THE UNIVERSITY OF GOROKA
SCHOOL OF EDUCATION
DICISION OF SPECIAL INCLUSIVE EDUCATION AND CURRICULUM STUDIES
UNDERSTANDING HEARING IMPAIRMENT
A COMPREHENSIVE GUIDE FOR REGULAR TAECHERS IN PNG SCHOOLS
COURSE CODE: ESE 324
LECTURER/SUPERVISOR: Ms. DONNA MAILIL
SEMESTER: TWO (2)
ID NO: 202410549
Written and compiled by Robinson Eweido (In-service Student)
OCTOBER, 2024
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TABLE OF CONTENTS
PAGE
Acknowledgement: ………………………………………………………………….. 3
Forward: …………………………………………………………………………….. 4
Background information: …………………………………………………………… 5
The Ear and the Hearing: ……………………………………………………………. 6
Anatomy, physiology and Pathology: ……………………………………………….. 7
Hearing Impairment: ………………………………………………………………… 15
Causes of Hearing Loss: …………………………………………………………….. 17
Degree of Hearing Loss: …………………………………………………………….. 19
Lifestyle adjustment for individual with hearing impairment: ……………………… 22
Types of Hearing Aid: ………………………………………………………………. 25
Effect of Hearing impairment on Educational and Social Development: ……………28
Language and Communication Options: ……………………………………………. 30
Accommodation for the Classroom: ………………………………………………… 35
Appendix: ……………………………………………………………………………..36
Glossary: …………………………………………………………………………….. 42
Reference: …………………………………………………………………………….44
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ACKNOWLEDGEMENT
To develop this major project, I would like to express my great appreciation to my
course lecturer Ms. Donna Mailil for her presence and time commitment during the
lecture period from semester one all the way to semester two, for her guidance and
support in completing my project. Her willingness to give time and effort for
implementing this booklet is very much appreciated.
Another special thanks to my course mates from the University of Goroka who
contributes ideas, support and assisted me to develop this valid resource booklet of
hearing impairment successfully.
Very special thanks to the Division of Curriculum Studies and Special Inclusive
education of the University of Goroka for giving their full support to our course
lecturer to impart content knowledge, skills and to implement this book
successfully. Lastly, I would like to give thanks for the task that I have created due
to my time commitment, ability, energy and efforts applied to develop this booklet
is much appreciated.
Robinson Eweido
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……………………………………. Forward …………………………………
“Understanding hearing impairment; A Comprehensive Guide for Teachers
in PNG Schools” is an important resource book for teachers and parents working
with students who are deaf or hard of hearing. This guide provides through
overview of hearing impairment, types, hearing loss, anatomy, physiology and
pathology of the ear. It also covers practical strategies for supporting students in
the classroom and offers insights into the unique challenges and opportunities for
teaching and guiding students with hearing impairments. This guide will help you
to increase your knowledge and skills which allow you to change your mind set
and create more friendly, safe, inclusive and supportive learning environment for
all students. This book will assist individual teachers, parents and students to
understand and respect each other differences, appreciate and celebrate each other
then we can work and live together in peace, unity, harmony and inclusive society.
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BACKGROUND
Quality Education for all is the most fundamental weapon for shaping Integral Human
Development of every individual throughout the world. In PNG, quality education for all is the
best approach for developing human resources and these are young children and youths. Thus,
National goals and Directive Principles goal number 4 also support “equality and participation”.
This means that all children should receive formal quality education in regular schools including
vulnerable and children with disabilities such as vision, physical, hearing, intellectual or speech
impairment. However, children or people with any forms of disabilities are fully protected and
guided by International and National Guiding Principles and policies. For this reason, every
individual regardless of gender, cultural or religious differences, abilities or disabilities have
rights for education and quality life skills as stated in the National Constitution of Papua New
Guinea. Therefore, all children should receive formal quality education in PNG regular schools
for promoting inclusive education.
Nevertheless “Inclusive education is the best quality approaches developed from the best
fundamental beliefs of human rights (1948) and fairness which are embraced by many country
throughout the world including PNG” (ESE 324:)
Human beings are made up of different organs which are essential for performing specific
functions in our body including five common senses, which are performed different task in our
body such as hearing, taste, smell, sight and touch to live as healthy lifestyles. Ability to hear is
the most common sense in human lives, which helps to develop speech and language for
learning, thinking and communication skills. Hearing helps individuals to receive correct
information so that communication takes place effectively. This booklet is based on hearing
impairment which designed specifically for regular teachers in primary school in PNG to equip
knowledge and skills to take on challenges on hearing impairment.
“Understanding Hearing Impairment: Comprehensive Guide for Teachers in PNG
Schools”. This guide aim to provide teachers with knowledge and skills which they need to
support students with hearing impairments (deaf) in the classroom. By understanding the
different types of hearing impairments, causes symptoms and treatment, teachers can create a
more inclusive and supportive learning environment for all students. In fact, hearing is caused by
biological, environmental or medical factors which affect people to become temporary or
permanent deafness. Today, deafness is the most serious problem which affects millions of
people around the world and about “half of the population in PNG is living with hearing
impairment” (SIERC). According to the American Speech Language Hearing Association
(ASLHA), reasons out that people who have experienced deafness in their live may severely
affect their speech and language development skills, lowering academic performance, social
relationship, isolation, poor self-concept and career choices.
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THE EAR AND THE HEARING
IMPORTANCE OF HEARING





