Los Angeles Unified School District
Division of Special
Education
Schools for All
Children
Audiologic
Resource Unit
Donnalyn Jaque-Antón
Associate Superintendent
Overview
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Audiometry or Audiology ??
Types of Hearing Loss
Degrees of Hearing Acuity
Reading the Audiogram
Educational Implications of Hearing Loss
The Unfair Hearing Test
Help for Students with Hearing Loss
ARU Services
The ARU Referral Process
The DHH Referral Process
Contacts
Acknowledgements
Resources
Educational Audiology
Program
Audiologic Resource Unit
(ARU)
LAUSD System:
Audiometry and Audiology
 Audiometry
– Student Health
& Human Services
– Travels to schools
– Screens hearing
– Refers to audiology (ARU)
as needed
 Audiology
– Division of Special Education
– Works in a permanent sound
booth
– Provides comprehensive
evaluation of hearing
– Refers to DHH as needed
LAUSD System:
Audiometry and Audiology
 Audiometrists go to schools and screen
the hearing of students
 If the student fails this hearing
screening…
 She/he may be referred for a more
comprehensive audiological evaluation by
an Educational Audiologist in a sound
room (at the ARU)
Types of Hearing Loss
 Conductive
– Usually not permanent
– Often treated medically
– Left untreated, loss may become
permanent
– Affects outer and middle ear
Conductive loss
= Problem in
outer and/or
middle ear
Types of Hearing Loss
 Sensorineural
– Permanent hearing loss
– Affects inner ear (sensory), and/or
– Auditory nerve (neural)
Sensorineural loss
= problem with
inner ear (cochlea)
and/or nerve
Types of Hearing Loss
 Mixed Hearing Loss: combination of
– sensorineural (permanent)
AND
– conductive (usually temporary)
Mixed loss
Problem in outer
and/or middle ear
along with problem
with inner ear and/or
nerve
Degrees of Hearing Loss
 Normal Hearing ~ 0-15
decibels
 Minimal (Borderline) ~ 16-25
decibels
 Mild ~ 26-40 decibels
 Moderate ~ 41-70 decibels
 Severe ~ 71-90 decibels
 Profound ~ 91+ decibels
Audiogram
(graph of hearing status)
low pitch
high pitch
(FREQUENCY)
soft
= RIGHT EAR threshold of hearing
(DECIBELS)
loud
= LEFT EAR threshold of hearing
Frequency (pitch)
Low pitch
soft
Loudness
(decibels)
Average
conversational speech
level
loud
High pitch
= RIGHT EAR
(Remember
red/round
= RIGHT)
 Student can hear
sounds BELOW the line
 Student will have
difficulty hearing sounds
above the line
= LEFT EAR
 Student can hear
sounds BELOW the line
 Student will have
difficulty hearing sounds
above the line
= RIGHT EAR
= LEFT EAR
You may see both
ears on the same
audiogram
This audiogram
indicates a mild to
moderate loss in the
right ear
and a moderate to
profound loss in the
left ear.
Educational Implications of
Normal Hearing
 Child detects complete speech signal even
at soft conversational level
 Good hearing does not preclude auditory
processing problems
Educational Implications of
Minimal (Borderline) Loss
Child with a cold or the consistent mouth
breather…
 May have difficulty hearing
– Faint or distant speech
– At a distance
– If classroom is noisy
 May miss portions of fast-paced interactions
 May fatigue more easily because of listening
effort
Educational Implications of
Fluctuating (conductive) Loss
 Hearing ability may change daily
 Typical of listening with fluid behind
eardrum
 Can “hear” but misses fragments of the
message
 May be accused of “daydreaming” or “not
paying attention”
 Speech and listening/attention skills may
be affected if child experiences chronic
fluctuating hearing acuity before age 7
years
Educational Implications
of Mild Loss
 Degree of difficulty experienced depends
on
– Noise level in classroom
– Distance from teacher (speaker)
– Configuration of hearing loss
 May miss portions of fast-paced
interactions and classroom discussions
 Student often accused of
– Not paying attention
– Hearing when s/he wants to
 Increased fatigue from listening effort
Educational Implications of
Moderate Loss
 Difficulty understanding conversational
speech at a distance of 3 feet
– Needs face to face communication
– Needs structure and vocabulary controlled
 Communication characterized by
– Delayed receptive and expressive language
– Limited vocabulary
– Articulation errors
Educational Implications of
Moderate-Severe Loss
 Communication significantly affected
 Marked difficulty in verbal communication in
both one to one and group situations
 Social interaction is increasingly difficult
 Communication may be characterized by
– Delayed receptive and expressive language
– Limited vocabulary
– Articulation errors
 Possible impact on self-esteem
Educational Implications of
Severe Loss
 May hear loud noises one foot from ear
 If loss is pre-lingual in onset, oral language
and speech may not develop spontaneously
or will be severely delayed
 If hearing loss is progressive or sudden,
speech may deteriorate
Educational Implications of
Profound Loss
 Most students cannot depend solely on
listening for communication access
 Degree and configuration of loss will affect
speech skills
 If loss is pre-lingual in onset, oral language
and speech will not develop
spontaneously or will be severely delayed
 If hearing loss is progressive or sudden,
speech may deteriorate
Unfair Hearing Test
Children with Hearing Loss
Need …Our Help!
