Peripheral Hearing Loss In Children

Effects of Various Types of Peripheral Hearing Loss

 

As you read the attached, please keep in mind that “all children with hearing loss require periodic audiologic evaluation, rigorous amplification checks, regular monitoring of their access to instruction and the effectiveness of their communication skills. Children with hearing loss (especially conductive) need appropriate medical attention along with educational accommodations and services.

Individuals with Disabilities Education Act requires that “hearing aids worn by deaf and hard of hearing children in school are functioning properly.” A daily battery/listening check and an electroacoustic evaluation of hearing aid function by an audiologist two or more times per year is important.”

For Teachers:“All children require access to verbal instruction if they are to succeed in school . A child without effective access to teacher instruction will not receive an appropriate education. Distance, noise in classroom and fragmentation caused by hearing loss prevent access. Use of visuals, FM classroom amplification, visual communication systems, note-takers, communication partners, etc. provide access to instruction. Components of good classroom management for a child with hearing loss include: 1) Keep in close proximity to the child during instruction, 2) Call on students by name  during discussions and summarize important points, 3) Reduce noise sources, 4) Check student comprehension following directions, 5) Adapt/modify curriculum for student to experience success, 6) Utilize classroom amplification daily for all large group instruction, 7) Be aware of potential changes in hearing ability and report if suspected, 8) Facilitate socialization between the child and peers, 9) Keep lighting from windows on teacher’s face.”

 


Minimal Hearing Loss (16 – 25 dB)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Impact of hearing loss that is approximately 20 dB can be compared to ability to hear when index fingers are placed in your ears.  Child may have difficulty hearing faint or distant speech.  At 16 dB student can miss up to 10% of speech signal when teacher is at a distance greater than 3 feet.  A 20 dB or greater hearing loss in the better ear can result in absent, inconsistent or distorted parts of speech, especially word endings (s, ed) and un-emphasized words.  Percent of speech signal missed will be greater when there is background noise in the classroom, especially in the elementary grades where instruction is primarily verbal.  Young children have the tendency to watch and copy the movements of other students rather than attending to auditorily fragmented teacher directions.

Possible Psychosocial Impact of Hearing Loss

May be unaware of subtle conversational cues which could cause child to be viewed as inappropriate or awkward.  May miss portions of fast-paced peer interactions which could begin to have an impact on socialization and self concept.  May have immature behavior.  May be more fatigued due to extra effort needed for understanding speech.

Potential Educational Accommodations and Services

Due to noise in typical classroom environments which impede the child from having clear access to teacher instruction, will benefit from improved acoustic treatment of the classroom and any sound-field amplification.  Favorable seating necessary.  May often have difficulty with sound/letter associations and fine auditory discrimination skills necessary to learn phonics for reading.  May need attention to vocabulary or speech, especially when there has been a history of ear problems.  Appropriate medical management necessary for conductive losses.  Depending on loss configuration, may benefit from a low power hearing aid with personal FM system.  In-service on impact of so called “minimal” hearing losses on language development, listening in noise and learning, required for teacher.

 


Mild Hearing Loss (26 – 40 dB)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Impact of hearing loss that is approximately 20 dB can be compared to ability to hear when index fingers are placed in your ears. Mild hearing loss causes greater listening difficulties than a “plugged ear” loss. Child can “hear” but misses fragments leading to misunderstanding. Degree of difficulty experienced in school will depend upon noise level in the classroom, distance from the teacher, and configuration of the hearing loss. At 30 dB can miss 25% – 40% of the speech signal. At 35 to 40 dB may miss 50% or more of class discussions, especially when voices are faint or speaker is not in the line of vision. Will miss brief or un-emphasized words and consonants, especially when a high frequency hearing loss is present. Often experiences difficulty learning early reading skills such as letter/sound associations. With personal hearing aids alone, child’s ability to understand and succeed in the classroom will be substantially diminished by speaker distance and background noise, especially in the elementary grades.

