STUDENTS WITH HEARING IMPAIRMENT

I. Definition

1. Hearing Impairment or Disability refers to reduced function or loss of the normal

function of the hearing mechanism. The impairment or disability limits the person’s sensitivity to
tasks like listening, understanding speech, and speaking in the same way those persons with
normal hearing do.
2. a person who is deaf cannot use hearing to listen, understand speech and
communicate orally without special adaptations mainly in the visual mode.
3. a person who is hard of hearing has a significant loss of hearing sensitivity but
he or she can hear sounds, respond to speech and other auditory stimuli with or without the use of
a hearing aid.

II. Classification of Hearing Impairment

BASIS: A. affected part of the ear

1. conductive hearing loss occurs in the outer and middle ear thereby blocking the
passage of the acoustic energy. The blockage may be caused by abnormal growths or
complications of the outer or middle ear. Impacted cerumen results from the excessive build up of
earwax in the auditory canal. Diseases of the ear can leave fluid or debris. Malformation, incomplete
development, or abnormal growth and improper movement of the ossicular chains can cause
conductive hearing loss.
2. sensorineural hearing impairment occurs in the inner ear. The sensitive
mechanisms and the auditory nerve may be damaged.
3. mixed hearing impaiment results from combination of both conductive and
sensorineural hearing losses.
4. any dysfunction in the central auditory nervous system between the brain stem
and the auditory cortex in the brain results in a central hearing disorder.
B. unilateral if present in one ear only or bilateral if present in both ears.
C. congenital when condition is present at birth or adventitious when acquired
after birth or later on.
D. prelingual if condition occurs before the child learns to talk or postlingual when
acquired after the child has learned speech and usually at age two.

III. Etiology of Hearing Impairment

1. hereditary and chromosomal abnormalities causes genetic and hereditary

types of deafness
2. infections such as maternal rubella, CMV, hepB, virus, syphilis, mumps and otitis
media may occur during pregnancy or after birth,.
3. adventitious hearing loss can be attributed to environmental factors such as
excessive and constant exposure to very loud noises. Drugs and medication that can turn toxic
when administered to the mother or to the child at inappropriate times and circumstances.
Traumatic factors can cause hearing impairment at birth. LBW, difficult and prolonged labor can
traumatize the hearing mechanism and cause hearing loss and permanent damage to the ear.
Skull fractures due to accidents as well as pressure changes may damage ear.

IV. Characteristics of Persons with hearing Impairment

1. cups hand behind the ear, cocks ear/tilts head at an angle to catch sounds.
2. has strained or blank facial expressions when listening or talked to.
3. pays attention to vibration and vibrating objects
4. moves closer to speaker, watches face especially the mouth and the lips of the speaker
when
Talked to
5. less responsive to noise, voice, music and other sources of sounds
6. used more natural gestures, signs and movements to express itself
7. shows marked imitativeness at work and play
8. often fails to respond to oral questions
 9. often asks for repetition of questions and statements
10. often unable to follow oral directions and instructions
11. has difficulty in associating concrete with abstract ideas
12. has poor general learning performances

V. Identification and Assessment of Children with hearing Impairment

(early ID of a hearing impairment increases the chances for the child to receive early
treatment and special education intervention)
1. Audiological Evaluation
Audiology is the science of testing and evaluating hearing ability to detect and describe
hearing impairments.
Audiological evaluation is done by an audiologist through the use of sophisticated
instruments and techniques. The purpose is to determine frequencies of sounds that a particular
person hears.
Audiometer is an electronic device that generates sound at different levels of intensity and
frequency.
Pure tone audiometry utilizes pure tones in air and bone conduction tests which yield
quantitative as well as qualitative description of a child’s hearing loss.
Speech audiometry uses speech instead of pure tones. Here, the person’s detection of
speech at the minimum audible level is measured. The understanding of speech sound and the
ability to discriminate different speech sounds under sufficient loudness are also determined.
Sound field audiometry, evoked response audiometry, impedance audiometry, play
audiometry, operant conditioning audiometry and behavior observation audiometry are alternative
audiometric techniques.
Informal Hearing Tests:
a. Whisper test
b. conversational live voice test
c. ball pen click test
2. Cognitive Assessment
It measures intellectual capacity of children with hearing impairment do no rely
primarily on verbal abilities. Hiskey-Test of learning aptitude, Wechsler Intelligence Scale for
Children (WISC) and Stanford Achievement Test (SAT) are widely used because of the nonverbal
performance subtests in USA.
3. Assessment of Communication Abilities
It includes analysis of the development of the form, content and use of language.
Articulation, pitch, frequency and quality of voice are examined.
4. Social and Behavioral Assessment
Hearing Impairment brings about significant effects on social-emotional and
personality development as a result of the restrictions in interactive experiences and communication
activities with their age group. Linguistic difficulties oftentimes show in low self-concept and social-
emotional maladjustment.

VI. Nursing Care

• Provide sufficient time to discuss needs with the student before/during their initial teaching
session.
• People who depend on their eyes to 'hear' will not be able to take notes as well as lip read
or watch an interpreter, so it is helpful to provide notes or to arrange for copies from
another student.
• Face the person at all times when speaking. Speak clearly and encourage other students to
do the same. Speak at a measured but normal speed as speaking too slowly distorts lip
patterns, which then become impossible to read.
• Arrange lighting and seating so that everyone's face is well lit. Avoid standing in front of a
window or light: this places the face in shadow.
• Do not talk and write on a board or talk and demonstrate at the same time.
• Try to keep background noise to a minimum.
• Be aware that loud noises can be distressing when amplified through a hearing aid.
• Lip-reading is very tiring: students may need to have periodic rests.
• Unknown vocabulary is hard to lip-read. Write vocabulary down and check that it is
understood.
• It is difficult to lip-read if the context is not known. The better a talk is structured the better is
it followed. Handouts and overheads can be very helpful in complementing spoken
instructions and descriptions, but provide these in advance, as students cannot lip-read at
the same time.
• Use short clear statements and vocabulary, avoiding or explaining abstract concepts or
jargon. If students misunderstand, a different way of explaining the same idea should be
explored.
• Important announcements, key concepts and new technical words should be written on the
board or given as a handout.
• Repeat the beginning of an utterance and not just the end, and do not change the wording.
Deaf and hearing impaired people may tune-in late to the fact that they are being
addressed and miss the beginning.
• When working with interpreters make time for them, and always address the deaf person,
not the interpreter.
• Interpreting is tiring: do not speak too quickly. During long sessions allow interpreters to
have short rest breaks. There might be times when two interpreters are needed.
• Any videos or audio tapes that are to be used in the session should have written
transcripts. Deaf students will benefit if interpreters and communication support workers
have access to these before the session and are given notes, handouts and scripts of
videos in advance.
• If a student has speech difficulties, this is not a reflection of intellectual ability or
understanding. Encourage students to contribute to discussions and be patient to allow
communication to take place.
• Students with hearing impairments may experience difficulties with grammar if they are
using British Sign Language as a first language. These students may require extra time
and/or assistance for their written work.
• Some students may need to record lectures; others may have a note-taker or interpreter.
Make time for interpreters, be aware of time lags, e.g. when asking questions, and allow
time for the hearing impaired students to answer.
• Group work can be difficult for hearing impaired students as they may not know who is
speaking and thus who to watch unless an interpreter is present. Encourage students to
indicate with a gesture when they are speaking.
• Provide extra time after group sessions to check that the content has been understood.
• Approach a deaf student who is working from the front or side to avoid startling them.