Transcript Working With Children With Cochlear Implants

Working With Children
With Hearing Loss
Stephanie Morrison,
Lindsay Tucker, Au.D
How do we learn language?
• Exposure: We see language. We hear language. We use
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language to communicate. We process the world around us through
language.
Hearing loss creates a barrier to natural language learning.
90% of deaf children are born to hearing parents
Hearing parents generally do not know sign language
We live in a hearing world. Education is successfully tailored to
meet the hearing child’s educational needs.
What about the child with hearing loss? How do they learn
language? How are they educated?
Visual language and or hearing assistive technology can help.
Effects of hearing loss
Researchers (e.g., Luckner, Slike, & Johnson, 2012)
identified the following five potential consequences of
hearing loss:
• 1) Language, Vocabulary, and Literacy Delays
• 2) Gaps in Background and Domain Knowledge
• 3) Inadequate Knowledge and Use of Learning
Strategies
• 4) Social Skills Deficits
• 5) Reliance on Assistive Technology.
Quick Facts
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About 2 to 3 out of every 1,000 children in the United States are born with a
detectable level of hearing loss in one or both ears.1
More than 90 percent of deaf children are born to hearing parents.2
One in eight people in the United States (13 percent, or 30 million) aged 12
years or older has hearing loss in both ears, based on standard hearing
examinations.4
As of December 2012, approximately 324,200 cochlear implants have been
implanted worldwide. In the United States, roughly 58,000 devices have
been implanted in adults and 38,000 in children.9
Five out of 6 children experience ear infection (otitis media) by the time they
are 3 years old.10
The U.S. Food and Drug Administration (FDA) first approved cochlear
implant devices for adults in 1985 and for children in 1990. According to the
National Institute on Deafness and Other Communication Disorders, as of
December 2010 approximately 70,000 individuals—over half of whom were
children—had received cochlear implants in the United States. More than
219,000 individuals have received cochlear implants worldwide.
Early Detection of Hearing
Impairment (EDHI)
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Newborn Hearing Screening and Diagnosis
In 2013, Centers for Disease Control and Prevention (CDC) data showed
that over 97% of newborns in the United States were screened for hearing
loss. [Data table]
– Of those who were screened, 1.6% did not pass the final or most recent
hearing screening. [Data table]
Of those babies not passing the hearing screening, 69.0% were diagnosed
as either having or not having a hearing loss before 3 months of age. [Data
table]
There was an increase in the number of infants screened for hearing loss
from 2006 (95.2%) to 2012 (96.6%). [Progress in Identifying Infants with
Hearing Loss]
Degree of hearing loss.
• Speech sounds occurs between 20-55 decibels.
• Normal hearing is 0 to 15 decibels
• As the degree of loss increases so does the
adverse affect on education and language
access.
• A moderate loss equates to missing out on 50%
of speech (41 dB to 55 dB)
• A person is classified as deaf when they have a
profound loss (71+ dB)
Technology Utilized
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Hearing Aids
Cochlear Implants
Bone Anchored Hearing Appliances
FM System
Continued
Bone Anchored Hearing
Appliances
• Conductive Hearing Loss
• Single Sided Deafness
• Mixed Losses
FM systems
• Understanding wireless technology
• FM technology refers to a type of wireless system that helps people
better understand speech in noisy situations. FM systems commonly
work together with a user’s hearing aids, although systems are also
available for those with otherwise normal hearing (such as people
who suffer from APD, ADHD etc.).
• An FM system works like this:
• The person speaking wears or holds a transmitter microphone, or
the transmitter is placed in the middle of the group (picking up
speech from all around).
• Using harmless radio waves, the FM system sends speech signal(s)
to the listener, who wears a tiny FM receiver behind the ear.
FM Systems and Sound Field Systems
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Increase signal to noise ratio
Benefits all children
Repeat answers
Classroom systems
Personal FMs –directly to child
Differences between
hearing aids and cochlear
implants
• Although cochlear implants (CI) and hearing aids (HA) serve the
same purpose (providing access to sound) there are differences
between them.
• Hearing aids deliver amplified sound to the damaged cochlea. A
hearing aid can be programmed to shape the amplification of sound
to match the loss.
• Sound is still being delivered to damaged nerves, so HAs are limited
in ability to aid severe and profound loss beyond environmental
sounds and vowels in speech. The signal is still processed by the
damaged cochlea and sent to the brain with its added distortion.
• Even with substantial amplification, you may not hear very much,
and you become tired and strained due to the loud sounds being
presented to your ear.
