HEARING

IMPAIRMENT
Introduction to Special
Education

HEARING IMPAIRMENT
Refers to the reduced function or loss
of the normal function of the hearing
mechanism.
Limits the persons sensitivity to
tasks like listening, understanding
speech, and speaking in the same
way those persons with normal
hearing do.

 According to the age of onset,

hearing impairment can be
congenital when the condition is
present at birth or adventitious
when it is acquired after birth or
later on.
When the condition occurs before
the child learns to talk, deafness is
prelingual.
Deafness is postlingual when it is
acquired after the child has learned
speech usually at the age of two.

DEAFNESS
Cannot use hearing to listen,
understanding speech and
communicate orally without special
adaptations mainly in the visual
code.HARD OF HEARING
Has a significant loss of hearing
sensitivity but he or she can hear
sounds, respond to speech and
auditory stimuli with or without the
use of hearing aid.

THE ANATOMY AND PHYSIOLOGY OF

THE HUMAN EAR
AUDITION act or sense of hearing
The ear is one of the two lead sense organs that
allows a person to gather auditory stimuli and
information from near and far sources in the
environment that come in the form of acoustical
energy.
Audition transforms acoustical energy into a
form called mechanical energy and finally into
neural energy or nerve impulses that can be
interpreted by the brain.
Neural energy language of the brain

 EAR
Three main parts:
External or Outer Ear
Middle Ear
Inner Ear

EXTERNAL or OUTER EAR

Called the auricle or pinna
Directs the sounds into the auditory
canal or external acoustic meatus.
When sounds enter the external acoustic
meatus, they are slightly louder or
amplified as they are directed toward the
middle ear.

 MIDDLE EAR
Sounds enter the middle ear through the
Eustachian tube and pass through the
tympanic membrane or eardrum.
The eardrum moves in and out response to
changes in sound pressure. The
movements of the eardrum change the
acoustical energy into mechanical energy
which is transferred to the three smallest
bones in the body, the ossicles or
ossicular chain, composed of the
malleus or hammer, incus or anvil and
stapes or stirrup.

 The footplate or base of the stapes rests in

an opening called the oval window, the
path through which mechanical energy
enters the inner ear.

INNER EAR
The vibrations of the ossicles transmit the
mechanical energy from the middle ear
to the inner ear with little loss.
The most complex and sensitive part of
the entire hearing apparatus, the inner
ear is covered by the temporal bone,
the hardest bone in the body.

 The cochlea is the main receptor organ for

hearing and contains two fluid-filled cavities
and the organ of Corti. The cochlea looks like
a coiled shell of a snail. The vibrations
stimulate the approximately 20,00 tiny hair
cells to transforms the mechanical energy into
electrical nerve impulses or neural energy.
These impulses are transmitted along the
auditory nerve through the central nervous
system pathways to the brain where the
auditory experience is processed and
understood.
The semicircular canals in the inner ear control
the sense of balance.

CLASSIFICATION OF
HEARING IMPAIRMENT

CONDUCTIVE HEARING
LOSS
Occurs in the outer and middle ear thereby
blocking the passage of the acoustic energy.
The blockage may be caused by abnormal growths
or complications of the outer or middle ear.
Malformation, incomplete development, or
abnormal growth and improper movement of the
ossicular chains can cause conductive hearing loss.
If the inner ear is intact, conductive hearing
impairment can be corrected through surgical or
medical treatment.
Hearing aid is usually prescribed.

SENSORINEURAL HEARING
IMPAIRMENT
Occurs in the inner ear
The sensitivity mechanisms and the auditory nerve
may be damaged.
When the cochlea is impaired, the neural energy
delivered to the brain is distorted or not delivered at
all.
Audition does not take place and speech is not heard.
May be congenital or adventitious because of illness
or traumatic incidents.
Only a very small percentage of sensorineural
deafness can be reversed by medical intervention.

MIXED HEARING IMPAIRMENT

Results from combination of both conductive and
sensorineural hearing losses.

CENTRAL HEARING DISORDER

Results of any dysfunction in the central auditory
nervous system between the brain stem and the
auditory cortex in the brain.
Another basis for classifying hearing impairment is
its being unilateral or present in one ear only, or
bilateral or present in both ears.

Degree
of
Hearing
Loss

Decibel
Loss

Resulting Impairment

Normal

0 20 dB

Slight

27 40
dB

Faint sounds and distant conversations

are difficult to hear. With a hearing aid,
the student can attend regular school.

