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Children with hearing loss

sensory; impairment; hearing; aid; ear; ears; meningitis; deafness; deaf; Usher's; syndrome; conductive; sensorineural; sign; language; Auslan; signed; english; lip; reading; fingerspelling; speech; cochlear; implants; bionic; ear; TTY; teletypewriter; communication; aural; CAP; auditory; processing; sound; noise; disability; better; start; initiative;

Colds, infections, allergies and flu can temporarily reduce hearing. However some children have permanent hearing loss. This may be due to serious illness (such as meningitis), genetic problems (such as Usher's syndrome) or untreated ear problems. In many cases, the cause of a hearing loss is not known.

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There are a range of professionals who can help children with hearing loss develop their skills and talents. These include your local family doctor, paediatrician, ear nose and throat specialist, audiologist, speech pathologist and teachers. Staff at local community health centres and early intervention services for children with additional needs can also provide help.

Sometimes, special teaching methods may be needed to develop communication skills. There may be local centres and services especially for children who are deaf or hearing impaired.

Alert:
Consult your doctor or an audiologist if there appears to be a sudden change in your child's hearing. Some conditions require prompt treatment to prevent permanent damage.

What is hearing loss (impairment)?

Having a hearing loss (impairment) means that a child has lost some hearing in one or both ears. Hearing impairments are described according to how much hearing has been lost. Loss is usually explained as mild, moderate, moderate to severe, severe or profound.

  • Mild hearing loss (impairment)
    The child can hear normal conversation but may not hear whispers or soft sounds.
  • Moderate hearing loss (impairment)
    The child does not hear normal speech. However, he will hear if a person speaks in a loud voice. A moderate hearing impairment will affect a child's language and/or speech development because not all words and sounds are heard clearly.
  • Moderate to severe hearing loss (impairment)
    Speech must be very loud to be heard. Even when speech is loud, not all words and sounds will be heard clearly. Speech and language development will be affected and the child will benefit from specialised professional help.
  • Severe hearing loss (impairment)
    The child will not hear normal conversation and will only be able to pick out a few loud sounds and words. Speech and language development will be affected and specialised professional help will be needed.
  • Profound hearing loss (impairment)
    No sounds can be heard without the help of a hearing aid. In some cases, a cochlear implant will be used to increase the amount of sound a child can hear. Speech and language development will be affected and professional assistance will be needed.

Deafness is another name for profound hearing loss. However, people who call themselves 'Deaf' usually are identifying themselves as members of the Deaf Community. This means that they use Auslan (Australian Sign Language) as their first language. Not all people with a severe or profound hearing loss use Auslan.

Different types of hearing loss (impairment)

Professionals usually talk about three different types of hearing loss.

  • Conductive hearing loss happens when there is some block to the transfer of sound from the outer ear to the inner ear (cochlea). In some types of conductive loss, hearing levels may change gradually over time or they may change from day to day. Middle ear infections cause conductive hearing loss.
  • Sensorineural hearing loss happens when there is damage to the inner ear (cochlea) or to the auditory (hearing) nerve. This type of hearing impairment may affect:
    • how loud the sound seems
    • how clear the sound seems.
  • Combined conductive and sensorineural hearing loss (sometimes called mixed loss) happens when sound is not transferred from the outer to the inner ear (cochlea) and there is also damage to the inner ear or auditory (hearing) nerve.

In addition, professionals talk about whether the hearing loss is in one (unilateral) or both ears (bilateral).

There are also disorders that involve listening and understanding, such as Central Auditory Processing (CAP) Disorder. CAP Disorder is also referred to as Auditory Processing Disorder.

diagram of ear

Causes of hearing loss (impairment)

There are many causes of hearing loss. These may include:

  • repeated middle ear infections
  • holes in the ear drum
  • disorders that damage nerves involved in hearing (degenerative disorders)
  • inherited condition or genetic cause, such as Usher's syndrome
  • infections that occur during pregnancy such as rubella (german measles) and toxoplasmosis
  • infections after birth, such as meningitis, mumps
  • exposure to very loud noise over long periods
  • abnormalities of the head and face that affect the structure of the ear
  • premature birth, especially when the birth weight is less than 1500 grams
  • head injury including loss of consciousness or skull fracture.

However, in some cases it may not be possible to identify the cause of deafness or hearing loss.

Treatment

  • The treatment for hearing loss depends on the reason for the impairment, and the severity of the impairment.
  • Most conductive hearing losses can be improved by medication or surgery.
  • Sensorineural hearing loss usually cannot be treated. Different types of technology are used to help children with permanent hearing loss. Hearing aids and cochlear implants are used most often to improve hearing in children with permanent disabling hearing loss.

Hearing aids
A hearing aid is a device that makes sounds louder. Hearing aids are fitted to match the hearing loss of your child. Hearing aids will increase your child's hearing but will not make hearing normal.

Different types of hearing aids are named according to where they are worn. Hearing aids can be:

  • in-the-ear (ITE)
  • in-the-canal (ITC). This is the passage between the outer and middle ear.
  • behind-the-ear (BTE)
  • body level hearing aids that clip on to a belt or clothing
  • hearing aids that are built onto the ear pieces of spectacles (eye glasses).

In school classrooms, FM soundfield amplification systems can be used to make the teacher's voice louder for students with a hearing loss or who are deaf.

Cochlear implants
A cochlear implant is sometimes called a bionic ear because it uses technology to allow the person to hear. A cochlear implant is designed to stimulate the surviving nerve cells in the inner ear (cochlea). This allows messages about sound to be sent from the inner ear to the brain.

