Sound is collected in the outer ear, travels through the ossicles (or bones) of the middle ear and delivers pressure waves through the oval window of the cochlea (of the inner ear) onto the basilar membrane.

The inner ear is a fluid-filled space. The cochlea contains sensory cells that are set off by auditory stimuli. The vestibular system contains sensory cells that are sensitive to rotational motion, linear motion, and changes in the position of the head with respect to the ground.

. Both the external ear and middle ear are air-filled spaces. The key work of the external ear and middle ear is to convert air pressure waves into liquid pressure waves. "Air pressure waves" are "sound waves." Liquid pressure waves in the inner ear stimulate highly-specialized nerve cells in the cochlea. Then nerve impulses are sent to the brain, and the mind perceives sound - HEARS.

Adapted from a paper on identifying hearing losses in new borns - Amie L. Gordon-Langbein, D.O.*

Hearing loss in children is high. Studies suggest that 14.9 percent of school-aged children have some degree of hearing loss .Out of 1000 newborns, 3 to 6 are born with congenital bilateral sensorineural hearing loss. So, congenital hearing loss is one of the most common health conditions to affect newborn babies today. It is more common than any other health condition newborns are currently screened for by means of blood samples.

Unfortunately, the average age for detecting a congenital hearing loss in the US is two-and-a-half years. Children with mild to moderate hearing loss tend to be diagnosed even later, at age four. A baby cannot usually tell that he or she cannot hear. Hearing loss is invisible! since the child does not realize that others hear more than they can, they are unlikely to tell anyone of hearing problems.

Any degree of hearing loss is significant in a young child since hearing loss can affect children's behavior, self-esteem, and academic performance, as well as their social interactions with others. After all, hearing is fundamental to learning language, especially in children, who have yet to master the basic building blocks of speaking. Studies estimate that as much as 90 percent of what young children learn comes through reception of incidental conversations around them. To acquire new information, children must be able to hear the information, and through a series of complex events send the information to their brains for further processing.

The first four years of a child's life are crucial in terms of speech and language development, and clearly speech and language skills are the precursors to higher levels of cognitive maturation. Researchers have postulated that 80 percent of a child's ability to acquire speech, language, and other cognitive processes is determined by the time they are three years of age (ASHA, 1997). Children who cannot hear the world around them are at a distinct disadvantage on a multitude of levels. Early detection of hearing loss is the key to early intervention. Researcher Christine Yoshinago-Itano has demonstrated that if a newborn with a hearing loss is diagnosed prior to six months of age and treated appropriately, the child achieves higher language levels than children with delayed diagnoses (Yoshinago-Itano, Sedey, Coulter, and Mehl, 1998). Likewise, children who are diagnosed and treated early develop speech and language skills equivalent to their peers (Yoshinaga-Itano et al., 1998).

References

American Academy of Pediatrics, Task Force on Newborn and Infant Hearing. (1999). Newborn and infant hearing loss: Detection and intervention. Pediatrics,103, 527-530. American-Speech-Language-Hearing Association. (1991). Joint Committee on Infant Hearing 1990 Position Statement, 22(Suppl. 5), 3-6.

American Speech-Language-Hearing Association. (1997). Model Universal Newborn/Infant Hearing Screening, Tracking, and Intervention Bill, 1-10.

Anderson, K. L. (1992). Keys to effective hearing conservation programs: Hearing status of school age children. In E. Cherow (Ed.), Proceedings of the ASHA Audiology Superconference (pp. 38-47).

Bess, F. H., & Paradise, J. L. (1994). Universal screening for infant hearing impairment: Not simple, not risk-free, not necessarily beneficial and not presently justified. Pediatrics, 93, 330-334. Flexer, C. (1993, August 14). Classroom management of children with hearing loss: Preferential seating is not enough. Presentation, San Francisco, CA. Mehl, A. L., & Thomson V. (1998). Newborn hearing screening: The great omission. Pediatrics,101, E4.

Musselman, C. R., Wilson, A. K., & Lindsay, P. H. (1988). Effects of early intervention on hearing impaired children. Exceptional Children, 55, 222-228.

