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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".) 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.) 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: 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: 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: 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: 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. 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. 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 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 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 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.