Hearing is important for development of speech and language. Language is the basis of thinking,
learning and communication skills.
In babies ear disease and hearing loss can affect the development of speech and language
In school aged children ear disease can affect their learning.
Children with long term hearing loss can grow up with communication problems. This can affect
opportunity for further employment and training. It can affect social communication with other
people.
Therefore, it is important that ear disease and hearing loss are detected as early as possible. This is
so the ear disease can be treated. Also, in the case of permanent hearing loss early detection is
important so that early intervention through education can be started.
Sources: ESE 324: Course Handbook: p.3
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ANATOMY, PHYSIOLOGY AND PATHOLOGY OF THE EAR
The Structure of Ear (Anatomy)
Source: NIH/NIDCD
FUNCTION OF EAR (Physiology)
Parts of ear
Pinna
Ear canal
Eardrum
Three bones
Eustachian tube
cochlea
Functions/Description
Collect sound waves and pass them into the ear canal.
Entry way of sound waves towards eardrum
Act as drum when sound hit it. This is to vibrate and amplify the sound
further moves to tinny bones in the middle ear.
To increase the strength of vibrations coming from the ear drum before
passing them into the inner
To equalize air pressure between the atmosphere and the middle ear.
Yawning and swallowing cause contraction of the muscles connected to the
Eustachian tube which allows the tube to open to small amount of air.
It contains hair cells that convert sound waves into electrical impulse
carried along the auditory nerves to the brain. It changes the sound into
nerve message and send to the brain
Nerves that connect inner ear for passing electrical sound to the brain
To handle balance and equilibrium and cochlea nerves is for hearing
It is contain three tinny fluid filled tubes that help to keep balance.
Auditory nerves
Vestibular nerves
Semicircular canal
Temporal bone
Sources: https://en.wikipedia.org
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There are three parts of ear:
1. Outer Ear





It is consist of pinna, auditory canal and
end at the eardrum.
It is a visible part of the ear.
It is consist of ridged cartilage and skin
bone, and it contains glands that create
earwax.
It is funnel shaped canal about 24mm
leads to eardrum (tympanic Membrane).
The ear drum has three layers: outer layer
is skin, middle layer is fibre which helps to
eardrum bounce and the inner layer is
mucous membrane which is the lining of
the middle ear.
Source: https://www.cochlea.eu
2. Middle Ear
The main function of middle ear is to
transmit vibrations of sound from the
eardrum.
 It consists of three bones;
hammer (malleus), anvil (incus)
and stirrup (stapes), Eustachian
tube. The three bones are acted
as a bridge for sound passes
from eardrum to the inner ear.
 It begins at the mucous
membrane of eardrum
 It is connected to noise through
Eustachian tube. This helps to
allow air into the middle ear
and it is opened during
swallowing, yawning and
sneezing.
 Eustachian tube is longer in an
adult compare to the children.
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Source: https://audiocardio.com
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3. Inner Ear
There are two main type of inner ear:
1. Cochlea consists of tinny hair cells stand on the fluid filed chamber. Fluid inside the
cochlea causes the tinny hair cells to moves and vibrates, sending electrical energy to the
brain for hearing the sound
2. Semicircular canal is responsible for balance. It tells our brain which direction our head
is moving.
There are two main functions of ear:
1. Hearing
2. Balance
1. HEARING
Pinna from the outer ear acted as antenna to collects sound waves; it passes travel down to ear
canal and hits on the ear drum. The eardrum starts vibrates and amplify the sound passes on to
three little bones in the middle ear which are connected to the eardrum. The three little bones
(hammer, anvil and stirrup) amplify and transmit the sound waves further into the inner ear.
Once the sound waves reach at inner ear, the hair cells which stand on the fluid starts to move
and convert the vibration of the sound into electrical energy and send it along the auditory nerves
to the brain. Finally, the brain analyses and interprets the sound by knowing that someone is
calling your name.
2. BALANCE
The inner ear contains semicircular canals filled with fluid and hair cells like sensors. When we
move our head, the fluid inside semicircular canal moves the hair cells. The hair cells transmit
the information along the vestibular nerves to the brain. Finally, the brain sends signal to our
muscles to help us to stay balance. (Source: https://my.clevelandclinic.org)
EAR INFECTIONS (Pathology)
An ear infection occurs when bacteria, fungi or viruses get trapped in the ear caused
inflammation and building up fluid. It can affect outer, middle or inner ear. Ear infections are
mostly common for children.
OUTER (EXTERNAL) EAR INFECTIONS
Common Signs and symptoms of Out Ear Infections are:
 Pain
 Itching
 Swelling
 Redness
 Ear blockage
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Common problems in the Out Ear
Problems/Infections
Foreign bodies occlusion
(Source: https://altru.org/health-library/conditions/swimmer’s-ear)
Description
Photographs
It can be inorganic or organic
such as beans or bead, cotton
tips and even insects. It can be
caused trauma to the ear canal,
the eardrum or even the
middle ear.
Cerumen impaction
An ear wax in the ear canal
can affect the sound to the
eardrum. It can cause problem
with hearing and balance Ear
wax can also protect bacteria
and insects into the middle
ear.
Otitis External
It is known as swimmer’s ear
and caused by bacteria. It
create pain, swelling,
discharge, itching. It is treated
with antibiotics
Exostoses
Bony growth covers by skin. It
does not causes any trouble
with hearing
Furuncle
It is a painful infection of a
hair follicle located in the ear
canal. It is caused by bacteria
Congenital malformation
Pinna is small abnormally
shaped it can occur in one side
or both side of the ear.
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Prevention Measures of Outer Ear
 Keep your ear dry canal
 At home, preventive treatment
 Swim wisely
 Protect your ear while swimming
 Protect your ear from irritant
 Use caution after an ear infection or surgery
 Avoid putting foreign into your ear
Treatment
Swimmer’s ear, doctors can give medication for infection
treatment depends on the type of serious infections.
 Antibiotic to kill bacteria
 Steroid to reduce inflammation
 Antifungal medication to fight infection caused by
fungus.
 Acidic solution help ear antibacterial environment
MIDDLE EAR INFECTIONS
Common signs and symptoms of middle ear infections are:
 Pain
 Discharge (leaking pus or fluid out from your ear)
 Difficulty hearing (ringing or buzzing)
 Ear pressure
 Fever/headache
Common Problem in the Middle Ear
PROBLEMS/INFECTIONS DESCRIPTIONS
It occurs when the lining of
Eustachian Tube Blockage
the nose become
inflammation. It is due to
common cold or influenza.
Perforation of the eardrum
PHOTOGRAPHS
It is a hole in the eardrum. It is
caused by loud sound, foreign
objects in the ear, head
trauma, middle ear infection
or rapid pressure of air travels.
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Otitis Media
Cholesteatoma
An infection of air filed space
behind the eardrum in the
middle ear. It is caused by
bacteria or viruses and treated
with antibiotics
It is developed when dead skin
cells gather behind eardrum to
form a lump or look like pearl.
It may become infected or
grow large to damage hearing.
Treatment is done by surgery
to remove growth.
Eardrum perforation
For more information, visit: https://www.my.clevelandclinic.org
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Prevention Measures
 Protect your ear during flight
 Keep your ear free from foreign objects
 Guard against explosive noise.
 Drink plenty of water to keep your mucus thin.
Treatment
 Medical surgery for cholesteatoma and chronic Eustachian blockage
 Visit health clinic to get antibiotics
Tara Anand, Verywell Health
INNER EAR INFECTIONS
Signs and symptoms of inner ear infections
 Balance problems
 Dizziness
 Nausea and vomiting
 Tinnitus (ringing)
 Fluid draining from your ear.
Common Problem in the inner Ear
 Old age
 Noise damage
 German Measles (during
pregnancy)
 Malaria, high fever or headache
(childhood diseases)
 Meningitis
 Trauma
 Heredity
 Meniere Disease
The two main types of inner ear infections
are:
1. Labyrinthitis (affect hearing and
balance)
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Visit: https://www.my.clevelandclinic.org
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2. Vestibular neuritis (affects balance and eye movement)
Sources:
https://www.propelphysiotherapy.com
Treatment
Medical treatment is not recommended as this may delay and compensate the central nerves
system.
Factors that increase chances of developing ear infections are:
 Respiratory infections
 Changes of air pressure (airplane)
 Swimming in dirty water
 Cleaning ear too much with cotton bud
 Cut or scratch on the outer ear
 Not drying ear well after swimming or bathing
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HEARING IMPAIRMENT
Definition
HEARING
Hearing refers to the ability of sound by
the ear, its analysis and its transmission
to the brain.
IMPAIRMENT
Impairment is any loss or abnormality of
psychological, physiological or
anatomical structure or function.
HEARING IMPAIRMENT
Hearing impairment refers to a range of conditions that
affect an individual’s ability to hear. It is a full partial
decrease in the ability to detect or understand the sounds
and can be caused by biological or environmental factors;
loss of hearing can happen to any anybody.
DEAF
Deaf is a condition of hearing impairment
Types of Hearing Impairment

