Dr G K HEBBAR'S MICRO EAR SURGERY & ENT ENDOSCOPY CENTRE Frequently Asked Questions on IMPACT OF HEARING LOSS IN Ear

and Sinus Disorders CHILDREN

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Introduction: A hearing impairment is a decrease in one's ability to hear (i.e. perceive auditory information). Deafness is the second most common disability and is largely invisible. Approximately 3 in every 1,000 children born have a hearing loss. The majority are deaf children born to hearing parents. While some cases of hearing loss are reversible with medical treatment, many are permanent. Whether temporary or permanent, how severely hearing is compromised is not uniform. In some cases the hearing loss is only mild or moderate, and individuals may not even be aware they are affected. In other cases the degree of deafness is profound and, although vibrations will be sensed, even the sound of a nearby jet engine will not be heard. Parents, teachers and the public need to have a thorough understanding of the challenges faced by these hearing impaired children in order to handle them properly. The general reaction of the public when they come across such children is that of ridicule, little understanding the trauma faced by such children. Children may have different levels of hearing loss. Classification of hearing impairment: They may be classified as a) Mild hearing loss, where the child suffers from a hearing loss between 15 40 dbHL.These children may have difficulty in following speech in noisy situations. b) Moderate hearing loss ( 41 70 dbHL). These children have difficulty in following speech without a hearing aid. Also, they have great difficulty in noisy situations. C) Severe hearing loss (71-95 dbHl). These children have difficulty in following speech even with a hearing aid. D) Profound hearing loss (>96 dbHL) Hearing aids will be of little to no help. When the hearing loss occurs at

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a young age, interference with the acquisition of spoken language and social development may occur. Hearing aids and cochlear implants may alleviate some of the problems caused by hearing impairment, but are often insufficient. Pre-lingual hearing impairment exists when the impairment is congenital or otherwise acquired before the individual has acquired speech and language, thus rendering the disadvantages more difficult to treat because the child is unable to access audible /spoken communication from the outset. It is important to note that those children born into a deaf family using sign language have no delay in language development and communication. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma; therefore, families commonly have no prior knowledge of deafness. Post-lingual hearing impairment is, where hearing loss is adventitious after the acquisition of speech and language, usually after the age of six. It may develop due to disease, trauma, or as a side-effect of a medicine. Typically, hearing loss is gradual, and often detected by family and friends of the people so affected long before the patients themselves will acknowledge the disability. Hearing impairment has an impact on the childs social life, psychology, and on learning capabilities. Social impact in the hearing impaired pre-lingually

In children, hearing loss can lead to social isolation for several reasons. First, the child experiences delayed social development that is in large part tied to delayed language acquisition. It is also directly tied to their inability to pick up auditory social cues. This can result in the deaf child becoming generally irritable. A child who uses sign language, does not generally experience this isolation, particularly if he attends a school for the deaf, but may conversely experience isolation from his parents if they do not know sign language. A child who is exclusively or predominantly oral (using speech for communication) can experience social isolation from

his or her hearing peers, particularly if no one takes the time to explicitly teach the child social skills that other children acquire independently by virtue of having normal hearing. Finally, a child who has a severe impairment and uses some sign language may be rejected by his or her deaf peers, because of an understandable hesitation in abandoning the use of existent verbal and speech-reading skills. Social impact in the hearing impaired post-lingually

Those who lose their hearing later in life, such as in late adolescence or adulthood, face their own challenges. For example, they must adjust to living with the adaptations that make it possible for them to live independently. They may have to adapt to using hearing aids or a cochlear implant, develop speechreading skills, and/or learn sign language. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability. The challenge is made greater by the need for those around them to adapt to the person's hearing loss. Children who suffer from untreated hearing loss often find it extremely difficult to participate in social activities, even within their own family. Some common social problems for children with untreated hearing loss include: isolation and withdrawal, inattentiveness, bluffing, distraction/lack of concentration. Psychological consequences It is commonly known that untreated hearing loss may have serious negative psychological effects. Some are more common than others -- here are some of them: shame, guilt and anger, embarrassment, poor concentration, sadness or depression, worry and frustration, anxiety and suspiciousness, self-criticism and low self-esteem/self-confidence. Physical consequences Untreated hearing loss often results in certain physical problems such as tiredness or exhaustion, headache,