 Early intense intervention is essential for
receptive and expressive language
development
 Students need appropriate and consistent
amplification for all their waking hours from
an early age
 Classroom acoustics need to be arranged
to the student’s advantage… (think about
things that make it easier for YOU to hear in
a group situation)
Help for Students with
Hearing Loss
 Flexible/preferential classroom seating
 Amplification/FM systems
–
–
–
–
Personal hearing aids
Personal FMs
Classroom speaker system
Personal speaker system
 Acoustic modifications of classroom
Audiologic Resource Unit
(ARU) Services
 Provides audiologic evaluations for any child
residing within the geographic boundaries of
LAUSD, infant to age 22
 Educational Audiologists provide designated
instruction and services (DIS) to Deaf and
Hard of Hearing Special Day Programs to
– Ensure properly functioning amplification systems
– Support teacher in developing skills for use of residual
hearing
Audiologic Resource Unit
(ARU) Services
 Provides resource to DHH Itinerant
Program regarding
– Residual hearing
– Amplification systems
 Provides counseling to parents regarding
– Hearing loss
– Amplification
– Services and resources available to the student
Audiologic Resource Unit
(ARU) Services
 Provides professional development to
District staff and outside agencies
 Refers for possible assistance through
California Children’s Services (CCS) for
coverage of hearing aids and hearing health
care services
Referral Process For Students with
Suspected Hearing Loss
 Begins with a referral to the ARU
If...
– Student fails hearing screening (at school, by
Audiometry)
OR
– Student has an audiogram from outside facility
OR
– Student has known hearing loss
OR
– Parent/school requests audiologic evaluation
LOS ANGELES UNIFIED SCHOOL DISTRICT
DIVISION OF SPECIAL EDUCATION
AUDIOLOGIC RESOURCE UNIT
(213) 241 - 8258
REFERRAL FOR ARU SERVICES
Student Name: _______________________________________ Birth date: ________________
Address: ____________________________________________ Home Phone: ______________
Parent/Guardian: _____________________________________ Work phone: ________________
School: ___________________________ Loc.District: _______ Home language: _____________
REASON FOR REFERRAL
 Failed hearing screening (Date____________)
 D HHitinerant assessment; 3rd Year (Date ________________)
 Hearing loss suspected
Comments___________________________________________
Student is receiving special education services  No  Yes
If yes, please specify program:  Special Day Class _________________(Please attach a copy of
current IEP)
 Itinerant
DHH ___ LAS ___ RSP ___ APE ___ VH ___
Comments:________________________________________________________________________
Fill in all identifying information
Include reason for referral
Identify special education services student is receiving, if any
Include any other information to assist the audiologist
PERTINENT HEALTH INFORMATION: (per health office)
MEDICAL
 chronic ear infections  PE tubes  Other _________________________________
 under private medical care; Physician ________________________________________
Comments: ____________________________________________________________________
AUDIOLOGIC
Has the student had a recent AUDIOLOGIC evaluation?  No  Yes If yes,
Date/Location____________________________
and please forward a copy of evaluation to: AUDIOLOGIC RESOURCE UNIT
AMPLIFICATION STATUS:
Does the student have hearing aids?  No  Yes, Right_______ Left________
Dispenser______________________________
Is the student using amplification on a consistent basis?  No  Yes
Comments: ______________________________________________________________________
Student’s health history has important implications for referral
process…. please fill this out as fully as possible
Information from outside service providers is essential to
appropriate diagnosis and management of hearing
impairments…if they have had private hearing tests please attach
a copy!
