Hearing Problem is considered to be the most prevalent

Congenital Abnormality in newborns and is more than

twice as prevalent as other conditions that are screened for

at birth (Finitzo & Crumley, 1999).

Hearing Loss is a common problem that often develops

by Repeated Exposure to Loud Noises.

According to a careful estimate, there are more than 10

Million (about 1 in 6) people in one or the other degree

of Hearing Problem.

To understand how and why Hearing Problem

happens, it will be worth mentioning to know How Ear

Works.

Ear is made up of three different sections:

The Outer Ear,

The Middle Ear, and

The Inner Ear.

These parts work together in Hearing and Processing

the Sounds. (Contd)

The Outer Ear, or Pinna (the part you can see), picks

up Sound Waves and the waves then travel through the

outer ear canal.

When the Sound Waves hit the Eardrum in the

Middle Ear, the Eardrum starts to Vibrate.

When the Eardrum vibrates, it moves Three Tiny

Bones in the Ear.

(Contd)

These bones are called the Hammer, Anvil,

and Stirrup. They help sound move along on its journey

into the Inner Ear.

Stirrup Bone is the Smallest Bone in the body which

is located inside the ear.

Stirrup Bone is only 0.25 to 0.33 cm long (0.10 to 0.13

in) and Weighs only 1.98 to 4.3 mg.

◦ (Contd)

The Vibration then travels to the Cochlea, which is filled

with Liquid, having Thousands of Tiny Hair on the

inner surface.

Inside the Ear, there are Two Types of Hair Cells:

The Outer Cells and the Inner Cells.

The sound vibrations make the Tiny Hair move. The Outer

Hair Cells take the Sound information, Amplify it (Make it

Louder), and Tune it.

(Contd)

The Inner Hair Cells send the Sound Information

to the Hearing Nerve,

The Hearing Nerve then sends it to the Brain,

allowing the person to Hear.

The level at which a normal person can barely

hear the tone is his/her Hearing Threshold

level.

Sound intensity is measured in dB HL (Decibels

Hearing Level), i.e. dB relative to the Quietest

Sounds that a Young Healthy Individual

ought to be able to hear.

The Hearing Thresholds (Measured in

Decibels) are recorded on a chart called an

Audiogram.

The Tones at different Pitches and Frequencies

are measured in "Hertz," which is a special term

for Cycles/Second.

Pitch is the quality that allows us to classify a sound as

relatively high or low. Pitch is determined by the

frequency of sound wave vibrations.

Hertz is a unit of frequency alternating current

Hertz (abbreviated Hz), 1 Hz is equivalent to 1

Cycle/Second.

It is named for Heinrich Rudolf Hertz, the first

person to provide conclusive proof of the existence of

Electromagnetic Waves.

Audiologists conduct clinical Audiogram Test

Tones between 250 and 8000 Hz are presented at

varying levels,

To determine a patient's Tone Detection Thresholds

(the Quietest Audible Sounds) in the left and right

ear.

Thresholds between 10 and 20 dB are considered in

the Normal Range

Sound Intensity is measured in decibels (dB HL).

The top line, at 0 decibels (dB HL), represents a very soft

sound, with each horizontal line below representing

successively Louder Sounds.

Frequency is measured in Hertz (Hz).

Just like a Piano's keyboard, the Frequencies are low on

the Left Side (125 or 250Hz), and then gradually climb

to Higher Frequencies on the Right Side (8000Hz).

Note: The Piano ranges actually go from 28 Hz to

4,000 Hz.

The most important frequencies for Speech fall into the

250-6000 Hz range.

Students with Hearing Disabilities face unique

challenges during the process of Learning.

In our Educational Settings, Common Teaching

Learning Process includes Lectures, Audio-Visual

Aids (AV Aids) Discussion groups and even One-

on-one Conversations.

All these are nothing less than a Struggle for those who

have any level of Hearing Difficulty.