vertigo, tense muscles, stress, problems with sports, eating and/or sleeping disorders and stomach disorders. Effects of hearing loss on learning Childhood hearing loss is a very common problem within our schools. Even a very mild loss can affect how a student learns. Every teacher in the early elementary school can expect to have one-fourth to one-third of his or her students without normal hearing on any given day. Children spend at least 45% of their day engaged in active listening activities. It is obvious that teachers need to be aware of the impact such a loss can have on learning. The maximum desirable noise level for children having normal hearing is 35 decibels (dB). The noise level can reach up to 44 decibels in an empty classroom with only traffic noise from the street or hallways. With 25 students and one teacher, the noise level can reach from 55-75 dB. Children in the process of building their language base do not have the same linguistic experience as adults. Adults call on their experience with language (previous knowledge of a topic, known vocabulary, grammatical/sentence structures) to fill in the gaps in hearing. It is only when children reach their teens that their speech recognition in difficult listening conditions comes close to that of an adult. It also has a negative impact on verbal language, reading, writing and academic performance. A loss of any type or degree can present a barrier to incidental learning because:

90% of the knowledge acquired by a young child is learnt incidentally. A hearing loss is a barrier to overhearing and learning from the environment. Children with a loss often miss social clues. Children with a loss cannot listen and learn--at least 10% of classroom instructions may be missed.

Academic losses occur in children as early as kindergarten and first grade. Most children with losses begin to show considerable learning difficulties when they reach third grade. This difficulty may be due to the

changes in language complexity, less visual clues, more verbalizations, greater need to sequence and recall and lack of development of pre-skills in the previous grades. Similarities between mild hearing loss and attention deficit disorder Often the symptoms of a hearing loss are mistaken for an Attention Deficit problem. The chart below shows the similarities. MILD HEARING LOSS ATTENTION DEFICIT DISORDER
Blurting out answers before questions are completed

Inappropriate responses

Difficulty following Difficulty following directions through on instructions and organizing tasks Difficulty in listening to Difficulty sustaining attention others without being during oral presentations distracted or interrupting Impulsive Acts on the spur of the moment

Focuses only with frequent reinforcement or Frequently asks for repetition is under very strict control Academic failure Poor self-concept Doesn't assignments complete Multiple problems with schoolwork and social activities Isolated and low self esteem Frequently fails to finish schoolwork, or works carelessly "Can't sit still and listen!"

Doesn't seem to listen

How can teachers help? Teachers need to evaluate the listening environment and the skills of their students.

Suggestions to aid in meeting the specific needs of the hearing impaired child in the classroom are: 1. Do not turn away to write on the board or cover your mouth while talking. 2. Rephrase if the child does not understand rather than repeat the same words over and over. 3. Seat the child away from hallways, playground noise, etc. 4. Allow the child to move around in the room in order to clearly see the speaker. 5. Use as many verbal cues as possible. Take time to explain things. Give context clues-- a written word, object or picture to set the stage to help follow the change of subject. 6. Write key words of an idea or lesson on the board or use an overhead projector. 7. Assignments should be written on the board so that the student can copy them into a notebook used for this purpose 8. Appoint a helper/notetaker for the child 9. If the child's hearing impairment involves only one ear or if the impairment is greater in one ear than the other, seat the child in front of the room with his poorer ear towards the noisy classroom and his better ear towards the teacher. 10. Speak clearly and with moderate speed. Use of assistive devises will help those with moderate to severe sensorineural hearing loss. A HI child attending classes with normally hearing children might need to use hearing aids. The introduction of FM systems into the classrooms of the deaf has had a significant impact on student learning. Numerous studies have shown improvement in attention, understanding directions, classroom participation and school behavior. Amplification equipment is meant to enhance the acoustical accessibility to teacher instruction to all children by: increasing the overall level of the teacher's speech, substantially improving the speech-to-noise ratio, and producing a uniform speech level in the classroom that is unaffected by

teacher or pupil position. In conclusion, parents, teachers and the general public should understand the problems faced by the hard of hearing children. Everybody should realize that these children are handicapped, though invisibly. They should try and adapt to the needs of these children. The parents and teachers should be patient with these children and be more accommodating. As far as possible these children should be tried to be accommodated in normal schools with the aid of assistive hearing devises. The normal hearing public have a duty to integrate these handicapped children into our normal society.