hearing loss traducir

8/3/2019 Hearing Loss Traducir

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HEARING LOSSHEARING LOSS


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Hearing loss:Hearing loss:

Hearing loss is a diminished ability to detect,Hearing loss is a diminished ability to detect,

recognize, discriminate, perceive, and/orrecognize, discriminate, perceive, and/or

comprehend auditory information.comprehend auditory information. Because the ability to hear sounds is crucial forBecause the ability to hear sounds is crucial for

the typical development of spoken language, athe typical development of spoken language, a

hearing loss is classified as a communicationhearing loss is classified as a communication

disorder.disorder.


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Level of severity: table IILevel of severity: table II--22

minus 10 to plus15 dB HL Normalminus 10 to plus15 dB HL Normal

1616--25 dB HL Borderline25 dB HL Borderline

2626--40 dB HL Mild40 dB HL Mild 4141--55 dB HL Moderate55 dB HL Moderate

5656--70 dB HL Moderate70 dB HL Moderate--SevereSevere

7171--90 dB HL Severe90 dB HL Severe >90 dB HL Profound>90 dB HL Profound


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Hearing of speech frequency rangeHearing of speech frequency range

The overall degree of hearing loss may be described based on theThe overall degree of hearing loss may be described based on theaverage of the childs hearing level for three frequencies withinaverage of the childs hearing level for three frequencies withinthe speech frequency range (500, 1,000, and 2,000 Hz) (Figurethe speech frequency range (500, 1,000, and 2,000 Hz) (Figurebanana speech).banana speech).

For example, if a child has a hearing threshold of 25 dB HL atFor example, if a child has a hearing threshold of 25 dB HL at500 Hz, 30 dB HL at 1,000 Hz, and 35 dB HL at 2,000 Hz, the500 Hz, 30 dB HL at 1,000 Hz, and 35 dB HL at 2,000 Hz, theaverage would be 30 dB HLaverage would be 30 dB HL


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T

ypes of hearing lossT

ypes of hearing loss


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Conductive hearing lossConductive hearing loss

Results from problems in the outer and/or middle ear,Results from problems in the outer and/or middle ear,creating a diminished efficiency with which the sound iscreating a diminished efficiency with which the sound isconducted to the inner ear.conducted to the inner ear.

The bone conduction thresholds are normalThe bone conduction thresholds are normal

The air conduction thresholds are in the borderline toThe air conduction thresholds are in the borderline tomoderate rangemoderate range

The hearing loss is not severe or profoundThe hearing loss is not severe or profound


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Sensory hearing lossSensory hearing loss::

Results from problems in the inner ear that preventResults from problems in the inner ear that preventneural impulses from being generated by the hair cellsneural impulses from being generated by the hair cellsin the cochlea.in the cochlea.

The bone conduction thresholds are also impairedThe bone conduction thresholds are also impaired The hearing loss can range from borderline toThe hearing loss can range from borderline to

profoundprofound

Some frequencies may show a greater loss than doSome frequencies may show a greater loss than do

othersothers


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Neural hearing lossNeural hearing loss::

Results when neural impulses are not able toResults when neural impulses are not able to

reach the brain in a normal manner. Neuralreach the brain in a normal manner. Neuralhearing loss may be the result of problems in thehearing loss may be the result of problems in the

auditory nerve, the brainstem, or the centralauditory nerve, the brainstem, or the centralauditory pathway.auditory pathway.


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Mixed hearing lossMixed hearing loss::

Results from problems in both the middle andResults from problems in both the middle and

the inner ear. For example, children with athe inner ear. For example, children with asensory hearing loss can also have a conductivesensory hearing loss can also have a conductive

hearing loss due to otitis media with effusionhearing loss due to otitis media with effusion(OME). The conductive hearing loss(OME). The conductive hearing loss

compounds the sensory hearing loss, increasingcompounds the sensory hearing loss, increasing

the childs overall hearing loss.the childs overall hearing loss.


