FREQUENTLY ASKED QUESTIONS
1. CLASSROOM BASICS
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My student seems to have a hearing loss. What should I do?
What are the types of hearing loss?
What are the degrees of hearing loss?
What does each level of hearing loss sound like?
How do I know the degree of my student’s hearing loss?
How does minimal hearing loss impact learning?
How does a moderate hearing loss impact learning?
How can I help a hard of hearing student?
2. SIGN LANGUAGE
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Where can I go online to learn sign language?
How do I develop signing skills in a student with cerebral palsy or hand differences?
When should sign language be considered?
When should sign language not be considered?
What are good indicators that sign language is accessible to a student when they are not yet using it expressively?
3. AUDIOLOGY: HEARING AIDS/ COCHLEAR IMPLANTS/BAHA
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How does a cochlear implant, bone anchored hearing aid (BAHA) or hearing aid work?
Should I be using a sound field system?
How do I troubleshoot a hearing aid?
My student doesn’t want to wear his/her hearing aid. How do I encourage its use?
1. Classroom Basics
My student seems to have a hearing loss. What should I do?
- Refer child to special education services in your school.
- Refer family to the audiologist.
- Refer student to Special Education Service Agency.
What are the different types of hearing loss?
- Hearing loss can be found in different parts of the ear. Where the hearing loss occurs determines what can be done to aide the students.
Hearing aids, cochlear implants, and surgical repairs are options that can be discussed but only in conjunction to specific types of
hearing loss.
- Conductive hearing loss
This type of hearing loss occurs in the mechanics of the ear and can be due to a blocked ear canal, malformed pinna, ear infections, birth
defects, and trauma to the outer and middle ear. Conductive losses can sometimes be repaired surgically. Creating an ear canal for a
child born without one can to be done when the child is at least 6 to 8 years old. The student may require a bone conduction hearing aid
in the meanwhile. Some conductive losses clear up when the child is older such as chronic ear infections. Some conductive losses are
not fixed by surgery and a bone anchored hearing aid (BAHA) maybe attached to the skull behind the ear.
- Sensory-neural hearing loss
This type of hearing loss occurs in the middle and inner ear. A sensory-neural hearing loss cannot be fixed with surgery. This hearing
loss is related to the electrical connections to the brain. Many times, this type of hearing loss is situated in the cochlea. The cochlea
transmits the sounds that come from the outer ear into an electrical pulse that is sent to the brain. When issues present itself in this area,
amplification may be successful. When the hearing loss is great enough, cochlear implants may be used. Cochlear implants are a type
of hearing technology that is introduced to the body through surgery. Electrodes are put into the cochlea to stimulate the parts that may
not be functioning.
- Mixed hearing loss
This type of hearing loss is the combination of conductive and sensory-neural hearing losses.
What are the degrees of hearing loss?
• Mild - 26 to 40 dB
A mild hearing loss is very common and may go undetected. A cold or ear infection can often cause this level of temporary hearing loss. If
untreated, an ear infection or very high fever can cause permanent hearing loss. At this level of hearing loss, the student will miss some
speech sounds. Hearing loss differs in each person, but typically, the student won't be able to hear the Z, V, S, TH and F sounds.
Note that these sounds are important because they are grammar markers for plurals/singulars, present-tense/past-tense. The
individual will not hear the difference between “dress” and “dresses” (a Z sound), “stave” and “stay” (a V sound), “two” and
“tooth” (a TH sound), and may not hear or be able to distinguish between blends “sleep” versus “leap.”
The student may or may not qualify for hearing aids. If so, these should be worn as much as possible.
• Moderate - 41 to 55 dB loss
A moderate loss has many subtle but important characteristics. The individual may not realize that he or she has a hearing loss, even though
it prevents hearing at least half of the speech sounds. A hearing aid is vital to typical language development. The student responds when
called, answers questions, and therefore people may assume the student has typical hearing. The speech, language, and literacy, social skills
and even self-esteem can be affected.
• Moderately severe - 56 to 70 dB loss
Speech sounds are out of range in a moderately severe hearing loss and hearing aids are required if any gains are to be made in speech. Team
members such as Teachers of the Deaf and speech language pathologists will need to assist in educating students with this hearing loss. The
team should discuss speech and language services as well as sign language possibilities.
• Severe -71 to 90 dB loss
Students, even when aided, will have trouble hearing intelligible speech. Speech and language development would be strongly effected and
American Sign Language may give full access to academic learning. If intelligible speech is the goal, significant work in auditory
discrimination and speech development, would be recommended. Keep in mind that if the proper supports are in place, this student can
thrive academically and socially. Students may qualify for a cochlear implant
• Profound - 90 + dB loss
Although the student may be very adept at using contextual clues and using the vibrations from loud sounds to understand his or her
surroundings, without being aided, speech sounds are not audible. Services specifically designed for deaf students should be implemented.
This student may or may not be successful with hearing aids alone. This student may likely qualify for a cochlear implant and/or the use of
American Sign Language services.
What does each level of hearing loss sound like?
