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Child Hearing Loss
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Child Hearing Loss
Overview/Definition of the Disorder
Hearing loss is an invisible condition that results in communication problems that
can ultimately interfere with learning and social development (Nelson, 1997). It is
becoming a widespread problem for a significant amount of children. Stedman’s Medical
Dictionary defines hearing loss and hearing impairment as “a reduction in the ability to
perceive sound; may range from slight to complete deafness” (1990).
Sound is measured by its frequency and its loudness. Hearing loss occurs when
impairments occur in either area or both. The tool to measure your hearing is an
audiogram, which plots an individual’s response to sounds as shown in Figure 1. In a
sense an audiogram is a picture of you hearing. The vertical lines represent the pitch,
which is measured in Hertz. The pitches move from the lowest pitch to the left and the
highest pitch to the right. The most important pitches would there for be in the middle
around 500 Hz to 2000 Hz. The horizontal lines represent loudness, which is measured
in decibels. The ranges are measured from the top down (Mehr, 2001). Normal hearing
for children ranges from 0-20 decibels in all frequencies.
Figure 1.
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Hearing loss is separated in two different categories. First there are congenital
causes and second there is acquired hearing loss. Congenital hearing loss that exists or
dates from birth and Acquired is hearing loss which appears after birth, at any time in
one's life, perhaps as a result of a disease, a condition, or an injury (ASHA, 2004).
Acquired hearing loss would also fall in the same field as conductive hearing loss.
This hearing loss occurs when the construction pathway which are the either the middle
or outer ear have problems transmitting sounds to the inner ear. This type of hearing loss
does not result in severe hearing disabilities (NICHCY, 2004). The number one causes of
hearing loss in the conductive category are ear infections, which in medical terms is
called Otitis Media. The National Center for Health Care Statistics estimates that
annually there are 70 OM cases for every 100 children under the age of 5 years
(Nelson,1997). An infection from fluid in the middle ear (right behind the eardrum) is
the cause of Otitis Media. In most causes these ear infections will clear up on their own
or with the help of a doctor’s prescription of antibiotics (Mehr, 2001). Rarely do these
infections cause permanent damage to the eardrums of long term hearing loss. However
when otitis media does occur over again, damage to the eardrum, the bones of the ear, or
even the nerve can occur and cause permanent sensorineural hearing loss.
Meningtitis is an acquired hearing loss. Meningitis is an inflammation in the
lining of the brain. Hearing loss can occur from actually result of the infection or the
body’s response to the infection. Measles and mumps can cause viral infections to the
auditory nerve
Congenital Hearing can result from genetic factors or prenatal defects at or during
birth. There are three types of genetics factors: auto dominant, auto recessive, and x-
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linked hearing. Auto dominant means that if one parent has the dominant gene of hearing
loss than there is a 50% chance that child will be affected. Auto recessive mean that if
both parents carry the recessive gene of hearing loss than there will be a 25% chance of
the child to experience hearing loss. X-linked hearing is completely sex related. A
mother could carry a recessive trait for hearing loss on the sex chromosomes and pass it t
her male children (ASHA, 2004).
Prenatal complications can harm a child’s hearing. Premature births can cause a
child not to able to form the little bones in is ear or other essential growth parts. Sexually
transmitted diseases like syphilis and herpes can also be transmitted to the child through
the birthing procedure. These diseases can also be a cause of hearing loss.
Characteristics
If a child is diagnosed with hearing loss that does not mean that the child is deaf.
There are varying degrees of hearing loss. These degrees range from mild to severe
hearing. Kluwin and Stinson (2001) did a longitudinal study of the deaf students in
public schools. After their study they were able to label the deaf students in one of four
different hearing loss classifications. The first group was a collection of students who
depicted moderate hearing loss. This category of students portrayed above average
grades, intelligible speech and did not need the assistance of an interpreter. These
students were able to function well independently. There moderate hearing loss did not
affect them. The second group was a collection of students who depicted a more severe
hearing loss. These students still read on the same grade level and had comprehendible
speech but were helped with assistive listening devices or and interpreter. The third
group was a collection of students who were profoundly deaf. These students read below
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the grade level. Though they will use speech when appropriate they prefer to sign
instead. The last group was a collection of students who suffered the severest hearing
loss. These students read considerably below the grade level and prefer pointing and
grunting as a source of communication.
Discrepancy in these four types occurs when background information of the child
is brought into the picture. For example a student’s race or economic situation may be a
major factor. A lower income family may not have the necessary funds to help their
child who is in group two and as a result their child’s hearing loss might worsen and the
child will be moved to group three. Also it is very common for a child labeled in group
four to have very poor family support. These students might have families that have not
adjusted or responded to the diagnosis of hearing loss (Kluwin and Stinson, 2001). The
way a child performs in school may also result in the different communication
philosophies, friendship patterns, and history of placement situations. The age at the
onset of deafness, the age of the diagnosis of the child’s hearing loss, the availability of
early services and the families responses to those services could also be school
performance factors (Kluwin & Stinson, 2001).
There are three main characteristics of hearing loss, language communication,
psychosocial dimensions, and education (Turnball, 2004).
Children who experience hearing loss tend to communicate either using
oral/aural, simultaneous or American Sign Language communication. These children
with hearing loss have to develop unique communication skills through their eyes rather
than their ears. Oral/aural communication is communication in spoken English through
the use of speech, speech reading, residual hearing, and amplification of sound (Turnball,
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2004). American Sign Language is the primary language used in the United States for
the hard of hearing or deaf individuals. In sign language, facial expression including the
raising or lowering of the eyebrows while signing and body language are integral parts of
communicating. These actions help give meaning to what is being signed, much like
vocal tones and inflections give meaning to spoken words (Sternberg, 1994).
Simultaneous communication uses the components or both oral/aural communication and
American Sign Language together.
A child’s emotional and social personality can be highly affected and suffer if
communication is a problem. In most cases children who suffer from hearing loss have
parents whom are not deaf. These hearing parents find it very difficult to communicate
with their children. This communication problem becomes a roadblock for the parents by
not being able to fundamentally teach their children and give them positive interaction
(Turnball, 2004). If communication between peers and teachers is partial and incomplete
then this can affect a child’s ability to be part of a social group and develop a positive
self-image. With out good communication a child can be in the dark about the different
social norms, rules of conversation and appropriate ways to respond to certain situations
(Turnball, 2004).
Turnball cut the last characteristic of hearing loss, education, into two major
concerns (2004). The first issue was whether they should put students in inclusion of a
regular classroom of if the students should be segregated in deaf-only classrooms. The
second issue is the performance level of non-white deaf students. Turnball concludes that
hearing loss students perform at different levels than normal hearing students.
Statistics of Hearing Loss
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After numerous studies and reports statistics have shown that:

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 (Hearing Loss Organization).

Males of all ages are more likely to suffer from hearing loss than women
(National Academy on an Aging Society, 1999).

When children are not identified and do not receive early intervention,
special education for a child with hearing loss costs schools an
additional $420,000, and has a lifetime cost of approximately $1 million
per individual (Hearing Loss Organization).

Whites are more likely to suffer from hearing loss than blacks (National
Academy on an Aging Society, 1999)

Families with lower incomes are more likely to suffer from hearing loss
than higher income families (National Academy on an Aging Society,
1999).

Of the 12,000 babies in the United States born annually with some form
of hearing loss, only half exhibit a risk factor – meaning that if only
high-risk infants are screened, half of the infants with some form of
hearing loss will not be tested and identified. In actual implementation,
risk-based newborn hearing screening programs identify only 10-20% of
infants with hearing loss. When hearing loss is detected beyond the first
few months of life, the most critical time for stimulating the auditory
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pathways to hearing centers of the brain may be lost, significantly
delaying speech and language development (Hearing Loss Organization)

Only 69% of babies are now screened for hearing loss before 1 month of
age (up from only 22% in 1998). Of the babies screened, only 56% who
needed diagnostic evaluations actually received them by 3 months of
age. Moreover, only 53% of those diagnosed with hearing loss were
enrolled in early intervention programs by 6 months of age (Hearing
Loss Organization).

