Hearing problems are common congenital abnormalities in newborns and affect a significant portion of the population, highlighting the importance of understanding ear function and types of hearing loss. Various classifications of hearing loss, such as conductive, sensorineural, and mixed, impact communication, social skills, and academic achievement in children, particularly those with early-onset deafness. Efficient identification and intervention of hearing loss can significantly mitigate its adverse effects on language development and overall life quality.

2.  Hearing Problem is considered to be the most prevalent
Congenital Abnormality in newborns and is more than
twice as prevalent as other conditions that are screened for
at birth (Finitzo & Crumley, 1999).
 Hearing Loss is a common problem that often develops
by Repeated Exposure to Loud Noises.
 According to a careful estimate, there are more than 10
Million (about 1 in 6) people in one or the other degree
of Hearing Problem.

3.  To understand how and why Hearing Problem
happens, it will be worth mentioning to know How Ear
Works.
 Ear is made up of three different sections:
 The Outer Ear,
 The Middle Ear, and
 The Inner Ear.
 These parts work together in Hearing and Processing
the Sounds. (Contd)

4.  The Outer Ear, or Pinna (the part you can see), picks
up Sound Waves and the waves then travel through the
outer ear canal.
 When the Sound Waves hit the Eardrum in the
Middle Ear, the Eardrum starts to Vibrate.
 When the Eardrum vibrates, it moves Three Tiny
Bones in the Ear.
(Contd)

5.  These bones are called the Hammer, Anvil,
and Stirrup. They help sound move along on its journey
into the Inner Ear.
 Stirrup Bone is the Smallest Bone in the body which
is located inside the ear.
 Stirrup Bone is only 0.25 to 0.33 cm long (0.10 to 0.13
in) and Weighs only 1.98 to 4.3 mg.
◦ (Contd)

6.  The Vibration then travels to the Cochlea, which is filled
with Liquid, having Thousands of Tiny Hair on the
inner surface.
 Inside the Ear, there are Two Types of Hair Cells:
 The Outer Cells and the Inner Cells.
 The sound vibrations make the Tiny Hair move. The Outer
Hair Cells take the Sound information, Amplify it (Make it
Louder), and Tune it.
 (Contd)

7.  The Inner Hair Cells send the Sound Information
to the Hearing Nerve,
 The Hearing Nerve then sends it to the Brain,
allowing the person to Hear.

8.  The level at which a normal person can barely
hear the tone is his/her Hearing Threshold
level.
 Sound intensity is measured in dB HL (Decibels
Hearing Level), i.e. dB relative to the Quietest
Sounds that a Young Healthy Individual
ought to be able to hear.

9.  The Hearing Thresholds (Measured in
Decibels) are recorded on a chart called an
Audiogram.
 The Tones at different Pitches and Frequencies
are measured in "Hertz," which is a special term
for Cycles/Second.

10.  Pitch is the quality that allows us to classify a sound as
relatively high or low. Pitch is determined by the
frequency of sound wave vibrations.
 Hertz is a unit of frequency alternating current
 Hertz (abbreviated Hz), 1 Hz is equivalent to 1
Cycle/Second.
 It is named for Heinrich Rudolf Hertz, the first
person to provide conclusive proof of the existence of
Electromagnetic Waves.

11.  Audiologists conduct clinical Audiogram Test
 Tones between 250 and 8000 Hz are presented at
varying levels,
 To determine a patient's Tone Detection Thresholds
(the Quietest Audible Sounds) in the left and right
ear.
 Thresholds between 10 and 20 dB are considered in
the Normal Range

12.  Sound Intensity is measured in decibels (dB HL).
 The top line, at 0 decibels (dB HL), represents a very soft
sound, with each horizontal line below representing
successively Louder Sounds.

13.  Frequency is measured in Hertz (Hz).
 Just like a Piano's keyboard, the Frequencies are low on
the Left Side (125 or 250Hz), and then gradually climb
to Higher Frequencies on the Right Side (8000Hz).
 Note: The Piano ranges actually go from 28 Hz to
4,000 Hz.
 The most important frequencies for Speech fall into the
250-6000 Hz range.

