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Deaf and Hard of Hearing
Compiling a brief lecture on what a professional should know about deafness and hearing
related disabilities presents quite a challenge. There are many types of hearing loss and
the range of hearing related disabilities is from minimal to complete loss of hearing.
What we have attempted to compile here is some basic information but you are
encouraged to fully explore this topic and to visit as many of the additional cited and
provided websites for a greater understanding of the topic.
Definitions
A natural beginning point for discussing Deaf and Hard of Hearing issues is with
how does a professional use appropriate terminology in referring to/classifying the needs
of consumers with hearing related disabilities. Amy Frasu answers the question “Which
is Correct?:Deaf, deaf, hard of hearing, or hearing impaired” at the following website:
http://www.deaflinx.com/label.html
“Which is correct? There is no easy answer to this question because it is impossible to
create a definite rule that is acceptable to everyone. In most cases, an appropriate label
depends on how the person identifies himself or herself, rather than a specific degree of
hearing loss. It is preferable to use a specific term - Deaf, deaf, or hard of hearing.
Deaf: (Please note the capital "D".)
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This is a reference to members of the Deaf community and Deaf culture.
They are proud to be Deaf and feel that Deafness is a vital part of their identity,
cherished as much as ethnicity, gender, and religious background.
People in this cultural group most likely attended residential schools for the deaf,
use American Sign Language (ASL), and view Deafness as a difference rather
than a disability.
Deaf people often feel a cultural bond with one another based on sharing a
common language and experience of oppression.
Although they most likely recognize ASL as their primary/native language, they
may or may not use speech to communicate.
deaf: (Please note that the "d" is lowercase.)
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This is a general term which encompasses many groups of people, most of whom
do not identify themselves as being part of the cultural Deaf community.
People who are "deaf" are usually oral deaf people who use speech and residual
hearing to communicate instead of sign language.
This definition varies in different regions, but it usually is connected to people
with a severe or profound hearing loss who choose to associate mainly with
hearing people.
hard of hearing:
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This is usually a term for people with a mild, moderate, or severe hearing loss.
Hard of hearing people often use speech as their primary mode of communication,
but may be involved in the Deaf community.
This group of people usually can transition back and forth between the Deaf and
hearing cultures.
Hard of hearing people often form advocacy groups of their own, due to their
special communication needs which are overlooked due to misconceptions about
hearing loss.
hearing impaired:
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This term is considered highly offensive. Just as "deaf-mute" and "deaf and
dumb" are inappropriate labels, "hearing impaired" is an outdated way to
collectively label people with any level of hearing loss. It does not account for
cultural identity.
Elderly people with a hearing loss developed late in life often refer to themselves
as being hearing impaired. This is an appropriate exception, but is often
overgeneralized by the majority of the American public.
The use of "hearing impaired" may be considered less blunt by many hearing
people, but within the Deaf community, it is an insulting term and a sign of
ignorance.
hearing:
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This is a label for people who have no hearing loss.
"Hearing culture" is the mainstream American culture which is primarily focused
on auditory experiences rather than visual experiences. ”
As one can see from the above descriptions, a major defining component of Deaf Culture
is language. Definitions pertaining to signed languages follows:
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American Sign Language (ASL) is a visual-gestural language that is used as a
primary means of communication by many deaf people in the United States and
Canada. For a long time, it was thought to be either a crude collection of gestures,
or to be an "inferior" form of English. However, linguistic research beginning in
the 1960s has shown that ASL is a true, complete and rich language in its own
right, unrelated to English. ASL is a major part of American Deaf culture, and is
transmitted from one generation of signers to the next. ASL is used by many deaf
in the United States, thus its use promotes assimilation into the Deaf Community.
ASL is a visual language, and speechreading or listening skills are not needed to
learn ASL fluently. Because of its visual nature, ASL is very graphic, and
understanding of concepts can be promoted more easily. It has developed over
time through usage by deaf individuals and is a free-flowing, natural language.
ASL is a language complete in itself. It is not usually written or spoken, but can
be translated, just like French or German, to English and vice versa. ASL has it's
own syntax and grammar. It does count as a language credit at University level,
because it is a separate language.
