Download Conductive Hearing Loss

DEAF
AWARENESS
TRAINING
Alex Johnston
E-Learning Prototype version 0.1
Deaf Awareness Training
Hearing loss is a major public health issue in Northern Ireland, with almost 300,000
people affected by some form of hearing loss, that’s one in six of the population. As our
society ages, the numbers are set to grow. In addition, tinnitus severely impacts on the
quality of life of 9,000 people.
Hearing loss has significant personal and social costs and can lead to high levels of
social isolation and consequent mental ill health. Up to forty per cent of people with
hearing loss experience mental health problems at some point, nearly double the twenty
five per cent in the general population (Paddock et al, 2008).
There are thousands of people with unaddressed hearing loss: of the 300,000 people in
Northern Ireland with hearing loss, up to 150,000 could benefit from hearing aids and yet
don’t have them.
Deaf Awareness Training
Hearing loss has serious economic ramifications, especially when people face barriers
in getting a job or when it compounds other health problems.
There are 20,000 people in Northern Ireland who are severely or profoundly deaf,
including more than 1,400 children. Many of them do not have equal access to
employment, education, healthcare and services.
What’s Included in the Training:
Quiz
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1. How many people in Northern Ireland have a hearing loss?
100,000
200,000
300,000
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Of these, how many are profoundly deaf?
250,000
150,000
20,000
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2. What are the three most common causes of hearing loss?
Blindness
Noise exposure
Infection
Asthma
Age
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3. Which of these does not cause tinnitus?
Hearing loss
Genetics
Noise exposure
Ear infections
Stress
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4. When communicating with deaf people it is important to over emphasise your speech?
True
False
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5. Which of these is not a communication method that a deaf or hard of hearing person
would use?
BSL/ISL interpreter
Electronic note taker
Braille
Lip speaker
Speech to text reporter
Manual note taker
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6. It takes on average five years for a person to take action on hearing loss?
True
False
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7. People with hearing loss have a greater risk of developing which of the following?
Depression
Mental health problems
Dementia
All of the above
Answers to Quiz
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Question 1
300,000
1 in 6 people in NI have a hearing loss 20,000 are profoundly deaf.
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Question 2
Age, infection and exposure to noise
Other causes include: blockage i.e wax, damage i.e perforated ear drum, or infection eg glue ear,
exposure to loud noise, drug side effects or genetics.
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Question 3
Genetics
The following can cause tinnitus: hearing loss, noise exposure, ear infections, some ear diseases,
head/neck injuries, circulation disorders, side effects of certain medicines and stress.
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Question 4
False
You should speak normally and naturally.
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Question 5
Braille
BSL/ISL interpreter, Electronic note taker, Lip speaker, Speech to text reporter, Manual note taker,
are all methods used.
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Question 6
False
Research shows that there can be a 15 year delay in a person taking action. Early intervention is
key and it is important to go to your GP at an early stage.
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Question 7
All of the above
Hearing loss more than doubles the risk of depression in older people and children with hearing
loss also have an increased risk of mental health. People with mild hearing loss have nearly
double the chance of developing dementia and this risk increases significantly for those with
moderate and severe hearing loss.
Terminology
People who are deaf
This is a general term used when talking about people with all degrees of hearing loss.
People who are hard of hearing
This is used to describe people with mild to severe hearing loss or for those people who have lost
their hearing gradually.
People who are deafened
People who were born hearing and became severely or profoundly deaf after learning to speak
are often described as deafened. This can happen either suddenly or gradually.
People who are deafblind
Many people who are deafblind have some hearing and vision. Others may be totally deaf and/or
totally blind.
The Deaf Community
Many deaf people whose first or preferred language is British Sign Language (BSL) consider
themselves part of the Deaf community. They may describe themselves as Deaf with a capital D
to emphasis their Deaf identity.
• Don’t say ‘the deaf’ and try to avoid ‘deaf people’. Say ‘people who are deaf’ or ‘people with
hearing loss’ to avoid defining people solely by their deafness.
