7. hearing disabilities

Hearing Disabilities
the problem
How it works
Normal Hearing Threshold
How to Measure Hearing
Degrees of Hearing Loss
deafness

1. HEARING DISABILITIES Dr. MOHIBULLAH KHAN MARWAT SUIT Peshawar [email protected] Cell. 03333161616 Cell. 03113161616

2. Hearing Problem is considered to be the most prevalent Congenital Abnormality in newborns and is more than twice as prevalent as other conditions that are screened for at birth ( Finitzo & Crumley , 1999). Hearing Loss  is a common problem that often develops by Repeated Exposure to Loud Noises . According to a careful estimate, there are more than 10 Million (about 1 in 6) people in one or the other degree of  Hearing Problem . State of the Problem

3. To understand how and why Hearing Problem happens, it will be worth mentioning to know How Ear Works. Ear is made up of three different sections: The Outer Ear, The Middle Ear, and The Inner Ear. These parts work together in Hearing and Processing the Sounds. ( Contd ) How Hearing Works

4. The Outer Ear , or Pinna  (the part you can see), picks up Sound Waves and the waves then travel through the outer ear canal. When the Sound Waves hit the Eardrum in the Middle Ear, the Eardrum starts to Vibrate. When the Eardrum vibrates, it moves Three Tiny Bones in the Ear. ( Contd ) How Hearing Works (Continued)

5. These bones are called the  Hammer, Anvil, and  Stirrup . They help sound move along on its journey into the Inner Ear . Stirrup Bone is the Smallest Bone in the body which is located inside the ear. Stirrup Bone is only 0.25 to 0.33 cm long (0.10 to 0.13 in) and Weighs only 1.98 to 4.3 mg. ( Contd ) How Hearing Works (Continued)

6. The Vibration then travels to the  Cochlea , which is filled with Liquid, having Thousands of Tiny Hair on the inner surface. Inside the Ear, there are Two Types of Hair Cells : The Outer Cells and the Inner Cells . The sound vibrations make the Tiny Hair move. The Outer Hair Cells take the Sound information, Amplify it (Make it Louder), and Tune it. ( Contd ) How Hearing Works (Continued)

7. The Inner Hair Cells send the Sound Information to the Hearing Nerve , The Hearing Nerve then sends it to the Brain, allowing the person to Hear. How Hearing Works (Continued)

8. The level at which a normal person can barely hear the tone is his/her  Hearing Threshold level. Sound intensity is measured in  dB HL   (Decibels Hearing Level) , i.e. dB relative to the Quietest Sounds that a Young Healthy Individual ought to be able to hear . What is Normal Hearing Threshold in dB?

9. The Hearing Thresholds ( Measured  in Decibels) are recorded on a chart called an Audiogram . The Tones at different Pitches and Frequencies are measured in "Hertz," which is a special term for Cycles / Second . How to Measure Hearing?

10. Pitch  is the quality that allows us to classify a sound as relatively high or low. Pitch is determined by the frequency of sound wave vibrations. Hertz is a unit of frequency alternating current  Hertz  (abbreviated Hz), 1 Hz is equivalent to 1 Cycle/Second. It is named for  Heinrich Rudolf Hertz , the first person to provide conclusive proof of the existence of Electromagnetic Waves . How to Measure Hearing?

11. Audiologists conduct clinical Audiogram Test Tones between 250 and 8000 Hz are presented at varying levels, To determine a patient's Tone Detection Thresholds (the Quietest Audible Sounds ) in the left and right ear. Thresholds between 10 and 20 dB are considered in the Normal Range What is Audiogram Test 

12. Sound Intensity  is measured in  decibels  (dB HL). The top line, at 0 decibels (dB HL), represents a very soft sound, with each horizontal line below representing successively Louder Sounds. Measurement of the Intensity of Sound

13. Frequency  is measured in  Hertz   (Hz). Just like a Piano's keyboard, the Frequencies are low on the Left Side (125 or 250Hz), and then gradually climb to Higher Frequencies on the Right Side (8000 Hz) .  Note : The Piano ranges actually go from 28 Hz to 4,000 Hz . The most important frequencies for Speech fall into the 250-6000 Hz range . Measurement of the Frequency of Sound

