Hearning Impairment Documentdocx

DEPARTMENT OF SPECIAL NEEDS AND INCLUSIVE EDUCATION.
COURSE NAME:-EDUCATION OF PERSON WITH HEARING IMPAIRMENT

BY INSTRUCTOR:- HABTAMU DEBASU
CHAPTER ONE
OVERVIEWS AND TERMINOLOGY OF HEARING IMPAIRMENT
Introduction and definition: Understanding Hearing Impairment

You already know that hearing is one of the five senses that allows us to perceive
sound. Hearing impairment, or hearing loss, occurs when you lose part or all of your ability
to hear. Other terms that are used to refer to hearing impairment are deaf and hard of hearing.
The ear is the part of the body that is used for hearing. Information about the world is acquired
through hearing. Anybody that hears nothing around him, no matter how loud the sound is
should be seen as having ear problem. It is a condition or rather an impairment which is a
physical, observable condition of tissue that can affect the function of the organ system of
which that tissue is a part.
Hearing impairment is a disability that can affect the effective functioning of the total
personality no matter the period of onset (Okeke, 2001). Among the earliest attempt to define
hearing impaired was the one made by the committee of Nomenclature of the conference of
Executives of American schools for the deaf (1938) which says that the deaf are those people
in whom the sense of hearing is non-functioning for the ordinary purpose of life. According to
them also, the hard-of-hearing can be defined as those in whom the sense of hearing although
defective is functional with or without a hearing aid. The committee went on to categorize the
deaf into two, thus:
i. The congenially deaf (people that become deaf from birth)

ii. The adventurously deaf (people who though were not born deaf, still became deaf
later in life, due to some accident or illness).
Hearing impaired is the generic term that include both the hard of hearing (partially hearing)
and deaf. These two terms came up because of newer diagnostic and testing method, persons
classified as deaf have been classified as hard-of-hearing.
2nd year 1st semester SNIE majoring regular students. January 23/2022/2014.
Together we can! Bonga, Ethiopia
The hard-of-hearing are those who can benefit maximally from auditory training and from
wearing hearing aids. This then enables them to acquire speech and language naturally.
The deaf are set of people whose sense of hearing is completely lost as a result of damage in
the auditory channel, thus such people's sense of hearing are rendered in-active and non-
functional with or without hearing aids for the day-today life purposes.
Hearing impaired include both the hard-of-hearing (partially hearing) and the deaf. The two
describe the degree of impairment. The hard of hearing refers to those who’s hearing loss in
the pre-lingual period or later is not of sufficient severity to preclude the development of some
spoken language, and those who have normal hearing in the pre-lingual period but acquire
hearing loss later. The category of their impairment is not as severe as that of the deaf. Bryan
(1975) observed that it is well documented that deaf children are worse than hard-of-hearing
and normal hearing children in arithmetic problems involving reading skills. Proper diagnosis
is therefore important for proper categorization and eventual realization of the fullest potentials
of hearing impaired children.
The Individuals with Disabilities Education Act (IDEA), defines “hearing impairment” and
“deafness” separately. Hearing impairment is defined as an “impairment in hearing, whether
permanent or fluctuating that adversely affects a child’s educational performance.” Deafness
is defined as a “hearing impairment that is so severe that the child is impaired in processing
linguistic information through hearing, with or without amplification.”
Children who are deaf and hard of hearing receive special education and related services under
the federal disability category of hearing impairments. IDEA defines deafness and hearing
loss as follows:
Deafness means a hearing loss that is so severe that the child is impaired in processing
linguistic information through hearing, with or without amplification, [and] that adversely
affects a child’s educational performance.
Hearing loss means a loss in hearing, whether permanent or fluctuating, that adversely affects
a child’s education performance but that is not included under the definition of deafness in this
section.
Most special educators distinguish between children who are deaf and those who are hard of
hearing. A child who is deaf cannot use hearing to understand speech. Normal hearing
generally means that a person has sufficient hearing to understand speech. Under adequate
listening conditions, a person with normal hearing can interpret speech without using any
special device or technique. Even with a hearing aid, the hearing loss is too great to allow a
deaf child to understand speech through the ears alone. Although most deaf people perceive
some sounds through residual hearing, they use vision as the primary sensory mode for
learning and communication. Children who are hard of hearing can use their hearing to
understand speech, generally with the help of a hearing aid.
The speech and language skills of a child, who is hard of hearing, though they may be delayed
or deficient, are developed mainly through the auditory channel.
Many deaf people do not view themselves as disabled and consider hearing loss an
inappropriate and demeaning term because it suggests a deficiency or pathology. Like other
cultural groups, members of the Deaf community share a common language and social
practices (Woll& Ladd, 2011). When the cultural definition of hearing loss is used, Deaf is
spelled with a capital D, just as an uppercase letter is used to refer to a French, Japanese, or
Jewish person. While person-first language is the appropriate way to refer to individuals with
disabilities, people who identify with the Deaf culture prefer terms such as teacher of the Deaf,
school for the Deaf, and Deaf person.
Hearing loss is also described in terms of being unilateral (present in one ear only) or bilateral
(present in both ears).
Most deaf and hard-of-hearing students have bilateral losses, although the degree of loss may
not be the same in both ears.
Children with unilateral hearing loss generally learn speech and language without major
difficulties, although they tend to have problems localizing sounds and listening in noisy or
distracting settings.
It is important to consider the age of onset-whether a hearing loss is congenital (present at
birth) or acquired (appears after birth). The terms pre lingual hearing loss and post lingual
hearing loss identify whether a hearing loss occurred before or after the development of spoken
language. A child who cannot hear the speech of other people from birth or soon after will not
learn speech and language spontaneously, as do typically developing children with normal
hearing. To approximate the experience of a child who is deaf from birth, watch a television
program in a foreign language with the sound turned off. You would face the double problem
of being unable to read lips and understand an unfamiliar language.
A child who acquires a hearing loss after speech and language are well established, usually
after age 2, has educational needs very different from the prelingually deaf child. The
educational program for a child who is prelingually deaf usually focuses on acquisition of
language and communication, whereas the program for a child who is postlingually deaf
usually emphasizes the maintenance of intelligible speech and appropriate language patterns.
CAUSES OF HEARING IMPAIRMENT
Surprising Causes of Hearing Loss

Connect Hearing
You're no doubt aware of the most common causes of hearing loss. Exposure to excessive
noise, including restaurants, bars, concerts, headphones, and even certain household
appliances. Degradation of hearing due to old age or pre-existing genetic conditions. Ear
infections, diseases, or injuries.
These aren't the only things that can trigger temporary or permanent hearing loss, however.
There are many things you might not expect to impact your hearing that do. Here are some of
the most surprising causes of hearing loss, and how you can avoid them.
1. Stress
It's already established that there's a connection between stress and tinnitus, so this one may
not be as much of a surprise. Hypertension accompanying severe stress can cause
hemorrhaging in the ears, which can ultimately result in either temporary or permanent damage.
Fortunately, there are many ways you can address stress-induced tinnitus and hearing loss.
If you want to reduce or avoid unpleasant buzzing in your ears, experts recommend you:
 Reduce caffeine intake.

 When you feel stressed, try refocusing your attention on a simple task like cleaning.
 Talk with a supportive person such as a friend, family member, or therapist.
 Exercise and maintain as healthy diet.
2. Excessive Exercise
Generally, moderate exercise is recommended as a way to promote better overall health,
including hearing. But believe it or not, overdoing it at the gym can damage more than your
muscles. It can also wreak havoc on your hearing. We're not just talking about hearing damage
due to loud workout music or dropping weights, either, though listening to music about 85
decibels is a risk.
Vigorous exercise can lead to a range of hearing problems, including dizziness, temporary
tinnitus, or even damage to the membranes in your inner ear. Fortunately, this hearing loss is
usually temporary. It should subside with a bit of rest.
3. Medication
Hearing loss is rarely mentioned in the laundry list of side effects rattled off at the end of
pharmaceutical commercials. But some prescription medications, such as diuretics for heart
disease and chemotherapy, are known to cause damage to the cells inside your ears. While the
risk is more serious for those taking higher doses of certain medication, you should speak with
your doctor about all potential side effects of medications you are prescribed.
4. Poor diet
Individuals who are severely overweight or suffering from dietary disorders experience a much
higher risk of hearing loss. This is because poor dietary practices, such as consuming excessive
fats and sugars or failing to consume nutrients such as vitamin B12, can interfere with the flow
of blood through the body, particularly to the ears. Fortunately, this is simple enough to address.
5. Allergies
Allergies are frequently accompanied by symptoms such as itchy eyes, a scratchy throat, and
severe congestion. However, swelling from an allergic reaction can also block the ear canal,
building up fluid in the ears which can cause infection. While the subsequent hearing
impairment generally only lasts during allergy season, if untreated, the infection may develop
into something more permanent.
6. Lack of sleep
As you might expect, poor sleep comes with a whole laundry list of potential conditions. It
causes issues for pretty much your entire body, including your mental health, gastrointestinal
health, and cardiovascular health. Bad sleep habits can also worsen conditions such as tinnitus.
7. Smoking
According to research from the U.S. National Library of Medicine, smokers are at a
considerably higher risk of suffering from noise-induced hearing loss. Even former smokers
suffer from a slightly higher risk of hearing damage. This is because smoking irritates the lining
of the middle ear, and the nicotine in cigarettes blocks the neurotransmitters that send auditory
information to your brain. Even second hand smoke carries with it some risk, but significantly
reduced compared to habitual smokers.
8. Illness
It's not just illnesses and infection of the ears that can impact your hearing. Influenza (or the
flu) can sometimes cause your hearing to go haywire. Your ears may feel clogged or stuffed,
due to fluid in the tubes of your middle ear.
Meningitis, inflammation of the spinal fluid, can also cause hearing loss, particularly if it's
localized around the upper spinal cord. Children are especially susceptible to this, and in rare
cases, they may even suffer permanent damage. Other illnesses such as measles may also cause
damage to the ears.
9. Diabetes
As noted by the American Diabetes Association, there is a significant link between the disease
and hearing loss, noting that according to one study, it can be twice as common in people with
diabetes compared to those without. The good news is that avoiding type 2 diabetes is as simple
as watching what you eat.
10. OTITIS MEDIA(inflammation of the middle ear):- A temporary, recurrent infection of

the middle ear, otitis media is the most common medical diagnosis for children. Nearly 90%
of all children will experience otitis media at least once, and about one-third of children under
age 5 have recurrent episodes (Bluestone & Klein, 2007). Left untreated, otitis media can result
in a buildup of fluid and a ruptured eardrum, which causes permanent conductive hearing loss.
11. MENINGITIS:- The leading cause of postlingual hearing loss is meningitis, a bacterial or
viral infection of the central nervous system that can, among its other effects, destroy the
sensitive acoustic apparatus of the inner ear. Children whose deafness is caused by meningitis
generally have profound hearing losses. Difficulties in balance and other disabilities may also
be present.
12. MÉNIÈRE’S DISEASE :-A disorder of the inner ear, Meniere’s disease is characterized
by sudden and unpredictable attacks, fluctuations in hearing, and tinnitus (the perception of
sound when no outside sound is present). In its severest form, Meniere’s disease can be
incapacitating. Little is understood about the mechanisms underlying the condition, and at
present no reliable treatment or cure exists. Meniere’s disease most often occurs between the
ages of 40 and 60, but it can affect children under the age of 10 (Minor, Schessel, & Carey,
2004).
13. NOISE EXPOSURE:- Repeated exposure to loud sounds is a common cause of hearing
loss. It is estimated that 10 million Americans have noise-related permanent hearing loss and
that 22 million U.S. workers are exposed to hazardous noise levels at work.
Occupational hearing loss is the most common work-related injury in the U.S. (Centers for
Disease Control and Prevention, 2011).
Noise-induced hearing loss (NIHL) caused by chronic exposure to recreational and

occupational noise often occurs gradually, and the person may not realize his hearing is being
damaged until it is too late. Sources of noise that can cause NIHL include motorcycles, jet
aircraft, target shooting, leaf blowers, and amplified music, all emitting sounds from 120 to
150 decibels. Prolonged or repeated exposure to noise above 85 dB can cause gradual hearing
loss. Regular exposure of more than 1 minute to noise at 110 dB risks permanent hearing loss
(NIDCD, 2011a).
Age of Onset of Hearing Loss