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Central Auditory DisorderCentral Auditory Disorder::

Results from problems in the processing ofResults from problems in the processing ofsound in higher auditory areas of the brain. Thissound in higher auditory areas of the brain. Thistype of auditory problem affects more complextype of auditory problem affects more complex

auditory processes such as understanding speechauditory processes such as understanding speechwhen there is background noise. Hearingwhen there is background noise. Hearingsensitivity and physiologic tests such assensitivity and physiologic tests such asotoacoustic emissions (OAE) and auditoryotoacoustic emissions (OAE) and auditorybrainstem response (ABR), are normal inbrainstem response (ABR), are normal inchildren with a central auditory disorder.children with a central auditory disorder.


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Causes:Causes:

Acute otitis media. The conductive hearing lossAcute otitis media. The conductive hearing lossassociated with otitis media may be mild andassociated with otitis media may be mild andfluctuating. OME may persist within the middle earfluctuating. OME may persist within the middle earspace without any signs (such as fever or discomfort)space without any signs (such as fever or discomfort)

for weeks or months.for weeks or months. Chronic otitis media may result in rupturing of theChronic otitis media may result in rupturing of the

tympanic membrane (eardrum). The repeated rupturingtympanic membrane (eardrum). The repeated rupturingand healing of the tympanic membrane can lead to scarand healing of the tympanic membrane can lead to scar

tissue on the eardrum resulting in conductive hearingtissue on the eardrum resulting in conductive hearingloss.loss. Sensorineural hearing loss can result from a variety ofSensorineural hearing loss can result from a variety of

causes, both genetic and nongenetic. Nongenetic causescauses, both genetic and nongenetic. Nongenetic causesinclude ototoxic drugs and various infections, such asinclude ototoxic drugs and various infections, such as

meningitismeningitis


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Early detectionEarly detection

Screening programsScreening programs identify newborns thatidentify newborns that

might have a hearing problem. Those who domight have a hearing problem. Those who donot pass the newborn screening test are referrednot pass the newborn screening test are referred

for further audiological followfor further audiological follow--up.up.

Hearing loss is confirmed using a battery ofHearing loss is confirmed using a battery ofaudiologic testsaudiologic tests..


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Hearing LossHearing Loss

ChecklistChecklistAdapted from the CaliforniaAdapted from the California

Department of Health Services'Department of Health Services'checklistchecklist


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Birth to 3 monthsBirth to 3 months

Becomes quiet when around everyday voices orBecomes quiet when around everyday voices or

soundssounds

Reacts to loud sounds: baby startles, blinks,Reacts to loud sounds: baby startles, blinks,stops sucking, cries, or wakes upstops sucking, cries, or wakes up

Makes soft sounds when awake: baby gurglesMakes soft sounds when awake: baby gurgles


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3 to 6 months3 to 6 months

Turns eyes or head toward sounds: voices, toysTurns eyes or head toward sounds: voices, toys

that make noise, a barking dogthat make noise, a barking dog

Starts to make speechStarts to make speech--like sounds: "ga," "ooh,"like sounds: "ga," "ooh,""ba," and p, b, m sounds"ba," and p, b, m sounds

Reacts to a change in your tone of voiceReacts to a change in your tone of voice


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Responds to soft sounds, especially talkingResponds to soft sounds, especially talking

Responds to own name and looks when calledResponds to own name and looks when called

Understands simple words: "no," "byeUnderstands simple words: "no," "bye--bye,"bye,""juice"juice

Babbles: "da da da," "ma ma ma," "ba ba ba"Babbles: "da da da," "ma ma ma," "ba ba ba"


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Consistently responds to both soft and loudConsistently responds to both soft and loud

soundssounds

Repeats single words and copies animal soundsRepeats single words and copies animal sounds Points to favorite toys or foods when askedPoints to favorite toys or foods when asked


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Uses 10 or more wordsUses 10 or more words

Follows simple spoken directions: "get the ballFollows simple spoken directions: "get the ball

Points to people, body parts or toys when askedPoints to people, body parts or toys when asked "Bounces" to music"Bounces" to music


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Uses 20 or more wordsUses 20 or more words

Combines two or more words: "more juice,"Combines two or more words: "more juice,"