14. Students with Hearing Disabilities face unique challenges during the process of Learning. In our Educational Settings, Common Teaching Learning Process includes Lectures, Audio-Visual Aids (AV Aids) Discussion groups and even One-on-one Conversations . All these are nothing less than a Struggle for those who have any level of Hearing Difficulty . Hearing Disabilities & Education

15. Deafness, Hearing Impairment , Hearing Loss Hard of Hearing Residual Hearing, all refer to Partial or Total inability to Hearing, Processing and Interpreting sounds. Degree of Hearing Loss

16. Deafness Deafness refers to a level of hearing loss severe enough that the individual is limited in his/her hearing ability to process Acoustical Language , whether they are using assistive listening devices or not. Deafness refers to a person who has a profound hearing loss and uses sign language The State of Deafness

17. "Deafened" usually refers to a person who becomes Deaf as an adult and, therefore, faces different challenges than those of a person who became deaf at birth or as a child. In other words, it is an Acquired State of Deafness The State of "Deafened"

18. Hearing Impairment Hearing Impairment denotes a degree of hearing loss wherein the individual can Hear and Understand verbal communication, but only with the help of an Assistive Listening Device or Hearing Aid . Hearing Impairment is a general term used to describe any Deviation from Normal Hearing, whether Permanent or Fluctuating, and ranging from Mild Hearing Loss to Profound Deafness. The State of Hearing Impairment

19. Hard of Hearing  refers to a person with a Hearing Loss who relies on Residual Hearing to communicate through Speaking and Lip-Reading . Many individuals who are deaf or Hard of Hearing prefer the term “Hard of Hearing," because they consider them to be more positive than the term “Hearing Impaired," which shows that something is wrong that makes a person Less than Whole . The State of Hard of Hearing

20. Residual Hearing   refers to the hearing that remains after a person has experienced a Hearing Loss. Basically, Residual Hearing is the ability to hear some sounds even if a hearing loss exists. Most people with Significant Hearing Loss still have some Residual Hearing that can be stimulated by Amplifying sound using a Hearing Aid .  The State of Residual Hearing

21. 1. Conductive Loss Conductive Loss  affects the Sound-Conducting Paths of the Outer and Middle ear . People with Conductive Loss might speak softly, and might experience Ringing in their ears. The degree of loss can be decreased through the use of a Hearing Aid or by Surgery . ( Contd ) Types of Hearing Loss

22. 2. Sensorineural Loss   It affects the Inner Ear and the Auditory Nerve and can range from Mild to Profound Degree . People with Sensorineural Loss might Speak Loudly , experience Difficulty in Distinguishing difference among the words having Similar Sounds , and not hear well in Noisy Environment . ( Contd ) Types of Hearing Loss (Continued)

23. 3. Mixed Hearing Loss . Mixed Hearing Loss  is a combination of a Sensorineural and Conductive Hearing Loss . It results from problems in both the Inner and Outer and/or Middle Ear .  In other words, there may be damage in the Outer or Middle Ear and/or in the  Inner Ear (Cochlea) or auditory nerve. This type of Hearing loss is referred to as a  Mixed Hearing Loss. Types of Hearing Loss (Continued)

24. In a Developing Child, Hearing Loss might reflect in the behaviour which may look like: Misbehaving Not following directions Immature Social Skills (Awkward Activities) Unclear Speech Production (Articulation Issues) Inattention Distractibility ( Contd ) Hearing Loss is Invisible

25. Used to Play Alone at an age when other children actively Play Together Limited Vocabulary Lack of Understanding of Idioms, Figurative Language , Humour Lack of Readiness to Read Behaviour of Passivity (Never speaks up or takes a Leadership Role with peers) Hearing Loss is Invisible (Continued)

26. Hearing Loss at Birth ( Congenital Hearing Loss) Hearing Loss After Birth ( Acquired Hearing Loss) Ear Infections ( Otitis Media ; Inflammation of the Middle Ear characterized by the accumulation of infected fluid in the middle ear, pain in the ear.) Noise Medications Common Causes of Hearing Loss

27. Hearing Loss from Birth Most congenital hearing loss can be identified within 1-2 days of birth via hospital hearing screening. In the US, almost all babies have their hearing screened within a day of being born.  Approximately 1 0ut of 10 newborns who fail hearing screening end up being diagnosed with hearing loss . Newborns who spend time in a neonatal intensive care unit (NICU) have a greater chance of being identified with a hearing loss than those children with no birth complications.

