Compiled by Sandy Heflin, President and Founder of Color of Language

Our sincere thanks to Dr. Allen Mahr for permitting us to share the clear and informative audiogram charts he developed to help others understand hearing loss. They are the best we have ever seen. They are available also on his website along with a wealth of information about the physical aspects of hearing loss.

AUDIOGRAMS AND WHAT THEY TELL US ABOUT HEARING LOSS

We strongly recommend you vist his website at www.pacificaudiology.com/audiogram/uya.html Pacific Audiology Center 120Color of Language | www.ColorofLanguage.com |Salem, Oregon 97302| (661) 393-4658 Ramsgate Square SE Suite 100 coloroflanguage@bak.rr.com 503 364-2828

TABLE OF CONTENTS I. ABOUT COLOR OF LANGAUGE A. OUR MISSION STATEMENT B. OUR GOALS C. FACTORS AFFECTING LEVELS OF COMPETENCE AND SUCCESS OF DEAF CHILDREN II. AUDIOGRAMS AND WHATY THEY TELL US ABOUT HEARING LOSS A. INTRODUCTION B. ABOUT AUDIOLOGY C. UNDERSTANDING YOUR AUDIOGRAM 1. CHARTS ON HEARING LOSS (Provided by Dr. Allen Mehr from Pacific Audiology Center, Salem, Oregon) a. Environmental sounds and the Speech Banana b. What do the vertical lines indicate on an audiogram? c. What do the horizontal indicate on an audiogram? d. Sounds on an Audiogram e. Where are the speech sounds indicated on an audiogram? f. Illustration of a common hearing loss left and right ears. g. Degrees of Hearing Loss illustrated h. Audiogram showing normal hearing i. Audiogram typical of the aging process. 2. Links to helpful resources III. FAQs on the physical aspects of hearing loss

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Introduction
This resource is created based on my years of experience in Deaf Education and now as a business owner of a Sign Language/Deaf Education resources. It also comes about through my experiences during these years as I have worked with students and met parents and other educators of the Deaf and Hard of Hearing. Sometimes what is needed desperetly are sources of reliable information which will aid to finding solutions. Though solutions vary and can be different from case to case, there are similar and consistent actions to take, knowledge to know and tools to use to help a child whom is deaf and hard of hearing overcome and achieve great things despite the dramatic limitations of not being able to hear. This introduction will briefly explain the basics of the science known as Audiology and the role of an Audiologist. Then I have contacted Dr. Allan S. Mehr and asked for permission to use information and illustrations that he has created to help parents and families understand more about hearing and the tests involved. He has graciously allowed us to present to you his findings and information. As I mentioned, during the course of this resource, I do use Dr. Mehrs illustrations as a way to show visually what is being written about and to help illustrate the content. Finally, it is with great hope that I present this resource to you. My hope is that you will find this information, diagrams and the links herein helpful on your quest to better understand and equip yourself to teach and enable your child to great heights. You are your childs greatest advocate. Blessings, Sandy Heflin, Founder and President of Color of Langauge About Audiology Audiology is the scientic study of hearing, balance and related disorders. Audiologists treat those with hearing loss and prevent related damage. Employing tests (e.g. hearing tests, otoacoustic emission measurements, videonystagmography, and electrophysiologic tests), audiology aims to determine whether someone can hear within the normal range, and if they cannot, to discover which portions of hearing (high, middle, or low frequencies) are affected and to what degree. Tests results are presented on audograms. When an audiologist determines there is a hearing loss or vestibular abnormality they will provide recommendations to a patient as to what options are available to the patient (e.g. hearing aids, cochlear implants, surgery, appropriate medical referrals). In addition to testing hearing, audiologists can also work with a wide range of clientele in rehabilitation (cochlear implants and/or hearing aids), paediatric populations and assessment of the vestibular system. Adapted from Wikipedias entry of Audiology.

