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HEARING IMPAIRMENTS
A GUIDE FOR STUDENTS
AND FOR TEACHERS.
By Eric Ryan EDU 410 November 18th 2009
Hearing Impairment Defined:
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Deafness means a hearing impairment that is so severe
that the child is impaired in processing linguistic
information through hearing, with or without
amplification, that adversely affects a child's
educational performance.
Hearing impairment means an impairment in hearing,
whether permanent or fluctuating, that adversely
affects a child's educational performance but that is not
included under the definition of deafness in this section.
(IDEA 300.7[c][3][5])
Varying Types of Hearing Impairments
Hearing Loss can manifest at different periods of life.
 Prelingual Hearing Loss – Hearing loss that occurs
before an individual develops the use of language.
Usually due to a cognitive defect.
 Postlingual Hearing Loss – Hearing loss that occurs after
an individual has developed the use of language.
Usually due to illness, disease, prolonged exposure to
loud noises over 80-100 dB’s, or old age.
Merriam-Webster's Medical Dictionary
Noises and How We Measure Them.
Noise is measured in units called decibels, on a scale from zero to 140.
Here is a list of common noises and their decibel levels:
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Aircraft at take-off (180)
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Fireworks (140)
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Snowmobile (120)
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Chain saw (110)
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Amplified music (110)
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Lawn mower (90)
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Noisy office (90)
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Vacuum cleaner (80)
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City traffic (80)
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Normal conversation (60)
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Refrigerator humming (40)
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Whisper (20)
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Leaves rustling (10)
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Calm breathing (10)
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Noise levels of 130 decibels or over will be painful and is very likely to cause immediate hearing damage.
Deafness and Hearing Aids website
Varying Degrees of Hearing Loss
The “Normal” range of hearing falls within 0-15dB.
Hearing loss begins beyond that and is grouped into
the following significant ranges:
 16-25 dB = Minimal loss
 25-40 dB = Mild hearing loss
 40-65 dB = Moderate hearing loss
 65-90 dB = Severe hearing loss
 Greater than 90 dB = Profound hearing loss
Vaugn, Bos, and Schumm 2007
Minimal to Mild Hearing Loss
In this range of hearing loss, 16-40 dB’s, an individual
would be referred to as being “hard of hearing”.
Their ability to hear whispering, watch gears ticking or
simple voiced fricative consonants like z, v, f, s, k, and th
would be compromised and complicated.
Many voiceless fricatives would begin to be hard to
distinguish for those individuals closer to the 40 dB
hearing loss range: j, m, d, b, p, h, and g.
Watkins, S. (Ed.). (1993). Sky*HI resource manual (p. G9).
Moderate to Severe Hearing Loss
Those that are fortunate enough to be classified with
Moderate hearing loss would retain the ability to hear
some speech, musical instruments, loud animal sounds
and motorized machinery and/or motorized equipment.
Individuals in the highest portion of this range, 6590dB’s, would be referred to as deaf. These individuals
would most certainly have lost all ability to hear simple
speech and most aforementioned sounds.
Watkins, S. (Ed.). (1993). Sky*HI resource manual (p. G9).
Profound Hearing Loss
Very few individuals classified with Profound
Hearing Loss, <90 dB, may be able to hear the
loudest of sounds. Large scale sounds like live rock
bands, airplanes, helicopters, large trucks, etc.
Again, these individuals would be considered deaf,
or totally deaf, and would be beyond any mode of
amplification or technical assistance.
Watkins, S. (Ed.). (1993). Sky*HI resource manual (p. G9).
Watkins, S. (Ed.). (1993). Sky*HI resource manual (p. G9).
The Prevalence and Incidence of
Hearing Loss in Children
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The number of Americans with a hearing loss has evidentially doubled during the past 30
years. Data gleaned from Federal surveys illustrate the following trend of prevalence for
individuals aged three years or older: 13.2 million (1971), 14.2 million (1977), 20.3 million
(1991), and 24.2 million (1993) (1, 2). An independent researcher estimates that 28.6 million
Americans had an auditory disorder in 2000 (3). This estimate is reasonably well within
projections from the 1971-1993 trend line that evolved from Federal surveys (4).