28. Ear infections or Fluid behind the Eardrum is the biggest cause of hearing loss in young children. During Preschool Hearing Screening , it is important to identify the children who have a history of Ear Infections, Hearing Loss in the family or Whose family members have been concerned about the Child’s Hearing . Identifying Hearing Loss in Early Childhood

29. While Hearing Loss Type is important the affect on a patient’s life is often determined by the Degree of Hearing Loss. In past, Audiologists used to define Hearing Loss through a Percentage i.e. 20% loss, 50% loss etc. However, as Hearing Losses are not Flat and the degree of loss may vary at different pitches. It has become widely accepted practice to describe the hearing loss based on a Classification System. ( Contd ) Degree of Hearing Loss

30. Mild Hearing Loss : Speech may be heard in Quiet, but becomes difficult to understand when there is Background Noise in the environment or when Speech is at a Distance . Moderate Hearing Loss: Speech can be heard at a normal level only in Quiet and in Very close Proximity . ( Contd ) Degree of Hearing Loss (Continued)

31. Moderately- Severe Hearing Loss: Even in a quiet environment speech must be loud in order to be heard, understanding may be impaired even with this louder signal. Severe Hearing Loss: Speech is very difficult to understand in all situations. Profound Hearing Loss: Communication can be very difficulty even with hearing aids. Degree of Hearing Loss (Continued)

32. The prevalence of Early-onset Hearing Loss in most Developed Countries is estimated to range between 2-4 infants with Moderate-Severe Hearing Loss in every 1000 births. In contrast, only Limited Information is available about Developing Regions, including the Middle East especially in the Arab countries, where the prevalence is estimated to be markedly higher ( Attias  et al., 2006). ( Contd ) Prevalence of Hearing Loss

33. In Developing Countries, More than 10 infants in every 1000 Births are estimated to be affected by a Severe Profound Hearing Loss . Of the 62 Million Deaf children younger than 15 Years old Worldwide , Two-Third are in the Developing Countries (Smith, 2003 ). Prevalence of Hearing Loss (Continued)

34. The negative impact of Hearing Loss on Older Adults is significant ( LaForge  et al., 1992). Hearing Loss is associated with Depression, Social Isolation, Poor Self-esteem, and Functional Disability ( Mulrow  et al., 1990a), The Impact of Hearing Loss

35. It is well recognized that Hearing is critical to Speech, Language Development , Communication, and Learning . The Earlier Hearing Loss occurs in a child's life, the More Serious Effects on the Child's Development . Similarly, the Earlier the problem is Identified and intervention begun , the Less Serious is the Ultimate Impact on Child Development . Effects of Hearing Loss on Development

36. There are Three main aspects in which Hearing Loss affects children: 1. It causes Delay in the development of Receptive and Expressive Communication skills ( Speech and Language ) . 2. The language deficit causes Learning Problems that result in Reduced Academic Achievement . 3. Communication difficulties often lead to Social Isolation and Poor Self-concept . Hearing Problems and Children

37. 1. Vocabulary Vocabulary develops More Slowly in children confronted with Hearing Loss . Children with Hearing Loss learn Concrete Words like  cat,   jump,   five , and  red   more easily than abstract words like  before ,  after ,  equal to , and  jealous . They also have difficulty with function words like the , an, are , and  a . ( Contd ) Hearing Impacts upon Specific Aspects

38. (Vocabulary Contd ) Children with Hearing Loss have difficulty in understanding Words with Multiple Meanings . For example, the word  “ Bank”  can mean the Edge of a river or stream OR a place where We Take and Put Money . ( Contd ) Hearing Impacts upon Specific Aspects

39. 2. Sentence Structure Children with Hearing Loss normally produce Shorter and Simpler Sentences than children with Normal Hearing . Children with Hearing Loss often have Difficulty in Understanding and Writing Complex Sentences , such as " The teacher whom I have engaged for math was sick today. ” or passive voice " The ball was thrown into the water by Ahmad. " ( Contd ) Hearing Impacts upon Specific Aspects

40. (Sentence Structure Continued ) Children with Hearing Loss often cannot Hear word endings such as  s   or  ed . This leads to Misunderstandings and Misuse of Tense , Pluralization , Nonagreement of Subject and Verb . ( Contd ) Hearing Impacts upon Specific Aspects

