What are hearing loss and deafness?
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The terms
hearing loss andhard of hearing describe a wide range of conditions that partially or totally prevent individuals from receiving sound in all or most of its forms. -
Children with hearing loss may hear sounds very differently. Some children respond well to hearing amplification, such as hearing aids, and can hear speech clearly. Other children may have very little response to sounds in their environment.
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New technology such as cochlear implants can affect the quality of a child’s hearing.
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The Individuals With Disabilities Education Act (IDEA) includes “hearing impairment” and “deafness” as 2 separate categories under which children may be eligible for special education and related services programming.
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Hearing loss is defined by IDEA as “an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance.”
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Deafness is defined as “a hearing loss that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification.”
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How common are they?
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Hearing loss affects individuals of all ages and may occur at any time from infancy through adulthood. Current US Department of Education statistics mention that 1.3% of all students with disabilities receive special education services under the category of “hearing impairment.”
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Information from the universal newborn hearing screening literature suggests that 1 to 3 children per 1,000 are identified with hearing loss now that all newborns are screened. Other statistics suggest that 6 per 1,000 school-aged children have hearing loss.
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Mild hearing loss is only diagnosed after it is suspected because the screening equipment does not screen for mild hearing loss.
What are some characteristics of children with hearing loss or deafness?
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Children with hearing loss may have difficulty with sensing the loudness or intensity of sound (measured in units called decibels, dB), or the frequency or pitch of sound (measured in units called hertz, Hz).
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Hearing loss is generally described as
slight, mild, moderate, severe, orprofound. The severity of hearing loss depends on how well a person can hear the intensities or frequencies most greatly associated with speech. -
Children whose hearing loss is greater than 90 dB are considered deaf for the purposes of educational placement.
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There is increasing awareness that children with mild or unilateral hearing loss have difficulties in certain settings, especially in noisy environments.
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There are 4 types of hearing loss.
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Conductive hearing loss occurs when diseases of the outer or middle ear cause an obstruction of the pathway of sound to reach the inner ear. Middle ear fluid from chronic ear infections can cause this type of hearing loss. Conductive hearing loss can be helped by hearing aids or surgery. -
Sensorineural hearing loss results from damage to the delicate sensory hair cells of the inner ear or surrounding nerves. Children with this type of hearing loss may hear certain frequencies better than others. Sensorineural hearing loss may perceive distorted sounds with hearing aids, making this condition more difficult to treat. -
Mixed hearing loss refers to a combination of conductive and sensorineural hearing loss. These children may have problems with the outer/middle ear and the inner ear. They may do well with hearing aids, but may experience difficulty during a cold or an ear infection. -
Central hearing loss results from damage to the nerves of the central nervous system, either in the pathways to the brain or in the brain itself.
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Who is the treatment team?
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The treatment team for children with hearing loss includes the pediatrician or primary care provider, pediatric otolaryngologists, audiologists, speech therapists, and education specialists.
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Pediatricians and other primary care providers are important in the management of ear infections, which often lead to more impairment for these children.
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A young child with hearing loss is at high risk of having receptive and expressive language difficulties, so
early intervention is necessary. Early intervention is a system of services to support infants and toddlers with disabilities and their families. These therapists can work with caregivers/teachers to incorporate exercises and equipment into the day-to-day lives of the children. -
For children 3 years and older,
special education and related services are available through the public school to provide therapies necessary for school achievement.
What are some elements of a Care Plan for hearing loss and deafness?
The Care Plan for children with hearing loss may include
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Regular speech, language, and auditory training (if chosen by a family)
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Amplification systems such as hearing aids, FM systems, and cochlear implants
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Interpreter services for those children who use sign language
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Preferential seating in class to facilitate lip reading
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Captioned films, videos, and DVDs
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Assistance of a note taker for students with hearing loss so that they may fully attend to instruction
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Alternative communication methods and devices
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Counseling
What adaptations may be needed?
Medications
Children with cochlear implants may be at increased risk of acquiring bacterial meningitis, and these children should refer to their health professional’s specific immunization recommendations related to pneumococcal and
Physical environment
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Most children with hearing loss are born to hearing parents who have had to learn communication strategies with their child. Partner with parents/guardians to learn how to best communicate with a child who has hearing loss.
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Vocabulary, grammar, word order, and figures of speech may be much more difficult for children with hearing impairments. Early and consistent use of visible communication modes (eg, sign language) is important.
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Children with hearing loss use oral communication (eg, speech, lip reading, residual hearing) or manual communication (eg, signs, finger spelling), or a combination of both (known as total communication) to learn.
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Text telephones (known as TTs, TTYs, or TDDs) enable hearing-impaired students to type phone messages over a telephone network known as the Telecommunications Relay Services. Technologic advances such as video relay, text pagers, and visual fire alarms are available. These can be accessed all over the United States by dialing 711, and the relay service is free.
What should be considered an emergency?
Hearing loss does not lead to any specific emergency situation, although some children with hearing loss may have another condition (eg, seizure disorder) where an emergency medical services (EMS)/911 plan is necessary. In this situation, the EMS/911 plan should include measures to enhance communication with the child during an emergency. Children with hearing loss may need special attention in a programmatic emergency such as a fire.
What types of training or policies are advised?
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Sign language—learning some key signs can help with communicating with the child. Other situations call for having a sign language interpreter available.
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In-service from speech therapists or other professionals.
What are some resources?
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National Dissemination Center for Children with Disabilities, 800/695-0285 (voice/TTY),www.nichcy.org
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American Society for Deaf Children, 800/942-2732 (voice/TTY),www.deafchildren.org
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American Speech-Language-Hearing Association, 800/638-8255, 301/296-5650 (TTY),www.asha.org
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Hands & Voices, 303/492-6283,www.handsandvoices.org
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Boys Town National Research Hospital,www.babyhearing.org
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Alexander Graham Bell Association for the Deaf and Hard of Hearing, 202/337-5220, 202/337-5221 (TTY), info@agbell.org,www.agbell.org
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.