Communication Sciences and Disorders A Clinical Evidence-Ba

Communication Sciences and Disorders: A Clinical Evidence-
Based Approach, 3e
Laura M. Justice and Erin E. Redle
© 2014, 2010, 2006 Pearson Education, Inc.
All rights reserved.
Chapter 13
Pediatric Hearing Loss
Based Approach, 3e
Justice and Redle
All Rights Reserved.
13-*
Focus Questions
What is pediatric hearing loss?
How is pediatric hearing loss classified?
What are the defining characteristics of prevalent types of
pediatric hearing loss?
How is pediatric hearing loss identified?
How is pediatric hearing loss treated in evidence-based
practice?
What is an auditory processing disorder, and how is it identified
and treated?

Based Approach, 3e
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IntroductionDeafness is a much worse misfortune [than
blindness] for it means that loss of the most vital stimulus – the
sound of the voice that brings language, sets thoughts astir, and
keeps us in the intellectual company of man. Helen Keller, 1933
Based Approach, 3e
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Case 13.1: LaurynLauryn has a behind-the-ear hearing aid in her
left ear but has not been fitted for one for her right ear. This is
due to structural abnormalities of her right ear. She has been
receiving speech-language and hearing intervention but is not
developing listening and language skills on par with her peers.
Options for her include:Surgically implantable bone-anchored
hearing applianceImplantable middle-ear hearing aidCochlear
implant
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Brainstorm and Discussion
If you were an interventionists working with Lauryn and her
parents, would you endorse a decision for repair? Why or why
not?
What challenges face children who are raised in the Deaf
community?
Based Approach, 3e
Justice and Redle
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What Is Pediatric Hearing Loss?Hearing lossRefers to a
condition in which a child or adolescent is unable to detect or
distinguish the range of sounds normally available to the human
ear.Auditory processing disorders (APD)Hearing loss resulting
from damage to the processing centers of the brain.
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DefinitionLocation of damage to the hearing
structures.OuterMiddleInner Because we have two ears, hearing
loss varies in whether it affects one or both
ears.BilateralUnilateralThe extent to which hearing acuity is
impacted.Congenial hearing lossAcquired hearing loss

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TerminologyHearing lossHearing impairmentHearing disorder
DeafnessHard of hearingDeafdeaf Deaf Community
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Prevalence and IncidenceThe reported prevalence of hearing
loss among children varies significantly, depending on the
criteria used to identify the loss. The term “educationally
significant” refers to a hearing loss that is serious enough to
impact a child’s ability to perform well
educationally.ImpactIntegration into the CommunityThe Deaf
CommunityCommunication Development
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ImpactHearing loss not identified early and addressed with an
appropriate communication approach can have far reaching

affectsAbility to develop relationshipsAbility to succeed
academicallyAbility to be involved with extracurricular
activitiesParental response is key
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Integration into the CommunityParents must
decideCommunication modeHow child will communicate;
speech or sign languageOrientationMember of oral or Deaf
community
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The Deaf CommunityIdentity is centered on shared attitudes and
a common languageIt is a social community based on a shared
set of beliefsA common belief is that deafness is an attribute
and not a deficiency
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Communication DevelopmentMost states have infant hearing
screening in placeFor those not identified early or provided an
effective means of communication, difficulties exist
in:VocabularyGrammarCommunicative intent and interaction
styleSpeech intelligibilityAcademic achievement
Based Approach, 3e
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How is Pediatric Hearing Loss Classified?
EtiologyTypically classified according to its etiology, its
manifestation and impact, and its severity.Genetic or
Environmental CauseAge of OnsetType of Loss
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Genetic or Environmental CauseGenetic and environmental
factors that can result in hearing loss are numerous, although in
many cases the specific cause is unknown. Autosomal dominant
hearing lossAutosomal recessive hearing loss

