Hearing Impairment

Assistive Listening Devices

Personal amplifiers are designed to enhance sound levels during in person talks and small group conversations.

Deafness
A severe hearing impairment that affects a child's ability to process linguistic information through hearing, with or
without amplification, adversely impacting educational performance.

Hearing Impairment
An impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational
performance but is not classified as deafness.

Definitions of Deaf and Hard-of-Hearing Learners

Deaf Community
Comprises deaf and hard-of-hearing individuals sharing a common language, experiences, values, and ways of
interacting with each other and hearing people.
Different labels are accepted within the community:
"Deaf" is acceptable for those who are totally deaf and embrace deaf culture, often communicating
through sign language.
"deaf" (with a small d) is used for hard-of-hearing individuals using hearing aids or cochlear implants.
The term d/Deaf learners is inclusive, identifying both types of disabilities under hearing impairment.

Categories of Hearing Impairment

Deafness
A severe hearing impairment affecting linguistic processing through hearing, impacting educational performance.
Hard-of-Hearing
Individuals with residual hearing sufficient for processing linguistic information through audition, often aided by
hearing devices.

Types and Causes of Hearing Loss

Types of Hearing Loss

Conductive Hearing Impairment
Disruption in sound transmission in the middle or outer ear.
Sensorineural Hearing Impairment
Issues within the inner ear or connection to the brain.
Mixed Hearing Impairment
Presence of both conductive and sensorineural impairments simultaneously.
Classifications of Hearing Loss
Unilateral: Hearing loss in one ear,
Bilateral: Hearing loss in both ears, Onset:
•
Congenital: Acquired at birth.
Acquired: Present after birth.
•
Pre-lingual: Acquired before spoken language development.
Post-lingual: Acquired after learning spoken language,

Causes of Congenital Hearing Loss

Genetics:
Recessive genes from both parents can lead to autosomal recessive hearing loss.
Autosomal active hearing loss occurs if one parent has a hearing loss gene.
Other Causes:
Maternal rubella during pregnancy. Prematurity or low birth weight,

Causes of Acquired Hearing Loss

Otitis Media
A middle ear infection that can cause temporary or permanent hearing loss,
Acute Otitis Media (AOM)
Rapid-onset infection causing inflammation and fluid accumulation in the middle ear,
leading to fever and temporary hearing loss.
Otitis Media with Effusion (OME)
Accumulation of fluid in the middle ear without infection, impairing hearing and balance.
Chronic Suppurative Otitis Media (CSOM)
 Persistent middle ear infection harming the eardrum and small bones, potentially causing permanent hearing
impairment,
Other Causes
Meningitis: Inflammation of protective membranes around the brain, leading to post-lingual hearing loss,
Noise Exposure: Sounds above 120 dB to 150 dB can cause hearing degradation.
Hearing Loss and Assessment

Understanding Hearing Loss

Hearing loss can go unnoticed, especially in noisy work environments,
Common professions at risk include:
Aircraft operators
Sound operators
Construction workers
Measurement of Hearing Loss
Hearing loss is measured in decibels (dB),
Intensity refers to the energy a sound has over an area,
Example: A sound in a small area has more intensity than in a larger area.
The relationship between intensity and loudness: O, dB is the softest sound measured. 120, dB is the loudest sound. A
whisper is about 10, dB, while thunder is around 100, dB, Sounds above 85, dB can cause pain and potential hearing
loss. The threshold of pain is at 120, dB O, dB is known as the zero hearing-threshold level or audiometric zero.

Sound Characteristics
Pitch helps distinguish between low and high sounds.
Frequency (in hertz, Hz) measures the number of vibrations a sound wave experiences in a unit of time.
Higher frequency = lower pitch.
Hearing Loss Classification
Normal Hearing: O - 25, dBHL
Mild Loss: 25 - 40, dBHL
Moderate Loss: 40 - 55, dBHL
Moderate to Severe Loss: 55 - 70, dBHL Severe Loss: 70 - 90, dBHL
Profound Loss: 91, dBHL, +

Health Professional Roles

Doctor/General Practitioner
Conducts basic hearing screenings.
Refers patients to specialists.
' Audiologist
Expert in non-medical interventions for hearing loss. Conducts comprehensive auditory
examinations and diagnostic assessments.
Provides and customizes hearing aids.
Offers psychotherapy and auditory rehabilitation services.
Guides on hearing preservation and equipment use.
' Otolaryngologist
Specializes in medical and surgical care for ear, nose, throat (ENT), and head/neck disorders.

