Only
about 1 child in 1000 is born with impaired hearing,
but many others lose hearing as the result of congenital factors or
disease. Conductive hearing loss
from ear disease and allergy is common in young children.Only
about 1 child in 1000 is born with impaired hearing,
but many others lose hearing as the result of congenital factors or
disease. Conductive hearing loss
from ear disease and allergy is common in young children.
Hearing
loss in older adults is very prevalent. More
than 40% of people over the age of 65 experience a hearing loss sufficient to
interfere with daily conversation, and an even greater proportion of nursing
home residents are hearing impaired. Many older people hear speech without
clarity. Acquired
hearing loss can result in social isolation, loneliness, and/or
depression. Friends and relatives can be trained to avoid or overcome communication difficulties that result from an older
person’s hearing loss.
There are two main features of sensorineural hearing loss: (1) a loss of sensitivity (an inability to hear weak sounds); and (2) a loss of clarity (an inability to hear small differences between sounds). Most people with sensorineural hearing loss also experience a greater loss in the high frequencies, rapid loudness growth just above threshold, and interference from background noise.
A doctor can
easily remove earwax in the outer ear. Antibiotics
and decongestants are effective treatments for middle ear disease.
A surgeon can insert a grommet in the eardrum to promote drainage and
evaporation of fluid. Surgery has been
successful in cases of anatomical abnormality or where the middle ear bones have
become immobile as the result of otosclerosis.
Hearing aids
are small self-contained amplification systems worn behind the ear,
in the outer ear, or in the ear canal. Sound is detected by a small microphone, amplified, and
delivered via an earmould to the eardrum. Analog
or digital circuitry insures that sound is amplified to
listening levels that are matched to the person’s needs and comfort.
Most people with moderate-to-severe hearing loss experience communicative
benefits.
Cochlear
implants are special devices designed to restore hearing sensation and
perception to a person with an extreme hearing loss. Sound is detected by a head-worn microphone, encoded by a
small digital signal processor, and presented directly to the person’s inner
ear via an array of surgically implanted electrodes.
For people with extreme hearing loss, the ability to perceive speech may
be greatly improved.
These
are special amplification systems used to enhance communication over the
telephone, in noisy places, or at great distances. A
microphone is placed at an optimal location, often connected to a small FM
transmitter.
The person with impaired hearing listens through personal hearing aids or
headphones.
In most cases, the the negative effects of background noise are reduced, and the received
quality of speech is improved.
Most
people with impaired hearing watch the speaker’s mouth and face
for visible cues as they listen through their hearing aids, implants, or
assistive devices. Lipreading helps
a person obtain speech information that is not heard clearly (e.g., place of
articulation of consonants), increases a person’s ability to participate in
conversation, and reduces communicative effort.
Educators use
a variety of methods to accelerate speech and language learning by children with
impaired hearing: parent training during the pre-school years, auditory-verbal
techniques to develop listening skills, a quiet/non-reverberant environment to
optimise benefit from hearing aids/cochlear implants, good classroom
illumination, instruction in small groups, and one-to-one tutoring.
Adults with
acquired hearing loss often use behavioural strategies to improve their ability
to participate in conversation and to reduce stress that they may experience
during daily interaction. These include control of the surrounding environment to reduce
auditory and visual distractions, management of conversation, self-help through assertiveness, and
use of timely requests for
clarification.
Parents, teachers, family, and friends play an important supportive
role. A child or adult with impaired hearing will acquire/maintain
spoken language more easily if communication
partners produce speech that is consistently audible, visible, and clear.
Partners can develop empathy, increase their speech and language clarity, and
learn essential communication strategies as the result of training with the
HELOS hearing loss simulator.
Parents
and teachers are the young child's main communication partners.
Most educators recommend that parents and teachers play major roles in
the language-development process.
Spouses, friends, family, and carers are the older adult’s
main communication partners. Most
therapists and counsellors recommend that these people actively help to maintain communication.
