Aural Impairment (types and causes):
Brief note of Aural Impairment:
Individuals with hearing impairments make up 11% of the school age population and
1.2% of the students served under idea (U.S. Department of Education, 2005). Hearing
impairments range in severity from mild to moderate to severe to profound, with the greatest
educational distinctions occurring between hard of hearing and deaf. Individuals classified as
hard of hearing can hear speech tones when wearing hearing aids, while persons who are deaf
cannot hear even with hearing aids. The age that a child loses hearing affects the degree of
language delay and development. Children who are born with deafness have congenital
hearing losses (prelingual) and more difficulty with language development than those who
acquire deafness after age 2 (postlingual). Pure tone audiometers are used to assess hearing
ability. Tones with different pitches (or frequency measured in Hertz [Hz]) and volume
(measured in decibels [dB]) are presented via headphones, and individuals raise their hand
when they hear a sound.
Levels of hearing impairment are classified along a continuum, with reference to zero
dB indicating the quietest sound a person with normal hearing can detect. Individuals with
slight hearing losses (27–40 dB) may not have difficulty in most school situations.
Individuals with mild losses (41–55) may miss up to 50% of classroom discussion if voices
are faint or faces cannot be seen. Individuals with moderate losses (56–70 dB) can understand
only loud speech, and may have limited vocabularies. Individuals with severe losses (71–90
dB) may be able to hear loud voices within one foot from the ear, and speech is likely to be
impaired. Individuals with profound losses (> 90 dB) may hear some loud sounds, but are
more likely to sense vibrations, and may rely on vision rather than hearing as a primary
vehicle for communication (Heward, 2006). Specialized tests are needed to accurately assess
the cognitive and academic functioning of individuals with hearing impairments.
History:
In the United States, adult aural rehabilitation started as a result of the number of
soldiers who incurred hearing loss in World War II and were in need of services. Back
then, audiologists and speech-language pathologists would put emphasis on speech reading
(lip-reading) auditory training, and would fit the soldiers with very primitive hearing aids. In
the past, the main components of the rehab process were training clients in lip-reading
techniques and listening exercises. Today, the list includes a thorough hearing evaluation,
intervention with hearing instruments, and counseling for the client before and after the
hearing device is selected.
Causes of hearing impairments
Causes of hearing impairments include heredity, prenatal infections such as
maternal rubella, ear infections, meningitis, head trauma, prematurity, and oxygen
deprivation. Impairments can be conductive, meaning the outer or middle ear along the
passageway are damaged; sensor neural, referring to inner ear damage; or they can be a
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combination of the two. Many children with hearing impairments have academic and
cognitive deficiencies or developmental lags due to difficulties processing language
(Meadow- Orlans, 1990). Some children experience social-emotional functioning difficulties
due to communication difficulties (Luterman, 1996).
There are some of the defects to understand about the aural impairments
Mild Hearing Loss:
The student can hear nearly all speech sounds but may hear incorrectly if not looking
at the speaker or if there is background noise. It should be noted that most classroom
situations will involve varying levels of background noise. It can be very difficult to identify
this condition, unless the child is tested by an audio logical scientist. Newborn Hearing
Screening, introduced in Ireland since 2011, has helped to identify children with hearing loss
at an earlier age than ever before. Students may have difficulties responding to conversational
speech especially with background noise.
Moderate Hearing Loss:
The student experiences difficulty hearing others speaking, even those who are close
by. The student may subconsciously augment his/her understanding with lip-reading and
visual cues. It can be difficult to identify the student’s hearing loss from his/her speaking
voice, but on close examination the student misses word endings (e.g. plurals and suffixes)
and omits definite and indefinite articles.
Severe Hearing Loss:
The student requires a hearing/amplification device, such as a hearing aid or Cochlear
Implant and needs to use lip-reading and body language to augment understanding. The
student’s speaking voice is characterized by shortened sentences, the omission of small words
and/or word endings and inaccurate grammar.