There are many simulations online.
A popular website is: http://www.youtube.com/watch?v=TD5E88fFnxE
How do I know what degree of loss my student has?
For this information, you will need to look at an audiology report. The report has two parts: the audiogram and a written statement explaining
the findings. If the report is not clear, you can fax the audiology report to the SESA office for some assistance. However, you always need
parent permission before sharing information with us.
How does minimal hearing loss impact learning?
The student often can't hear some consonants, especially at the end of words, even wearing his or her hearing aids. When the student writes
what he hears, this would cause him to make grammatical errors, such as to leave off the /s/ in plural nouns and the /d/ in past tense verbs that
he can’t hear. This isn’t really a grammar or literacy issue, however. The student may understand how phonics work, and may be spelling just
as he or she hears (leaving out or distorting sounds). This can be remediated by listening to minimal pairs (words that are the same except for
the absence and presence of these sounds, such as "lip" and "lips") and learning to distinguish between them.
Many hard-of-hearing students are able to distinguish between vowels audiologically. A student can hear vowels better than consonants
because they are often lower in pitch and longer in duration. If the student makes mistakes with vowels in words it's because he or she hasn't
learned the rules of vowel sounds and diphthongs; i.e. how to spell various vowel sounds. This might need to be taught separately.
Individuals with a hearing loss often have more difficulty hearing in an environment with background noise due to the signal to noise ratio.
This refers to the fact that an individual with a 40 dB hearing loss can only hear sound that is 40 dB above the background noise. This should
be kept in mind when working in large group activities and in the gym.
Frequent ear infections in an otherwise hearing individual can cause enough of a hearing loss to delay speech, language, and literacy skills.
How does a moderate level of hearing loss impact learning?
The student may produce speech that sounds correct in its intonation and other futures, but may sound muffled.
The student may think that he or she can understand when actually the student is missing part of the speech signal.
The student may be unaware of who is being spoken to, and may assume that people are talking about him or her. This occurrence is often
more evident as a student gets older.
Environmental sounds may impede learning. Even 10 dB loss of sound (the volume of leaves blowing on the ground) may mean the difference
between detecting sound and understanding. It is highly recommend that environmental sound be as minimal as possible.
The student may overgeneralize the skill of using environmental clues to skills in missing sounds. This is common in verbal students with a
significant hearing loss. Although the ability to use contextual clues is vital, when it becomes the main or easiest way to understand language, it
can be detrimental because.
As the student gets older, and less environmental clues are present, he or she will struggle to a greater extent.
How can I help a hard-of-hearing student?
1. Make sure that your mouth and face are always visible to the student. Many hard of hearing students use lip movements and facial
expression to aid in understanding a spoken message.
2. If you have a beard and mustache, make sure it is trimmed so that your lips are visible.
3. Try to face the student when speaking. For example, when writing on the blackboard, wait until you are finished before continuing to talk.
4. If you are assisting a student at his or her desk try to sit or crouch opposite the student rather than next to or behind the student. This way,
the student can focus on both your speech, and the paper you are working on, without missing parts of the message.
5. Be cautious of holding objects, such as pieces of paper in front of your mouth while speaking.
6. Hard-of-hearing students often have difficulty with comprehension in group situations. This is due to the speakers’ mouths being too far
away making speech reading difficult. The student may have difficulty following who is speaking if turn-taking is rapid.
7. During group discussions, it helps to sit in a circle, where the student has the most access to classmates’ speech.
8. It may help if the speaker raises his or her hand before speaking, signaling who should be visually attending to.
9. It often helps a hard-of-hearing student to understand a spoken message if he or she has contextual clues to what is being discussed. This
will give the student an idea of what kinds of words to look for when speech reading.
10. It often helps to have photos or examples of objects and ideas being discussed. If discussing the parts of a cell, a poster with the different
parts illustrated that can be pointed to would aid in comprehension. The student not only knows what is being discussed, but what part of
the whole is being referred to.
11. If possible, it helps to have an actual example of the object to use during a lecture. Some hard-of-hearing students need to spend a
tremendous amount of energy attending to an extended lecture, and having a physical object to refer to makes listening easier, because
they have context clues.
2. SIGN LANGUAGE
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Where can I go to learn sign language online?
We have a list of resources. See
http://www.sesa.org/content/hearing-impairment/hearing-impairment-resource-links
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How to develop signing skills in a student with cerebral palsy or hand differences?
First look at the ASL articulation inventory in the “DSI” section of this website. It explains the process. The link is:
http://sesa.org/content/dual-­‐‑sensory-­‐‑impairment/dsi-­‐‑resource-­‐‑links -
When should using sign language be considered?
§ When a student has a significant hearing loss and speech is not fully accessible. This includes students whose audiogram shows a
moderate loss, but functions like a student with a profound loss.
§
With a student who has language, learning, or cognitive impairment which makes visual information significantly more accessible than
an auditory mode of communication.
§
With a student who has emerging skills in communication for which the concrete nature of signs may form a bridge to spoken language.
