Hearing Impaired Children - Research Paper Example

Hearing Impaired Children Abstract Hearing impairment may have extensive, critical effects on childhood development of thinking and language skills. Three additional disabilities frequently reported in deaf children or children who are hard of hearing are emotional/behavioral, intellectual and learning disabilities. This paper gives a description of the learning and behavioral characteristics of a hearing impaired child of elementary/primary school age. It also defines the area of hearing impaired, its prevalence in the United States, the precautions that may be taken to decrease chances of children getting this disorder, the evaluation methods of determining the disorder, strategies that the teacher may use to include this special learner in the regular class and the use of technology to assist a hearing-impaired learner. Introduction Definition and Classification Numerous definitions of hearing impairment as well as its classification systems have emerged the most frequent categories being between hard of hearing and deaf. Different professionals define the two differently. There are those who hold the educational orientation as well as those who firmly hold a physiological orientation. The later represent the extreme viewpoints and they are chiefly interested in the measurable extent of hearing loss. Classified as ‘deaf’ are children who cannot perceive sounds at or above specific loudness/intensity level while classified as ‘hard of hearing’ are others with a hearing loss. Those who hold a physiological viewpoint measure hearing sensitivity in units of relative loudness of sounds called decibels (dB) and zero decibels designates the degree at which the normal person with normal hearing can perceive the slightest sound. Generally, to them, people with hearing losses of less than 90 decibels are hard of hearing and those with about 90 or more decibels are deaf. On the other hand, the concern of those who hold an educational point of view is how much the loss of hearing is likely to affect the child’s speaking ability as well as his ability to develop language. Owing to the close causal link between language development delay and hearing loss, they classify chiefly on spoken language abilities basis (Sulman & Zuberi, 2003). The most generally accepted set of definitions mirroring the educational viewpoint include hearing impairment, a generic term that indicates a hearing disability that may vary in severity from mild to profound and it includes hard of hearing and deaf subsets. They also define a deaf person as one whose hearing disability prevents successful linguistic information processing via audition, with or with no hearing aid. Thirdly, they give a definition of a hard of hearing person as one who normally, using a hearing aid has enough residual hearing to enable successful linguistic information processing via audition (Sulman & Zuberi, 2003). Hsod.org defines hearing impairment or deafness as a partial or full decline in the capability of detecting or understanding sounds that is caused by a wide range of environmental and biological factors. The article adds that the severity of a hearing impairment is classified in accordance with how much louder over the usual levels a sound must be made, before the listener can perceive it. In profound deafness, even the loudest sounds that an audiometer, the instrument that measures hearing, can produce may not be perceived. In the description of hearing loss, three attributes are usually considered. These are type, degree as well as the configuration of hearing loss. Types of Hearing Loss The three central hearing loss types are sensorineural, conductive and mixed hearing loss. Sensorineural hearing loss results from damage of the cochlea/inner ear or of retrocochlea/nerve pathways from the inner ear to the brain. This kind of hearing loss is permanent and cannot be rectified surgically or medically. It entails a sound level reduction and reduction of the ability to perceive faint sounds and it affects the ability of hearing clearly or understanding speech. It results from genetic syndromes, toxic drugs to the auditory system, exposure to noise, birth injury, aging, diseases, tumors and head trauma and viruses. Conductive hearing loss on the other hand results from inefficient sound conduction to the eardrum through the outer ear canal and the middle ear ossicles. Usually, it entails ability to hear faint sounds or sound level reduction and it can be surgically or medically corrected (Goldberg, B. et al., 1997). Thirdly, mixed hearing loss is a combination of both sensorineural and conductive hearing loss. Put differently, mixed hearing loss results from damage in the cochlea, outer or middle ear and in auditory nerves. Unilateral Hearing Loss means that there is normal hearing in one ear and a hearing loss in the other ear. Around one out of a thousand children is born with Unilateral Hearing Loss.The range of hearing loss is from mild to very severe. The American Speech-Language-Hearing Association records that approximately three percent of school-aged children have Unilateral Hearing Loss and that compared with their normal hearing peers, most of these children are at a higher risk of experiencing academic, language/speech and emotional/social difficulties. Hearing loss can also be described as bilateral where both ears are affected as opposed to unilateral where only one ear is affected, symmetrical versus asymmetrical, progressive versus sudden and