"what's that?"what's that? Uses many different consonant sounds at theUses many different consonant sounds at the

beginning of words: b, g, mbeginning of words: b, g, m

Listens to simple stories and songsListens to simple stories and songs


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2 to 3 years old2 to 3 years old

Uses sentences with two or three wordsUses sentences with two or three words

At 2 years, the child's speech is understoodAt 2 years, the child's speech is understood

some of the time (25%some of the time (25%--50%)50%)At 3 years, the child's speech is understood mostAt 3 years, the child's speech is understood most

of the time (50%of the time (50%--75%)75%)

Follows twoFollows two--step instructions: "get the ball andstep instructions: "get the ball andput it in the box"put it in the box"


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InterventionIntervention


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Prescription of some sort ofPrescription of some sort of

assistive device to amplify theassistive device to amplify the

sound:sound:

Hearing aids.Hearing aids.

FM systems.FM systems. Cochlear implantCochlear implant


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A primary focus of early intervention forA primary focus of early intervention for

children with hearing loss is to promote theirchildren with hearing loss is to promote theircommunicative competencecommunicative competence


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Auditory approaches:Auditory approaches:

AuditoryAuditory--VerbalVerbalapproaches emphasize thatapproaches emphasize that

hearing is essential for developing spokenhearing is essential for developing spokenlanguage.language.

AuditoryAuditory--OralOralapproaches also emphasize the roleapproaches also emphasize the roleof hearing with the goal of developing spokenof hearing with the goal of developing spoken

language but may add supplementary visuallanguage but may add supplementary visual

information from spoken language.information from spoken language.


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Combination approaches using vision toCombination approaches using vision tosupport Englishsupport English::

Cued SpeechCued Speechsupplements spoken language visuallysupplements spoken language visuallythrough the use of eight handshapes to represent thethrough the use of eight handshapes to represent theconsonants of speech and four different hand locationsconsonants of speech and four different hand locations

near the face and neck to represent the vowels.near the face and neck to represent the vowels. TotalCommunication (TC)TotalCommunication (TC)approaches use signs, speech,approaches use signs, speech,

hearing, and gestures to convey the message usinghearing, and gestures to convey the message usingEnglish grammar.English grammar.

SimultaneousCommunication (SimCom)SimultaneousCommunication (SimCom)is the simultaneousis the simultaneoususe of signs that systematically represent English anduse of signs that systematically represent English andspeech.speech.


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Visual approaches using American SignVisual approaches using American SignLanguage (ASL)Language (ASL)::

ASL is the language used in the DeafASL is the language used in the Deaf

community. ASL is a complete language (totallycommunity. ASL is a complete language (totallydifferent from English) that has no written ordifferent from English) that has no written or

spoken form.spoken form. BilingualBilingualapproaches use ASL asapproaches use ASL asthe primary language, and the child learnsthe primary language, and the child learns

English as a second language.English as a second language. BilingualBilingual--BiculturalBicultural

(Bi(Bi--Bi)Bi)approaches use ASL as the primaryapproaches use ASL as the primarylanguage with English as a second language andlanguage with English as a second language and

also incorporate instruction in Deaf culture.also incorporate instruction in Deaf culture.


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Effects ofearly intervention onEffects ofearly intervention oncommunication, language, andcommunication, language, and

general developmentgeneral development


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1. Early intervention can improve outcomes in1. Early intervention can improve outcomes in

children with identified hearing impairmentschildren with identified hearing impairmentsregardless of the degree of hearing loss, mode ofregardless of the degree of hearing loss, mode of

communication, cognitive ability, or sociocommunication, cognitive ability, or socio--economic status.economic status.