Possible Psychosocial Impact of Hearing Loss

Barriers build with negative impact on self esteem as child is accused of “hearing when he/she wants to”, “day dreaming”, or “not paying attention”. May believe he/she is less capable due to understanding difficulties in class. Child begins to lose ability for selective listening, and has increased difficulty suppressing background noise causing the learning environment to be more stressful. May be more fatigued due to extra effort needed to listen.

Potential Educational Accommodations and Services

Noise in typical class will impeded child from clear access to teacher instruction. The child will benefit from hearing aid(s) and use of a personal FM system or sound-field FM system in the classroom. He/she needs favorable acoustics, seating and lighting. Refer to special education for language/educational evaluation. The child may need attention to language development, auditory skills, articulation, speech-reading and/or support in reading and self-esteem. In-service teacher on impact of “mild” hearing losses on listening and learning.

 


Moderate Hearing Loss (41-55 dB)

Possible Effect of Hearing Loss on the Understanding of Language and Speech

Even with hearing aids, child can “hear” but typically misses fragments of what is said. Without amplification, understands conversational speech at a distance of 3-5 feet, only if sentence structure and vocabulary are controlled; the amount of speech signal missed can be 50+% with 40 dB loss and 80+% with 50 dB loss. Child is likely to have delayed or disordered syntax, limited vocabulary, imperfect speech production and fl at voice quality. Early consistent use of amplification and language intervention increases the probability that the child’s speech, language and learning will develop more normally. Use of a visual communication system to supplement speech may be indicated, especially if large language delays and/or additional disabilities are present. Child will not have clear access to verbal instruction due to
typical noise in class. A personal FM system to overcome noise in the classroom and distance from the teacher may be necessary. With personal hearing aids alone, ability to perceive speech and learn effectively in the classroom is at high risk.

Possible Psychosocial Impact of Hearing Loss

Barriers build with negative impact on self esteem as child is accused of “hearing when he/she wants to,” “daydreaming,” or “not paying attention.” Often with this degree of hearing loss, communication can be significantly affected, and socialization with peers can be difficult, especially in noisy settings such as lunch or recess. May be more fatigued than classmates due to effort needed to listen.

Potential Educational Accommodations and Services

Consistent use of amplification (hearing aids/FM) is essential. Needs favorable classroom acoustics, seating and lighting. Program supervision by hearing impairment specialist to coordinate services is essential. Special academic support may be necessary, especially for elementary grades; attention to growth of oral communication, reading, written language skills, auditory skill development, speech therapy, self esteem likely. Teacher in-service required with attention to peer acceptance.

 


Moderate to Severe Hearing Loss (56-70 dB)

Possible Effect of Hearing Loss on the Understanding of Language and Speech

Even with hearing aids, child can usually “hear” people talking around him/her, but will miss fragments of what is said resulting in difficulty in situations requiring verbal communication in both one-to-one and groups. Without amplification, conversation must be very loud to be understood; a 55 dB loss can cause a child to miss up to 100% of speech information without working amplification. Delayed spoken language, syntax, reduced speech intelligibility and fl at voice quality likely. Reliance on vision to complement hearing to achieve functional access to communication necessary. Age when amplified, consistency of hearing aid use and amount of language intervention strongly tied to speech, language and learning development. Use of visual communication system often indicated, especially if language delays and/or additional disabilities are present. Use of a personal FM system will reduce noise and distance and to allow
increased auditory access to verbal instruction. With hearing aids alone, ability to understand in the classroom is greatly impacted by distance and noise.

Possible Psychosocial Impact of Hearing Loss

Often with this degree of hearing loss, communication is significantly affected, and socialization with peers can be difficult, especially in noisy settings such as lunch or recess. Tendency for poorer self concept and social immaturity will contribute to a sense of rejection; peer in-service helpful.

