Transcript From the other medical dictionary Middle ear infection

Conductive Hearing Loss
Impacts on hearing, listening and language
for ESL students
Supporting Student Learning:
It's Everybody's Business
SSD Hearing Team
Hearing Team Coordinator – Denyse Bainbridge
Alice Springs/Barkly – Craig Rawlinson
Arnhem – Lynnette Rosenberg
Katherine – Denyse Bainbridge
Darwin – Christine Walmsley
Palmerston - Liz Fisher
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Anatomy of the Ear
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Anatomy of the Ear
Ossicles:
Pinna
Semicircular Canals
Hammer, Anvil, Stirrup
External Auditory Canal
Auditory (or Cochlear) Nerve
Vestibule
Cochlear
Inner Ear
Tympanic Membrane
(Ear Drum)
Outer Ear
Middle Ear
Eustachian Tube
(to nose and throat)
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Types of Hearing Loss
•
•
•
•
•
Conductive
Occurs in outer and
middle ear
Fluctuating
Mild - Moderate
Medical treatment
Amplification
•
•
•
•
•
•
Sensori-Neural
Occurs in inner ear
Permanent
Mild – Profound
Cochlear Implant
Amplification
Sign Language
Mixed Loss
Auditory Processing
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
PD Available to schools
www.deet.nt.gov.au
Middle Ear Problems
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Middle Ear Problems
Otitis Media
•
Otitis media is a complex chronic disease in the NT
•
Has associated preventable hearing loss ranging from mild to severe
•
Indigenous babies are high risk for chronic deterioration (worst hearing)
•
Extended periods of hearing loss beginning at 2-3 months of age
•
Cumulative factors increase disabling consequences including poverty, overcrowding, pre-lingual onset, support
(home and education) and bilingual ESL home environment
•
Otitis media deteriorated state is established during early childhood (<3 years) but hearing loss may continue if still
active causing
•
No clinical evidence of improved prevalence of hearing loss and otitis media for generations in NT
Normal
Chronic perforation
Air air filled and intact eardrum
Effusion
Chronic Pus (CSOM)
Fluid filled and intact eardrum
staph and pseudomonas
Acute
Infected fluid and bulging eardrum
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
Acute & perforated
www.deet.nt.gov.au
NT audiology assessment information
Australian Institute Health Welfare (AIHW) data on child health
check follow up from NT Emergency Response June 07
Environment – acoustics, amplification & strategies
Individual amplification, classroom acoustics and ISA
1600
1400
1200
1000
Severe/ Profound Hearing Disability (1%)
1447
AIHW 12/08
1132
AIHW 06/09
AIHW 12/09
Moderate hearing disability (9%)
670
800
600
400
343
No hearing loss, no processing disorder (10%)
16
200
Children 0
Number
NTER
Audiology
Data
No loss Unilateral Bilateral
Mild
Moderate Severe+
Unilateral OR mild hearing impairment , processing disorder (35%)
No hearing loss, processing disorder (45%)
3165 total children
tested (35%)
42% referrals
1244 referrals DET
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Middle Ear Problems
Eustachian Tube Dysfunction
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Middle Ear Problems
Otitis Media
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Middle Ear Problems
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiometric Report
PD Available to schools
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
www.deet.nt.gov.au
Audiograms
• Audiogram is a graph
• Shows threshold of hearing ie softest sound
that a person can hear at that pitch
Frequency
Pitch
Hertz (Hz)
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
Intensity
Loudness
Decibels (dB)
www.deet.nt.gov.au
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Fletcher
•Speech spectrum
•Where sounds in isolation
approximately occur
•Examples of where
environmental sounds occur
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Low Frequencies
Low Frequencies - Hertz (Hz)
125
250
500
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Low Frequency
Low Frequencies 125 Hz, 250 Hz, 500 Hz
ah, e, a, u, o, n, v, r, j
This is wht it’s like t hv
a l frqunc lss.