Children who are hard of hearing will find it much more difficult than children who have
normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other
aspects of verbal communication (5).
The number of children with disabilities, ages 6-21, served in the public schools under the
Individuals with Disabilities Education Act (IDEA) Part B in the 2000-01 school year was
5,775,722 (in the 50 states, D.C., and P.R.). Of these children, 70,767 (1.2%) received
services for hearing. However, the number of children with hearing loss and deafness is
undoubtedly higher, since many of these students may have other disabilities as well (6). Data
by disability are not reported by the Department of Education for ages birth to 5 years.
1997-2009 American Speech-Language-Hearing Association
The Prevalence and Incidence of
Hearing Loss in Children, continued.
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Several studies indicate variance in the prevalence of newborns with congenital hearing loss in
the United States. The overall estimates are between 1 to 6 per 1,000 newborns (7, 8). Most
children with congenital hearing loss have hearing impairment at birth and are potentially
identifiable by newborn and infant hearing screening. However, some congenital hearing loss
may not become evident until later in childhood (9).
According to Blanchfield, et. al., as many as 738,000 individuals in the U.S. have severe to
profound hearing loss. Of these, almost 8% are under the age of 18 (10).
Among African-American, Cuban-American, Mexican-American, Puerto Rican, and nonHispanic White children, it is estimated that approximately 391,000 school-aged children in
the U.S. have unilateral hearing loss (11).
According to Niskar and colleagues, approximately 14.9% of U.S. children have lowfrequency or high-frequency hearing loss of at least 16-dB hearing level in one or both ears
(12).
Profound, early-onset deafness is present in 4-11 per 10,000 children, and is attributable to
genetic causes in at least 50% of cases (13).
1997-2009 American Speech-Language-Hearing Association
Co-Occurring Disabilities as a result of
Hear Impairment
The prevalence of several specific disabilities occurring with diminished hearing
has been documented over time (Craig & Craig, 1993, 1983, 1973). The
three additional disabilities most often reported in children who are deaf or
hard of hearing are learning disabilities, intellectual disabilities, and
emotional/behavioral disabilities.
The 1993 reference issue of the American Annals of the Deaf reports:
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learning disabilities are the largest co-occurring disability. 9% prevalence.
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Intellectual disabilities occurring with a prevalence at 8%.
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Emotional/behavioral disabilities was the least with 4% prevalence.
Hearing Impaired students with these Co-Occurring disabilities display a range of learning
difficulties other than their limited hearing potential that range from:
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inappropriate, disruptive, aggressive behaviors
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generalized delay in development across all areas of learning
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Limited problem-solving abilities and lowered adaptive skills
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specific learning deficits that restrict accomplishments
ERIC Digest #E548
Technology For Helping Those With
Hearing Loss?
"Blindness cuts you off from things; deafness cuts you off from people." — Helen Keller
American Sign Language (ASL) is the primary mode of communication for the deaf.
This visual gesturing language uses agreed upon symbolism to convey words or actions. This is not
a universal language, nor does it represent English language. It uses unique grammar and usage, but it does
utilize Finger Spelling represent English letters to convey a word or action that has no symbol.
Amplification devices, or Hearing Aids, are electronic devices that are usually worn in
or behind the ear of a hearing-impaired person for amplifying sound. Hearing Implants are the next step in
electronic aids when normal hearing aid apparatus are no benefit.
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Cochlear – small electronic device that can provide a sense of hearing to a person who is profoundly
deaf or severely hard-of-hearing
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Middle Ear - Microphones that transmit sound from middle to inner ear for persons with conductive or
mixed hearing loss.
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Bone-anchored - Conduct sound from an implant in the skull behind the ear to the inner ear for a variety
of hearing loss.
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Auditory Brain – Electrodes applied to the brain stem providing electric impulses for a sense of hearing
for those who do not have adequate auditory nerves.
Vaugn, Bos, and Schumm 2007
Universal Design for Learning
CAST, Center for Applied Special Technology, has
been investigating and designing the Universal
Design for Learning (UDL) since 1984. They have
described UDL as a theoretical framework to guide
the development of curricula that are flexible and
supportive of all students, with all types of needs in
mind, so that methods, materials, and assessment
are usable by all.
