Minimal Hearing loss (16-25 dB)
This category of hearing loss is specific to children. In adults, normal limits of hearing sensitivity range from 25 dB and less (i.e., 25 dB to 0 dB or below 0dB). In children however, it is very important that an audiologist consider a minimal hearing loss to be a true loss as this degree of hearing loss can have an impact on the child.
Potential effects of hearing loss on the understanding of language and speech:
- A loss of 20 dB is comparable to someone listening with their index finger placed in the ear canal.
- The child with a minimal hearing loss may have difficulty hearing faint or distant speech, such as a classmate on the opposite side of the room answering a question or reading aloud.
- A loss of 20 dB or more in the child's better ear (if the hearing loss is not symmetrical) can result in parts of speech being absent, inconsistent, or distorted, both in production of these sounds by the child and when the child is listening to someone else speak.
- About 25% of the speech signal will be missed in a quiet environment, but even more will be missed in the presence of background noise, such as in classrooms.
- The child may be unaware of subtle conversational cues which may cause others to view the child as awkward or inappropriate.
- The child may miss parts of of fast-paced interactions with peers which may impact their socialization and/or self-concept.
- They may act immaturely for their age.
- The may appear to be more fatigued at the end of the school day due to the extra effort put forth to understand speech in class.
- The student may benefit from improved acoustic treatment of the classroom, such as the addition of carpeting and other absorbent material to reduce acoustic reverberation; and the addition of sound-field classroom amplification. This may also provide benefit to students with normal hearing.
- The student with minimal hearing loss should certainly have favorable, or preferential seating in the classroom. This could be at the front of the class if the teacher does not move around the classroom extensively, however, this is not always the case. Anywhere in the classroom that the student will receive the most benefit can be considered preferential.
- In children with minimal hearing loss, especially those who have a history of ear infections and other middle ear problems, special attention to development of vocabulary or speech through individual speech therapy may be warranted.
- If the hearing loss is conductive and due to some sort of middle ear problems, such as a middle ear infection (otitis media), appropriate medical management is warranted.
- The student may receive some benefit from a low-power hearing aid or from a personal FM-system. These two devices can help to increase the speech signal the child is missing, without enhancing the background noise present.
- Finally, some kind of in-service training on the impact of "minimal" hearing loss on language development and listening in noise is certainly recommended for teachers who have children with a minimal hearing loss in their classes.
This category, and all others discussed from here on, is the same for children and adult patients alike. As such, the information presented is specific to children, and similar information applies to adults, with some obvious differences.
Possible effects of hearing loss on the understanding of speech and language:
- With this degree of hearing loss the child can hear conversations, however, they may miss fragments of the conversation which may lead to confusion and misunderstandings.
- The degree of difficulty experienced by the child in school will be dependent upon multiple variables including noise levels in the classroom, the distance of the child from the teacher, and the configuration, or shape, of the hearing loss.
- With a 30 dB hearing loss, the child may miss between 25% and 40% of the speech signal. A hearing loss between 35-40 dB can result in missing 50% or more of the speech signal when voices are faint or the speaker is not in direct line of sight.
- When a high frequency loss is present, brief or under-emphasized words and/or consonants will likely be missed.
- Barriers are built up with a negative impact on the child's self-esteem as they are accused of "hearing when they want to", also referred to as selective hearing, or "daydreaming and not paying attention".
- Due to the difficulties experienced in class, the child may believe s/he is less capable of performing well.
- The child begins to lose the ability for selective hearing and has increasing difficulty ignoring, or suppressing, background noise which causes the learning environment to be more stressful.
- With even greater effort needed to listen and focus on what is being said, the child is greatly fatigued by the end of the day.
- Due to the background noise found in most classrooms, the student will benefit from the use of hearing aids and personal FM systems or sound-field classroom amplification.
- Adjustments in classroom acoustics can be made to make a less reverberant, more conducive learning environment. Also, favorable classroom seating and lighting for visual cues will be necessary.
- A referral to special education for a speech/language/educational evaluation may be necessary to determine if placement in a mainstream classroom is appropriate.
- The student may need additional attention to language development, auditory skills, articulation, speechreading and/or support in reading and self-esteem.
- An in-service training for teachers and educators on the impact of mild hearing loss on students performance is warranted.
Possible effects of hearing loss on the understanding of language and speech:
- Even with use of hearing aids, the child can hear, but typically will miss fragments of what is said.
- Without the use of amplification, the child can understand conversational speech at a distance of 3-5 feet only if the sentence structure and vocabulary are controlled.
- When the hearing loss is 41 dB and greater, the child can miss 50+% of the speech signal, and if the hearing loss is 50 dB or greater they can miss 80+% of the speech signal.
- The child is likely to have delayed or disordered syntax, limited vocabulary, imperfect speech production, and a flat or monotone voice quality.
- Consistent use of amplification and language intervention from early on can increase the probability that the child's speech, language, and learning will develop in a more natural progression.