fluctuating versus stable hearing loss (The American Speech-Language-Hearing Association, 1997). Prevalence Hearing impairment is among the commonest medical problem presented to health care professionals. The prevalence of this condition is on the increase especially with progressive advancement in medicine culminating into lifetime. By the year 2000, the United States of America was spending fifty billion dollars per year on hearing loss. This exceeded the combined effect of Parkinson disease, multiple sclerosis, stroke, spinal injury Huntington disease and epilepsy. Furthermore, approximately two out of every one thousand children had a moderate to severe hearing impairment. Fifty percent all sensorineural hearing loss (SNHL) is characteristic of genetic factors. Of the remaining fifty percent, half are idiopathic and the remainder has an obvious environmental cause. Reports indicate that graduates of Neonatal Intensive Care Unit (NICU) experience increased hearing loss risk. Of these, one in one hundred and seventy four has hearing loss. In non-neonatal Intensive Care Unit, one in two hundred and seventy eight children experience hearing loss (Selesnick & Zadeh, 2000). Goldberg and his co-authors point out that auditory system disorders affect twenty eight million Americans. Causes of Hearing Loss Hearing impairment can emanate from some congenital factors such as use of ototoxic drugs, jaundice, fetal iodine deficiency effects, maternal rubella, syphilis, premature birth and other conditions during the birth process whereby the baby does not have s enough oxygen to breathe. Hearing impairment can also be hereditary. If one or both parents of a child is/are deaf, the child is more vulnerable or has higher risk of developing this disorder. Osteogenesis imperfecta, cockayne syndrome, hunter syndrome, hurler syndrome and hereditary nephritis among others are some of the genetic conditions responsible for hearing impairment. Hearing impairment can also result from traumatic injury for example, skull fracture/temporal bone, barotraumas/differences in pressure, traumatic perforation of eardrum and acoustic trauma including explosions, gunfire, fireworks, earphones and rock concerts (Goldberg, B. et al., 1997). Goldberg and his colleagues further assert that one of the commonest causes of hearing impairment is ear infection. They explain that otitis media/middle ear infection leads to fluid accumulation and inner lining of middle ear swelling. Using ototoxic drugs, for instance some anti-malarial drugs and antibiotics can led to cochlea damage and cause hearing loss in any age. A loud noise is another common cause of hearing impairment. Persistent exposure to extremely loud noises injures a delicate structure of inner ear culminating in hearing loss. Additionally, wax accumulation of in the ear canal, head injury, foreign body lodged in the ear canal, allergy, blocked Eustachian tubes, and perforated or scarred eardrum can lead to hearing impairment. Some infectious diseases like meningitis, mumps and measles can also lead to hearing impairment. Although it does not apply to children, aging/presbycusis is the most significant cause of hearing impairment. Loss of hearing ability starts in the middle ages in most people, which worsen during old age. This is because of damaged hair cells within the cochlea thereby hindering efficient transmission of electrical signals (Goldberg, B. et al., 1997). Sulman and hi co-author assert that in about half the hearing-impaired people, the cause is mysterious. They explain that for about 14% of the hearing impaired, viruses like meningitis, cytomegalovirus and rubella account for sensorineural hearing losses and that genetic factors and heredity cause about 13% of hearing impairments. Other causes at birth such as birth complications, pre-maturity, high fever, trauma and infections account for 22%. The age at which hearing impairment is discovered is very significant as far as the development of the child’s speech, language, psychological and cognitive development is concerned. However, unilateral hearing impairment of an average child is not diagnosed until the age of three years or even older (Selesnick & Zadeh, 2000). In some cases, diagnosis of hearing impaired children takes place early on and before beginning teaching the child, the teacher is already aware of the hearing loss. However, there are cases where the teacher may be the first to realize that a possible hearing loss exists in a child on observing difficulties like relying on written information, copying other students’ work, checking of conversations as well as misunderstanding and loss of key information when verbal instructions are being given. There are many kinds of hearing impairment and each affects children in different ways. There is also a great variation in the causes and while some hearing impairments occur before birth (congenital), others occur at a later stage of development (acquired) (Goldberg, B. et al., 1997). Behavioral characteristics/indicators of hearing impaired students Learning and behavioral characteristics/indicators of hearing impaired students include very closely observing teachers’ or other speakers’ lips, poor use of speech sounds, inattentiveness during oral presentations, turning head and leaning toward the speaker, not responding when called from behind and turning television or radio volume up constantly. Others include difficulties following oral directions and presentations, complaining of earaches, frequent ear infections