Hall, T., Strangman, N., & Meyer, A. (2003). Differentiated instruction and implications for UDL implementation (CAST)
UDL Continued,
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CAST’s study of UDL has lead to the identification of the three network
pathways the brain uses in processing information and learning.
Recognition networks
Gathering facts. How we identify and categorize what we see, hear, and
read. Identifying letters, words, or an author's style are recognition tasks—
the "what" of learning.
Strategic networks
Planning and performing tasks. How we organize and express our ideas.
Writing an essay or solving a math problem are strategic tasks—the "how"
of learning.
Affective networks
How students are engaged and motivated. How they are challenged,
excited, or interested. These are affective dimensions—the "why" of
learning.
WWW.CAST.ORG
Differentiated Instruction
CAST suggests that the best method of meeting a Universal
Designed Learning plan is through Differentiated Instruction.
Differentiated Instruction (DI)is a process to teaching and
learning for students of differing abilities in the same class.
The intent of differentiating instruction is to maximize each
student’s growth and individual success by meeting each
student where he or she is, and assisting in the learning
process.
There are three areas of focus for DI that CAST suggest are
imperative for educators to be successful. Content, Process,
and Products.
Hall, T., Strangman, N., & Meyer, A. (2003). Differentiated instruction and implications for UDL implementation (CAST)
Differentiated Instruction cont,
Content
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Several elements and materials are used to support instructional content. These include acts, concepts, generalizations or
principles, attitudes, and skills. Access to the content is seen as key.
Align tasks and objectives to learning goals. Designers of differentiated instruction view the alignment of tasks with instructional
goals and objectives as essential. An objectives-driven menu makes it easier to find the next instructional step for learners
entering at varying levels.
Instruction is concept-focused and principle-driven. The instructional concepts should be broad-based, not focused on minute
details or unlimited facts. The content of instruction should address the same concepts with all students, but the degree of
complexity should be adjusted to suit diverse learners.
Process
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Flexible grouping is consistently used. Learners are expected to interact and work together as they develop knowledge of new
content. Teachers may conduct whole-class introductory discussions of content big ideas followed by small group or paired
work. As one of the foundations of differentiated instruction, grouping and regrouping must be a dynamic process, changing
with the content, project, and on-going evaluations.
Classroom management benefits students and teachers. To effectively operate a classroom using differentiated instruction,
teachers must carefully select organization and instructional delivery strategies.
Products
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Initial and on-going assessment of student readiness and growth are essential. Meaningful pre-assessment naturally leads to
functional and successful differentiation. Incorporating pre and on-going assessment informs teachers so that they can better
provide a menu of approaches, choices, and scaffolds for the varying needs, interests and abilities that exist in classrooms of
diverse students.
Students are active and responsible explorers. Teachers respect that each task put before the learner will be interesting,
engaging, and accessible to essential understanding and skills. Each child should feel challenged most of the time.
Vary expectations and requirements for student responses. Items to which students respond may be differentiated so that
different students can demonstrate or express their knowledge and understanding in different ways.
What does UDL & DI do for the Hearing
Impaired Students & their classroom?
The tools that may be required to help educate students
with a hearing impairment may also be used or
incorporated into whole-class lessons in an effort to
benefit all students.
Technology such as, closed captioning on classroom
informational videos, additional vocabulary instruction,
visual aides for lesson plans, and group work activities
could help any struggling student, as well as aid in the
development of the hearing impaired student(s).
Furthermore, including the entire class in their aliment
may help to socialize everyone to the problem, instead
of reviling it.
Tools For Teachers To Help Students
With Hearing Loss
These are just a few helpful tips for the classroom from a book other than our
text called “The Inclusive Classroom: Strategies for Effective Instruction”
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Adapt the physical environment so students are seated close enough to the front of the class to maximize
their hearing and enable them to read speech. They should also be able to turn to face other students while
they are speaking. Because hearing aids are extra sound-sensitive, loud or irritating noises should be
avoided. Consider choosing a room with carpeting and located away from noisy school areas, such as the
cafeteria and gym.
