Deafness and Hearing Loss

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					                                                                         Deafness and
                                                                         Hearing Loss
        Caroline’s Story
    Caroline is six years old,                                                         A publication of NICHCY
with bright brown eyes and, at                                                           Disability Fact Sheet #3
                                                                                                       June 2010
the moment, no front teeth,
like so many other first graders.
She also wears a hearing aid in
each ear—and has done so
since she was three, when she            Caroline was immediately                     Hearing Loss
was diagnosed with a moderate       fitted with hearing aids. She
                                    also began receiving special
                                                                                     in Children
hearing loss.
                                    education and related services            Hearing is one of our five
    For Caroline’s parents, there   through the public school             senses. Hearing gives us access
were many clues along the way.      system. Now in the first grade,       to sounds in the world around
Caroline often didn’t respond       she regularly gets speech             us—people’s voices, their
to her name if her back was         therapy and other services, and       words, a car horn blown in
turned. She didn’t startle at       her speech has improved               warning or as hello!
noises that made other people       dramatically. So has her vocabu-
jump. She liked the TV on loud.     lary and her attentiveness. She           When a child has a hearing
But it was the preschool she        sits in the front row in class, an    loss, it is cause for immediate
started attending when she was      accommodation that helps her          attention. That’s because
three that first put the clues      hear the teacher clearly. She’s       language and communication
together and suggested to           back on track, soaking up new         skills develop most rapidly in
Caroline’s parents that they        information like a sponge, and        childhood, especially before the
have her hearing checked. The       eager for more.                       age of 3. When hearing loss
most significant clue to the                                              goes undetected, children are
preschool was Caroline’s                                                  delayed in developing these
unclear speech, especially the                                            skills.1
lack of consonants like “d” and
                                                                              Recognizing the importance
“t” at the end of words.
                                                                          of early detection, the Centers
    So Caroline’s parents took                           is the           for Disease Control and Preven-
her to an audiologist, who                                                tion (the CDC) recommends
                                     National Dissemination Center
collected a full medical history,                                         that every newborn be screened
                                     for Children with Disabilities.
examined the little girl’s ears                                           for hearing loss as early as
inside and out, ran a battery of                                          possible, usually before they
hearing tests and other assess-                                           leave the hospital. Catching a
                                    1825 Connecticut Avenue N.W.,
ments, and eventually diag-                                               hearing loss early means that
                                               Suite 700
nosed that Caroline’s inner ear                                           treatment can start early as well
                                        Washington, DC 20009
(the cochlea) was damaged. The                                            and “help the child develop
                                     1.800.695.0285 (Voice / TTY)
audiologist said she had senso-                                           communication and language
                                      202.884.8200 (Voice / TTY)
rineural hearing loss.                                                    skills that will last a lifetime.”2

                                      Disability Fact Sheet #3 (FS3)
       Types of Hearing Loss            cells of the inner ear or the                  How Common is
                                        nerves that supply it. These
    Before we describe the types        hearing losses can range from
                                                                                        Hearing Loss?
of hearing loss a person may            mild to profound. They often                Each year in the United
have, it’s useful to know that          affect the person’s ability to          States, more than 12,000 babies
sound is measured by:                   hear certain frequencies more           are born with a hearing loss;
                                        than others. Thus, even with            often, the cause is unknown.4
•   its loudness or intensity
                                        amplification to increase the           Profound deafness occurs in 4-
    (measured in units called
                                        sound level, a person with a            11 per 10,000 children; in at
    decibels, dB); and
                                        sensorineural hearing loss may          least 50% of these cases, the
•   its frequency or pitch              perceive distorted sounds,              cause is genetic.5
    (measured in units called           sometimes making the success-
    hertz, Hz).                         ful use of a hearing aid impos-             Through the Universal
                                        sible.                                  Newborn Hearing Screening
    Hearing loss is generally                                                   program, many states now
described as slight, mild, mod-             A mixed hearing loss refers to      mandate that all newborns be
erate, severe, or profound,             a combination of conductive             screened for hearing loss within
depending upon how well a               and sensorineural loss and              hours of birth.7
person can hear the intensities         means that a problem occurs in
or frequencies most strongly            both the outer or middle and               Signs of a Hearing Loss
associated with speech. Impair-         the inner ear.                                   or Deafness
ments in hearing can occur in
                                              A central hearing loss                 Just as with Caroline, our
either or both areas, and may
                                        results from damage or impair-          first grader, there will be signs
exist in only one ear or in both
                                        ment to the nerves or nuclei of         that a child may not be hearing
ears. Generally, only children
                                        the central nervous system,             normally. Parents may notice
whose hearing loss is greater
                                        either in the pathways to the           that their child:
than 90 decibels (dB) are
                                        brain or in the brain itself.
considered deaf.
                                                                                             A diagram of the ear.6
   There are four types of
hearing loss, as follows.3
                                                     Outer ear      Middle ear     Inner ear
    Conductive hearing
losses are caused by                                                                                 Semicircular
diseases or obstructions in                                                                          canals
the outer or middle ear
(the pathways for sound
to reach the inner ear).
Conductive hearing losses
usually affect all frequen-        Pinnus
cies of hearing evenly                                                                                     Auditory
and do not result in                                                                                       nerve
severe losses. A person
with a conductive hearing
loss usually is able to use
a hearing aid well or can
be helped medically or             External
surgically.                        auditory
    Sensorineural hearing                                                    Eustachian                Cochlea
losses result from damage                          Eardrum                   tube
to the delicate sensory hair