A hearing loss can be either congenital, meaning present at birth, or acquired, meaning that it
has occurred in either childhood or adulthood. The timing of an acquired hearing loss will have
a critical impact on the child’s language and speech.
A hearing loss that occurs before the child’s language has developed is a prelinguistic
hearing loss, and one that occurs after the child has acquired some speech and language is
called a post linguistic hearing loss. The timing of the hearing loss is critical because it shapes
the child’s early communication, language, and speech development. If the hearing loss occurs
congenitally, the child will have no experience with the sounds of speech and will encounter
greater difficulties understanding and producing speech. If the loss occurs before the child has
acquired speech, the language delay is likely to be greater than it would be if the child had
already developed a solid language and speech foundation. The stronger the child’s speech and
language foundation is prior to the loss of hearing, the more the child can draw on it to support
his or her communication.
Prevalence of hearing impairment
Hearing plays an important role in student development and daily performance. Hearing
impairment occurs when there's a problem with or damage to one or more parts of the hearing
mechanism. It is identified as one of the ten most prevalent causes of disability in the United
States. The U.S. Department of Health and Human Services (1991) reported that five percent
of children 18 years and under have a hearing loss. A student with a hearing impairment is
part of a heterogeneous group whose one common characteristic is some degree of hearing
loss. To effectively teach students with hearing impairment, teachers need to become familiar
with hearing related concepts.
Chapter Two:
Anatomy and Physiology of Ear
1. How We Hear?
Audition, the sense of hearing, is a complex and not completely understood process. The ear
gathers sounds (acoustical energy) from the environment and transforms that energy into a
form (neural energy) that can be interpreted by the brain. The outer ear consists of the external
ear and the auditory canal. The part of the ear we see, the auricle (or pinna), funnel sound
waves into the auditory canal (external acoustic meatus) and help distinguish the direction
of sound.
When sound waves enter the external ear, they are slightly amplified as they move toward the
tympanic membrane (eardrum). Pressure variations in sound waves move the eardrum in and
out. These movements of the eardrum change the acoustical energy into mechanical energy,
which is transferred to the three tiny bones of the middle ear (the hammer, anvil, and stirrup).
The base (called the footplate ) of the third bone in the sequence, the stirrup, rests in an opening
called the oval window , the place where sound energy enters the inner ear. The vibrations of
the three bones (together called the ossicles) transmit energy from the middle ear to the inner
ear with little loss.
The inner ear, the most critical and complex part of the entire hearing apparatus, is covered by
the temporal bone, the hardest bone in the entire body. The inner ear contains the cochlea, the
main receptor organ for hearing, and the semicircularcanals, which control the sense of
balance. The cochlea, named for its resemblance to a coiled snail shell, consists of two fluid-
filled cavities that contain 30,000 tiny hair cells arranged in four rows. Energy transmitted by
the ossicles moves the fluid in the cochlea, which in turn stimulates the hair cells. Each hair
cell has approximately a hundred tiny spines, called cilia,at the top. When the hair cells are
stimulated, they displace the fluid around them, which produces minute electrochemical signals
that are transmitted along the auditory nerve to the brain. High tones are picked up by the hair
cells at the basal or lowest turn of the cochlea; low tones stimulate hair cells at the apex, or top,
of the cochlea.
Components of the Ear
The ear is divided into three major parts –
the outer,
the middle and
inner ear.
The organ of hearing is the ear and it is composed of three major parts: the outer, middle and
inner ear. It is important to understand the basic anatomy of each part and how it works before
reading about the different types of hearing impairments. Refer
to http://www.echalk.co.uk/Science/Biology/InteractiveDiagrams/Ear.htm for a diagram of
the ear. The anatomy and contribution of each part of the ear has been described below:
 The ear is the sense organ that enables us to hear
Hearing is the process by which humans use their ears to detect and perceive sounds. The
perception of sound energy via the brain and central nervous system.
 The ear is divided into three main parts – the outer ear, the middle ear, and the inner ear
Ears are important for hearing and for controlling a sense of position and balance.
To hear sound, the ear has to do three basic things
 Direct the sound waves into the hearing part of the ear.
 Sense the fluctuations in air pressure.
 Translate these fluctuations into an electrical signal that the brain can
understand.
The outer ear
Outer Ear - Includes the external visible part of the ear (pinna) and the ear canal.
1. Sound waves are received by the pinna from the environment.

2. Sound waves travel through the ear canal.
3. Sound waves make their way to the beginning of the middle ear called the ear drum
(thin membrane that separates the outer ear from the middle ear). (Dugan, 2003;
Scheetz, 2000).
The outer ear consists of the pinna and the ear canal
 Pinna
The pinna is a protuberant skin-covered flap located on the side of the head, and is the visible
part of the ear. It collects sound waves and channels them down the external ear canal through
patterns formed on the pinna known as whorls and recesses. Its shape also partially shields
sound waves that approach the ear from the rear/back/, therefore enabling a person to tell
whether a sound is coming directly from the front or the back.
 Ear canal
The ear canal is roughly 3cm long in adults and slightly S-shaped. It is supported by cartilage
at its opening, and by bone for the rest of its length. Skin lines the canal, and contains glands
that produce secretions that mix with dead skin cells to produce cerumen (earwax). Cerumen:-
along with the fine hairs that guard the entrance to the ear canal, helps prevent airborne particles
from reaching the inner portions of the ear canal
Middle ear
Middle ear:-Includes the eardrum, ossicles or three tiny bones(hammer/malleus; anvil/incus;

stirrup/stapes) and Eustachian tube.
1. Sound waves reach the eardrum.
2. The ear drum begins to vibrate and makes the three tiny bones / ossicles to move
together.
3. These bones help sound move into the inner ear.
The middle ear is filled with air and for optimal hearing the air pressure inside the middle ear
and outside of the ear needs to be the same. The Eustachian tube connects the middle ear to
the back of the nose. The Eustachian tube helps keeps the air pressure in the middle ear equal
to the air pressure in the environment. (Dugan, 2003; Fraser, 1996)
The middle ear is located between the external and inner ear. It is separated from the ear canal
of the outer ear by the tympanic membrane (the eardrum).The middle ear functions to transfer
the vibrations of the eardrum to the inner ear fluid. This transfer of sound vibrations is
possible through a chain of movable small bones, called ossicles, which extend across the
middle ear, and their corresponding small muscles. From the outermost to innermost the
bones are known individually (according to their shapes) as the: malleus (hammer), incus
(anvil) and stapes (stirrup)
 Malleus
The malleus is attached to the eardrum. It has a handle that attaches to the inner surface of the
eardrum, and a head that is suspended from the wall of the tympanic cavity.
 Incus
is connected to the malleus on the side closer to the eardrum, and to the stapes on the side
closer to the inner ear
Tympanic membrane (eardrum)
The tympanic membrane (the eardrum) is commonly known as the eardrum. It separates the
ear canal from the middle ear. It is about 1cm in diameter and slightly curving inward on its
outer surface. It vibrates freely in response to sound. The membrane is highly innervated,
making it highly sensitive to pain
The Eustachian tube
 It is a narrow tube that connects the middle ear to the back of the nose (nasopharynx) and
throat. During swallowing, it opens up to allow air into the middle ear, so that air pressure
on either side of the tympanic membrane is the same.
Inner ear
The inner ear is the deepest part of the whole ear. It is located in a place known as the bony
labyrinth, which is a maze of bone passageways lined by a network of fleshy tubes known as
the membranous labyrinth.
Inner Ear - Includes a snail-shaped, fluid filled structure called the cochlea, tiny hair cells
(cilia) and the auditory nerve, which travels from the inner ear to the brain.
1. The vibration of the sound waves causes the cilia to move.

2. This movement creates electrical impulses or signals that are sent to the brain via the
auditory nerve.
3. The hearing centres in the brain interpret these signals as sound and help give them
meaning. (Lysons, 2003).
The outer ear picks or collects energy, the middle ear transmits the energy which is then
converted into nerve impulses in the inner ear.
Cochlea
Next to the vestibule is the cochlea. Organ of hearing, as it is the part of the whole ear that
actually converts sound vibrations to the perception. The cochlea is in the form of a snail-like
spiral, so that a longer cochlea is able to fit inside an enclosed space. It is about 9mm wide at
the base and 5mm high, and winds around a section of spongy bone called the modiolus. The
cochlea has approximately 30,000 hearing nerve endings in the hair cells. The hair cells in the
large end of the cochlea respond to very high-pitched sounds, and those in the small end (and
throughout much of the rest of the cochlea) respond to low pitched sounds.
Organ of corti
The organ of Corti (containing specialized sensory hair cells) – converts vibrations into nerve
impulses (nerve messages). It is supported by a membrane called the basilar membrane. It is
about the size of a pea, and acts as a transduce, converting vibration into nerve impulses. It has
hair cells and supporting cells
The vestibular system
The vestibular system consists of the semicircular canals, saccule and utricle. The
semicircular canals also contain fluid and hair cells, but these hair cells are responsible for
detecting movement rather than sound. As the head moves, fluid within the semicircular
canals (which sit at right angles to each other) also moves.This fluid motion is detected by the
hair cells, which then send nerve impulses about the position of the head and body to the
brain to allow balance to be maintained. The utricle and saccule work in a similar way to the
semicircular canals, allowing you to sense your body’s position relative to gravity and make
postural adjustments as required
 Stapes:
The stapes has an arch and a footplate. This footplate is held by a ring like piece of tissue in
an opening called the oval window, which is the entrance into the inner ear
 Stapedius
The stapedius is the muscle of the inner ear that inserts on the stapes.
 Tensor tympani:-
The tensor tympani is the inner ear muscle that insert on the malleus.
The Nature of Sound

Sound is measured in units that describe its intensity and frequency. Both dimensions of sound
are important in considering the needs of a child who is deaf or hard of hearing. The intensity
or loudness of sound is measured in decibels (dB). Zero dB represents the smallest sound a
person with normal hearing can perceive, which is called the zero hearing-threshold level
(HTL), or audiometric zero. Larger-decibel numbers represent increasingly louder sounds on
a ratio scale in which each increment of 10 dB is a 10-fold increase in intensity. A low whisper
5 feet away registers about 10 dB; conversational speech 10 to 20 feet away ranges from 20 to
50 dB. Traffic on a city street produces sound at about 70 dB and a lawnmower about 90 to
100 dB.Sounds of 125 dB or louder cause pain to most people.
The frequency, or pitch, of sound is measured in cycles per second, or hertz (Hz). 1 Hz equals
1 cycle per second. Pure tones consist of one frequency only. Speech and most environmental
sounds are complex tones containing different frequencies. The lowest note on a piano has a
frequency of about 30 Hz, middle C about 250 Hz, and the highest note about 4,000 Hz. The
human hearing can detect sounds ranging from approximately 20 to 20,000 Hz. Although a
person who cannot hear very low sounds (e.g., a foghorn) or very high sounds (e.g., a piccolo)
may experience some inconvenience, she will encounter no significant problems in the
classroom or everyday life.
A person with a severe hearing loss in the speech range, however, is at a great disadvantage in
acquiring and communicating in a spoken language.
The frequency range most important for hearing spoken language is 500 to 2,000 Hz, but some
speech sounds have frequencies below or above that range. For example, the /s/ phoneme (as
in the word sat) is a high-frequency sound, typically occurring between 4,000 and 8,000 Hz
(Northern& Downs, 2002)
The following diagram summarises this process
How We Can Sound????
Understanding Sound
• From the study of physics we learn that an object produces sound when it vibrates in
matter. This object could be:
• A solid, such as earth.
• A liquid, such as water.
• A gas, such as air
When something vibrates in the atmosphere, it moves the air particles around it. Those air
particles in turn move the air particles around them, carrying the beat of the vibration through
the air. These are called sound waves.
Sound waves are characterized by:
• Frequency (measured in cycles per second, cps, or hertz, Hz).