Use technology, including hearing aids, television captioning, adapted telephone equipment (TTY),
computer-assisted instruction, and the Internet. When appropriate, use FM sound systems, which include
cordless microphones for teachers, and receivers that attach to hearing aids for students. Pass your
microphone to classmates who are speaking in a class discussion so they can also be heard.
Use visuals such as illustrations, diagrams, pictures, and three-dimensional models to introduce vocabulary
and concepts and enhance comprehension.
Use language cards that contain vocabulary and illustrations of concepts and definitions that can
accompany verbal presentations and be used to pre-teach. Encourage students to maintain personal
dictionaries of their language cards.
Create authentic experiences by connecting new language and knowledge to real-world experiences in a
context relevant to the student’s linguistic and experiential background.
The Inclusive Classroom: Strategies for Effective Instruction, by M.A. Mastropieri & T.E. Scruggs, 2007
Tools For Teachers To Help Students
With Hearing Loss, continued
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Reiterate major points, write out assignments, or write down questions on overhead transparencies or the
chalkboard. Give students outlines or closing summaries as handouts. Repeat questions or answers that other
students contribute, to enable hearing impaired students to fully participate in class. Sequence steps or
procedures on written cards and place them in clear view.
Use hand signals or devise a signaling system to denote transitions or allow students with hearing
impairments or interpreters to review questions, answers, and concepts.
Alert students as to when to look or listen and position yourself so students with hearing impairments can
clearly see your face, without shadowing from backlighting or the reflection of glaring light.
Use a “listen, then look, then listen” sequence of instruction, so students can focus on your face as you speak,
then focus on the other aspects of the lesson separately, then focus on your face again. Say, for example,
“Now, I’m going to pour the oil in with this water” (listen); then pour the oil (look), then say, “I poured the oil
into the water. Who can tell me what happened?” (listen).
Plan for interpreters. Interpreters often assist students who are deaf, by translating lecture information,
tutoring, and assisting special and regular education teachers. Extra space, including chairs or desks, may
be required for interpreters to be near students with hearing impairments. Remember that an interpreter
cannot proceed at the same pace as your verbal presentation, and you need to slow your rate of
presentation accordingly.
Work with family members. Parents and other family members have an important influence on students with
hearing impairments, with respect to such activities as going out and interacting with people, joining sports
and other recreational activities, and monitoring and assisting homework (Stewart & Kluwin, 2001). Work
with family members to help them prioritize and encourage important activities.
The Inclusive Classroom: Strategies for Effective Instruction, by M.A. Mastropieri & T.E. Scruggs, 2007
References
Benson, V., & Marano, M.A. (1995). Current estimates from the National Health Interview Survey, 1993. National Center
for Health Statistics. Vital Health Stat 10(190). (1997-2009 American Speech-Language-Hearing Association)
Blanchfield, B.B., et. al. (2001). The severely to profoundly hearing-impaired population in the United States: Prevalence
estimates and demographics. Journal of the American Academy of Audiology, 12, 183-189. (1997-2009 American
Speech-Language-Hearing Association)
Bunch, G. & Melnyk, T. (1989). A review of the evidence for a learning-disabled, hearing impaired sub-group. American
Annals of the Deaf, 134, 297-300. (ERIC Digest #E548 No. ED414666)
Castrogiovanni, A. (2004, May 4). Incidence and prevalence of hearing loss and hearing aid use in the U.S. – 2004
edition. http://www.asha.org/research/reports/hearing.htm. (1997-2009 American Speech-Language-Hearing
Association)
Craig, W.N. & Craig, H.B. (Eds.).(1993). Tabular summary of schools and classes in the U.S. American Annals of the Deaf,
138(2), 169-170. (ERIC Digest #E548 No. ED414666)
Craig, W. N. & Craig, H.B. (Eds.). (1983). Tabular summary of schools and classes in the U.S. American Annals of the
Deaf, 127(2), 188-189. (ERIC Digest #E548 No. ED414666)
Craig, W.N. & Craig, H.B. (Eds.). (1973). Tabular summary of schools and classes in the U.S. American Annals of the Deaf,
118(2), 134-135. (ERIC Digest #E548 No. ED414666)
Cunningham, M., & Cox, E.O. (2003, February). Hearing assessment in infants and children: Recommendations beyond
neonatal screening. Pediatrics, 111(2): 436-440. 1997-2009 American Speech-Language-Hearing Association)
Hall, T., Strangman, N., & Meyer, A. (2003). Differentiated instruction and implications for UDL implementation. Wakefield,
MA: National Center on Accessing the General Curriculum. Retrieved November 15 2009 from
http://www.cast.org/publications/ncac/ncac_diffinstructudl.html
References, continued
How Loud Is Too Loud. Retrieved November 09, 2009, http://www.deafness-andhearingaids.net/2007/03/07/how-loud-is-too-loud-decibel-levels-of-common-sounds/
Individuals with Disabilities Education Act Amendments Final Regulations for Part B of IDEA, 57 C.F.R. 300.7
(1992).