Mild

41 55
dB

As much as 50 percent of classroom

conversations are missed. Limited
vocabulary and speech difficulties may
result.

Moderate

56 70
dB

Loud conversations can be heard.

Defective speech, language difficulties
and limited vocabulary may result.

Severe

71 90
dB

Hearing is limited to a radius of one foot,

enough to discriminate loud sounds.
Defective speech and language and
severe difficulty in hearing consonant
sounds may result.

Profound

91 and
above

Sounds and tones cannot be perceived.

Vision becomes the primary sense of

Incidence and Prevalence

(Philippines), estimated is 2% of the population has
hearing impairment and the number may increase if
children below school age and persons who lose
hearing sensitivity due to old age are included.
(United States), at least 1 in every 22 newly born
infants has some degree of hearing impairment.
At least 3 in 1000 infants have a severe or profound
hearing impairment.
US Department of Education claimed that children
with hearing impairment constitute 1.3% of pupils
provided with special education services and 11% of
the total age population.

ETIOLOGY OF HEARING IMPAIRMENT

GENETIC AND HEREDITARY TYPES OF
DEAFNESS occur in 1 out of 1000
live births. Causes are hereditary
and chromosomals abnormalities.
INFECTIONS such as maternal
rubella, cytomegalovirus, hepatitis B
virus, syphilis, mumps, and otitis
media may occur during pregnancy
or after birth.

 These impulses are transmitted along

the auditory nerve through the
central nervous system pathways to
the brain where the auditory
experience is processed and
understood.
The semicircular canals in the inner
ear control the sense of balance.

 The more specific cause of conductive

hearing loss are otitis media (middle ear
infection), excessive earwax (impacted
cerumen), and ostosclerosis (spongy
boney growth around the stirrup which
impedes its movements).
Sensorineural hearing loss results from
damage to the cochlea or the auditory
nerve. Other causes are viral diseases,
Rh incompatibility, hereditary factors,
exposure to noise, aging and ototoxic
medications

 FISTULA
Hole in or rupture of the oval or round
window in the inner ear
May leak perilymph (clear fluid) into the
middle ear
Caused by head injuries, diving,
barotraumas, violent sneezing, etc.
Results in fluctuating and/or sudden
sensorineural hearing loss
Can be a complication of cholesteatoma
Dizziness can also be a symptom

 OTOTOXICITY
Can be caused by a wide variety of
strong antibiotics such as amino
glycosides gentamicin, kanamycin and
others as well as chemotherapeutic
agents such as cisplatin, or loop
direutics
Can result from exposure to various
chemical agents in the environment
Characterized by a progressive highfrequency sensorineural hearing loss
following such exposure

CHARACTERISTICS OF
PERSONS WITH HEARING
IMPAIRMENT

Some of the observable behavioral and

learning characteristics of a child with
hearing impairment are as follows:
Cups hand behind the ear, cocks ear/tilts head
at an angle to catch sounds
Has strained or blank facial expression when
listening or talked to
Pays attention to vibration and vibrating
objects
Moves closer to speaker, watches face
especially the mouth and the lips of the
speaker when talked to
Less responsive to noise, voice, music and
other sources of sounds

 Uses more natural gestures, signs and

movements to express self
Shows marked imitativeness at work and
play
Often fails to respond to oral questions
Often asks for repetition of questions and
statements
Often unable to follow oral directions and
instructions
Has difficulty in associating concrete with
abstract ideas
Has poor general learning performance

As mentioned earlier, the primary

effect of a hearing impairment is on
the development of speech and the
acquisition of language and skills.
The more severe the hearing loss is,
the more difficult it is to acquire skills
in listening, speech and
communication, reading and writing.
Speech is usually labored,
unintelligible, unpleasant and difficult
to understand.