STUDENT PERFORMANCE: (per classroom teacher)
SPEECH & LANGUAGE
Is a speech/language problem suspected?
 No  Yes If yes,
Comments____________________________________________________________________
ACADEMICS
 Above grade level
 At grade level
 Below grade level
Comments:_________________________________________________________
ATTENTION
 Good work habits  Completes assignments  Short attention span  Easily
distracted  Follows oral directions
Comments:_________________________________________________________
BEHAVIOR
 Well-behaved  Cooperative  Helpful  Easily frustrated
 Behaves inappropriately  Relates well with peers
 Interacts with peers inappropriately
Comments:_________________________________________________________
Referred by
Received by
________________________________
School Designee
________________________________
Audiologic Resource Unit
Date ___________________
Date ___________________
Student’s performance provides valuable information for establishing
testing conditions… we may need two audiologists to test this student
reliably
Remember… although you know the student, the educational
audiologist has only the information you provide
Referral Process for DHH
Services
 Based on the hearing evaluation, the
ARU determines whether
– Student has normal hearing, ending DHH
referral process
– Student’s hearing loss may adversely affect
academic performance and/or access to the
core curriculum, necessitating a referral to
DHH for assessment to determine eligibility for
DHH services
Referral Process for DHH
Services
 ARU will
– Complete a report of each student tested
– Complete page 1 of “Request for Special
Education Assessment” and
 ARU will mail the above to
– School
– DHH Office
Referral Process for DHH
Services
 School will:
– In order to make sure all areas of parental
concerns are addressed the school will assist
parent in completing page 2 of Request for
Special Education Assessment: “Student
Information Questionnaire”
– The school will generate Assessment Plan within
15 days, including all areas of suspected
disability
Referral Process for DHH
Services
 School will
– Check areas specific to DHH assessment
• Academic-DHH assessor
• Communication-DHH assessor and/or speech-language
pathologist
• Health-nurse/doctor
– Send copy of signed Assessment Plan and
Student Information Questionnaire to DHH
Program, Beaudry-16th Floor
Referral Process for DHH
Services
 When signed Assessment Plan is
received the DHH Assessor will contact
school to arrange DHH Assessment to
determine if
– Hearing loss impacts access and progress in
standards based core curriculum
– Hearing loss impacts communication skills
adversely affecting educational performance
Referral Process for DHH
Services
 Once all assessments are completed,
school will
– Contact all committee members
– Schedule and complete IEP within 50
day time-line
 Student’s eligibility, determination of
services and placement will be
discussed at the IEP Team Meeting
For Assistance Please
Contact
Audiologic Resource Unit
333 South Beaudry Avenue-16th Floor
Los Angeles, California 90017
(213) 241-8053
Marilyn Geffeney, Coordinator, ARU / DHH
(213) 241-8225
Roe Saxman, Senior Audiologist
(213) 241-8258
Acknowledgements
 Authors
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–
–
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Marilyn Geffeney, Coordinator ARU / DHH
Roe Saxman, Senior Educational Audiologist
Sandy Keaton, Educational Audiologist
Patty Klein, Educational Audiologist
With input from the
Audiologic Resource Unit Educational Audiologists
 Technical Assistance
– Kate Brandon, Coordinator in Instructional Initiatives
– Daniel Gumarang,Instructional Technology Advisor
Resources
• American Academy of Audiology (AAA)
audiology.org
• American Speech-Language-Hearing Association
(ASHA) asha.org
• Educational Audiology Association (EAA)
edaud.org
• California Academy of Audiology (CAA)
caaud.org
Disclaimer: These sites have been chosen for educational and professional purposes. LAUSD does
not endorse of guarantee any information contained in these sites.
Getting Through, recording from Zenith Radio Corp
Hearing Loss Simulation, Med Rx Inc.