NICHCY:                               2                                Deafness and Hearing Loss (FS3)
•   does not respond                 •   complications during                     To access early interven-
    consistently to sounds or            pregnancy (such as                       tion: To identify the EI
    to his or her own name;              the Rh factor,                            program in your neigh-
                                         maternal diabetes,                        borhood, consult
•   asks for things to be re-            or toxicity).                              NICHCY’s State-Specific
    peated or often says “huh?”                                                     Information for your
                                         A child’s hearing                          state (online at:
•   is delayed in developing         loss or deafness may
    speech or has unclear                                                
                                     also be a characteristic                      families-community/
    speech;                          of another disability                        states/). Early interven-
•   turns the volume up loud         such as Down syn-                            tion is listed under the
    on the TV and other elec-        drome, Usher syndrome,                      first section, State Agen-
    tronic devices.8                 Treacher Collins syn-                       cies. The agency that’s
                                     drome, Crouzon syn-                      identified will be able to
    Causes of Hearing Loss           drome, and Alport syndrome.10       put you in contact with the
        and Deafness                     In all cases, early detection   early intervention program in
                                     and treatment are very impor-       your community. There, you can
   Hearing loss and deafness
                                     tant to the child’s development.    have your child evaluated free
can be either:
                                                                         of charge and, if found eligible,
•   acquired, meaning that the                    There
                                               Is There                  your child can begin receiving
    loss occurred after birth, due          Help Available?              early intervention services.
    to illness or injury; or
                                         Yes, there’s a lot of help           To access special education and
•   congenital, meaning that the     available, beginning with the       related services: We recommend
    hearing loss or deafness was     free evaluation of the child. The   that you get in touch with your
    present at birth.                nation’s special education law,     local public school system.
                                     the Individuals with Disabilities   Calling the elementary school
    The most common cause of                                             in your neighborhood is an
acquired hearing loss is expo-       Education Act (IDEA), requires
                                     that all children suspected of      excellent place to start. The
sure to noise.9 Other causes can                                         school should be able to tell
include:                             having a disability be evaluated
                                     without cost to their parents to    you the next steps to having
•   build up of fluid behind the     determine if they do have a         your child evaluated free of
    eardrum;                         disability and, because of the      charge and, if found eligible, he
                                     disability, need special services   or she can begin receiving
•   ear infections (known as         under IDEA. Those special           services specially designed to
    otitis media);                   services are:                       address your child’s needs.
•   childhood diseases, such as      •   Early intervention |                There are also special
    mumps, measles, or chicken           A system of services to         services available to low-income
    pox; and                             support infants and toddlers    children through the Early
                                         with disabilities (before       Periodic Screening, Diagnosis,
•   head trauma.
                                         their 3rd birthday) and their   and Treatment (EPSDT) pro-
    Congenital causes of hear-           families.                       gram, the child health compo-
ing loss and deafness include:                                           nent of Medicaid. To learn more
                                     •   Special education and           about the EPSDT program, visit:
•   a family history of hearing          related services | Services
    loss or deafness;                    available through the public
•   infections during pregnancy          school system for school-
    (such as rubella);                   aged children, including
                                         preschoolers (ages 3-21).