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Pidgin Signed English(PSE) or Signed English - PSE is probably the most
widely used communication modality in the United States among deaf and
hearing persons who work with them. Many teachers use PSE or Signed English.
The vocabulary is drawn from ASL but follows English word order. Words that
do not carry information (e.g. to, the, am, etc.) are often dropped, as are the word
endings of English (e.g. -ed, -s, -ment, etc.). This means that the signer can easily
speak while signing, since it is possible to keep pace with spoken English. It is
simpler to learn than ASL or SEE, since one does not need to include all English
endings, nor does one to master the structure or idioms of ASL.
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Signing Exact English - SEE is based upon signs drawn from ASL and expanded
with words, prefixes, tenses, and endings to give a clear and complete visual
presentation of English. The ASL sign for the concept of "pretty, lovely, beauty,
beautiful" and other such synonyms is retained for beauty, initialized with P for
pretty, L for lovely, and the suffix -ful is added for beautiful. The child thus has
an opportunity to develop an expanded vocabulary. The learning of this English
based sign system may be more comfortable for English-speaking parents.
Maximum use of residual hearing and speechreading is encouraged since the
signs match the elements of spoken English. SEE encourages the incorporation of
ASL features to show intonation visually. SEE does require more signing time
that PSE, because of the word endings and prefixes, etc. Overconcentration on
signing every word may lead to "colorless" signing.
http://www.listen-up.org/sign2.htm
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Cochlear Implant A cochlear implant is an electronic device designed to
stimulate hearing in children and adults who have severe to profound hearing loss
and can derive little or no benefit from hearing aids. Many people who receive
cochlear implants have heard little or no sound before their implant surgery.
Rehabilitation is an essential part of the process. Extensive speech therapy and
auditory training are also necessary for pre-lingual deaf candidates so that they
can make sense of the sounds they hear. Even then, they will not hear and
understand speech the way a hearing person does. Currently, over 20,000 people
worldwide have cochlear implants. More than 8,000 are children.
http://www.pbs.org/wnet/soundandfury/cochlear/cochlear_flash.html
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Hearing Aid electronic device that brings amplified sound to the ear. A hearing
aid usually consists of a microphone, amplifier, and receiver.
www.nidcd.nih.gov/health/glossary/glossary.asp
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TTY - TTYs (also called Telecommunication Devices for the Deaf (TDD) and
text telephones) are terminals used for two-way text conversation over a
telephone line. They are the primary tool used by deaf people (and some hard of
hearing people) for telephone conversation. Other visual telecommunications
technologies and services, such as Internet chat and messaging, email, e-paging,
and fax and e-mail are also widely used in telecommunications by people who are
deaf or hard of hearing. http://tap.gallaudet.edu/tty.htm
Statistics
According to The Gallaudet Research Institute, the following statistics are representative
of the 1990-91 US Census Data
 Total U.S. population: 235,688,000
 Of those roughly 236 million, 20,295,000 or about 8.6%"Have hearing
problems" (includes both deaf and hard of hearing)
How many of the above 20,295,000 are specifically deaf and not hard of hearing? Note
how the numbers in the Gallaudet Research Institute's figures, below, change depending
on which of three different definitions of "deaf" is used:
Deaf
(definition: "in 421,000
both ears"
0.18%
Deaf
(definition:
"cannot hear
552,000
and understand
any speech"
0.23%
Deaf
(definition: "at
best, can hear
1,152,000 0.49%
and understand
words shouted
into the better
ear")
http://library.gallaudet.edu/dr/faq-statistics-deaf-us.html
Types of Hearing Loss and Diagnosis
An Audiologist, or health care professional who is trained to evaluate hearing loss and
related disorders, including balance (vestibular) disorders and tinnitus, and to rehabilitate
individuals with hearing loss and related disorders. An audiologist uses a variety of tests
and procedures to assess hearing and balance function and to fit and dispense hearing aids
and other assistive devices for hearing.
www.nidcd.nih.gov/health/glossary/glossary.asp
According to http://www.asha.org/public/hearing/disorders/types.htm hearing loss is
assessed using three attributes: type of hearing loss, degree of hearing loss, and the
configuration of the hearing loss.
