What is Hearing Loss?
A hearing loss can happen when any part of the ear is not working in the usual way. This includes the outer ear, middle ear, inner ear, hearing (acoustic) nerve, and auditory system.
Hearing difficulties exist on a continuum. Children with hearing loss may have mild issues, such as not being able to hear sounds that are so soft that you wouldn’t hear them if you are not paying attention. Or they may be so profound that the child cannot even hear a jack hammer right next to them. Some children are unable to hear sounds of a certain frequency (pitch) while being able to hear other frequencies normally.
Yet, other children may have fluctuating hearing loss. This can have several causes; but the most common of which is middle ear infection. During middle ear infection, fluid is trapped in the ear canal, obstructing the conduction of sound to the ear drums. With infections, the hearing problems usually clear up along with the infection.
Hearing Loss and Language Development
No matter the issues, hearing loss has an implication on language development. This is because children need to hear language in order to learn language. Children who cannot hear sounds of a given loudness will miss out on many learning opportunities. Or they may hear words that sound very different from what they should sound like.
The sounds in our language when plotted on a graph with the loudness on the Y-axis and pitch on the X-axis, resemble a banana. We call this the speech banana. Children who are unable to hear certain frequencies may miss out on sounds of a certain pitch.
For example, children who are unable to hear in the 1000-2000Hz range, may not be able to hear “p”, “h”, “g”, “t”, “ch” and “sh” for example. Imagine hearing this message “Eter as one to ange oes”. The original message is “Peter has gone to change shoes”. Can you now imagine how confusing the world of a child with hearing loss must be if they are hearing only parts of words?
Thankfully, given the advent of technology, hearing loss can now be detected even before a child turns 3 months. As well, the improvement in hearing aides and technology like cochlear implants have given some hearing back to children who may other wise have to live in a quieter world.
Speech Therapy for Hearing Loss
Regardless of whether the child can regain their hearing or not, all children with hearing loss need speech therapy. For children with profound hearing loss, we need to teach them an alternative way to communicate. These children can usually communicate quite well with signs or other assistive technology.
For children with partial hearing loss, we have to help them make the most of their hearing and provide them with sound stimulation and language. This can be done not just with speech therapy, but with environmental modification as well.
Environmental Accommodation for Children with Hearing Loss
For children with mild hearing loss, they may still be able to participate in normal classrooms with the use of hearing aides and environmental modifications.
Reduce Extraneous Noises
Children with hearing loss may not be able to hear sounds that are too soft. Or it may impact on their hearing of certain frequencies. The problem with hearing aides is that it amplifies everything, not just human voices. This reduces the signal to noise ratio, with the speech being the signal and noise being the background sound.
This makes it hard for them to focus on what others are saying as the ambient noises are competing for their attention.
Therefore, reducing background noise can improve the child’s ability to hear what they want to hear. Here are some strategies to use when talking to someone with hearing difficulties:
-Make sure that doors are closed;
-Make sure that windows are closed;
-Make sure that all machines that make noises are off; and
-Make sure that TV, Computers, iPads and Radios are turned off when speaking to the child
Reduce Echoes
Hard surfaces in the classroom can also cause reverberations, which distort the sound quality of the target sound. Therefore we can improve a child’s reception if we can reduce this unwanted echoes. We can do so using the following methods:
-Install curtains on the windows to absorb sounds;
-Make sure that walls are padded. Some good materials to consider are cork board and sound proofing materials;
-Make sure that there are carpets or rugs on the floor.
Change Seating Position of Child
Another thing that we can do is to change the seating position of the child. We can ask the child to sit at the front so that he can hear the teacher. He should also sit away from the walls to minimise the effects of reverberations.
If possible, teachers can also try seating the children in the classroom in a circle facing each other, so they can see each other as they speak. This can likewise be done at home with a round dinner table.
Amplification
The most straight-forward accommodation is to have a hearing aide fitted. It helps to amplify all sounds, without the need for others and the environment to change. However, because of the technology behind it, hearing aides are expensive and seldom covered by insurance. In addition, some children find it embarrassing to wear them.
Sound Field System/Personal FM
Alternatively, we can also amplify the sound signal using technology. There are several such amplification systems. For example with the personal FM, the teacher will wear the microphone and the sound will be transmitted directly to the hearing aid that the child is wearing. One pro is that it is relatively cheap and easy to implement. However, this may interfere with the child’s participation in class as it may make it harder for him to hear what his classmates are saying.
Another system that can be considered is a sound field system. This works similarly to the personal FM except that this time, the sound is broadcast over a speaker. This means that other students will also get to benefit from the sound amplification. In addition, the classroom participation of the child with hearing difficulties will also not be compromised. The downside of this is the cost to implement such a system.
These systems may be harder to implement at home since it means that either all members of the family will need a microphone, or that they will have to pass the microphone back and forth as they speak. This is troublesome and makes the whole interaction very unnatural.
Captions
If you are watching videos, make sure that there are captions so the child can follow along. Some systems can also translate words into readable text, so it can be useful in the classroom and at home.
Communication Accommodation for Children with Hearing Loss
Another strategy that we can employ is to change how others around the child behave by becoming an advocate for the child. We can educate them about how the child’s hearing loss impacts his communication and impart strategies that they can use to enhance their interaction with the child. Here are some useful strategies:
-Talking louder
-Stand closer to the child and on the side with better hearing
-Always face the child you are talking to
-Use facial expressions and gestures to add another layer to your communication. If the child cannot catch what you are saying, your expressions and gestures may help them guess what you are trying to convey
-Provide written information. This provides a visual input for the child in case they didn’t hear it.
-Repeat what others have said. This is particularly important for teachers in the classroom. If another child have answered the question, the teacher should repeat the other child’s answer. This is because the other child may not have spoken loudly enough, or may be seated far away. Repeating the information thus give the child with poor hearing another opportunity to hear the answer again. Parents may also do the same at home so that the child can join in the conversation.
-Check for understanding. Some children, especially the shy ones may not clarify even if they are unsure. Therefore, it is important to check in on them to make sure that they are following along with the conversation.
Conclusion
Helping a child with hearing difficulties with their language is a long-drawn process. But environmental and communication accommodations can have an immediate impact on the child’s communication and is the first step for any intervention. What other strategies have you found to help children with hearing loss participate better in their homes and classrooms?