NICHCY:                          3                              Deafness and Hearing Loss (FS3)
         More on IDEA               “hearing impairment.”12 How-
                                    ever, the number of children
    It’s helpful to know that,      with hearing loss and deafness
while the terms “hearing im-        is undoubtedly higher, since
pairment” and “hearing loss”        many of these students have
are often used to describe a        other disabilities and may be
wide range of hearing losses,       served under other categories.
including deafness, IDEA
actually defines the two terms          Educational Implications
separately, as follows:
                                        Hearing loss or deafness
    Hearing impairment is           does not affect a person’s            idiomatic expressions, and
    defined by IDEA as “an          intellectual capacity or ability to   other aspects of verbal commu-
    impairment in hearing,          learn. However, children who          nication. For children who are
    whether permanent or            are hard of hearing or deaf           deaf or have severe hearing
    fluctuating, that               generally require some form of        losses, early, consistent, and
    adversely affects a             special education services in         conscious use of visible com-
    child’s educational             order to receive an adequate          munication modes (such as sign
    performance.”                   education. Such services may          language, fingerspelling, and
                                    include:                              Cued Speech) and/or amplifica-
    Deafness is defined as                                                tion and aural/oral training can
    “a hearing impairment           •   regular speech, language,         help reduce this language delay.
    that is so severe that the          and auditory training from a      By age four or five, most chil-
    child is impaired in                specialist;                       dren who are deaf are enrolled
    processing linguistic                                                 in school on a full-day basis
    information through             •   amplification systems;
                                                                          and do special work on com-
    hearing, with or with-          •   services of an interpreter for    munication and language
    out amplification.”                 those students who use sign       development.
    Thus, deafness is viewed as a       language;
                                                                              It is important for teachers
condition that prevents an          •   favorable seating in the class    and audiologists to work to-
individual from receiving sound         to facilitate lip reading;        gether to teach the child to use
in all or most of its forms. In                                           his or her residual hearing to
contrast, a child with a hearing    •   captioned films/videos;           the maximum extent possible,
loss can generally respond to       •   assistance of a notetaker,        even if the preferred means of
auditory stimuli, including             who takes notes for the           communication is manual.
speech.                                 student with a hearing loss,      Since the great majority of deaf
                                        so that the student can fully     children (over 90%) are born to
    The U.S. Department of
                                        attend to instruction;            hearing parents, programs
Education reports that 14,787
                                                                          should provide instruction for
children received audiology         •   instruction for the teacher       parents on implications of
services in early intervention          and peers in alternate            deafness within the family.
programs in the fall of 2004,           communication methods,
while 139,643 children received         such as sign language; and            People with hearing loss use
speech-language pathology                                                 oral or manual means of com-
services.11                         •   counseling.                       munication or a combination of
                                                                          the two. Oral communication
    The Department also reports         Children who are hard of
                                                                          includes speech, lip reading,
that, during the 2003 school        hearing will find it much more
                                                                          and the use of residual hearing.
year, 79,522 students aged 3 to     difficult than children who have
                                                                          Manual communication in-
21 received special education       normal hearing to learn vocabu-
                                                                          volves signs and fingerspelling.
services under the category of      lary, grammar, word order,
                                                                          Total Communication, as a