Pure Tone Audiometry

Measures an individual's ability to hear specific pure tones.
Determines type and severity of hearing loss by identifying difficult frequencies.
Methods used:
Manual audiometry (conventional)
Automatic audiometry (Békésy)
Computerized audiometry

Speech Audiometry
A collection of tests using speech as the stimulus.
Conducted in quiet and noisy conditions.
Assesses ability to perceive and comprehend spoken languages
Speech Reception Threshold (SRT): The decibel level at which speech comprehension occurs.
' SRT is often determined by evaluating two-syllable words, assessing each ear independently.

Alternative Audiometric Techniques

Behavior Observation Audiometry

A non-invasive assessment technique.
Involves observing the child l s responses to noises,
An auditory stimulus is gradually intensified until a consistent reaction is seen, such as: Movement of the
head
 Blinking of the eyes
Stopping of play

Characteristics of Deaf and Hard-of-Hearing Learners

The characteristics of learners with hearing impairment vary widely depending on the cause of their hearing loss.
Common characteristics include:
Difficulty with speech, reading, and writing due to the close relationship of language and hearing.
Delayed or slow responses to spoken or verbal instructions. Use of hearing aids and/or amplification systems to
enhance oral communication.
Preference for visuals or American/Filipino Sign Language for communication.

Educational Approaches

Technology and Support

Some learners with hearing impairment (HI), especially those who are hard-of-hearing, use hearing assistive
technology (HAT) to support their audition and understanding in various settings.

Hearing Aid
The most common type of HAT.
An ear-worn or behind-the-ear electronic device that amplifies sounds.
Comes in different shapes and sizes with three parts:
Microphone
Amplifier
Speaker

Cochlear Implants
A viable alternative for those with profound hearing impairment due to inner-ear damage,
Utilizes a sound processor positioned behind the ear,

Augmentative and Alternative Communication (AAC)

Devices that provide alternative means of communication for those unable to use spoken language due to profound
hearing loss or speech problems.
' Often synonymous with speech-generating devices (SCD), typically in the form of tablets or laptops.

Alerting Devices
Provide visual or tactile cues for safety and awareness of significant sounds or alerts.
Commonly known as signalers or notification devices, using flashing lights and/or vibrations.

Speech-to-Text Translation
Software or applications that convert verbal input into text. Aids learners with HI to visually access class
discussions and enhance understanding.

Audio/Video Transcriptions
Essential for providing access to multimedia content.
Modern technology, like televisions, often includes captioning features for better comprehension.

Teaching Approaches

Oral Approaches
Excludes the use of sign language, emphasizing the development of receptive (hearing) and expressive (spoken)
language skills.
Focuses on:
Amplification
Auditory training
Speechreading
Cued speech (a visual communication system with hand signals for phonemes).

Technological Aids and Verbal Communication

Total Communication / Simultaneous Communication

Total communication is both an educational philosophy and a communication method.
Known as "SimCom," it combines spoken words and manual communication (like signing and fingerspelling) to help
children use one or both forms of communication (Hawkins & Brawner, 1997),
Techniques Used
Sign language
 Spoken language Auditory perception
Fingerspelling Gestures Facial
expressions
Lipreading

Premise and Goal

The approach is based on the belief that deaf children can develop strong communication skills using any available
tools.
The goal is to enhance language acquisition by using the most effective methods tailored to each child's needs
(National Deaf Children's Society, 2024).

Bicultural-Bilingual Approach
The bicultural-bilingual approach has three key elements (Schirmer,
2001):
 American Sign Language (ASL) is the primary language; English is secondary.
 Hearing-impaired individuals significantly
 Education on Deaf culture,

Bilingual Education
For deaf students, bilingual education can be organized in two ways:
Learning ASL first, then English.
Teaching both languages simultaneously,

Additional Accommodations
Use voice modulation and audio amplification devices for better instruction.
Adapt visual cues, picture-supported texts, written notes, outlines, and diagrams to aid comprehension.

Placement Options
Residential Schools
Residential schools for the Deaf can effectively help learners develop communication and language skills with peers.
These schools offer specialized instruction and programs tailored to the unique learning styles and needs of Deaf
students.
Inclusive Classroom
While there are barriers for Deaf children in regular classes, socializing and exposure to hearing individuals are crucial.