EDUC20069 Deafness and Communication

Accessing hearing and

spoken language

Created by Lois Grant, Melbourne University

Updated by Karin Gillies, Australian Hearing
 Outline

1. Understanding hearing loss

2. How we diagnose hearing loss
3. Universal Newborn Hearing
Screening
4. (Re)habilitation of hearing loss

Image courtesy of Australian Hearing

 Identifying hearing loss

Opportunities to access hearing and to use spoken

language for communication have been transformed
in the last thirty years.
How?
New technologies have provided better hearing
devices and more accurate assessment of hearing for
younger children, including newborns.
Anatomy of the ear

Image courtesy of Australian Hearing

 Causes of hearing loss

Congenital
Present at birth
Progressive

Acquired
Injury (e.g., physical trauma, exposure to loud
noise, ototoxic drugs)
Aging
Medical (e.g., Otosclerosis, cholesteatoma,
acoustic neuroma)
Types of hearing loss

Image courtesy of Australian Hearing

 Management of hearing loss

1. Diagnose the hearing loss

2. Provide the most appropriate device
hearing aid
cochlear implant
3. Support the child & family with early intervention
multi-disciplinary approach early intervention (Audiologist, Teacher of
the Deaf, Speech & Language Pathologist, etc.)
communication system (Oral vs Manual approach)
4. Adults with acquired hearing loss will need support to adjust
to life with a hearing loss
use their device effectively
develop good communication tactics & strategies
 Signs of a hearing loss

How do you know if you or someone has a hearing loss?

Typical type of hearing loss in adults:
- Permanent
- Reduction in sensitivity to high pitched sounds
What behaviours might you see in an adult with a hearing loss?

Typical type of hearing loss in children:

Most common is a temporary hearing loss from fluid build up
reduction in all sounds, particularly low pitched)
Less common is permanent hearing loss
Reduction in high pitched sounds or all sounds
What behaviours might you see in a child with hearing loss?
 Assessing hearing in babies

Electrophysiological tests

Otoacoustic emissions (OAEs)

measures the health of the inner ear cells
does not give information about what is
sent beyond the inner ear (cochlea).

Auditory Evoked Potentials (ABR)

measures the response of
the acoustic nerve to sound
gives information beyond
the inner ear (cochlea).
 Assessing hearing in babies

Behavioural assessment techniques

Behavioural Observation audiometry (BOA)

Young babies (0-6mths) may

respond to noisemakers
(e.g. rattles, voice, chime bars)
To demonstrate to parents what
the baby is responding to
 Behavioural Assessment of hearing

Visual Reinforcement Audiometry (VRA)

Appropriate for older babies

and toddlers (6mths-2.5 Years)
Taught to turn to sounds and
reinforced with a visual reward
such as a puppet
Calibrated sounds presented
via a speaker
 Play Audiometry

Play Audiometry

Appropriate for preschool

children
tested using an adult-like
hearing test that is turned into
a listening game

Photo courtesy of PEJS

 Newborn Hearing Screening

Why screen newborns?

Prior to the introduction of a newborn hearing screening
program
babies often weren't diagnosed with hearing loss until at least one year of
age
Children often diagnosed as late as 2 or 3 years of age, after language
delays become clear
These babies are at higher risk of having poorer long-term outcomes in
language and learning
 Newborn Hearing Screening

The newborn hearing screen aims to detect bilateral

moderate, severe or profound congenital hearing
impairment.
The screen will also
detect mild and unilateral
hearing loss

Acquired or progressive
hearing loss may not
be detected until later
in infancy or childhood
Cost benefits of Neonatal Screening
 Hearing screening in children

Congenital hearing impairment affects up to two in every

1,000 infants born in Victoria (110 born each year)
Moderate or greater both ears: 1/1000 (70 each year)

If detected late children may experience very significant

delays in language, academic, and social skills

Source: http: infanthearing.vihsp.org.au

 Hearing loss and child
development

Children use their hearing

- to learn about the world around them
- to develop their language and communication skills

The first few years are the most important period for speech
and language development

By the time a child is around four years old, they already know
around 1500 words and begin to tell stories

Source: http: infanthearing.vihsp.org.au

 Hearing loss and child
development
The effects of hearing loss on childrens language
development include:
limited vocabulary (i.e. smaller repertoire of words a child says)
unclear pronunciation and unintelligible speech
difficulty understanding language

Delays to speech and language development can affect:

a childs relationships,
education and employment later in life.