Vocabulary is limited with problems

in syntax.
Speech sounds telegraphic and has
poor rhythm.
There are problems in articulation
such as omission, addition, and
substitution of letters and sounds or
distortion of the words.
Poor reading ability results to
difficulties in learning the other
school subjects

IDENTIFICATION AND ASSESSMENT OF

CHILDREN WITH HEARING IMPAIRMENT

AUDIOLOGICAL EVALUATION
Done by audiologist through the use of
sophisticated instruments and
techniques
To determine frequencies of sounds that
a particular person hears
AUDIOLOGY science of testing and
evaluating hearing ability to detect and
describe hearing impairments
AUDIOMETER electronic device that
generates sounds at different levels of
intensity and frequency

 PURE TONE AUDIOMETRY utilizes

pure tone in air and bone conduction
tests which yield quantitative as wells as
qualitative description of a childs
hearing loss.
SPEECH AUDIOMETRY which uses
speech instead of pure tones.
Alternative audiometric techniques:
sound field audioemetry, evoked
response audiometry, impedance
audiometry, play audiometry, operant
conditioning audiometry and behavior
observation audiometry.

 INFORMAL HEARING TESTS (used in

the Phils.)
WHISPER TEST
Sit the child comfortably. Ask him or her to
stick the
tip of the forefinger in one ear.
The tester sits behind the child where the
uncovered
ear is. After a deep breath, whisper
some familiar words that contain high
pitch and low pitch tones right behind
the unblocked ear. The child must be

 CONVERSATIONAL LIVE VOICE TEST

Keeping the same position but facing the
child, ask him or her to repeat words
that contain high and low pitch
consonants. Start with a whisper and
increase the intensity up to 20 dB
moving away from the child little by
little. If the child hears at a distance of
3 to 6 meters, hearing is normal. If the
child can repeat the words but speech
is unclear, he or she might be hard of
hearing

 BALL PEN CLICK TEST

Use a retractable ball pen and place it one
inch away from the ear. While the other
ear is blocked by a finger, press the
button of the ball pen down and release
it. Do it only once. The child indicates
that he or she hears the click by either
raising one hand or acknowledging it
with a yes or a nod.

 COGNITIVE ASSESSMENT
Do not rely primarily on verbal abilities
(US) The Hiskey Test of Learning Aptitude, the
Wechsler Intelligence Scale for Children (WISC)
and the Stanford Achievement Test (SAT) are
widely used because of the nonverbal
performance subtest

ASSESSMENT OF COMMUNICATION ABILITIES

Includes an analysis of the development of the
form, content and use of language.
Articulation, pitch, frequency, and quality of
voice are examined

 SOCIAL AND BEHAVIORAL

ASSESSMENT
Hearing impairment brings about
significant effects on social-emotional
and personality development as a result
of the restrictions in interactive
experiences and communication
activities with their age group.
Linguistic difficulties oftentimes show in
low self-concept and social-emotional
maladjustment

 EDUCATIONAL PLACEMENT
In the Phils., students with
hearing impairment like other
students with disabilities are
mainstreamed in regular
classes either on full-time or
part-time basis.

 SUPPORT SERVICES
Communication accessibility is provided
by sign language and oral interpreter
inside and outside of the classrooms.
Computer-aided instruction (CAI)
reinforces the knowledge and skills
learned in the different subject areas

Educational Approaches
Used When Working with
Students with Hearing
Impairment

 BILINGUAL-BICULTURAL
Basic Position: Considers American Sign
Language (ASL) to be the natural language
of the Deaf culture and urges recognition
of ASL as the primary language choice with
English considered a second language.
Objective: To provide foundation in the
use of ASL with its unique vocabulary and
syntax rules; ESL instruction provided for
English vocabulary and syntax rules
Method of Communication: ASL
(American Sign Language)

 TOTAL COMMUNICATION
Basic Position: Support the belief that
simultaneous use of multiple communication
techniques enhances an individuals ability
to communicate, comprehend and learn.
Objective: To provide a multifaceted
approach to communication to facilitate
whichever method(s) works best for each
individual.
Method of Communication: Combination
of sign language (accepts the use of any of
the sign language systems), fingerspelling,
and speechreading.

 AUDITORY-ORAL
Basic Position: Supports the belief that
children with hearing impairment can
develop listening/receptive language and
oral language expression (English) skills;
emphasizes use of residual hearing (the
level of hearing an individual possesses),
amplification (hearing aids, auditory
training), and speech/language training.
Objective: To facilitate the development
of spoken (oral) English.
Method of Communication: Spoken
(oral) English

Suggestions for Teaching Students with

Hearing Impairment in a Regular Class
1. Promote the acceptance of the student with
hearing impairment in the regular class.
2. Be sure that prescribed hearing aids and
other amplification devices are used.
3. Provide preferential seating.
4. Increase visual information.
5. Minimize classroom noise.
6. Modify teaching procedures.
7. Have realistic expectations.