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiogram
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Middle Frequencies
Middle Frequencies – Hertz (Hz)
1000
2000
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Middle Frequencies
• Middle Frequencies 1000 Hz, 2000 Hz
d, l, m, z, q, w,
This is at it’s ike to
have a oss in the ile
freencies
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiogram
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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High Frequencies
• High Frequencies 4000 Hz, 8000 Hz
• Sounds h, s, t, sh, ch, k, p, f, th
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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High Frequencies
• High Frequencies 4000 Hz, 8000 Hz
h, s, t, sh, ch, p, f, th
i i wa i ik o av a i
requeny los
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiogram
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Intensity of Sound
• Loudness is measured in decibels (dB)
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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normal
hearing
mild loss
moderate loss
moderately
severe loss
severe loss
profound loss
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiometric Report
Mild (20-40dBHL)
- Difficulty with hearing quiet
speech
- Amplification may assist
- Should be able to hear 2/3 of
speech – all vowels and most loud
consonants
- Difficulty with listening if
classroom environment is noisy
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiometric Report
Moderate (41-70 dBHL)
- May have difficulty understanding
conversational speech
- Should benefit from hearing aids
- Should hear about1/2 of the speech
area, most vowels and louder
consonants
- Difficulty with listening if classroom
environment noisy
- May use lip reading to assist with
understanding
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Audiometric Report
•AGI – Australian
Government Intervention
•Different format of report
•Easier to identify hearing
problems
•May get this format in
remote communities
PD Available to schools
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Categories of Hearing Loss cont.
Sensori-neural Hearing Loss only
Severe (71 – 90dBHL)
- May hear loud voices close to ear but will have difficulty understanding speech
without a hearing aid
- Sign language may be beneficial to assist with language learning
- Can hear virtually no speech sounds without amplification
Profound Hearing Loss (91dBHL onwards)
- May have limited awareness of loud conversation only with hearing aids
- Sign language may be beneficial to assist with language learning
- May be able to learn to use hearing aids effectively to help understand speech
through lip reading
- May be able to hear sounds, but not identify them through hearing aids
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Fletcher
•Speech spectrum
•Where sounds in isolation
approximately occur
•Examples of where
environmental sounds occur
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Classroom Acoustics
Sound or Noise?
• What is sound?
Sound is what we hear. Sound may be pleasant or
unpleasant. Sound is measured in dB and travels in waves.
• What is noise?
Noise is unwanted sound.
• How is sound in a room measured?
Sound Level Meters give a reading in dBs.
PD Available to schools
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
www.deet.nt.gov.au
Classroom Acoustics
• Signal to Noise Ratio (SNR)
• Description The SNR is the difference between the intensity of the
signal and the intensity of the background noise. For a student to hear well the
teacher’s voice should be about 15 to 20dB louder than the background noise.
The greater the SNR the better. Younger children need a better SNR than
older children.
• Measurement
First measure the level of background
noise using a sound level meter.
Next measure the teacher’s voice
while talking to the class at a distance of about 2 metres.
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Acoustic Measurements
Type of measurements
• The amount of ambient noise (35dB)
• The reverberation of sound (0.4 sec)
• The audibility of the teachers voice (+ 15db signal/noise)
GLEN
Ambient noise dB(A)
Teacher voice level
Locatio
n
Unoccupied AC/Fan
on
Unoccupied AC/Fan
off
Occupied AC/Fan
on
Occupied AC/Fan
off
Voice
Level
SNR
A
60
X
67
X
77
+10
B
67
X
75
X
77
+2
C
63
X
74
X
77
+3
D
63
X
73
X
74
+1
E
68
X
79
X
74
-5
Range
60-68
X
67-79
X
74-77
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
Amplified
voice
SN
R
www.deet.nt.gov.au
Classroom Acoustics
Background Noise
•Sources of background noise include:
• traffic and aircraft
• playgrounds
• corridors
• adjacent classrooms
• maintenance work /leaf blower/mower
• classroom equipment
• fans
• air-conditioners
• fridges/running taps
• computers
45 dBA is the maximum level recommended
by Australian Standard for an empty classroom
- AS2107. (35dBA in the United States)
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
• radio / CD player
• chairs without stoppers on the legs
www.deet.nt.gov.au
Classroom Acoustics
Reverberation
• Reverberation is one factor that
contributes to background noise
in the room.
• It is the reflection of sound from
surfaces in a room.
• Hard surfaces reflect sound
more.
If your school is being
refurbished please consult
with the hearing team.
• Soft furnishings such as carpet
and curtains can reduce
reverberation and noise in a
room.