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2. Early, systematic intervention may result in:2. Early, systematic intervention may result in:

Better child outcomes such as more advancedBetter child outcomes such as more advanced

social, communication, and preacademic skillssocial, communication, and preacademic skillsA reduction of maternal stress related to healthA reduction of maternal stress related to health

and attitude towards the childand attitude towards the child


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3. Early diagnosis, early intervention, and family3. Early diagnosis, early intervention, and family

involvement are important factors in achievinginvolvement are important factors in achievingbetter language outcomes regardless of the agebetter language outcomes regardless of the age

of onset, degree of hearing loss, or type ofof onset, degree of hearing loss, or type ofinterventionintervention


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Children with hearing loss and participate in anChildren with hearing loss and participate in anearly intervention program beginning at 8 to 9early intervention program beginning at 8 to 9months of age, compared with children whomonths of age, compared with children who

begin intervention at 20 to 21 months of age,begin intervention at 20 to 21 months of age,have higher scores on measures of:have higher scores on measures of:

Expressive and receptive language Expressive and receptive language

V

ocabulary and vowel productionV

ocabulary and vowel production Personal and general development Personal and general development

Situational and conceptual comprehension Situational and conceptual comprehension


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Valuable aspects of earlyValuable aspects of earlyintervention programsintervention programs

include:include:


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Modeling communication and play techniquesModeling communication and play techniques

Information about the deaf communityInformation about the deaf community

Visits or opportunities to meet deaf adultsVisits or opportunities to meet deaf adultsAccess to professionals experienced with youngAccess to professionals experienced with young

children who are deaf and hard of hearingchildren who are deaf and hard of hearing

Access to parent counselors and support groupsAccess to parent counselors and support groups Sign language trainingSign language training


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Goals:Goals:

Preventing or reducing communicationPreventing or reducing communication

problems that typically accompany early hearingproblems that typically accompany early hearinglossloss

Improving the childs ability to hearImproving the childs ability to hear

Facilitating family support and confidence inFacilitating family support and confidence in

parenting a child with hearing lossparenting a child with hearing loss


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Factors when considering intervention options:Factors when considering intervention options:

The best available scientific evidence about theThe best available scientific evidence about the

effectiveness of the intervention and alternativeseffectiveness of the intervention and alternatives

T

he developmental needs and skills of the childT

he developmental needs and skills of the child The potential benefits as well as limitations andThe potential benefits as well as limitations and

risksrisks


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Factors relating to the individualFactors relating to the individual

child and family:child and family:

The childs chronological age and developmental level The childs chronological age and developmental level

The type and severity of the childs hearing loss The type and severity of the childs hearing loss

Other developmental status Other developmental status

C

oexisting problems, including the childs vision, sensoryC

oexisting problems, including the childs vision, sensoryfunction, motor coordination, and balancefunction, motor coordination, and balance

Priorities, resources, and concerns of the family Priorities, resources, and concerns of the family

Family stressors Family stressors

Other therapies the child is receiving Other therapies the child is receiving

The familys ability to participate in the chosen intervention The familys ability to participate in the chosen intervention

Language used by the child and the family Language used by the child and the family

Community resources such as child care Community resources such as child care


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Considering the cultural context ofthe child andConsidering the cultural context ofthe child and

familyfamily

Use of a language that will:Use of a language that will:

Facilitate and encourage natural interaction andFacilitate and encourage natural interaction and

communication between child and parent(s) atcommunication between child and parent(s) athomehome

Allow the child to develop a firm foundation inAllow the child to develop a firm foundation in

a first language before introducing a seconda first language before introducing a secondlanguage to the childlanguage to the child


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Professional experienceProfessional experience

Knowledge of amplification and assistiveKnowledge of amplification and assistivetechnologytechnology

Knowledge of communication development inKnowledge of communication development in

children with hearing losschildren with hearing loss Skills in facilitating auditory and speechSkills in facilitating auditory and speech

development in children who have hearing lossdevelopment in children who have hearing loss

Fluency in the selected communicationFluency in the selected communicationapproachapproach

Knowledge of family dynamicsKnowledge of family dynamics


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Parent educationParent education

What to expect regarding their childs hearingWhat to expect regarding their childs hearingloss and general developmentloss and general development

The implications of various assessmentsThe implications of various assessments

Intervention optionsIntervention options

Intervention goals, objectives, and methodsIntervention goals, objectives, and methods

How to evaluate progressHow to evaluate progress

How to use naturally occurring opportunities toHow to use naturally occurring opportunities tosupport and integrate intervention objectivessupport and integrate intervention objectivesinto the childs care at homeinto the childs care at home


