THE UNIVERSITY OF DODOMA.

COURSE CODE: SN121

NAME: INTRODUCTION TO HEARING

IMPAIRMENT.

INSTRUCTOR : KAYOMBO P.S.

INTRODUCTION TO HEARING IMPAIRMENT.
We should firstly know some Basic Concepts in Hearing Impairment;
What is Hearing?, What is Listening?, What is impairment?, What is
disability?
HEARING
Hearing is the ability to perceive sound.
LISTENING
Is active process of receiving and responding to spoken message,
listening involves paying attention or concentrating to a sound.
IMPAIRMENT
is a loss or abnormality of psychological, physiological or anatomical
structure of a body part / sense organ.
Concepts….
DISABILITY
Is an inability of a body part to perform a certain task which is considered to
be normal to a person.
A handicap is defined as the “loss or limitation of opportunities to take part in the
life of the community on an equal level with others.” For example, a boy not getting
a job or a girl not getting the opportunity to go for higher education
HEARING IMPAIRMENT
according to Individuals With Disabilities Education Act ( IDEA) IS referred as is
“an impairment in hearing, whether permanent or fluctuating, that adversely affects a
child’s educational performance. Or is a partial or total inability to hear.
OR hearing loss is the totally or partially loss of hearing ability that adversely affect
the effective functioning of a person.
Therefore; Hearing impairment is a general term often used to describe people with
any degree of hearing loss, from mild to profound.
Categories of Hearing impairment….
Hearing impairment has divided into two categories those are; Deaf
and Hard of hearing;
Deaf
"Deaf" usually refers to a hearing loss so severe that there is very little
or no functional hearing
Hard of Hearing
refers to a hearing loss where there may be enough residual hearing
that an auditory device, such as a hearing aid or FM system, provides
adequate assistance to hearing.
People who are deaf or hard of hearing may have speech that is difficult
to understand due to the inability to hear their own voice.
Variation of people with Hearing Impairment,

We must know that individuals with hearing impairment is

highly heterogeneous. This means that the functioning levels
of the individuals with hearing impairment can be very
different from each other. You may meet a child with hearing
impairment who is managing verbal communication very well
with you. The next child you meet may not be able either to
talk fluently or even read, write adequately.
Content…………..
The followings are the factors that cause the occurrence of the
variations;
Hearing impairment can be;
 Age of ONSET; Congenital (Congenitally Deaf)– This means a person
born with hearing impairment, Acquired (Adventurously Deaf) –
Means a person acquire hearing impairment after birth, a person can
acquire hearing loss pre lingual (means after language acquisition)or
acquired post lingual (after language acquisition), or acquired due to
ageing (Presbycusis).
Bilateral or unilateral. Bilateral means hearing loss in both ears.
Unilateral means hearing loss in one ear
Hearing impairment can be reversible (medically / surgically treated)
or it can be irreversible (medically untreatable).
Content….
Hearing impairment can be temporary or it can be permanent.
Fluctuating or stable hearing loss. Fluctuating means hearing loss
that changes over time. It sometimes gets better, sometimes gets
worse. Stable means that your hearing loss has stayed the same
Symmetrical or asymmetrical. Symmetrical means the severity and
shape of hearing loss are the same in each ear. Asymmetrical means
each ear has a different severity and shape
Hearing impairment can co-exist with other disabilities / medical
concerns
Hearing impairment can be of various degrees like mild, moderate,
severe, and profound.
D egE resoG R
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Degree of hearing loss Hearing loss range (dB HL)

Normal –10 to 15

Slight 16 to 25

Mild 26 to 40

Moderate 41 to 55

Moderately severe 56 to 70

Severe 71 to 90

Profound 91+

Source: Clark, J. G. (1981). Uses and abuses of hearing loss classification. Asha, 23, 493–500.
Degrees…………

