This chapter discusses individuals with hearing impairments. Definitions and concepts relating to hearing impairment are reviewed as are classifications of hearing impairments. The chapter presents a discussion of how hearing impairments are measured and assessed. Likewise assessments typically used to assess other areas of educational relevance with students with hearing impairments are discussed. Differences in pre- and post-lingual hearing impairments are summarized and a brief history of the education of students with hearing impairments is given. Prevalence and etiologies of hearing impairments are presented along with implications. Characteristics of individuals with hearing impairments are described in terms of intelligence, speech and language abilities, social development, and educational achievement. Educational considerations presented include placement decisions and instructional interventions such as methods of communication and the use of audiologists and interpreters. Services for individuals with hearing impairments of different ages (young children, those transitioning from school to adulthood, and adults) are described. The chapter concludes with discussions of family and diversity issues; the use of technology with this population; and trends, interests, and controversies involved in dealing with individuals with hearing impairments. 

Learning Objectives:

• Define hearing impairment, deaf, and hard of hearing.
• Distinguish between conductive and sensorineural hearing loss.
• Explain the various assessment procedures used to measure hearing loss.
• Describe the difference between prelingual and postlingual hearing impairments.
• Outline the historical evolution of educational services for children and youth with hearing impairments.
• List possible causes of hearing loss.
• Identify representative academic, social, and language characteristics of individuals with hearing impairments. 
• Distinguish among oral, manual, and total communication approaches for instructing students with hearing impairments.
• Describe the concept of the Deaf culture.
• Summarize educational services for persons with hearing impairments across the life span.
• Explain how technology benefits individuals with hearing impairments.

Lecture Outline:

1. Definitions and Concepts in the Field of Hearing Impairment
   
   1. Hearing impairment: disordered hearing
   2. Hearing sensitivity loss: described in range from mild to profound
   3. Deaf/deafness: nonfunctional hearing; federal definition refers to the educational impact due to the hearing loss
   4. Hard of hearing: residual hearing ability
   5. Minimal hearing loss: difficultly hearing at a distance or with background noise
   6. The term impairment may be offensive to some because it implies a deficiency. The Deaf culture (with a capital D) asserts that deafness is not disabling, rather it is the social and cultural factors surrounding deafness that are disabling.
   7. Any hearing loss may cause difficulties with speech and language functioning.
2. Anatomy of the Ear
   
   1. Outer ear: The outer ear functions to protect the middle ear, direct sound into the ear canal, and enhance sound localization. In addition, the outer ear serves to enhance the intensity of sounds in the mid-frequency range where the sound spectrum of speech is located.
   2. Middle ear: Sound waves travel to the inner ear and cause vibrations that are converted in energy.
   3. Inner ear: This energy is transformed into electrical nerve impulses that are sent to the brain for decoding.
   4. Central auditory nervous system: transmits energy to the brain for interpretation.
3. Classifications of Hearing Loss
   
   1. Conductive hearing loss: Sound transmission is blocked in the middle or outer ear
   2. Sensorineural hearing loss: Involves the inner ear (cochlea) and/or the auditory nerve
   3. Mixed hearing loss: Combination of conductive and sensorineural loss
   4. Central hearing loss: Dysfunction in the central nervous system
4. Measurement of Hearing Impairments
   
   1. Audiologist- professional who evaluates hearing loss; speech-language pathologists also often assess hearing loss within schools
   2. Audiometry/Audiogram- evaluation conducted to determine hearing loss. Includes:
      
      1. pure-tone- determines hearing threshold (two types):
         1. air-conduction- thresholds in inner, middle, outer ear
         2. bone-conduction- inner ear vibrations
      2. speech recognition- assessed under multiple conditions
      3. play observation- assesses response to sound in young or difficult to assess children
      4. inner ear acoustics- called evoked otoacoustic emissions
      5. acoustic transmission- called acoustic immittance
   3. Age of onset significantly alters the language abilities of individuals with hearing loss. Classifications include:
      
      1. Prelingual- present at birth or before speech onset
      2. Postlingual- deficit acquired after speech onset
5. Brief History of the Field
   
   1. 1817: First school for students with hearing impairments (American Asylum for the Education of the Deaf and Dumb)
   2. 1864: First college for the hearing impaired (today named Gallaudet University after Thomas Gallaudet)
   3. Communication methods:
      
      1. Manual communication- sign language/finger spelling
      2. Oral communication- encouraged use of residual hearing and speech reading
      3. Total communication- combination of spoken and manual communication
6. Prevalence and Etiology of Hearing Impairments
   
   1. Prevalence of Hearing Impairments by Age
      
      1. Marked increase with age. the number of people with hearing impairment has doubled in the last 10 years
      2. Hearing loss affects nearly 28 million people and 1 in 22 infants born the United States have some degree of hearing impairment.
      3. 69,300 students 6-21 identified as having a hearing impairment in the 2011-2012 school year.
   2. Etiology of Hearing Impairments
      
      1. Genetic/Hereditary factors
         1. Recessive and dominant traits transmitted genetically
         2. X- linked: carried by the mother
      2. Infections
         1. Can occur before (pre-), during (peri-), or after birth (post-)
      3. Developmental abnormalities
         1. Congenital abnormalities: abnormal development of the outer or inner ear structure
      4. Environmental/traumatic factors
         1. Loud noise, low birth weight, medication, etc.
7. Characteristics of Individuals with Hearing Impairments
   