Potential Educational Accommodations and Services

Full time, consistent use of amplification (hearing aids / FM system) is essential. Depending upon loss configuration, frequency transposition aid may be of benefit. Program supervision by specialist in hearing impairment necessary. May require intense support in language skills, speech, aural habilitation, reading and writing. Sign increasingly useful to access instruction as it becomes more linguistically complex. Note-taking, captioned films and visual aids are needed accommodations. Teacher in-service required.

 


Severe Hearing Loss (71 – 90 dB)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Without amplification, may hear loud noises about one foot distant from ear. When amplified optimally, children with hearing ability of 90 dB or better should be able to detect many sounds of speech if presented from a close distance or via FM. Individual ability and early intensive intervention will determine the degree that sounds detected will be discriminated and processed into meaningful input. Often unable to perceive higher pitch speech sounds sufficiently loud enough to discriminate them, especially without the use of FM. Reliance on vision to complement hearing to achieve functional access to communication is necessary. If loss is present at birth, oral speech and language will likely be severely delayed or not develop spontaneously. Use of visual communication system often indicated. The younger the child wears amplification consistently and intensive speech and language intervention is provided, the greater the probability that speech, language and learning will develop at a more normal rate. Use of child’s communication mode by family members is essential. If progressive or recent onset hearing loss, speech will likely deteriorate with quality becoming flat.

Possible Psychosocial Impact of Hearing Loss

Communication is significantly affected, and socialization with hearing peers is often difficult. Child often more comfortable interacting with deaf or hard of hearing peers due to the ease of communication. Relationships with peers and adults who have hearing loss can make positive contributions toward the development of a healthy self-concept and a sense of cultural identity. Poorer self-concept and greater social immaturity is typical unless child is in a deaf school or with a peer group. Child in mainstream classroom may have greater dependence on adults due to difficulties comprehending oral communication.

Potential Educational Accommodations and Services

There is no one communication system that is right for all hard of hearing or deaf children and their families. Whether a visual communication approach or auditory/oral approach is used, early and extensive language intervention, full-time consistent amplification use and constant integration of the communication practices into the family will highly increase the probability that the child will become a successful learner. Self-contained educational placement with other deaf and hard of hearing students (special school or classes) may be a less restrictive option due to access to free-flowing communication. Specialized supervision, support services and continual appraisal of access to communication is required. Depending on hearing loss, a frequency transposition aid or cochlear implant may be remotely possible options. If an auditory/oral approach is used, early training is needed on all auditory skills, speech-reading, concept development and speech. If culturally deaf emphasis is used, frequent exposure to deaf, ASL users is important. Oral or sigh language interpreter likely necessary in mainstream settings, especially as instruction becomes more linguistically complex. Note-taking, captioned films and visual aids necessary; training in communication repair strategies is helpful. In-service of mainstream teachers is essential.

 


Profound Hearing Loss (91+ dB)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Detection of speech sounds is dependent upon the hearing loss configuration and the optimal use of amplification. May be aware of vibrations more than tonal patterns. Degree and configuration of hearing loss, use and appropriateness of amplification, quality of early intervention and individual ability, all combine to influence the degree to which a profoundly deaf child can detect, discriminate, process and understand the sounds of spoken language. If loss is present at birth, speech and language will not develop spontaneously. If loss is of recent onset, speech and language is likely to deteriorate rapidly. Most profoundly deaf children are not able to use hearing by itself for communication and learning, and utilize visual communication systems and languages.

Possible Psychosocial Impact of Hearing Loss

Parents and family members who are fluent in the child’s communication mode are essential for the child’s feelings of acceptance, self esteem and his/her optimal communication development Child often more comfortable interacting with deaf or hard of hearing peers due to the ease of communication. Relationships with peers and adults who have hearing loss can make positive contributions toward the development of a healthy self-concept and a sense of cultural identity: important tools that can help the child function more effectively in the mainstream. Signing club or classes for hearing peers beneficial. Often in the mainstream, child will have greater dependence on adults due to difficulties understanding oral communication. In-service to hearing peers and teachers is essential to foster acceptance.

