By: Pam George

How will I communicate with this student? Do I need to learn sign language?

Can he/she hear me when I am teaching a lesson?

Who is the hearing support teacher and what does that person do?

Who is the interpreter and what does that individual do?

What is this chart with X’s and O’s on it? What does a hearing loss sound like?

Resource for information regarding hearing loss In-service staff in school building about hearing loss

Ensuring student success rates in mainstream setting Addressing any and all concerns classroom teacher

may have Troubleshooting equipment “Hub” of IEP team

On-going communication between team members Caseload manager

Familiarizing teachers with specially designed instruction and student needs Modifications to tests, assignments, etc.

Outer Ear (Pinna)The part of the ear you see every day.Made of cartilage and skin.

Ear Canal (External Auditory Meatus)You find ear wax in this part of the ear.

Purpose of the Outer EarAmplifies soundAssists in localization of sound, especially

elevation and front and back

Tympanic Membrane (Eardrum) Thin layer of skin stretched tightly to allow

vibration of sound Ossicles

Malleus, Incus, Stapes- the smallest bones in the body!

Eustachian Tube Runs from the middle ear to the back of the

throat Purpose of the Middle Ear

Serves as a bridge from the outer ear to the inner ear

Cochlea The hearing portion of the ear filled with fluid Shaped like a snail Has tiny hairs that move to create impulses that

are sent to the brain Beyond the cochlea

The VIII Nerve Carries impulses from cochlea to brainstem

The Brainstem Serves as a relay station

The Brain Receives signals from the brainstem and interprets

the signals in terms of their sound content

Four types of hearing loss:Conductive

Caused by injury, obstruction, or disease of the outer or middle ear that prevents the ear from conducting sound.Fluid in the middle ear, wax build-up, absence or

malformation of the outer ear, ear infectionsThe loss CAN be medically or surgically corrected

Sensorineural Damage to the sensory hair cells of the inner ear or

the auditory nerve that leads to the brainEffects the way one hears clearly and how one

understands speech correctlyThe loss is permanent and CANNOT be corrected

Mixed A combination of conductive and sensorineural

lossesPart of the damage is in the outer ear or

middle ear and the other part is in the inner ear.

Central The outer, middle, and inner ear are intact. The impairment is to the VIII nerve or brain.

Degree of Hearing Loss

Hearing Loss Range(db HL)

Normal -10 to 15Slight 16 to 25Mild 26 to 40Moderate 41 to 55Moderately Severe 56 to 70Severe 71 to 90Profound 91+

Decibel: the unit measurement of intensity, or loudness, of sound

MILD (26 to 40 dB)Difficulty understanding faint or distant speechMay need work to develop vocabularyFavorable seating and lighting in classroom

MODERATE (41-55 dB)Understands speaker face to face or a short

distanceMay miss as much as 50% of class discussionMay need vocabulary development, speech

therapy, or special class placement in primary grades

MODERATELY SEVERE (56-70 dB)Conversation must be loud to be heardWill need a hearing aid and training with its useIs likely to have problems pronouncing sounds,

have language delays, and limited vocabularyWill need extra help in Language Arts, speech

therapy SEVERE (71-90 dB)

May hear loud voices or sounds very close to earSpeech and language development are delayed.Will need extra help with language skills, concept

development, speech, intensive communication building skills should be taught

May be a candidate for cochlear implant(s)

PROFOUND (91+ dB)May be a candidate for cochlear implant(s)Socializing with hearing peers may be

difficultMay have language delays, very limited

vocabulary, intensive speech therapyNote-taking, captioning, and other visual

enhancement strategies are necessary

http://www.audibel.com/understanding/simulator_flash.html

Gives us volumes of information about what a student can and cannot hear.

It is conducted by an audiologist in a sound-proof booth

Child wears headphones and listens for tones, or beeps, and gives a conditioned response Raising handPlacing toys into bins

Red: Right Ear

Blue: Left Ear

Low

Soft

High

Loud

Does this student have a hearing loss? Take a look at the DEGREE of hearing loss chart and

compare…

Approximately 28 million Americans have a hearing impairment. Hearing loss affects approximately 17 in 1,000 children under age 18.

Incidence increases with age: Approximately 314 in 1,000 people over age 65 have hearing loss and 40 to 50 percent of people 75 and older have a hearing loss.

About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. 9 out of every 10 children who are born deaf are born to parents who can hear.

Everyday in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with another 2-3 out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America

o Only 1 out of 5 people who could benefit from a hearing aid actually wears one.

Three out of 4 children experience ear infection (otitis media) by the time they are 3 years old.

There are approximately 22 million hearing-impaired persons in the U.S. Deaf people have safer driving records than hearing people nationally. The huddle formation used by football teams originated at Gallaudet

University, a liberal arts college for deaf people in Washington, DC, to prevent other schools from reading their sign language.

