About Your Hearing
Hearing difficulty is not a minor problem. Nor is it one you have to live with. Wilks Hearing Center is committed to assisting people find the right solutions.
Along with our manufacturers, and other leaders in the field, Wilks Hearing Center seeks to provide information to assist in answering your questions and providing you with important insight.
Types of Hearing Loss
Hearing loss can be categorized by which part of the auditory system is damaged. There are three basic types of hearing loss: conductive, sensorineural hearing loss and mixed hearing loss.
Conductive hearing loss occurs when sound does not pass efficiently from the outer ear canal through the tiny bones (ossicles) of the middle ear to the eardrum. Conductive hearing loss usually involves a reduction of sound level or the inability to hear faint sounds. This type of hearing loss can often be corrected medically or surgically.
Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. Typically, SNHL cannot be corrected medically or surgically. This is the most common type of permanent hearing loss.
SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or muffled.
Sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss, which is referred to as a mixed hearing loss.
Effect of a Hearing Loss
Sound and Hearing
|0-15 dB HL
||borderline normal (children)
||minimal difficulty with soft speech
||difficulty with soft speech
||frequent difficulty with normal speech
||occasional difficulty with loud speech
||frequent difficulty with loud speech
||near total loss of hearing
Generally, a hearing impairment greater than 25 dB in adults may lead to difficulties in communication. For children, a hearing threshold greater than 15 dB may lead to difficulties in speech-language acquisition and production.
The table below details the effects of a hearing loss on children. It also shows recommended countermeasures.
Normal Hearing: -10 to +15 dB HL
Minimal 16-25 dB HL (Borderline)
- Children have better hearing sensitivity than the accepted normal range for adults. A child with hearing sensitivity in the -10 to +15 dB range will detect the complete speech signal even at soft conversation levels. However, good hearing does not guarantee good ability to discriminate speech in the presence of background noise.
Mild 26-40 dB HL
- May have difficulty hearing faint or distant speech. At 15 dB, a student can miss up to 10% of speech signal when the teacher is at a distance greater than 3 feet and when the classroom is noisy, especially in the elementary grades when verbal instruction predominates.
- May be unaware of subtle conversational cues, which could cause the child to be viewed as inappropriate or awkward. May miss portions of fast-paced peer interaction, which could begin to have an impact on socialization and self concept. May have immature behavior. Child may be more fatigued than classmates due to the additional listening effort needed.
- May benefit from mild gain/low MPO hearing instrument or personal FM system dependent on loss configuration. Would benefit from sound field amplification if the classroom is noisy and/or reverberant. Favorable seating will help. May need attention to vocabulary or speech, especially with recurrent otitis medical history. Appropriate medical management necessary for conductive losses. Teacher must be educated to understand the impact of hearing loss on language development and learning.
Moderate 41-55 dB HL
- At 20 dB, a child can miss 25-40% of speech signal. The degree of difficulty experienced in school will depend upon the noise level in the classroom, distance from teacher and the configuration of the hearing loss. Without amplification, the child with 35-40 dB loss may miss at least 50% of class discussions, especially when voices are faint or the speaker is not in line of vision. Will miss consonants, especially when a high frequency hearing loss is present.
- Barriers beginning to build, with a negative impact on self esteem as the child is accused of "hearing when he or she wants to," "daydreaming," or "not paying attention." The child begins to lose the ability for selective hearing, and has increasing difficulty suppressing background noise, which makes the learning environment stressful. Child is more fatigued than classmates due to additional listening effort needed.
- Will benefit from a hearing instrument and use of a personal FM or sound field FM system in the classroom. Needs favorable seating and lighting. Refer to special education for language evaluation and educational follow-up. Needs auditory skill building. May need attention to vocabulary and language development, articulation or speechreading and/or special support in reading. May need help with self esteem. Teacher training required.
Moderate to Severe 56 to 70 dB HL
- Understands conversational speech at a distance of 3-5 feet (fact-to-face) only if structure and vocabulary are controlled. Without amplification the amount of speech signal missed can be 50% to 75% with 40dB loss and 80% to 100% with 50dB loss. Is likely to have delayed or defective syntax, limited vocabulary, imperfect speech production and an atonal voice quality.
- Often with this degree of hearing loss, communication is significantly affected, and socialization with peers having normal hearing becomes increasingly difficult. With full-time use of hearing instruments/FM systems, the child may be judged as a less competent learner. There is an increasing impact on self-esteem.
- Refer to special education for language evaluation and for education follow-up. Amplification is essential (hearing instruments and FM system). Special education support may be needed, especially for primary children. Attention to oral language development, reading and written language is required. Auditory skill development and speech therapy usually needed. Teacher inservice required.
Severe 71 to 90 dB HL
- Without amplification, conversation must be very loud to be understood. A 55 dB loss can cause child to miss up to 100% of speech information. Will have marked difficulty in school situations requiring verbal communication in both one-to-one and group situations. Delayed language, syntax, reduced speech intelligibility and atonal voice quality likely.
- Full time use of hearing instruments/FM systems may result in child being judged by both peers and adults as a less competent learner, resulting in poorer self concept, social maturity and contributing to a sense of rejection. Inservice to address these attitudes may be helpful.
- Full time use of amplification is essential. Will need resource teacher or special class depending on magnitude of language delay. May require special help in all language skills, language based academic subjects, vocabulary, grammar, pragmatics as well as reading and writing. Probably needs assistance to expand experiential language base. Inservice of mainstream teachers required.