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How to promote the childs languageHow to promote the childs language

development in daily routinesdevelopment in daily routines

How to use the chosen communicationHow to use the chosen communicationapproach effectivelyapproach effectively

How to manage their childs assistive technologyHow to manage their childs assistive technology

to ensure appropriate and consistent useto ensure appropriate and consistent use

How to advocate effectively for their childHow to advocate effectively for their child


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Family supportFamily support

Discuss their feelings about the diagnosis of theDiscuss their feelings about the diagnosis of the

childs hearing loss and their perception of thechilds hearing loss and their perception of theimpact on the familyimpact on the family

Receive support from peers and professionalsReceive support from peers and professionals

Receive professional counseling and supportReceive professional counseling and support


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Informing parents about interventionsInforming parents about interventions

Communication approach optionsCommunication approach options

Audiologic aspects of hearing loss includingAudiologic aspects of hearing loss includinghearing aids and other assistive technologyhearing aids and other assistive technology

Description of cochlear implants and the typeDescription of cochlear implants and the typeand severity of hearing loss for which they areand severity of hearing loss for which they areappropriateappropriate

Language development milestonesLanguage development milestones Effective advocacyEffective advocacy

Costs associated with the various optionsCosts associated with the various options

C i i A h f YC i i A h f Y


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Communication Approaches for YoungCommunication Approaches for YoungChildren With Hearing LossChildren With Hearing Loss

Selection depends on:Selection depends on:

1.The primary language either English (or another spoken1.The primary language either English (or another spokenlanguage) or American Sign Language (ASL)language) or American Sign Language (ASL)

2. The modality (or modalities) used to convey2. The modality (or modalities) used to conveyinformation. The approaches used to communicateinformation. The approaches used to communicate(convey information) range on a continuum from(convey information) range on a continuum fromauditory (spoken) to visual (signs and cues) andauditory (spoken) to visual (signs and cues) andcombinations that include both auditory and visualcombinations that include both auditory and visualapproaches.approaches.


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AuditoryAuditory--VerbalVerbalapproachapproach

Emphasizes that hearing is essential forEmphasizes that hearing is essential for

developing spoken language. By using hearingdeveloping spoken language. By using hearing(audition) as the primary way of acquiring(audition) as the primary way of acquiring

language, this approach attempts to replicate thelanguage, this approach attempts to replicate thelanguage learning process experienced bylanguage learning process experienced by

children who have normal hearing.children who have normal hearing.


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AuditoryAuditory--OralOralapproachapproach

Also emphasizes the role of hearing with theAlso emphasizes the role of hearing with the

goal of developing spoken language. However,goal of developing spoken language. However,this approach may add supplementary visualthis approach may add supplementary visual

information from spoken language such as lipinformation from spoken language such as lipreading (now referred to as speech readingreading (now referred to as speech reading

because it involves watching the whole face, notbecause it involves watching the whole face, not

only the lips).only the lips).


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Cued SpeechCued Speech

supplements spoken language visually throughsupplements spoken language visually through

the use of eight handshapes to represent thethe use of eight handshapes to represent theconsonants of speech and four different handconsonants of speech and four different hand

locations near the face and neck to represent thelocations near the face and neck to represent thevowels. These handshapes are not consideredvowels. These handshapes are not considered

signs but merely cues to enhance the visualsigns but merely cues to enhance the visual

perception of spoken language.perception of spoken language.


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TotalCommunication (TC)TotalCommunication (TC)

Uses signs, speech, hearing, and gestures toUses signs, speech, hearing, and gestures to

convey the message using English grammar.convey the message using English grammar.Specific TC systems that convey specific EnglishSpecific TC systems that convey specific English

syntax are sometimes referred to as manuallysyntax are sometimes referred to as manuallycoded English (MCE) systems. Examples ofcoded English (MCE) systems. Examples of

MCE systems are Signed English, Signing ExactMCE systems are Signed English, Signing Exact

English, and Seeing Essential EnglishEnglish, and Seeing Essential English


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SimultaneousCommunication (SimCom)SimultaneousCommunication (SimCom)

Is sometimes considered to be a component ofIs sometimes considered to be a component ofTotal Communication. It is broadly defined asTotal Communication. It is broadly defined asthe simultaneous use of signs and speech.the simultaneous use of signs and speech.


