We know a lot about how hearing loss occurs. By far the most common cause is the natural aging process. Just like our hair thins and gets gray, and our eyes lose fine focus, hair cells in the inner ear weaken, break and grow unresponsive with age.
The second leading cause of hearing loss is exposure to noise. Loud machinery at home or where you work can damage your ears – even short bursts of sound over 90 decibels can have an impact. Prolonged noise is worse. Our lives are filled with noise we can’t control: in military or factory environments, and from airplanes, subway trains, and traffic sounds. There’s also plenty of noise we can control, but choose not to…rock concerts, loud cheering at sporting events, and all those power tools around the house.
All of these forms of hearing loss are examples of sensorineural loss. Heredity can also play a role in developing this kind of hearing loss. Hearing losses can also be caused by illness such as severe ear infection, disease, tumors or injury – for example, a blow to the head. Another cause, easily fixed, is a build-up of earwax in the ear canal. Some of these problems will ease on their own, while others may respond to medicines or surgery. These are examples of conductive hearing loss.
When it comes to treating hearing loss, you can often improve your ability to hear and communicate with hearing instruments. The first step is getting screened by a hearing professional.
We know a lot about how hearing loss occurs. By far the most common cause is the natural aging process. Just like our hair thins and gets gray, and our eyes lose fine focus, hair cells in the inner ear weaken, break and grow unresponsive with age.
The second leading cause of hearing loss is exposure to noise. Loud machinery at home or where you work can damage your ears – even short bursts of sound over 90 decibels can have an impact. Prolonged noise is worse. Our lives are filled with noise we can’t control: in military or factory environments, and from airplanes, subway trains, and traffic sounds. There’s also plenty of noise we can control, but choose not to…rock concerts, loud cheering at sporting events, and all those power tools around the house.
All of these forms of hearing loss are examples of sensorineural loss. Heredity can also play a role in developing this kind of hearing loss. Hearing losses can also be caused by illness such as severe ear infection, disease, tumors or injury – for example, a blow to the head. Another cause, easily fixed, is a build-up of earwax in the ear canal. Some of these problems will ease on their own, while others may respond to medicines or surgery. These are examples of conductive hearing loss.
When it comes to treating hearing loss, you can often improve your ability to hear and communicate with hearing instruments. The first step is getting screened by a hearing professional.
Hearing loss can occur at any age. You can be born with hearing impairment, or experience it as a normal part of the ageing process. When it occurs, it doesn’t just affect the person with the loss, it affects the whole family. Therefore, it is important that the family be able to recognise what is happening and take action to help the situation.
Hearing loss is one of the world’s most common health problems. Some people are born with hearing impairment, while with others the hearing loss slowly occurs over time and the persons don’t even notice they are experiencing a hearing loss. A head injury, ear infection or prolonged exposure to loud noise can also cause hearing problems.
A hearing loss is not simply like listening to sounds with the volume turned down. Instead, you will probably notice that there are certain ranges of sound or tones that you have difficulty hearing. Normal speech is a combination of many different frequencies. Your hearing loss may effect your ability to hear some frequencies better than others. Sometimes it can seem as if people are mumbling and not speaking clearly. So, while a person may not hear that people are talking, others may not be able to understand what they hear.
SIGNS OF HEARING LOSS IN ADULTS
For many people, hearing loss is a normal part of growing older. It is often such a gradual process that the affected person is the last to realise there is a problem. Signs of hearing loss may be recognised in the following:
■ Turning up the volume on Radio or Television
The person with hearing loss may increase the loudness on the radio or TV sets. The person usually does not realise it is uncomfortably loud for others. If others do complain, he/she just moves closer to the source of the sound to hear better.
■ The difficulty in hearing or listening to conversations in a crowd or noisy situations
Problems hearing in group situations like parties or restaurants is a classic indicator of a hearing loss. Damaged ears frequently have trouble separating out desired sounds from unwanted ones. Normal ears can pick out conversations that are actually softer than the background noise, even when the noise is other conversations.
■ Asking people to repeat
Persons with hearing loss can often get enough cues to understand the message if it is repeated, therefore they may ask people to repeat what has been said, continuously. They may think others are mumbling. Because people become aggravated at being asked to repeat, the hearing impaired may stop asking people to repeat and their ability to communicate is greatly impaired.
■ Changing posture and facial expression when listening
Because persons with hearing loss have difficulty hearing, they often cup their hands behind their ears, frown, lean forward or turn their heads to hear the speaker better.
■ Dependency on others
Persons with hearing loss may come to accept the fact that they have difficulty communicating and may rely on others, usually a spouse or a child, to assist them. They will then constantly turn to that person to tell them what was said.
■ Withdrawal and Isolation
People with hearing loss may feel very isolated and lonely and this could affect their personalities. They may be scared to take part in conversations because of fear of mistaking what was said and responding inappropriately. Most persons with hearing loss have been embarrassed at some time for thinking a person said one thing when actually something else was said. Those kinds of mistakes can cause a person to loose confidence in themselves and social gatherings.
