Developmental Review, 31 (4), 207-239.

• Virginia Department of Health. (2003). Virginia early hearing detection and intervention Program 2003 annual report. Retrieved from: http://www.vdh.virginia.gov/ofhs/childandfamily/childhealth/hearing/documents/2012/publications/pdf/2003.pdf.

• White, K. R. (2006). Early intervention for children with permanent hearing loss: finishing the EDHI revolution. The Volta Review, 106, 237-258

• Wiley, S. & Moeller, M. (2007). Red flags for disabilities in children who are deaf/hard of hearing. The ASHA Leader. Retrieved from http://www.asha.org/Publications/leader/2007/070123/f070123b.htm.

• Yoshinaga-Itano, C. (2003). From seening to early identification and intervention: discoveringpredictors to successful outcomes for children with significant hearing loss. Journal of Deaf Studies and Deaf Education, 8(1), 11-30.

References• http://www.ted.com/talks/deb_roy_the_birth_of_a

_word.html• http://www.doe.virginia.gov/special_ed/reports_p

lans_stats/child_count/• http://www.medel.com/blog/photographic-tour-of

-the-cochlea• http://www.asha.org/public/hearing/Degree-of-He

aring-Loss/

• http://www.youtube.com/watch?v=5-fwQpCylW4• http://

www.youtube.com/watch?v=v6UQBX8sNPY• http://www.youtube.com/watch?v=6yNPTFjNyzI• http://

www.youtube.com/watch?v=QFStsUmrwUQ• http://www.youtube.com/watch?v=MeGSIixY4jc