Next: Understading Your Audiogram

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Understanding Your Audiogram by Dr. Allan S. Mehr Audiologist FAAA Salem, Oregon
An audiogram is a picture of your hearing. The results of your hearing test are recorded on an audiogram. This demonstrates where different sounds and would be represented on an audiogram. The yellow banana shaped figure represents all the sounds that make up the human voice when speaking at normal conversational levels.

Information and charts developed by Dr. Allen Mehr and available at www.pacificaudiology.com/audiogram/uya.html

Next: Vertical Lines

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Vertical Lines
The vertical lines on an audiogram represent pitch or frequency. The 125 Hertz (Hz) vertical line on the left side of the audiogram represents a very low pitch sound and each vertical line to the right represents a higher pitch sound. Moving from left to right on the audiogram would be consistent with moving from left to right on a piano keyboard. The most important pitches for speech are 500-3000 Hz.

Information and charts developed by Dr. Allen Mehr and available at www.pacificaudiology.com/audiogram/uya.html

Next: Horizontal Lines

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Horizontal Lines
The horizontal lines represent loudness or intensity. The 0 decibel (dB) line near the top of the audiogram represents an extremely soft sound. Each horizontal line below represents a louder sound. Moving from the top to the bottom would be consistent with hitting the piano key harder or turning up the volume control on your stereo.

Information and charts developed by Dr. Allen Mehr and available at www.pacificaudiology.com/audiogram/uya.html

Next: Sounds on an Audiogram

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Sounds on an Audiogram
Therefore, every point on an audiogram represents a different sound. For example, point A on the audiogram to the right represents a soft low pitch sound and point B represents a soft high pitch sound. Point C represents a loud mid pitch sound.

Information and charts developed by Dr. Allen Mehr and available at www.pacificaudiology.com/audiogram/uya.html

Next: Left Ear and Right Ear

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Left Ear and Right Ear

This audiogram represents the hearing of an individual with normal hearing in the low frequencies (pitch) sloping to a severe high frequency hearing loss in the left ear and a moderate to severe hearing loss in the right ear. The blue X's indicate the thresholds for the left ear and the red O's indicate the thresholds for the right ear.

Information and charts developed by Dr. Allen Mehr and available at http://www.pacificaudiology.com/audiogram/uya.html

Next: Yellow Banana

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Yellow Banana
If we now superimpose the speech area on the audiogram, we can obtain some information regarding this individual's ability to hear speech. The listener is able to hear all the low and mid speech sounds but is not able to hear the high pitch speech sounds (ie. F, S, TH) in the left ear (blue X's). The listener is not able to hear any of speech sounds in the right ear. This person would rely on the left ear for speech understanding and would probably experience difficulty hearing in noisy environments.

Information and charts developed by Dr. Allen Mehr and available at www.pacificaudiology.com/audiogram/uya.html

Next: Degrees of Hearing Loss

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Degrees of Hearing Loss

The softest sound you are able to hear at each pitch is recorded on the audiogram. The softest sound you are able to hear is called your threshold. Thresholds of 0-25 dB are considered normal (for adults). The audiogram below demonstrates the different degrees of hearing loss.

Information and charts developed by Dr. Allen Mehr and available at www.pacificaudiology.com/audiogram/uya.html

Next: Audiogram Samples

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http://www.hearingprofessionals.co.nz/Images/Normal-Audiogram.gif

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TYPICAL OF THE AGING PROCESS:

www.bayareahearingservices.com/.../audiogram.jpgwww.bayareahearingservices.com/.../audiogram.jp