HEARING LOSS LEADS TO 3 KINDS OF COMMUNICATION DIFFICULTIES
■ Difficulty hearing soft speech (loss of sensitivity)
Most people think that hearing loss is simply a reduction in loudness – something that makes speech and other sounds difficult to hear at ‘normal’ loudness levels. When someone loses their sensitivity to soft sounds, these sounds need to be amplified to make them loud enough to hear. Simply turning up the volume (on a TV) or speaking a bit louder may be enough to compensate for a mild loss of sensitivity.
■ Difficulty hearing consonants (high-frequency loss)
People with high-frequency hearing loss usually have problems hearing and understanding soft, high-frequency (high pitch) consonants, such as t, sh, f , p, s, th. When this happens, it become difficult to distinguish between words such as cap, cat, and catch. This can make it particularly hard to follow a conversation and can sometimes result in inappropriate answers to questions.
■ Difficulty understanding speech in noise (focus loss)
Some people who seem to have no problems understanding speech in quieter and one-to-one situations suddenly experience much greater problems when background noise is present. The noise may not even be as loud as the level of speech, but it can still ‘mask’ or cover the speech sounds you need to hear to understand. A person with normal hearing can generally separate the speech from the background sounds. But for someone with a hearing loss, background music, other people talking in a restaurant or even the noise of a car can make it very difficult to distinguish speech from the other sounds. Usually a person with hearing loss experiences all these problems to varying degrees. Depending on the nature and severity of the hearing loss, some people have difficulties in only certain situations, whereas others might have problems hearing and understanding almost all the time. While it might appear that some people practice ‘selective listening’ (he/she hears what they want to hear) a mild or high frequency hearing loss might be the true culprit.
A hearing loss is described in terms of degree of loss. The hearing loss is plotted on a graph called an Audiogram and is reported as a function of frequency or pitch and decibels or intensity. An Audiogram is a chart which records the hearing response of each ear from 125 Hz to 8000 Hz, which is the range most essential for speech perception. Hearing response is unique for each patient.
The most common type of hearing loss is called “sensorineural” or “nerve deafness”. A common age-related sensorineural loss primarily affects high-frequency sounds. This condition makes it difficult to understand the speech of women and children and leads to confusion of high-frequency consonant sounds such as “sh”, “f” and “s”. These are the people who say “I can hear, but just can’t understand the words.
Hearing aids are the most common form of help for a person affected by sensorineural hearing loss. Hearing aids can selectively amplify sounds in the frequency range of the patients hearing loss. Just as eyeglasses must be prescribed specifically for a person’s visual loss, so should a hearing aid be custom programmed to provide the best possible hearing improvement.
In the Audiogram, the horizontal axis shows frequency in Hz. The vertical axis shows hearing loss in decibels (dB). Normal hearing is the 0 dB level. The degree of handicap is considered mild at 20 dB, moderate at 40 dB, severe at 60 dB, and profound at 80 dB.
AUDIOGRAM
Hearing loss is plotted on a graph called an Audiogram and is reported as a function of frequency or pitch and decibels or intensity. It records the hearing response of each ear from 125 Hz, which is the range most essential for speech hearing. Hearing response is unique for each patient. The Audiogram demonstrates the position of everyday common sounds and speech information relative to pitch and loudness. On the conversational speech level, many of the consonants are high pitched sounds and very soft. Especially the ‘th’, ‘f’ ‘sh’ and ‘s’ sounds. These sounds are often misheard by individuals with hearing loss, but a hearing aid can often improve the clarity of these sounds.
Hearing Loss in Children.
If you suspect or if you know that your child has a hearing loss, you may not find it easy to come to terms with it. As you have the desire to find the best possible solution for your child, many questions will occur to you. This section attempts to provide answers to some of your questions and tells you where you can find professional help.
WHAT TO DO IF YOU THINK YOUR CHILD HAS A HEARING LOSS
First, try not to worry, there is a whole range of technological and medical solutions to help and now more than ever children with hearing loss are able to live full and successful lives. The first step is to meet with a medical practitioner who may refer your child for tests which help determine hearing levels in infants or children. No child is too young to receive a thorough hearing evaluation. In fact, hearing assessment can even be completed at birth.
While simple hearing screenings may be conducted by nurses or trained volunteers, a complete assessment of hearing in a child should only be completed by an audiologist.
The purpose of the audiological evaluation is to determine if a hearing loss exists in one or both ears, to what degree, and to help determine the type of hearing loss. Test results are recorded on an audiogram.
COMMUNICATION MILESTONES
The cochlea which is the sensory organ of hearing, attains full adult size and enables the child to hear by the 20th week of pregnancy. This means that children can be used to the sound of their mothers and other voices even before they are born. It is therefore possible for the child to be aware of music and other sounds which can prove soothing when the child is born as they are associated with the protected life in-utero.