Potential Educational Accommodations and Services

There is no one communication system that is right for all hard of hearing or deaf children and their families. Whether a visual communication approach or auditory/oral approach is used, early and extensive language intervention, full-time consistent amplification use and constant integration of the communication practices into the family will highly increase the probability that the child will become a successful learner. If an auditory/oral approach is used, early training is needed on all auditory skills, speech-reading, concept development and speech. Full-time, consistent use of amplification (hearing aids/FM) is essential if hearing is to be maximized; older deaf child may decide to discontinue hearing aid use if extremely limited functional benefit. A frequency transposition aid or cochlear implant may be options. If culturally deaf emphasis is used, frequent exposure to deaf, ASL users is vital. Self-contained educational placement with other deaf and hard of hearing students (special school or classes) often a less restrictive option due to access to free-flowing communication with peers and teachers. Specialized supervision, support services and continued appraisal of access to communication is required. Inclusion into regular classes as much as is beneficial to student (with oral or sign interpreter). Note-taking, captioned films and visual aids are necessary accommodations. Training in communication repair strategies is helpful. In-service of mainstream teachers is essential. School for the Deaf is a social and program consideration.

 


Mid-Frequency Hearing Loss or Reverse Slope Hearing loss (“Cookie Bite” loss: Approx. 750 Hz – 3000 Hz, Reverse Slope loss: Approx. 250 Hz – 2000 Hz)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Child can “hear” whenever speech is present, but will have difficulty understanding in certain situations; may have difficulty understanding faint or distant speech, such as a student with a quiet voice from across the classroom. The “cookie bite” or reverse slope listener will have greater difficulty understanding speech when the environment is noisy and/or reverberant, such as a typical classroom setting. A mild degree of loss in the low to mid-frequency range may cause the child to miss approximately 30% of speech information, if unamplified; some consonant and vowel sounds may be heard inconsistently, especially when background noise is present. Speech production of these sounds may be affected.

Possible Psychosocial Impact of Hearing Loss

Child may be accused of selective hearing due to discrepancies in speech understanding in quiet vs. noise. Social problems may arise as child experiences difficulty understanding in noisy lunch or recess situations. May misconstrue peer conversations. Child may be more fatigued in classroom setting due to greater effort needed to listen. May appear inattentive, distractible or frustrated.

Potential Educational Accommodations and Services

Personal hearing aids important but must be precisely fit to loss. Child likely to benefit from a sound-field FM system, a personal FM system or assistive listening device in the classroom. Student is at risk for educational difficulties. Can experience some difficulty learning sound/letter associations in Kindergarten and 1st grade classes. Depending upon degree and configuration of loss, child may experience delayed language development and articulation problems. Educational monitoring and teacher in-service warranted. Annual hearing evaluation to monitor for loss progression is strongly suggested.

 


High Frequency Hearing loss
(Approximately 1500 Hz – 8000)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Child can “hear” but will miss important fragments of speech. Even a mild loss of high frequency hearing may cause the child to miss 20 – 30% of vital speech information if unamplified. Consonant sounds “t, s, f, th, k, sh, ch” likely heard inconsistently, especially in background noise. Will have difficulty understanding faint or distant speech, such as a student with a quiet voice from across the classroom, and will have much greater difficulty understanding speech when the environment is noisy and/or reverberant. Many of the critical sounds for understanding speech are high-pitched, quiet sounds, making them difficulty to perceive. The words “cat, cap, calf, cast” would be perceived as “ca”, word endings possessives, plurals and unstressed brief words are difficult to perceive and understand. Speech production may be affected. Use of amplification often indicated to ease learning.

Possible Psychosocial Impact of Hearing Loss

Child may be accused of selective hearing due to discrepancies in speech understanding in quiet vs. noise. Social problems may arise as child experiences difficulty understanding in noisy lunch or recess situations. May misinterpret peer conversations. Child may be more fatigued in classroom setting due to greater listening effort. May appear inattentive, distractible or frustrated. Could affect self-concept.