These delays can be prevented or reduced through early

diagnosis of the hearing loss and early intervention.
Source: http: infanthearing.vihsp.org.au
 Effectiveness of early identification

Early Intervention:
Associated with better language outcomes, especially for children using
oral communication
better outcomes on standardised language tools is associated with using spoken
language as the mode of communication (Ching, 2014)

Early identified children had significantly higher personal social skill

development than later identified children
http://pediatrics.aappublications.org/cgi/content/abstract/102/5/1161
 The Effectiveness of Early Identification

Research suggests the best outcomes when

hearing loss is diagnosed and early intervention
commences before six months of age.
Ching (2014), Yoshinago-Itano et al (1998)

Photo courtesy of
aussiedeafkids.org.au

Hearing Diagnostic Early

3 months

6 months
Collaboration between 1 month
newborn hearing screening screening audiology to intervention,
programs, diagnostic while in confirm including
audiologists and hospital hearing loss hearing aid
Australian Hearing/ Early fitting
Intervention programs.
Predictors of language outcomes

From Ching (2014)

Comparison with normally hearing children

From Ching (2014)

 Neonatal screening

Australia has Universal Newborn Hearing Screening

From Ching, et al. (2013)

When NSW adopted universal screening on a statewide basis

Average age of diagnosis fell from 18 months to 1.5 months
Average age of first hearing aid fitting fell from 22 months (for severe
losses) to 3.8 months for all hearing losses.
 Impact of infant hearing screening

Courtesy of Australian Hearing. From Demographic Details of Young Australians aged less than 26 years with a
hearing impairment, who have been fitted with a hearing aid or cochlear implant at 31 December 2014.
 Early Intervention

Multi-disciplinary approach:
A comprehensive intervention and management program is also a critical
component of the management of children with hearing loss.

Surveys of parents (Luterman & Kurtzer-White, 1999; Scarinci, et

al, 2017) indicates the following initial priorities for parents:
Contact with other parents of children with hearing loss
unbiased information about all options
sufficient time to process complex information
counseling from a skilled, empathetic audiologist
 Early Intervention

Research suggests that the diagnosis of hearing loss followed

by appropriate early intervention by age 6 months is the most
effective strategy for the normal development of language in
young children (Ching, 2014; Arehart & Yoshinaga-Itano, 1999)

Parents report that the benefit of early diagnosis is that they

bond with their newborn as a child who ids deaf or hearing
impaired and dont have to change their mind about who
their baby is.

Questions of identity, diversity and acceptance are part of an

evolving landscape for parents and children (Young &
Tattersall, 2007)
 Devices for access to sound and speech

Degree of hearing loss

What do Hearing Aids do?
 Fitting Hearing Aids

Children and adults diagnosed with a hearing loss that is, or

will, impact on their life are usually fitted with hearing aids
 Fitting hearing aids

What do you mean by fit a hearing aid?

Current hearing aids are digital and programmed via software
Every person needs the device to be fitted individually
 Fitting Hearing Aids

Current hearing aids are

programmed via a computer

Measurements are taken

with the hearing aid in the
persons ear to see what the
aid is doing

Ongoing adjustments usually need

to be made
 What are hearing aids

What do they do?

