HEARING IMPAIRMENT

PART I. DEFINITION
Hearing impairment is linked to increased fatigue, yet little is known about the real-
world impact of this fatigue. This study investigated the experience of daily-life
fatigue in people with a hearing impairment. Hearing loss happens when something
affects your hearing system. If you have hearing loss, you may have trouble
understanding, following or participating in conversations. It may be hard for you to
hear telephone conversations, to take part in online meetings or follow dialogue when
you’re watching television. Hearing loss can affect your ability to work, communicate
with others and generally enjoy life. Most often, hearing loss can’t be reversed. But
audiologists — healthcare providers who specialize in diagnosing and treating hearing
loss — can help. They can recommend treatments like hearing aids or cochlear
implants that reduce hearing loss.

PART II. INCIDENT/PREVALANCE

This study investigated the prevalence of hearing loss in the Philippines using a large-
scale survey of 2,275 adults and children. The study found that hearing loss is a
significant issue in the Philippines, with higher prevalence rates compared to high-
income countries. Specifically, 7.5% of children under 18 years old had moderate or
worse hearing loss, while 14.7% of adults between 18 and 65 years old and a
staggering 49.1% of adults over 65 years old showed signs of hearing loss. The study
also identified factors associated with an increased risk of hearing loss, including
middle ear conditions, socioeconomic status, and age. Furthermore, the study found
that a considerable proportion of participants had wax occlusion (12.2%) and outer or
middle ear disease (14.2%). These findings highlight the importance of addressing
hearing loss in the Philippines, particularly considering the high prevalence of severe
to profound hearing loss observed in the study.

The study also provides valuable insights into the global prevalence of hearing loss,
revealing that approximately 8% of the world's population (half a billion people) have
hearing loss. In the United States, 13% of adults aged 12 and older have hearing loss
in both ears, with the prevalence increasing significantly with age. The study also
emphasizes the impact of occupational noise exposure, showing that adults with
prolonged exposure to very loud noise at work are significantly more likely to
experience hearing loss.

PART III. TYPES/CLASSIFICATION

There are three types of hearing loss:
1. Conductive hearing loss: In this hearing loss, something keeps sound from passing
through your outer ear (ear canal) or your middle ear.

2. Sensorineural hearing loss: This hearing loss happens when something damages
your inner ear over time. Rarely, sensorineural hearing loss happens very quickly.
This is sudden sensorineural hearing loss (SSHL), or sudden deafness. SSHL may
happen all at once or over a few days.

3. Mixed: This happens when you have issues in your middle or outer ear (conductive
hearing loss) and your inner ear (sensorineural hearing loss).
PART IV. CLINICAL SYMPTOMS
What are hearing loss symptoms?
Most people lose their hearing gradually. They may not even notice that it’s
happening. In general, you may be developing hearing loss if:

-You often ask people to repeat themselves.

-You have trouble following a conversation, especially when you’re talking on the
telephone or in a noisy environment like a restaurant.
-You think people are mumbling.
-You have tinnitus (ringing in your ears).
-Your ear hurts (earache).
-You feel as if there’s pressure or fluid inside your ear.

What are symptoms of hearing loss in babies and children?

Babies with hearing loss may seem to hear some sounds but not others. They may:
-Not startle to loud noises.
-Not turn to the source of a sound after 6 months of age.
-Not say single words like “mama” or “dada” by age 1.
-Not react when you say their name.

PART V. CAUSES
CAUSES
What usually causes hearing loss?
Many things can cause hearing loss. For example, short-term or sudden exposure to
very loud noise — like attending a loud concert — can affect your hearing.

Conductive hearing loss causes include:

-Earwax that’s built up in your ear.

-Fluid in your middle ear from colds or allergies.
-Middle ear infection (otitis media).
-Swimmers’ ear (otitis externa).
-Eustachian tube issues that traps fluid in your middle ear.
-Ruptured eardrum.
-Ear tumors.
-Something stuck in your ear.
-Congenital conditions (conditions present at birth) that affect how babies’ middle or
outer ears are formed.

PART VI. ASSESSMENT

Methods of Assessment

1. Physical Examination
A healthcare provider examines the ears to identify possible causes of hearing loss,
such as earwax buildup or infections.

2. Screening Tests
Whisper Test: The provider covers one ear and speaks at various volumes to assess
the individual's ability to hear spoken words.
App-Based Hearing Tests: Mobile applications can screen for hearing loss and
provide preliminary assessments.

3. Tuning Fork Tests

Tuning forks are used to determine the type and extent of hearing loss. They produce
sound that helps assess both conductive and sensorineural hearing loss.

4. Audiometer Tests
Conducted by an audiologist, these tests involve playing sounds and words through
earphones at varying volumes to determine the quietest sounds a person can hear.

5. Otoacoustic Emissions
A probe is placed within the child's ear and serves as both a stimulus emitter and
recorder. Standard testing utilizes multiple frequencies ranging from 2000 Hz to 5000
Hz. Many practices use TEOAE for screening purposes, although both TEOAE and
DPOAE are acceptable. Results are binary and qualitative with either a "pass" or
"refer" result based on the presence or absence, respectively, of cochlear
microphonics.

6. Auditory Brainstem Response

Earphones are placed in the child's ear, and electrodes are placed on the scalp. If the
patient is a newborn or young child, feeding and performing diaper hygiene may
facilitate sleep. The earphones emit a sound signal ranging in frequency and intensity
that are detectable by electrical changes seen on a monitor. The results can be viewed
at waves I to V, representing the anatomic landmarks described in the Anatomy &
Physiology section.