14.  Students with Hearing Disabilities face unique
challenges during the process of Learning.
 In our Educational Settings, Common Teaching
Learning Process includes Lectures, Audio-Visual
Aids (AV Aids) Discussion groups and even One-
on-one Conversations.
 All these are nothing less than a Struggle for those who
have any level of Hearing Difficulty.

15.  Deafness,
 Hearing Impairment,
 Hearing Loss
 Hard of Hearing
 Residual Hearing, all refer to Partial or
Total inability to Hearing, Processing
and Interpreting sounds.

16.  Deafness
 Deafness refers to a level of hearing loss severe enough
that the individual is limited in his/her hearing ability to
process Acoustical Language, whether they are using
assistive listening devices or not.
 Deafness refers to a person who has a profound hearing
loss and uses sign language

17.  "Deafened" usually refers to a person who
becomes Deaf as an adult and, therefore, faces
different challenges than those of a person who
became deaf at birth or as a child.
 In other words, it is an Acquired State of
Deafness

18.  Hearing Impairment
 Hearing Impairment denotes a degree of hearing loss
wherein the individual can Hear and Understand
verbal communication, but only with the help of an
Assistive Listening Device or Hearing Aid.
 Hearing Impairment is a general term used to
describe any Deviation from Normal Hearing,
whether Permanent or Fluctuating, and ranging
from Mild Hearing Loss to Profound Deafness.

19.  Hard of Hearing refers to a person with a Hearing
Loss who relies on Residual Hearing to communicate
through Speaking and Lip-Reading.
 Many individuals who are deaf or Hard of Hearing
prefer the term “Hard of Hearing," because they
consider them to be more positive than the term
“Hearing Impaired," which shows that something is
wrong that makes a person Less than Whole.

20.  Residual Hearing refers to the hearing that remains
after a person has experienced a Hearing Loss.
 Basically, Residual Hearing is the ability to hear some
sounds even if a hearing loss exists.
 Most people with Significant Hearing Loss still have
some Residual Hearing that can be stimulated by
Amplifying sound using a Hearing Aid.

21.  1. Conductive Loss
 Conductive Loss affects the Sound-Conducting
Paths of the Outer and Middle ear.
 People with Conductive Loss might speak softly, and
might experience Ringing in their ears.
 The degree of loss can be decreased through the use of a
Hearing Aid or by Surgery.
 (Contd)

22.  2. Sensorineural Loss
 It affects the Inner Ear and the Auditory Nerve and
can range from Mild to Profound Degree.
 People with Sensorineural Loss might Speak
Loudly, experience Difficulty in Distinguishing
difference among the words having Similar Sounds,
and not hear well in Noisy Environment.
 (Contd)

23.  3. Mixed Hearing Loss.
 Mixed Hearing Loss is a combination of a Sensorineural
and Conductive Hearing Loss.
 It results from problems in both the Inner and Outer
and/or Middle Ear.
 In other words, there may be damage in the Outer or
Middle Ear and/or in the Inner Ear (Cochlea) or
auditory nerve.
 This type of Hearing loss is referred to as a Mixed Hearing
Loss.

24.  In a Developing Child, Hearing Loss might reflect in
the behaviour which may look like:
 Misbehaving
 Not following directions
 Immature Social Skills (Awkward Activities)
 Unclear Speech Production (Articulation Issues)
 Inattention
 Distractibility
 (Contd)

25.  Used to Play Alone at an age when other children
actively Play Together
 Limited Vocabulary
 Lack of Understanding of Idioms, Figurative
Language, Humour
 Lack of Readiness to Read
 Behaviour of Passivity (Never speaks up or takes a
Leadership Role with peers)

26.  Hearing Loss at Birth (Congenital Hearing Loss)
 Hearing Loss After Birth (Acquired Hearing Loss)
 Ear Infections (Otitis Media; Inflammation of the
Middle Ear characterized by the accumulation of
infected fluid in the middle ear, pain in the ear.)
 Noise
 Medications

27.  Hearing Loss from Birth
 Most congenital hearing loss can be identified within 1-2 days of
birth via hospital hearing screening.
 In the US, almost all babies have their hearing screened within a day
of being born.
 Approximately 1 0ut of 10 newborns who fail hearing
screening end up being diagnosed with hearing loss.
 Newborns who spend time in a neonatal intensive care unit (NICU)
have a greater chance of being identified with a hearing loss than
those children with no birth complications.