§
With a student who has limited motion and is able to produce approximate signs but does not produce comprehensible speech.
- When should adapted sign language be considered?
§ A student who is severely or profoundly deaf and has little vision may be able to use tactile sign language, where signs are presented
into the communication partner’s hands.
§
A student with a field loss may be able to use signs if they are produced in a small space, and in the area of his or her vision that is best.
In addition, the signer should be seated further away from the communicator.
§
A student who is able to attend to sign in his or her periphery but is unable to maintain contact due to:
· uncontrolled movement
· behavioral condition
· developmental disability
- When should sign language not be used?
With a student who is an emerging communicator, and is not yet able to use picture or object cues successfully. Except in rare cases, the
abstract nature of signing compared to the use of object or picture cues would indicate that the student is not yet ready for sign.
With a student who finds eye contact inaccessible, and who is not attending to you in their periphery.
To a student who finds the motion of sign language very distracting from the topic being discussed, and has other communication options
that are less so.
With a student who is not able to produce comprehensible signs
With a student who is able to use another method that is widely understood.
- What are good indicators that sign is accessible to a student when they are not yet using it expressively:
§ He or she stops moving when you begin to sign.
§
He or she is much more interested in looking at you or your hands when you are signing than when you are not signing.
§
His or her facial expression reflects what you are signing. For example, they smile when you sign “good job,” or close their eyes
purposefully when you sign that it is time to clean up.
§
They respond to signed directions.
§
The student is using his or her hands to “babble.” In other words, even though they’re not signing, they move their hands purposefully
in sign-like movements when it is their turn to communicate.
§
They make sign-like movements with their hands when engaged in imaginary play (to their dolls, for example).
3. AUDIOLOGY: HEARING AIDS/ COCHLEAR IMPLANTS/BAHA
- How does a cochlear implant, bone anchored hearing aid (BAHA) or hearing aid work?
§ All of the technologies take sound that is present in the environment,
1.
change it to a digital form,
2.
amplify the sound
3.
present it to the user.
Each type uses a different pathway to the brain.
§
Cochlear implants have an internal and an external part.
The external part consists of a processer where the battery compartment is located and a magnet to attach to the internal part.
The internal part is a magnet attached to a length of electrodes that is inserted into the cochlea to stimulate different parts of the
cochlea. Those stimulations travel to the hearing nerve and onto the brain. This is the most invasive type of hearing technology.
§
Hearing aids come in different forms and the type of hearing loss a student has determines which kind of hearing aid is needed.
Hearing aids that work for sensory-neural hearing losses include behind the ear, in the ear, and in the concha. Sensory-neural type
hearing aids amplify the sound and present the sound to the ear canal.
§
The hearing aids that work for conductive losses include bone conduction hearing aids (soft band and hard band) and BAHA (bone
anchored hearing aids). These sounds bypass the mechanics of the ear and present the sound to the cochlea. The way this occurs is the
bone conduction hearing aid vibrates the skull. The cochlea translates this sound in to electrical information and presents it to the
hearing nerve.
- Should I be using a sound field system?
Each student’s needs are different and those needs dictate whether or not a sound field system will work for them. First let’s define
what a sound field system is. Sound field systems amplify the sound of the teacher’s voice for all students. The teacher wears a
microphone and the sound is transmitted to speakers that are mounted on walls or as a freestanding tower. When looking at the
universal approach to education, this seems to be beneficial for all students. Another added benefit is less strain on the teacher’s vocal
chords. Many teachers have reported that they have less instances of laryngitis because of the use of these systems. If the student does
not use a personal FM system and they rely on auditory information to gain access to curriculum, this may be the way to go. If the
student utilizes a sign language interpreter, a sound field system may be beneficial for the interpreter. With mild to moderate hearing
losses, sound field systems produce the greatest results. For more severe hearing losses, personal FM systems are usually the better
choice.
- How do I troubleshoot a hearing aid?
Each manufacturer has its own guidelines for troubleshooting. The best way to troubleshoot a hearing aid is to go online and find the
manufacturers’ troubleshooting guide. The first thing to check is ALWAYS the battery. Nine out of ten times, the battery is the issue.
Other things do go wrong, but the first thing to check is the battery. Always have on hand a battery tester that will inform you of the
strength of the battery. Battery testers that only state dead or active are not always useful. Hearing aids with FM systems cannot use a
battery with a minimal charge, but a hearing aid alone may use a minimal charge. For other issues pertaining to the hearing aid, look to
the manufacturers guidelines.
- My student doesn’t want to wear his/her hearing aid. How do I encourage its use?
Each child has their own temperament and will be motivated by different factors. There is a need to find out the preferred motivation for
the student.
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Some younger students may be persuaded by a sticker system, earning free time or game time.
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Students in upper elementary or lower middle school may be persuaded by grades and academics. A strong motivator is the notion
that if they hear more information, they will get better grades.
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Older students may be motivated to fit in with peers. The motivation is to socialize with their friends and not miss any important
conversations [i.e. to hear whispers from friends].