HEARING & SPEECH DISABILITY -

EARLY IDENTIFICATION , MANAGEMENT

& ROLE OF TEACHERS

UGC- HRD CENTRE

PUNJABI UNIVERSITY
Dr. Ravi Kapoor PATIALA
In-Charge Speech & Hearing Unit 19-10-2018
Department of ENT 10:00-11:30 AM
Govt. Medical College & Hospital,
Chandigarh
 SPECIAL THANKS TO

• PROF. YOGRAJ and team

HEARING LOSS

• Most common physical

disability

• Hidden handicap

• Very little interaction

without hearing
TERMS TO BE DISCUSSED

• IMPAIRMENT

• DISABILITY

• HANDICAP
 IMPAIRMENT

• Deranged function of one or another

type

• Distortion of sound

• Defined on the basis of behavioural

or electro-physiological measures
 DISABILITY

• Auditory consequences
of the impairment for the
patient
 HANDICAP
Where is
your
papa? My name is Raju.

General effects on
the individual’s life
arising indirectly
from the hearing
loss
HEARING LOSS
 PROBLEMS CAUSED BY HEARING
LOSS - ACADEMIC
• Delays in auditory processing
skills affect language skill
development

• Delays from auditory processing

affect the receptive and expressive
language skills for speech

• Language developmental delays

affect learning causing delays in
academic development
PROBLEMS CAUSED BY HEARING
LOSS - SOCIAL

• Delays in language
could affect the child
socially

• Isolation is often a
result of language
delays and the child’s
limited communication
abilities
PROBLEMS CAUSED BY HEARING
LOSS - VOCATIONAL

• Delays in language development can affect

the child’s job skill development

• Could limit the child’s long term vocational

choices
 DEAF

Term is used to describe a person

whose primary development of

communication skills are through a

visual modality, either sign language

or speech reading, and whose

primary mode or interpersonal

communications are visually based

 GLOBAL BURDEN

World scenario

• Hearing loss one of the commonest

disabilities in the world

• Referred to as the hidden disability

• 278 million people with disabling hearing

loss, 364 million with mild hearing loss

• 2/3 of burden is in developing countries

 GLOBAL BURDEN
Indian scenario

• 63 million people with significant hearing

loss

• Most are children, commonest cause is WAX

• Other causes include

• Otitis Media

• Congenital hearing loss

• Presbyacusis

• Noise Induced Loss

• Ototoxicity
 PREVALENCE
NATIONAL HEARING STUDY, UK
• 90% of the hearing impaired are atleast 50 yrs of age
• 35% of over 50 years group have atleast mild hearing
loss in their better ear
• People above 50 years usually have hearing impairment
• Very few people younger than 50 years have even a mild
hearing loss in their better ear
IN INDIA: Estimate is that 70 children are born hearing
impaired every day (NSSO,2002)
 NATIONAL PROGRAM FOR
PREVENTION & CONTROL OF
DEAFNESS (NPPCD) IN INDIA
• Over 50% of causes of Hearing loss are Preventable
– Hearing loss caused by Infections of the ear (ASOM, CSOM), Secretory
Otitis Media, Traumatic, Rubella deafness, Noise Induced Hearing loss,
Ototoxicity

• It leads to severe loss of productivity, both physical

& economic

• Most causes are Treatable

• In others, Rehabilitation is possible

HEARING LOSS

• Causative agents or process leads

to damage of auditory pathway

• Wide range of conditions affect the

auditory pathway
• Middle ear, cochlea and VIII nerve

• Genetic, metabolic or systemic

• Single or multiple agents

• Affects one or multiple area

 CLASSIFICATION
Deafness

Conductive Mixed Sensori-neural

 AUDIOGRAM – PICTURE OF
HEARING LEVELS

Normal 0-25

Mild 26-40

Moderate 41-70

Severe 71-90

Profound >91
 EARLY IDENTIFICATION

• SCREENING
– QUESTIONNAIRE

– VOICE TEST

– AUDIOMETER
 VOICE TEST
Speak in whisper :
Correct response = normal hearing
Incorrect response : Repeat in conversational voice