Some parts of the cochlear implant (the speech processors) are worn in a pocket, belt pouch or body harness. Other parts are surgically fitted into the head and inner ear.

Methods of communication

People with hearing impairments may communicate in different ways.

  • Many use speech as their main method of communication. However, they usually rely on hearing aids or cochlear implants to help them do this.
  • Other people use a type of signed or written language.
  • Some people use a combination of signing and talking known as Total Communication.
  • In Australia, people with hearing impairment may learn Auslan, the language of Australia's Deaf Community.

Auslan
Auslan is the sign language that has developed in the Australian Deaf Community. Auslan is a unique language that uses hand signs, body movements, facial expressions, mime and gestures. It is not another form of English.

Methods to support use of English
There are different ways that people with hearing impairments can communicate using English.

  • Signed English is a way of communicating in English using signs for each English word. Often, a person speaks in English and signs the same message while she speaks. This is an artificial system used in schools to teach English to hearing impaired children.
  • Fingerspelling uses set hand positions for each letter of the English alphabet. This way, words can be spelled out using the fingers and hands. In Australia, the fingerspelling alphabet uses both hands. In other countries, like the United States, this alphabet requires only one hand.
  • Lip Reading or Speech Reading is used by some people with hearing impairment when speaking with people who do not sign, fingerspell, etc. Usually, a person will watch facial expressions and body language as well as lip movements.

Using the telephone

People with hearing impairments can use a special telephone called a teletypewriter (TTY). A TTY is a typewriter or computer that is connected to a telephone or modem. This means that people with hearing impairments can use the telephone by sending and receiving typed messages to other people with TTY connections. Sometimes you will see a TTY telephone number listed for some services.

When people with a hearing impairment wish to contact someone who does not have a TTY connection, they can use:

  • a fax
  • e-mail
  • the Short Message Service (SMS) - text messages sent between mobile phones
  • the National Relay Service.

The National Relay Service can help by providing:

  • Voice Carry Over (VCO). VCO is for people with hearing impairment who are able to use their voice to speak but cannot properly hear what is said to them over the telephone. When Voice Carry Over is used, the relay officer at the National Relay Service translates information spoken to the person with hearing impairment into typed messages and sends it to their teletypewriter.
  • Hearing Carry Over (HCO). HCO is for people who can hear but who cannot speak clearly enough to communicate over the telephone. Messages from the person with speech impairment are typed and sent to a relay officer from the National Relay Service. The relay officer then reads the message for the other caller.

Dual sensory loss or deafblindness

  • The combination of hearing and vision loss is often referred to as 'dual sensory loss'.
  • Most children will have some degree of hearing or sight. Very few are both profoundly deaf and totally blind.
  • The term 'Deafblind' is used for children who are totally blind and profoundly deaf. Some people also use this term when speaking about children who have both a significant hearing loss and a significant vision loss but may have some degree of hearing or vision.
  • Individuals will have different needs depending upon the combination of hearing and vision impairments affecting them.

What you can do

  • See a doctor promptly if you feel that your child is not responding to sounds, and ask to be referred for a hearing test.
  • In some places, you can visit your doctor or local health clinic for a hearing screening.
  • There may be an audiology service or clinic in your local area. Many audiologists do not require a referral from a doctor.
  • However, if you are not sure about your choices, your doctor or the staff from local community health services can advise you. They can help you make an appointment with an audiologist (hearing specialist) in your area.
  • See a doctor if your child complains of pain in the ears. (Young children may cry and pull on their ears if they are not yet able to talk.)
  • If your child wears hearing aids or has a cochlear implant, keep the equipment clean and cared for. Teach the child to do this as well.
  • Even if your child has a recognised hearing impairment, he will still need regular hearing checks, at least once a year.
  • Some parents find it helpful to join support groups. Some groups are listed at the end of this topic.

Preschool and school

At preschool or school, teachers will think about seating and classroom acoustics.

  • Teachers will also think about special needs for sound amplification, communication devices and changes to their teaching.
  • Depending on the needs of your child, teachers may get extra help in the classroom or advice from visiting specialist teachers.
  • Parents can assist teachers by giving them all necessary and up-to-date information about their child's hearing.

There are different ways to teach communication to children with hearing impairments. These include the:

  • Bilingual/bicultural approach using Auslan
    In this approach, children are taught the two languages of English and Auslan. They learn the different cultures and concepts that are part of each language.
  • Oral/aural method
    This approach concentrates on developing spoken language in the child with hearing impairment.
    • The child is able to listen to and understand what others say by using hearing aids or cochlear implants.
    • Usually, this method requires intense teaching on a one-to-one basis, especially if the hearing loss is severe.
    • Auditory/Verbal Therapy is one method of Oral/Aural teaching that is used to help children with hearing impairment learn listening skills.
  • Total communication
    Total communication is an educational philosophy that uses all types of communication including signed language and speech.

The approaches selected will depend upon your child's degree of hearing loss, personality, age and general abilities.

Resources

Better Start initiative

Better Start for Children with Disability (Better Start) initiative. This initiative aims to assist eligible children with developmental disabilities to access funding for early intervention services. Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA)

Australia

South Australia

  • Hearing Assessment Centre (clinics are held at South Tce, Adelaide, Noarlunga Hospital, Elizabeth Vale and major country centres)
    Address: 295 South Terrace, Adelaide, 5000
    Tel. 8303 1530 (Country callers - 1300 364 100) 
    http://www.cyh.com/SubContent.aspx?p=138 

For a more comprehensive list of resources in South Australia, and books about hearing loss, see the topic Children with hearing loss - resources.

General


Prepared in collaboration with
Department of Education, Training and Employment
Ministerial Advisory Committee on Students with Disabilities

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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