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BilingualBilingualapproachapproach

Uses American Sign Language (ASL) as theUses American Sign Language (ASL) as the

primary language, and the child learns English asprimary language, and the child learns English asa second language.a second language.


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BilingualBilingual--Bicultural (BiBicultural (Bi--Bi)Bi)approachapproach

Also uses ASL as the primary language, and inAlso uses ASL as the primary language, and in

addition, incorporates instruction in Deafaddition, incorporates instruction in Deafculture.culture.


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American Sign Language (ASL)American Sign Language (ASL)

Is a complete visual sign language that does notIs a complete visual sign language that does not

use English (or any other spoken language) asuse English (or any other spoken language) asthe basis for the signs.the basis for the signs.

G n r l consid r tions for s l ctingG n r l consid r tions for s l cting


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General considerationsfor selecting aGeneral considerationsfor selecting a

communication approachcommunication approach

Child: It is important to recognize that manyChild: It is important to recognize that many

children with hearing loss have sufficientchildren with hearing loss have sufficientresidual hearing to develop spoken language asresidual hearing to develop spoken language as

their primary form of communication. Mosttheir primary form of communication. Mostchildren who have mild or moderate hearing losschildren who have mild or moderate hearing loss

will probably receive an auditory communicationwill probably receive an auditory communication

approach.approach.


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Family: Regardless of the communicationFamily: Regardless of the communication

approach parents choose, it is recommendedapproach parents choose, it is recommendedthat the intervention program have ongoingthat the intervention program have ongoing

parent training and education, and emphasize aparent training and education, and emphasize ahigh level of family participation in thehigh level of family participation in the

intervention.intervention.

General considerations for providing a languageGeneral considerations for providing a language


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General considerationsfor providing a languageGeneral considerationsfor providing a language--

rich environmentrich environment

Optimal language development requires aOptimal language development requires a

languagelanguage--rich environment. Regardless ofrich environment. Regardless of

the communication approach that parents select,the communication approach that parents select,

it is important to provide a homeit is important to provide a home

environment filled with language and learning inenvironment filled with language and learning in

order to facilitate development oforder to facilitate development of

cognitive as well as communicative abilities incognitive as well as communicative abilities inchildren with hearing loss.children with hearing loss.


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Home adaptation:Home adaptation:

Provide bright lighting to facilitate speechProvide bright lighting to facilitate speech

reading and reading signsreading and reading signs

Consider assistive devices, as appropriate, suchConsider assistive devices, as appropriate, such

as doorbell signalers, telephone flashers,as doorbell signalers, telephone flashers,vibrating alarm clocks, captioningvibrating alarm clocks, captioning

Control the background noise in the homeControl the background noise in the home

because it may make it more difficult to usebecause it may make it more difficult to useresidual hearing effectivelyresidual hearing effectively


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Have the child move closer to the speakerHave the child move closer to the speaker

Assist with focusing the childs visual attentionAssist with focusing the childs visual attentionon the speakeron the speaker

Avoid situations in which the child cannot viewAvoid situations in which the child cannot view

the speakers facethe speakers face


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Give child opportunities for multipleGive child opportunities for multiple

communication partners, including peers as wellcommunication partners, including peers as wellas adults. Communicating with comfort and easeas adults. Communicating with comfort and ease

in a variety of settings is socially and emotionallyin a variety of settings is socially and emotionallyhealthy for children with hearing loss.healthy for children with hearing loss.


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Auditory approachesAuditory approaches

Amplification devices or a cochlear implant beAmplification devices or a cochlear implant be

used to allow the child to have optimal auditoryused to allow the child to have optimal auditoryaccess to speech in a variety of listeningaccess to speech in a variety of listening

situations.situations.