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

Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Central hearing loss
Conductive (Mechanical) hearing loss





Conductive hearing loss refers to decrease in sound
caused by a problem in the outer or middle ear.
Conductive hearing loss caused any condition or
diseases that affect the sound from the outer ear to
the middle.
It can be the result of blockage in the outer ear or can
be caused by any disorder.
The sound intensity or loudness of sound energy cannot reach at the inner ear or less
intense than that in the original stimuli.
It can be medically treated or hearing aids can be used effectively to correct remaining
hearing loss.
Sensorineural (Nerves) Hearing Loss
 It is refers to a problem located in the inner ear
or along the nerves pathway between the inner
ear and the brain.
 Sensorineural hearing loss affect in the inner ear
or auditory nerves dysfunction.
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 The sensory part may be damaged to the organs such as hair cells which gives message to
the nerves of hearing.
 It does not medically treated and therefore, it described as permanent condition
Mixed Hearing Loss
 Mixed hearing loss can be either in the outer,
middle or the inner ear.
 Conductive hearing loss can be occur when
sound waves do not reach the inner.
 Sensorineural hearing loss can be occur when
sound waves are not processed correctly in the
inner ear to the brain.
Central Hearing Loss
 It is caused by a problem with auditory
nerves or sound centre.
 The sound waves travel to the ear but
pathway from the nerves unable to send
electrical impulse to the brain and cannot
receive the sound correctly.
 The common symptom is the ability to
detect sound but not being able to
understand it.
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COMMON CAUSES OF HEARING LOSS
Duration of Hearing Loss
Duration of hearing loss depend on its causes, hearing loss may be temporary or permanent.
Temporary hearing loss is always conductive while permanent hearing loss is sensorineural. The
chart below shows the relationship and outlines the causes.
Temporary Hearing Loss


More common
Mostly conductive
Middle ear fluid and
other causes
HEARNG LOSS
Permanent Hearing Loss


Structural
Problem
Less common
Mostly sensorineural
Drug Related
Genetic
Infections
Physical Trauma
Causes of Temporary Hearing Loss are:




