Developed for FIRST YEARS - http://firstyears.org/ - SPHS 898, Literacy Development in Young Children with Hearing Loss November 2009

Degree of Long-Term Hearing Loss to Psychosocial Impact and Educational Needs

Source: Phonic Ear. (1991). Degree of Long-Term Hearing Loss to Psychosocial Impact and Educational Needs. Retrieved on November 19, 2009, from http://www.phonicear.ca/resourcefiles/DegreeOfLongTermHearingLossToPsychosocialImpactAndEducationalNeeds.PDF

Degree of Possible Effect Possible Potential Hearing Loss of Hearing Loss on the Psychological Educational Based on Understanding Impact of Needs and modified pure of Language & Hearing Loss Programs tone average Speech (500-4000 HZ) NORMAL Children have better hearing HEARING sensitivity than the accepted -10 - + 15 dB HL normal range for adults. A child with hearing sensitivity in the -10 to +15 dB range will detect the complete speech signal even at soft conversation levels. However, good hearing does not guarantee good ability to discriminate speech in the presence of background noise. MINIMAL May have difficulty hearing faint or May be unaware of subtle May benefit from mild (BORDERLINE) distant speech. At 15 dB student conversation cues which could gain/low MPO hearing aid or 16-25 dB HL can miss up to 10% of speech cause child to be viewed as personal FM system signal when teacher is at a inappropriate or awkward. May dependent on loss distance greater than 3 feet and miss portions of fast-paced configuration. Would benefit when the classroom is noisy, peer interactions which could from soundfield amplification especially in the elementary begin to have an impact on if classroom is noisy and/or grades when verbal instruction socialization and self concept. reverberant. Favorable predominates May have immature behavior. seating. May need attention Child may be more fatigued to vocabulary or speech, than classmates due to especially with recurrent otitis listening effort needed. media history. Appropriate medical management necessary for conductive losses. Teacher requires inservice on impact of hearing loss on language development and learning. MILD At 30 dB can miss 25-40% of Barriers beginning to build with Will benefit from a hearing 26-40 dB HL speech signal. The degree of negative impact on self esteem aid and use of a personal FM difficulty experienced in school will as child is accused of "hearing or soundfield FM system in depend upon the noise level in when he or she wants to", the classroom. Needs classroom, distance from teacher "daydreaming", or "not paying favorable seating and and the configuration of the attention". Child begins to lose lighting. Refer to special hearing loss. Without amplification ability for selective hearing, and education for language the child with 35-40 dB loss may has increasing difficulty evaluation and educational miss at least 50% of class suppressing background noise follow-up. Needs auditory discussions, especially when which makes the learning skill building. May need voices are faint or speaker is not in environment stressful. Child is attention to vocabulary and line of vision. Will miss more fatigued than classmates language development, consonants, especially when a due to listening effort needed. articulation or speech reading high frequency hearing loss is and/or special support in present. reading. May need help with self esteem. Teacher inservice required.

