Download Auditory Bases of Spoken Language and Instructional Practices

Georgia State University Series:
Early Intervention with Children
who are Deaf and Hard of Hearing
Part 1, Presentation 3
July 2001
Orientation to Hearing Loss
Aren’t all babies who have hearing loss the same?
No. There are
different levels of
hearing loss ranging
from mild to profound.
In addition, two people
with the same level of
loss will have different
hearing
characteristics.
There are many variables that
may effect the progress of
your child.
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•
•
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Age of onset
Etiology
Degree of loss
Type of loss
Use of amplification
devices
• Health of the child
• Involvement of the
family
• Accompanying
disabilities
Etiology
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•
•
•
Unknown
High Risk Factors
Meningitis
Congenital Infections
– Congenital Rubella
– CMV
– Toxoplasmosis
Hearing losses can be:
 Congenital or acquired
 Affect one or both ears
 Fluctuate or remain constant
 Can be the result of developmental
differences in various parts of the ear
 Can be the result of illness
Degrees of Loss
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•
Minimal (Borderline): 15 to 25 dB
Mild: 26 to 40 dB
Moderate: 41 to 55 dB
Moderate to Severe 56 to 76 dB
Severe: 71 to 90 dB
Profound: 90dB +
Slight Loss 15-25 dB
• No significant speech and language delays
• Hearing abilities should be tested on a
regular basis
Mild Loss 26-40dB
• Possible difficulty
hearing faint /distant
speech
• May benefit from
hearing aid as loss
goes toward 40dB
• Will not usually have
difficulty in school
• Need vocabulary work
• Needs favorable
seating and lighting in
school
• May need to speech
read to increase
understanding of what
is spoken
• May need speech
therapy to correct
mispronounced sounds
Moderate Loss 41-55dB
• Understands speaker
face to face at 3-5 feet
• May miss 50% of
class discussion
• Child referred to
special education to
determine support
needs
• May have limited
vocabulary
• Problems pronouncing
some speech sounds
• Benefit from FM
System
• Need favorable seating
Moderately Severe
Loss 56-70 dB
• Conversation must be
loud to hear it
• Needs a hearing aid
• Difficulty in group
activities
• Likely to be deficient
in language use and
comprehension
• Need special help in
language, grammar,
vocabulary, reading
and writing
• Attends to visual and
auditory situations
• Need resource teacher,
special class or tutor
With hearing aid, Can hear:
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Clock ticking
Liquid pouring
Snapping fingers
Doorbell
Knock at door
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Radio at normal level
Voices
Singing
conversation
Severe Loss 71-90 dB
• May hear loud voices
about 12” from the ear
• Speech and language
development delayed
• Speech and language will
not develop spontaneously
if loss is present before
age 2
• May be able to
discriminate vowels but
not all consonants
• Education program needs
special emphasis on
language skills, concept
development, speech,
communication skill
development
• May be placed in regular
class part time
• May benefit from using
sign language
With Hearing Aid, Can hear:
Thunder
Telephone ringing
Alarm clock
Piano
Auto horn
• Radio at louder than
average level
• Group singing
• Loud shots
• Baby crying
Profound Loss 90 dB or more
• May hear some loud
sounds, is aware of
vibrations more than
tones
• Hearing aid is
necessary
• Relies on vision as
primary avenue for
communication
• May need alternatives
to hearing aid
• Continuous
assessment of
communication needs
is required
• Use of sign language
will be helpful
• Speech therapy needed
for functional
communication
development
With hearing aid, Can hear:
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Organ
Audience applauding
Heavy objects dropped on a hard floor
Banging door
Large deep bell
Types of Loss
• Conductive : A change in hearing due to
reduction in sound transmission through the
outer ear, middle ear, or both (Ex. Otitis
Media)
• Sensorineural: A change in hearing due to
damage to structures within the cochlea, to
the VIII cranial nerve, or to both
• Mixed: Conductive and sensorineural
hearing loss occurring simultaneously
ABILITY TO HEAR SPEECH WITH A HEARING LOSS
NORMAL
Freddie
thought
he
should
find
a
whistle
MILD
Freddie
though-
-e
-ould
-ind
a
whi-le
MODERATE
-reddie
-ough-
-e
-ould
-i-
a
-i-le
PROFOUND
LOUDsoft
LOUD
soft
soft
LOUD
soft
LOUDsoft
The Speech Banana
Most sounds
associated with
speech are found
within the shaded
area of the
audiogram
affectionately
referred to as the
speech banana.
Impact on Development
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Language Learning
Education
Cognition
Social-Emotional
Development
• Communication
Impact (continued)
“Without early intervention, the deaf infant
will be delayed in normal developmental
processes- self confidence, intellectual
curiosity, good social relations, and the
ability to use language to communicate and
further the learning process.”
Hayes & Northern, 1996
Hearing Aid and Cochlear
Implant Facts
Caregivers must
have realistic
expectations for
the hearing aid.
ALL sound is
amplified, not just
speech.
Amplification
devices, including
hearing aids, do not
restore hearing to
normal.
A person with a
hearing loss will
never have “normal”
hearing.
Facts (Continued)
• 92-95% of those who are deaf have SOME
hearing. This is called residual hearing.
• The goal is to maximize your child’s use of his or
her residual hearing.
• It is extremely important for parents to understand
that hearing aid use is an ongoing process due to
changes in hearing loss, growth of the ear canal
and advances in technology.
• Children as young as 4 weeks old can be fitted
with a hearing aid
The FDA has approved Cochlear
Implantation for children who:
• Have a profound hearing loss in both ears
• Receive little or no benefit from hearing
aids
• Have not other medical conditions that
would make surgery risky
• Are involved, along with the parents, in all
aspects of the informed consent process
Cochlear Implant Facts
(Continued)
• Understand, along with the parents, his or
her individual role in successful use
• Have, along with the parents, realistic
expectations
• Are willing to be involved in intensive
habilitation services
• Have support from educational programs to
emphasize the development of auditory
skills
Patience- teach your child how to use the sound
available to them, which will require many
modifications. Be patient!
Access- amplification will give your child access to
the speech signal.
Relevance- make all interactions with the child
meaningful.
Expectations- high, but realistic, expectations for
your child are critical.
Nurture- provide an abundance of affection.
Time- learning speech and language through
listening is an ongoing process.
Success- what you put in is what you get out!
Glossary
Assistive Listening Devices (ALDs)- refers to systems that
improve the signal-to-noise ratio by transmitting
amplified sound directly to the listener and transforms
sound into a visual or tactile signal.
Audiogram- table that summarizes how loud a sound must
be at a particular frequency for an individual to hear it
Bilateral- affecting both ears.
Cochlea- the osseous (bony) portion of the inner ear which
surrounds the organ of hearing.
Decibels (dB)- used to express sound pressure.
Frequency- perceived by people as the “pitch”- low or high
spectrum of sound.
Inner Ear- the area beyond the bones of the middle ear
space; includes the cochlea.
Mastoid Bone- the lower portion of the temporal bone
which lies just behind the ear.
Residual Hearing- the amount of hearing that is left when a
hearing loss is present.
Speech Banana- an area on an audiogram (which holds the
shape of a banana) that covers the frequency area in
which speech sounds are produced.
Unilateral- affecting one ear.