Deafness,

Hearing Impairment,

Hearing Loss

Hard of Hearing

Residual Hearing, all refer to Partial or

Total inability to Hearing, Processing

and Interpreting sounds.

Deafness

Deafness refers to a level of hearing loss severe enough

that the individual is limited in his/her hearing ability to

process Acoustical Language, whether they are using

assistive listening devices or not.

Deafness refers to a person who has a profound hearing

loss and uses sign language

"Deafened" usually refers to a person who

becomes Deaf as an adult and, therefore, faces

different challenges than those of a person who

became deaf at birth or as a child.

In other words, it is an Acquired State of

Deafness

Hearing Impairment

Hearing Impairment denotes a degree of hearing loss

wherein the individual can Hear and Understand

verbal communication, but only with the help of an

Assistive Listening Device or Hearing Aid.

Hearing Impairment is a general term used to

describe any Deviation from Normal Hearing,

whether Permanent or Fluctuating, and ranging

from Mild Hearing Loss to Profound Deafness.

Hard of Hearing refers to a person with a Hearing

Loss who relies on Residual Hearing to communicate

through Speaking and Lip-Reading.

Many individuals who are deaf or Hard of Hearing

prefer the term “Hard of Hearing," because they

consider them to be more positive than the term

“Hearing Impaired," which shows that something is

wrong that makes a person Less than Whole.

Residual Hearing refers to the hearing that remains

after a person has experienced a Hearing Loss.

Basically, Residual Hearing is the ability to hear some

sounds even if a hearing loss exists.

Most people with Significant Hearing Loss still have

some Residual Hearing that can be stimulated by

Amplifying sound using a Hearing Aid.

1. Conductive Loss

Conductive Loss affects the Sound-Conducting

Paths of the Outer and Middle ear.

People with Conductive Loss might speak softly, and

might experience Ringing in their ears.

The degree of loss can be decreased through the use of a

Hearing Aid or by Surgery.

(Contd)

2. Sensorineural Loss

It affects the Inner Ear and the Auditory Nerve and

can range from Mild to Profound Degree.

People with Sensorineural Loss might Speak

Loudly, experience Difficulty in Distinguishing

difference among the words having Similar Sounds,

and not hear well in Noisy Environment.

(Contd)

3. Mixed Hearing Loss.

Mixed Hearing Loss is a combination of a Sensorineural

and Conductive Hearing Loss.

It results from problems in both the Inner and Outerand/or Middle Ear.

In other words, there may be damage in the Outer or

Middle Ear and/or in the Inner Ear (Cochlea) or

auditory nerve.

This type of Hearing loss is referred to as a Mixed Hearing

Loss.

In a Developing Child, Hearing Loss might reflect in

the behaviour which may look like:

Misbehaving

Not following directions

Immature Social Skills (Awkward Activities)

Unclear Speech Production (Articulation Issues)

Inattention

Distractibility

(Contd)

Used to Play Alone at an age when other children

actively Play Together

Limited Vocabulary

Lack of Understanding of Idioms, Figurative

Language, Humour

Lack of Readiness to Read

Behaviour of Passivity (Never speaks up or takes a

Leadership Role with peers)

Hearing Loss at Birth (Congenital Hearing Loss)

Hearing Loss After Birth (Acquired Hearing Loss)

Ear Infections (Otitis Media; Inflammation of the

Middle Ear characterized by the accumulation of

infected fluid in the middle ear, pain in the ear.)

Noise

Medications

Hearing Loss from Birth

Most congenital hearing loss can be identified within 1-2 days of birth via hospital hearing screening.

In the US, almost all babies have their hearing screened within a day of being born.

Approximately 1 0ut of 10 newborns who fail hearing screening end up being diagnosed with hearing loss.

Newborns who spend time in a neonatal intensive care unit (NICU) have a greater chance of being identified with a hearing loss than those children with no birth complications.