National Institutes of Health Consensus Statement. (1993, March). Early identification of hearing impairment in infants and young children. National Institutes of Health Consensus Development Statement, Bethesda, MD, 1-24.

Niskar, A. S., Kieszak, S. M., Holmes, A., Estaban, E., Rubin, C., Brody, D. J. (1998). Prevalence of hearing loss among children 6-19 years of age: The third national health and nutrition examination survey. Journal of the American Medical Association, 279(14), 1071-1075.

Northern, J. L., & Downs, M. P. (1991). Hearing in children, 4th edition. Baltimore, MD: Williams & Wilkins.

White, K. R., Vohr, B. R. & Behrens, T. R. (1993). Universal newborn hearing screening using transient evoked otoacoustic emissions: Results of the Rhode Island Hearing Assessment Project. Seminars in Hearing,14, 18-29.

Yoshinago-Itano, C., Sedey, A. L., Coulter, D. K., & Mehl, A. L. (1998). Early- and later-identified children with hearing loss. Pediatrics,102, 1161-1171.

* Amie L. Gordon-Langbein, D.O., is a parent of two children, one of whom has a hearing loss. She is also a board-certified family physician and works as a consultant and advocate for children with hearing loss and their families. She is a member of the Alexander Graham Bell Association for the Deaf and Hard of Hearing. - http://www.agbell.org/langbein.html

Viral infections like mumps or measles

Premature birth

Anoxia

Prenatal infections

Meningitis or other bacterial infections

Side effects from medicines ( including aspirin and antibiotics)

Excessive noise - above 85 decibels

Hearing disorders home page

National Institute of Health (NIH) info on early recognition of hearing loss

Article on early screening

Links to support and strategies for hearing

Links on international sites

Center to facilitate children hearing

Explanation of biological components of the ear

Listen up web site with activities, exercises, readings, and more

Noise awareness

Audiogram

Jennifer Woolensack Kent State University Gaines, R., & Halpern-Felsher, B. L. (1995). Language preference and communication development of a hearing and deaf twin pair. American Annals of the Deaf, 140(1), 47-55.

Summary: Language characteristics of deaf and hard of hearing students vary as all children's characteristics do. However, language and communication development can be enhanced by preference and environmental factors. The twins being studied are both girls, one is Ann, who was healthy until the age of 7 months, when she contracted pneumococcal meningitis and became binaurally profoundly deaf. The other twin is Dianne, who is hearing and healthy. The study examines the communication development and language preferences of twin girls who are alike in age, genetic structure, and home and school environment, but who are different in one particular way: hearing ability. At the age of 13 months, the twins were brought to HI CHIPS program, to educate them both at the same place. They were taught both vocal and sign language. The twins were videotaped over a 20-month period, in monthly intervals.

All communication was recorded and categorized by style. The language preference analysis showed that Ann preferred nonvocal language, and that Diane used vocal language. The bulk of the hand gestures were used in the request category by both twins. However, body movements were preferred much more by Ann. The study showed that both twins had the ability to learn language and to communicate.

This shows that deafness does not prevent language acquisition. Although Ann was not as successful in vocal language, she still was able to develop appropriate visual language that was parallel to her chronological age. Diane was able to use both forms of language, visual and vocal, but preferred vocal. However, with knowing both forms, she helped her twin sister by communicating with her, which made Ann's language development more accelerated.

This observation shows that early intervention and diverse modes of communication can benefit the development of language, especially for the deaf. Key Points: Language characteristics vary from person to person, but environment and preference play a crucial role. Deafness does not prevent language acquisition. Early intervention and diverse communication are key to the development of language for the deaf.

Assistive Listening Devices

Alerting devices

There are many things in life that we are blessed with that we take for granted. We can walk, talk, hear and see things in our world. For the most part we don’t have any huge disabilities, and we walk around assuming everyone has it just as easy. But they don’t.

There are millions of Americans who get up each morning and go about a days work struggling through our world of communication. They wake up but not to the sound of an alarm clock or music, not to the voice of the ones they love, but to silence. These Americans can’t hear, and it affects the lives of about twenty million people living in the United States.