- It is usually necessary to to use a personal FM system to overcome the background noise present in the classroom.
- These are the same as for a mild hearing loss, with one exception: with this degree of hearing loss, communication can be significantly affected and socialization with peers can be difficult, especially in very noise environments such as lunch or recess.
- Consistent use of amplification, both hearing aids and FM systems is essential to overcome background noise.
- Favorable classroom seating, lighting, and acoustics.
- Program supervision by a hearing impairment specialist is essential for coordination of educational services.
- Special academic support may be necessary, especially for students in elementary grades.
- Attentional to growth of oral communication, reading, written language skills, auditory skills development, speech therapy, and self-esteem improvement are services likely to be needed.
- Teacher in-service training on the hearing loss and attention to peer acceptance.
Possible effects of hearing loss on the understanding of language and speech:
- With the use of hearing aids, the child can usually hear people talking around him or her, but will miss fragments of what is said which can result in difficulty communicating in situations which require verbal communication such as one-on-one and group conversations.
- Without the use of hearing aids, in order for the child to understand any conversation, it must be very loud.
- With a 55 dB hearing loss, a child can miss up to 100% of the speech information without the aid of working amplification.
- A child with this degree of hearing loss will have delayed spoken language, syntax, reduced speech intelligibility, and a flat or monotone voice.
- Typically with this degree of hearing loss, communication is significantly affected and socialization with peers is difficult, especially in noisy environments.
- The child will have a tendency for a poorer self-concept and social immaturity will contribute to a sense of rejection.
- It is helpful to have someone speak to the child's peers about the hearing loss and what they can do to help the child fit in more and feel more welcome.
- Full time, consistent use of amplification in the form of both hearing aids and possible FM systems is absolutely essential.
- Use of sign language becomes increasingly helpful for access to instructions as they become more linguistically complex.
- The child may require intense support for language skills, speech, aural rehabilitation, reading, and writing.
- Note-taking, captioned films, and visual aids are necessary accommodations.
Possible effects of hearing loss on the understanding of language and speech:
- Without amplification, the child may hear loud noise that are at a distance of roughly one foot from the ear.
- With amplification, the child with hearing sensitivity of 90 dB or better should be able to detect the sounds of speech presented from a close distance or through the use of an FM system.
- Individual ability and early intensive intervention will determine the degree that sounds being detected by the child will be discriminated and processed into meaningful input.
- The child will be reliant on their sense of sight to complement hearing to achieve functional access to communication.
- The use of a visual communication system is often recommended.
- It is essential that the mode of communication the child uses is also used by the family when communicating with them.
- Communication is significantly affected by this hearing loss.
- Socialization with hearing peers is often very difficult.
- The child may feel more comfortable interacting with other deaf or hard-of-hearing peers due to the ease of communication between them.
- Relationships with peers and adults who have hearing loss can lead to positive contributions toward the development of a healthy self-concept and a sense of cultural identity.
- A child with this degree of hearing loss in a mainstream classroom may have greater dependence on adults due to the difficulties experienced with comprehension of spoken communication.
- It should be stated that there is no single communication system that is right for all hard-of-hearing or deaf children and their families.
- No matter what system is being used (visual communication or auditory/oral), early and extensive language intervention. full time consistent amplification use, and constant integration of the communication practices will dramatically increase the chances that the child will have success at learning.
- Self-contained educational placement with other deaf and hard-of-hearing students may be a less restrictive option due to access to free-flowing communication.
- Specialized supervision, support services, and continual appraisal of communication is necessary.
- Depending on the configuration of the hearing loss, a hearing aid with frequency transposition technology or a cochlear implant may be very possible options.
Possible effects of hearing loss on the understanding of language and speech:
- The detection of speech sounds will be dependent on the configuration of the hearing loss and on optimal use of amplification.
- The child may be more aware of vibrations than tonal patterns in speech.
- The degree and configuration of the hearing loss, use and appropriateness of amplification, quality of early intervention and individual ability are all contributing factors which influence the degree to which the child can detect, discriminate, process, an understand the sounds of spoken language.
- Most children who are profoundly deaf are unable to use hearing alone for communication and learning, and the use of visual communication system and languages is common.
- Parents and families who are fluent in the communication mode of the child are essential to the development of acceptance, self-esteem, and optimal communication development for the child.
- The child is often more comfortable communicating with other deaf or hear-of-hearing peers because of the ease of communication.
- Being a member of a signing club or being part of classes that utilize sign language are beneficial to the child and their hearing peers.
- These are similar to those of the child with severe hearing loss.
- If a cultural Deaf emphasis is utilized at home and within the family, then exposure to other Deaf individuals who utilized American Sign Language is vital for self- and social-identity development.
- In-service training on profound hearing loss and the effects of the loss on the student is essential for mainstream educators.
- School for the Deaf is a social and educational program consideration.
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