Profound 91 dB HL or more
- Without amplification, the child may hear loud voices about one foot from the ear. When amplified optimally, children with hearing ability of 90 dB or better would be able to identify environmental sounds and detect all the sounds of speech. If loss is of prelingual onset, oral language and speech may not develop spontaneously or will be severely delayed. If hearing loss is of recent onset, speech is likely to deteriorate with quality becoming atonal.
- Child may prefer other children with hearing impairments as friends and playmates. This may further isolate the child from the mainstream. However, these peer relationships may foster improved self concept and a sense of cultural identity.
- May need full-time special aural/oral program with emphasis on all auditory language skills, speechreading, concept development and speech. As loss approaches 80 - 90 dB, may benefit from a Total Communication approach, especially in the early language learning years. Individual hearing instrument/personal FM system essential. Need to monitor effectiveness of communication modality. Participation in regular classes as much as beneficial to student. Inservice of mainstream teachers essential.
Unilateral (One normal hearing ear and one ear with at least a permanent mild hearing loss)
- Aware of vibrations more than tonal pattern. Many rely on vision rather than hearing as primary avenue for communication and learning. Detection of speech sounds dependent upon loss configuration and use of amplification. Speech and language will not develop spontaneously and is likely to deteriorate rapidly if hearing loss is of recent onset.
- Depending on auditory/oral competence, peer use of sign language, parental attitude, etc., child may or may not increasingly prefer association with the deaf culture.
- May need special program for deaf children with emphasis on all language skills and academic areas. Program needs specialized supervision and comprehensive support services. Early use of amplification likely to help if part of an intensive training program. May be cochlear implant or vibrotactile aid candidate. Requires continual appraisal of needs in regard to communication and learning mode. Part-time in regular classes as much as beneficial to student.
- May have difficulty hearing faint or distant speech. Usually has difficulty localizing sounds and voices. Unilateral listener will have greater difficulty understanding speech when environment is noisy and/or reverberant. Difficulty detecting or understanding soft speech from side of bad ear, especially in a group discussion.
- Child may be accused of selective hearing due to discrepancies in speech understanding in quiet versus noise. Child will be more fatigued in classroom setting due to greater effort needed to listen. May appear inattentive or frustrated. Behavior problems sometimes evident.
- May benefit from personal FM or sound field FM system in classroom. CROS hearing instrument may be of benefit in quiet settings. Needs favorable seating and lighting. Student is at risk of education difficulties. Educational monitoring warranted with support services provided as soon as difficulties appear. Teacher inservice is beneficial.
Understanding Digital Hearing Technology
Fully (100%) Digital Fittings
Available since summer 1996, these instruments represent the newest development in hearing. By converting sound into computer language and processing amplification ON chip, these instruments are similar to a CD player. They DO NOT contain amplification circuits. This technology offers:
- EASE OF USE - The computer chip takes over all of the functions of the hearing aid and volume controls are often eliminated.
- SOUND PROCESSING - by performing calculations at rates faster than a desktop computer, voice and non-voice signals are actively analyzed.
- DIGITAL (CD) SOUND QUALITY - clean, clear sound reproduction.
- SUPERIOR FITTINGS - Independent programming of multiple frequency bands to compensate for individual needs.
- BETTER HEARING IN NOISE - Incoming signals are analyzed to improve speech understanding.
- FEEDBACK CONTROL - Circuit designs specifically reduce the likelihood of "whistling."
- RE-PROGRAMMING FOR HEARING CHANGES - The chip can be re-programmed to suit future needs.
Digital instruments vary in level of sophistication, with the newest, most advanced chips performing more calculations and providing hearing improvement features, such as
Staying on top of technology, is one of the most important reasons for your successful fitting. Our Audiology Staff receives ongoing training within the United States and Europe.
- DIRECTIONAL MICROPHONES - depending on the instrument design, sound coming from the direction of speech is amplified, while reducing sound (which is usually noise) from other directions. Some have fixed directionality, while others can change depending on the sound environment.
- NOISE REDUCTION CIRCUITRY - the computer chip differentiates between speech and noise, reducing amplification for noise signals.
- HIGH GAIN - with less feedback. Many new digital instruments are available for those with severe hearing loss.
Central Auditory Processing Problems
Some children (and adults) with perfectly normal hearing can still have difficulty understanding spoken language. This may be due to subtle deficits in areas of the central nervous system that are involved in decoding sounds.
Standard hearing testing consists of measuring one's ability to hear loudly and clearly enough to follow speech. It fails to determine the individual's ability to understand what is heard, which is especially important during early learning.
Problem areas may be:
which can result in
- Difficulty understanding speech in noise or in a classroom
- Poor auditory attention skills
- Receptive language difficulties
To address this need, qualified audiologists specializing in pediatrics established a protocol to evaluate Central Auditory Processing in school age children and adults.
- Poor school performance
- Reading and spelling difficulties
- Distractibility and attention problems
- Failure to respond to commands
A standard hearing evaluation is conducted prior to the day of central testing. Although standard hearing evaluations can be conducted even for young infants, frequently the minimum age requirement for central auditory evaluation is 5 years old.
The evaluation consists of responding to various listening tests, which are designed to locate specific areas of possible difficulty. For children, they play listening games with the examiner for about one hour.
Should a central auditory processing problem be detected, specific areas of deficit may be pinpointed. Comprehensive reports can be furnished and to assist your professional in developing a remediation plan. Our Board Certified Audiologists routinely work closely with your
- Speech/Language Pathologist
- Reading Specialist
- Learning Disability Specialist
- Special Ed. or Resource Room Teacher
- Classroom Teacher
- School Psychologist
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