7. Tympanometry
An ear probe with a soft tip (immittance probe) is placed within the ear canal of the
test ear, with the tip sealing the ear to maintain pressure. The pressure within the
external ear is changed while the child hears low-frequency noise stimuli. Recordings
of the movement of the tympanic membrane are obtained. The standard probe tone is
a 226 Hz signal, which is used for most purposes in children over six months of age.
Some research suggests that a 1000 Hz probe- tone may be more accurate at
diagnosing middle ear effusions in children under six months old due to improved
stiffening of the tympanic membrane with a higher frequency probe tone.

8. Genetic and Laboratory Testing

Patients with bilateral sensorineural hearing loss or ANSD may benefit from a genetic
workup. Approximately 50% of congenital hearing loss is reportedly genetic, with the
vast majority of genetic cases being non-syndromic in nature. Syndromic cases can be
divided into autosomal dominant and autosomal recessive cases.

PART VII. EDUCATIONAL APPROACHES

a. Suggestions for teaching students who are deaf or hard of hearing

1. Communication Strategies
 Get Attention First: Use visual signals (tap, wave) before speaking.
 Set Context: Introduce the topic to help follow the conversation.
 Speak Clearly: Enunciate slowly and avoid exaggeration or shouting.
 Maintain Eye Contact: Look directly at the student; avoid obstructions.
 Avoid Mouth Obstructions: Don’t chew, smoke, or cover your mouth while
speaking.
 Use Open-Ended Questions: Encourage detailed responses to confirm
understanding.

2. Classroom Setup

 Optimal Seating: Position students to see the speaker clearly.

 Good Lighting: Ensure speakers are well-lit, avoiding bright backgrounds.
 Provide Vocabulary in Advance: Share new terms ahead of discussions or
lectures.
 Avoid Movement While Speaking: Stay still when addressing the class to
facilitate lip reading.

3. Engagement Techniques

 Rephrase When Necessary: If misunderstood, rephrase instead of repeating.

 Incorporate Visuals: Use body language, facial expressions, and visual aids.
 Use Written Communication: Utilize paper or digital tools for important
messages.
 Check for Understanding: Regularly confirm comprehension through
discussions or reflections.

4. Additional Considerations

 Be Courteous: Acknowledge distractions and keep the student informed.

 Manage Information Flow: Write down important changes or assignments.
 Slow Down Pace: Allow extra time for processing and responding.
 Repeat Important Information: Ensure clarity on comments made from the
back of the room.

By focusing on these key points, educators can create a more inclusive and effective
learning environment for students who are deaf or hard of hearing.

b. Working with a Sign Language Interpreter

1. Direct Communication

 Speak to the Student: Address the student with hearing impairment directly, not
the interpreter.
 Maintain Normal Tone: Use a normal speaking voice; avoid rushing or
shouting.

2. Interaction with the Interpreter

 Give Time for Interpretation: Allow the interpreter time to finish before asking
questions or moving on in the discussion.
 Avoid Side Comments: Do not make comments to the interpreter that aren’t
meant for the student.

3.Environment Considerations

 Provide Adequate Lighting: Ensure the interpreter is well-lit, especially when

darkening the room for presentations. Use auxiliary lighting if necessary.

4.Group Discussions

 One Speaker at a Time: Limit discussions to one person speaking at a time to

allow the interpreter to follow and convey the message accurately.
 Pause Between Speakers: Allow brief pauses to give the interpreter time to
finish.

5. Facilitating Engagement

 Clear Handouts: Allow students time to review handouts or visual materials

without having to divide their attention.
 Call on Individuals: Proactively engage students by calling on them to speak,
ensuring they don’t miss opportunities to contribute.

6. Additional Tips

 Clarification Requests: Be open to requests from the interpreter or the student

for clarification or repetition.
 Monitor Participation: Watch for non-verbal cues from the student to ensure
they are involved and following along.

By following these guidelines, educators can create a more inclusive and effective
learning environment for students who are deaf or hard of hearing, facilitating better
communication and participation.

c. American Sign Language

1. Understanding Deafness

 More Than Hearing Loss: Deafness encompasses a range of communication

challenges, especially for those who were born deaf or lost hearing before age
two.
 Language Acquisition: Many deaf individuals primarily use American Sign
Language (ASL), which has its own syntax and grammar. They often struggle
with English since they may have never heard it.

2.Communication Challenges

 Residual Hearing: Most deaf individuals have some residual hearing, but their
ability to understand speech varies significantly.
 Need for Multiple Supports: Students may rely on speech reading (lip reading),
hearing aids, interpreters, or real-time captioning to succeed academically.
 Limitations of Speech Reading: Only about 25% of speech is visible on the lips,
making speech reading insufficient on its own.

3. Hearing Aids and Background Noise

 Amplification Issues: Hearing aids amplify all sounds, including background

noise, which can make it difficult to differentiate speech from other sounds.
 Understanding Speech: Without previous auditory experience, students may
find it challenging to interpret speech patterns and consonants.

4. Intelligence and Speech Ability

 No Correlation with Intelligence: A student's hearing impairment does not

reflect their speech abilities or intelligence. Communication challenges should
not be mistaken for cognitive limitations.

By recognizing these complexities, educators and peers can better support deaf and
hard-of-hearing students in their academic journeys, fostering an inclusive and
understanding environment.

PART VIII. REFERENCES

https://www.tandfonline.com/doi/full/10.1080/14992027.2019.1597284#abstract
https://my.clevelandclinic.org/health/diseases/17673-hearing-loss
https://www.who.int/deafness/Global-estimates-on-prevalence-of-hearing-loss-
Jul2018.pptx?ua=1
https://pubmed.ncbi.nlm.nih.gov/32608243/
https://www.edtechreview.in/trends-insights/insights/inclusive-education-for-
students-with-hearing-impairment/