   1. Intelligence: Intelligence is distributed similarly to individuals without hearing impairments. Intellectual development for people with a hearing impairment is more a function of language development than cognitive ability
   2. Speech and language: Most severely affected area due to a hearing impairment particularly for children who are born deaf. Students who cannot hear the sounds of spoken language may have difficulty learning the meanings associated to the sounds and also may have difficulty using spoken language because they lack early experiences with the sounds of language.
   3. Social development: Social-emotional development relies heavily on communication skills and children with a hearing loss hear less auditory information. Children with hearing impairments may play differently due to a limited ability to share abstract ideas and often prefer to work with pairs of children rather than large groups.
   4. Educational achievement: Educational achievement may be delayed although the student may have average, or above-average, intelligence. Reading skills are often delayed due to limited understanding of sound/word relationships. Educational environments often rely on spoken words to transmit information.
8. Assessment of Individuals with Hearing Impairments
   
   1. Cognitive achievement: Levels of academic performance
   2. Communication assessment: Receptive and expressive language skills, Articulation, pitch, loudness, quality, rate
   3. Personal/social/behavioral assessment: Social adjustment, self-image, emotional adjustment
9. Educational Considerations
   
   1. Impact of hearing loss of academic ability
   2. Educational Placements
      
      1. A large percentage of students with hearing impairments receive their education in the regular education classroom in a public school rather than a residential program for students with hearing impairments.
   3. Classroom Strategies to maximize success
   4. Communication methods
      
      1. Sign language
      2. Oral
      3. Cued speech
      4. Total communication
      5. Fingerspelling
      6. Interpreter
   5. Signed language systems
      
      1. American Sign Language (ASL)
      2. Signing exact English
      3. Signed English:
   6. Educational Approaches
      
      1. Bilingual/bicultural: Considers American Sign Language (ASL) to be the natural language of the Deaf culture and urges recognition of ASL as the primary language choice with English considered a second language
      2. Total communication: Supports the belief that simultaneous use of multiple communication techniques enhances an individual’s ability to communicate, comprehend, and learn
      3. Auditory-Oral: Supports the belief that children with hearing impairments can develop listening/receptive language and oral language expression (English) skills; emphasizes use of residual hearing (the level of hearing an individual possesses), amplification (hearing aids, auditory training, etc.), and speech/language training
10. Hearing Impairments Across the Lifespan
    
    1. Services for Young Children with Hearing Impairments
       
       1. Early identification importance
       2. Early identification procedures
       3. Early intervention services
       4. Family support
    2. Transition and Individuals with Hearing Impairments
       
       1. Transition planning includes:
          1. Family support: families may need support to deal with adolescents with hearing impairments
          2. Higher education: the ADA requires institutions of higher learning to provide accessible facilities and support; six postsecondary programs for exist specifically for people with hearing impairments
          3. Employment: may involve support services or personnel
          4. Personal, social, community: communication difficulties may cause difficulties as a person with a hearing impairment enters a new phase of life
11. Services for Adults with Hearing Impairments
    
    1. Two mandated types of services
       
       1. State commission or office on deafness
       2. State vocational rehabilitation services
    2. National Association of the Deaf
    3. Alexander Graham Bell Association
    4.  
12. Family Issues
    
    1. Most children with hearing impairments have hearing parents
    2. Acceptance of the disability
    3. Family relationships
13. Issues of Diversity
    
    1. Almost 50% of all students in programs for the deaf and hearing impaired are from culturally diverse groups (Gallaudet Research Institute, 2011)
    2. Research is needed to address the needs of students with hearing impairments who come from non-English speaking families
    3. People who identify with the Deaf culture are proud of their heritage including their language, history, values, and literature
14. Technology and Individuals with Hearing Impairments
    
    1. Hearing aids
       
       1. There are different types of hearing aids. Hearing aids can be tailored to amplify incoming sounds differently rather than amplify all incoming sounds equally.
    2. Auditory training devices
       
       1. Sound amplification systems used in the classroom (such as the FM system worn by teachers to amplify his/her speech)
    3. Computers
       
       1. Opportunities for individualized learning, speech synthesizing programs
    4. Alerting devices
       
       1. Devices can be fitted with vibrating or visual alarm systems rather than auditory alerts (doorbells, fire alarms, wristwatches, smoke detectors, etc.)
    5. Captioning
       
       1. Many TV shows and movies provide a written transcription of the spoken words across the bottom of the screen
    6. Telecommunication devices
       
       1. Telephones can have the sound amplified
       2. A telecommunication device for the deaf (TDD) is similar to a telephone but uses types messages
       3. Text messaging has become increasingly popular
    7. Cochlear implants
       
       1. A device is surgically implanted into the cochlea to stimulate nerves in order to make sounds audible. It is connected, by a special magnet, to a transmitter that rests behind the ear. Not all individuals with hearing loss will benefit from a cochlear implant.
15. Trends, Issues, and Controversies
    
    1. Appropriate educational methods
       
       1. Debate continues whether children with hearing impairments should be taught oral or signed language or use a combination of both. The child’s level of hearing loss and needs should be considered.
    2. Move from child-centered to family-centered approach
    3. Deaf culture
       
       1. The term Deaf (with a capital D) refers to individuals who identify with the Deaf culture
       2. The term deaf (lowercase d) refers to the physical condition
       3. Culture is established through shared history, language, experiences
       4. Deaf culture considers American Sign Language (ASL) to be the natural language of the Deaf culture and urges recognition of ASL as the primary language choice with English considered a second language
       5. Advocates for the Deaf culture consider hearing loss to be nonpathological and, therefore, not a condition requiring medical intervention. The Deaf culture asserts that deafness is not disabling, rather it is the social and cultural factors surrounding deafness that are disabling.
       6. The Deaf culture does not view hearing loss as impairment and rejects the term hearing impaired. Members of the Deaf culture are proud of their heritage that includes language, history, values, and literature. The Deaf culture advocates the use of ASL and rejects cochlear impacts as an attempt to correct something that they do not consider to be problematic or in need of a cure or medical intervention.
    4. Full inclusion