Correct response = slight H. loss

Incorrect response : Repeat in loud voice

Correct response = moderate H. loss

Incorrect response : Repeat by shouting in the ear
Correct response = Severe H. loss
Incorrect response : Total Deafness
Grade of Level tested Level tested with the Recommendations
impairment with an Voice Test
Audiometer
Normal hearing 25 dB or less Able to hear whispers Preventive counseling
Slight impairment 26 - 40 dB Able to hear and repeat Counseling. Hearing aids
words spoken in may be needed
conversational voice at
1metre
Moderate 41 - 60 dB Able to hear and repeat Hearing aids usually
impairment words using loud voice recommended
at 1 metre
Severe 61 - 80 dB Able to hear some Hearing aids needed.If no
impairment words when shouted hearing aids available,lip-
into the ear reading and signing
should be taught
Profound 81 dB or more Unable to hear and Hearing aids may help
impairment understand even a understanding words.
shouted voice Additional rehabilitation
needed. Lip-reading and
sometimes signing
essential
Adapted from:Report of the Informal Working Group on Prevention of Deafness and Hearing
Impairment Programme Planning WHO,Geneva,1991
 EARLY IDENTIFICATION

• DIAGNOSIS
– AUDIOMETER
• PURE TONE

• Brain stem Evoked Response Audiometry

(BERA)

• Otoacoustic Emissions (OAE) Analysis

 Management of Speech &
Hearing Disabled
An inter-disciplinary team to maintain high standard of rehabilitation

• Audiologists

• Speech- language Pathologists

• Special educators/Teachers

• Psychologists

• Social workers

• ENT specialist

• Pediatrician

• Neurologist
 AMPLIFICATION HELPS THE
CHILD GET CORRECT INPUT TO
THE BRAIN
 HEARING AIDS

• Hearing aid :Device which processes

sound in such a way as to make it
clearly audible to the user

• Types of hearing aids includes:

• Body worn hearing aids

• Behind the ear

• In-the-ear aids

• Bone conduction aids

• Middle ear implants

• Cochlear Implants
 AMPLIFICATION & ASSISTIVE
DEVICES – COCHLEAR IMPLANTS

• The cochlea is electrically

stimulated with surgically
inserted device

• Children with profound loss

– when implanted early

– have better chance of good

language / literacy skills
PREVENTION OF HEARING
IMPAIRMENT
 PREVENTION
• Advice to Lactating mother
• Adequate diet rich in proteins, vitamins, iron
& Calcium

• Encourage breast feeding

• Add solids to baby's diet at 4 months

• Immunization as per schedule

• Child should never be fed in head

dependent position

• Burping should be done after each feed

 PREVENTION
• General advice
• Seek advice from qualified
doctors for all ear problems

• Ear pain with fever is serious

illness

• Avoid self medication

• Regular check ups for BP,

Blood Sugar and obesity

• Do not play loud music

 PREVENTION

• Never clean ear with sticks

or pins

• Do not get ear cleaned by

quacks

• Never hit anybody on the

face near the ear or on the
ear
 PREVENTION

• Reduce Noise
Pollution
– Occupational noise

– Recreational noise
 PREVENTION

• Avoid bathing in dirty

water ponds

• Do not put anything in the

ears

• Wear helmets and seat

belts while driving

• Avoid marriages in near

relatives
 WHO NEEDS
ADVICE AND SUPPORT WHEN
THERE IS SOMEONE IN THE
FAMILY WITH
HEARING IMPAIRMENT?
WHO NEEDS ADVICE AND SUPPORT?