Profound Hearing Loss:
The student may use a hearing/amplification device, such as a hearing aid or Cochlear
Implant but relies on visual cues and/or sign language to communicate. The student’s
speaking voice may seem incomprehensible but some students can achieve good oral skills.
Radio aids/FM Systems may be used to transmit the speaker’s voice directly to the listener.
Children with any degree of hearing loss, from mild to profound, can benefit from the
fitting and consistent use of amplification devices such as hearing aids, Cochlear Implants,
Auditory Brainstem Implants etc. Consistent use of such devices can help the child to
develop spoken language, particularly when fitted at a young age (optimum age for fitting
being before 3years of age).
The majority of students with hearing loss in mainstream schools will have mild to
moderate hearing loss and use oral /aural (speaking /listening) methods as their main mode of
communication. However, an increasing number of students with severe to profound loss are
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now entering mainstream education and some of these students choose to use sign language
as their preferred mode of communication. Irish Sign Language (ISL) is a fully developed
language, with its own grammar and structure, which differs to that of spoken English.
Indicators of a hearing loss may include difficulties pronouncing some words or
speech sounds, omission of word endings, failure to pay attention when spoken to, frequent
observation of peers for a lead as to what to do, giving incorrect answers to simple questions,
a high frequency in asking for repetition of words and sentences, intense face and/or lip
watching, mispronunciation of some words/sounds, straining to watch a speaker, tiredness, a
tendency to speak loudly and to have difficulty monitoring voice level, and withdrawal.
Aural rehabilitation
Aural rehabilitation is the process of identifying and diagnosing a hearing loss,
providing different types of therapies to clients who are hard of hearing, and implementing
different amplification devices to aid the client’s hearing abilities. Aural rehab includes
specific procedures in which each therapy and amplification device has as its goal the
habilitation or rehabilitation of persons to overcome the handicap (disability) caused by a
hearing impairment or deafness.
Aural rehabilitation is frequently used as an integral component in the overall
management of individuals with hearing loss and refers to services and procedures for
facilitating adequate receptive and expressive communication in individuals with hearing
differences. Aural rehabilitation is often an interdisciplinary endeavor involving physicians,
audiologists and speech-language pathologists.
Types of aural rehabilitation therapies
Hearing aid orientation:
The process of providing education and therapies to persons (individual or group) and
their families about the use and expectations of wearing hearing aids to improve
communication.
Listening strategies:
The process of teaching hard of hearing persons common and alternative strategies
when listening with or without amplification to improve their communication.
Speech reading:
The process of using or teaching the understanding communication using visual cues
observed from the speaker’s mouth, facial expressions, and hand movements.
Auditory Training:
The process of teaching an individual with a hearing loss the ability to recognize
speech sounds, patterns, words, phrases, or sentences via audition.
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Unisensory:
Therapy philosophy that centers on extreme development of a single sense for
improving communication.
Cued speech:
The process of using and teaching manual hand or facial movements used to
supplement an auditory-verbal approach to the development of communication competence.
Regardless of treatment method for an infant, toddler, or child, the following problems
have to be considered:
Perceptual problems
Communication problems (aural, oral, manual)
Literacy problems (cognitive, memory, dexterity)
Social, emotional, psychological problems
Education and vocational placement problems
Family and societal problems
Treatment strategies for adults center on:
Hearing aid and or assistive listening device evaluation and orientation
Providing therapy to maintain speech and language
Providing therapy to increase listening strategies and speech reading
Counseling to facilitate adjustment to hearing aid and or assistive listening device and
possible psychological, emotional, and occupation impacts of hearing loss.
Bibliography
1. Aural rehabilitation – Wikipedia https://en.wikipedia.org/wiki/Aural rehabilitation.
2. Types of Hearing Loss, Types of Hearing Impairment
www.betterhearing.org/hearing pedia/types-hearing-loss.
3. Types and Causes of Hearing Loss – Starke
https://www.starkey.com/blog/2018/01/The-human-hearing-system-and-hearing-loss.