Next: Links to Resources

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AUDIOGRAMS , DEAFNESS AND HEARING AIDS FAQs: 1. What is an audiogram? ANSWER: An audiogram is a personalized chart that shows what an individual is or is not hearing. It shows what level of volume (loudness or softness) that the person hears. It shows the frequencies (High sounds verses low sounds) that the person hears. The horizontal lines of the chart show the levels of volume, the top being the softest, and the bottom being the loudest. The volume is measured in decibels. The vertical lines show the frequencies the left being the lowest tones, the right being the highest tones. 2. Why does my son respond to my husbands voice and not mine? ANSWER: A mans voice is usually in a lower frequency than a womans voice. Your sons hearing loss may be more in the high frequency tones. If that is the case, he would not hear your high voice, but can hear your husbands low voice. You can try speaking in a lower voice to him and see if that makes a difference. If he can hear you when you use a low voice, great. If not, then just be sure you are facing him when you speak to him so he can see your facial expressions and practice reading your lips. Give him every available mode of communication so that he does not lose valuable language input and information. 3. Why does my daughter seem to hear some things and not others? ANSWER: What sounds your child hears depends entirely upon the frequencies and decibels she hears or does not hear. Her audiogram will show exactly where her loss is and using the charts provided here, you can determine and predict what she can or cannot hear and make adjustments or accommodations using that information. 4. How do I know if the assessment of my sons hearing loss is accurate? ANSWER: If you have gone to a reputable audiologist, you can feel confident that it is accurate. You can always test it out with the procedures described in question and answer # __. If someone who has not been trained as an audiologist has given you the assessment, then I would suggest you visit a certified, licensed audiologist. The screenings done in a primary care doctors offices by an M.D., nurse, or nurse practitioner are just that screenings. They are not intended to be a detailed, definitive analysis of hearing loss. The purpose is to discover if there is possibly a hearing loss and if it is significant. If so, then, you will be referred to a qualified audiologist who is trained to do effective, reliable audiological exams. 5. Is it possible that the diagnosis of hearing loss at my doctors office is wrong? ANSWER: Oh, yes. Whether the diagnosis is positive or negative, it could most definitely be inaccurate. Most doctors offices have the basic screening device to detect hearing loss. Unfortunately, most of the personnel do not have extensive training in how to test. They are given basic instructions to push the buttons for each frequency and each decibel in the full range of normal hearing and to instruct the patient to raise their hand if they hear the sound. This method does not usually cover things such as: a. The intelligence of your child to know how to beat the system

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1. He knows few minutes have passed and he has not heard a sound, so, of course, wanting to do a good job, and get the right answer he raises his hand anyway. The child is watching the testers hand move and knows a button has been pushed. He is not blind. 2. The child watches the testers face and reads the signals when a button is pushed. Or b. The child doesnt really understand what he is expected to do, or what the purpose of the test is. c. A child is shy and doesnt respond, even when he hears the sound. 6. Is it important to have an accurate audiogram? ANSWER: YES! Definitely. 7. What information will I gain from an audiogram and how will that help me? ANSWER: You will gain so much vital information such as: a. Would your child benefit from a hearing aid? b. Does he need hearing aids in both ears? c. Exactly what kind of hearing aid is needed. d. What speech sounds he can or cannot hear. e. Is he hearing any speech sounds at all. f. How loud the sounds have to be for him to hear them. g. What are the softest sounds he can hear. h. Does he hear more in the left ear than the right ear. i. Is he deaf or hard of hearing. All this information will make such a difference for you in making the most of the hearing your child does have and reducing frustration for both of you. In the following questions and answers, we will discuss how knowing these things will help you. 8. What is the dividing line between being hard of hearing and deaf? ANSWER: Wow. We could spend hours on that question and all its implications. We will try to keep it brief. The chart in this article entitled Degrees of Hearing Loss will help you picture what is written here. Lets just briefly say that people who do not hear sounds below 25 decibels have normal hearing. These people are unaware that they are not hearing everything. Not hearing sounds from 25 to 40 decibels is considered a mild hearing loss. These people can hear almost all the speech sounds and function without hearing aids. They may be considered stuck up or aloof for not responding when spoken to, simply because they did not hear. Children with this loss can function in a regular classroom, but need to sit up front, face whoever is speaking to make use of facial clues and lip read. They will need some accommodations, including hearing aids, but with them, should function well. After 40 decibels, a hearing aid is definitely required. With this moderate hearing loss almost all of the speech sounds are inaudible. Communication is extremely difficult. Environmental sounds are generally intact, depending on the frequency. Children with this loss must have serious accommodations to do well in school. With a loss of 50-70 decibels, the term deaf would certainly apply. Early and continuous intervention must take place with involvement from the family as well as the teacher, school and other agencies.