Ear infections or Fluid behind the Eardrum is the

biggest cause of hearing loss in young children.

During Preschool Hearing Screening, it is

important to identify the children who have a history of

Ear Infections, Hearing Loss in the family or

Whose family members have been concerned about the

Child’s Hearing.

While Hearing Loss Type is important the affect on a

patient’s life is often determined by the Degree of

Hearing Loss.

In past, Audiologists used to define Hearing Loss

through a Percentage i.e. 20% loss, 50% loss etc.

However, as Hearing Losses are not Flat and the

degree of loss may vary at different pitches. It has

become widely accepted practice to describe the hearing

loss based on a Classification System.

◦ (Contd)

Mild Hearing Loss: Speech may be heard in Quiet, but

becomes difficult to understand when there is

Background Noise in the environment or when Speech

is at a Distance.

Moderate Hearing Loss: Speech can be heard at a

normal level only in Quiet and in Very close Proximity.

(Contd)

Moderately- Severe Hearing Loss: Even in a quiet

environment speech must be loud in order to be heard,

understanding may be impaired even with this louder

signal.

Severe Hearing Loss: Speech is very difficult to

understand in all situations.

Profound Hearing Loss: Communication can be very

difficulty even with hearing aids.

The prevalence of Early-onset Hearing Loss in most

Developed Countries is estimated to range between

2-4 infants with Moderate-Severe Hearing Loss in

every 1000 births.

In contrast, only Limited Information is available

about Developing Regions, including the Middle East

especially in the Arab countries, where the prevalence

is estimated to be markedly higher (Attias et al., 2006).

(Contd)

In Developing Countries, More than 10 infants in

every 1000 Births are estimated to be affected by a

Severe Profound Hearing Loss.

Of the 62 Million Deaf children younger than 15

Years old Worldwide, Two-Third are in the

Developing Countries (Smith, 2003).

The negative impact of Hearing Loss on Older

Adults is significant (LaForge et al., 1992).

Hearing Loss is associated with Depression,

Social Isolation, Poor Self-esteem, and

Functional Disability (Mulrow et al., 1990a),

It is well recognized that Hearing is critical to Speech,

Language Development, Communication, and

Learning.

The Earlier Hearing Loss occurs in a child's life, the More

Serious Effects on the Child's Development.

Similarly, the Earlier the problem is Identified and

intervention begun, the Less Serious is the Ultimate

Impact on Child Development.

There are Three main aspects in which Hearing Lossaffects children:

1. It causes Delay in the development of Receptive and

Expressive Communication skills (Speech and

Language).

2. The language deficit causes Learning Problems that

result in Reduced Academic Achievement.

3. Communication difficulties often lead to Social

Isolation and Poor Self-concept.

1. Vocabulary

Vocabulary develops More Slowly in children confronted

with Hearing Loss.

Children with Hearing Loss learn Concrete Words

like cat, jump, five, and red more easily than abstract

words like before, after, equal to, and jealous.

They also have difficulty with function words like the, an,

are, and a.

(Contd)

(Vocabulary Contd)

Children with Hearing Loss have difficulty in

understanding Words with Multiple

Meanings.

For example, the word “Bank” can mean the

Edge of a river or stream OR a place where We

Take and Put Money.

(Contd)

2. Sentence Structure

Children with Hearing Loss normally produce Shorter

and Simpler Sentences than children with Normal

Hearing.

Children with Hearing Loss often have Difficulty in

Understanding and Writing Complex Sentences,

such as "The teacher whom I have engaged for math was

sick today.” or passive voice "The ball was thrown into the

water by Ahmad."

(Contd)

(Sentence Structure Continued)

Children with Hearing Loss often cannot Hear word

endings such as s or ed.

This leads to Misunderstandings and Misuse of

Tense, Pluralization, Nonagreement of Subject

and Verb.

(Contd)

3. SPEAKING

Children with hearing loss often cannot hear quiet

speech sounds such as "s," "sh," "f," "t," and "k"

and therefore they do not include them in their

speech.

