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Flashcards in Hearing Impairment Deck (29)
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1

Hearing Loss

Disability

2

Culturally Deaf

Native language is sign language
Identify with the attitudes, traditions, values, and mores of deaf culture

Social identity – hearing loss is a difference NOT a disability
Hard of hearing as a difference
Speech is the primary means of communication
Individual chooses to construct their view of hearing loss

3

Congenital hearing loss

Present at birth or shortly after birth

4

Prelingual/Postlingual Hearing Loss

Prelingual loss – hearing loss present at birth or before speech and language have developed ( ~2 years of age)
~50% due to genetics

Postlingual loss – hearing loss occurs after speech and language development

5

The Speech Chain

Step 1: The speaker’s brain
The speaker organizes his/her message
What do you want to say; how do you want to say it
A complex process but takes seconds

Step 2: The speaker’s brain
The speaker formulates his/her message into language

Step 3: The speaker’s central nervous system
The speaker’s brain sends neural impulses (signals) through the central nervous system to the muscles of:
Respiration
Phonation
Articulation
arms, hands, torso (for support), etc.

Step 4: Sound waves
Air flow from the larynx is constricted by the articulators creating pressure changes in the air surrounding the speaker’s mouth
Intensity (decibels) amount of energy per unit of air
Frequency (hertz) cycles per second
These patterns of pressure changes are sound waves
Pure tones – sound at one frequency
Complex tones – have fundamental frequency, harmonics, and formants
Sound waves travel through the air to reach the listener’s ear drum

6

The Speech Chain

Step 1: The speaker’s brain
The speaker organizes his/her message
What do you want to say; how do you want to say it
A complex process but takes seconds

Step 2: The speaker’s brain
The speaker formulates his/her message into language

Step 3: The speaker’s central nervous system
The speaker’s brain sends neural impulses (signals) through the central nervous system to the muscles of:
Respiration
Phonation
Articulation
arms, hands, torso (for support), etc.

Step 4: Sound waves
Air flow from the larynx is constricted by the articulators creating pressure changes in the air surrounding the speaker’s mouth
Intensity (decibels) amount of energy per unit of air
Frequency (hertz) cycles per second
These patterns of pressure changes are sound waves
Pure tones – sound at one frequency
Complex tones – have fundamental frequency, harmonics, and formants
Sound waves travel through the air to reach the listener’s ear drum

Step 5: The listener receives the sound waves
The external ear receives the sound waves
The middle ear converts sound into mechanical energy.
The inner ear converts mechanical energy into electrical energy/signals.
Electrical energy travels through the VIII cranial nerve (vestibulocochlear) to the auditory cortex.

Step 6: The listener's brain
The listener’s brain decodes the neural energy
What brain structure?
The speaker’s message is interpreted and received

7

Conductive Hearing Loss

Outer or middle ear dysfunction
Sound is softer
May be treated with medical or surgical intervention

Some causes:
Head trauma
Fluid in the middle ear
Perforated Eustachian tube
Otitis media
Can cause mild fluctuating hearing loss
May result in language delay

8

Sensorineural Hearing Loss

Damage/dysfunction of cochlea or VIII cranial nerve
Sound is softer and distorted (bc hair cells are tuned to specific frequencies; damaged cells no longer detect those frequencies)
Typically, can’t be medically or surgically corrected

Severity of hearing loss depends on location and number of damaged elements

Amplification may help with sound volume

Some causes:
Congenital – e.g., prematurity
Diseases – e.g., meningitis
Presbycusis

9

Mixed Hearing Loss

Combined conductive and sensorineural
Conductive component medically treated
Sensorineural loss persists

Central Auditory Processing Disorder – dysfunction in the brain’s ability to process auditory information (difficulty processing auditory information in the brain)
Diagnosed by an Audiologist
Speech-language pathologist is part of the multidisciplinary team
Academic challenges may be present

10

Hearing Assessment

Audiologist
Evaluates an individual’s hearing
Recommends and fits assistive listening devices

11

Speech Audiometry

Quantifies hearing threshold for speech

Speech Reception Threshold – minimum hearing level for speech
Recognize 50% of speech material
Used to confirm pure-tone results
Speech discrimination – repeat monosyllabic words presented at a comfortable listening level

12

Otoacoustic Emissions

Sounds emitted by the inner ear when the cochlea is stimulated by sound
The sound is measured by a probe inserted into the ear canal
The sound isn’t present with sensorineural or conductive hearing loss

13

Degree of Hearing Loss

Average of pure-tone thresholds at:
500, 1000, and 2000 Hz
Greater severity, greater the affect on communication