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
www.deet.nt.gov.au
Classroom Acoustics
Distance
• The distance between the
teacher and student directly
affects % of speech
discrimination by the child.
• Seating arrangements should
be carefully considered by
teachers.
• An ideal seating configuration
is a semi circle or u shape
formation so that students can
see the teachers face clearly as
well as that of other students.
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
www.deet.nt.gov.au
Classroom Acoustics
Consequences of noise
•
•
•
•
•
•
•
Teacher vocal fatigue
Teacher repeating instructions
Teacher and student stress
The room seems noisy even when students are on task
Learner short attention span and high distractibility
Poor classroom behaviour
Poor academic performance
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Classroom Acoustics
Classroom Strategies
• Reduce background noise.
• Establish clear and defined listening protocols in your room
• Ensure you do not stand in front of a window. The glare from the
window casts your face into shadow and makes speech reading difficult
• Don’t talk and write on the board at the same time
• Encourage a circle formation when students are sitting on the floor
• Gain students’ attention first by auditory and visual cues before speaking
• Speak clearly and naturally, rephrase rather than repeat directions when
necessary
• Avoid tasks that require divided attention
• Use visual aids wherever possible
• Ensure instructions are understood by asking questions such as “What do
you need to do now?” rather than “Did you hear me?”
• Do not give too many instructions at once - be aware of the auditory
memory of your students
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Hearing or Listening?
• What is the difference between hearing and
listening?
• What percentage of the school day do we
expect children to spend listening?
45% of the school day is engaged in listening activities
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Hearing is not understanding
Four levels required in listening
Detection
•Detection: determine if sound is
present or absent
•Discrimination: perceive differences and
similarities between sounds
Discrimination
•Identification: recognising a sound/what
has been said
Identification
•Comprehension: understanding what has
been said and reacting appropriately to the
message
Comprehension
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Conductive Hearing Loss
• Speaking and listening provide the foundation for
all language learning and underpin the successful
development of reading and writing skills
First Steps: Oral Language Development Continuum
• The effect of inaccurately hearing sounds and
words makes it very difficult to understand
language, especially if it is their second language
‘Do you hear what I hear?’, Living and Learning with
Conductive Hearing Loss, Otitis Media.
DYHWIH? PPP
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Language Differences
• Spoken English and Australian Aboriginal
languages have some key differences in their
structure and sounds
• The differences add to the challenges
children face in learning English as a second
(or foreign) language
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Impact of Hearing Loss on
Socialisation
Children with a hearing impairment are likely to present with
social and emotional challenges due:
• Their own frustration and/or the frustration of their peers
• Avoidance
• Just not ‘getting it’ i.e. the subtleties and unwritten rules of
social exchanges
Children with a hearing impairment might:
• Lack confidence
• Low self-esteem
• Lack resilience
• Overcompensate
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
www.deet.nt.gov.au
Auditory Strategies
•
•
•
•
•
•
•
•
•
•
•
Rhymes
Jingles
Silly verse
Raps
Songs
Rhythm – clapping, drumming
Nonsense syllables
Fingerplays
Tongue Twisters
Listening Games
Barrier Games
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Visual Strategies
• Gesture, facial expression, body language
• Demonstrations, modelling
• Videos (captioned), smartboards, pictures,
photos, posters
• Labels, flashcards
• Charts, diagrams, maps, lists, timetables,
flowcharts
• Signing, symbols, cued articulation, PECS
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Conductive Hearing Loss
All school staff can make a difference to the learning of students
with a hearing loss if they encourage and support a whole of
school approach focusing on these five areas:
1. Acoustics and amplification
2. Ear Health [especially for students with/or at risk of CHL]
3. Identification and management of hearing loss
4. Classroom support
5. Program sustainability [at the school level]
PD Available to schools
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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Listening in noise
is like
trying to read in the dark
Northern Territory 2010
Hearing Health for Indigenous School
Children
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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You wouldn’t teach a class in the dark
...
why would you teach a class in noise?
Northern Territory 2010
Hearing Health for Indigenous School
Children
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
www.deet.nt.gov.au
Hearing Tests
1800 826 500
Telscreen - Australian Hearing test
over the phone
8922 7110
NT Hearing Service – Cas Plaza
DEPARTMENT OF EMPLOYMENT, EDUCATION AND TRAINING
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