• Hearing impaired

• Parents

• Family

• Teachers
 ADVICE THE PATIENT

• Get ears checked and tested regularly /

yearly
– Clean

– Healthy

– Hearing has not deteriorated

• Use hearing aids

 ADVICE THE PATIENT

• An adult should find if there

are any other hearing impaired
or deaf people in the
community and form a support
group

• An older persons, due to old

age may only need the family
to speak a bit more slowly and
clearly and face them while
they are speaking
 ADVICE TO PARENTS & FAMILY

• It is sometimes difficult for a person – even a child – to understand

why he/she is hearing impaired

• They are sometimes seen as ‘different’ or ‘stupid’ and so they can

become withdrawn

• If no family support, difficult to learn

– to communicate

– develop language

– learn about the world around them

• If the patient is a child, should be referred for special education

 ADVICE TO PARENTS & FAMILY

• Their parents and family

should be encouraged to
communicate with them
– using pictures

– signs

– pointing to things
 ADVICE TO PARENTS & FAMILY

• Parents and family members play an important role in the life of

a person with hearing impairment or deafness

• The hearing impaired person needs to learn to communicate

first in the home

• Family members can develop a simple sign language to

support their speech when talking to a hearing impaired or deaf
person

• They should include the hearing impaired or deaf person in all

activities in and around the home
 ADVICE TO PARENTS & FAMILY

– Parents and family members should educate themselves and

learn how to communicate with the hearing impaired or deaf
person

– With support, people with hearing impairment can be

educated and enter into the job market

– Parents should ensure that their children receive the best

possible education and training so that they may become
self-sufficient

– Parents could join, or form, support groups in their own

community and so offer support to each other
 ADVICE TO TEACHERS

• At normal school the

teachers should be
made aware that the
child having a hearing
problem may be given
special attention
 ADVICE TO TEACHERS

• Let the child see your face when you speak to him /her

• Make sure there is good light for the child to see your
face

• Get the child’s attention before you speak to him /her

• Decrease other distractions – especially loud noises

• Encourage hard of hearing children to listen and

discriminate different sounds especially if they are
using a hearing aid
 ADVICE TO TEACHERS

• Stand close to the child when you speak

• Speak clearly and more slowly

• Repeat words and instructions many times

• Use gestures, drawings, paintings – point at things

• Encourage lip-reading
 ADVICE TO TEACHERS

• Don’t shout and exaggerate movements

• Don’t eat or chew while talking to the child

• Do not over protect the child

• If the child has a hearing aid he/she must use it

• Be patient – it takes time to learn to communicate

ROLE OF TEACHERS
 HOW TO HELP STUDENTS WITH
HEARING LOSS?

• Provide better acoustics in the classrooms

• Classroom strategies to aid the child’s

instruction

• Model and promote a positive attitude

TEACHING STRATEGIES- ACOUSTICS

• Normal Classroom Acoustics

– Slick surfaces

– Noise pollution

– Low signal-to-noise ratios (voice level to

noise level)
TEACHING STRATEGIES- ACOUSTICS

– Problems in Classroom Acoustics

• Sound reflects off slick surfaces and echoes

• Most surfaces are slick

– Desk

– Floors

– Walls

• Hearing aids amplify ALL sounds including

noise
TEACHING STRATEGIES- ACOUSTICS
• Noise Pollution
– Noise enters the room

• Heating and air conditioning vents

• Outside noises – mowing, playground

• Other classrooms

– Noise inside the room

• Students talking

• Rustling paper

• Pencil tapping

• Chair movements
TEACHING STRATEGIES- ACOUSTICS

– Signal-to-noise ratios (teacher’s voice level to noise

level)
– Voice is not loud enough to be heard above the noise

– The teacher’s voice level needs to be about 15-20 dB

above the noise level for understanding of words spoken
WAYS TO HELP STUDENTS WITH
HEARING LOSS - STRATEGIES
• Preferential seating to be able to lip-read

