hearing impairment

Hearing Impairment

Hearing impairment is the decreased ability to hear and discriminate among sounds. It is one of the most common birth defects. Each year in the United States, about 12,000 babies (3 in 1,000) are born with significant hearing impairment. Hearing impairment that is present at birth is called congenital hearing impairment. Hearing impairment also can develop later in childhood or during adulthood.

The Centers for Disease Control and Prevention (CDC) recommends that all babies be screened for hearing impairment before 1 month of age, preferably before they leave the hospital. This is because language and communication develop rapidly during the first two to three years of life, and undetected hearing impairment can lead to delays in developing these skills. Without newborn screening, children with hearing impairment usually are not diagnosed until 2 to 3 years of age.

The goal of early screening, diagnosis and treatment is to help children with hearing impairment develop language and academic skills equal to those of their peers. Most states have an Early Hearing Detection and Intervention Program to help ensure that all babies are screened, and that infants who do not pass the screening receive the follow-up care they need.
Hearing impairment can be inherited (genetic) or nongenetic. Nongenetic causes include illness or injury occurring before, during or after birth. In some cases, the cause of hearing impairment is not known. About 90 percent of babies with congenital hearing impairment are born to hearing parents.

Genetic factors are believed to cause 33 percent of cases of hearing impairment in infants and young children. Scientists believe that mutations (changes) in as many as 400 genes may contribute to hearing impairment.

Genetic causes of hearing impairment can be:

Syndromatic: One feature of a group of birth defects that occur together. This type of impairment accounts for about 30 percent of cases.

Nonsyndromatic: A solitary birth defect. About 30 percent of cases of nonsyndromatic hearing impairment are caused by a mutation in a gene called Connexin 26.

About one-third of cases of hearing impairment are caused by nongenetic factors. They include illnesses during pregnancy, such as:
Rubella (German measles)
Cytomegalovirus infections
Toxoplasmosis
Herpes infection
Syphilis
Preterm birth (before 37 completed weeks of pregnancy) also can be a cause.
After birth, head injuries and childhood infections (such as meningitis, measles or chickenpox) can cause permanent hearing impairment. Certain medications, such as the antibiotic streptomycin and related drugs, also can cause hearing impairment.
Ear infection (otitis media) may cause temporary hearing impairment. Frequent and poorly treated ear infections can cause damage sufficient to impair hearing.
The causes of the remaining third of cases of hearing impairment in infants and children are unknown.

The Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act (P.L. 94-142), includes "hearing impairment" and "deafness" as two of the categories under which children with disabilities may be eligible for special education and related services programming. While the term "hearing impairment" is often used generically to describe a wide range of hearing losses, including deafness, the regulations for IDEA define hearing loss and deafness separately.

Hearing impairment is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance."

Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."
Thus, deafness may be viewed as a condition that prevents an individual from receiving sound in all or most of its forms. In contrast, a child with a hearing loss can generally respond to auditory stimuli, including speech.

Characteristics
It is useful to know that sound is measured by its loudness or intensity (measured in units called decibels, dB) and its frequency or pitch (measured in units called hertz, Hz). Impairments in hearing can occur in either or both areas, and may exist in only one ear or in both ears. Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most greatly associated with speech. Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf for the purposes of educational placement.
There are four types of hearing loss. Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the conduction pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.
Sensorineural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves which supply it. These hearing losses can range from mild to profound. They often affect the person's ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.
A mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear. A central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain.

Parents should be alert to any signs of hearing impairment and discuss them with their child's health care provider. Some signs include:

* Failure to startle at loud sounds
* Not turning toward the sound of a voice or imitating sounds after about 6 months of age
* Lack of babbling at 9 months of age
* Not using single words by 18 months of age *Using gestures instead of words to express needs
* Parents should be concerned about hearing impairment in older children if they:
* Develop vocabulary more slowly than their peers
*Have speech that is difficult to understand or that is too loud or too soft
* Often ask for words to be repeated
*Turn on the TV too loud
*Appear inattentive at school and have difficulties learning to read or perform simple mathematics

Instructional methods
Provide opportunities for fingerplay games with child ( i.e. eensy weensy spider, waving your fingers in fun patterns for the child to see).

visual learning - child can help make signs for classroom ie. Toy shelf, book area, art center

feely bag - children pick out on object and class learns the sign for it

Picture books

communication board - velcro strips are placed on a board with pictures of items frequently used by child throughout his day; ie. Water, bathroom, pencil, etc. Parental involvement in making this is great for establishing more communication between teacher and caregiver.
modifications

use proper lighting in the room. Dim lights make it harder for the visual learner.

Use a circular seating arrangement. This offers deaf or hard of hearing students the best advantage for seeing all class participants.

When desks are arranged in rows, keep front seats open for students who are deaf or hard of hearing and their interpreters.

Repeat the comments and questions of other students, especially those from the back rows; acknowledge who has made the comment so the deaf or hard of hearing student can focus on the speaker.

When appropriate, ask for a hearing volunteer to team up with a deaf or hard of hearing student
Face the class while speaking; if an interpreter is present, make sure the student can see both you and the interpreter

If there is an interruption in the class, get the deaf or hard of hearing student's attention before resuming teaching.

Use visuals frequently. Because visual information is a deaf student's primary means of receiving information, films, overheads, diagrams, and other visual aids are useful instructional tools.

Be flexible: allow a deaf student to work with audiovisual material independently and for a longer period of time.

Don't assume. When in doubt about how to assist the student, ask him or her.

Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class).

regular speech, language, and auditory training from a specialist;

services of an interpreter for those students who use sign language;
favorable seating in the class to facilitate lip reading;
captioned films/videos;

instruction for the teacher and peers in alternate communication methods, such as sign language
Make sure you have a deaf student's attention before speaking. A light touch on the shoulder, a wave, or other visual signal will help.

technology
assistive listening devices, TTYs, volume control telephones, signaling devices (e.g., a flashing light to alert individuals to a door knock or ringing telephone), notetakers, and captions for films and videos.
amplification systems to be used by teacher and student
cochlear implant
hearing aid

Annotations
http://www.marchofdimes.com/professionals/14332_1232.asp nice check list for care givers to refer to
http://www.cdc.gov/ncbddd/ehdi/ good FAQ information

http://www.nlm.nih.gov/medlineplus/hearingproblemsinchildren.html#cat5

http://www.helpkidshear.org/resources/education/teachers.htm excellent instructional strategy ideas and a section for kids games

Medwid, Daria., & Weaton, Denise.(1995). Kid - Friendly Parenting with Deaf and Hard of hearing Children.Washington, DC. Galluadet University Press This book has many great ideas for activities to promote better behavior through fun activities.