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From 70 decibels to 90 decibels, a person would definitely be considered deaf, not hard of hearing. He benefits very little from spoken communication and must rely on other means of understanding and being understood. A hearing aid may bring his loss into the moderate range, but communication is still very difficult, and he will still need auxiliary aids to communicate effectively. He can hear only loud environmental sounds. When the loss is this severe, drastic measures must be employed for him to learn language as he will not hear it audibly. With a loss of 90 decibels or more, most environmental sounds are lost as well as everything else. It is questionable whether they would benefit from a hearing aid. They are considered profoundly deaf and will not learn language without a huge amount of intervention and effort on the part of the family, school and other knowledgeable agencies with expertise in deafness and deaf education. Parents of children with hearing losses od more than 60 decibels will not be able to rely on information from those whos training and experience has not prepared them for the challenges ahead. These parents must find teachers, deaf adults and those who have chartered these waters to gain the knowledge, insight and encouragement they will need to help their child succeed. All the odds are against them and it will not be an easy task, but many have overcome the odds and succeeded. Find those people and learn how they did it. Dont just take anyones advice on a matter of this import. Research, study and find out your options, then give it everything you have. You will be glad you did, and so will your child. 9. When should my child be fitted with hearing aids? ANSWER: As soon as possible. 10. Why does my sons hearing aid make that loud eeeee sound? ANSWER: 1. The volume is too high. Simply turn down the volume 2. The mold is not fitting properly inside the ear see below Children grow fast. The mold he was fitted for when he got the aids needs to be replaced as he grows. A baby needs a new one every six months. As he grows, a new one every year should suffice. That sound is annoying to you and the child, and it turns heads everywhere you go. Careful attention needs to be paid to it, as it will discourage him from wearing hearing aids as well as decrease their effectiveness. If the molds are new, it is possible that there was a mistake when they were fitted or made and they are defective. It is rare, but it does happen. If they start off making that squeaky sound, simply return to the audiologist and ask him to check them and replace them, if necessary. 11. My son doesnt like to wear his hearing aid. It is such a struggle to get him to wear them. Should I just wait until he is older and try then? ANSWER: No, absolutely not. Your son cannot afford to lose the information he will lose if he is not wearing his aids. Depending on his hearing loss, it could rob him of vital speech sounds or of helpful environmental sounds. There are many ways to overcome his objections, but the most important factor is that you understand the importance of them, so you will make the effort to help him adjust to them. They do require an adjustment period. Usually, the older he is when he is fitted, the harder the adjustment. First, be sure they are not physically hurting him. Check the molds and the volume setting to be sure there is nothing wrong with the aids themselves. Begin a regime of wearing them for a few minutes
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at a time, several times a day. If he knows he can have them removed by throwing a fit, then you will have a fit on your hands each time you try to put them on. Do not let his fits determine when he will wear them. Remove them when he is distracted and not throwing a fit. Put them back and repeat the procedure several times a day. His tolerance for them will grow. If you give up, you will both lose. He will lose the benefit of developing his hearing and all the auditory brain processes that hearing develops. You and he will lose the benefit of him developing speech and language easier and quicker. 12. How do I know if my daughter is benefitting from her aids? ANSWER: Unfortunately, you may or may not see the benefit or results for a long time. The brain is developing auditory processes that you will never see, per se. But you will definitely see the results if those processes do not occur. She will be unable to process auditorally and that will show up in her thinking processes and academic skill level. Thinking processes can be developed through being exposed to visual language. In fact, the studies are showing that both the right and the left brain are active when signing is experienced with speech. With auditory language input the left side of the brain is used and developed. It is important that both speech and visual language be used together produces optimum results. Check out the articles on brain development and Sign Language. 13. How can I tell if the battery is dead in the hearing aid? My daughter is too young to tell me. ANSWER: Check it regularly. Each day you can test quickly to see if it is working. When you put the aid in, take a few minutes to make sounds or noises at the sound level and decibel level that your daughter hears. Watch her response. Just be sure she is responding to the sound and not visual clues such as glimpses of you or something else. If she turns to look in the direction of the noise, then the batteries are fine. Be aware of how long the batteries usually last, according to manufacturers assessment, other hearing aid wearers or your own Observation and change them accordingly. 14. How do I know if his hearing aid is too loud or not loud enough? ANSWER: If it is too loud, your child will definitely let you know! The hearing aid dispenser or audiologist should explain the volume settings to you and explain what volume is optimum. Teach the child to adjust them himself as soon as possible so he can change them when loud noises are present and make him uncomfortable or if they are too low for him to hear someones soft voice. The settings can be accidently changed when handling the aids. Memorize the settings and check them each time you place them on your child. If he is old enough to do it himself, he is old enough to change the volume control to be comfortable for him. You may need to check that he has not decided to turn them off for some quiet time.

