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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 NICHCY hearing tests and other assess- leave the hospital. Catching a 1825 Connecticut Avenue N.W. ments, and eventually diag- hearing loss early means that Washington, DC 20009 nosed that Caroline’s inner ear treatment can start early as well 1.800.695.0285 (Voice / TTY) (the cochlea) was damaged. The and “help the child develop 202.884.8200 (Voice / TTY) audiologist said she had senso- communication and language firstname.lastname@example.org rineural hearing loss. skills that will last a lifetime.”2 http://nichcy.org 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 canal Sensorineural hearing Eustachian Cochlea losses result from damage Eardrum tube to the delicate sensory hair NICHCY: http://nichcy.org 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: http:// • is delayed in developing loss or deafness may speech or has unclear nichcy.org/state- also be a characteristic organization-search-by- speech; of another disability state). 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 http://mchb.hrsa.gov/epsdt/ 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: http://nichcy.org 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: http://nichcy.org 4 Deafness and Hearing Loss (FS3) method of instruction, is a References combination of the oral 1 method plus signing and March of Dimes. (2007). Hearing impairment. Available online at: fingerspelling. www.marchofdimes.com/professionals/14332_1232.asp 2 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 www.cdc.gov/ncbddd/ehdi/default.htm loss, including those who are 3 eHealthMD. (n.d.). Different types of hearing loss. Available online at: deaf, now have many helpful www.ehealthmd.com/library/hearingloss/HL_types.html devices available to them. Text 4 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 www.cdc.gov/ncbddd/ehdi/default.htm 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 www.asha.org/public/hearing/disorders/children.htm 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: www.michigan.gov/documents/mdch/ (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 at: www.infanthearing.org/status/index.html 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: www.asha.org/public/hearing/ disorders/how_know.htm 9 The Merck Manual’s Online Medical Library. (2007, April). Hearing loss and deafness. Available online at: http://www.merck.com/mmhe/sec19/ ch218/ch218a.html 10 American Speech-Language-Hearing Association. (n.d.). Causes of hearing loss. Available online at: www.asha.org/public/hearing/disorders/ causes.htm 11 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: https://www.ideadata.org/tables29th/ar_6-6.htm 12 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 FHI 360 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: http://nichcy.org 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 Info to Go | Laurent Clerc To Parents of Deaf Children | National Deaf Education Center http://www.deaf-culture- Alexander Graham Bell Associa- 202.651.5051 online.com/parents-of-deaf- tion for the Deaf and Hard of http://www.gallaudet.edu/ children.html Hearing | www.agbell.org clerc_center/ information_and_resources/ Early Intervention American Hearing Research www.infanthearing.org/ Foundation | www.american- info_to_go.html earlyintervention/index.html hearing.org Listen Up! | www.listen-up.org Assistive Technology for Hearing American Society for Deaf Medline Plus www.asha.org/public/hearing/ Children |1.800.942.2732 www.nlm.nih.gov/medlineplus/ treatment/assist_tech.htm www.deafchildren.org/ hearingdisordersanddeafness.html Communications ASHA | American Speech- National Association of the Deaf Considerations A-Z | Language-Hearing Association www.nad.org www.handsandvoices.org/ 1.800.638.8255 comcon/index.html www.asha.org/public/hearing/ National Center for Hearing Assessment & Management Communication Plan for a Beginnings | For parents of chil- 435.797.3584 Child Who is Deaf or Hard of dren who are deaf or hard of hearing www.infanthearing.org/ Hearing www.ncbegin.org/index.php www.handsandvoices.org/pdf/ NIDCD | National Institute communication_plan.pdf Better Hearing Institute on Deafness and Other 1.800.327.9355 Communication Disorders Cochlear Implants | http:// www.betterhearing.org 1.800.241.1044 www.nidcd.nih.gov/health/ CDC | Centers for Disease http://www.nidcd.nih.gov/health/ hearing/pages/coch.aspx Control and Prevention hearing/Pages/Default.aspx Resources for People Who 1.800.CDC.INFO PEPNET | Working to increase Can't Afford Hearing Aids and http://www.cdc.gov/ncbddd/ access to postsecondary education for Cochlear Implants | hearingloss/index.html persons who are deaf. www.hearingexchange.com/ Deaf Culture Online www.pepnet.org articles/paulas-110601.htm www.deaf-culture-online.com/ Strategies for Teachers index.html Helpful Readings www.as.wvu.edu/~scidis/ Hands and Voices on Specific Subjects hearing.html www.handsandvoices.org/ Tips for Teachers Your Child’s Hearing Hearing Loss Association of http://deafness.about.com/od/ Development Checklist | America | www.hearingloss.org/ schooling/a/inclassroom.htm www.nidcd.nih.gov/health/ How’s Your Hearing? hearing/pages/silence.aspx www.howsyourhearing.com/ This publication is copyright free. 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