• Mild Hearing Loss

People with a mild hearing loss may have difficulty hearing soft spoken people and young children.
They are often able to hear the loud or more intense vowel sounds, but may miss some of the softer
consonant sounds. They may have to ask people to speak up or repeat themselves on occasion. For
someone with typical hearing, this is comparable to placing fingers in one's ears.
• Moderate Hearing Loss
In addition to missing consonant sounds, vowel sounds then become more difficult to hear. People
with a moderate hearing loss often comment that without hearing aids they hear, but can’t always
understand.
• Moderately Severe Hearing Loss
Without hearing aids, speech is inaudible. Even with hearing aids, speech may be difficult to
understand. Increasing the amplification doesn’t always make it clearer.
• Severe
Without hearing aids or cochlear implants, speech is inaudible.
• Profound
Without hearing aids, may be unable to hear very loud sounds like airplane engines, traffic, or fire
alarms. Also, this refers to completely loss of hearing where a person cant hear any sound.
Degrees…..
 TYPES OF HEARING LOSS

• Hearing loss is categorized into different types, depending on where or

what part of the auditory system is damaged.
• Therefore in order to understand the types of hearing loss, we need to
understand the parts of the auditory system
• The human ear is divided into three major parts- the outer, middle and
inner ear. The outer ear picks or collects energy, the middle ear
transmits the energy which is then converted into nerve impulses in the
inner ear.
• External ear (outer ear): It consists of the pinna and the ear canal,
Middle ear: It consists of the eardrum and the 3 small bones (Ossicles),
Inner ear: It consists of the cochlea and the semi-circular canals.
• Look at the picture bellow;
A HUMAN EAR
Types…

So Basically, we have four sometimes Five types of Hearing

Loss those are;
1. Conductive Hearing Loss
2. Sensory-neuron hearing loss
3. Mixed hearing Loss
4. Central hearing loss
5. Malingering hearing loss
Types…

1. Conductive Hearing Loss

Conductive hearing loss occurs when sound is not sent easily through
the outer ear canal to the eardrum and the tiny bones (ossicles) of the
middle ear.
This means is a conditions whereby there are any problems in the ear
canal, for example wax or foreign body in the ear, and / or any problem
in the middle ear, for example, perforation (hole) in the eardrum.
It occurs as a result of obstruction of the passage of sound waves
through the external canal or by way of the ossicular chain through the
middle ear. It does not affect the inner ear.
Conductive hearing loss usually involves a reduction in sound level (or
the ability to hear unclear sounds). This type of hearing loss can often
be corrected medically or surgically
Continue….
2. Sensory-neuron Hearing Loss (Sensory – Organ of court, Neuron (Hair cells and earth nerves)
Sensorineural hearing loss (SNHL) happens when there is
damage to the inner ear (cochlea) or to the nerve pathways
from the inner ear to the brain.
Sensorineural hearing loss not only involves a reduction in
sound level, or ability to hear faint sounds, but also affects
speech understanding, or ability to hear clearly. Even when
speech is loud enough to hear, it may still be unclear or sound
muted.
Most of the time, SNHL cannot be medically or surgically
corrected unless there is problem with the cochlea.
This is the most common type of permanent hearing loss.
Types……….

3. Mixed Hearing Loss

Mixed hearing loss occurs when a conductive hearing loss happens in
combination with an SNHL.
In other words, there may be damage in the outer or middle ear and
in the inner ear (cochlea) or auditory nerve.
Mixed hearing loss are often difficult to diagnose and treat because
are problems of both conduction and processing of sound.
Types….
4. Central Hearing Loss (Central deafness (CD) )
is a broad term referring to conditions in which partial or complete loss of hearing
occurs due to damage or dysfunction of the central auditory nervous system (CANS).
The auditory cortex processes and interprets the sounds amplified and received by
the ossicles and cochlear hair cells
Therefore if there is interference caused by with the pathway through which nerve
fibre proceed from the brain stem to the temporal lobes of the cerebral cortex, it is
the results to central hearing loss or central deafness.
Injuries such as brain tumors and embolic strokes in the region of the transverse
temporal gyri affect speech discrimination more than they affect hearing threshold
levels, as patients with central hearing loss often have normal audiograms.
5. Malingering hearing Loss
is a form of Non Organic Hearing Loss and this term implies that the subject is
consciously pretending to have a worse level of hearing than the real one in order to
avoid some responsibility/seeking material compensation.
 CAUSES OF HEARING LOSS