Fluid in the middle ear due to infections
Eardrum perforation
Narrowing of ear canal due to surgery or diseases
Excessive ear wax that plugs the ear canal
Causes of Permanent Hearing Loss are:





Genetic
Infection
Drug Related
Physical Trauma
Structural Causes
CAUSES OF PERMANT
HEARING LOSS
Genetic
Infections
Drug Related
Structural Problems
This information on the pie chart allow
better treatment and management of
hearing loss and make prediction for the
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Physical Trauma
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chances of future children who will have hearing loss. For more information, download free
book at https://hearing.harvard.edu
Genetic
There are two types of hearing loss caused by genetics.
1. Syndromic hearing loss: other health problems in addition to hearing loss and about
30% of people with syndromic hearing loss such as vision impairment, kidney or heart
problems.
2. Non syndromic hearing loss: The person only has hearing loss and it is about 70% of
people have non syndromic hearing loss.
Infection
During Pregnancy



Diseases caused by viruses like rubella
Syphilis
Toxoplasmosis (consumption of food or water contaminated with animal faeces or raw
meat)
After Birth


Infections caused by bacteria (Bacterial meningitis, syphilis)
Infection caused by virus (measles, mumps)
Drug
Drugs and other chemical can be the causes of hearing loss. It may affect the foetus while others
are after the birth
During Pregnancy


Alcohol
Medication (Chemotherapy)
After the Birth

Ototoxic drugs (e.g. aminoglycoside antibiotics)
Physical Trauma


Head injuries
Exposure to loud noise
Structural Problem of the Ear
Sometimes person can be born with incomplete ear. This could affect all three parts of the ear.
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


Stenosis (narrowing of the ear canal)
Malformation of outer ear, ear canal, eardrum or ear bones.
Inner ear malformation (enlarge vestibular)
Summary
Finding the causes of hearing loss is not an easy job. Making an accurate diagnosis and finding a
way to manage the hearing loss requires a combination of:




Physical exam
Family history
Clinical test (genetic test, CT scan)
Ongoing hearing test with and audiologist
It is best if hearing loss is identified early. It is very important that help for the hearing loss begin
as early as possible such as communication therapy, parents support, hearing aid and cochlea
implant. The child should also enrol in an early intervention program. This program will help the
children with hearing loss have chances to develop their language and speech, social interaction
and improve academic results.
Sources: Causes of Hearing Loss; For Parents & Families (Handbook pdf) _Harvard Medical
School, Centre for Hereditary Deafness
DEGREE OF HEARING LOSS
Degree of hearing loss refers to severity level of hearing loss. Classifying hearing loss on a
percentage is inaccurate way to label hearing loss and make it difficult for the person with
hearing loss to understand the audiogram. It is classified as:
 Mild hearing loss: Person with mild hearing loss may have difficulty hearing the soft
consonant sound. Noisy environment make hearing more complicated.
 Moderate hearing loss: People with moderate hearing loss may have difficult to hear
conversation and ask to repeat the conversation, if they do not used hearing aid.
 Severe hearing loss: People with severe hearing loss used hearing aid to understand the
speech and the conversation is conducted loudly.
 Profound hearing loss: People with profound hearing loss cannot hear person has
speaking. Hearing aid is used to understand speech.
Hearing loss is described by level for decibel (dB), which measures loudness and softness level
of sound. A chart or graph that shows that result of hearing test is called Audiogram
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AUDIOGRAM FOR THE LEVEL OF HEARING
Audiometer is an instrument used to measure loudness or softness of sound and its unit is called
decibel (dB). For instance, dog barking is 75dB which is considered as severe hearing loss.
Frequency is used to measure the high and low pitch sound and its unit is called Hertz (Hz). For
example, human can be eligible to hear sound low as 12Hz and high as 28 kHz. The human
auditory system is more sensitive to frequencies between 2,000 to 5,000 Hz.
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The level of hearing loss is summaries in an audiogram shown below.
LOW
125
Pitch in Hz
250
500
1000
2000
High
4000
Symbol
O = Result, Right Ear
8000
X = Result, Left Ear
10
Soft
0
10
S = Result, listening through
speaker
Normal hearing
20
30
Mild Hearing Loss
40
50
Moderate Hearing Loss
60
(dB)
70
Severe Hearing Loss
80
90
100
Profound Hearing Loss
110
Loud
120
The series of letter X and O represent on the audiogram are left (X) and right
(O) ear. Their position indicates the softest sounds that we can hear across a range of
frequencies. This is called threshold. It is running from bottom to top on the left side of the
graph is indicate the loudness in decibels. Low to high pitch sound are shown from left to right at
the top of the graph
Audiogram can help person diagnose issues and find other inner ear problems. After hearing test,
the result will be represented on an audiogram. (www.audiogram/graph.com)
Hearing loss can be described as:



Unilateral or Bilateral: hearing loss in only one side ear is described as unilateral while,
in both ears are called Bilateral hearing loss.
Pre-lingual and Post-lingual: hearing loss occurs before a person or children learn to
talk is described as Pre-lingual deafness, and after person or children learnt to talk is
called post-lingual deafness.
Congenital or acquired: hearing loss is present at birth is described as congenital
whereas, appears sometime later in life is called acquired or delayed onset hearing loss.
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LIFESTYLE ADJUSTMENT FOR INDIVIDUAL WITH HEARING IMPAIRMENT
How to Manage Hearing Loss and Maintain Healthy Lifestyle:
Healthy lifestyle prevents you from any infections or hearing loss. Some common healthy
lifestyles to manage our hearing loss are:
Get regular hearing test:
Regular hearing test will help to get right treatment for specific hearing loss, because every day,
we exposed to loud sound. Hearing test is conducted by the audiologist frequently to check and
seek if the hearing is deteriorating further or stays the same. For example, problem in the middle
ear is the factor of sound traveling from the outer to your inner ear. Test to assess the middle ear
are tympanometry, speech test, ear screening test and Tuning Fork test.
1. Tympanometry
Audiologist scans the ear to know how the eardrum moves. It is a small device placed into the
ear canal. A machine record the movement on tympanogram, a device that shows the result in
graph form as shown on previous page 16.
Source:
https://www.hearillinois.com
2. Speech Test
It is to determine how well you can hear spoken
language. You will put a pairs of headphones
and audiologist speaks to you through the
headphone, asking to repeat words all in
different volume. They will record the lowest
words are able to hear.
Source: iHear Better Now, Hearing & ENT Centre
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3. Ear screening test
It is carried out to find which ear is involved hearing loss. This test will help to determine the
types of hearing loss that the child is experiencing such as conductive, sensorineural or mixed
hearing loss. Audiologist hit on any objects and ask the child to hear or not and record the
results. See appendix for ear screening hearing test form
4. Tuning Fork Test
Tuning fork is a small metal device with two prongs that produce a sound when it vibrates.
Audiologist places the tuning fork behind the child’s ear or above the head and hit the fork to
make sound. As the child where he or she hears the sound like left ear, right ear or both. The
position of the tuning fork helps to detect the types of hearing loss.
By Magaret Etudo, 2024 Test for hearing Test
(a): Weber Test (Where do you hear the sound)
(b): Rinne Test (Bone Conduction)
(c): Rinne Test (Air conduction)
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Focus on your nutrition:
Eating balance diet can help to protect your hearing from any hearing loss. It may also reduce the
risk of developing hearing infections. Examples of food are: fish, broccoli, banana, garlic and
legumes.
Source: La Canada
Hearing Aid and
Audiologist
Try to limit the amount of loud sound:
Loud noises are the common causes of
hearing loss that affect individual who
experienced mild, moderate, severe
profound hearing loss. Today, most of the
young people are using ear piece listening
to music and enjoy themselves without
realizing the effect of the direct sound into
the ear canal. Therefore, keep your ear
piece at a reasonable volume to prevent
your ear become deaf.
In order to protect your hearing
Source: World Health Organisation (WHO, 2024)
 Keep the volume of music or ear
pieces down
 Wear earplug for noisy places
 Stay away from any sources of sound like speaker or noisy machineries
 Limit the time spent engage in noisy activities
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Give up smoking and other drugs
Smoking and other drugs can cause blockage that end up leading to lose your hearing. It may
also affect the nerves system causing person become deaf or may affect the baby in the womb.
Avoid smoking and drinking alcohol can help you to stay healthy lifestyle.
According to research by National Library of Medicine (NLM) 2024, demonstrate that higher
risk of hearing loss among cigarette smokers about 75% of people with hearing loss were
reported compare to non-smokers.
Sources: National Drug and Alcohol Fact Week (March, 22-28th 2021)
TYPES OF HEARING AIDS
Hearing aid is a device used to improve hearing by making the sound audible to individual who
suffer from hearing loss. It is invented by a son of deaf man Miller Reese Hutchison in 1898.
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There are different types of hearing aids.
1.
2.
3.
4.
5.
Behind – The –Ear (BTE)
Receiver-In –The- Canal or Receiver-In-The-Ear (RITC)/(RITE)
In-The-Ear (ITE)
In-The-Canal (ITC)
Completely-In- Canal (CITC)
Behind-The- Ear (BTE)




Behind-The- Ear (BTE) hearing aid is placed behind the ear.
A separate pieces known as earmold or thin sound tube with a soft silicon earpiece is
used to direct sound into the ear canal.
It is a more durable hearing aid as the electronic parts are away from the ear canal due to
the effect of ear wax, discharge or moisture.
It comes in different sizes depend on their power
performance.
Advantages




Suitable for all degree of hearing loss, including
profound hearing loss.
Available for wireless connectivity device.
Earmold is custom fit and can be replaced separately.
Less susceptible for moisture damage.
It is most suitable for:


Mild to profound hearing loss
Individual children with arthritic conditions
Receiver - In-The -Ear (RITE)


It is more comfortable than BTE as it inserted into the ear covered by a soft pliant silicon
tip.
RITE’s main body sits behind the individual’s ear while the receiver or speaker sits in the
ear canal
Advantages



Comes with rechargeable battery option
It is wireless connectivity devices
Speaker can be replaced separately.
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It is most suitable for:


Patients who experienced mild to profound hearing loss.
Those who have an excellent ability to handle small object.
In-The-Ear (ITE)


It is more comfortable hearing aid sit
visible part of an individual’s ear.
Due to its sizes, ITE is easier to manage
and for moderate to profound hearing
issues with no eyesight problems.
Advantages


Ability to use telephones and handset
normally
Camouflage in the ear
In-The-Canal (ICT)


It is placed in the ear canal and even more visible that BTE
It is preferred choice of individual who wish to keep their hearing private.
Advantages



Discreet
Longer Battery life
More features than IIC and CIC
It is more suitable for:


An individual looking for discretion
Individual with mild to moderate hearing loss and
those who struggle on the phone.
Completely-In-Canal (CIC)