28.  Ear infections or Fluid behind the Eardrum is the
biggest cause of hearing loss in young children.
 During Preschool Hearing Screening, it is
important to identify the children who have a history of
Ear Infections, Hearing Loss in the family or
 Whose family members have been concerned about the
Child’s Hearing.

29.  While Hearing Loss Type is important the affect on a
patient’s life is often determined by the Degree of
Hearing Loss.
 In past, Audiologists used to define Hearing Loss
through a Percentage i.e. 20% loss, 50% loss etc.
 However, as Hearing Losses are not Flat and the
degree of loss may vary at different pitches. It has
become widely accepted practice to describe the hearing
loss based on a Classification System.
◦ (Contd)

30.  Mild Hearing Loss: Speech may be heard in Quiet, but
becomes difficult to understand when there is
Background Noise in the environment or when Speech
is at a Distance.
 Moderate Hearing Loss: Speech can be heard at a
normal level only in Quiet and in Very close Proximity.

 (Contd)

31.  Moderately- Severe Hearing Loss: Even in a quiet
environment speech must be loud in order to be heard,
understanding may be impaired even with this louder
signal.
 Severe Hearing Loss: Speech is very difficult to
understand in all situations.
 Profound Hearing Loss: Communication can be very
difficulty even with hearing aids.

32.  The prevalence of Early-onset Hearing Loss in most
Developed Countries is estimated to range between
2-4 infants with Moderate-Severe Hearing Loss in
every 1000 births.
 In contrast, only Limited Information is available
about Developing Regions, including the Middle East
especially in the Arab countries, where the prevalence
is estimated to be markedly higher (Attias et al., 2006).
 (Contd)

33.  In Developing Countries, More than 10 infants in
every 1000 Births are estimated to be affected by a
Severe Profound Hearing Loss.

 Of the 62 Million Deaf children younger than 15
Years old Worldwide, Two-Third are in the
Developing Countries (Smith, 2003).

34.  The negative impact of Hearing Loss on Older
Adults is significant (LaForge et al., 1992).
 Hearing Loss is associated with Depression,
Social Isolation, Poor Self-esteem, and
Functional Disability (Mulrow et al., 1990a),

35.  It is well recognized that Hearing is critical to Speech,
Language Development, Communication, and
Learning.
 The Earlier Hearing Loss occurs in a child's life, the More
Serious Effects on the Child's Development.
 Similarly, the Earlier the problem is Identified and
intervention begun, the Less Serious is the Ultimate
Impact on Child Development.

36.  There are Three main aspects in which Hearing Loss
affects children:
 1. It causes Delay in the development of Receptive and
Expressive Communication skills (Speech and
Language).
 2. The language deficit causes Learning Problems that
result in Reduced Academic Achievement.
 3. Communication difficulties often lead to Social
Isolation and Poor Self-concept.

37.  1. Vocabulary
 Vocabulary develops More Slowly in children confronted
with Hearing Loss.
 Children with Hearing Loss learn Concrete Words
like cat, jump, five, and red more easily than abstract
words like before, after, equal to, and jealous.
 They also have difficulty with function words like the, an,
are, and a.
 (Contd)

38.  (Vocabulary Contd)
 Children with Hearing Loss have difficulty in
understanding Words with Multiple
Meanings.
 For example, the word “Bank” can mean the
Edge of a river or stream OR a place where We
Take and Put Money.
 (Contd)

39.  2. Sentence Structure
 Children with Hearing Loss normally produce Shorter
and Simpler Sentences than children with Normal
Hearing.
 Children with Hearing Loss often have Difficulty in
Understanding and Writing Complex Sentences,
such as "The teacher whom I have engaged for math was
sick today.” or passive voice "The ball was thrown into the
water by Ahmad."
 (Contd)

40.  (Sentence Structure Continued)
 Children with Hearing Loss often cannot Hear word
endings such as s or ed.
 This leads to Misunderstandings and Misuse of
Tense, Pluralization, Nonagreement of Subject
and Verb.
 (Contd)

41.  3. SPEAKING
 Children with hearing loss often cannot hear quiet
speech sounds such as "s," "sh," "f," "t," and "k"
and therefore they do not include them in their
speech.
 Thus, their speech is always Difficult to
Understand.
 (Contd)

42.  (SPEAKING Continued)
 Children with Hearing Loss may not Hear Their
Own Voices when they speak.