or colds and ear discharge, limited use of vocabulary and delayed language development (Sulman & Zuberi, 2003). Further, the child may talk very loudly, uses sign language and gestures, make unintentional noises and tend to isolate himself/herself owing to communication barriers, may write on paper or decline to writing on paper if he/she feels inadequate (Johns & Crowley, 2005). Keller further adds that the child may exhibit difficulties in recalling facts and in learning new skills thereby relying on memorization and difficulties with planning which make them unable to finish assignments on time. He/she may also have difficulties in reading and may have spelling errors for instance substitutions of words like home and house, inversions in letters like m and w, transpositions in words like left and felt and reversal of letters such as d and b. He/she may also have trouble learning the connection between sounds and letters/phonetics, learning about time, may confuse arithmetic signs, transpose number sequences, may confuse basic words, develop impulsive behavior, and may have poor coordination making him or her accident prone due to his unawareness of physical surroundings. Teacher strategies for inclusion in a regular class When dealing with these kinds of learners, a teacher should be very careful and should ensure that a hearing-impaired learner has a suitable and consistent access to the learning environment. Johns & Crowley point out that some of the strategies that the teacher may use to include this special learner in the regular class include using total communication, which is an approach in which the teacher teaches hearing impaired learners on the use oral and sign methods simultaneously as their communication means. The teacher can also use an overhead projector or power point in such a way that he/she faces the class with his/her mouth fully visible during instruction. He/she should also stand in areas devoid of bright backlighting, use advance organizers and make the most of visual and tactile access. Other strategies include ensuring that hearing aid is turned on and functioning properly, using face-to-face contact as much as possible and using visual cues during instructional presentation and when referring to objects in the classroom. Others include talking slowly and stressing on clear articulation when speaking rather than loudness, teaching social skills and encouraging independent activities, seating the learner away from distracting sounds and near center of desk arrangements, reducing the distance between the teacher and the learner as much as possible and providing additional context using complete sentences during instructional presentations or conversations. The teacher can also have other learners take notes during oral presentations for the learner to transcribe after the lesson and should ensure that the learner turns head and leans toward him/her (Sulman & Zuberi, 2003). Keller adds that the teacher should provide a comprehensive course syllabus prior to the beginning of the class, study guides or chapter outlines that indicate key points to the students in their readings, overhead transparencies and clear photocopies of his notes, give assignments to students both in oral and written form, use visual aids like graphs and charts. He/she should also use gestures, facial expressions and other body language to aid in communication, get the student’s attention before speaking and touch a student gently on the arm or on the shoulder as an indication that he/she is addressing him/her. Use of written announcements and use simple visual alarms such as flashing lights to supplement audible alarm systems is also important. Other teaching strategies include writing legibly, involving the child’s parents by having them make a note of ambiguities or difficulties that arise at home regarding lessons or assignments, frequently obtaining feedback from the students at every opportunity to gauge the understanding level of the student. If the student uses an interpreter, the teacher should address the student directly not the interpreter (Keller, 2005). Importance of technology in assisting this learner The use of technology can also be very successful in assisting hearing impaired learners. Different assistive technologies include the use of overhead projectors to avoid the teacher speaking with his/her back on the learners as well as to make them understand what he/she is saying. The teacher can also provide videos, captioned films and laser disks to both the hearing-impaired students and their interpreters use Assistive Learning Devices (ALD) that comprise a transmitter which sends electronically enhanced sound to receivers hard-of-hearing individuals. Teachers also use A Computer-Aided Realtime Translation (CART) that uses a stenotype machine with special software and a phonetic keyboard. The phonetic symbols are translated into English captions by a computer almost immediately (Keller, 2005). As Sulman & Zuberi point out, there is also the use of assistive listening devices or hearing aids. These include FM transmission and amplification equipment, infrared system, online chat as well as electronic mail audio trainers and audio induction loops, which are special types of devices that help the hearing-impaired learners to utilize their residual hearing better. They also point out that there has been the invention of electronic mail and modems/computer fax and telecommunication devices whereby keyboards with printers or screens joined to telephones