Hearing Aid = mini microphone
Hearing Aids and Language Access
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Increase signal to noise ratio
Half back
Digital technology –amplify signal
3-6 feet optimal range
Hearing Loss Fatigue
• Putting puzzle together all day
• Academically demanding classes at the first of the day
• Less demanding classes at the end
Reduce Fatigue
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Increase signal to noise ratio
Visuals represent key concepts
Clear concise presentation
Outline or organizers
Processing time
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• Cochlear implants operate very differently than hearing aids. A
cochlear implant bypasses the damaged hair cells by delivering
electrical current directly to the cochlear, or auditory, nerve. A
cochlear implant presents a wide range of frequencies, regardless of
the pre-implantation hearing loss.
• People who transition from HAs to CIs generally find that
compensation techniques such as lip-reading become easier.
• With hearing aids, many people try to increase the volume as much
as possible. Cochlear implants provide plenty of sound, so that you
don’t need to have high volumes blasted into your ear just to get
those sounds. Your job is to learn how to interpret them so that it
becomes second nature.
Cochlear Implant = computer processor
Advantages of Hearing
Aids
• Advantages of Hearing Aids:
• It is easy to try different hearing aids to see which works
best for you
• You can take advantage of new technology as it
becomes available (improved earmolds, tubing, telecoils,
digital/analog programming strategies)
• Retain residual hearing for possible future technology or
medical improvements
• May provide better low frequency sounds, such as those
in vowels.
• Does not require surgery
Advantages of CI
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Advantages of Cochlear Implants:
Eliminates earmolds, their acoustic feedback issues and irritation of the ear
bowl
Can enable you to hear conversation and thus learn spoken language with
relative ease, particularly for those with severe-profound hearing loss
May enable you to use a regular telephone
Easier high- frequency speech component perception ( /sh/, /s/, /f/, /t/, /k/,
/p/, /h/)
Better overall hearing at high frequencies
Distance hearing is likely better than with hearing aids
May enable you to overhear conversations and other environmental sounds
Better feedback which may help improve your voice quality
May be the only option when a hearing aid is insufficient.
May help with auditory neuropathy
What is a Cochlear
Implant?
A cochlear implant is an electronic medical device that
replaces the function of the damaged inner ear. Unlike
hearing aids, which make sounds louder, cochlear implants
do the work of damaged parts of the inner ear (cochlea) to
provide sound signals to the brain.
More about cochlear implants
• Profoundly deaf
• Hearing aids use would not allow access to
speech
• Must learning to listen
• Implant off = profoundly deaf
• Mini expensive computers
• Damaged by dampness, heat, static electricity
• Use sign language interpreter
Cochlear Implant
Manufacturers
• Med- El
• Advanced Bionics
• Cochlear Corporation
Med-El
• https://www.youtube.com/watch?v=qxnqJI
1e8So&index=11&list=PLT_-N4wea5Dsb48603HI8obw53bCUZ0e
Advacned Bionics
Works with Phonak
Easy FM capabilities
https://www.youtube.com/watch?v=szAtDQ
9sJOU
Cochlear Corporation
Works with Resound Hearing Aids
Direct FM capability
Trouble Shooting
• If no sound is heard
• Visually inspect the cable for any damage or breakage and verify it
is firmly attached to
• the headpiece and sound processor.
• Remove any materials (hat, scarf, headband, etc.) that may be
covering the microphone.
• Unaided listeners may perform a listening check of the microphones
as described in the
• Replace the cable.
• Replace the headpiece.
• Remove the battery cartridge.
• Reattach the battery cartridge.
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If static or distorted sounds are heard, try the following troubleshooting steps:
Remove any materials (hat, scarf, headband, etc.) that may be covering your
microphone.
Visually inspect the cable for any damage or breakage. If any problems are noted,
replace cable.
Verify that the cable is firmly attached to the headpiece and sound processor and that
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headpiece is positioned properly on the head.
If the input is from the headpiece microphone and the static or distorted sounds
persist,
replace the headpiece cable.
Visually inspect the microphones for signs of debris or wear.
If available, replace the headpiece and/or headpiece Color Cap.
Clean the battery contacts on the processor.
Replace the Microphone Cover.
LING 6 Sound Check
Why are Ling Sound important?
What can you do improve
language access?
• Increase signal to noise ratio
Listening Checks/ assistive technology working
Use visuals and more visuals
Use Close Captioning
Outlines and organizers
Model thinking
Establish one at a time talking … point
Role play
Allow for processing time
Get the students attention when addressing them
Keep face uncovered to allow for lip reading and facial cues
Allow TOD and interpreters to be part of your team
Seek to understand
Be flexible, approachable, and teachable
Resources
• http://www.nidcd.nih.gov/health/statistics/p
ages/quick.aspx
• http://www.cdc.gov/ncbddd/hearingloss/eh
di-data2013.html