Potential Educational Accommodations and Services

Student at risk for educational difficulties. Depending on onset, degree and configuration of loss, child may experience delayed language and syntax development and articulation problems. Possible difficulty learning sound/letter associations in Kindergarten and 1st grade classes. Early evaluation of speech and language skills is suggested. Educational monitoring and teacher in-service warranted. Will often benefit from personal hearing aids and use of a sound-field or a personal FM system in the classroom. Use of ear protection in noisy situations is imperative to prevent loss progression from hearing damage.

 


Unilateral Hearing loss (one normal ear and one ear with permanent loss)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Child can “hear” but will have difficulty understanding in certain situations, such as hearing faint or distant speech, especially if poor hearing ear is closest to the person speaking. Will usually have difficulty localizing sounds and voices using hearing alone. The unilateral listener will have greater difficulty understanding speech when the environment is noisy and/or reverberant, especially with the normal ear towards the overhead projector or other sound source and poorer hearing ear towards the teacher. Exhibits difficulty detecting or understanding soft speech from the side of the poorer hearing ear, especially in a group discussion.

Possible Psychosocial Impact of Hearing Loss

Child may be accused of selective hearing due to discrepancies in speech understanding in quiet vs. noise. Social problems may arise as child experiences difficulty understanding in noisy cooperative learning, lunch or recess situations. May misinterpret peer conversations and feel rejected or ridiculed. Child may be more fatigued in classroom setting due to greater effort needed to listen, especially if class is active or has relatively poor acoustics. May appear inattentive, distractible or frustrated, with behavior or social problems sometimes evident.

Potential Educational Accommodations and Services

Allow child to change seat locations to direct the better ear toward the most effective listening position. Student is at risk for educational difficulties as half of students with unilateral hearing loss experience significant learning problems. Often have difficulty learning sound/letter associations in Kindergarten and 1st grade settings. Educational monitoring is warranted. Teacher in-service is beneficial. May benefit from a hearing aid in the poorer hearing ear if there is residual hearing, and occasionally a CROS aid can be successful. Will benefit from use of a sound-field FM system in the classroom, especially in the lower grades, or a personal FM system with low gain/power.

 


Fluctuating Hearing Loss (Conductive Loss due to Otitis Media with Effusion)

Possible Effect of Hearing Loss on the Understanding of Speech and Language

Of greatest concern are children who have experienced hearing fluctuations over many months in early childhood (multiple episodes with fluid lasting three months or longer). Listening with a hearing loss that is approximately 20 dB can be compared to hearing when index fingers are placed in the ears. This loss or worse is typical of listening with fluid behind the eardrums. Child can “hear”, but misses fragments of speech. Degree of difficulty experienced in school will depend on the classroom noise level, the distance from the teacher and the current degree of hearing loss. At 30 dB, can miss 25 – 40% of the speech signal. A child with a 40 dB loss associated with “glue ear” may miss 50% of class discussions, especially when voices are faint or speaker is not in the line of vision. Will frequently miss unstressed words, consonants and word endings.

Possible Psychosocial Impact of Hearing Loss

Barriers build with negative impact on self esteem as the child is accused of “hearing when he/she wants to”, “day dreaming”, or “not paying attention”. Child may believe he/she is less capable due to understanding difficulties in class. Typically poor at identifying changes in own hearing ability. With inconsistent hearing, the child learns to “tune out” the speech signal. Children are judged to be immature, with greater problems in attention, insecurity, distractibility, and self-esteem. Tend to be non-participative and distract themselves from classroom tasks.

Potential Educational Accommodations and Services

Primary impact is on attention in class and acquisition of early reading skills. Language development can also be delayed. Screening for language delays is necessary starting at a young age. Ongoing hearing monitoring in school with communication between the parent and teacher is necessary. Educational monitoring is warranted. Child will benefit from use of a sound-field FM system or assistive listening device in the classroom. May need attention to speech/language, reading, self-esteem and listening skills development. In-service for the teacher is beneficial.

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