Misconceptions: All students use residual hearing the same way. Examples:

A student with a PROFOUND hearing loss may use speech only and is a good lip reader and another student with a PROFOUND loss may use sign language with no speech and does not lip read.

When I talk, the student looks like she’s heard me and understands what I’ve said. If you hear a person speaking Japanese, you HEARD it,

but did you UNDERSTAND it?

Hearing aids and cochlear implants cure hearing loss. Yelling at a deaf person will help him/her understand you better. All deaf and hard of hearing students use sign language. Politically correct: Deaf and Hard of Hearing

Amplification allows a better chance of understanding speech

Help a child access residual hearing and learn how to use this hearing in the most optimal way

Let’s take a look at different listening devices and assistive technology…

How they work:All have a…

Microphone: receives sound/signal Amplifying circuit: shapes the sound to make

it louder Receiver: changes the signal back into sound

that can be heard Earmold: the colored ear piece in the ear canal

Are powered by batteries Internal controls are set by an audiologistExternal controls are set by the user

(volume)

Most common among children Can attach to assistive listening devices

(FM) Microphone is on the back part behind

the ear May hear “squealing” from the aid

This is called FEEDBACKDue to the closeness of the microphone to

the receiver, there is “feedback” or squealing when the earmold is loose or too small

Each group has a hearing aid, stethoscope, battery tester, and a battery

1st: Check the battery in the tester 2nd: Put into the hearing aid 3rd: Put canal part of earmold into the

stethoscope hose 4th: Turn on hearing aid 5th: Ling Six Sound Test

Say: /ah/, /ee/, /oo/, /s/, /sh/, /m/How did it sound?????

In the Ear (ITE)

In the Canal (ITC)

These types of hearing aids are rarely used with children.

Surgically implanted device Offers severe-to-profoundly deaf children

access to sound Bypasses the damaged part of the inner

ear, stimulates nerve, sends information directly to brain

Three parts:Receiver- the part that is implantedTransmitter- head piece (circular piece)Speech Processor- worn on the body, shapes

sound

Sound waves enter the microphone located in the headpiece

Sound is sent through the transmitter and along the wire to the speech processor

Speech processor changes the sound into a special signal that is sent to the implanted receiver

The receiver sends the signal to the brain where it is interpreted into sound

LET’S WATCH!!

How a cochlear implant works...

Cochlear Implant Simulations

What is an FM?Frequency-Modulated system that allows a

D/HH student hear over a distance and sends the speaker’s voice directly to the hearing aid or cochlear implant

*Without an FM, the speaker’s voice can be difficult to understand when paired with everyday background noise (heaters, buzzing lights, pencil sharpeners, etc.)

An assistive listening device that’s microphone is worn 6 inches from the mouth

Improves the sound-to-noise ratio by reducing distance of sound source

Each personal FM system can be very different depending on the hearing aid type and its unique features

Campus S Easylink

Accessibility of the teacher’s voice to all students in the classroom

A microphone is worn around the neck Sound is sent from the microphone to

amplifier that is connected to loudspeakers

Carpeted box in all of the classrooms Has several benefits to both D/HH

students AND hearing students

Many children benefit from sound field systems:Children with hearing lossChildren with central auditory processing

disorderStudents with ADD and ADHDStudents with developmental delaysPreschoolers, kindergarteners, and first

graders who are in crucial learning stages of language development

ESL studentsStudents with dyslexia

•Several Different Modes:•Auditory/Oral•Auditory-Verbal•American Sign Language (ASL)•Cued Speech•Signed English or (SEE)•Total Communication•Rochester Method•Contact Signing•Manually Coded English (MCE)

There is no ONE PERFECT mode for every child. Each child’s hearing loss is unique and his/her communication mode should match that loss.

Responsibilities: Facilitate communication Sign everything that is voiced Will stand/sit close to teacher

Not responsible: Classroom management Tasks such as teaching, grading papers,

making copies Disciplining students (deaf and hearing)

Language delayed Spoken language

Not uncommon for students to speak with nasal or atonal quality

Academic performance Vocabulary development delays Reading and writing difficulty Difficulty in comprehension across academic subjects

Idioms and familiar English phrases interpreted literally Written and oral language will reflect the way he/she hears-Word endings –s,-ed, -ing Depends on age child was diagnosed with a hearing loss.

Many deaf children are not “vanilla deaf” Limited phonemic awareness

What does the student hear during everyday conversation? Look at the Speech Banana. Example: The fox saw two hens. Even with a mild loss, the student misses

most of those sounds. /e ok aw oo en/ Imagine reading and pronouncing these sounds that D/HH

students so rarely hear.