It is known as second smallest custom made
hearing aid.
It is not suitable for older people with sight
problems and children
It is more suitable for those who suffer mild to
moderate hearing loss, with ability to handle
small object.
Advantages
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

Very discreet
High sound quality because of how they fit within the ear.
For more information, visit: https://www.jglasseshearing.com.
EFFECTS OF HEARING IMPAIRMENT ON EDUCATIONAL AND SOCIAL
DEVELOPMENT
Educational Development




Affect language or speech development
Poor academic result
There is a gap in academic achievements
between hearing impaired students and others.
Children with severe to profound hearing loss
usually achieve skills no higher than others,
unless early educational appropriate intervention.
Social Development
 Lack of social interaction or socialization
 Communication problems, contributing to social
and behavioural difficulties.
 Adjustment problems or serious social adaptation
 Difficulties with interpersonal relationships
What a Regular Class Teacher in a Primary School can do to support students with
hearing impairment in a class or school?
1. Mild hearing loss
 Avoid background noises
 Speak slowly, clearly and loudly
Teaching strategies




Emphasis of the important instructions/keyword
Allowing children time to find out about the topic in advance.
Writing new vocabulary on the flipchart or blackboard.
Make sure pace of discussion is not too fast in oral lesson
2. Moderate Hearing Loss
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 Get the child’s attention by waving your arms or touching the child gently before
speaking.
 Do not stand in front of window or a light when
speaking.
 Do not cover your mouth with your hand as it
distorts speech sound.
Teaching Strategies





Uses of visual clues to make it clear what is
being said.
Giving homework instructions when the class is
quiet.
Rephrasing and repeating phrases and words not
understood.
Keeping class noise as low as possible
Not walking around when giving instructions
3. Severe Hearing Loss
 Face the child when speaking, and do not turn your back.
Teaching Strategies

Allowing children to make sure that the instructions are clear.
4. Profound Hearing Loss
 Use your face, hands and body to help express what you wish to communicate.
Teaching strategies


Adapting outdoor activities to ensure full participation and safety.
Avoid giving notes to the class orally.
Possible placement options for students with hearing Impairment
 In classroom situation, the child should be placed him/her front.
 Hearing impairment students should be placed in a special school especially for those
who are severe and profound hearing loss.
 Those with mild and moderate hearing loss ca be included with others in regular schools.
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Additional Teaching Strategies are:
There are some different kinds of inclusive teaching strategies that can assist all students to learn.
However, some specific teaching strategies are useful for teaching students with hearing
impairment.








Encourage students with hearing impairment to sit in
front. This is important for the students to master
the lip-reading, facial expression and body
gesture and teachers to respect their choices.
Uses assistive devices such as hearing aid
Ensure that any background noise is
minimized
Repeat clearly any questions ask by students
in the class
Do not talk when facing the blackboard
Provide written notes rather than oral.
Allow assignment or reviews to be completed on an
in depth study of few text rather than broad study.
Invite sign language interpreter to promote teaching styles.
Assessment Strategies
Always consider alternative form of assessment where necessary. Standard are not expected to
be lowered to accommodate students with hearing loss but rather are required to give them a
reasonable opportunity to demonstrate what they have learnt. Once you have a clear picture of
how the hearing loss impact on learning. You can consider the alternative assessment strategies.
 When their range of literacy is an issue, students may require the use of dictionary during
exam.
 Provide alternative assignment which are based on interview, questionnaire and be
flexible with assignment due date, particularly if students have to wait for report card of
learning session.
 Provide extra time in examination, particularly for reading questions. Some students will
prefer to have questions and instructions sign to them.
LANGUAGE AND COMMUNICATION OPTIONS
How will Children Learn to Communicate?
What are some options?
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Australian Sign Language: This is a manual sign language that is not based on the English
language. This is the language used most of the deaf community in the pacific countries
including PNG.
Source: www.deafbook.co.uk
Auditory Verbal: This method teaches the child to
develop listening skills through on and on therapy. It
teaches the child to use the hearing aid. It is
recommended that No sign language or any type of
manual communication be used with the students
when using auditory verbal approaches.
Source: Stepping Stones Therapy, Auditory Therapy
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Cued Speech: This is a mode of communication using 8 hand shapes or cues that represent
sound of speech. The speaker uses the cues while speaking. These cues help the students
distinguish sounds that look similar on the lips. The students will use their hearing aid to
maximize the hearing. Cues speech can be learnt through classes taught by a trained therapist. It
takes some time and lot of practice to learn cued speech and to become proficient.
Source: Facebook Page Cued Speech Go
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Oral Auditory: This is a program that helps the child learn to use their remaining hearing to
maximum extent possible through the hearing aids such cochlea implant, FM system. Students
need to be taught to lip and read as well. Manual or sign language communication is not used
with is program. Some natural gesture can be used.
Source: Carle Auditory Oral School
Total communication: This option uses all means to teach communication with deaf children.
This might include sign language, fingers spelling, natural gestures, speech reading, body
language, oral speech and the uses of hearing aids. The aim is to teach language by whatever
means that is effective for the child.
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Lip Reading/Speech Reading
Lips reading as defined by Wikipedia:
A technique of understanding speech by visually interpreting movement of the lips, face and
tongue with information provided the context, language and ant other residual hearing.
It is estimated that 30% - 40% of sounds in the English language are not distinguishable by sight
alone. When speaking to a person that is a good lip reader, it is not helpful to exaggerate your
mouth movement because it makes difficult for them to read your lips. A person that lips read
also will use visual cues from the environment, and knowledge they have about what is being
discussed.
Not all the children or people with hearing
impairment are good lips readers. For some people, it
may come easy but others have to be taught and even
then it might not work for them. Being able to lip
reading might be considered a gift or a talent.
Visual Phonics
Visual phonics was created by a mother of 3 deaf children. It was a system of 45 hand signs that
look like and feel like the sound that they represent. There also written symbols that looks like
the hand sign. Visual phonics help students learn to read spell and speak.
Visual phonics is a way that helps students learns difference between the letters and the sound.
They will learn the letters and sound makes along with the symbol which give them a visual in
relationship to sound.
Visual Phonics has three Parts
1. Sign system for sound. The hand will mimic the mouth to
help the child see how the sound is made.
2. Written Symbol: It look like the hand motion used to imitate
the mouth and how the sound is made.
3. Pictures for Words:
If I cannot learn the way you teach me…Teach me the
way I learn!!!!
Sources: Socony Mobile –Oil Co. /Alphabetic Phonics Teacher
Training.
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ACCOMMONDATION FOR THE CLASSROOM








