Deaf with Access to Sound/Hard of Hearing

Key Terms

deaf – a loss of hearing so severe that the student is “impaired in processing linguistic information through hearing, with or without amplification (e.g. Hearing Aids) that adversely affects the child’s educational performance. (McLeskey, Rosenberg & Westling, 2010, p. 176)

Deaf – In this capitalized form, the word "Deaf" generally implies that the person doesn't hear well enough to understand speech from their hearing, alone, but it also means that they consider themselves part of the "Deaf Community".
People in the "Deaf Community" typically use sign language. In the US, they use American Sign Language (ASL), but in other countries, just like spoken languages, sign language varies greatly. Not everyone who is deaf, considers themselves "Deaf". It's a personal decision. (http://www.nchearingloss.org/gloss.htm)

American Sign Lang. – (ASL) uses hand shapes, positions, movements, facial expressions, and body movements to convey meaning. ASL uses an alphabet (finger spelling), sign representing ideas, and gestures. ASL is an independent language that has its own grammar and syntax; it is not simply a manual version of English. (http://www.nchearingloss.org/asl.htm)

Cued Speech – Cued Speech is a system of hand shapes and movements that can be used to supplement spoken sounds so that people with severe hearing loss can still understand what is being said. (http://www.nchearingloss.org/gloss.htm)

Audiologist – An audiologist is a trained professional who measures hearing loss and can fit hearing aids. (http://www.nchearingloss.org/gloss.htm)

Audiogram – An audiogram is a means of recording the results of a hearing test. It will include a table and a graph for each ear showing how well you could hear sounds at various frequencies. (http://www.nchearingloss.org/gloss.htm)

Cochlear Implants - Also known as an implantable hearing aid. This device is implanted surgically through the cochlea, bypassing the failing hair cells and directly connecting to the auditory nerve. This gives the severe to profound loss enough amplification in order to use spoken English as a primary means of communication for many users if therapy post activation is implemented.

Ainsley, age 2, hearing age, 1 year.

"http://www.youtube.com/v/6sV9o7SdrRk?version=3

Ainsley, age 4, "reading" to her sister.

http://www.youtube.com/v/ks07238usk0?fs=1&hl=en_US


Hearing Aids – A hearing aid is anything that helps you hear better. (http://www.nchearingloss.org/gloss.htm)
They consist of three main parts:
1. Microphone
2. Amplifier
3. Speaker

FM System - An amplification system that can be tied directly to a hearing aid or cochlear implant in order to give direct sound to the individual with hearing loss. Can also be provided as a speaker or sound field in the room to amplify the speakers voice.

Characteristics Associated with the Exceptionality

1. The severity of the hearing loss. When given an Audiogram, the students hearing level will be recorded in decibel levels. Below is an explanation on the range of decibel levels and an explanation of the severity of hearing loss.

Normal hearing range 0-15 dB HL
Minimal loss range 16-25 dB HL
Mild loss range 26-40 dB HL
Moderate loss range 41-55 dB HL
Moderately severe loss range 56-70 dB HL
Severe loss range 71-90 dB HL
Profound loss range 91 dB HL or greater
(http://clerccenter.gallaudet.edu/)

2. The type of hearing loss or where the loss occurs in the auditory system.

Sensorineural Hearing Loss – This type of hearing loss occurs when the hair cells in the inner ear fail to work correctly, prohibiting sound to travel to the auditory nerve and then to the brain for processing. This type of hearing loss is permanent. Onset can occur during pregnancy or later in life.

Often with Sensorineural hearing loss, the loss is permanent and depending on the extent of the damage to the cochlea (inner ear) will depend on the extent of the hearing loss.
http://clerccenter.gallaudet.edu/

Conductive Hearing Loss – Conductive hearing loss is caused by a problem in the outer or middle ear. Sound is ineffectively "conducted" to the hair cells in the inner ear that are responsible for sensing sound. In a purely conductive hearing loss, the actual hair cells/nerves of hearing are intact and ready to accept incoming sounds. Sound, however, does not adequately reach these hair cells/nerves. Sounds therefore are heard at a reduced level. The degree of loss depends on what is causing the problematic sound conduction.
Often with Conductive Hearing Loss the loss can be treated through medical procedures (e.g. Tubes inserted to reduce fluid in the ear canal and/or ear infections). The hearing may be temporary.
(http://www.asha.org)



Prevalence

In children – About 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf and about another 2-3 out of 1,000 babies born with some sort of hearing loss. (Facts on Hearing Loss, 2005 - 2010)




In children – About 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf and about another 2-3 out of 1,000 babies born with some sort of hearing loss.
(Facts on Hearing Loss, 2005 - 2010)

Types
Sensorineural Hearing Loss – This type of hearing loss occurs when the hair cells in the inner ear fail to work correctly, prohibiting sound to travel to the auditory nerve and then to the brain for processing. This type of hearing loss is permanent. Onset can occur during pregnancy or later in life.