NICHCY:                            4                            Deafness and Hearing Loss (FS3)
method of instruction, is a                                                 References
combination of the oral
method plus signing and                    March of Dimes. (2007). Hearing impairment. Available online at:
                                           Centers for Disease Control and Prevention. (2010). Early Hearing
    Using the Relay Service               Detection & Intervention (EHDI) program: EHDI basics. Available online at:
    Individuals with hearing    
loss, including those who are             3
                                           eHealthMD. (n.d.). Different types of hearing loss. Available online at:
deaf, now have many helpful     
devices available to them. Text
telephones (known as TTs,                   Centers for Disease Control and Prevention. (2010). Early Hearing Detec-
TTYs, or TDDs) enable persons             tion & Intervention (EHDI) program: EHDI basics. Available online at:
to type phone messages over     
the telephone network.                    5
                                            American Speech-Language-Hearing Association. (n.d.). The prevalence
    The Telecommunications                and incidence of hearing loss in children. Available online at: http://
Relay Service (TRS) makes it    
possible for TT users to com-             6
                                            Michigan Department of Community Health. (2004). A diagram of the
municate with virtually anyone            ear. Available online at:
(and vice versa) via telephone            DCH0519A_201145_7.pdf
through a communications                  7
assistant. Dial 711 to access all           National Center for Hearing Assessment & Management. (n.d.). Status of
                                          early hearing detection and intervention in the United States. Available online
telecommunications relay
services anywhere in the United
States. The relay service is free.        8
                                            American Speech-Language-Hearing Association. (n.d.). How do I know if
                                          I have a hearing loss? Available online at:
                                           The Merck Manual’s Online Medical Library. (2007, April). Hearing loss
                                          and deafness. Available online at:
                                            American Speech-Language-Hearing Association. (n.d.). Causes of hearing
                                          loss. Available online at:
                                            U.S. Department of Education. (2006). Table 6-6. Infants and toddlers ages
                                          birth through 2 served under IDEA, Part C, by type of service on the individual-
                                          ized family service plan (IFSP) and state: Fall 2004. Available online at:
                                            U.S. Department of Education. (2007). 27th annual report to Congress on
                                          the implementation of the Individuals with Disabilities Education Act, 2005
                                          (Vol. 2). Washington, DC: Author.

   This publication is made possible through Cooperative Agreement #H326N080003 between the Academy for
   Educational Development (AED) and the Office of Special Education Programs, U.S. Department of Education. The
   contents of this document do not necessarily reflect the views or policies of the Department of Education, nor does
   mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

NICHCY:                                 5                                    Deafness and Hearing Loss (FS3)
                                           Resources of Additional Information

In alphabetical order, here’s a starter list of organizations providing info and guidance on deafness and hearing
loss. Explore the sites below and the wealth of material they offer on types of hearing loss, newborn and
early childhood screening, the EHDI program for early detection of hearing loss, guidance for parents,
suggestions for educators working with children who are deaf or hard of hearing, and much more.

          Organizations                    How’s Your Hearing?                          To Parents of Deaf Children |
Alexander Graham Bell Associa-                                                
tion for the Deaf and Hard of              Info to Go | Laurent Clerc                   children.html
Hearing |                   National Deaf Education Center
                                           202.651.5051                                 Early Intervention
American Hearing Research          
Foundation | www.american-                 Clerc_Center/Information_and_                earlyintervention/index.html                                Resources/Info_To_Go.html
                                                                                        Assistive Technology for Hearing
American Society for Deaf                  Listen Up! |     
Children |1.800.942.2732                                                                treatment/assist_tech.htm                      Medline Plus
ASHA | American Speech-                    hearingdisordersanddeafness.html             Considerations A-Z |
Language-Hearing Association                                                  
1.800.638.8255                             National Association of the Deaf             comcon/index.html     
                                                                                        Communication Plan for a
Beginnings | For parents of chil-          National Center for Hearing                  Child Who is Deaf or Hard of
dren who are deaf or hard of hearing       Assessment & Management                      Hearing                  435.797.3584                       
Better Hearing Institute
1.800.327.9355                             NIDCD | National Institute                   Cochlear Implants |                      on Deafness and Other              
                                           Communication Disorders                      hearing/coch.asp
CDC | Centers for Disease                  1.800.241.1044
Control and Prevention                               IEPs for Children who are Deaf
1.800.CDC.INFO                             hearing/                                     or Hard of Hearing |                                                        
ddhi.htm                                   PEPNET | Regional postsecondary              resources/advocacy/
                                           education centers to increase access         advocacy.htm#iep
Deaf Children and Parents                  to postsecondary education for            persons who are deaf.                        Resources for People Who
index.html                                                      Can't Afford Hearing Aids and
Deaf Culture Online                                                                     Cochlear Implants                                                  
                                                    Helpful Readings                    articles/paulas-110601.htm
index.html                                         on Specific Subjects
Hands and Voices                                                                        Strategies for Teachers                    Your Child's Hearing               
                                           Development Checklist |                      hearing.html
Hearing Loss Association of      
America |                                                          Tips for Teachers

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