• Amplitude: the size of the waves.
Intensity of Sound
The range of sounds is measured in hertz or number of sound waves per second.
The intensity or strength of a sound is given in terms of a scale of decibels which usually
ranges from 0 to 140 decibels where 0 decibels represents the quietest level of hearing
accessible to the average healthy human ear and 140 decibels, where physical damage
immediately occurs.
CHARACTERISTICS OF CHILDREN WITH HEARING IMPAIRMENT
Hearing impairment is a handicapping condition that affects the normal functioning of the
child.
Any discussion of characteristics of students who are deaf or hard of hearing should include
three qualifications. First, students who receive special education because of hearing loss
comprise an extremely heterogeneous group (Karchmer& Mitchell, 2011).
It is a mistake to assume that a commonly observed behavioral characteristic or average level
of academic achievement is representative of all children with hearing loss. Second, the effects
of hearing loss on a child’s communication and language skills, academic achievement, and
social and emotional functioning are influenced by manyfactors, including the type and degree
of hearing loss, the age at onset, the attitudes of the child’s parents and siblings, opportunities
to acquire a first language (whetherthrough speech or sign), and the presence or absence of
other disabilities.
Third, generalizations about how deaf people are supposed to act and feel must be viewed with
extreme caution. Lane (1988), who makes a strong case against theexistence of the so-called
psychology of the deaf, notes the similarity of the traitsattributed to deaf people in the
professional literature to traits attributed to Africanpeople in the literature of colonialism and
suggests that those traits do not “reflect thecharacteristics of deaf people but the paternalistic
posture of the hearing experts makingthese attributions”
Cognitive Development of Children with Hearing Loss

Have some types of cognitive deficits, which contribute to problems in language development
and academic performance.
The most important thing to remember about children who are deaf or hard of hearing is that
most possess normal intelligence and some are intellectually gifted. A hearing loss will not
impact a child’s overall cognitive abilities; but because the children cannot hear as well as
children with normal hearing he may experience developmental delays. As children with
hearing losses mature, however, they will have different background experiences,
communication histories, and knowledge, and so they will also have different needs. They will
need specialized instruction to reach the same cognitive and developmental milestones as
children who can hear (Marschark, Lang, & Albertini, 2002). Furthermore, a hearing loss may
be accompanied by disabilities that require more complicated interventions. It can be difficult

to determine the intellectual level of children with hearing losses in part because intelligence
tests used to measure cognitive abilities were not designed for children with hearing losses.
Orally (speech) administered intelligence tests often greatly underestimate the abilities of a
child whose primary language is manual (Salvia et al., 2007). To assess children who are deaf
or hard of hearing in written English is also problematic if the child’s primary language is
American Sign Language, because the vocabulary, syntax, and grammar of ASL are
significantly different from those of English. A child whose first language is ASL should
receive the same assessment accommodations that any child whose primary language is not
English receives. This means that the assessment should be conducted in the child’s primary
language (ASL) and that the assessor should be bilingual and if possible bicultural.
Furthermore, appropriate assessments must address both the child’s access to the stimulus
(spoken or printed words) and his or her ability to respond to the test prompts (either by
speaking or writing; Salvia et al., 2007). When nonverbal tests are used with a sign system
familiar to the child, children often perform well within the normal range (Bellugi&Studdert-
Kennedy, 1984).
Social and Personal Adjustment of Children with Hearing Loss

Many youngsters who are deaf or hard of hearing will make friends with both their hearing and
non-hearing peers. Brittany’s story in this chapter shares her successes with social skills and
forming friendships. Luckner and Muir (2001) conducted interviews with twenty successful
students who are deaf and who were receiving most of their education in general educational
settings.
They found that many of the students attributed their success to working hard, studying, paying
attention, advocating for oneself, getting involved in sports, and making friends. Most students
acknowledged the importance of their families and the help and support they received from
teachers, interpreters, and note takers, but every student spoke about the importance of his or
her friends (Luckner& Muir, 2001). The students in this study had all done well and were
recognized by their teachers as being successful, and forming friendships was part of this
success. But friendships may be difficult for some children who are deaf or hard of hearing. A
hearing loss may bring with it communication problems, and communication problems can
contribute to social and behavioral difficulties.
Consider the boy with prelinguistic hearing loss who has limited speech and who wants a turn
on the playground swings. He cannot simply say, “I want my turn” or “It’s my turn now.” What
does he do? He may push another youngster out of the way. Obviously, this kind of behavior
is going to cause the child difficulties with interpersonal relationships. And when it is repeated
many times, it can create serious social adaptation problems. Lack of verbal language makes it
difficult for children who are deaf to make friends with children who speak and do not sign.
Several factors should improve the social adjustment of children who are deaf or hard of
hearing (Luckner& Muir, 2001): Early identify cation and intervention that markedly improve
the child’s overall functioning and increase feelings of self-esteem.
Family support and acceptance of the child Sophisticated technological aids such as the Internet
that provide access to information and social contacts Participation in extracurricular activities
(sports, Scouts, service clubs) Skilled and caring professionals who work with the child and
family Promoting Alternative Thinking Strategies (PATHS) is a curriculum designed to
improve social competence and to reduce behavioral problems for children who are deaf. It
teaches self-esteem and interpersonal competencies.
Social /Emotional development

Those who are deaf prefer to be with others who are deaf and tend to cluster in groups, socialize
and marry. The deaf tend to lag behind the hearing in social maturity.
Communication
• Children who are deaf are often passive participants in communication,
• The vocabulary and syntax of children who are deaf grow slowly.
Academic Development of Children with Hearing Losses

Reading levels of children who are deaf or hard of hearing tend to be substantially lower than
those of their hearing peers, but we may be closing this gap (Teachers College Record, 2007;
McCough& Barbara, 2005; Trezek& Wang, 2006). A child who has not heard the sounds of
the language will not be able to decode print if he or she is taught in the usual method of
matching speech sounds-phonemes-to print. Because phonemic awareness, or the ability to use
speech sounds, may be limited for children who are deaf or hard of hearing, alternative methods
must be used to teach reading (McGough &Schirmer, 2005; Trezek& Wang, 2006). If reading
is taught visually or by a manual method (e.g., American Sign Language or finger spelling),
children who are deaf or hard of hearing are able to learn how to read, write, and use appropriate
language forms, such as past tense, questions, and logical propositions such as if-then or either-
or (Trezek& Wang, 2006;Yoshinaga-Itano et al., 1998).
This picture may be changing, however. As early hearing screening and educational,
technological, and medical interventions reach more children, we may see the achievement gap
in reading decrease. The demand for cochlear implants for children is increasing by around 20
percent each year (Martindale, 2007). And increasing numbers of young children are receiving
hearing aids and early supports for language development. With these changes, more young
children with hearing losses are gaining access to speech sounds, and this is likely to help them
in learning to read (Martindale, 2007).
The severity of hearing loss, the age of its onset, and the hearing status of the students’ parents
are related to the academic success
Students who are congenitally deaf tend to have more difficulty acquiring academic skills than
those who can hear.
Hearing is one of the most important senses. It plays a vital part in the learning process. It is
held that more than 80% of education is received through hearing (Pagliano, 1994). American
Speech-Language-Hearing Association (ASHA) stipulates that hearing impairment can
affect children in the following ways:
 It causes delay in the development of receptive and expressive spoken language skills.
It also usually causes delay in general language acquisition and receptive and
expressive communication. (However, in the minority of deaf children born to signing
Deaf families, language and communication skills usually develop at a normal rate.)
 The language deficit can cause learning problems that result in reduced academic
achievement.
* Communication difficulties may often lead to social isolation and poor self-concept.
* It may have an impact on vocational choices.
Hearing impairment can impose basic limitations on an individual in terms of
 access to spoken language

 access to environmental auditory experiences
 ease of interacting with a wide range of people, due to the above restrictions.
Difficulty in accessing spoken language may appears to be an obvious result of hearing

impairment. On the contrary, there are many variables which affect just how much access a
hearing impaired person has to spoken language. As noted earlier, there are different levels of
hearing loss; yet, even within these levels many layers exist. For example, two different people
may have the same type of hearing loss, the same level of hearing loss and all practical,
physiological processes could be almost identical, but they may not have the same access to
spoken language. Person A may have acquired the hearing loss post-lingually, which has
provided the opportunity to hear and the hearing nerves to be used. Person B may have had to
learn to listen without ever experiencing sound, and would have had to learn that sound itself
has meaning before beginning to interpret what those sounds mean.
Clear access to speech is contingent upon many variables, including:
 background noise being at a minimum

 well-functioning and optimal hearing technology
 clear speech being expressed by the speaker
Hearing technology continues to improve but still has limitations. One of the limitations is that
background noise is not usually completely eliminated when a person with hearing impairment
is listening to some source of sound. This means that the important information (i.e., speech)
has to be separated from the background noise during cognitive processing.
Clear speech is not exaggerated speech, and the student with hearing impairment uses all the
visual and auditory information available to aid understanding of the message. If any of these
are exaggerated or distorted, the student has to cognitively explore the possibilities of what was
said before trying to repair their misunderstanding of the message. Accents, speech
impediments, prostheses (braces), moustaches and beards can all contribute to the challenge of
understanding with ease.
Environmental auditory experiences enable hearing students to retrieve information about what
is happening in their environment. Hearing students are able to learn incidentally about the
world around them and about important functions of language. In contrast, students with a
hearing impairment are rarely able to hear enough (without attending to a specific interaction)
to learn incidentally from:
 Discussions and interactions between parents, teachers, other adults or peers

 Disagreements or resolutions between these same people
 Television or radio
 Conversations on the telephone.
 Most environmental sounds are very informative. Hearing sounds around the house can
indicate where a person is and what that person might be doing. For example, hearing
water boiling or the microwave timer lets you know that someone is cooking in the
kitchen. Environmental sounds can help you predict what might happen next.
For example, hearing the phone ring tells you that someone will get up and move to another
area, or start you wondering if that the phone call might be for you. When they hear such things,
subconsciously, hearing people make predictions and assumptions without effort. For person
with hearing impairment, some of these environmental sounds may be heard and some may
not, which in turn means that the appropriate assumptions and predictions may not be made. A
student with hearing impairment may not understand why the teacher and all the students are
looking out the window, when they heard a car crash on the road outside, or why the teacher
stops talking and looks at some other students in the room who have been whispering.
 Warnings of danger, such as smoke alarms, fire alarms and car horns are usually given
by sound signals, and the student with a hearing impairment may not be aware of the
location of the sounds or what they mean. Some of these auditory signals can be
supplemented by a range of visual ones, such as flashing strobe lights. These
accommodations should be considered by schools with students who are hearing
impaired.
All these factors are challenges to students with hearing impairments. While most will be
aware of the challenges, they may not always be aware of the strategies they can employ to
help them glean information to stay abreast of the happenings in their environment. These
strategies can be utilized and encouraged by teachers.
CHAPTER THREE
TYPES OF HEARING IMPAIRMENT
A hearing impairment results when there is a problem in one or more components of the hearing
mechanism. Hearing impairments are classified in terms of the severity and type of hearing
impairment. When describing hearing impairment, three attributes are considered:
1. Type of hearing loss - part of the hearing mechanism that is affected

2. Degree of hearing loss - range and volume of sounds that are not heard
3. Configuration - range of pitches or frequencies at which the loss has occurred
1. Conductive hearing impairment
2. Sensorineural hearing impairment
3. Central hearing impairment
4. Mixed hearing impairment.
Details of these are presented below:
The conductive hearing impairment: occurs as a result of obstruction to the passage of sound
waves through the external canal or by way of the ossicular chain through the middle ear. It
does not affect the inner ear. In this case therefore if sound vibrations can be transmitted in
anyway directly to the inner ear without having to pass through the middle ear, the child hears.
The person suffering from conductive hearing loss can be helped through surgery or through
wearing bone conduction hearing aids behind the ears.
Conductive hearing loss is when a hearing impairment is due to problems in the outer ear,
middle ear, ear canal, eardrum, or the ossicles, which are the tiny bones in the middle ear. When
the sound is not being conducted properly through the ear, conductive hearing loss occurs.
Most cases of conductive hearing loss can be corrected medically or surgically.
Causes of conductive hearing loss include:
 Fluid in the middle ear as a result of colds

 Otitis media, commonly referred to as ear infection
 Poor eustachian tube function
 Perforated eardrum
 External otitis, commonly referred to as ear canal infection
 Allergies
 Earwax buildup
 Benign tumors or having a foreign body in the ear
 Structural abnormalities of the outer ear, ear canal, or middle ear.
Sensori-nueral hearing impairment; is prevalent among children. This is associated with the
inner ear because it is damage to or degeneration of the sensory structure of the inner ear that
causes it. Those who suffer from this hearing loss are unable to hear most frequencies in the
human voice in most cases.
Sensorineural hearing loss (SNHL), also referred to as nerve hearing loss, occurs when there
is damage to either the auditory nerve or the cochlea, which is the inner ear. The hearing loss
in SNHL is permanent, although it may be possible to treat it with hearing aids.
Causes of SNHL include:
 Exposure to excessively loud noise

 Head trauma or sudden air pressure changes (e.g., during airplane descent)
 Illnesses, such as Meniere's disease and meningitis
 Structural abnormality of the inner ear
 Tumors
 Aging
 Medication side effects (e.g., aspirin and Vicodin)
 Autoimmune inner ear disease
 Otosclerosis, the abnormal growth of the bone that is in the middle ear
Central hearing impairment; Cerebral cortex is the part of the brain where the sensation of
sound is produced and interpreted meaningfully. Therefore if there is interference with the
pathway through which nerve fibres proceed from the brain stem to the temporal lobes of the
cerebral cortex it results to central hearing loss. In other words an error in the auditory center
in the brain causes central deafness.
Central hearing loss occurs when there are problems within the brain that interfere with the
ability to interpret or understand sounds. This is the rarest type of hearing impairment and the
hardest to treat.
Causes of central hearing loss include:
 Damage to brainstem structures

