Hard of Hearing (HOH) Tip Sheet

What is Hard of Hearing (HOH)? ● Hard of Hearing refers to people who do not hear well out of one or both ears at differing levels of severity

Did You Know? ● 2 ­3 out of 1,000 children in the U.S. are born with a detectable level of hearing loss in one or both ears.1 ​ ● The NIDCD estimates that approximately 15 percent of Americans (26 million people) between the ages of 20 and 69 have high frequency hearing loss due to exposure to noise at work or during leisure activities.6 ​ ● More than 90 percent of deaf children are born to hearing parents.2 ​ ● Men are more likely than women to report having hearing loss.3 ​

Physiology of Hearing Loss ● Conductive Hearing Loss: occurs in Outer or Middle Ear; sound waves are blocked from continuing to other ​ structures of the ear ● Sensorineural Hearing Loss: occurs in Inner Ear; auditory nerve impacted, results in limited signals to the brain ​ ​ ● Central Hearing Loss: damage in the part of the brain that receives signals from the auditory nerve ​

Levels of Hearing Loss ● Normal hearing is approximately 15 dB (decibels) ● Typical children require signal­to­noise (S/N) ratio of +10 when the teacher speaks at 10dB ● Students with HOH require +15 S/N ratio

Severity of % of Information dB Level Hearing Loss Impact Missed in Audible Conversation Slight 16 dB – 25 dB Will miss 10% of Vowels usually heard, unvoiced consonants missed Hearing Loss speech information Mild Hearing 26 dB – 40 dB Will miss 25­40% of Difficulty with distant sounds Loss speech information Moderate 41 dB – 55 dB Miss most sounds at conversational levels, speech Will miss 50­80% of Hearing Loss problems if pre­linguistically deafened speech information Moderately Delayed language and syntax, will have reduced speech Will miss 100% of Severe 55 dB – 77 dB intelligibility speech information Hearing Loss May hear a loud voice at 1­ft distance and identify Severe Will miss 100% of 71 dB – 90 dB environmental noises; severe speech problems persist, Hearing Loss speech information and alternate forms of communication are needed Person cannot hear speech but may react to sounds, feel Profound vibrations, hearing is not the primary form of Will miss 100% of 91 dB < Hearing Loss communication unless a cochlear implant is used speech information successfully

Causes of Deafness and Hard­of­Hearing ● Head trauma ● Repeated exposure to loud noise ● Autoimmune ear diseases ● Aging ● Malformation of inner ear ● Bacterial Meningitis: causes permanent hearing loss in 2%­28% in BM survivors ● Congenital Rubella: may develop visual and hearing impairments, resulting in deaf­blindness ● Meniere’s Disease: disorder of the inner ear that causes: (i) spinning­sensation (i.e. vertigo), (ii) fluctuating (occasionally permanent) hearing loss, (iii) tinnitus (ringing in ear), (iv) pressure on affected ear (MD only occurs in one ear) Hard of Hearing (HOH) Tip Sheet

Lifespan Issues ● Receive distorted or limited sensory information from ears resulting in learning/ skills/ social delays ● Developmental milestones attained at later ages not from cognitive delays rather delays in communication and socialization; specific effects include:

Behavioral Effects Academic Effects ● Responding one day, not the next ● Asking for repetition ● Does not follow oral directions well ● Limited phonemic and phonetic awareness ● Balance problems (when eyes closed) ● Omitting word endings ● Delayed developmental milestones ● Responds to visual directions faster

Social Effects Physiological Effects ● Turning one ear toward sound ● Tilting head forward ● Closely watching faces ● Ear discharge ● Limited response to oral stimuli ● Excessive Wax

Educational Implications – How to modify a classroom to help students with HOH: ​ ​

Modify Auditory Environment ● When sound hits a surface it bounces creating reverberations ● Use carpets, drapes, sound­absorbing materials, sound­absorbing tiles, double pane windows and solid doors ● Reduced noisy equipment like overhead projectors and sitting next to noisy windows

Modify Visual Environment ● Remove visual obstructions from board material and line­of­vision to instructor ● Place sign­language interpreter next to student in line with the instructor, take turns speaking for interpreter, and speak to student not interpreter ● Be aware of fatigue as overuse of residual hearing causes fatigue

Modify Materials and Direct Instruction ● Lectures/ films/ audio should have written components (i.e. closed caption, transcripts) ● Use visual organizers for nearly all directions/texts ● Use carbon paper to provide/produce written class notes for peer

Assistive Technology ● Hearing aids, cochlear implants, microphones, speakers ● Enlist use of listening devices, text­to­speech and speech­to­text

Helpful Resources

Hearing Loss Association of America ● National organization for advocacy, resources, and legal representation for people with hearing loss. ● http://www.hearingloss.org/content/helpful­website­links

National Organization of the Deaf ● National civil rights organization in healthcare, education, employment, and early intervention. ● https://nad.org/