take advantage of vision to improve communication for these kinds of learners. Diagnosis One of the evaluation methods used to determine the disorder is the nose and ears examination along with simple hearing tests done by the physician to detect many of hearing loss common causes. Because these simple methods frequently produce a diagnosis, an audiogram often concludes the evaluation. In case the defect is in the acoustic nerve or the brain, more neurological imaging and testing is required. There are several uses of the audiogram in the diagnosis of hearing deficits. The hearing loss pattern across the perceptible frequencies gives clues to the cause. Additional information can come from several alterations in the procedure of testing. For instance, compared to pure tones, speech is perceived differently. Adequate sound perception together with inability to recognize words indicate a brain problem not a conductive or sensory deficit. in certain areas, disease distort loudness perception but in others, it does not. Often, acoustic neuromas alter loudness perception (Tierney, L.M. et al., 2003). Prevention/Precautions Treating children promptly and following-up middle ear infections in them attentively is one of the preventive measures of conductive hearing loss. Infectious childhood diseases control has greatly led to the reduction of sensory hearing loss as an epidemic disease complication. Measles is one example of infectious childhood disease. Additionally, institution of laws that require loud noise protection would considerably reduce noise-induced hearing loss occurrences. If someone lives in an excessively noisy environment, he/she should wear hearing protectors, which are devices that decrease the sound intensity reaching the eardrum. Hearing protectors are of two –forms earmuffs, which fit over the entire exterior ear forming an air seal in such a way that it blocks the ear’s entire circumference and earplugs, which are small inserts that fit into the external ear canal that like earmuffs must block the ear canal totally with an airtight seal. Properly fitted earmuffs or earplugs reduce noise fifteen to thirty decibels. While earmuffs are better for high frequency noise, earplugs are better for low frequency noise. Additionally, using the two simultaneously usually adds ten to fifteen decibels more protection than using either alone. When noise exceeds one hundred and five decibels, one should consider combined use (Goldberg, B. et al., 1997). Conclusion From this paper, it is evident that the area of hearing impaired is quite broad and that this area of exceptionality is on the increase especially in the United States of America. Most of the causes are avoidable and people must unite in eradicating them and taking the necessary precautions– starting with the expectant mother to the society as a whole. The United States of America’s law grants children with hearing impairments and other disabilities the right to receive free education just like their peers. The government should provide the necessary materials required to make their learning successful. Teachers must be thoroughly equipped on how to deal with learning impaired learners and they must be very keen and know their learners in and out so that it may be easy to identify any hearing impairments and other disabilities. Knowledge of the cause of a student’s hearing impairment is also paramount as it helps the teacher in making decision pertaining the appropriate treatments. For instance, a teacher will communicate differently with a child who was deaf at birth from the way he/she would communicate with a child who became hearing impaired after having learnt to talk. If a child’s hearing impairment is not severe, he/she can obtain learning from a normal classroom. Teachers should be there to help them and to encourage the other learners to help and accept their hearing-impaired counterparts. However, the teacher should strike a balance between the two groups to avoid neglecting one group at the expense of the other. Severe cases may call for isolation where the learner is given special care and learning by a specialized personnel. References Goldberg, B. et al. (1997): Alternative Medicine: The Definitive Guide. Berkeley, CA: Celestial Arts Hsod.org, (n.d): Hearing Impairment. Retrieved March 24, 2010, from http://www.hsod.org/ Johns, B. & Crowley, E.P. (2005): Students with Disabilities and General Education: A desktop Reference for School Personnel. Horsham, PA: LRP Publications. Keller, (2005): Strategies for Teaching Students with Learning Disabilities. Retrieved March 22, 2010, from http://www.as.wvu.edu/~scidis/hearing.html#sect6 Selesnick, S.H. & Zadeh, M.H. (2000): Evaluation of Hearing Impairment. Journal of Comprehensive Therapy. New York: Humana Press Inc. Vol.27, No.4 Sulman, N. & Zuberi, S. (2003): Hearing Impairment – Causes & Implications on Behavior & Learning. Retrieved March 22, 2010, from http://webcache.googleusercontent.com/search?q=cache%3AeVzBZuh659MJ%3Awww.amic.org.sg%2Fict%2Fexternal%2Fawards%2F0202a2_l59attachment1.pdf+learning+and+behavioral+characteristics+of+a+hearing+impaired+child&hl=en&gl=ke The American Speech-Language-Hearing Association, (1997): Type, Degree, and Configuration of Hearing Loss. Retrieved March 23, 2010, from http://www.asha.org/public/hearing/disorders/types.htm Tierney, L. M., McPhee, S. J. & Papadakis, M. A. (2006): Lange Current Medical Diagnosis & Treatment 2007: Current Medical Diagnosis & Treatment. New York: Mcgraw-Hill. Read More