 Severe head trauma
 Damage to the auditory nerves or the pathways that lead to them
 Brain tumors
Mixed, hearing impairment: is the combination of conductive and sensorinueral hearing loss.
An individual here has outer-or middle and inner ear problem combined. Mixed hearing
deafness; are often difficult to diagnose and treat because there are problems of both conduction
and processing of sound.
 PROBLEMS OF HEARING IMPAIRMENT
Hearing impairment is a challenging condition as pointed out earlier, therefore a hearing

impaired child or person is bound I have some problems. These problems range, from language
difficulty, social and emotional problems, thinking difficulty, to academic achievement
problems.
1. Language difficulty - Severe hearing loss could deprive the affected person of the natural
ability to acquire verbal language which could impede development. Bakare (1979) expressed
that perception is the first major process in the cognitive processes and that the defects in the
hearing organ of the deaf create a deficit in the development continuum of language skills. In
the past, it is common to pass a deaf person for deaf and dumb meaning that he/she could
neither here nor talk. Today researches are beginning to reveal the complexity of the
relationship' between the two (hearing and speaking).
2. Social and emotional problems: The social integration of hearing impaired students with
the classroom generally depends on whether or not their hearing peers perceived them good
enough to make effective member of a discussion group or project group. Socially the hearing
impaired child is bound to be less mature than the hearing child of the same age because of
certain frustrating problems he is subjected to like poor language development. Studies have
shown that the hearing impaired manifest a great degree of emotional maladjustment than their
normal peers. They are often emotionally insecure in their relationship with others as in most
cases they are not sure of being understood by other people when they use sign language.
3. Thinking and academic achievement: The hearing impaired children due to lack of
auditory experience have their intellectual development defective when compared with the
hearing children. Okeke (2001) argued that if the children's hearing impairment is not
ameliorated, poor or lack of complex and abstract reasoning will Pose a serious threat to the
child's academic aspirations. In other words language disabilities resulting from deafness"
directly interfere with intellectual performance and indirectly affect thinking by obstructing
normal patterns of cognitive stimulation and interpersonal communication and interaction.
Classification of Hearing Loss based on Degree
Hearing loss is usually described by the terms mild, moderate, severe, and profound,
depending on the average hearing level, in decibels, across the frequencies most important for
understanding speech (500 to 2,000 HZ). It is important to recognize, however, that no two
children have exactly the same pattern of hearing, even if their responses on a hearing test are
similar. Just as a single intelligence test cannot provide sufficient information to plan child’s
educational program, the special education needs of a child who is deaf or hard of hearing
cannot be determined from an audiometric test alone. Children hear sounds with differing
degrees of clarity, and the same child’s hearing ability may vary from day to day. Some children
with very low levels of measurable hearing can benefit from hearing aids and can learn to
speak. On the other hand, some children with less measurable hearing loss do not function
well through the auditory channel and rely on vision as their primary means of communication.
The severity of the hearing impairment is categorized based on the minimum sound that can be
heard with your better ear. The higher the decibel (dB), the louder the sound.
Classification of hearing loss and effects on speech& language and probable educational
needs
Degree of
Hearing Loss Classification Impact on Speech and Language
25 to 40 dB Mild • With mild hearing impairment, the minimum sound that

can be heard is between 25 and 40 dB.
People at this level cannot hear soft noises and may have
trouble following conversations in noisy settings.
Can understand face-to-face conversation with little
difficulty
• Misses much of classroom discussion-particularly when
the speaker cannot be seen clearly Or several students are
speaking at once
• May have some classmates who are unaware she has a
hearing loss
• Benefits from a hearing aid
• Most benefit from speech and language assistance from a
speech-language pathologist
40 to 70 dB Moderate • With moderate hearing impairment, the minimum

sound that can be heard is between 40 and 70 dB. People at
this level cannot hear soft or moderately loud noises and
may have trouble hearing unless they use a hearing aid.
Without hearing aid can hear conversational speech only if
it is near, loud and clear
• Finds it extremely difficult to follow group discussions
• Full-time amplification is necessary
• Speech noticeably impaired but intelligible
• Many benefit from time in a special class where intensive
instruction in language and communication can be provided
70 to 95 dB • With severe hearing impairment, the minimum sound

that can be heard is between 70 and 95 dB. People at this
Severe level are unable to hear most noises and may rely on lip-
reading and/or sign language, even with the use of a hearing
aid.
Can hear voices only if they are very loud and 1 foot or less
from her ear
• Wears a hearing aid, but it is unclear how much it helps
• Can hear loud sounds such as a slamming door, vacuum
cleaner, and airplane flying overhead
• May distinguish most vowel sounds but few if any
consonants
• Communicates by speech and sign
• May split school day between a special class and a general
education classroom with an educational interpreter
95 dB or more Profound • With profound hearing impairment, the minimum

sound heard is 95 dB and over. People at this level may only
hear very loud noises and rely solely on lip-reading and/or
sign language. Hearing aids are not effective.
Cannot hear conversational speech
• Hearing aid enables awareness of certain very loud sounds,
such as a
fire alarm or a bass drum
• Vision is primary modality for learning
• American Sign Language likely to be first language and
principal
means of communication
• Has not developed intelligible speech
• Most require full-time program special education program

for students
who are deaf
It is important to understand each specific type of hearing impairment in terms of the continuum
of degree of hearing impairment. The degree or severity of impairment ranges across mild,
moderate, severe and profound. Sometimes a hearing impairment may be borderline between
two categories, such as “moderately severe” (Northern & Downs, 2002). Having an
understanding of the student’s degree of hearing loss is useful for determining the types of
supports that will be required.
It is important to note that the parameters of these categories are not universally accepted and
different authorities may assign different degrees of loss to each category. However, for our
purposes, degree of hearing loss will be classified using the descriptions given below. First, it
is important to understand that sound is measured by its loudness or intensity (measured in
units called decibels, dB). The greater the number of decibels the louder the sound. For
example, a 70 dB sound is much louder than a 30 dB sound. A person without a hearing
impairment can hear sounds ranging from 0 to 140 dB. A whisper is around 30
dB. Conversations are usually 45 to 50 dB and with background noise, about 60-65dB. Sounds
that are louder than 90 dB can be uncomfortable to hear. A loud rock concert might be as loud
as 115 dB. Sounds that are 120 dB or louder can be painful and can result in temporary or
permanent hearing loss.
CHAPTER FOUR (4)
Identification, assessment and intervention of hearing impairment

identifying a Student with Hearing Loss
Niemann, Greenstein & David (2004) describe the impact of a hearing impairment where a
child can see people talking but cannot understand what is being said. This results in the child
having difficulties understanding the world and in expressing personal needs, resulting in
limited interactions and social isolation. Thus, it is important to identify the hearing
impairment as early as possible; otherwise the child will also miss out on important educational
experiences (Pagliano, 2005). Sometimes hearing impairment can go unidentified partly
because it is not immediately visible. A hearing impairment could be so mild that it may it
may have gone unnoticed for many years (Smith, Polloway, Patton & Dowdy, 1998). On the
other hand, a hearing impairment may develop over time. The student is often the last one to
recognise or report a loss in hearing unless it has deteriorated significantly. If the hearing
impairment remains undetected, it can result in the student facing a substantial educational
disadvantage. The adverse affect of the hearing impairment can create challenges of a
personal, academic and social nature for the student and interfere with reaching full
potential. Teachers need to be aware of the indicators that signal the possibility that a student
has an undiagnosed hearing loss. On a medical note, if the hearing problem is undetected and
untreated, it can cause permanent loss of hearing and the long-term consequences for the
quality of life can be serious.
Consider the case of Sue, a 10 year old girl who had undiagnosed conductive hearing
impairment with a mild hearing loss in her left ear. She thought most of her friends mumbled
a lot. Sue stated that she had to strain to listen to them and found it difficult following a
conversation, especially in group situations. She would often have to ask her friends to repeat
themselves. Often Sue wouldn’t realize that someone was calling her, especially if they were
in another room or if it was a very noisy classroom. She would often ask for the volume of the
TV or stereo to be turned up or would sit closer to them to hear properly. Without adult
awareness, her impairment continued unrecognized.
Possible Sign of a Hearing Impairment

Turning head to position ear in the direction of the speaker
Favoring one ear over another
Using a loud voice when speaking
Mispronouncing words (such as misarticulation of certain speech sounds or omitting certain consona
sounds)
Asking for information to be repeated frequently
Not responding when addressed
Difficulty with following directions or instructions
Seeming distracted and/or confused
Appearing to be inattentive, restless, tired or daydreaming
Distracted easily by visual or auditory stimuli
Lack of, or delayed development of speech and language
Intently watching faces during conversation
Giving incorrect answers to questions
Not startled by loud noises
Preferring to be by themselves (i.e., playing alone rather than with a group, or withdrawing from soci
situations)
Problems hearing environmental sounds (i.e., doorbell, telephone ringing, people calling and/or talkin
to the student from behind)
Sitting close to the sound source (i.e.,TV, radio, and/or turning up the volume
The observable signs by which the hearing impaired could be identified include the following:
Articulation of certain speech sounds correctly often eludes the child.

The child finds it difficult to write down dictations.
The individual fails to respond to or confuse verbal directions.
Complains of a buzzing or ringing sound in the ear.
Fails to respond when called from a distance.
Complains of discharge from the ears.
Speaks in an abnormally low, high or loud voice.
The child responds only when he/she sees the speakers face or gesture.
The individual has frequent colds and hay fever.
The child bends forward so as to hear or understand what is said to him.
Asks the speaker to repeat sentences or words.
When called from a distance the child fails to respond.
Gives wrong answers to simple questions.
Often times the child dodges situations that may require him listen or talk to people.
The individual is insensitive to sound.
Rubs the ears frequently or turning to one direction as if trying to locate a sound.
The individual has frequent ear aches and running ears.
The child often screams to express pleasure, annoyance or need.
 The following areas are underscored some of those that are affected by a hearing
impairment:
 Early relationships, experience and early learning opportunities of the hearing
impaired student will have made a lasting impact upon that student’s ongoing social,
language, cognitive, and emotional development.
 Communication and language are greatly affected by hearing impairment. Early
delay in receptive and expressive communication skills may have an ongoing impact
upon the student’s ability to understand, process and use the information being acquired
throughout one’s educational life. Individual students with hearing impairment may
have varying abilities in their communication abilities. The student may have
difficulties with reading or with subjects incorporating jargon specific to that subject,
but not used much in everyday language. There may also be difficulties with
hypothesizing or with seeing things from another person’s perspective.
 Social skills refer to those skills necessary for effective communication with other
people. They include both verbal and non-verbal behaviors. Some of the skills include
eye contact, proximity, word choice, intonation, ability to read non-verbal cues, facial
expressions, take the perspective of another, shift attention, and maintain topic of
conversation (Disability News, 2001). Social skills are crucial to our lives for personal,
academic and vocational success. A student with a hearing impairment has difficulty
with accessing auditory information and expressing ideas in a way that others can
understand.
The Learning Disabilities Association of Ontario (1999) states that a student with hearing
impairment may appear disoriented, distracted, or at times confused because of difficulties with
accessing accurate auditory information. The student may try to cope with difficult situations
by copying peers or pretending to understand what is going on in the class while actually
misunderstanding the situation. The student with hearing impairment may appear to hear
normally, when in fact the student cannot hear speech sounds clearly enough and is
misinterpreting the information. The student may have difficulties pronouncing speech sounds
correctly, poor vocal quality, or trouble explaining ideas clearly. All of the above- stated
factors can negatively impact social skill development as well as the ability to freely
communicate, resulting in the student becoming shy, socially isolated, or displaying behaviors
of concern (Learning Disabilities Association of Ontario, 1999).
Assessment of Infants
New born respond to sounds by startling or blinking. At a few weeks of age, infants with normal
hearing can listen to quiet sounds, recognize their parents’ voices, and pay attention to their
own gurgling and cooing sounds. All infants, hearing and deaf alike, babble. In children with
normal hearing, vocalizations containing a minimum of a consonant and vowel sound, called
canonical babbling, emerge between 7 and
12 months (Bass-Ringdahl, 2010). Children who are deaf tend to stop babbling and vocalizing
because they cannot hear themselves or their parents, but the baby’s increasing silence may go
unnoticed for a while and then be mistakenly attributed to other causes.
The Joint Committee on Infant Hearing (2007) recommends that all infants be screened by 1
month of age.
Intervention programs in most states is working toward the goal of having all babies being
screened by 1 month, diagnosed by 3 months, and enrolled in early intervention programs no
later than 6 months of age. The two most widely used methods of screening for hearing loss in
infants measure physiological reactions to sound. With auditory brain stem response, sensors
placed on the scalp measure electrical activity as the infant responds to auditory stimuli. In
otoacoustic emission screening, a tiny microphone placed in the baby’s ear detects the
“echoes” of hair cells in the cochleaas they vibrate to sound (Ross & Levitt, 2000).
Even though an infant passes screening in the hospital, hearing loss can develop later. Figure
9.3 lists some common auditory behaviors emitted by infants with normal hearing. An infant
who fails to demonstrate these responses may indicate a hearing loss, and an audiological exam
is recommended.
Pure-Tone Audiometry
A procedure called pure-tone audiometry is used to assess the hearing of older children and
adults. The test determines how loud sounds at various frequencies must be for the child to
hear them. The examiner uses an audiometer, an electronic device that generates pure tones at
different levels of intensity and frequency.
Most audiometers deliver tones in 5-dB increments from 0 to 120 dB, with each decibel level
presented in various frequencies, usually starting at 125 Hz and increasing in octave intervals
(doubling in frequency)to 8,000 Hz. The child, who receives the sound either through
earphones (air conduction) or through a bone vibrator (bone conduction), is instructed to
depress a button when he hears a sound and to release the button when he hears no sound. To
obtain a hearing level on an audiogram, the child must detect a sound at that level at least 50%
of the time. For example, a child who has a 60-dB hearing loss cannot detect a sound until it is
at least 60 dB loud. The results of the test are plotted on a chart called an audiogram.
Speech Reception Test
A complete hearing exam includes testing a person’s detection and understanding of speech
sounds. A list of phonetically balanced one- and two-syllable words is presented at different
decibel levels. The speech reception threshold (SRT), the lowest decibel level at which the
individual can repeat half of the words, is measured and recorded for each ear.
Alternative Audiometric Techniques
Several alternative techniques have been developed for testing the hearing of very young
children and individuals with severe disabilities who may not understand and follow
conventional audiometry procedures. In play audiometry, the child is taught to perform simple
but distinct activities, such as picking up a toy or putting a ball into a cup whenever she hears
the signal, either pure tones or speech. A similar procedure is operant conditioning
audiometry, in which the child receives a token or a small candy when she pushes a button in
the presence of a light paired with a sound. No reinforce is given for pushing the button when
the light and sound are off. Next, the sound is presented without the light. If the child pushes
the button in response to the sound alone, the examiner knows the child can hear that sound.
Behavior observation audiometry is a passive assessment procedure in which the child’s
reactions to sounds are observed.
A sound is presented at an increasing level of intensity until a response, such as head turning,
eye blinking, or cessation of play, is reliably observed.
To fully evaluate the hearing condition, abilities and needs of the student, a two-fold approach
is required, involving diagnosis and assessment.
Initially, the diagnosis of a hearing impairment is based upon a comprehensive evaluation by a