• Don’t use the phrases ‘deaf and dumb’ or ‘deaf mute’, they are considered offensive and
outdated. People who use sign language rather than speech to communicate are (usually)
profoundly deaf.
• Don’t use negative terms such as ‘victim’ or ‘sufferer’ and some people don’t like the terms
‘hearing impaired’ or ‘partially deaf’.
About Hearing Loss
Almost ten million people in the UK are deaf or have a hearing loss. There are a number of
different reasons why someone might be deaf or lose their hearing:
Age
Most are older people who are gradually losing their hearing as part of the ageing process.
Nothing can be done to ‘cure’ deafness caused by ageing, but modern hearing aids can make a
huge difference, making it possible to communicate with less stress and take a full part in
everyday life. More than fifty per cent of people over the age of sixty have some degree of hearing
loss. But, only one in three people who could benefit from a hearing aid actually have one.
About Hearing Loss
Conductive Hearing Loss
Conductive hearing loss is the result of sounds not being able to pass freely to the inner ear. This
usually results from a blockage in the outer or middle ear, such as a build-up of excess ear wax or
fluid from an ear infection (especially common in children). It can also happen as a result of some
abnormality in the structure of the outer ear, ear canal or middle ear – or be due to a ruptured
eardrum.
A condition known as otosclerosis (which results in the abnormal growth of bone in the middle ear)
can cause severe conductive hearing loss. The excess bone prevents the ossicles in the middle
ear from moving freely. The result of this type of hearing loss is that sounds become quieter,
although not usually distorted. Depending on its cause, a conductive hearing loss can either be
temporary or permanent. Conductive hearing losses can often be corrected with medical
management, or minor surgery.
Sensorineural Hearing Loss
This type of hearing loss is sometimes referred to as sensory, cochlear, neural or inner ear
hearing loss. A permanent sensorineural hearing loss is the result of damage to the hair cells
within the cochlea or the hearing nerve (or both). Damage to the cochlea occurs naturally as part
of the ageing process (age-related hearing loss is known as presbycusis). There are many causes
of sensorineural hearing loss these include:
• Regular and prolonged exposure to loud sounds. These sounds do not necessarily have to be
unpleasant – for example, exposure to loud music can be just as harmful as exposure to loud
machinery. Even short term exposure to loud sound can cause temporary deafness.
• Ototoxic drugs – some medicines are harmful to the cochlea and/or hearing nerve. These
include drugs that are used in the treatment of serious diseases such as cancer but also include
certain types of antibiotics.
• Certain infectious diseases, including Rubella.
• Complications at birth.
• Injury to the head.
• Benign tumours on the auditory nerve - although rare, these can cause hearing loss.
• Genetic predisposition – some people are especially prone to hearing loss.
Sensorineural hearing loss not only changes our ability to hear quiet sounds, but it also reduces
the quality of the sound that is heard, meaning that individuals with this type of hearing loss will
often struggle to understand speech. As there is currently no treatment, once the cochlea hair
cells become damaged, they will remain damaged for the rest of a person’s life.
Noise-Induced Hearing Loss
Prolonged and repeated exposure to loud noise, whether at work or when listening to loud music
can damage hearing. The World Health Organisation states that noise exposure is the biggest
cause of permanent hearing damage around the world, and, it’s avoidable.
Genetics
In the UK, one or two babies in every thousand are born with a significant hearing loss.
Approximately one in 1,600 children are born moderately to profoundly deaf because of a genetic
cause.
Tinnitus
Tinnitus is a medical term to describe noises that people can hear in one ear, two, or their head.
There are many different types of noises people hear, but common ones are ringing, buzzing and
whistling. The common link is that there is not an external noise source. An estimated seven
million people in the UK have experienced tinnitus at one time or another and it affects people of
any age from childhood, teens to adults. Some people have mild symptoms and others find it
severely encumbers their lifestyle.
Whilst there are no cures for tinnitus, there are several different types of tinnitus treatments which
can help. These include sound therapy, relaxation exercises, hearing aids, distraction techniques
and complementary therapies.