 They may Speak Too Loudly.

 They may have a Speaking Pitch Too High.

43.  4. Academic Achievement
 Children with Hearing Loss have difficulty with all
areas of Academic Achievement, especially Reading
and Mathematical Concepts.
 Children with Mild to Moderate Hearing Losses,
on average, Achieve Grade Levels Lower than their
Peers with Normal Hearing, unless appropriate
management is followed.
 (Contd)

44.  (Academic Achievement Continued)
 The gap in Academic Achievement between children
with Normal Hearing and those with Hearing Loss
usually Widens with the Passage of Time as they
progress through school.
 The level of Achievement is related to Parental
Involvement and the Quantity, Quality, and Timing
of the Support Services provided to the children.
 (Contd)

45.  5. Social Functioning
Children with Severe to Profound Hearing Loss
often report Feeling Isolated, Without Friends,
and Unhappy in School, particularly when their
Interaction with other children with Hearing
Loss is Limited.
 These social problems appear are frequent in children
with a Mild or Moderate Hearing Loss than in
those with Severe to Profound Loss.

46.  Tinnitus refers to “Ringing in the
Ears" when no other sound is present.
 Tinnitus can sound like Hissing,
Roaring, Pulsing, Chirping,
Whistling, or Clicking.
 Tinnitus can occur in one Ear or
Both Ears.

47.  Yes.
 Almost Everyone at one time or another has
experienced Brief Periods of Mild Ringing or other
sounds in the ear.
 Some people have more Annoying and Constant
Type of Tinnitus.
 One Third of all adults Experience Tinnitus at some
time in their lives.
 (Contd)

48.  About 10%–15% of adults have Prolonged
Tinnitus requiring Medical examination.
 The Exact Cause of Tinnitus is often Not
Known.
 One thing is Certain; Tinnitus is Not
Imaginary.
 (Contd)

49.  No.
 Just as Fever or Headache
accompanies many different Illnesses,
 Tinnitus is a Symptom, Common to
Many Problems.
 If you have Tinnitus, chances are the
Cause will Remain a Mystery.

50.  Conditions that might cause Tinnitus include:
 Hearing Loss
 Loud Noise exposure
 Migraine Headaches
 Head Injury
 Medicines that are Toxic to hearing
 Anemia (Deficiency of the RBCs or Hemoglobin in the
blood, resulting in Paleness and Weariness).
(Contd)

51.  Hypertension
 Stress
 Too much Wax in the Ear
 Certain Types of Tumors
 Too Much Use of Coffee
 Chain Smoking

52.  During the day, the daily activities and the sounds
around you make your Tinnitus Less Noticeable.

 When your Surroundings are Quiet, your Tinnitus
can seem Louder and More Bothersome.

 Fatigue and Stress may also make your Tinnitus
Worse.

53.  Tinnitus is a Symptom of a Problem.
 The first thing is to find out its Underlying Cause.
 Medical Examination with special attention given to
Conditions Associated with Tinnitus.
 Full Hearing Evaluation by an Audiologist is
always right step to see if Hearing Loss may be
Causing Tinnitus.

54.  The most Effective Treatment for Tinnitus is to
eliminate the Underlying Cause.
 Tinnitus, in some cases, can be a Symptom of a
treatable Medical Condition.
 However, in many cases, the cause of tinnitus cannot
be identified, or Medical or Surgical Treatment is
not an option.
 In these cases, the Tinnitus can still be managed using
a variety of other methods.
 (Contd)

55.  Physical Examination:
 Physical Examination will focus on the Head and Neck,
and especially the Ears, including the Auditory Canals.
 A careful Neurologic Examination of the short Nerves
that lead directly from the Brain to the Face, Head and
Neck is needed.
 Weakness or Numbness in the Face, Mouth, and Neck
may be associated with a Tumor or other Structural
Abnormality Pressing on a Nerve.