multidisciplinary evaluation team, which includes a physician, an audiologist, and an
otolaryngologist or otologist. Table 2 below describes the roles of the various professionals
involved in the hearing assessment process and information they can provide to educators to
help the student.
Health Role
Professional
Doctor/General Examines the ears by carrying out a basic hearing screening.
Practitioner
Refers patients to the appropriate health care professionals such as
audiologists, otolaryngologists or otologists.

Audiologist Trained specialist in the evaluation and non- medical treatment of hearing impairment:
 Performs an extensive hearing test,

 Completes a diagnostic assessment,
 Prescribes and fits hearing aids
 Offers counseling and auditory rehabilitation,
 Gives advice about hearing conservation and assistive devices.
Otolaryngologist Physician specializing in the medical and surgical management and treatment of
patients with diseases and disorders of the ear, nose, throat (ENT), and
related structures of the head and neck. In the domain of the ear, is trained in
both the medical and surgical treatment of hearing, ear infections, balance disorders,
ear noise (tinnitus), and congenital (birth) disorders of the outer and inner ear.
Pediatric otolaryngologist receives advanced training in the medical a

children. (Dugan, 2003)
Otologist A physician specializing in the medical and surgical diagnosis and treatment of disorder
Pediatric otologists treat children from the newborn period through the teenage years. The
in the medical and surgical care of children.
Hearing assessment
Audiological Exam
Once the referral to the appropriate professional has been made, an audiological examination
is performed. An audiological examination is conducted by an audiologist to determine:
1. if a hearing loss is present;

2. which tones are affected;
3. the degree of the hearing loss;
4. the type of hearing loss (i.e. conductive, sensorineural, or mixed);
5. the best method of treating the hearing loss; including selection of an appropriate
hearing aid, if appropriate.
The audiologist then performs several tests in order to obtain an accurate measure of the child’s
hearing abilities to determine the existence and extent of the hearing impairment.
When these tests have been completed, the audiologist may conduct more specialized
procedures, such as the evaluation of the mechanical functioning of the eardrum and bones of
the middle ear (“intermittence teats”), and other measures to assess the function of the cochlea.
Alternatively, if deemed necessary, the audiologist will make referrals to other professionals.
After reviewing the child’s information and test results, the audiologist will be able to describe
a hearing loss as unilateral (affecting one ear) or bilateral (affecting both ears), the degree of
hearing impairment (mild, moderate, severe or profound), and the type of loss (conductive,
sensorineural or mixed). The audiologist will make recommendations regarding amplification
and provide suggestions on how to best manage the hearing impairment. It is important to
remember that every student is an individual and as Scheetz (2000) emphasizes, “One must be
careful not to pigeonhole or label someone based on this information” (p. 52). To help the
student we need to then individualize the supports that we provide by consulting with other
professionals.
Below is information about some of the tests that are performed to assess hearing. They
include:
 Otoscopy. Otoscopy is a physical examination of the ear that involves looking into the
ear with an instrument called an “otoscope” (or “auriscope”) to examine the structures
of the outer ear and the eardrum. Otoscopy can help detect problems such as a hole
(perforation) in the eardrum and infections of the middle ear (such as acute Otitis
Media, an infection that produces pus, fluid, and inflammation within the middle ear).
The nose, nasopharynx (space within the skull that is above the roof of the mouth, and
behind the nose), and upper respiratory tract are also examined.
 Tympanometry. Tympanometry measures the ability of the middle ear to conduct
sound. It is particularly useful in detecting fluid in the middle ear; Eustachian tube
dysfunction (such as negative middle ear pressure); disruption of the ossicles (bones);
tympanic membrane (ear drum) perforation; and otosclerosis (abnormal growth of bone
in the middle ear). To perform this test, a soft probe is placed into the ear canal and a
small amount of pressure is applied. The instrument then measures mobility of the
tympanic membrane and its response to the pressure changes. The results of the test
are printed as a graph, called a “tympanogram” which can help identify middle ear
problems. For example, a flat line on the tympanogram may indicate that the eardrum
is not mobile or not vibrating properly due to fluid in the middle ear (Hain, 2002).
The audiologist begins the examination of the child by first taking a case history. The
audiologist asks questions about the child’s medical conditions, hearing behaviors, hearing loss
in the family, and any concerns of the child and the family.
Audiometry is the testing of a person’s ability to hear sounds at a range of frequencies. This
includes air conduction tests, bone conduction tests, and speech audiometry tests. An
audiometric test is used to determine the types of sounds the child can and cannot hear.
Air conduction tests involve the presentation of beeps and whistle-like sounds, called “pure
tones,” through headphones in a soundproof room. Sounds are of varying loudness (intensity
measured in dB) and of different pitch (or frequencies measured in Hz) .The pure tones go via
the air, down the ear canal, through the middle ear into the inner ear. The child is asked to
respond when he or she detects a sound (such as by raising a hand or pushing a button). The
loudness of each tone is reduced until the child can just hear the tone. The softest sounds the
child can hear constitute the hearing threshold. This is marked on a graph called an
“audiogram,” which can be used to identify and diagnose hearing impairment (Martin & Clark,
2003).
A bone conduction test involves using a skull vibrator such as a vibrating tuning fork. It is
placed behind the ear to measure the softest sounds that the child can hear to test the functioning
of the inner ear. The child is asked to respond when detecting a sound produced by the
device. As the sound travels through the bones of the skull to the inner ear (cochlea, auditory
nerves), the sound sidesteps the outer and middle ear.
Intervention of hearing impairment

INTERVENTION PROCEDURES OF HEARING IMPAIRMENT
For the hearing impaired child to benefit maximally from special education programmes, there
is need for proper management of his challenged state. Obikeze and Ofojebe (2000) identified
ten measures for the management and control of hearing impairment in children. These are as
follows:
1. The use of new drugs in treating infections of the ear, nose and throat.
2. Surgical treatment where possible
3. Use of improved hearing test techniques and equipment for diagnostic purposes.
4. Use of improved hearing aids such as ear trumpets.
5. Giving of better prenatal care to expectant mothers.
6. Availability of good medical and nursing care during the period of delivery and control of
accidents and possible brain injury during and immediately after.
7. Regular medical and health care in infancy and during the school years.
8. Firm control of contagious diseases via vaccination and immunization.
9. Prompt treatment of colds and coughs in children.
10. Prompt treatment of middle ear infection such as otosclepsis
Strategies and programmes for educating the Hearing impaired It is often difficult to
mainstream the hearing impaired but when they are mainstreamed, such students need sign
language interpreters in the classroom as well as supplementary resources assistance. Teaching
the hearing impaired will definitely pose a problem to the teacher because deafness being a
serious sensory deprivation is noted to hinder the afflicted person's development generally and
their academic achievement in particular. Thus Alade and Abosi /1991) found out that hearing
impairment has adverse effects on academic achievement but the magnitude of such adverse
effects depends on the degree of hearing loss.
For effective teaching and learning therefore the hearing impaired needs appropriate
methods that could facilitate the acquisition of language as well as social and emotional
adjustment. These methods include:
1. Auditory method: - This method involves teaching hearing impaired children to recognize
sounds. It emphasizes the development of listening skills. It is a situation whereby the hearing
impaired is constantly exposed to sound and language in their environment together with the
provision of some kind of hearing aids for amplification.
2. The oral method:- Here gestures and signs are not allowed. The oral method rather uses
speech, lip reading and auditory training to teach. Stressing assisting the hearing impaired to
acquire communication skills and de-emphasizing gestures and signs is necessary and central
in the education of hearing impaired. Special educators also place emphasis in the development
of early meaningful communication in the management of hearing impaired individuals.
3. Rochester method:- This method emphasizes reading and writing. Rochester method
combines the oral method and finger spelling or writing in the air technique.
4- Neo-oralism:- The central task of this method is to give tools of communication especially
expressive communication at an early to change youngster who are passive into being active
and therefore develop an initiative in learning. The method, like Rochester method makes use
of finger spelling. If the young deaf child masters finger spelling, the language mastery process
becomes easy like that of the hard-of-hearing child.
5. Simultaneous total communication method:- This approach involves using oral

communication audition, finger spelling, signs, gestures, dramatization reading, pencil and pen
writing and drawing. All the sense modalities are used in this method.
 Writing on what the teacher should do to educate the hearing impaired or the deaf stated
the following:
1. Learning by deaf children is visually oriented. What they can see is important to them
and not what they are supposed to hear. So, the teacher should therefore make use of the
black board, pictures, diagrams etc.
2. Making use of concrete objects creates and sustains interest in the lesson.
3. The concept of over-learning is very important in working with deaf children. A single
idea or concept should be presented in a variety of ways, and by using more than one sense
modality.
4. Every subject on the time - table could provide an opportunity for teaching language, or
some form of communication skills. He added that teachers should seek co-operation of the
home of the child and ensure that he/she is accepted, loved and encouraged by his/her
parents /guardians.
Revision Questions
1 a. What do you understand by hearing impairment?
b. List about ten signs of hearing impairment.
2 a. What are the causes of hearing impairment?
b. Write short notes on
i. the partially sighted
ii. the congenitally deaf
iii. the adventurously deaf
3. The hearing impaired is faced with some problems. Comment on this statement.
4 a. Mention four major types of hearing impairment
b. Explain fully the management and intervention of the hearing impaired child.
c. How can the classroom teacher help the hearing impaired?
Interpretation of Air Conduction and Bone Conduction Results
 If air conduction and bone conduction thresholds are within normal limits, then hearing
is normal.
 If the air conduction thresholds indicate a loss and the bone conduction thresholds do
not indicate a loss, then a conductive hearing loss is present. In other words a person
does not hear normally when sound has to go through the outer, middle and inner ear,
but if the sound bypasses the conductive mechanism (i.e. the outer and middle ear), and
goes directly to the inner ear, then hearing is normal.
 If there is a loss by both air- and bone - conduction and the abnormal thresholds are
essentially similar, then a sensorineural hearing loss exists. In other words, there is a
hearing loss by air conduction, such as when the sound goes through the outer, middle
and inner parts of the ear. There is the same amount of hearing loss when the sound
bypasses the outer and middle ear and goes directly to the inner ear. If there is a loss by
both air conduction and bone conduction, but the loss by air conduction is worse than
the loss by bone conduction, a mixed hearing loss exists. Both conductive and
sensorineural components are present.
Designing the Individual Educational Plan
Once a hearing impairment has been identified, the next step involves creating a plan of action,
or the Individual Education Plan (IEP), that meets the abilities and needs of the student. It is
important to do this by using a team approach. Table 3 below describes the various team
members. The team can be comprised of a variety of educational specialists, such as a certified
teacher and assessment professionals. The team also includes a variety of other health
professionals such as Occupational Therapists, Audiologists, and Speech and Language
pathologists. The composition of the team will depend on the needs and abilities of your
student. Hence your team may not necessarily include all the people listed below.
Speech Audiometry
This involves presenting the child with a series of simple recorded syllables, words and
sentences spoken at various volumes into the headphones. The test is designed to assess speech
threshold (i.e., when the child can first hear speech) and the child’s ability to understand speech
(Scheetz, 2000). The test requires the child to repeat each word back to the audiologist as it is
heard. This provides information on the volume (quantity) of the speech sound that the child
can hear and also the quality of the sound (clear vs. distorted) the child hears. The level at
which the child can repeat 50% of test materials correctly provides information about the type
and degree of hearing impairment (Lysons, 1996). This is useful to determine the candidacy
for hearing aid and reaffirm the findings of the pure-tone audiometry test.
Designing the Individual Educational Plan
Once a hearing impairment has been identified, the next step involves creating a plan of action,
or the Individual Education Plan (IEP), that meets the abilities and needs of the student. It is
important to do this by using a team approach. Table 3 below describes the various team
members. The team can be comprised of a variety of educational specialists, such as a certified
teacher and assessment professionals. The team also includes a variety of other health
professionals such as Occupational Therapists, Audiologists, and Speech and Language
pathologists. The composition of the team will depend on the needs and abilities of your
student. Hence your team may not necessarily include all the people listed below.
Educational staff Role