- amplify sounds (speech, music and environmental sounds)
- bring back awareness of sounds that are softer than the hearing
level
- increase volume of sounds that are too soft or inaudible with a
hearing loss

Which sounds?
- Between 250 Hz and 10,000 Hz (most important for hearing speech)
- Sounds at different frequencies might be amplified different
amounts

Hearing aids work differently depending on the

individuals hearing loss
A typical hearing-aid electronic circuit
Parts of a hearing aid
Parts of a hearing aid
 How things have changed

http://www.hearingawarenessweek.org.au/history

Images courtesy of
Hearingaidmuseum.com
hearingofamerica.com
 How well do hearing aids work

Factors for success

Adults (e.g., motivation, expectations, dexterity, persistence, age, relationship
with the audiologist, need and benefit)
Children (e.g., motivation, parental support, school support, need and benefit)

Limitations
The degree and type of hearing loss
Frequency sensitivity
Tolerance of loud sounds
The listening conditions
distance from the talker
Presence of background noise
voice levels
Availability and use of visual cues
www.hear-it.org
 How do digital hearing aids work?

Most digital hearing aids are non-linear in the way they amplify
sound
not all sounds are amplified by the same amount

They use compression

to make more sounds
comfortably loud for a
hearing impaired listener
 What can hearing aids do today?

Match the hearing loss much more closely

Reduce background noise
Offer different programs for different listening environments
Transpose high frequency sounds into a low frequency
bandwidth
Do all this automatically
Connect a user with their mobile, TV or computer via
bluetooth

www.hear-it.org
What can hearing aids do today?

https://www.signia-hearing.com.au/insio-primax/
 What its like to have a hearing loss?

Hearing loss simulation

http://www.nal.gov.au/hearing-loss-simulations.shtml

www.pedsent.com
 Lecture Summary

Choice of hearing test depends on the developmental age of the child

or adult.

Newborn hearing screening now exists and with early intervention,

normal speech and language development can be achieved by
many of these children.

Hearing aids are the most common way of reintroducing sound

- They are fitted and programmed digitally for the individual
- They can look very different depending on what the individual or
their parents prefer (and is appropriate for their hearing)

Who is important in the process of hearing (re)habilitation?

- The individual with hearing loss and parents/ family
- Audiologist, Teacher, Speech Pathologist, other health professionals
- YOU!
 References

Arehart, K.H. & Yoshinaga-Itano, C. (1999). The role of educators of the deaf in the
early identification of hearing loss. American Annals of the Deaf, 101(94), 19-23.

Ching, T.Y.C. (2014). Longitudinal Outcomes of children with hearing impairment

(LOCHI): 5-year outcomes. Presentation at HEAL Conference June 5-7, 2014,
Cernobbio, Italy.

Ching, T.Y.C, Leigh, G. and Dillon, H. (2013). Introduction to the Longitudinal

Outcomes of Children with Hearing Impairment (LOCHI) study: Background,
design, sample characteristics. International Journal of Audiology, 52, S4S9

Dillon, H. (2012). Hearing Aids 2nd Eds. Sydney: Boomerang Press/Thieme.

Luterman, D. & Kurtzer-White, E. (1999). Identifying hearing loss: parents needs.

American Journal of Audiology, (8), 13-18.

Mehl, A., & Thompson, V. (1998). Newborn hearing screening: The great omission.
Pediatrics, 101(1), E4.
 References

Scarinci, N. Erbasi, E. Moore E. Ching, T. Y. C. & Marnane, V. (2017). The parents

perspective of the early diagnostic period of their child with hearing loss:
information and support. International Journal of Audiology, 1-12.
doi:10.1080/14992027.2017.1301683

Yoshinaga-Itano, C. Sedey, A. L. Coulter, B. A. & Mehl, A. L. (1998). Language of

early and later-identified children with hearing loss. Pediatrics, 102, 1168-1171.

Young, A. & Tattersall, H. (2007). Universal Newborn Hearing Screening and

identification of deafness: Parents responses to knowing early and their
expectations of child communication development. Journal of Deaf Studies and
Deaf Education 12(2), 209-220.
Thank you

Acknowledgements:
Diane Toe
Caitlyn Barr

Copyright The University of Melbourne 2011