Message: Ann needed new shoes.Question: “Who needed new shoes?”Student’s response: “Ann nanna”

DID vs. DIG *A student who uses sign and speech to communicate reads a passage two times. The first time is with speech ONLY. He reads, “The boy walked to school. He did this everyday”. Then, when asked to SIGN the sentences, he signs The-boy-walk-to-school. He DIG this everyday.

Did he get it right? Is the message still the same? No way!

•Use visual aids whenever possible

•Use overhead instead of the board

•Have key vocabulary accessible visually

•Provide a note-taker or hand-out of notes

•Allow for breaks •Educate the class about hearing loss

•Eliminate or reduce extraneous noise

•Reduce the distance from you to student

•Face the student when speaking

•Appropriate use of equipment

•Advantageous seating for student

•Repeat questions and comments other students make

•Do not speak with back faced to class

•Point out who is speaking in class discussions

•Do not stand or sit in front of a bright window

•Write announcements and assignments on board

•Always use captioned films/videos

•Flicker lights to get classroom attention

•Avoid chewing gum while lecturing

•Lecture from the front of the room, avoid pacing

•Speak directly to the student, not the interpreter

What can be done to setup the deaf student for success?SEATING

“U” shaped desk arrangement Close to where teacher will be doing most of lecturing Facing away from the windows Students with cochlear implants should sit with C.I. side closest to speaker. At ear level to the sound field, if used, approximately 3-6 feet away Avoid seating the student next to noisy heaters and fans, buzzing lights,

computers/printers, projectors, pencil sharpeners, or classroom sink

ACOUSTICS Cover hard, smooth surfaces with sound-absorbing materials like

carpeting, felt, table cloths. When noise is present, the student will have difficulty understanding or

attending to discussion. Inappropriate acoustics can compromise understanding speech, behavior,

language experiences, concentration and academic achievement.

Modified curriculum Accessibility to communication via an educational

interpreter Clear desk prior to new assignment Establish eye contact prior to giving directions Management of noise level in classroom Increased wait time to allow for language processing Use of appropriate amplification (hearing aids, C.I.’s,

etc.) Modify assignments to meet language needs Preferential seating Frequent review of skills and concepts

•Exposure to loud noises over an extended period of time damages the hair cells in the ear.•These hair cells cannot grow back causing noise-induced hearing loss.•Examples of harmful loud noises:

•Motorcycles•Firecrackers•Explosions•Concerts•MP3 players at loud volume•Chainsaws•Jet Engines

•The length of time exposed to these noises will determine whether a person will acquire noise-induced hearing loss.

•What can be done to prevent it?•Limit exposure and time of exposure to loud harmful sounds

•Wear protective hearing devices or earplugs

American Speech-Language-Hearing Association. (2005). Acoustics in Educational Settings: Position Statement [Position Statement]. Available from www.asha.org/policy Bess F. The minimally hearing-impaired child. Ear and Hearing, 1985; 6:43-47 Centers for Disease Control and Prevention. National Center for Birth Defects and Developmental Disabilities, Early Hearing Detection and Intervention Program. http://www.cdc.gov/ncbddd/ehdi/default.htm. "Interesting Facts about the Deaf." DeafNet. 19 July 2008 <www.deaf.net>. http://kidshealth.org/parent/general/eyes/cochlear.html website Laughton, Joan. "Educating Children Who are Deaf or Hard of Hearing: Cochlear Implants." ERIC Clearinghouse on Disabilities

and Gifted Education Reston, VA. 15 Sep. 2008 <www.ericdigests.org/1998-2/implants.htm>. “Mainstreaming the Student Who is Deaf or Hard-of-Hearing.” Guidebook. Melanie Doyle, M.Ed., Linda Dye, M.A., CCC-A

Director of CCHAT Center, SanDiego. January 2002.       

National Association of the Deaf website. Community & Culture. <www.nad.org>

"Noise-Induced Hearing Loss." www.nidcd.nih.gov. 1 May 2007 <nidcd.nih.gov/health/hearing/noise.asp>.http://www.nidcd.nih.gov/health/hearing/coch.asp websiteImages:http://www.bcchildrens.ca/NR/rdonlyres/1E47B20B-D686-44BF-A811-

B4AE48E4DCB7/16095/BTE.jpg http://www.theitinerantconnection.com/images/hearing%20aid%20in%20ear.jpg http://mortonplant.com/images/In%20canal.jpg http://www.youtube.com/watch?v=SmNpP2fr57A http://www.phonak.com/de/professional/productsp/instrumentsp/digitalp/

products_instruments_digital_micropower.htm?activetab=31736 http://www.netac.rit.edu/gphx/tipsheets/cued.gif