Causes of Conductive Hearing Loss

• perforated eardrum (i.e. hole in the tympanic membrane), benign
tumors
• Impacted earwax (cerumen)
• Infection in the ear canal (external otitis)
• Presence of a foreign body
• Absence or malformation of the outer ear, ear canal, or middle ear
• fluid in the middle ear from colds,
• allergies,
• Poor Eustachian tube function,
• ear infection (otitis media),
Causes..
Causes of Sensorineural Hearing Loss
• Specific illnesses or infections
• Traumatic brain injury
• Drugs that are toxic to the auditory system
• Genetic syndromes
• Excessive or extreme noise exposure
• Viral infection in pregnancy
• Rh incompatibility
• Head trauma
Causes……
• Ageing
• Tumors
• Infections involving the inner ear and hearing nerve
• Hearing loss that runs in the family (genetic or
hereditary)
• Meningitis
• Consanguineous marriages-Marriage between close
relations.
THE CAUSES OF HEARING LOSS TO NEWBORNS

•Low birth weight (especially less than 3.3 pounds, or 1.5 kilograms)
•Low Apgar score (lower than 5 at 1 minute after birth or lower than 7 at 5 minutes after
birth)
•Low blood oxygen levels or seizures resulting from a difficult delivery
•Infection before birth with rubella, syphilis, herpes, cytomegalovirus, or toxoplasmosis
•Abnormalities in the skull or face, especially those involving the outer ear and ear canal
(see Developmental Abnormalities of the Outer Ear)
•A high level of bilirubin (a waste product) in the blood ( see Jaundice in the Newborn)
•Bacterial meningitis ( see Meningitis in Children)
•Bloodstream infection (sepsis)
•Use of a ventilator (a machine that helps air get in and out of the lungs) for a long time
•Use of certain drugs that can damage the ears, such as aminoglycoside antibiotics and
some diuretics
•History of early hearing loss in a parent or close relative
 PREVENTION OF HEARING LOSS

Primordial Prevention measures are as follows,

• Avoid marriages amongst close relatives.
• Immunize adolescent girls and women in child bearing age against
Rubella.
• Ensure good health of the expectant mother.
• Do not clean the ears with pointed objects like pencils, hairpins etc.
• If there is a need to clean the ears in case of impacted wax, go to ENT
surgeon (otorynolyngology (Ear, throat and nose).
• Avoid cleaning ears by roadside quacks.
Preventions……

• Do not use oil or any other liquid for cleaning the ears.
• Do not swim in dirty water it can enter your ears and may cause
infection.
• Visit an ENT doctor immediately if you have pain, swelling, discharge,
a wound in ear or frequent and prolonged coughs and colds.
• Use ear protectors while working in noisy places.
• Control upper respiratory tract infections, especially in children below
5 years of age
Secondary Prevention measures are as follows;
Occurrence of hearing loss cannot always be prevented, but definitely its
impact can be reduced,
• if identified and intervened early.
• High risk babies should be screened for hearing loss at the time of birth.
• All school children should be screened for hearing loss.
• If there is no medical or surgical treatment available, immediately
consult an audiologist for appropriate amplification
• Raising awareness of users of ototoxic medications
• Developmental milestones of each child should be monitored for any
delays and deviations.
• If there is any indicator of hearing loss, hearing should be assessed
immediately.
ASSIGNMENT
• With vivid examples Discuss the Psychological and behavioral
characteristics of people with hearing impairment and hard of
hearing. (Group work - present)
• As a teacher describe Teaching and learning strategies as well as
methods that you will use to children with hearing impairment and
hard of hearing (Individual Assignment).
• DEADLINE 28th April, 2023.
 HUMAN EAR

Anatomy, Physiology
and Pathology of the
Ear.
CONFIGURATION OF HEARING IMPAIRMENT
The configuration, or shape, of the hearing loss
refers to the degree and pattern of hearing loss
across frequencies (tones) as illustrated in a graph
called an audiogram.
For example, a hearing loss that only affects the
high tones would be described as a high-
frequency loss, Its configuration would show good
hearing in the low tones and poor hearing in the
high tones.
On the other hand, if only the low frequencies
were affected, the configuration would show
poorer hearing for low tones and better hearing
for high tones. Some hearing loss configurations
are flat, indicating the same amount of hearing
loss for low and high tones.
Therefore the ​results from a hearing test are
displayed on an audiogram.
AUDIOGRAM
An audiogram is a graph that shows the audible
threshold that a person can hear at different pitches
or frequencies as measured by an audiometer.
An audiogram is a graph that shows the audible
threshold for standardized frequencies as measured
by an audiometer.
In the Audiogram there are Y and X axes. The Y axis
represents intensity measured in decibels and the X
axis represents frequency measured in hertz.
AUDIOGRAM
Audiogram Symbols
• An "O" often is used to represent responses for the right ear and an
"X" is used to represent responses for the left ear.