Conductive hearing loss - occurs when sound is not conducted efficiently through the
outer and middle ears, including the ear canal, eardrum, and the tiny bones, or ossicles, of
the middle ear. Conductive hearing loss usually involves a reduction in sound level, or
the ability to hear faint sounds. This type of hearing loss can often be corrected through
medicine or surgery.
Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or to
the nerve pathways from the inner ear (retrocochlear pathway of the acoustic nerve) to
the brain. Sensorineural hearing loss not only involves a reduction in sound level, or
ability to hear faint sounds, but also affects speech understanding or ability to hear
clearly. Sensorineural hearing loss cannot be corrected medically or surgically. It is a
permanent loss. Sometimes a sensorineural hearing loss occurs in combination with a
conductive hearing loss. In other words there may be damage in the outer or middle ear
and the cochlea or auditory nerve. When this occurs, the hearing loss is referred to as a
mixed hearing loss.
A central auditory processing disorder (CAPD) occurs when auditory centers of the
brain are affected by injury, disease, tumor, heredity or unknown causes. CAPD does not
necessarily involve (although it may) hearing loss. Central auditory processing involves
sound localization and lateralization, auditory discrimination, auditory pattern
recognition, the temporal aspects of sounds, and the ability to deal with degraded and
competing acoustic signals. Therefore, a deficiency in one or more of the above listed
behaviors may constitute a central auditory processing disorder. CAPD is often
associated with Attention Deficit disorder (ADD) or Attention Deficit Hyperactivity
Disorder (ADHD) .
Degree of Hearing Loss
Degree of hearing loss refers to the severity of the loss. There are seven categories that
are typically used. The numerical values are based on the average of the hearing loss at
three frequencies 500 Hz, 1000 Hz, and 2000 Hz in the better ear without amplification.
Normal range or no impairment = -10 dB to 15 dB
Slight Loss/Minimal loss = 16 dB to 25 dB
Mild loss = 26 dB to 40 dB
Moderate loss = 41 dB to 55 dB
Moderate/Severe loss = 56 dB to 70 dB
Severe loss = 71 dB to 90 dB
Profound loss = 91 dB or more)
Configuration of Hearing Loss
The configuration or shape of the hearing loss refers to the extent of hearing loss at each
frequency and the overall picture of hearing that is created.
Other descriptors associated with hearing loss are:
Bilateral vs. unilateral. Bilateral hearing loss means both ears are affected. Unilateral
hearing loss means only one ear is affected.
Symmetrical vs. aysmmetrical. Symmetrical hearing loss means that the degree and
configuration of hearing loss are the same in each ear. An asymmetrical hearing loss is
one in which the degree and/or configuration of the loss is different for each ear.
Fluctuating vs. stable hearing loss. Some hearing losses change - sometimes getting
better, sometimes getting worse. Such a change commonly occurs in young children who
have hearing loss as a result of fluid in the middle ear. Other hearing losses will remain
the same year after year and would be regarded as stable.
Progressive vs.sudden hearing loss. Progressive hearing loss is a hearing loss that
becomes increasingly worse over time. A sudden hearing loss is one that has an acute or
rapid onset and therefore occurs quickly, perhaps as a result of head trauma, or perhaps a
tumor in the auditory nerve.
http://www.asha.org/public/hearing/disorders/types.htm
Functional Hearing Loss
Functional hearing loss involves a psychological or emotional problem, rather than
physical damage to the hearing pathway. Individuals with this type of hearing loss do not
seem to hear or respond; yet, in reality, they have normal hearing. The most important
challenge for physicians is to classify this condition properly. It may be difficult to
determine the specific emotional cause, but if the classification is made accurately, the
proper therapy can begin. Too often, a functional hearing loss is not recognized, and
individuals receive useless treatments for prolonged periods. In turn, this process may
aggravate the emotional element and cause the condition to become more resistant to
treatment.
http://yourmedicalsource.com/library/hearingloss/HL_types.html
Other related terms
Hereditary Conditions – The following are inherited conditions that cause hearing loss:
Wasrdenburg’s synderome, Alport’s syndrome, Usher’s syndrome, Pendred’s syndrome
and Jervell-Lange-Nielson syndrome.