Before we can totally grasp the thought of waking up to silence each morning, we must first understand how our hearing ears work and then what goes wrong with deaf peoples ears. There are three main parts to our ears and three different levels on which we hear. First, lets start with the parts of the ear. Starting with the part you can see there is the outer ear. This part of our ears doesn’t do that much, but without it there would be nothing to direct sound into the rest of our ear. So the pinna (the outer part of the ear you can see) collects sounds and directs them back into the auditory canal. It is also a protector, in that it protects the internal structures of our ears.

Then we move toward the middle ear. The eardrum separates the outer ear and the middle ear. When you get past the eardrum you would see three small bones. These bones carry the vibrations of sound across the middle ear into the inner ear cavity. These bones are called the malleus, incus and stapes. There is also the Eustachian tube that sits in the middle ear and it equalizes the pressure built up in your ears. When someone gets and ear infection, it is because the Eustachian tube isn’t controlling the air pressure correctly and fluid builds up as a result. So the last part of the ear that we need to know is the inner ear. Inside there are the most important parts of our ears. There is the cochlea and the vestibular mechanism. The vestibular mechanism is used so we can keep our balance, but the cochlea is the whole reason we can hear. In its small snail shell form it contains the auditory nerve endings. Those nerve endings are what sense the sound vibrations and with the help of central auditory processing we can hear and understand speech and language.

Now lets look at the different levels in which we hear. These have been studied and given to us by a man named Ramsdell. He says that we hear on a symbolic level, a signal or warning level and an auditory background or primitive level. The symbolic level is used to understand another persons spoken words. It helps us to turn the words into actual objects or concepts in our minds. The signal or warning level keeps us alert of our surroundings and whether or not we need to fear something. The auditory background or primitive level is how we monitor our surroundings constantly.

For someone that is considered hard-of-hearing, they don’t have the ability to perform at the auditory background level. Now that we know something about the way we hear, let’s look at what it really means to be deaf or hearing impaired. These two words have different meanings although many people use them interchangeably.

Deafness means that someone has a hearing loss that is so immense that it can’t be used to develop oral language.

When someone says hearing impaired it is a generic term that designates a person with some kind of hearing loss, but it doesn’t specify the intensity of that loss. When we look at hearing impaired, we will find two groups that people will fit into; either they are deaf or hard-of-hearing. If we first look at hard-of-hearing we will see that it is simply a person, with the help of a hearing aid, which can hear sufficiently to successfully process language/speech through audition. But looking at someone that would be classified as deaf, we see there is a lot more to it.

Those that are hard of hearing generally gain this problem through aging or from the work that they do. Deafness is brought on by birth problems, illness or accident. If you were born deaf, then you would be congenitally deaf. There would be a reason behind how you developed and such; it wasn’t caused by an accident or any kind of illness. Then there is adventitious deafness. This is when someone born with normal hearing experiences nonfunctional hearing because of and accident or illness. This can last only a little while or it can be permanent.

We will look at adventitiously deaf in more depth, because it has more causes and resolutions to it. The first big thing is that there are five major types of adventitiously deaf. They are 1) conductive, 2) sensorineural, 3) mixed hearing loss, 4) functional, or 5) central auditory disorder.

Each type of hearing loss has some reason and some result to it. Conductive hearing loss stems from a structural problem with the outer and middle ear. The most common cause of this is otitis media, otherwise known as an ear infection. This is especially common among school age children and it can be fixed with medication. If it becomes a constant problem with a child, they may need to surgically place a special tube inside the ear to help the Eustachian tube to correctly balance the air pressure.

The conductive hearing loss can also result from an earwax build-up or otoscierosis. Otoscierosis is a spongy, bony growth around the stapes one. If this occurs a doctor can do surgery to overcome the difficulty. There is rarely a time that a conductive hearing loss becomes so severe that it is permanent. For the most part, these problems can be treated and the child will have normal hearing, speech and language.