Even with amplification devices or a cochlearEven with amplification devices or a cochlear

implant, a child with hearing loss may notimplant, a child with hearing loss may not

perceive sounds in the same way as a child withperceive sounds in the same way as a child withnormal hearingnormal hearing


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Provide opportunities to:Provide opportunities to:

Maximize auditory potential during dailyMaximize auditory potential during daily

activitiesactivities

Participate in programs or activities in whichParticipate in programs or activities in which

they can interact with children who have normalthey can interact with children who have normalhearing and when spoken language is the onlyhearing and when spoken language is the only

language used by the children at all timeslanguage used by the children at all times


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AuditoryAuditory--verbal approach,verbal approach,

Integrates listening into the development of communication andIntegrates listening into the development of communication andsocial skillssocial skills

Utilizes parents as primary facilitators of language in the childsUtilizes parents as primary facilitators of language in the childsnatural settingsnatural settings

Has parents fully participate in sessions and become the primaryHas parents fully participate in sessions and become the primarymodels of spoken languagemodels of spoken language Teaches parents to model language, conduct practice drills, andTeaches parents to model language, conduct practice drills, and

perform regular listening checks of the amplification devices orperform regular listening checks of the amplification devices orcochlear implantcochlear implant

Does not use visual modes of communication (such as speechDoes not use visual modes of communication (such as speechreading, lip reading, gestures, and signs) during therapy sessionsreading, lip reading, gestures, and signs) during therapy sessions

Teaches children to monitor their own voices and the voices ofTeaches children to monitor their own voices and the voices ofothers in order to enhance the intelligibility of their spokenothers in order to enhance the intelligibility of their spokenlanguagelanguage


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AuditoryAuditory--oral approachoral approach

Encourages parent involvementEncourages parent involvement

Teaches parents strategies for speech and oral languageTeaches parents strategies for speech and oral languagedevelopment with an emphasis on speech productiondevelopment with an emphasis on speech production

and the development of auditory skillsand the development of auditory skills Provides direct therapy with the child that is enhancedProvides direct therapy with the child that is enhanced

by parent involvement and carryby parent involvement and carry--over into the childsover into the childsnatural environmentnatural environment

Uses some supplementary visual information (such asUses some supplementary visual information (such asspeech reading, lip reading, facial expressions, andspeech reading, lip reading, facial expressions, andnatural gestures) to support auditory inputnatural gestures) to support auditory input

Using visual communication approaches toUsing visual communication approaches to


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Using visual communication approaches toUsing visual communication approaches to

supportEnglishsupportEnglish

The child be encouraged to use and integrate the appropriateThe child be encouraged to use and integrate the appropriatevisual information (which may include signs, cues, speechvisual information (which may include signs, cues, speechreading, facial expressions, gestures, finger spelling, or bodyreading, facial expressions, gestures, finger spelling, or bodylanguage) in addition to the auditory informationlanguage) in addition to the auditory information

Those communicating with the child be encouraged to use andThose communicating with the child be encouraged to use andintegrate the appropriate visual communication methods (whichintegrate the appropriate visual communication methods (whichmay include signs, cues, speech reading, facial expressions,may include signs, cues, speech reading, facial expressions,gestures, finger spelling, or body language) in addition togestures, finger spelling, or body language) in addition toproviding auditory informationproviding auditory information

The professionals working with the child ensure a balanced useThe professionals working with the child ensure a balanced useof visual input and spoken languageof visual input and spoken language

Visual communication system toVisual communication system to


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Visual communication system toVisual communication system to

support Englishsupport English

Ensuring that parents and other family membersEnsuring that parents and other family membersparticipate in training sessions to learn and becomeparticipate in training sessions to learn and becomefluent in the visual communication systemfluent in the visual communication system

Ensuring that parents use and facilitate the childs useEnsuring that parents use and facilitate the childs useof both spoken and visual language in naturalisticof both spoken and visual language in naturalisticsettingssettings

Teaching children to monitor their own voices and theTeaching children to monitor their own voices and the

voices of others in order to enhance the intelligibility ofvoices of others in order to enhance the intelligibility oftheir spoken languagetheir spoken language