• A key on the audiogram, similar one found on a map, identifies what

the different symbols mean.

• The pitches shown on the audiogram are those most important for
hearing and understanding conversation.

See the Diagram bellow;

Configuration content…
The diagram bellow shows an audiogram with degrees of hearing loss
Configuration…

• Each sound we hear when someone speaks

has a different pitch and loudness. For
example, the "s" sound is high in pitch and
quiet. The "o" sound is low in pitch and
louder.
• The audiogram shown below has a shaded
area that shows the range of pitch and
loudness for most speech sounds
HOW DO WE GET AN AUDIOGRAM

During a hearing test, sounds are presented in

different ways. When testing with earphones or
loudspeakers, the sounds go into the ear canal,
through the middle ear to reach the inner ear. This is
known as air conduction testing.
Air conduction testing looks at how the whole
hearing system responds to sound.
Air conduction thresholds are usually marked with
an O for the right side and an X for the left side
If air conduction testing shows a hearing loss, bone
conduction testing is used. ​A device called a bone vibrator
or a bone oscillator is placed behind the ear to send sounds
directly to the inner ear.
This allows for stimulation of the cochlea via mechanical
vibration of the skull with almost no stimulation of the outer
and middle ear.
Bone conduction thresholds are often marked with an < for
the right side or an > for the left side.
NB: The difference between air conduction(AC) and bone conduction
(BC)is called “airborne gap” and reflects outer or middle ear problem
If air conduction and bone conduction thresholds are similar, this indicates that the outer ear and middle ear can carry sounds to the cochlea without resistance, but there is an issue in the inner ear or
hearing nerve. This would be sensorineural hearing loss (SNHL)
Audiogram
• What an audiogram of sensorineural hearing loss looks like
For sensorineural hearing impaired, both bone conduction and air
conduction is abnormal and the two test lines are relatively close to
each other.
What an audiogram of conductive hearing loss looks like

• In this circumstance, bone conduction result is normal while air

conduction result showing there is a hearing loss.
What an audiogram of mixed hearing loss looks like
• Both air and bone conduction are both showing hearing loss problem.
Pure-Tone Testing / Audiometry

You may have had your hearing tested in school or at the doctor’s
office. You might remember putting earphones on and raising your hand
whenever you heard the "beep." This is pure-tone testing.
It is also called air conduction testing since the sounds go through your
outer and middle ear. This test helps find the quietest sound you can
hear at different pitches, or frequencies. Having earphones on lets the
sounds go to one ear at a time.
• You may respond to the sounds by
• Raising a finger or hand
• Pressing a button and pointing to the ear where you heard the sound
• Saying "yes" to indicate that you heard the sound
• The audiologist records your results in an audiogram
Testing Young Children

Young children sometimes do better if they play games. There are ways to
test your child's hearing through play. The most common ways are visual
reinforcement audiometry (VRA) and conditioned play audiometry (CPA).
• Visual Reinforcement Audiometry
This is the best way to screen children between 6 months and 2 years old.
The audiologist will teach your child to look to where the sound came
from. When your child looks in the direction of the sound, they see a
moving toy or flashing light. This rewards your child for looking at the
sound. Both ears are tested at the same time.
• Conditioned Play Audiometry
This type of testing is good for toddlers and preschoolers, ages 2–5. Your
child will do something each time they hear a sound. They might put a
block in a box, put pegs in a hole, or put a ring on a cone.
Bone Conduction Testing

• Audiologists use this type of testing when something, such as wax or

fluid, is blocking your outer or middle ear.
• For this test, the audiologist will put a small device behind your ear or
on your forehead. The sounds sent through this device cause your
skull to gently vibrate.
• This vibration goes to the inner ear, or cochlea, and skips the outer
and middle ear.
• This test tells the audiologist how well you hear and if there is a
problem in the outer or middle ear
Otoacoustic emissions OAEs