A more serious form of hearing loss is sensorineural hearing loss. This occurs when damage has been done to the cochlea or the auditory nerve. A viral disease is a major one of the causes, although other illnesses and disease can cause this. It requires painstaking treatment, and cannot be cured all the way. The degree to which a child may be deaf depends. One way a baby may be born with sensorineural hearing loss is if the pregnant mother catches rubella during the first three months of pregnancy. Another big cause for babies with sensorineural problems is Rh incompatibility. Usually babies born under these circumstances don’t survive, but if they do they have a high risk of being deaf.

Hereditary factors may also play in the role of hearing loss in children. Someone with mixed hearing loss has a mixture of the problems discussed above. This kind of hearing loss can create incredible difficulties for school children. The last two hearing loss problems are functional hearing loss and central auditory disorders. A functional hearing loss is usually to compensate for another problem a child is having. It is usually masking some type of real or perceived social or psychological struggle. This occurs generally in children ages of 9 to 13. These are also usually found in the hearing tests performed in schools.

A central auditory disorder is one where there isn’t any measurable peripheral hearing loss. It is a result of a lesion or damage to the central nervous system. The child may show signs of difficulty with auditory comprehension, language development or auditory learning. The actual cause of this is very hard to discover. As I said in the introduction, there are millions of Americans that fight with this everyday. Total there is about 8-10 percent of people in this country with a hearing disorder of some kind. Over a million pre-school, elementary and secondary education children have hearing loss and twelve million young adults between the ages of 18 and 25. This is a very prevalent problem within the United States, and I’m sure with the rest of the world as well.

As a future teacher, I know that it could affect my classroom and so it is important that I am aware, as with the rest of teachers, what signs to look for and how it affects a classroom. There are many ways to evaluate someone’s hearing ability. Most schools, if not all public schools perform a pure tone-screening test. This is when the child hears different frequencies from a machine and must raise his/her hand to respond to it. They test the frequency range from 250 Hz to 8000 Hz and at an intensity of 20 to 25 dB.

Another type of test is a threshold test. There is the air conduction threshold test that will reveal any hearing loss and tells the amount as well. Then there is the bone conduction, which measures the sensorineural mechanism of the inner ear. This is the best test to check for a mixed or sensorineural hearing loss. There are also the speech reception threshold test and special audiometric test. The speech test will test whether or not a child can hear and understand speech and the special audiometric helps physicians treat otitis media, a middle ear infection. There are many types of treatments that can help make hearing loss easier on the individual. There are hearing aids and assistive listening devices that can make it easier for the deaf to make it in a communication-based world.

There is also auditory training that can teach those with hearing impairment to use their residual hearing to its greatest extent. This kind of training is used to familiarize parent and children with the nature of hearing loss, with the types of rehabilitation and with what they can expect from auditory training. When educating a child with hearing loss, you must first know how to recognize the problem. One big thing to notice in a child with possible hearing loss is whether they are paying attention in class. If they have a lot of earaches or a discharge from their ear(s) it is a good idea to have them sent to a doctor. When they can’t answer easy questions or they fail to respond when spoken to it is possible that they are having trouble hearing speech and language.

Teachers also need to be aware that there are specific ways to teach children with hearing loss. Those children with mild to moderate hearing loss should be given appropriate seating in the classroom and special attention to complete their work. They may need to be placed in a special class depending on how they progress through school. IF a child has moderate to severe hearing loss they will probably need special therapy and reinforced drills in the classroom. If there are more than one hearing impaired student in any particular classroom, it is advised that a teacher set up some sort of auditory training unit so they can help each other out.

When it comes to social and personal concerns, there can be many problems. When a child becomes deaf at an early age or is born deaf they can have a high frequency of emotional and social adjustments. These result from parental difficulty with accepting deafness, lack of a role model, and limited activities in school and out of school. When considering the career of a teacher, you must realize that there are hurdles that you might have to jump over in the classroom. You have to be able to be flexible and work with children when they need help. Teachers need to be aware of their students’ struggles and disabilities. So when thinking of having a career that will greatly impact hundreds or thousands of lives, you must be able to assess the children correctly and be able to help them if they have special needs.

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