Kemper, A.R., & Downs, S.M. (2000, May). A cost-effectiveness analysis of newborn hearing screening strategies.
Archives of Pediatric and Adolescent Medicine, 154(5): 484-488. (1997-2009 American SpeechLanguage-Hearing Association)
Kochkin, S. (2001, December). MarkeTrak VI: The VA and direct mail sales spark growth in hearing aid market.
The Hearing Review, 8(12): 16-24, 63-65. (1997-2009 American Speech-Language-Hearing Association)
Lee, D.J., et. al. (1998, August). Prevalence of unilateral hearing loss in children: the National Health and
Nutrition Examination Survey II and the Hispanic Health and Nutrition Examination Survey. Ear and Hearing,
19(4): 329-332. (1997-2009 American Speech-Language-Hearing Association)
Marazita, M.L., et. al. (1993, June 15). Genetic epidemiological studies of early-onset deafness in the U.S.
school-age population. American Journal of Medical Genetics, 46(5): 486-491. (1997-2009 American
Speech-Language-Hearing Association)
Mastropieri M.A. & T.E. Scruggs. (2007) The Inclusive Classroom: Strategies for Effective Instruction, Prentice Hall,
74-77.
National Information Center for Children and Youth with Disabilities. ( 2004, January). Deafness and hearing loss
(Pub. No. FS3). Washington, DC: Author. (1997-2009 American Speech-Language-Hearing Association)
Niskar, A.S., et. al. (1998, April 8). Prevalence of hearing loss among children 6 to 19 years of age: the Third
National Health and Nutrition Examination Survey. JAMA, 279(14): 1071-1075. (1997-2009 American
Speech-Language-Hearing Association)
References, continued
postlingual. (n.d.). Merriam-Webster's Medical Dictionary. Retrieved November 09, 2009, from Dictionary.com
website: http://dictionary.reference.com/browse/postlingual
prelingual. (n.d.). Merriam-Webster's Medical Dictionary. Retrieved November 09, 2009, from Dictionary.com
website: http://dictionary.reference.com/browse/prelingual
Ries, P.W. (1994). Prevalence and characteristics of persons with hearing trouble: United States, 1990-91.
National Center for Health Statistics. Vital Health Stat 10(188). (1997-2009 American Speech-LanguageHearing Association)
Task Force on Newborn and Infant Hearing. (1999, February). Newborn and infant hearing loss: Detection and
intervention. Pediatrics, 103(2): 527-530. (1997-2009 American Speech-Language-Hearing Association)
U.S. Department of Education. (2002). To assure the free appropriate public education of all Americans: Twentyfourth annual report to Congress on the I implementation of the Individuals with Disabilities Education Act.
http://www.ed.gov/about/reports/annual/osep/2002/index.html. (1997-2009 American SpeechLanguage-Hearing Association)
Vaughn, S, & C. Bos, & J. Schumm. (2007). Teaching Students Who Are Exceptional, Diverse, and At Risk In The
General Education Classroom. United States of America, Pearson. (p. 193-197)
Watkins, S. (Ed.). (1993). Sky*HI resource manual (p. G9). Retrieved November 09, 2009
http://www.audrehab.org/audiogram2.jpg