Visiting teacher or  Assesses and evaluates the needs of each child
Hearing Support  Explains the impact of hearing impairment to staff and students without
Teacher impairment in terms of current and future implications
 Assists teaching staff understanding of audiological equipment (such
amplification technology)
 Offers support to the student (such as note-taking, assisting with concerns
academic work, social matters, audiological issues, speech, listening,
language and literacy goals)
 Provides advice on adaptations to the school environment needed for the studen
 Assists with educational programming for the student
 Provides advice to teaching staff regarding instructional and classroom ma
strategies
 Liaises and consults with parents and outside agencies
Health Professional Role

Occupational  Develops daily living skills (educational skills such as writing, and self-help s
Therapist as washing, dressing, eating)
 Advises on special equipment, aids and adaptations to the environment to
independence.
Physiotherapist  Assesses student’s gross-motor skills (ability to sit, stand or walk)

 Recommends exercises to develop motor skills, increase flexibility, bal
(Physical Therapist) coordination
 Provides mobility aids
Psychologist  Provides psycho-educational assessments

 Identifies student’s learning style and educational needs
 Addresses learning, behavior and emotional concerns
 Provides counseling as needed.
Social Worker  Provides family support and counseling

 Supports the family in accessing community services
 Assists the student in accessing programs in the community
Speech/ Language  Assesses communication skills

Pathologist  Provides communication intervention (Receptive skills intervention may
awareness of sound, localization of sound, discrimination of sound di
recognition of sound and comprehension of speech. Expressive skills interven
include developing breath control, vocalization, voice patterns and sound pr
Social skills intervention could involve support with making friends, r
clarifications, problem solving skills and developing a positive self concept.)
Educational staff Role

Visiting teacher or  Assesses and evaluates the needs of each child
Hearing Support  Explains the impact of hearing impairment to staff and students without
Teacher impairment in terms of current and future implications
 Assists teaching staff understanding of audiological equipment (such
amplification technology)
 Offers support to the student (such as note-taking, assisting with concerns
academic work, social matters, audiological issues, speech, listening, lang
literacy goals)
 Provides advice on adaptations to the school environment needed for the studen
 Assists with educational programming for the student
 Provides advice to teaching staff regarding instructional and classroom ma
strategies
 Liaises and consults with parents and outside agencies
Health Professional Role

Occupational  Develops daily living skills (educational skills such as writing, and self-help s
Therapist as washing, dressing, eating)
 Advises on special equipment, aids and adaptations to the environment to
independence.
Physiotherapist  Assesses student’s gross-motor skills (ability to sit, stand or walk)

 Recommends exercises to develop motor skills, increase flexibility, bal
(Physical Therapist) coordination
 Provides mobility aids
Psychologist  Provides psycho-educational assessments

 Identifies student’s learning style and educational needs
 Addresses learning, behavior and emotional concerns
 Provides counseling as needed.
Social Worker  Provides family support and counselling

 Supports the family in accessing community services
 Assists the student in accessing programs in the community
Speech/ Language  Assesses communication skills

Pathologist  Provides communication intervention (Receptive skills intervention may
awareness of sound, localization of sound, discrimination of sound di
recognition of sound and comprehension of speech. Expressive skills interven
include developing breath control, vocalization, voice patterns and sound pr
Social skills intervention could involve support with making friends, r
clarifications, problem solving skills and developing a positive self concept.)
In conclusion, teachers can work with a variety of professionals to plan an appropriate

educational program that will help the student with hearing impairment participate successfully
in the classroom. This chapter has provided an overview of hearing impairment by detailing
information on how we hear, how hearing is assessed, ways of identifying students with hearing
impairments in the classroom, and learning characteristics of students with hearing
impairments. Additional information has been provided on the types of professionals who can
be of assistance in diagnosing and educating students with a hearing impairment.
Hearing Aids
Technology such as hearing aids, cochlear implants, captioning, assistive listening devices
and alerting devices can amplify sounds to help maximize the student’s communication and
learning potential at school. With all of the devices described in this section it is crucial that a
thorough assessment of the classroom environment is carried out before a device is chosen. A
team approach should be used that consists of the classroom teacher, an assistive technology
consultant, audiologist, visiting teacher for hearing, parent, speech-language pathologist, and
the student. A major part of the assessment should include classroom observation to get a
thorough understanding of auditory-related concerns. Based on the assessment, the best
possible device to provide an appropriate educational environment for the student should be
determined (Smith, Polloway, Patton and Dowdy, 1998). Also, both teacher and student need
to receive appropriate in-service information and on-going follow-up support from a hearing
specialist for each of the device/s to gain maximum benefit from it in the classroom.
Access to information and the capacity to interact with that information in a variety of ways is
fundamental to a rich curricula experience. Through provision of technology solutions that are
viewed as tools, students with hearing impairment have greater opportunity to achieve access,
equity and opportunity.
How does a Hearing Aid work?
Hearing aid is an instrument which collects sounds, amplifies them and then directs the louder
sounds into the ear.
Hearing aids enable the student to use auditory perception to maximum effect. It is important
to remember that hearing aids are not comparable to eyeglasses. In other words, unlike eye
glasses, which can restore vision to normal, hearing aids do not correct or restore
hearing. Instead they enable the wearer to use his or her remaining hearing more effectively
by amplifying sounds.
The hearing aid includes the following parts that work together to help the student listen:
 Microphone – It picks up the sound signal and converts it into electrical energy. The
electrical signal is fed into the amplifier.
 Amplifier – It progressively boosts the power of the electrical signal through various
stages. The magnified electrical signal is fed into the receiver.
 Receiver – The receiver converts the electrical signal back into sound energy, which is
much louder than the original. This amplified sound is then fed into the ear canal. An
incoming signal can be boosted as much as 80 dB. For example, a sound entering the
microphone at 70dB can be boosted and emerge from the receiver at 150dB.
 Battery – It is the power source of the hearing aid. Currently, there are two main types
of batteries that are used: zinc-air and mercury. Zinc-air batteries are more commonly
used as they last twice as long and are much more environmentally friendly than
mercury batteries.
 Ear mould – Ear moulds are designed to fit the contour of the ear. Ear moulds are the
medium through which sound travels from the receiver to the student’s ear drum
without leaking. Leaking causes feedback in the hearing aid, resulting in a high-pitched
whistling sound.
The hearing aid is specifically tailored to meet the needs of the student with hearing
impairment. Factors such as the results of the audiogram, degree of hearing loss, shape of the
ear, demands on hearing, situations in which the student communicates, and expense contribute
to the selection of the hearing aid (Dugan, 2003).
Most hearing aids have a volume control feature that allows the student with hearing
impairment to adjust the volume manually as needed. If it’s a built-in volume control
(automatic signal processing) it adjusts the volume automatically. Hearing aids are “non
selective amplifiers, which means that all sounds within the range of the microphone are
amplified equally. Initially the student using the hearing aid maybe disturbed or distracted by
some everyday sounds, such as other students talking, coughing, sneezing, pencil dropping,
paper shuffling or any other sounds in the classroom, especially if they haven’t heard these
sounds before. With time and use of the hearing aid, the sounds become less disturbing.
Benefits of Hearing Aids
The benefits of hearing aids are dependent on the age of onset and the severity of the hearing
loss, type of hearing aid used, student’s communication abilities and motivation to use hearing
aid. Hearing aids can enhance quality of life by:
 Increasing the student’s ability to hear sounds

 Reducing speech reading effort
 Reducing communication stress/fatigue level
 Improving understanding of speech with or without visual cues
 Promoting independence (e.g. use of the telephone)
Tips for Teachers
 Help students develop realistic expectations of what their hearing aid can do. For
example, Lysons (1996) emphasizes that “not even the best aid can wholly provide the
clear discrimination, selectivity and location of sound that is obtained with normal
hearing” (p. 99).
 Help students become familiar with their hearing aid. For example, they should know
how to insert and remove the hearing aid, replace batteries, adjust volume, operate on-
off switch, use telecoil or telephone (Lysons, 1996)
 Encourage students to take care of their hearing aid. For example, students should wipe
the hearing aid regularly with a dry cloth or tissue. The hearing aid should never be put
in water. Additional information on cleaning the hearing aid will be provided by their
hearing aid supplier.
 Ensure that the material used in activities in which the student is involved does not
damage the hearing aid. For example, chemicals in cosmetics, after-shave, hair spray,
perfume, sunscreen and mosquito repellent can damage their hearing aid. Ask them to
remove their hearing aid before applying those products and allow time for the product
to dry.
 Speak to the audiologist for a checklist to assist with troubleshooting for commonly
occurring problems with hearing aids. Below is an example of such a checklist. Keep
it in a location for access by staff.
Cochlear Implants
Some students with a severe to profound sensorineural hearing loss may be using appropriate
hearing aids but are not receiving much benefit from them and are still having difficulty
communicating. Such students may be candidates for cochlear implants. Selecting a suitable
candidate for a cochlear implant involves an evaluation process that takes into consideration
factors such as: the student’s age, duration of hearing impairment, speech and language
abilities, results from the medical assessment, audiological assessment and psycho-social
factors (Chute, 2002, Miyamoto and Kirk, 1998).
What is a Cochlear Implant?
A cochlear implant is an electronic device that is surgically implanted into the cochlea (inner
ear) to compensate for the damaged or absent hair cells by directly stimulating the auditory
nerve fibers. The internal cochlear implant is coupled to external components that pick up
sounds from the environment (Turnbull, Turnbull, Shank and Smith, 2004). Dugan (2003)
states that “a cochlear implant is not a cure nor does it restore hearing to normal” (p.
77). Rather, it taps into the retained potential of the hearing pathway, by bypassing damaged
hair cells and directly stimulating the functional auditory nerve fibers in the cochlea (Dugan,
2003; Turnbull et. al, 2004).
A cochlear implant has internal and external parts.
The internal implant consists of an internal receiver coil and a receiver/ stimulator, which is
surgically implanted under the skin behind the ear, and electrodes that are inserted into the
cochlea. The external speech processor converts sound waves into a digital code, which is
transmitted via a mini radio link to the internal coil. The receiver/ stimulator then converts the
code into electrical currents, which the electrode delivers to the auditory nerve.
The external part consists of a microphone, a speech processor and a transmitter coil. The
microphone is located on the student’s head, held in place by the pinna. The speech processor
is either worn on the body or is positioned behind the ear. The external transmitter coil is held
in place over the internal receiver coil by a magnet. The external components work together
to collect, analyze, process and transmit auditory information to the internal parts to provide
the student with sound.
How does a Cochlear Implant work?
1. A microphone picks up sound.