African American and Hispanic students who are hard of hearing of deaf
perform significantly lower on measures of achievement compared to
their white, non-Hispanic peers who are hard of hear or deaf.
Educational Issues
Having any type of hearing loss will not affect a student’s ability to learn or take
in education. Children that are hard of hearing or deaf though will find that is extremely
difficult to learn vocabulary, grammar, word order, idiomatic expressions, and other
aspects of verbal communication (NICHCY, 2004). Every teacher in the United States
should expect at least one-third of the classroom to be hearing impaired. This creates a
problem in teaching when most normal hearing students spend about forty-five percent of
their day engaged in active listening activities (Mehr, 2001). Hearing loss can cause
significant educational and social problems. Some children experience academic delays
and miss school due to hearing loss problems. Most classrooms are very noisy, which
interferes with all children’s performance. The noise can affect speech and
understanding of children with hearing loss.
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Hearing loss can cause a barrier to accidental learning. Young children’s learning
is about ninety percent accidental (Mehr, 2001). Children miss important socials from
not being able to overhear conversations. Around the third grade is about the age that
students with hearing loss problems start to fall behind compared to the rest of their
normal hearing peers. This may be due to the changes in language complexity, less
visual cues, and more verbalizations.
One major educational issue is that students with hearing loss are misdiagnosed
with Attention Deficit Disorder. Inconsequently these two disorders share very similar
characteristics. Figure 2 shows similarities between mild hearing loss and Attention
Deficit Disorder.
ATTENTION DEFICIT
MILD HEARING
DISORDER
LOSS
Inappropriate responses
Blurting out answers before
questions are completed
Difficulty following
directions
Difficulty following through on
instructions and organizing tasks
Difficulty sustaining
attention during oral
presentations
Difficulty in listening to others
without being distracted or
interrupting
Impulsive
Frequently asks for
repetition
Academic failure
Acts on the spur of the
moment
Focuses only with frequent
reinforcement or is under very
strict control
Multiple problems with
schoolwork and social activities
Poor self-concept
Isolated and low self esteem
Doesn't complete
assignments
Frequently fails to finish
schoolwork, or works carelessly
Doesn't seem to listen
Figure 2. (Mehr, 2001)
"Can't sit still and listen!"
Under the Individuals with Disabilities Education Act (IDEA) every child with a
disability is guaranteed a free and appropriate education under federal law. Hearing
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impairment and deafness fall under two of the categories of IDEA in which children with
those disabilities may be eligible for special education and related services (NICHCY,
2004). As mentioned earlier in this paper the placement of where students with hearing
loss get their educational learning is very controversial. In the IDEA law it states that
students should be placed in the least restrictive environment. In other words educational
placements that will help them advance to higher levels of education. This definition is
could either mean a regular classroom for some or a private, restricted classroom from
others. Every child should go through an Individual Educational Plan (IEP) that will
determine where the child should be placed to best benefits his or her goals.
Treatments
Early intervention is the key to academic success for hearing loss students. It is
important to diagnose a hearing loss as early as possible so that early intervention
services can begin before 6 months of age. Early intervention can take many forms, such
as getting children fitted for hearing aids, providing counseling and support for parents,
and teaching parents how to stimulate speech and language in their child (AAO-HNS,
2002).
The treatment of hearing loss all depends on the severity of the child’s disorder.
With most causes of Otitis Media doctors can prescribe medications. Hearing aids are
probably one of the more known about treatments. Hearing aids though do not cure
hearing loss they just help make sounds louder which in return help a student hear better.
A hearing aid is powered by a battery and operates by picking up sound, magnifying its
energy and delivering this amplified sound to a child’s ear. The use of cochlear implants
have had a dramatic impact on the linguistic competence of the profoundly hearing
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impaired children (Geers, Nicholas, and Sedey, 2003). A cochlear implant is an
electronic device that compensates for the damaged or absent hair cells in the cochlea by
stimulating the auditory nerve fibers (Turnball, 2004). The implant has two parts an,
internal and external part as shown in Figure 3. The internal part is surgically placed
inside the ear where the cochlear is. The external part is worn like a regular hearing aid.
The literature on language development in children who use cochlear implants develop
language at a faster rate than children with similar degrees of hearing loss who use just
hearing aids (Geers, Nicholas, & Sedey, 2003).
Figure 3
Assistive listening devices are amplification equipment that are meant to enhance
the acoustical accessibility of the teachers instructions to all the children by: increasing
the overall level of the teachers speech, substantially improving the speech-to-noise ratio,
and producing a uniform speech level in the classroom that is unaffected by the teacher or
the pupil position (Mehr, 2001). One of the newer assistive listening devices is the
frequency modulation system. Students using assistive listening devices have shown a
twelve percent average improvement on their vocabulary scores and significant
improvement in Schlastic Reading Achievement Scores (Geers, Nicholas, and Sedey,
2003).
Interpreters are often used in school to transmit spoken English to sign language.
These are qualified professionals that serve as a link between a teacher and the student.
There are two types of interpreters, oral and cued speech. Oral interpreters’ mouth
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speech to students using facial expressions and cued speech interpreters mouth the words
to students and use hand signs (AAO-HNS, 2002). Captioning also helps a student to
learn by being able to read the words of what is being said. Caption videos can have
English subtitles printed across the screen. C-Print Captioning is a speech to print system
in which a hearing captionist (transcriber) types the words of the teacher and the other
students as they are being spoken in to a laptop computer.
Helpful websites and organizations
Alexander Graham Bell Association for the Deaf and Hard of Hearing
3417 Volta Place, NW, Washington, DC 20007
202.337.5220; 202.337.5221 (TTY)
WWW.AGBELL.ORG
American Society for the Deaf Children
P.O. Box 3355, Gettysburg, PA 17325
717.334.7922 (TTY)
WWW.DEAFCHILDREN.ORG
American Speech-Language-Hearing Association
10801 Rockville Pike, Rockville MD 20852
301.897.5700 (TYY)
WWW.ASHA.ORG
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