HEARING IMPAIRMENT/ DISABILITY

HEARING IMPAIRMENT/ DISABILITY
Definition:
Pasonella and Care (1981) defined Hearing Impairment as a generic term indicating a continuum of hearing loss from mild to profound, which includes the sub-classification of the Hard-of-hearing and Deaf.
A: Hard-of-hearing
A term describe persons with enough residual hearing, to use hearing (usually with hearing aid) as a primary modality for acquisition of language and in communication with others.
 Hearing loss between 21 and 69 Db (decibels)
B: Deaf:
A term used to describe persons whose sense of hearing is non-functional for ordinary use in communication, with or without a hearing aid.
 hearing loss above 70 dB
 They often uses Sign Languages

The Different Categorization of deafness:-
Congenitally deaf (Born deaf) or Adventurously deaf (deafness acquired some times after birth)
Otherwise it can be classified as:
1. Pre-lingual deafness (present at birth/ before speech is developed)
2. Post-lingual deafness (occurring after the development of speech)

In Ethiopia, no documents which helps understand both (Hard-of-hearing and Deaf) terms.
 it can be “idiots” – who can’t be educated to do not, not at all understand.
 In Amharic term “donkoro”
Meaning in Amharic dictionary:-
An individual whose hearing organ doest not at all function; mentally handicapped; and who lacked the ability to understand any language (Kesate Berhan, 1951)

Types of Hearing Impairment
They are three types:
1. Conductive
2. Sensory-neural
3. Mixed hearing loss

1. Conductive Hearing Loss:
It reduced the intensity of sound reaching the inner ear, where the auditory nerve begins.
 sound waves passing through external canal of the outer ear to the eardrum (the bone like structures) pass through inner ear.
 It is any condition hindering the sequence of vibrations or preventing from reaching the auditory nerve may cause conduction loss (Bamford & Sounders, 1994, Gallahger, 1983)

2. Sensory-neural Impairment:
This involves damage to the fine structures in the inner ear or auditory nerve transmitting the impulse to the brain.
 there is also central auditory disorder which results form damage to the central nervous system (CNS).
 This loss results in problem with auditory comprehension and discrimination.

3. Mixed Hearing Loss:
It is occurrence of both conductive hearing loss and sensory-neural impairment.
 for conductive hearing loss, can reduced by medical care with help of amplification of sound.
 But not possible with sensory-neural impairment.
Causes of Hearing Impairment:
It is in terms of:
 Birth period:- prenatal, perinatal and postnatal (Taylor, 1992)
 Genetic & environmental factors
 Chromosomal abnormalities, diseases, toxins etc. (Mittler, 1970)
 Ear structure:- Outer, Middle and Inner (Gardwood, 1983)
Other Causes:
-Hereditary – pregnancy – Rh incompatibility – Prematurity – Trauma – High fever – Infection – Measles

Identification, assessment and Intervention:
1. Identification: The primary identification is usually done by parents, teachers and doctors.
The following sign and symptoms are present to determine Hearing Impairment (Tirussew, 1998)
- Inattention, restlessness and distraction
- Complaints of ear ache, or visible discharge from ear
- Giving inappropriate answers to questions; watching and following what other children do.
- Needing to sit near a sound and asking for more volume, on TV, tape or record player to be turn-up.
- Some irritability or typical aggressive outbursts; behaviour upsets in school.
- Failure to turn immediately when called by name unless other visible signals are given.
- Speech limited and use of gestures and nail-biting
- Best work in small group

Heward and Orlansky (1988) offered following auditory behaviours as guides in the early detection of Hearing Impairment:
1 Month:
- will jump in response to loud noises
- will begin to make gurgling sound
3 Months:
- will aware of voices
- may quite down to familiar voices
- awakens from sleep when there is a loud sound
6 Months:
- make vocal sound when alone
- turn head towards sound or when name is called
- vocalize when spoken to directly
9 Months:
- responses differently to a cheerful versus angry voices
- tries to copy the speech sounds of others
- turn head towards sound or when name is called
12 Months:
- can locate a sound sources by turning head (whether the sound is at the side, above or below ear level)
- recognizes own name
- uses single words correctly
- laughs spontaneously
- attempts imitation of sounds and words
- responses to music or singing
24 Months:
- has more than 50 words in vocabulary
- uses two words together
- playing with sound-making objects
- shows understanding of many phrases uses in a daily life.
2. Assessment:
1. Audiological (hearing) assessment:
- careful observation of main sign and symptoms of Hearing Loss
- study the consequences and causes of hearing loss with the help of parents
- Distraction test, introduces a sound source behind and to either side of the child. In response, the child may turning the head (Freeland, 1989).
- Co-operation testing, where test is done as a game
- Tuning fork assessment; (for sound amplitude)
- Audiometric Assessment
2. Communication assessment
3. Assessment of speech and language development
4. Psycho-educational assessment
5. Personality assessment
6. Ecological Assessment :- Micro system – Exo System – Meso System – Macro System

3. Intervention:
It involves doctors specialized in children’s ear, teachers of the deaf, speech therapist, psychologist, audiologist, and parent (Freeland, 1989)

The Family:
The communication with a deaf child, the parents should observe the following points:
1. Develop positive attitude toward their children
2. Speak as clearly as they can and realize an exaggeration of the mouth is not required. – They will develop tip-reading skill.
3. Consider the gestures and try to use them with hearing impairment
4. Try to have hearing aids for the hard-of-hearing.
5. Communicate in home sign language and talk to the deaf children as much as possible.
6. To give opportunity for deaf child to communicate in sign, pointing gestures and noises.
7. The family should develop different strategies

The School:
- Teaching small groups
- Enhance positive self concept
- Develop IEP (Individual Educational Program)
- Deal crisis calmly and effectively
- Reduces distance between teacher and student
- Speak slowly
- Reduce background noises
- use face-to-face contacts
- during class uses visual clues
- encourage independent activities, cooperative learning and social skills.
- Listening to what the child has to say and allowing time for reply.