Thus, their speech is always Difficult to

Understand.

(Contd)

(SPEAKING Continued)

Children with Hearing Loss may not Hear Their

Own Voices when they speak.

They may Speak Too Loudly.

They may have a Speaking Pitch Too High.

4. Academic Achievement

Children with Hearing Loss have difficulty with all

areas of Academic Achievement, especially Reading

and Mathematical Concepts.

Children with Mild to Moderate Hearing Losses,

on average, Achieve Grade Levels Lower than their

Peers with Normal Hearing, unless appropriate

management is followed.

(Contd)

(Academic Achievement Continued)

The gap in Academic Achievement between children

with Normal Hearing and those with Hearing Loss

usually Widens with the Passage of Time as they

progress through school.

The level of Achievement is related to Parental

Involvement and the Quantity, Quality, and Timing

of the Support Services provided to the children.

(Contd)

5. Social Functioning

Children with Severe to Profound Hearing Loss

often report Feeling Isolated, Without Friends,

and Unhappy in School, particularly when their

Interaction with other children with Hearing

Loss is Limited.

These social problems appear are frequent in children

with a Mild or Moderate Hearing Loss than in

those with Severe to Profound Loss.

Tinnitus refers to “Ringing in the

Ears" when no other sound is present.

Tinnitus can sound like Hissing,

Roaring, Pulsing, Chirping,

Whistling, or Clicking.

Tinnitus can occur in one Ear or

Both Ears.

Yes.

Almost Everyone at one time or another has

experienced Brief Periods of Mild Ringing or other

sounds in the ear.

Some people have more Annoying and Constant

Type of Tinnitus.

One Third of all adults Experience Tinnitus at some

time in their lives.

(Contd)

About 10%–15% of adults have Prolonged

Tinnitus requiring Medical examination.

The Exact Cause of Tinnitus is often Not

Known.

One thing is Certain; Tinnitus is Not

Imaginary.

(Contd)

No.

Just as Fever or Headache

accompanies many different Illnesses,

Tinnitus is a Symptom, Common to

Many Problems.

If you have Tinnitus, chances are the

Cause will Remain a Mystery.

Conditions that might cause Tinnitus include:

Hearing Loss

Loud Noise exposure

Migraine Headaches

Head Injury

Medicines that are Toxic to hearing

Anemia (Deficiency of the RBCs or Hemoglobin in the

blood, resulting in Paleness and Weariness).

(Contd)

Hypertension

Stress

Too much Wax in the Ear

Certain Types of Tumors

Too Much Use of Coffee

Chain Smoking

During the day, the daily activities and the sounds

around you make your Tinnitus Less Noticeable.

When your Surroundings are Quiet, your Tinnitus

can seem Louder and More Bothersome.

Fatigue and Stress may also make your Tinnitus

Worse.

Tinnitus is a Symptom of a Problem.

The first thing is to find out its Underlying Cause.

Medical Examination with special attention given to

Conditions Associated with Tinnitus.

Full Hearing Evaluation by an Audiologist is

always right step to see if Hearing Loss may be

Causing Tinnitus.

The most Effective Treatment for Tinnitus is to

eliminate the Underlying Cause.

Tinnitus, in some cases, can be a Symptom of a

treatable Medical Condition.

However, in many cases, the cause of tinnitus cannot

be identified, or Medical or Surgical Treatment is

not an option.

In these cases, the Tinnitus can still be managed using

a variety of other methods.

(Contd)

Physical Examination:

Physical Examination will focus on the Head and Neck,

and especially the Ears, including the Auditory Canals.

A careful Neurologic Examination of the short Nerves

that lead directly from the Brain to the Face, Head and

Neck is needed.

Weakness or Numbness in the Face, Mouth, and Neck

may be associated with a Tumor or other Structural

Abnormality Pressing on a Nerve.