Conductive Hearing Loss – Conductive hearing loss is caused by a problem in the outer or middle ear. Sound is ineffectively "conducted" to the hair cells in the inner ear that are responsible for sensing sound. In a purely conductive hearing loss, the actual hair cells/nerves of hearing are intact and ready to accept incoming sounds. Sound, however, does not adequately reach these hair cells/nerves. Sounds therefore are heard at a reduced level. The degree of loss depends on what is causing the problematic sound conduction.
Mixed Hearing Loss – This is a combination of factors, both Conductive and Sensorineural, that lead to hearing loss.
(http://clerccenter.gallaudet.edu/)

Causes
1. Sensorineural Hearing Loss – Some causes included:

Onset before or during birth:
• Maternal infections such as rubella, herpes, toxoplasmosis, syphilis, cytomegalovirus (CMV)
• Heredity (genetics)
• Asphyxia or lack of oxygen at birth
• Possible association with birth weight of less than 1,500 grams
• Possible association with defects of the head and neck
• Possible association with maternal drug or alcohol abuse

Later onset (can occur any time after birth):
• Bacterial meningitis
• Ototoxicity (drug induced)
• Intense or excessive noise
• Physical trauma to the head or ear
• Aging (the most common cause in older adults)
(http://clerccenter.gallaudet.edu/)


2. Conductive Hearing Loss –
• Conditions associated with middle ear pathology such as fluid in the middle ear from colds, allergies (serous otitis media), poor eustachian tube function, ear infection (otitis media), perforated eardrum, benign tumors
• Impacted earwax (cerumen)
• Infection in the ear canal (external otitis)
• Presence of a foreign body
• Absence or malformation of the outer ear, ear canal, or middle ear
(http://www.asha.org)

Identification

Most States have adopted a ‘New Born Hearing’ screening that is able to detect at birth the hearing ability of the infant. If there is a cause for concern a follow-up ABR is suggested.

The Joint Committee on Infant Hearing7 and U.S. Public Health Service’s Healthy People
2010 health objectives8 recommend that all newborns be screened for hearing loss by 1
month of age, have diagnostic follow-up by 3 months, and receive appropriate intervention
services by 6 months of age.

(Facts on Hearing Loss, 2005 - 2010)

As the child grows and hearing loss is suspected at a later onset, other hearing tests/screenings may be required.

• OAE: The OAE screen (Otoacoustic Emission)
• ABR: The ABR screen (Audiotory Brainstem Response)
• Booth test
(http://www.asha.org)

Instructional Strategies and Tips
• Always face the class when presenting information.
• Provide written instructions as well as verbal.
• May use some signs or cues to help with articulation and comprehension.
• Preferred seating.
• Use of an FM system to amplify sound.
• Reduce incidental noise.
(McLeskey, et all, 2010, p. 176)


• Understanding that the visual is a large component of how deaf children interpret information.
• Clarify multiple meanings of terms or idioms that are unique to spoken English.
• Provide active, hands-on learning experiences.
• Long term and short term memory access is not the same as a hearing peer, make accommodations.
• Acquiring reading ability is difficult, may need to provide lower level readers, same content.
• Attending to 2 different types of communication is difficult, allow for extra processing time.
(Marschark, et all, 2002)


Key Resources
• Deafresources.com
• Hearing Loss Association of America
• Alexander Graham Bell Association
• National Association for the Deaf
• Laurent Clerc National Deaf Education Center Information on Deafness
• American Speech and Language Hearing Association
http://raisingdeafkids.org


References
1. Marschark, Marc, Lang, Harry G., & Albertini, John A. (Eds). (2002). Educating Deaf Students, From Research to Practice. New York, NY: Oxford University Press.
2. McLeskey, James, Rosenberg, Michael S., & Westling, David L. (Eds). (2010). Inclusion, Effective Practices for All Students. Upper Saddle River, NJ: Pearson Education.
3. American Sign Language (ASL) (n.d.) in Hearing Loss Association of North Carolina. Retrieved from http://www.nchearingloss.org/asl.htm
4. Gallaudet University. (1995 – 2009). Info to Go. Retrieved from http://clerccenter.gallaudet.edu/
5. American Speech – Language – Hearing Association. (1997 – 2010). Type, degree and Configuration of Hearing Loss. Retrieved from http://www.asha.org
6. Hearing Loss Association of North Carolina. (2003). HoH Glossary and Acronyms. Retrieved from http://www.nchearingloss.org/gloss.htm
7. Hearing Loss Association of America. (2005 – 2010). Facts on Hearing Loss. Retrieved from http://www.hearingloss.org/