41. 3. SPEAKING Children with hearing loss often cannot hear quiet speech sounds such as "s," " sh ," "f," "t," and "k" and therefore they do not include them in their speech . Thus, their speech is always Difficult to Understand. ( Contd ) Hearing Impacts upon Specific Aspects

42. (SPEAKING Continued) Children with Hearing Loss may not Hear Their Own Voices when they speak. They may Speak Too Loudly . They may have a Speaking Pitch Too High . Hearing Impacts upon Specific Aspects

43. 4. Academic Achievement Children with Hearing Loss have difficulty with all areas of Academic Achievement , especially Reading and Mathematical Concepts . Children with Mild to Moderate Hearing Losses , on average, Achieve Grade Levels Lower than their Peers with Normal Hearing , unless appropriate management is followed. ( Contd ) Hearing Impacts upon Specific Aspects

44. (Academic Achievement Continued) The gap in Academic Achievement between children with Normal Hearing and those with Hearing Loss usually Widens with the Passage of Time as they progress through school. The level of Achievement is related to Parental Involvement and the Quantity , Quality , and Timing of the Support Services provided to the children. ( Contd ) Hearing Impacts upon Specific Aspects

45. 5. Social Functioning Children with Severe to Profound Hearing Loss often report Feeling Isolated, Without Friends, and Unhappy in School , particularly when their Interaction with other children with Hearing Loss is Limited . These social problems appear are frequent in children with a Mild or Moderate Hearing Loss than in those with Severe to Profound Loss . Hearing Impacts upon Specific Aspects

46. Tinnitus refers to “Ringing in the Ears" when no other sound is present. Tinnitus can sound like Hissing, Roaring , Pulsing, Chirping, Whistling, or Clicking. Tinnitus can occur in one Ear or Both Ears . What is “Tinnitus”

47. Yes. Almost Everyone at one time or another has experienced Brief Periods of Mild Ringing or other sounds in the ear. Some people have more Annoying and Constant Type of Tinnitus . One Third of all adults Experience Tinnitus at some time in their lives. ( Contd ) Is Tinnitus a Common Problem?

48. About 10%–15% of adults have Prolonged Tinnitus requiring Medical examination . The Exact Cause of Tinnitus is often Not Known . One thing is Certain; Tinnitus is Not Imaginary . ( Contd ) Is Tinnitus a Common Problem?

49. No. Just as Fever or Headache accompanies many different Illnesses , Tinnitus is a Symptom, Common to Many Problems . If you have Tinnitus , chances are the Cause will Remain a Mystery . Is Tinnitus a Disease?

50. Conditions that might cause Tinnitus include: Hearing Loss Loud Noise exposure Migraine Headaches Head Injury Medicines that are Toxic to hearing Anemia (D eficiency of the RBCs or Hemoglobin in the blood, resulting in P aleness and W eariness ). ( Contd ) What Causes Tinnitus?

51. Hypertension Stress Too much Wax in the Ear Certain Types of Tumors Too Much Use of Coffee Chain Smoking What Causes Tinnitus?

52. During the day, the daily activities and the sounds around you make your Tinnitus Less Noticeable . When your Surroundings are Quiet , your Tinnitus can seem Louder and More Bothersome . Fatigue and Stress may also make your Tinnitus Worse . Why is Tinnitus Worse at Night?

53. Tinnitus is a Symptom of a Problem. The first thing is to find out its Underlying Cause . Medical Examination with special attention given to Conditions Associated with Tinnitus. Full Hearing Evaluation by an Audiologist is always right step to see if Hearing Loss may be Causing Tinnitus . How is the Cause of Tinnitus Diagnosed?

54. The most E ffective Treatment for Tinnitus is to eliminate the Underlying C ause . Tinnitus, in some cases, can be a Symptom of a treatable M edical Condition . However , in many cases, the cause of tinnitus cannot be identified , or Medical or Surgical T reatment is not an option. In these cases, the Tinnitus can still be managed using a variety of other methods . ( Contd ) How is Tinnitus Treated?

55. Physical Examination :   Physical Examination will focus on the Head and Neck , and especially the Ears , including the Auditory C anals . A careful Neurologic E xamination of the short Nerves that lead directly from the Brain to the Face , Head and N eck is needed . Weakness or Numbness in the Face , Mouth , and Neck may be associated with a Tumor or other Structural Abnormality Pressing on a Nerve . How is Tinnitus Treated?

56. THANKS to All