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An Overview For Parents of
School-Aged Children
By: Michelle Lazaro
The parents of school-aged children
will become familiar with the three
types of hearing loss and their main
causes.
They
will
familiarize
themselves with the options children
have with assistive listening devices
(ALDs), as well as their costs,
advantages, and disadvantages.
The Ear Consists of Three Distinct Areas:
* The Outer Ear (the pinna, auditory canal, and eardrum)
* The Middle Ear (the space behind the ear drum that contains
the small bones called the ossicles, up to the cochlea)
*The Inner Ear - (the cochlea and vestibular system)
How We Hear: Sound travels down the auditory canal and strikes
the eardrum, making it vibrate. Those vibrations in the eardrum
cause the ossicles to vibrate thereby creating movement of the
fluid in the inner ear. This movement in the cochlea causes
changes in the tiny structures called hair cells, which send
electrical signals from the inner ear up the auditory nerve to the
brain. The brain interprets these electrical signals as sound.
Hearing Loss:
Types and Causes
Three Types
 Conductive hearing loss: sound is
not conducted efficiently through
the outer ear canal to the middle
ear - - some type of barrier exists in
the outer or middle ear. This type
can often be corrected medically or
surgically.
***
 Sensorineural hearing loss (also
called nerve deafness): damage to
the inner ear or the nerve pathways
from the inner ear to the brain.
This is the most common type of
permanent hearing loss. It cannot
be corrected medically or
surgically.
Most Common Causes






Middle ear fluid from colds
Ear infections and allergies
Malformations of the pinna
Impacted ear wax (cerumen)
Perforated eardrum
Presence of a foreign body
***
 Head trauma
 Exposure to loud noise
 Age-related hearing loss, called
presbycusis, or genetic or hereditary
hearing loss
 Meningitis and illness-related
hearing loss
 Malformation to the inner ear
Hearing Loss:
Types and Causes
Most Common Causes
Third Type
 Mixed hearing loss:
 Combination of wax
having both a
conductive hearing loss

and a sensorineural
hearing loss. There may
be damage in the outer
or middle ear and in the 
inner ear (cochlea) or
auditory nerve.
impaction with presbycusis aging
Ear infection with a
meningitis-related hearing
loss
Malformed pinna (outer ear)
with abnormal cochlea
Degrees of Hearing Loss
Normal range of hearing: 0 – 25 dB
Mild hearing loss (HOH): 25 – 40 dB
 Soft noises are not heard. Understanding speech is difficult in a
loud environment.
Moderate hearing loss (HOH): 41 – 70 dB
 Soft and moderately loud noises are not heard. Understanding
speech becomes very difficult if background noise is present.
Severe hearing loss (HOH/Deaf): 71 – 90 dB
 Conversations have to be conducted loudly. Group conversations
are possible only with a lot of effort.
Profound hearing loss (deaf): 91 + dB
 Some very loud noises are heard. Without a hearing aid,
communication is no longer possible even with intense effort.
Listening Devices
There are listening devices available depending
on the type and degree of the hearing loss.
Technology Options:
Hearing Aids
Cochlear Implants
FM Systems
Infared Systems
Assistive Listening Devices
Hearing Aids
 A hearing aid is an electro acoustic - body worn
apparatus - which typically fits in or behind the
wearer's ear, and is designed to amplify and modulate
sounds for the wearer.
 All hearing aids work by collecting sounds from the
environment through a microphone, amplifying the
sound and then directing this amplified signal into
your ear by way of a loudspeaker. The amplified signal
stimulates your inner ear, which activates nerve fibers
that carry the sound impulses to your brain.
 Wearing two (binaural) hearing aids allows more
information to reach your brain and makes it easier to
hear speech against background noise.
Hearing Aids Recommended
for Children
 Behind-the-Ear (BTE) Aids
All parts of the aid are contained in a small plastic case
that rests behind the ear. The case is connected to an
earmold by a piece of clear tubing. This style is often
chosen for infants and young children for safety and
growth reasons.
 In-the-Ear (ITE) Aids
All parts of the aid are contained in a shell that fills in
the outer part of the ear. These aids are larger than inthe-canal aids and, for some people, may be easier to
handle than smaller aids. This style is often chosen for
older children and adults.
Hearing Aid Styles
 Behind-the-Ear (BTE) & Mini B-T-E Aid: Open Fitting
A small plastic case rests behind the ear, and a very fine clear tube runs into the ear
canal. Inside the ear canal, a small, soft silicone dome or a molded, highly vented
acrylic tip holds the tube in place. These aids offer cosmetic and listening
advantages and are used typically for adults.
 Receiver-in-Canal Aids (RIC)
These aids look very similar to the behind-the-ear hearing aid with a unique
difference: the speaker of the hearing aid is placed inside the ear canal, and thin
electrical wires replace the acoustic tube of the BTE aid. These aids also offer
cosmetic and listening advantages and are typically used for adults.