Communicating Effectively with People who are Deaf or Hard of Hearing
1. Always check what type of communication support the person requires e.g. Sign Language
Interpreter, Lip Speaker, Room Loop, Note Taker. Before starting to speak ensure you have the
deaf/hard of hearing person’s attention i.e. They are looking directly at you. Do not assume the
person who is deaf/hard of hearing can lip read.
2. Always talk directly to the person who is deaf/hard of hearing, not their friend, family member or
interpreter.
3. Remember, the person who is hard of hearing needs to see you and especially your face
clearly. Face the light or window and the person at all times also, check with the person if the
lighting in the room is suitable.
4. Always speak clearly, not too slowly, and use normal lip movements, facial expressions and
gestures. Be patient, never shout or raise your voice as it can be uncomfortable for a hearing aid
user if you shout, it also looks aggressive. Allow time for the person to understand what has been
said and as well as time to respond.
5. Never exclude the person who is deaf/hard of hearing in your conversation. Let them know
what you are talking about (particularly relevant during ward rounds).
6. If you’re talking to one person with hearing loss and one without, focus on both of them.
7. Always try to paraphrase your conversation to check if the person has heard what you have
said. If someone doesn’t understand try saying it in a different way.
8. Try to carry out the conversation in a quiet environment, away from noise and distractions.
9. Ensure you have a room loop available for someone who is Hard of Hearing and make sure
that it is working and you know how to use it.
10. Get to the point, use plain language and don’t waffle.
Working with a Communication Support Professional (CSP)
Preparation material
Try to send the CSP copies of any papers, teaching materials or other information at least two
weeks before the assignment, so that they know what to expect and can prepare as much as they
can for it.
Videos and DVDs
If you are intending to show a video or DVD during a meeting, it would be useful, if possible, to
show it to the CSP before the assignment starts.
Positioning
To communicate effectively, a sign language user and interpreter need to see each other clearly.
Anyone relying on spoken English will need to hear the interpreter well. Interpreters will advise on
the best place for them to sit or stand and will take into account lighting and visibility. If you are
using flipcharts, an overhead projector, handouts, film clips or practical demonstrations, they must
be positioned near to the interpreters so that the sign language user does not have
to change the direction of his or her attention. A user of a notetaker needs to be positioned in
order to see the screen on which the words are being typed.
Speakers/participants
Be aware and mindful of the needs of the CSP and the person they are providing support for.
It is good practice for only one person to speak at a time - it is obviously impossible to interpret or
type the words of two people speaking simultaneously.
Other tips include:
• Avoid jargon and abbreviations.
• Allow plenty of time when using visual aids as it will not be possible for the attendee to study
visual aids and watch the CSP at the same time.
• An interpreter needs time to comprehend and reproduce in English what has been signed in BSL
and vice versa, so expect short time delays as this happens. This is especially important during
questions or discussions.
• Talk at a reasonable, normal speed and talk directly to the people you are communicating with
and not to the CSP.
Key things to Remember:
• Ensure you book a CSP as early as possible (four to six weeks in advance, if possible).
• Make sure the CSP is registered with the National Registers of Communication Professionals
working with Deaf and Deafblind People (NRCPD). www.nrcpd.org.uk
• For legal and medical appointments you must book a registered sign language interpreter
(RSLI), not a trainee sign language interpreter (TSLI).
• If the meeting will involve specific jargon - legal terminology, for example – specify this when you
are making the booking.
• For meetings up to two hours you usually need to book just one interpreter (as long as there are
breaks); for longer meetings you will need two.
Writing for People with Hearing Loss
Writing for people with hearing loss is the same as writing for anyone else, you need to make
sure that the information you produce is easy to understand. The best way to do this is to write in
plain English. Here are some basic guidelines:
• Keep sentences and paragraphs short.
• Always substitute short words for long words where possible. For example, say ‘use’ not ‘utilise’ and
‘buy’ not ‘purchase’.
• Avoid jargon.
• Break up the writing with headings and bullet points.
• Think about using clear diagrams to replace long written descriptions.
• Use photographs to illustrate your points. These can be especially effective if they are real people and
not models.