• Face the child when speaking

• Avoid moving too much around the room

• Gain the child’s attention by a

– Gentle touch on the shoulder

– Calling their name

• Monitor for comprehension

• Repeat or rephrase instruction

• Pre-teach vocabulary
WAYS TO HELP STUDENTS WITH
HEARING LOSS - STRATEGIES

• Keep a positive attitude and model this for other student’s

benefit

• Teach the class about hearing loss and the equipment used to
help the loss

• Don’t use exaggerated pronunciations – speak normally, but

slowly and clearly

• Repeat what other students say in discussions

• Provide written, simple instructions

• Use an overhead to provide visual information

TEACHING STRATEGIES- ACOUSTICS

Improve classroom acoustics

– Use an FM system

– Carpeting on floors

– Fabric wall hangings and cushions

– Tennis balls on the bottoms of chairs

– Curtains over windows

– Suspended ceiling tiles

 POINTS TO REMEMBER ABOUT
HEARING LOSS

 You can’t fix a SENSORINEURAL hearing loss

 Any hearing loss – even MILD – impacts children’s

learning

 Improving classroom acoustics will improve learning

for hearing and hearing impaired children

 If children can’t hear, they can’t learn

COMMUNICATION METHODS
 COMMUNICATION METHODS
USED IN DEAF EDUCATION

• Speech Training, Sign Language, Total

Communication and Education

• There is no singularly successful method in

teaching the deaf

• The following approaches to teach deaf learners

are listed according to their proximity to the
spoken dominant language
 METHODS TO HELP HEARING-
IMPAIRED PEOPLE LIP-READ
• Face the person when speaking

• Get their attention before you speak to them

• Do not cover your mouth with your hand or newspaper

• Make sure there is good light for them to see your face

• Don't turn off the lights – they’ll not be able to see your lips

• Decrease other distractions – especially loud noises

• Turn off the radio or TV

• Speak clearly and more slowly

• Repeat words and instructions many times

PUBLIC AWARENESS
 RAISING AWARENESS IN THE
COMMUNITY AND IN SCHOOLS
• One problem in society
– Hard of hearing and deaf people are not seen

– They are shut away in the home

– They are believed to be ‘stupid’ and so cannot do anything

• When this happens community awareness of the problem of

hearing impairment is low

• Communities need to be made aware

– Of the problem of hearing impairment

– The communication problems that it causes

– Be made aware of how to help people with hearing impairment

 RAISING AWARENESS IN THE
COMMUNITY AND IN SCHOOLS
• Another problem
• Families sometimes do not realize that the family member is
in fact hard of hearing

• Do not take them to have their ears examined and tested

• Public awareness campaigns could create a better

understanding of hearing impairment and the disability
that it causes

• Local bodies should display posters about hearing

impairment and ear care to raise awareness amongst
patients
 RAISING AWARENESS IN THE
COMMUNITY AND IN SCHOOLS
• Communities should be encouraged to have "Healthy ear"
days

• Teachers should
• Talk about hearing impairment and its problems

• Encourage activities such as designing posters to raise

awareness

• Playing "What can you hear?" games to identify children with

hearing impairment

• Children should be introduced to their first language only

 RAISING AWARENESS IN THE
COMMUNITY AND IN SCHOOLS

• Encourage deaf adults to teach and talk about deafness

in classes

• Speak about hearing impairment

– To social, religious and other groups in the community
 RAISING AWARENESS IN THE
COMMUNITY AND IN SCHOOLS

– Promote the need to include hearing impaired people

• in the world of work

• in education

• in society

– Encourage the formation of support groups for the

hearing impaired and their families

– Recruit educated deaf adults to assist with deaf

awareness campaigns and help deaf children in school
and the community
 SPEECH AND LANGUAGE
• Speech is the motor act of
communicating by articulating verbal
expression

• Language is the knowledge of a

symbol system used for interpersonal
communication
 SPEECH DELAY
SPEECH DEVIATION
Deviation from normal
speech behavior may result
in disorders such as
• Stuttering
• Dyslalia
• Dysphonia (Voice problems)
SPEECH DELAY
A delay in speech development may be
a symptom of many disorders,
including
•hearing loss
•mental retardation
•expressive language disorder
•psychosocial deprivation
•autism
•receptive aphasia
•cerebral palsy
 SPEECH DISABILITY

• ACQUIRED APHASIA
– NEUROLOGICAL DISORDER

• LARYNGECTOMY
– SURGICAL REMOVAL OF LARYNX
HAVING CARCINOMA (CANCER)
 SPEECH DISORDER

• Speech disorder may have a significant

impact on
– Personal

– Social

– Academic

– Vocational life
 SPEECH DISORDER

• Timely detection and early intervention

may mitigate the
– emotional

– social

– cognitive deficits

of this disability and improve the outcome

 REHABILITATION

• Surgery

• Hearing aids

• Speech therapy

• Learning in special schools

• Vocational training