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Links to Resources
There is so much information available on the physical aspects of hearing loss. Information such as: causes (genetic-congenital, disease, rhubella, delivery complications, medicine) types (sensorineural, conductive, unilateral, progressive, auditory processing) signs (what to look for and how to confirm) Rather than reproduce all of that here, we have listed some links of websites where all your questions can be addressed. Please check them out and if you have or find any additional websites we should include, please email us so we can include them here. If you do not get your questions answered, please feel free to contact us for more information. That is the reason we exist.

LINKS WITH HELPFUL INFORMATION: www.raisingdeafkids.org/hearingloss/testing/audiogram http://www.audiologyawareness.com/hearinfo_audiogramread.asp www.deafness.about.com/cs/earbasics/f/audiograms.htm en.wikipedia.org/wiki/Audiogram www.wisc-online.com/objects/index_tj.asp?objID=MBY1802

Next: About Color of Language

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About Color of Language

Our Mission: Color of Language is a 501 (c)(3) non-profit company which develops educational materials for Deaf children and their families. By doing so, we hope to promote early intervention, development of language and cognitive skills for infants to adults, and provide sign language instruction for family members to encourage communication. Our Goals: In creating educational materials we seek to introduce families to a fun, effective, clear and complete language system that will: 1. Reduce frustration 2. Establish effective discipline 3. Enable meaningful bonding relationships 4. Promote healthy self-esteem 5. Develop cognitive skills 6. Result in age appropriate written skills. We believe the grief process can be shortened through early intervention which will move parents from denial, anger, and grief to acceptance and action! Factors Affecting Level of Competence and Success * Onset of hearing loss * Degree of loss * Early intervention and access to effective communication and language * Parental involvement and family support * Motivational level National statistics, which are rare and difficult to substantiate, indicate that 90% of deaf students graduate from high school with a 1st to 3rd grade reading level. 8%-10% graduate with fourth grade or above reading levels. Many factors contribute to this travesty. To list just three: 1. Late discovery or late diagnosis of deafness 2. Lack of adequate early intervention (even when diagnosed early) 3. Family members faced with the overwhelming task of learning a new communication method to communicate with their deaf child. All of the above add up to language deprivation in the most crucial language learning years 0-5 and increasing with each year that passes. Each year the language deprivation gap in deaf children increases as their hearing peers accelerate in reading and academic skills. The state of California, as many other states, has passed a law requiring hearing testing for all newborns. As that is implemented, it will go a long way to eliminate the first factor listed above: late diagnosis.
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