Provide students with an outline of the topic being discussed beforehand so the students
can go over it with the teacher, or speech therapist. Some of the vocabulary many need to
be pre taught.
Use visual aid as much as possible, such as pictures, videos, or overheads
Make sure any movies that are shown are closed captioned versions.
Provide a note taker,
especially if the student is
watching an interpreter. A
student cannot watch the
interpreter and take notes at
the same time.
Write important instructions
on the board; give students a
written copy of notes.
Write key vocabulary on the
blackboard or give students a
written copy of the words or
text.
Reduce the student’s distance from the speaker if possible.
Assign a hearing buddy to the students, if appropriate.
Emergency Situations at School
This is extremely important!!! Do not forget these students have unique needs in an emergency
situation. They need to be taught prior to an actual emergency situation how to respond, what to
do in the events of natural hazards. To be in compliance with American Disabilities Act (ADA),
there must be flashing exist strobe light in every school building. Parents may need to consider
them at home. There should be planned in place as who is going to do for emergency situation. If
students are older and change from class to class, they know whom to go for help and assistance.
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Appendix:
1. Hearing Handicap for the Elderly (HHIE) - Screening
Name: __________________________
Date: ________________
The purpose of this scale is to identify the problems your hearing loss may be causing you. Tick
“Yes”, “Sometimes”, or “No” for each questions. Do not skip any questions. If you are using
hearing aid, please answer the way you hear without hearing aid.
1
2
3
4
5
6
7
QUESTIONS
Does a hearing problem because you to feel frustrated when talking
your family members?
Do you have difficult hearing when someone speaks in a whisper?
Do you feel handicapped by hearing problems?
Does hearing problem cause you to talk less on the phone?
Does hearing problem affect you study?
Does hearing problems cause you nervous?
Does hearing problem cause your social relationship with others?
Does hearing problem cause you to go for church service?
Do you have difficult hearing when watching TV or movies?
Do you feel that any difficult with your hearing your personal life?
Does hearing problem causes you felt sad?
Does hearing problem cause you to avoid talking?
Do you have difficult hearing teacher someone talking in a normal
voice?
2. Ear Screening Form
Name: ______________
Grade: __________
Hearing Test Using
Noisemaker
Yes sometimes No
Procedures
Gender: ________
D.O.B: _________
A. Screening of Hearing Test
School: _____________ Date: ___________
1. Prepare a blocks and a rice
container
Yes/No
Right ear
Yes/No
Left ear
Level of hearing
Block
Voice
Rice (shake gently)
Rice (Roll gently)
2. Position a child four meters
away from the teacher.
3: Bang the blocks at once. If
the child respond then raises
his /her hand up.
Comment: __________________________________________
4. If the child cannot respond
to the sound, then bang the
blocks twice.
C/Teacher: ____________ H/Teacher: _______ Date: __________
5. Record the results
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3. Questionnaire to Identify Risk for Hearing Loss (Children 5 years of age
and above)
Name: ___________ Gender: _______ DOB: ____________ Date:
1. Have you gone through any hearing screening at birth?
= Yes
= No (1 point)
2. Did you go for hearing test before?
= Yes
= No (1 point)
3. Is there any history of deafness in your family? Who?
= Yes (1 point)
= No
4. Did you have any health problems? (meningitis, brain injury, otitis media, or any ear
infection)
= Yes (1 point)
= No
5. Do you pay attention to loud noise?
= Yes
= No (1 point)
6. Do you pay attention when someone called your name?
= Yes
= No (1 point)
7. Have y ou need any body gesture or voice used at high intensity to understand?
= Yes (1 point)
= No
8. Do you hear well when someone is talking?
= Yes
= No (1 point)
9. Do you understand orders even if he/she is not looking at a speaker? (Bring the spoon to
me without pointing to the object?
= Yes
= No (1 point)
10. Do you like listening to music
= Yes
= No (1 point)
11. Does someone comment that you didn’t hear well and your speech is very sad?
= Yes (1 point)
= No
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4: Sound Range of Hear and Range of Hearing Loss
Category of Hearing Loss
Mild hearing loss
(26 dB to 40 dB)
Moderate Hearing Loss
(41dB to 55dB)
Moderate severe hearing loss
(56dB to 70dB)
Severe Hearing Loss
(71dB to 90dB)
Profound Hearing Loss
(Over 90dB)
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5. SIGN LANGUAGE
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GLOSSARY OF TERMINOLOGY
Words
Meaning
Acquired hearing
loss
Anatomy
Audiogram
Audiometer
Auslan sign
language
Behind The Ear
Hearing loss which appears after the birth at any time due to the results of an
infections or injury.
Parts of the body
A chart that shows the result of hearing test
An instrument use to measure loudness or softness of the sound.
A sign language used by Australian Deaf community, British and the rest of the
pacific countries including PNG.