After birth, a newborn child’s cochlear sensitivity is similar to adults, but babies must learn how to use their hearing to form the foundations of communication.
YOUR CHILD’S SPEECH AND LANGUAGE DEVELOPMENT (AGE DEVELOPMENTAL MILESTONES)
The following milestones are rough “rules of thumb” for the majority of children. If your child is more than 2-3 months delayed compared to the age-groups mentioned below, it might indicate hearing loss or delayed speech-language development.
■ 9 months:
Demonstrate an understanding of simple words “mommy,” “daddy,” “no,” “bye-bye.”
■ 10 months:
Babbling should sound “speech like,” with single syllables strung together (“da-da-da-da”).The first recognizable words emerge at about this time.
■ 1 year:
One or more real words spoken
■ 18 months:
Understand simple phrases, retrieve familiar objects on command (without gestures) and point to body parts. Also should have a spoken vocabulary between 20 and 50 words and use short phrases (“no more,” “go out,” “mommy up”).
■ 24 months:
Spoken vocabulary should be at least 150 words, coupled with the emergence of simple two word sentences. Most speech should be understandable to adults who are not with the child daily. Toddlers also should be able to sit and listen to read-aloud picture books.
■ 3 to 5 years:
Spoken language should be used constantly to express wants, reflect emotions, convey information and ask questions. A preschooler should understand nearly all that is said. Vocabulary grows from 1000 to 2000 words which are linked in complex and meaningful sentences. All speech sounds should be clear and understandable by the end of the preschool period.
LOCALISATION
One of the earliest and easiest auditory skills to observe in your baby is localization, the ability to pinpoint the source of a sound. Because we hear through two ears (binaurally), we can localize sounds with extreme accuracy.
OBSERVING YOUR CHILD’S LOCALISATION ABILITY
In general, newborns will move or widen their eyes when they hear a sound, this is known as the startle reflex. Any loud sound should induce this reflex. When your infant gets older, about five or six months, you can better observe a true localization response by making soft sounds behind or to the side of your infant while your baby is looking straight ahead. (Be sure you are out of view when making the sounds!) A soft rattle, shake or a whisper should prompt your baby to turn his or her head toward the sound.
While we expect infants to startle when presented with very loud sounds, it is most important to see how well your baby responds to soft sounds (such as the speech sound “s”).
During the first year, your baby will refine listening skills and should alert to and look for the sources of common sounds around the home, such as a ringing doorbell or telephone, slamming door, children playing, a musical toy and speech
TRUST YOUR INTUITION
You should trust your intuition if you suspect your child has trouble hearing. If in doubt, make an appointment to see an audiologist or consult your family doctor to arrange a hearing test.
A child is never too young to have their hearing tested, and studies have shown that the sooner a child is fitted with hearing aids, the better their language skills can develop.
A hearing test is a simple and painless way to check whether your child is getting the absolute most out of the world around him or her.
MORE ABOUT HOW A CHILD’S HEARING LOSS IS DIAGNOSED AND HOW TO PROCEED AFTER THE DIAGNOSIS
The diagnosis process is there to confirm or dismiss your suspicions regarding your child’s hearing. Following several tests or perhaps several appointments, your audiologist or physician will provide you with the results of your child’s tests and a diagnosis.
You will be told of the type of hearing loss (conductive, sensorineural or mixed), degree of hearing loss (mild to profound) and whether one or both ears are affected. A prognosis, describing the expected change in the hearing loss over time should also be provided.
INFORMATION IS IMPORTANT
Regardless of the amount of information you may be given, your audiologist or physician will gladly supplement this by providing you with facts about hearing loss. Further discussion will focus on essential information which will assist you in deciding the best course of action in order to increase your child’s quality of life.
TYPICAL REACTIONS
Although you may have suspected your child’s hearing loss, its confirmation typically comes as a shock. Some parents may blame themselves and experience feelings of despair.
Others may deny or be unable to come to terms with the impairment. These reactions are quite normal. A certain amount of healing and acceptance must therefore occur to prepare for the times ahead.
Many of these emotions may arise from unanswered questions. Often, the answers to these questions and awareness of the solutions available can be a source of great comfort.
Therefore, talk about it to anyone whom you may feel will shed some light on the subject or simply be there to listen to your concerns. Such questions as “Will my child’s life be hampered by the hearing loss?”, “Will my child speak normally?” are quite typical.
REMEMBER THAT YOU ARE NOT ALONE
There are vast resources available to you and your child.
You may wish to talk to your audiologist, physician, other parents or educators or other hearing impaired children, or even individuals who themselves were diagnosed with hearing loss during childhood.
Not only can these people help to answer your questions and address your concerns, but their stories may also help give you a positive perspective on the entire matter.