How easily a child or adult learns to/continues to communicate through speech depends on: (1) what their communication partners say (e.g., short/simple sentences, familiar topics); and (2) how they say it (e.g., clear speech, turn-taking, appropriate responses).
Communication
involves the transfer of ideas
between people. Not all messages, however, are perfectly received.
Intelligibility is the
proportion of a message that the receiver can identify correctly.
Speech intelligibility depends on a speaker's voice pitch and level, syllable rate, lip/tongue positions, facial movements, and other factors. Most speakers listen to themselves (but cannot watch themselves) as they talk, and rely on this feedback to decide whether they have spoken clearly. They may pause, speak louder, or exaggerate to compensate - if they feel that lack of clarity has interfered with communication.
Speech
intelligibility depends
on what a speaker says.
Speech intelligibility depends on who is looking and listening. A listener with impaired hearing may perceive some of the message incorrectly - or not at all. What is received may be very different from what was spoken.
Nearly
all people with normal hearing speak with sufficient clarity to converse with
other people who have normal hearing. Experience
suggests, however, that many people do not speak clearly enough to be heard
easily by someone with a serious hearing loss, or to be understood easily by
someone who lipreads.
Parents, teachers, family, and carers may develop clear speech and language over many years. They acquire their skills slowly because:
a speaker cannot hear
his/her own speech as someone with impaired hearing does, and thus
cannot judge the way it sounds
a speaker cannot see
his/her own mouth while talking, and thus cannot judge the way it looks
the child or
adult with hearing loss may not provide
feedback regarding the speaker’s audibility, visibility, or language clarity
Clinicians generally recognize that training partners in conversational skills is vital to the early language development of children and the social rehabilitation of older people with hearing loss. Communication with a child or adult who has a serious hearing loss often requires special knowledge, skill, and patience. As the result of training, communication partners can increase their speech and language clarity.
Most courses in special education or rehabilitative audiology teach their students how to communicate with hearing-impaired children and adults. Some hospitals and community health centres offer similar training to parents, family, and carers.
InformationTraining usually includes a review of important principles (see below). A list of strategies like this usually is combined with other training procedures, because an awareness of basic principles alone does not necessarily lead to their use.
provide amplification
insure face visibility
speak at a short distance
avoid environmental distractions
indicate (changes of) topic
relate messages to the situation
speak slowly and carefully
use common words in short, simple sentences
pause between important thought units
apply appropriate repair strategies
check comprehension frequently
InstructionAn experienced teacher or therapist can provide insightful advice about a communication partner's voice and articulation. The instructor analyzes the speaker’s spoken language and suggests how to increase clarity. Similarly, communication training for parents, teachers, and students may include guidance from an observer and coach.
ObservationA partner can learn clear speech
and language strategies: (1) by observing
Most
university students obtain supervised classroom or clinical experience before
independent teaching or therapy. An
experienced teacher may show parents how to communicate with their own
child. Parents, family members, and students all can develop their speech
and language skills by communicating with another person who listens through the HELOS
hearing-loss simulator.
Most
communication partners want to understand the effects of hearing loss.
One
way to provide that understanding is to simulate hearing loss, that is,
to reproduce the sound qualities that a person hears through impaired ears.
There are many reasons to simulate hearing loss:
to illustrate the effects of hearing loss on learning and social interaction
to develop empathy in communication partners
to help communication partners produce clear speech and language
to guide the development of educational and rehabilitative procedures
to help researchers design hearing aids and other listening devices
The HELOS hearing loss simulator changes the quality of sound so that a person with normal hearing can hear speech as a child or adult with a hearing loss would hear it. Parents, family members, and students can develop their speech and language skills by communicating with another person who listens through HELOS. Educators and rehabilitation specialists have used this system for many years to teach university students, counsel families, conduct research, and inform the public about impaired hearing (Erber, 1996, 2002, 2008).