Hearing aid consists of hard plastic case worn behind the ear and connected to a
plastic earmold that fit inside the outer ear.
Type of hearing loss due to dysfunctions in the central auditory processing
system.
Sound not passing through the outer ear.
Hearing loss present at birth such as heredity in new born babies.
Central hearing
loss
Conductive
Congenital hearing
loss
Cued speech
Deaf
Decibel
Degree of hearing
loss
Dizziness
Earmold
Frequency
Hearing
Hearing
impairment
Hertz
impairment
Labyrinthitis
Lips reading
Meningitis
Meniere disease
Mixed hearing loss
Oral auditory
Pathology
Physiology
Post –Lingual
Hearing Loss
Visual mode of communication that uses hand shapes involves with mouth
movements and speech.
Conditions of hearing impairment
A unit measure the loudness and softness of the sound (symbol dB)
Severity levels of hearing loss
Range of sensation, such as feeling, faint, woozy, weak or unsteady.
Custom-fitted mould of pinna and the ear canal that connect with BTE hearing
aid through soft tube and amplify sound to the ear.
Measure the high or low pitch sound
Ability to hear sound
Range of conditions that affect ability to hear.
A unit used to measure or record the high or low pitch sound.
Any loss or abnormality of psychological, physiological or anatomical structure
or function
Inflammation of the inner ear or the nerves that connect the inner ear to the brain.
A technique of understanding speech by visually interpreting movement of the
lips, face and tongue with information provided the context, language and ant
other residual hearing.
The inflammation of the tissues surrounding the brain and spinal cord caused by
infections such as bacteria, viruses, fungus and parasites.
An infection in the inner ear which affect hearing and balance.
Sound not passing through outer, middle and inner ear.
An approach use to teach infant and young children to use hearing and speech to
develop spoken language for communication and learning.
Diseases of the body parts
Functions of the body parts
Hearing loss occur after a child has learnt some language.
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Pre-Lingual
Hearing Loss
Receiver- In- The
Ear (RITE)
Sensorineural
Hearing Loss
Total
Communication
Tympanometer
Tympanometry
Tuning Fork Test
Vestibular Neuritis
Visual phonics
Hearing loss occur the child who born deaf or who lost his or her hearing early in
childhood before acquiring language.
A style of hearing aid similar to BTE hearing aid with speaker that sits in the ear
canal.
Hearing loss caused by damaged to the inner ear or the nerves from the ear to the
brain.
An approach uses of different teaching methods involves body gesture, sign
language, drawing, facial expressing and mime.
An instrument used to record or print out the problems in the middle ear.
A test only checks for signs of problems in the middle ear.
A small metal device with two prongs that produce a sound when it vibrates
An inflammation affect the inner ear balance
A system of 45 hands and symbol cues that represent the phonemic of spoken
English.
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Reference
A.M. J Med, (2020): Cigarette Smoking, A Risk of Hearing Loss in women. National Library of
Medicine; 133(10): 1180 -1186. Doi: 10.1016/j.amjmed.2020.03.049.
ASLHA, (2024): Effect of hearing Loss on Development; Reading rockets; Speech, Language &
Hearing,
Australian Commission on Safety and Quality Health Care Review (2024) (Middle ear
Infections: Should my Child Take Antibiotics?), Infections and Clue Ear, Acute Otitis Media
Emergency Management Children
Cleveland Clinic (2021): Functions of Hearing: https://my.clevelandclinic.org
Curtis L, (2023): Signs and Symptoms of Ear Infections. Website: https://my.clevelandclinic.org
Dr. Elimers Hearing Clinic, (2023): How to Manage Hearing Loss and Maintain Healthy
Lifestyles: https://drelimershearingclinic.com
Dr. M. Abhisek, (2018): Disability Management and Special Education, Volume 1, No.1
ESE 324, Inclusion of children with Hearing Impairment, Course Handbook, University of
Goroke compiled by Ms. Donna Mailil, February, 2022
Frangulov A, (2004): Common Causes of Hearing Loss, For Parents and Family, Harvard
Medical School: Centre for Hereditary Deafness; Website: https://hearing.harvard.edu
Happy Ear Hearing Centre: Degree of Hearing Loss: www.happyearshearing.com
Hearing Health Care Centres, (2016): Disorders of the Outer Ear and Hearing Loss:
www.hearinghealthcarescentres.com /https://typesofheaing.org/uspstf/
Meeting the Needs of Students Who are Deaf or Hard of Hearing, Educational Services
Guidelines, National Association of State Directors or Special Education Inc. July 2006;
www.nasde.org/projects/deafEducationInitiatiave/tabid/412/default.aspx
Ohio Coalition for the Education of Children with Disabilities, (2015): A guide for Parents and
Educators of Deaf or Hearing Impairment. P.24-30. Website: https://www.i-nigma/pdf.com or
www.ocecd/.org
Sherard Audiology and Hearing Centres, 2024: Hearing Aid Styles:
https://sherardaudiologhearingcenterd/hearingaidstyle/
World Health Organisation, (2024): Deafness and Hearing Loss: Safe Listening:
https://worldheathoragnisation.int/news-room/
Strategies for teaching students with hearing impairment; https://www.as.wvu.edu/scidis/hearing.html
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