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MODERATE Understands conversational Often with this degree of Refer to special education for 41-55 dB HL speech at a distance of 3 -5 feet hearing loss, communication is language evaluation and for (face-to-face) only if structure and significantly affected, and educational follow-up. vocabulary controlled. Without socialization with peers with Amplification is essential amplification the amount of speech normal hearing becomes (hearing aids and FM signal missed can be 50% to 75% increasingly difficult. With full system). Special education with 40 dB loss and 80% to 100% time use of hearing aids/FM support may be needed, with 50 dB loss. Is likely to have systems child may be judged especially for primary delayed or defective syntax, limited as a less competent learner. children. Attention to oral vocabulary, imperfect speech There is an increasing impact language development, production and an atonal voice on self-esteem. reading and written quality. language. Auditory skill development and speech therapy usually needed. Teacher inservice required. MODERATE Without amplification, conversation Full time use of hearing Full time use of amplification TO SEVERE must be very loud to be aids/FM systems may result in is essential. Will need 56-70 dB HL understood. A 55 dB loss can child being judged by both resource teacher or special cause child to miss up to 100% of peers and adults as a less class depending on speech information. Will have competent learner, resulting in magnitude of language marked difficulty in school poorer self concept, social delay. May require special situations requiring verbal maturity and contributing to a help in all language skills, communication in both one-to-one sense of rejection. Inservice to language based academic and group situations. Delayed address these attitudes may be subjects, vocabulary, language, syntax, reduced speech helpful. grammar, pragmatics as well intelligibility and atonal voice as reading and writing. quality likely. Probably needs assistance to expand experimental language base. Inservice of mainstream teachers required. SEVERE Without amplification may hear Child may prefer other children May need full-time special 71-90 dB HL loud voices about one foot from with hearing impairments as aural/oral program for with ear. When amplified optimally, friends or playmates. This may emphasis on all auditory children with hearing ability of 90 further isolate the child from the language skills, speech dB or better should be able to mainstream, however, these reading, concept identify environmental sounds and peer relationships may foster development and speech. detect all of the sounds of speech. improved self concept and a As loss approaches 80-90dB, If loss is of prelingual onset, oral sense of cultural identity. may benefit from a Total language and speech may not Communication approach, develop spontaneously or will be especially in the early severely delayed. If hearing loss is language learning years. of recent onset speech is likely to Individual hearing deteriorate with quality becoming aid/personal FM system atonal. essential. Need to monitor effectiveness of communication modality. Participation in regular classes as much as beneficial to student. Inservice of mainstream teachers essential. PROFOUND Aware of vibrations more than Depending on auditory/oral May need special program 91 dB HL or tonal pattern. Many rely on vision competence, peer use of sign for deaf children with more rather than hearing as primary language, parental attitude, emphasis on all language avenue for communication and etc., child may or may not skills and academic areas. learning. Detection of speech increasingly prefer association Program needs specialized sounds dependent upon loss with the deaf culture. supervision and configuration and use of comprehensive support amplification. Speech and services. Early use of language will not develop amplification likely to help if spontaneously and is likely to part of an intensive training deteriorate rapidly if hearing loss is program. May be cochlear

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of recent onset. implant or vibrotactile aid candidate. Recent onset. requires continual appraisal of needs in regard to communication and learning mode. Part-time in regular classes as much as beneficial to student. UNILATERAL May have difficulty hearing faint or Child may be accused of May benefit from personal One normal distant speech. Usually has selective hearing due to FM or soundfield FM system hearing ear and difficulty localizing sounds and discrepancies in speech in classroom. CROS hearing one ear with at voices. Unilateral listener will have understanding in quiet versus aid may be of benefit in quiet greater difficulty understanding noise. Child will be more settings. Needs favorable least a speech when environment is noisy fatigued in classroom setting seating and lighting. Student permanent and/or reverberant. Difficulty due to greater effort needed to is at risk for educational mild hearing detecting or understanding soft listen. May appear inattentive difficulties. Educational loss speech from side of bad ear, or frustrated. Behavior monitoring warranted with especially in group discussion. problems sometimes evident. support services provided as soon as difficulties appear. Teacher inservice is beneficial.

References: . Olsen, W.O., Hawkins, D.B. VanTassell, D.J. (1987). Representatives of the Longterm Spectrum of Speech. Ear & Hearing, Supplement 8, pp. 100-108. . Mueller, H.G. & Killion, M.C. (1990). An easy method for ca lculating the articulation index. The Hearing Journal, 43, 9, pp. 14- 22. . Hasenstab, M. S. (1987). Language Learning and Otitis Media , College Hill Press, Boston, MA.

Developed by: Karen L. Anderson, Ed.S & Noel D. Matkin, Ph.D (1991)

Adapted from: Bernero, R.J. & Bothwell, H. (1966). Relationship of Hearing Impairment to Eductional Needs. Illinois Department of Public Health & Office of Superintendent of Public Instruction.

Peer Review by: Members of the Eductional Audiology Association, Winter 1991.

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