Your ear is made up of three parts—the outer, the middle, and the inner ear. The
OAE test is used to find out how well your inner ear, or cochlea, works. It measures
otoacoustic emissions, or OAEs.
These are sounds given off by the inner ear when responding to a sound. There are
hair cells in the inner ear that respond to sound by vibrating. The vibration produces
a very quiet sound that echoes back into the middle ear. This sound is the OAE that
is measured.
This test can also show if there is a blockage in your outer or middle ear. If there is a
blockage, no sounds will be able to get through to the inner ear. This means that
there will be no vibration or sounds that come back.
• How the OAE Is Done
A small earphone, or probe, is placed in your ear. The probe puts sounds into your
ear and measures the sounds that come back. You do not need to do or say anything
during the test. The person doing the test can see the results on the monitor screen.
• The OAE test is often part of a newborn hearing screening program
Auditory Brainstem Response (ABR)
Test or Brainstem Auditory Evoked Response (BAER) Test
Auditory Brainstem Response (ABR) or Brainstem Auditory Evoked
Response (BAER) is a test that checks the brain’s response to sound.
Because this test does not rely on a person’s response behavior, the
person being tested can be sound asleep during the test.
ABR focuses only on the function of the inner ear, the acoustic
(hearing) nerve, and part of the brain pathways that are associated
with hearing. For this test, electrodes are placed on the person’s head
(similar to electrodes placed around the heart when an
electrocardiogram (EKG) is done), and brain wave activity in response to
sound is recorded.
Behavioral Audiometry Evaluation

Behavioral Audiometry Evaluation will test how a person responds to

sound overall. Behavioral Audiometry Evaluation tests the function of
all parts of the ear. The person being tested must be awake and actively
respond to sounds heard during the test.
Infants and toddlers are observed for changes in their behavior such as
sucking a pacifier, quieting, or searching for the sound. They are
rewarded for the correct response by getting to watch an animated toy
(this is called visual reinforcement audiometry). Sometimes older
children are given a more play-like activity (this is called conditioned
play audiometry).
 INTRODUCTION TO AURAL REHABILITATION

INTRODUCTION

Hearing loss has a significant impact on individual person and communication in general.
Adverse effects on physical, cognitive, emotional, behavioral, and social functions can be
observed due to hearing impairment.1 It causes personal frustration leading the individual to
self-isolation and depression, distance to family and social activities; low self-esteem;
loneliness; depression and irritation.
 AURAL REHABILITATION

According to Boothroyd, A. (2007), Aural Rehabilitation is the reduction of

hearing loss (HL) induced deficits of function, activity, participation, and
quality of life through a combination of sensory management, instruction,
perceptual training, and counseling.
According to Montano (2014) A.R is a person-centered approach to assessment and
management of hearing loss that encourages the creation of a therapeutic
environment conducive to a shared decision process which is necessary to explore and
reduce the impact of hearing loss on communication, activities, and participations.
 Cont…..

The AIM/target of Aural rehabilitation is to restore quality of

life by

•eliminating,

•reducing, or

•circumventing these deficits and limitations. This goal can be

addressed through a combination of the following processes
 PROCESSES INVOLVED IN AURAL REHABILITATION

i. Sensory management to improve auditory function

ii. Instruction in the use of technology and control of the listening environment as well
as the provision of special services like sign language training and application for co-
instruction. To increase the probability of positive outcome from sensory management
iii. Perceptual training to improve speech perception and communication. to target
activity, by supplementing the learning opportunities provided by everyday
communication.
iv. Counseling to enhance participation and deal both emotionally and practically with
residual limitations. To target issues of participation and quality of life that result from
residual deficits of function and activity.
THE PROCESS OF AURAL REHABILITATION
 AURAL HABILITATION
Are the services provided to a child found to have hearing loss which
involves teaching the new skills to compensate the lost hearing ability.
AURAH HABILITATION depends on the following
i. Age of a child
ii. Age of onset of hearing loss
iii. Age of which the HL was discovered
iv. The type of the HL
v. The severity of HL
 ASPECTS OF AURAL
HABILITATION/REHABILITATION FOR
CHILDREN
1. Training in Auditory perception
2. Using visual cues (lips)
3. Speech training (production of sound)
4. Language Development (receptive &expressive)
5. Communication management
6. Managing hearing aids and other assistive listening devices
 GOALS OF AURAL REHABILITATION