2. Sound is sent from the microphone to the speech processor.
3. The speech processor analyzes and digitizes the sound into coded signals.
4. The speech processor is programmed to the student’s hearing needs.
5. Coded signals are sent to the transmitter.
6. The transmitter sends the code across the skin to the internal implant.
7. The internal implant converts the code to electrical signals.
8. The signals are sent to the electrodes to stimulate the remaining nerve fibres.
9. The signals are recognized as sounds by the brain, producing a hearing sensation.
Benefits of Cochlear Implants
For most recipients the cochlear implant is able to provide sufficient hearing to stimulate
speech and language development, enabling some children to attend mainstream schools and
enjoy broader education, employment and social opportunities.
Deaf children’s speaking and hearing success depends on a number of things, including how
long they were deaf before receiving any auditory stimulation. The earlier in life implants are
provided, the better the outcome, particularly with spoken communication, literacy and
mainstreaming.
According to parents, children with cochlear implants enjoy significant gains in sound
awareness, especially of softer sounds, speech understanding, monitoring their own speech and
understanding voices without looking at the speaker. This makes communication a great deal
easier and promotes success in communication.
Tips for Teachers
 Cochlear implants will not restore hearing to “normal”. In other words the student will
not immediately start understanding all the sounds that they are hearing. Once a student
has been fitted with a cochlear implant he or she must undergo extensive audition based
speech and language therapy to learn how to interpret the new sounds effectively.
 It is important to remember that each student is unique, and outcomes will differ from
student to student. A variety of factors (such as degree of hearing loss, type and amount
of auditory and speech intervention before and after cochlear implantation,
motivational factors) will affect how much and how quickly the student will benefit
from the cochlear implant.
 Please refer to the strategies discussed in the Accommodations chapter, as they are still
relevant when communicating with the student who has a cochlear implant. For
example, facing the student when interacting, speaking clearly and monitoring
background environmental noise and light are critical for successful communication.
Assistive Listening Devices
In writing this section I consulted with and appreciated the input (both information and images)
from Andrew Willis, Assistive Technology Consultant from Word of Mouth
Technology www.wom.com.au; Karina Badcock , Early Childhood Trained Teacher of the
Deaf (oral deaf and Auslan user), and Margaret Haenke, Manager of Deafness Resources
Australia: www.deafnessresources.net.au
The three most common factors that affect the student’s ability to hear and understand in the
classroom are background noise, reverberation and distance. Hearing aids provide maximum
benefit when the environment is relatively quiet, the acoustics are good and the student with
hearing impairment is interacting at a close distance to the speaker. However, in environments
such as the classroom, difficulties with background noise, reverberation and distance cannot
be solved by hearing aids alone. An assistive listening device (ALD) may be beneficial.
Assistive listening devices (ALDs) are specifically designed to enhance sound by minimizing
the negative effects of background noise, reverberation, and distance from the speaker and
thereby maximizing the student’s ability to hear and understand. ALDs are specifically
designed to pick up the desired sound from as close to the sound source as possible and send it
directly to the listener’s ear, which enhances hearing.
There is a wide range of ALDs, from personal amplifiers and television listening devices to
large area and stadium size systems (Thurman, 1999).
Three types of ALDs that are particularly useful for the classroom setting. They include
frequency modulated (FM systems), induction loops and sound field amplification systems.
Some suggestions for teachers to assist students with hearing impairments on the use of the
assistive listening devices to their maximum potential. For example, teachers should:
 Have sufficient knowledge about the type of ALD that the student uses.
 Understand how the device works and have some ideas for troubleshooting commonly
occurring problems.
 Be able to determine whether the ALD is functioning properly or not.
 Know how to take care of the ALD.
 Know whom to contact if there is a problem with the ALD.
FM Systems
A frequency modulation (FM) system can be used by teachers to transmit their voice
directly to the student and can be used indoors and outdoors. It consists of:
 Microphone
 Transmitter
 Receiver
How does an FM System work?
The sound (e.g. teacher’s voice) is picked up by a microphone which is connected through a
line input to the transmitter. The sound signals are then picked up by the receiver that is worn
by the student with hearing impairment. There are several options for getting the sound from
the receiver to the ear depending on the student’s degree of hearing loss and personal
preference. If the student wears hearing aids, normally there is a lead that physically connects
the FM receiver to the hearing aid (called direct audio input).
An FM system can also be used with headphones that directly transmit the teacher’s voice to
the student, resulting in less distraction by other noise in the room and better understanding of
what the teacher is saying.
An FM system can also be used in a classroom to transmit other audio signals to the student,
such as television and radio. This can be done using an audio lead that takes the audio signal
from the sound source and connects it to the auxiliary input on the FM transmitter.
Systems that use an FM signal can transmit through walls, so it is important to remember to
turn off the transmitter when you leave the room or wish to discuss something in private or
confidentially, as otherwise the student may be able to overhear your conversation.
Depending on the FM systems being used by students, it is also possible to transmit the signal
from PA systems in halls and stadiums on the school grounds directly to the student’s
receiver. This is a convenient means of providing access to students with hearing impairment
to schools that use a PA system. This process uses a product called a large area transmitter.
Benefits of FM Systems
 They can be used with students with a wide variety of hearing impairments.
 The student is able to receive high-quality sound over considerable distance.
 The FM system enables the student to hear the person speaking into the microphone
clearly and without most of the background noise.
 The student can hear the speaker clearly even when the speaker is not close by or is
moving around the room.
 The FM systems are portable and can be easily moved from one class to another and
used in situations where other classroom amplification systems are not practical (e.g.
on the playground or during field trips).
Tips for Teachers Using FM Systems
 It is important to wear the transmitter.

 Inquire whether or not the student has been issued an FM system and encourage its use.
 The speaker needs to be aware of the volume of his/her voice as it is being directly
broadcast to the student.
 The speaker must take care to eliminate interfering noise. For example, ensure that the
microphone does not rub on clothing (Downie, 2000), the speaker’s hair does not rustle
against the microphone and the speaker does not clear his/her throat or eat whilst
talking.
 The speaker wearing the transmitter needs to remember to turn it off when not
interacting with the student wearing the FM receiver.
 During group discussions, try to pass the microphone to each child who speaks
(Trautwein, 2005) so that the student wearing the FM receiver can hear all
contributions.
 If two transmitters are being used in the same classroom, e.g. in a team teaching
situation, ensure that the transmitting frequency channels are as distinct as possible.
Remind the student to change channels as they move from group to group (Trautwein,
2005).
 For multi-media lessons on TV, CD or DVD, place the FM transmitter microphone near
the sound source, or preferably connect the TV directly to the FM transmitter via the
auxiliary input jack (Trautwein, 2005).
Devices for Environmental Sounds
In writing this section I consulted with and appreciated the input from Margaret Haenke,
Manager of Deafness Resources Australia. www.deafnessresources.net.au
What are Devices for Environmental Sounds?
The telephone ringing, alarm clocks, smoke or fire alarms are sounds that alert people to daily
life occurrences. Many devices have been designed to assist students with hearing impairments
become aware of the sounds in the environment that are needed for personal safety or
convenience (Meier, 1999). These devices help compensate for the student’s hearing
impairment, allowing for a greater sense of confidence, independence and control of the
environment. Varying in their level of sophistication and complexity, there are many alerting
products available on the market today to help students with hearing impairments.
1. Alarm Clocks
 Vibrating alarm clock: It is a clock that has a vibrating device, which can be clipped
onto the pillowcase or a section of a bed or the entire bed. At the chosen time, the clock
activates the alarm signal, which in turn causes the vibrator to move the attached
section, thus awakening the sleeper.
 Flashing alarm clock: It is a clock that has a bright light, which will flash when the
alarm goes off.
 Combination alarm clock: It has a combination of both the vibrating and flashing light
features. (Meier, 1999)
2. Alarm Watches
 Vibrating alarm watch: The wristwatch vibrates when the alarm goes off. These
watches are generally used as reminder tools during the daytime, as they are usually not
strong enough to wake someone from sleep. Some alarm watches may have an
automatic reload countdown timer, which gives reminders as often as needed.
3. School bells, Smoke, or Fire Alarms
 Schools should have a flashing light system linked to the smoke or fire alarms and other
bells/sound systems to visually alert the student with hearing impairment. These
systems should be visible in classrooms and in general areas where the student maybe
alone, such as rest rooms or study carrels (Gloucestershire Country Council, 2004). It
is important to note that if a flashing light alert system is used for both the school bell
and smoke/evacuation alarms, it is critical that these flashing light alert systems be
distinctly different to each other. If the smoke/evacuation alert goes off, it is crucial
that the student respond immediately and that there is no danger of ignoring the flashing
light thinking that it’s ‘just the school bell’.
4. Telephones
Telephones - Hearing the telephone ring
 Ring Enhancers: A device that allows the student with hearing impairment to set the
volume of the ring to much louder levels than ordinary telephones (Meier, 1999).
 Telephone Light Flashers: A light is fitted into the telephone that flashes whenever
the telephone rings. This is generally a fairly small light and the student would need to
have the telephone in view for this to be effective. Alternatively, the telephone can be
connected to an external system to make lights flash throughout the room or the
building.
Telephones – Communicating using the telephone
 T-switch – alternatively also known as a telecoil. It is a coil of wire, which has the
capacity to pick up sound directly from a magnetic field created when sound is fed into
the coil. Many telephones can output a magnetic signal which hearing aids with a
telecoil can "hear." If the hearing aid or cochlear implant has a T-switch, then it only
responds to those sounds coming from the telephone so unwanted and distracting
background noises are not picked up.
 In-built amplifier – a telephone that has an in-built amplifier and an adjustable volume
control that the student can use to make the caller’s voice louder to compensate for the
hearing loss.
 Portable amplifier – a battery-powered amplifier which slips over the handset ear
piece. The student can adjust the volume to suit individual needs. It is convenient if
using several different phones, however, it may not work on all telephones or make the
volume as loud as some students may need it to be (Dugan, 2003).
 TeleTypewriter (TTY) also known as a Textphone: If neither the T-switch nor the
amplification allows the student to communicate well on the telephone, a TTY may be
a better option. A TTY unit consists of a QWERTY keyboard, visual display screen
and acoustic coupler. The acoustic coupler is two upward facing rubber cups – one for
the mouthpiece and one for the earpiece of the telephone handset. Some TTYs also
have a ‘direct connect’ option whereby the TTY can be plugged directly into the
telephone outlet, rather than using the acoustic coupling option. When a TTY calls
another TTY, the users send their message by typing what they want to say and the
words appear on the digital display of the other person’s TTY. Some TTYs also allow
the user the option to print the conversation on a piece of paper (Meier, 1999). If
someone who needs to use a TTY wishes to make a call to someone who doesn’t have
a TTY (or vice versa), then the call can be made through the Telecommunication Relay
Service, as known in USA, or the National Relay Service in Australia
 Telecommunication Relay Service – The Telecommunications Relay Service
provides telephone access service to people who have a hearing impairment or severe
speech impairment. Relay Officers, who are specially trained communication
assistants, serve as intermediaries, relaying conversations between the person using the
TTY and the person without a TTY. For example, students with hearing impairment
use the TTY to type what they want to say to the person they are calling. The Relay
Officer reads this text communication and simultaneously reads it aloud to the person
at the other end of the call. The Relay officer listens to the response and types it back
to the student to read and respond (Downie, 2000; Dugan, 2003).
5. Mobile Phones
There are many factors which impact on a Deaf person’s or person with hearing impairment’s
ability to successfully use a mobile phone, so it is important to choose carefully in terms of the
following features:
 Mobile networks (e.g. CDMA or GSM). People with a hearing aid may experience an
interfering noise when using a mobile phone. It can be a buzzing sound that makes
speech hard to understand. In severe cases, it can make the phone unusable. Possible
solutions to this problem include:
 Use a CDMA mobile phone
 If using a GSM mobile phone, use it with a T-link attachment and switch the hearing
aid to the 'T’ position.
 Use an alerting system for incoming calls (e.g. flashing screen or vibrating alert)
 Use the text messaging or short messaging service (SMS) feature, although there may
be restrictions on the length of the message (number of characters) that can be sent.
 These use the built-in QWERTY keyboard or can be attached to the mobile. (Downie,
2000; Dugan, 2003)
Teaching strategies and accommodation

Teachers who have students who are deaf or hearing impaired may be required to make
accommodations in order to help the student reach potential. This chapter lists some specific
accommodations that teachers may wish to incorporate into their classroom and teaching. By
implementing a few of the accommodations, the teacher can help the child with a hearing
impairment or deafness feel comfortable, confident, and successful in the general education
setting.
Allowing a student who is deaf or hard of hearing to explain his/her disability to the other
students in the classroom can help create a sense of community. This will allow the curiosity
of other students to be appeased, as well as allow the student to be the center of attention in a
positive way. Not every student will be comfortable talking about the disability; therefore, it
is important to check ahead of time rather than forcing a class discussion. If the student is
uncomfortable with the disability, the teacher needs to create a warm and inviting environment
within the classroom. This type of environment will help the student to feel safe and secure
when at school and therefore more comfortable about learning. If the teacher does choose to
have the discussion with the class, it is important to stress the similarities between all the
students rather than the differences. Many students will notice the differences and have
questions about them, but the similarities still need to be stressed. Allowing the student who
is hard of hearing or deaf a few minutes to talk about his/her disability and the other students a
chance to ask their questions, enables learning to take place with fewer distractions (Sanders,
1988; Tacchi, 2005).
Classroom Seating
When a student who is hard of hearing or deaf is placed within a general education classroom,
seating arrangements are crucial. Providing a student with a “preferred” seat in the classroom
can allow for more interaction with the teacher and peers. If the student is sitting in the front
of the classroom with all the other students behind them, it may be easier to follow the
conversation when the teacher is talking, but more difficult when other students are
speaking. Students relying on speech reading would need to turn around when a classmate
begins to talk.
When using preferred seating, the student should be able to see not only the teacher clearly but
the classmates as well. One form of preferred seating is the set up the seats in the classroom
in a “U” shape. This would allow the students to be able to see each other clearly, as well as
see the teacher. Another way of setting up the classroom would be in groups. This would
mean organizing the desks into small groups of about four or five students. If the room is
structured into groups, the students would be able to see most people clearly, and they could
easily turn to see the rest of the class. The teacher might also ask the student where he/she
would like to sit. This would allow the students to choose a seat from which they feel they can
communicate and learn to the best of their ability. The student should be allowed to change to
another location in the room as flexibly as possible for better viewing of the teacher and peer.
Through the use of preferred seating, a teacher can set up the classroom to allow all students
equal access to the conversations and curriculum.
Sign Interpreters and Notetakers
Students who are hearing impaired or deaf may have either a note-taker or a sign interpreter in
the classroom to assist in their learning. It is very important that the teacher and the child’s
support staff member work together to help the child gain full access the curriculum. The
interpreter’s role in the classroom must be clearly defined prior to entering the classroom, so
that situations do not arise out of misunderstanding. The teacher and interpreter should discuss
the following areas to insure that the student will receive the most benefit from the services
provided:
 Meet to discuss up-coming lessons and areas in which the child might struggle
 Provide the interpreter with lesson plans
 Keep each other informed of the student’s progress
 Discuss how the student will be disciplined and who is responsible for the discipline
 Address the student directly, not the interpreter
 Determine where the interpreter will sit or stand and the interactions he/she will have
with the class
 Determine how the interpreter will let the teacher know if the student does not
understand the material
 Discuss the interpreter’s role in group discussions
The teacher and the interpreter can assure student success in the classroom through constant
communication and monitoring of the student’s progress (Easterbrooks, 1998; National Deaf
Children’s Society [NDCS], 2004; British Colombia Ministry of Education [BCME], 2001).
The use of a note-taker in the classroom provides the student with the freedom to follow the
lesson and receive visual cues from the teacher. A student who has a hearing impairment or is
deaf may have difficulty taking notes and listening at the same time; however, with the use of
a note-taker, the problem is eliminated. in order for note-taking to be successful, several

