Hearing Impairments

Definition
"An impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance but that is not included under the definition of deafness as listed above."-IDEA
Types of Hearing Impairments

  • Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.
  • Sensorineural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves that supply it. These hearing losses can range from mild to profound. They often affect the person’s ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.
  • A mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear.
  • A central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain itself.*
Causes
Hearing impairments can be acquired by exposure to noise, build up of fluid behind the eardrum, ear infections, childhood diseases, and head trauma. Hearing impairments can be congenital due to family history, infections during pregnancy, or complications during pregnancy. 

Incidence
It is estimated that 1 in 1,000 newborns have hearing loss at birth.

Teaching Strategies

Strategies for inclusion 
■ Reduce noise in the environ- 
ment. 
We use hearing to communicate 
and to hear environmental sounds. 
■  Sandy is seven years old. She uses two hearing aids because she has a moderate 
hearing loss. 
■  Tiffany is four years old. She is profoundly deaf and her parents have chosen an 
“auditory-verbal” approach for her language/communication needs. 
■ Andy is three years old. He has normal hearing, but his parents are deaf. His 
mother has just started working, and although he is fluent in American Sign 
Language, this is his first experience with hearing children. 
Even a mild hearing loss may 
interfere with clear communication. 
If a child can’t hear speech clearly 
and consistently, then she will have 
more difficulty participating fully in 
activities with other people. 
For a child with a mild hearing 
loss, you will want to make sure 
that background noise levels and 
loud music do not compete with 
conversation. Carpets, area rugs, 
and soft wall coverings help make a 
child care environment less noisy. 
Sound-absorbent material, such as 
cork board or carpet tiles on the 
walls, will help minimize noise in a 
room. 
Noisy environments also can be 
a problem for children who wear 
hearing aids, especially in under- 
standing conversation. Hearing aids 
help the child hear better, but they 
do not restore perfect hearing. 
Remember that mild hearing 
losses may not interfere with com- 
munication. If hearing loss occurs at 
birth or in early childhood, a child 
will compensate for it. Some con-
versation may be missed, but with a bit of effort, 
such as seating the child near you as you read a 
story, there will be minimal impact. Seating is 
important in circle time so that a child with a mild 
hearing impairment can see everyone. 
■ Face the child when you speak. 
A child with a hearing loss needs to see as well 
as hear what you say to him. You do not need to 
exaggerate lip movements but you must speak 
clearly. Do not position yourself so he faces bright 
light and make sure visual barriers are minimized 
so that “line of sight” communication is possible. 
Furniture and bookcases should be low enough for 
children to see over them. When you show a child 
with a hearing impairment how to do something, 
use more demonstrations and gestures than you 
might with other children, but don’t overdo it. 
■ Use non-verbal cues to communicate. 
One way to get the attention of a child with a 
hearing impairment is to tap or thump on the table 
(if it’s not too distracting for other children). She 
will respond to the vibration. You also can touch 
her on the shoulder or arm to get her attention if she 
is busy playing. Other visual cues include waving 
your arms, stamping your foot, or flashing the 
lights (flip the switch up an down a few times). 
Of course, wild arm-waving is not recom- 
mended (it’s better to show other children effective, 
but not theatrical, ways to do this). Depending on 
the child’s age, the child with a hearing impairment 
can show other children what method works best. 
Children in your program can “role play” interac- 
tions so they learn how to communicate with each 
other. Role-playing in a warm and supportive way 
can do a lot to explain that the child with a hearing 
impairment may need to be tapped on the shoulder 
to get her attention, or see people’s faces as they 
speak. Explain to other children that if she does not 
respond to a verbal cue, it doesn’t mean she’s 
ignoring them.  Children often can work out com- 
munication difficulties by themselves if they are 
given an opportunity to practice with each other at 
first. 
■  Know what to do in an emergency. 
Have a clear and effective signal that will get the 
child’s attention in an emergency. Make sure he 
understands this signal and responds to it. Then 
practice the procedure. The best solution is to add 
flashing lights to an existing alarm system because a 
child with severe hearing impairments may not 
hear a smoke alarm. 
It also is important to establish emergency 
communication procedures for outdoor play areas, 
which can pose a difficult situation for children 
with hearing impairments. Children playing noisily 
out of the immediate reach of an adult may cause a 
child with a hearing impairment to miss the call to 
return to the building. A staff person may need to 
go to the child when outdoor play time is over, or a 
whenever a dangerous situation arises. 
■ Be a good role model. 
Other children see how you behave and will 
copy you. If you develop effective communication 
strategies, other children will, too. If you ignore the 
hearing-impaired child, other children also may do 
the same thing. Watch for signs of isolation, such as 
the child with a hearing impairment playing alone 
rather than with a group, or other children deliber- 
ately turning their backs on that child. If you see 
problems, handle it the same way you would any 
social or interpersonal difficulty. 
■ Know how to care for hearing aids. 
If a child in your care wears hearing aids, you’ll 
want his parents to show you how to care for them. 
An older child may be able to take care of them 
himself. Children sometimes take out their hearing 
aids and “misplace” them, so it is a good idea to 
ask parents how their child deals with hearing aids. 
Other children in your program need information 
about hearing aids, too. Invite a local hearing aid 
vendor or an audiologist to come to your program 
with hearing aids that children can see, touch, and 
listen to. 
Keep in mind that sand and dirt can cause 
problems for children who wear hearing aids. If 
possible, wood chips are a better choice than sand 
for outside play areas. Another option is to have 
the child leave his hearing aids indoors before 
going outside to play. Set up a specific place for 
him to put the device so that it doesn’t get lost (a 
common problem for young children). 
It is your responsibility to follow whatever 
communication strategies a child’s parents have 
decided to follow. There are several schools of 
thought about teaching language to children with 
hearing impairments. If sign language is part of the 
child’s communication strategy, then it is a won- 
derful opportunity for all children to learn some 
signs. Regardless of whether the child uses sign or 
verbal communication strategies, the hours a child 
spends with you can be incorporated into active
language acquisition. Involve yourself and staff by 
having the child’s speech therapist suggest ways to 
make your environment language-rich. *

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