1. Anatomy and physiology (Function)

 Physical and functional integrity, including the reliability of the outer ear, the
middle ear, the cochlea, neural pathways to the brain, and the brain itself.
 Basic perceptual capacity as measured in the clinic or research lab. This
includes threshold, dynamic range, frequency range, spectral and temporal
resolution, acoustic pattern discrimination, direction and distance perception,
attention, auditory working memory, processing speed, and noise resistance.
Cont…

2. Activity:
The use of this capacity the things one wants or needs to do with
hearing in the real world. Examples include being alerted by sound
monitoring the environment, recognizing and localizing events and
deducing their significance, monitoring and controlling one’s own
speech, and enjoying auditory experiences.

3. Participation:
The contribution of the hearing activities to daily life. Including
social interactions and relationships, employment, leisure, learning,
control, and creativity.
Cont…
4. Quality of life:
 Reflects self-assessment of the current life
experience and includes such things as enjoyment,
meaning, purpose, usefulness, value, freedom of
choice, and independence.
 Quality of life is a moving target. It is influenced by
function, activity, and participation, but is by no
means completely determined by them
Cont…
 CATEGORIES OF AURAL REHABILITATION

CATEGORIES OF AURAL REHABILITATION

1.Psychosocial Aural Rehabilitation

2.Educational Aural Rehabilitation
NB: Training programs must provide budding audiologists
with knowledge and skills in this area, including:

 An understanding of, and sensitivity to, the psychosocial

issues surrounding acquired hearing loss.
 Appropriate interactive styles
 The ability to recognize when there is a need for services
beyond their expertise and/or scope of practice.
 the realization that they do not treat hearing loss in people
they serve people with hearing loss
ASSISTIVE DEVICES

The terms assistive device or assistive technology can refer to any

device that helps a person with hearing loss or a voice, speech, or
language disorder to communicate. These terms often refer to devices
that help a person to hear and understand what is being said more
clearly or to express thoughts more easily.
 HEARING AID
• What is It?
A hearing aid is a small electronic device that you wear in or behind
your ear. It makes some sounds louder so that a person with hearing
loss can listen, communicate, and participate more fully in daily
activities. A hearing aid can help people hear more in both quiet and
noisy situations
A hearing aid has three basic parts: a microphone, amplifier, and
speaker.
The hearing aid receives sound through a microphone, which converts
the sound waves to electrical signals and sends them to an amplifier.
The amplifier increases the power of the signals and then sends them
to the ear through a speaker.
TYPES OF HEARING AID
• Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn
behind the ear and connected to a plastic ear mold that fits inside the
outer ear. The electronic parts are held in the case behind the ear.
Sound travels from the hearing aid through the ear mold and into the
ear. BTE aids are used by people of all ages for mild to profound
hearing loss.
• In-the-ear (ITE) hearing aids fit completely inside the outer ear and
are used for mild to severe hearing loss. The case holding the
electronic components is made of hard plastic. Some ITE aids may
have certain added features installed, such as a tele coil. A tele coil is
a small magnetic coil that allows users to receive sound through the
circuitry of the hearing aid, rather than through its microphone.
TYPES
• In the Canal aids fit into the ear canal and are available in two styles.
The in-the-canal (ITC) hearing aid is made to fit the size and shape of a
person’s ear canal. A completely-in-canal (CIC) hearing aid is nearly
hidden in the ear canal. Both types are used for mild to moderately
severe hearing loss
• FM systems use radio signals to transmit amplified sounds. They are
often used in classrooms, where the instructor wears a small
microphone connected to a transmitter and the student wears the
receiver, which is tuned to a specific frequency, or channel.
TEACHING STUDENTS WITH HEARING IMPAIRMENT

• Teaching Strategies
• When desks are arranged in rows, keep front seats open for students
who are deaf or hard of hearing and their interpreters.
• Provide hand-outs (preferably electronically) in advance of lectures and
seminars
• Use vision as a primary means of receiving information (Use Audio
Visual AIDS)
• Face the class while speaking
• Use more than one way to demonstrate or explain information.
• Keep instructions brief and uncomplicated as much as possible
• In small group discussions, allow for participation by students with
hearing impairments.