guidelines need to be followed:
 The note-taker turns in the notes to the teacher and the teacher reviews them for
accuracy
 The note-taker should be trained in note-taking skills
 The note-taker should have knowledge of the subject.
At the secondary level, a student with good note-taking skills might be asked to write notes on
impress carbon paper. At the end of class, the student with the hearing loss can receive these
notes without delay. By following the above guidelines, the student should benefit from the
note-taker and gain full access the lesson visually without missing any information.
Communication
Non-verbal Communication
Body language, facial expressions, and gestures are all an essential part of daily conversation
that is often taken for granted. All three of these things can help relate how the speaker is
feeling to the listener. For many students who are hard of hearing or deaf, non-verbal
communication becomes critical. It provides extra support to help determine what has been
said. Teaching students the importance of non-verbal communication can help support their
confidence with spoken language. It is not only important to teach the uses of body language,
facial expressions, and gestures in the classroom, but to model them as well. Teachers should
use non-verbal communication techniques on a daily basis to help support subject
content. Pointing out and explaining non-verbal cues also allows students to expand this
awareness into social situations outside the classroom.
Speech Reading
Some students with hearing impairment use the strategy of speech reading to enhance their
understanding of oral language. This involves not only looking at the lip movement as a person
speaks, but also at the facial expressions in order to determine the meaning of what is being
said. In order to encourage speech reading, the teacher needs to face the student when
talking. When the teacher’s back is turned, the student is forced to rely solely on what he/she
hears to gain information. By facing the student, the teacher is providing the student with an
extra assurance that he/she has understood the information correctly (Naussbaum, 2003). If
the teacher needs to write any information on the board or overhead projector, it is important
to do so before discussing the material (NDCS, 2004). This way, the students are not denied
the chance to speech read while the teacher is writing down the important information. It is
also important for the teacher to teach the other students to face each other when talking. In
order to avoid singling out the student who is deaf or hard of hearing, the teacher can explain
that it is common courtesy to face others when speaking to them, (The Ear Foundation,
1991). By doing this, the student with hearing impairment may feel more comfortable within
the classroom and may be more willing to interact with peers.
Lighting plays an important role in the classroom. Many classrooms have florescent lights and
windows that can cause shadows throughout the classroom. These lights can also cause a glare
for people who are looking towards them. When a teacher stands with his/her back to a
window, the students facing the teacher may see a glare (The Ear Foundation, 1991). Many
students may look away from the teacher and concentrate solely on what the teacher is
saying. For a student that relies heavily on speech reading, the backlighting causes them to
rely mostly on auditory information, as he/she cannot see the speaker. In order to keep this
from happening, the teacher must be aware of the lighting throughout the classroom. It might
be easier to keep the blinds on the windows shut in order to eliminate one cause of glare and
shadows. It is important for the teacher to watch the students within the classroom for cues as
to whether or not there is a glare. If many students are looking away, squinting, or using their
hand to block off part of the light, chances are there is a glare on the speaker. When a teacher
spots these signals, he/she should move to another area of the room and then continue talking
(Naussbaum, 2003; The Ear Foundation, 1991; Tacchi, 2005).
The teacher’s placement within the classroom also plays a major role in a student’s ability to
speech read. The teacher needs to remember to stay in the same area or spot as much as
possible. If the teacher is constantly walking around the classroom or pacing, the student who
is speech reading will be forced to follow the speaker with his/her eyes as well as try to
understand what is being said (NDCS, 2004).
When some people meet a person who is deaf or hard of hearing, they try to speak louder and
slower. As a teacher, it is important to remember to speak as naturally and clearly as
possible. The students are used to listening to daily conversations that are spoken at a normal
rate. For this reason, and to allow for easier speech reading, speaking with too loud or soft a
volume, or more quickly or slowly than normal speech can cause difficulty in comprehension
of what has been said. People may think that by speaking slower they are allowing the person
who is hard of hearing or deaf more time to comprehend what has been said, but in fact, they
are making it harder to speech read, as the movements of the face are different from when a
person is speaking naturally. It is not only important for the teacher to speak naturally, but to
ensure that the student's peers do as well (Naussbaum, 2003; Tacchi, 2005).
Speech reading is easiest when standing between three and six feet away from the person to
whom you are speaking. A teacher with a child who relies heavily on speech reading should
always keep this in mind. If you are too close, the student might have a hard time seeing your
entire face as well as watching your body language. If you are too far away, the student will
have to try harder to see your face clearly enough to speech read (The Ear Foundation, 1991).
Before beginning discussions, lecturing, giving directions, or any activity that requires
listening, it is important for the teacher to gain students' attention and focus on the speaker. It
will also provide them with a chance to refocus their attention before any critical information
has been given, therefore allowing them the chance to sure to identify the speaker whenever a
new person begins talking. This means that the teacher must identify the new speaker by name,
including when students are asking or answering questions during discussions. This will allow
all students the chance to give the new speaker undivided attention (NDCS, 2004).
Insisting on the rule of one speaker at a time is essential, so that a child who is wearing a
hearing aid will hear everything and avoid difficulties distinguishing among the noises within
the classroom. By insisting on the rule of one speaker at a time, the teacher is allowing a
student the chance to focus solely on the person speaking and not on tuning out background
noise (Peake, 2005).
Sign Language
Before a child can begin to read, it is critical to be fluent in the language. To promote fluency,
students should be immersed in the language and be able to comprehend what is said to them
on a daily basis. A child must be able to interact and converse with peers and others. For some
children with hearing impairment, this may mean teaching a visual language (sign language)
(French, 1999). When a teacher has a student who relies on sign language as the primary mode
of communication, it will be important for the teacher to learn a few basic signs. One way to
go about learning basic sign language would be to ask the interpreter who is helping the student
or ask the student personally. If the student is comfortable, he/she might be willing to teach
classmates some signs as well. The use of signing in the classroom, can make the student feel
more comfortable and at home while at school (Tacchi, 2005). Teaching all students in the
class as many signs as possible on an ongoing basis also creates a respect by hearing students
for sign language as a method of communication.
Vocabulary
Students have difficulty when they encounter new vocabulary within the classroom. When
teaching lessons where the new vocabulary words are essential to the content of the lesson, the
teacher should provide a vocabulary list to the student ahead of time. This will allow the
student to learn the vocabulary prior to the class and help with the use of speech reading. The
vocabulary can also be placed throughout the classroom with picture cues for the students as a
reminder of the definitions and the context in which the words will be used. The teacher should
also write the vocabulary on the board as it is discussed in the lesson for the students to use as
a reference (NDCS, 2004). Wherever possible, the sign for the vocabulary word should
accompany the picture cue. This will enable all students to learn both simultaneously.
For appropriate assessment, students with hearing impairments may require adapted tests or
testing environments. Oral directions prior to the test may be difficult for the student to follow;
therefore, some modifications may be necessary for the student to understand the instructions
for the activity. Beech (1999) noted that some accommodations that might be necessary
include:
 Extended time for testing

 Converting oral examinations to written examinations
 Change in location of test due to noise distractions
 Written instructions instead of oral instructions for completing the test
 Providing picture cues of directions (such as a stop sign or arrows)
 Underlining or highlighting important words in the instructions
 After the test, the teacher may want to discuss any problems the student encountered
and how he/she felt about them, with suggestions for improvement of the testing
process in the future.
Teachers should not find it necessary to write new tests for students with hearing
impairments. Rather these accommodations can help the student be successful when taking a
test in the classroom.
Activities
Social Interaction
 Correct Cartoon Behavior

Help students identify the proper actions in all types of settings.
 Respecting Others' Space

This activity serves to help them realize that there are certain touches that are okay
while others may be inappropriate or cause discomfort
 Talking with Peers

This activity serves to help students find interests that they have themselves that may
also be in common with their peers.
 We Are All Different

This activity presents many students with differences and asks students to identify
areas of common interest that would allow the students to find out more about a
student without being rued or insensitive.
 Real Friends
A reality of life for students is that many of them often have trouble making true
friends. They are often so eager to have any form of companionship that they allow
their peers to lead them into situations that are not good for them, or they allow
"friends" to take advantage of them.
 That's Too Personal

Help students recognize which comments are friendly and which ones are too
personal.
 Ice Breakers
Game to introduce students to social language and conversational skills
 The Circle of Communication
The teacher should explain to students that communication is not simply telling
someone to do something.
 Telephone
This activity stresses the importance of clear communication to the whole class.
Students who are hard of hearing who participate in this must have the use of a
hearing aid.
 Different Cultures
Throughout the school year there are different months and days to celebrate the
different cultures that make up the students in the school. Deaf and hard of hearing
students also have a culture that is like other cultures in that it has different styles of
communication and assumptions that go along with it.
Language Development and Academics
Reading Comprehension
 Word File Cards

 Show and Tell
 Language Experiences / Experience Stories
 Word Rings
 Play

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DEPARTMENT OF SPECIAL NEEDS AND INCLUSIVE EDUCATION.

COURSE NAME:-EDUCATION OF PERSON WITH HEARING IMPAIRMENT

OVERVIEWS AND TERMINOLOGY OF HEARING IMPAIRMENT

Introduction and definition: Understanding Hearing Impairment

i. The congenially deaf (people that become deaf from birth)

CAUSES OF HEARING IMPAIRMENT

Surprising Causes of Hearing Loss

 Reduce caffeine intake.

10. OTITIS MEDIA(inflammation of the middle ear):- A temporary, recurrent infection of

Noise-induced hearing loss (NIHL) caused by chronic exposure to recreational and

Age of Onset of Hearing Loss

Prevalence of hearing impairment

Anatomy and Physiology of Ear

The ear is divided into three major parts –

 The ear is the sense organ that enables us to hear

To hear sound, the ear has to do three basic things

1. Sound waves are received by the pinna from the environment.

Middle ear:-Includes the eardrum, ossicles or three tiny bones(hammer/malleus; anvil/incus;

1. Sound waves reach the eardrum.

Tympanic membrane (eardrum)

The Eustachian tube

1. The vibration of the sound waves causes the cilia to move.

The vestibular system

The Nature of Sound

How We Can Sound????

Sound waves are characterized by:

• Frequency (measured in cycles per second, cps, or hertz, Hz).

CHARACTERISTICS OF CHILDREN WITH HEARING IMPAIRMENT

Cognitive Development of Children with Hearing Loss

be accompanied by disabilities that require more complicated interventions. It can be difficult

Social and Personal Adjustment of Children with Hearing Loss

Social /Emotional development

Academic Development of Children with Hearing Losses

* It may have an impact on vocational choices.

Hearing impairment can impose basic limitations on an individual in terms of

 access to spoken language

Difficulty in accessing spoken language may appears to be an obvious result of hearing

Clear access to speech is contingent upon many variables, including:

 background noise being at a minimum

 Discussions and interactions between parents, teachers, other adults or peers

1. Type of hearing loss - part of the hearing mechanism that is affected

1. Conductive hearing impairment

2. Sensorineural hearing impairment

3. Central hearing impairment

4. Mixed hearing impairment.

Details of these are presented below:

 Fluid in the middle ear as a result of colds

 Exposure to excessively loud noise

 Damage to brainstem structures

Hearing impairment is a challenging condition as pointed out earlier, therefore a hearing

Classification of Hearing Loss based on Degree

25 to 40 dB Mild • With mild hearing impairment, the minimum sound that

40 to 70 dB Moderate • With moderate hearing impairment, the minimum

70 to 95 dB • With severe hearing impairment, the minimum sound

95 dB or more Profound • With profound hearing impairment, the minimum

• Most require full-time program special education program

Identification, assessment and intervention of hearing impairment

Possible Sign of a Hearing Impairment

Favoring one ear over another

Using a loud voice when speaking