Completely-in-the-Canal Aids (CIC)
They are worn inside the ear canal and not in the concha. They are inserted and
removed by a short clear cord.
 Extended Wear Hearing Aids
These aids are devices that are nonsurgically placed in the ear canal by an
audiologist. They are worn up to several months at a time without removal. The
devices are made of soft material designed to fit the curves of the ear. They are worn
continuously and then replaced with a new device. They are very useful for active
individuals because their design protects against moisture and earwax, and they can
be worn while exercising, showering, etc.
Styles: Pros, Cons, & Costs
Behind the ear (BTE):
 Pros: Larger size makes it easier to
manipulate. Direct audio input capability so it
can be hardwired to an ALD. Accommodates
directional microphone, volume control, easy
to clean because the earmold can be detached
and washed.
 Cons: Conspicuous. Awkward for phone use.
 Cost: $1,200-$2,700.
In the ear (ITE):
 Pros: Easy to insert; can house a directional
microphone and volume control; easy to use
with the telephone.
 Cons: Conspicuous and bulky.
 Cost: $1,300-$2,800.
Middle Ear Implant:
 Pros: , Reduction of occlusion effect and
feedback, reduction of cerumen build-up
problems, successful with patients who suffer
from otitis media.
 Cons: Necessity to under go anesthesia and
surgery, and high cost.
 Cost: $15,000 - $30,000.
Mini behind the ear (Mini BTE):
 Pros: Leaves the ear canal open, for more
natural sound, especially your own voice. No
custom mold required. No "plugged up"
feeling.
 Cons: Harder to use with the telephone.
 Cost: $1,300-$3,000.
Receiver in canal (RIC):
 Pros: One of the least noticeable devices. Can
give superior sound quality.
 Cons: Harder to use with the phone.
 Cost: $1,400-$2,900.
Completely–in-the-Canal (CIC):
 Pros: Easy to handle, reduction of occlusion
effect and feedback, elimination of wind
noise, virtually invisible, improved sound
localization.
 Cons: High-maintenance devices, cerumen
build up, does not accommodate directional
microphones.
 Cost: $300 - $2,000.
Cochlear Implants
 A cochlear implant is a device that provides direct
electrical stimulation to the auditory (hearing) nerve
in the inner ear. Children and adults with a severe to
profound hearing loss who cannot be helped with
hearing aids may be helped with cochlear implants.
Cochlear Implants Continued
 Cochlear implants are used for sensorineural hearing losses,
which means there is damage to the tiny hair cells in the part of
the inner ear called the cochlea. Because of this damage, sound
cannot reach the auditory nerve. With a cochlear implant, the
damaged hair cells are bypassed, and the auditory nerve is
stimulated directly.
 The cochlear implant does not result in “restored” or “cured”
hearing. It does, however, allow for the perception of the
sensation of sound.
 The benefits from a cochlear implant depend on many factors,
such as:
 The age of the patient when he or she receives the
implant
 Whether the hearing loss was present before or
after the patient developed language skills
 The motivation of the patient and their family
How does a cochlear implant work?
 Cochlear implants have external (outside) parts and internal (surgically
implanted) parts that work together to allow the user to perceive
sound.
 External parts: The external parts include a microphone, a speech
processor, and a transmitter. The microphone looks like a behind-theear hearing aid. It picks up sounds—just like a hearing aid microphone
does—and sends them to the speech processor.
Cochlear Implants – Parts:
 The speech processor may be housed with the microphone
behind the ear, or it may be a small box-like unit typically
worn in a chest pocket. The speech processor is a computer
that analyzes and digitizes the sound signals and sends
them to a transmitter worn on the head just behind the ear.
 The transmitter sends the coded signals to an implanted
receiver just under the skin.
 Internal parts: The internal (implanted) parts include a
receiver and electrodes. The receiver is just under the skin
behind the ear. The receiver takes the coded electrical
signals from the transmitter and delivers them to the array
of electrodes that have been surgically inserted in the
cochlea. The electrodes stimulate the fibers of the auditory
nerve, and sound sensations are perceived.
Children and Cochlear Implants
 Children can be considered for cochlear implants. Children as young as
14 months of age have received cochlear implants, and the potential
exists for successful implantation at younger ages.
 It is generally agreed that the best child candidates are those who:
 Have profound hearing loss in both ears
 Have had limited benefit from hearing aids
 Are healthy and have no medical conditions that would make the

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surgery risky
Are involved (when able), along with their parents, in all the steps in
the process
Understand (when able), along with their parents, their role in the
successful use of cochlear implants
Have (when able), along with their parents, realistic expectations for
cochlear implant use
Are willing to be actively involved in their habilitation/rehabilitation
Have support from their educational program to emphasize the
development of auditory skills
Cochlear Implants
Advantages
 An increased level of hearing
 Children who get the implant
are often able to function in
mainstream schools rather
than through specialized
schooling for the deaf.