Age of onset
Children
Adults

Course of onset
Gradual
Rapid
Other factors

14

Hearing Aids

Types

Components:
Microphone
Amplifier
Receiver
T-switch
Direct audio input (DAI)

Behind the ear (BTE)
In the ear (ITE)
Canal aids
Body and eye glass aids
Bone conduction aids
Digitally programmable hearing aids

15

Pure Tone Audiometry

Pure-tone thresholds
Compares thresholds to normal hearing
Air conduction and bone conduction
Test frequencies of 125-8000 Hz
Audiogram

16

Auditory Evoked Potentials

Records brain wave activity in response to sound

Used for site of lesion testing or when behavior prevents other testing

17

Auditory speech perception

Detect speech signal
Interpret acoustic/phonetic elements
Identify familiar patterns
Apply linguistic, paralinguistic, and situational information

May be improved through training
Encouraged for hearing aid users

Visual speech perception
Visual information improves speech comprehension
Speechreading and lip reading

18

Children with sensorineural or mixed hearing impairment (HI)

Development depends on:
Age of onset
Early vs. late
Audiometric configuration of hearing loss
Age of identification and amplification
Early vs. late
Amount and type of habilitation

19

Children with sensorineural or mixed HI:

Delay in babbling

Consonant substitutions and distortions

Neutralization or distortion of vowels

Suprasagmental deficits

Use more phonological processes than typically developing children
Initial and final consonant deletion
Cluster reduction
Voicing voiceless consonants

20

Children with sensorineural or mixed HI:

Language mediates cognition development
Language delay = cognitive delay
IQ normal but lower than normal hearing children
Language deficits may explain cognitive differences
Deaf culture and IQ
Norm-referenced tests

21

Sensorineural and mixed hearing losses

Normal language development, but often delayed
Syntax (inflectional morphemes)
Semantics (agent, action, object; relationship forms)
Discourse
Limited exposure to oral narratives
Pragmatic development (better than syntax, semantics)

22

Language Learning in Deaf Children

Children learn language through social interactions
Hearing parents may react differently to a child with a hearing loss
Can negatively influence language development
Parent-child interactions using ASL
Language
Literacy
Social and academic development

23

Literacy

Difficult for children with HI

Average reading comprehension for adolescent with HI is third-fourth grade

Study examining literacy skills of high school seniors with HI enrolled in mainstream or oral education programs (Geers & Moog, 1989)
Average to above average IQ
Good use of residual hearing
Strong oral English language skills
Syntax, semantics, discourse

Combined ASL and English instruction to improve literacy

Exposure to literacy & writing

24

Children with cochlear implants (CI)

Children implanted earlier tend to perform better
Implanted by preschool resulted in age-level language abilities (Schauwers, Gillis, and Govarts, 2005)
Intelligibility, syntax, and semantics improved with implantation
Early implantation and rehabilitation can improve intelligibility, discourse skills, and literacy (ASHA, 2004)

Children with CI out performed children with hearing aids (Geers, 2004)
Oral education was more effective than total communication

25

Children with Mild CHL

May be at risk for speech and language delay
Delays may not persist

Chronic otitis media (OM) but typical language development
Low risk for later language delay

History of OM and present with language delay
Educate and train families

26

Speech & Language Assessment

Use standardized and nonstandardized tests (to determine how they are functioning as compared to peers, and in individual strengths/weaknesses)
Speech and language production
Writing and reading
Discourse
Receptive language
Compare speech results to the audiogram (know what sounds they can hear before determining a problem)
Patterns of production and perception will inform treatment plans

Assessments results should be reported in terms of strengths and weaknesses

Treatment should build on strengths

27

Educational Approaches

Oral approach – English is used for speech, language, and literacy acquisition

Three variations
Auditory-oral: intensive speech instruction and auditory perception and speechreading are used to learn language
Auditory-verbal: auditory perception used to learn speech and language
Cued speech: auditory-oral approach is supplemented with hand cues

28

Total Communication

All communication modalities, but typically a combination of spoke English and invented sign
Invented sign forms of English- combine ASL signs and invented signs in ways that follow English word order rules
Manually coded English
Pidgin sign English

Bilingual/Bicultural approaches:
Knowledge and use of two languages and two cultures
ASL is considered the native language and English is the second language
Immersed in deaf and hearing culture

29

HL in Adults

Aural rehabilitation: focuses on improving effectiveness of communication for adults with hearing loss

Education:
Understanding hearing loss- both individual and family
Hearing aid and assistive devices selection and management
Legal Rights (right to continue working, right to education, rights not to face discrimination)

Training:
Strategies to improve auditory perception skills
Using visual cues

Individual and/or group treatment