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Age of OnsetThe age of onset for hearing loss is typically
differentiated into developmental or acquired.
DevelopmentalPresent at birthAcquiredOccurs sometime after
birthPrelingualLoss occurring before language is
acquiredPostlingual Loss occurring after language is acquired
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Type of LossType of loss identifies the auditory structures that
are affected. Conductive hearing lossSensorineural hearing
lossMixed hearing lossIn classifying the hearing loss of a given
individual, experts consider all these sources of information--
cause of loss, age of onset, and type of loss.
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ManifestationClassified according to the aspects of audition that
are impacted. Some children with hearing loss experience loss

of hearing acuity.More problematic than a loss in acuity is a
decrease in auditory comprehension.
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SeverityHearing loss is also classified according to its severity,
using the decibel (dB) system. DecibelsStandard unit of sound
intensity.Represents the differences in loudness available to
human hearing, from the threshold of sound at 0 dB (the drop of
a pin) to the threshold of pain between 120 dB and 140 dB (a
fire alarm close to your ear).ThresholdAudiogram
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What Are the Defining Characteristics of Prevalent Types of
Pediatric Hearing Loss?3 Types of Hearing
LossConductiveSensorineural Mixed
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Conductive Hearing Loss
Defining characteristicsWhen sound is not conducted efficiently
through the outer or middle ear, the result is an attenuating, or
reduction, of the sound heard.Bone conduction
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Causes and Risk FactorsCausesMalformation of the outer and
middle earUnderdeveloped or missing ossiclesWax build
upOtitis mediaRisk factorsBiologicalEnvironmental
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Sensorineural Hearing LossDefining characteristicsMost
common type of hearing lossResults from damage to the cochlea
or the auditory nerve that travels from the cochlea to the
brainDecrease in overall loudness, speech perception and ability
to distinguish speech from background noise
Based Approach, 3e

Justice and Redle
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Causes and Risk FactorsMost often, sensorineural hearing loss
is congenital.Most influential factorsMaternal health during
pregnancyBirth processChild’s health at birthHereditary
factorsExposure to ototoxic medicationsDisease Leading
causesGenetics and heredityPregnancy relatedPostnatal disease
or injury
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Mixed Hearing LossWhen both conductive and sensorineural
loss exist.Typically includes a permanent reduction of sound as
well as additional temporary loss of hearing from the
conductive component.
Based Approach, 3e
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How Is Pediatric Hearing Loss Identified?Assessment for
hearing loss in pediatric population requires a multi-tiered

approach.The Assessment
ProcessReferralScreeningComprehensive audiological
evaluationEvaluation of assistive technologyThe Importance of
an Accurate Diagnosis
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ReferralPrograms, whose purpose is early diagnosis of hearing
impairment, are present in most states.Their goal is to detect
hearing loss at birth, while the infant is still in the
hospital.These toddlers and preschoolers should be
referred:Exhibit developmental delays in communicationHave a
hereditary predisposition to hearing lossDevelop diseases or
disorders that impact the auditory mechanismSchool-age
children are routinely screened.
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ScreeningScreening generally falls into two categories,
depending on the child’s age. Infant screeningAlso called
newborn hearing screeningCompleted at birthInvolve
specialized testingConventional hearing screeningBehavioral
testing

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Comprehensive Audiological EvaluationAssesses the
following:Type and degree of hearing lossSpeech discrimination
and auditory perception abilities in quiet and noisy
conditionsAny other concernsMajor tools for evaluationCase
history and interviewOther interview and observationOtoscopic
examinationAudiometryObjective measures
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Evaluation of Assistive TechnologyAudiologist works with the
child and family to determine the most appropriate avenue for
habilitation.Assistive technologyHearing aidsAssistive listening
devicesCochlear implants
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The Importance of Accurate DiagnosisHearing loss is an
invisible disorder; there is typically no outward physical sign
that a problem exists. Reasons for missing hearing lossProblems
in under- and over-identification
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How Is Pediatric Hearing Loss Treated in Evidence-based
Practice? Communication ChoicesAmplification and Listening
DevicesAural HabilitationFads and FallaciesOverview of
Effective Treatment Approaches
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Communication ChoicesThe overarching goal of all
interventions for pediatric hearing loss is the development of
healthy, socially and emotionally balanced individuals who are
able to integrate fully into society and lead productive
lives.Parental orientation in choice
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Amplification and Listening DevicesMany child with mild to
severe hearing loss are fitted with amplification
devices.Hearing aidsAssistive listening devicesCochlear
implants
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Aural HabilitationDefinitionTreatment strategies designed to
achieve fluent communication in the manual or oral
modalityGoalsEnsuring an appropriate listening
environmentMaximizing auditionSupporting listening
development
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Fads and FallaciesImportance of peer-reviewed, data-based
studies with rigorous scientific standards for efficacy and
safetyAuditory enhancement training (AIT)