Menieire’s disease - a condition of the inner ear that is characterized by sudden severe
attacks of dizziness, ringing in the ear, vomiting, a reeling sensation, loss of equilibrium,
and progressive loss of hearing.
Presbycucis - loss of hearing that gradually occurs because of changes in the inner or
middle ear in individuals as they grow older.
www.nidcd.nih.gov/health/glossary/glossary.asp
Hyperacusis According to the Hyperacusis Network, hyperacusis is a collapsed tolerance
to normal environmental sounds.
Tinnitus - According to the American Tinnitus Association, tinnitus is the perception of
ringing, hissing, or other sound in the ears or head when no external sound is present.
Treatment for Hearing Loss
Treatment of hearing loss will depend upon the type of hearing loss that is diagnosed.
Congenital deformities of the outer or middle ear, resulting in a conductive hearing loss,
can sometimes be corrected through surgery. Sensorineural hearing loss cannot be cured
through surgery.
Hearing aids may be used in some situations for individuals who have either a conductive
or sensorineural hearing loss. Hearing aids can be beneficial but do not help instantly and
do not always enable an individual to discriminate environmental sounds or understand
speech.
A cochlear implant may be another option for some candidates. A cochlear implant is a
device that is surgically implanted into the cochlea and aids the individual in hearing
sounds through a magnet attached to a small body-worn computer.
Accommodations
The accommodations suggestions are extremely extensive when it comes to employment
and Deaf or Hard of Hearing Individuals. Please see visit The Job Accommodations
Network page for these details. http://www.jan.wvu.edu/media/Hearing.html
Additional Readings
http://www.pepnet.org/
PEPNet, the Postsecondary Education Programs Network, is the national collaboration of
the four Regional Postsecondary Education Centers for Individuals who are Deaf and
Hard of Hearing. The Centers are supported by contracts with the U.S. Department of
Education, Office of Special Education and Rehabilitative Services. The goal of PEPNet
is to assist postsecondary institutions across the nation to attract and effectively serve
individuals who are Deaf and Hard of Hearing. This site has two excellent interactive
programs, Orientation to Serving College Students Who Are Deaf or Hard of Hearing,
and Gate to Adventure that I recommend you check out.
http://www.nidcd.nih.gov/about/learn/mission.asp
The National Institute on Deafness and Other Communication Disorders (NIDCD) is one
of the Institutes that comprise the National Institutes of Health (NIH). NIH is the Federal
government's focal point for the support of biomedical research. NIH's mission is to
uncover new knowledge that will lead to better health for everyone. Simply described,
the goal of NIH research is to acquire new knowledge to help prevent, detect, diagnose,
and treat disease and disability. NIH is part of the U.S. Department of Health and Human
Services.
http://library.gallaudet.edu/dr/faq-statistics-deaf-us.html
Gallaudet University Library’s Dear Related Resources. Gallaudet University’s mission
is is to serve as a comprehensive, multipurpose institution of higher education for deaf
and hard of hearing citizens of the United States and of the world.
http://www.listen-up.org/sign2.htm
The Listen Up Web. A website dedicated to gathering information and developing
products geared to the special needs of hearing impaired children and their families.
http://www.asha.org/public/outreach/take-action/consumerchecklist.htm
The American Speech Language Hearing Association’s mission is "To promote the
interests of and provide the highest quality services for professionals in audiology,
speech-language pathology, and speech and hearing science, and to advocate for people
with communication disabilities"
http://ncod.csun.edu/ncod.html
The National Center on Deafness at California State University Northridge
http://www.jan.wvu.edu/media/Hearing.html
The Job Accommodation Network
Several Other Links of Interest:
http://www.dogsforthedeaf.org
http://www.harriscomm.com/catalog/default.php
http://www.deaftraining.com
http://www.cfv.org
Research Article
Anderson, G.B. , Boone, S.E., & Watson, D. (2003). Impact of federal legislation and
policy on VR services for consumers who are deaf or hard of hearing: Perspectives of
agency administrators and program specialists. American Annals of the Deaf, 148(4),
315-322.