 Another major benefit of
having the cochlear implant is
safety. Being able to hear some
environmental sounds,
ambulance sirens, a door
opening or someone yelling are
a few examples.
Disadvantages
 Cost is very high. The implant along with
the surgery and post-operative care can
easily cost over $50,000. While some
insurance plans may cover this cost, there
are many individuals who cannot afford to
get a cochlear implant even if they want
one.
 The difference between natural sounds and
the way sounds are transmitted through a
cochlear implant is also considered to be a
disadvantage of this technology. Children
typically have an easier time relearning how
certain sounds associate to different people
and situations, but adults sometimes have
difficulty interpreting the unfamiliar
sounds they hear through a cochlear
implant.
 As with any surgery, there is also a risk
associated with the procedure itself. There
is still a chance that damage to the auditory
nerve or facial nerve could occur.
FM Systems:
Personal Frequency Modulation (FM) Systems Help You Hear More Clearly
 Hearing aids perform best in quiet environments or when you are sitting close
to the person you want to hear. Using an FM system (with or without hearing
aids) makes it easier to hear in noisy environments or when you are sitting a
distance away from the person you want to hear. They are like miniature radio
stations. They operate on special frequencies assigned by the FCC. They usually
consist of a transmitter microphone used by the speaker and a receiver and
headset used by the listener.
 FM systems are used in a variety of situations such as listening to a tour guide, a
classroom lecturer, a sales trainer, a church leader, or to sounds at sporting
event or theatre. In most situations, the microphone and transmitter is built
into the overall sound system and can be used with hearing aids, cochlear
implants, or without hearing aids. They have accessories including neckloops
that are made for people with severe to profound hearing loss.
FM Systems
Advantages
 FM systems are portable, less
restrictive, easy to install and
generally work well with
direct auditory inputs (DAI)
of hearing aids. Additionally,
they can be run in adjacent
rooms if they are transmitting
on different frequencies. They
have transmission ranges of
up to 1,000 feet.
Disadvantages
 FM receivers are required to
hear the transmission, even if
the hearing aid has a "T" coil.
Both acoustic output and
teleloop options must be
available at public facilities.
Also, systems must operate
on different channels
(frequencies) when used
simultaneously in nearby
rooms. It is possible that
outside listeners tuning into
the same frequency can
overhear the transmissions.
Infrared systems
 Infrared systems transmit sound using infrared light
waves. Although they are often used in the home with
TV sets, they can also be used in large settings like
theaters and sporting events.
Infrared Systems
Advantages
 Adjacent rooms can operate
the IR systems
simultaneously without
interference which ensures
confidentiality (cannot be
tapped outside the room).
 Personal systems are easy to
install and there is no size
limitation as emitter panels
may be connected for longer
distances (room size
restrictions are minimal).
Disadvantages
 As with FM systems infrared
systems receivers are required to
hear the transmission, even if
the hearing aid has a "T" coil.
 They are not practical for
outdoor applications because of
sunlight interference. There are
some installation challenges
required for large area systems.
Electronic ballast for fluorescent
lights can interfere with 95 kHz
systems.
 There can be some "shadowing"
or loss of signal occur in areas of
room that do not have direct line
of sight with the IR transmitter.
Assistive Listening Devices “ALDs”
There are a variety of additional ALDs, some of
which are listed below:
TTYs and TDDs
Amplified Telephones
Notification Devices
Paging Systems
Alarm Clocks & Watches
Timers
Public Payphone TTYs
Fire Alarms & Emergency Calls
911 Response Center Equipment
Who pays for ALDs?
 The ADA specifies that ALD receivers be provided at
no cost, unless the facility has proven an undue
hardship for providing access to an ALD. Some
employers will cover these systems as part of a
workplace accommodation. Schools can be required to
provide these systems if it is a part of a student's IEP.
Personal systems may also be covered under private
insurance benefits. Vocational rehabilitation (VR), the
Veterans Administration (VA), and State Medicaid
may also be options for funding.
Health Insurance Coverage
for Hearing Aids
 There are various options available to assist in funding for hearing aids and associated
services:
 Some private health care plans cover the costs of audiologic tests, a hearing aid
evaluation, and even partial or full coverage of a hearing aid.
 At this time, Medicare does not cover hearing aids. Medicaid often does cover hearing
aids and related services for adults, and must cover them for children.
 Early intervention through the Individuals with Disabilities Education Act (IDEA) also
provides coverage for certain costs associated with audiology services. Early intervention
services are provided through either your local school system or your local health
department, depending on the state in which you live. Check with your early intervention
service coordinator to determine whether your child qualifies for early intervention and
what is covered.
 Hearing aid loaner banks may provide hearing aids on a temporary basis to children in
need. Please call your early intervention program to see if this service is available in your
area.
 The proposed Hearing Aid Tax Credit law would provide a tax credit of up to $500 per
hearing aid, once every 5 years, for parents purchasing a hearing aid for a dependent
child. This credit could also be used by persons over 55 years of age for the purchase of a
hearing aid.
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