The Disability Discrimination Act
Under the DDA service providers must also provide reasonable adjustments for disabled
people to enable them to access their services. There are four main types of adjustments:
1. Changing policies, practices and procedures
For example, people might need to make appointments in different ways: by email, text or in
person.
Another example is regarding who can accompany patients into clinical areas. A disabled person
who is visiting their GP may wish to be accompanied by a friend, family member or advocate, or
appropriate communication support.
2. Providing auxiliary aids and services
For example, providing discreet assistance to people with reading and writing difficulties. Or the
provision of human aids to communication, such as communicator guides or interpreters for BSL.
The Disability Discrimination Act
3. Providing an alternative service where the usual service location is not accessible
For example, if a doctor’s clinic is located in an inaccessible part of the hospital the doctor could
hold the appointment for a disabled person in a more accessible part of the hospital.
4. To remove, amend or avoid physical barriers to the surgery, hospital or clinic.
For example, by removing a set of steps and replacing these with a ‘level entrance’, or, by
amending the entrance by installing a ramp and steps, or, by avoiding the barrier by using another
accessible entrance.
Scenarios
1. Ciaran
Ciaran is 27 and is profoundly deaf, since birth. Ciaran arrives at the hospital for an appointment
relating to another medical condition. He is greeted by the receptionist who hasn’t been informed
that he is deaf and doesn’t appear to know that an interpreter is required. Please indicate how this
experience could have been improved?
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Ciaran should have provided his own interpreter.
Medical notes should highlight the fact that a patient has a hearing loss so that all frontline
staff are able to make reasonable adjustments.
All staff should receive deaf awareness training. This ensures that reasonable adjustments
can be made i.e. the health trust books an interpreter prior to Ciaran’s appointment.
2. Joan
Joan is 31 and is losing her hearing. You are writing to confirm an ENT appointment, how might
Joan confirm that the appointment suits?
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Letter
Telephone
Email
SMS
All of the above
3. Martin
Martin is 51 and wears a hearing aid. He arrives for an appointment with the audiologist. How
should you let him know that his appointment time has arrived?
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Use the speaker system.
Use the visual patient call system (remember this is not effective for people with a visual
impairment).
Approach Martin directly and tell him face to face that his appointment time has arrived.
Make sure that he
understands you.
4. Sheila
Sheila is 36 and became deafened after an illness ten years ago. What reasonable adjustments
should a GP practice make to ensure that she can attend her appointments?
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Alternative methods of communication should be encouraged i.e: email, letter, SMS, text
phone.
An induction Loop should be available.
Visual patient call system should be available (not effective for people with a visual
impairment).
The practice books an interpreter or electric note taker prior to Shelia’s appointment.
All of the above.
5. Alec
Alec is 89 and is almost completely deaf. He has no family support and doesn’t like to visit the
doctor. He has recently read an article about hearing aids but doesn’t know who he can contact
locally for more information. What advice could you provide Alec?
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Despite his reservations Alec should be encouraged to see his GP who can refer him to a
specialist, such as an ear, nose and throat (ENT) specialist or a hearing specialist
(audiologist).
Alec should be offered a hearing aid and be encouraged to use it. If he has problems using
it, he could be signposted to organizations such as an Action on Hearing Loss hearing aid
clinic or he could be referred for a home visit if he is unable to go to the clinic location.
Alec could be referred to the ‘In Touch’ befriending scheme which provides a one-to-one
befriending service across Northern Ireland to older people who are deaf or have a hearing
loss, both at home and in residential care, in order to reduce isolation, loneliness and risk.
All of the above
Key Points
Across all of these cases, three things should be noted:
1. The importance of deaf awareness for ALL frontline health care staff.
2. The need to have a Loop system in ALL public areas.
3. Medical notes should highlight the fact that a patient has a hearing loss so that all staff are
aware of it and make reasonable adjustments as a result.
Answers
1. Ciaran
Answer – 2 and 3.
2. Joan
Answer – 1, 3 and 4.
3. Martin
Answer – 2 and 3.
4. Sheila
Answer – 5.
5. Alec
Answer – 4.
We hope you have found this useful and now feel more
confident working with service users or colleagues who
have hearing loss or are Deaf.