Cued speech total communication andCued speech total communication and


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Cued speech, total communication, andCued speech, total communication, and

simultaneous communicationsimultaneous communication

Parents, family members, and professionals need more than a cursoryParents, family members, and professionals need more than a cursoryknowledge of signs in order to convey spoken English fluently in signknowledge of signs in order to convey spoken English fluently in sign

Focusing on the message and using every means possible to communicateFocusing on the message and using every means possible to communicate Learning and using signs for daily activities, feelings, and valuesLearning and using signs for daily activities, feelings, and values Providing visual information (such as family photos, sign books, sign videos,Providing visual information (such as family photos, sign books, sign videos,

picturespictures of how signs are formed, and visual daily schedules)of how signs are formed, and visual daily schedules) Keeping eye contact with the child when signingKeeping eye contact with the child when signing Encouraging turnEncouraging turn--taking, pausing, and waitingtaking, pausing, and waiting Encouraging other family members to sign during conversational times (suchEncouraging other family members to sign during conversational times (such

as at theas at the

dinner table)dinner table) Arranging seating so the child with hearing loss can see who is talking andArranging seating so the child with hearing loss can see who is talking and

who iswho is signingsigning Learning how to interpret the conversation of others for the childLearning how to interpret the conversation of others for the child

Techniques to Facilitate Listening andTechniques to Facilitate Listening and


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Techniques to Facilitate Listening andTechniques to Facilitate Listening andSpeechSpeech

AnAn amplification deviceamplification device or cochlear implantor cochlear implant

that allows optimal auditory access to speechthat allows optimal auditory access to speech

SpecificSpecific trainingtraining in the development ofin the development oflisteninglistening skillsskills

Therapy to promote theTherapy to promote theproduction of speechproduction of speech


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It is important to use results from a speech evaluationIt is important to use results from a speech evaluationto select the specific sounds to be included in theto select the specific sounds to be included in thespeechspeech--language therapy goals.language therapy goals.

It is recommended that therapy for improving speechIt is recommended that therapy for improving speech

production for children with hearing loss follow aproduction for children with hearing loss follow adevelopmental approach with a goal of maximizing agedevelopmental approach with a goal of maximizing ageappropriate communication skills.appropriate communication skills.

For children with hearing loss who are learningFor children with hearing loss who are learninglanguage through or partly through the auditorylanguage through or partly through the auditorychannel, it is important to emphasize the aspects ofchannel, it is important to emphasize the aspects ofspeech that are less salient (less audible, less visible)speech that are less salient (less audible, less visible)when providing therapy to improve speech production.when providing therapy to improve speech production.


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selecting speech soundsselecting speech sounds

The childs aided audiogram be used to select sounds that areThe childs aided audiogram be used to select sounds that areaudible to the childaudible to the child

A developmental speech methodology (such as the LingA developmental speech methodology (such as the Lingmethodology) be used as a frame of referencemethodology) be used as a frame of reference

Vowel sounds be among the first sounds selected because aVowel sounds be among the first sounds selected because avariety of clear vowel sounds constitutes a foundation for thevariety of clear vowel sounds constitutes a foundation for thedevelopment of natural voice for children with hearing lossdevelopment of natural voice for children with hearing loss

Specific speech sounds be chosen as target sounds and playfulSpecific speech sounds be chosen as target sounds and playfulways be devised to say the target sound when interacting withways be devised to say the target sound when interacting with

the childthe child A variety of sounds be used (such as short or long sounds withA variety of sounds be used (such as short or long sounds with

different pitch changes at different intensities)different pitch changes at different intensities)


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Sound be presented: Auditory, auditory/visualSound be presented: Auditory, auditory/visual

and Tactileand Tactile

Be positive and funBe positive and fun

Use sounds and words that are meaningful forUse sounds and words that are meaningful for

the childthe child

Gain interest by working at the childs skill levelGain interest by working at the childs skill level

Allow the child to feel success when usingAllow the child to feel success when usinghis/her voicehis/her voice


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MAINTAIN REGULARCONTACTWITHMAINTAIN REGULARCONTACTWITH

AUDIOLOGISTAUDIOLOGIST

hearing loss traducir

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