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Overview of Effective Treatment Approaches
Infants, Toddlers, and PreschoolersEarly InterventionParental
InvolvementNaturalistic EnvironmentsSocial
InteractionFunctional Outcomes
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School-Age ChildrenIntervention PrinciplesAn Effective Means
of CommunicationSelf-AdvocacyLiteracy
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What Is Auditory Processing Disorder, And How Is It Identified
and Treated?A type of hearing loss that adversely affects an
individual’s processing, or interpretation, of auditory
messagesProblems occur in one or more of the following
aspects of auditory processing:Sound localization and

lateralization with both earsAuditory discriminationRecognition
of patterns of soundDifferentiation of the temporal aspects of
soundAuditory performance when the message is incomplete or
when competing acoustic signals are present
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Defining CharacteristicsDifficulty interpreting and processing
auditory information, even though hearing acuity is
intactCommon indicators of APD include:Behaves as if a
hearing loss is present although it is notShows problems
following complex, multi-step directionsExhibits difficulties
with reading and spelling performanceReveals degraded
listening and audition in noisy environments or with competing
auditory stimuliAppears to seek out visual cues from the
environmentHas a history of fluctuating hearing loss, including
middle-ear infectionsHas difficulty staying on task, finishing
assignments and working independently
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Causes and Risk FactorsNo specific cause is
unknownAssociated with other disordersDyslexiaAttention-
deficit disorderAutism spectrum disorderSpecific language

impairmentDevelopmental delay
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AssessmentNo gold standard for identifying the presence of an
auditory processing disorderThe assessment tasks examine
Sensitivity to the temporal ordering of soundsAbility to listen to
sounds when they are degraded or have other sounds
competingAbility to listen to different stimuli in both ears
simultaneously
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Treatment ApproachesCurrently, treatment for APD focuses on
reducing the symptoms of the disorder.The most common
symptoms cluster into four areas of
concern:BehaviorsLiteracyLinguistic abilityOrganization
Based Approach, 3e
Laura M. Justice and Erin E. Redle

All rights reserved.
Chapter 14
Hearing Loss in Adults
Based Approach, 3e
Justice and Redle
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Focus Questions
What is adult hearing loss?
How is adult hearing loss classified?
What are the defining characteristics of prevalent types of adult
hearing losses?
How is adult hearing loss identified?
How is adult hearing loss treated in evidence-based practice?
Based Approach, 3e
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IntroductionInvisible DisabilityHearing loss in adults often
emerges gradually with age.Can be mistaken for cognitive
decline or psychological issues. Untreated hearing loss can have
detrimental effects on an social-emotional, psychological, and
physical wellbeing.May resist seeking intervention for hearing

loss:A perception that the hearing loss is not severe
enoughConcerns about the costs associated with
treatmentNegative images associated with hearing aids
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Case Study 14.1: Mr. JohnsonMr. Johnson is 58 years old and
has been exposed to noise throughout his life, both in the
military and on his job. He has a mild to moderate sensorineural
hearing loss. His audiologist suggested counseling, fitting and
maintenance of hearing aids, some assistive listening devices
for home and office, and aural rehabilitation. He was fitted with
bilateral hearing aids. His quality of life improved with the
improvement in his hearing.
Based Approach, 3e
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Brainstorm and Discussion
What are some activities that Mr. Johnson and his family could
practice to promote better communication?
What are some approaches husbands or wives might use to
support their spouses as they seek intervention?

Based Approach, 3e
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What Is Hearing Loss?DefinitionDeviation or change for the
worse in either auditory structure or auditory function that
differs significantly from normal.If loss impacts person
negatively, it is considered a hearing handicap or a hearing
impairment.
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Definitions Three classifications of adult hearing
lossSensorineural LossConductive LossMixed LossTerms
RecruitmentTinnitusSignal-to-noise ratio (SNR) loss
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Social-Emotional, Psychological, and Physical ImpactHearing
loss goes undetected or untreated in more than 75% of adults
with hearing loss. Left untreated, it can impact hearing acuity

and clarity. Can have devastating effects on Social -emotional
well-beingPsychological well-beingPhysical
healthLifestyleEducational choicesVocational choices
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TerminologyHearing loss Objective; refers specifically to a
decrease in hearing acuity or clarity as a malfunction of the
hearing mechanisms. Handicap, disability, and impairment
References the impact of hearing loss on daily living
activities.PresbycusisHearing loss that occurs as a result of
agingAcquired from exposure to noise
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How Is Hearing Loss Identified?Hearing loss in the adult
population is classified in terms of:EtiologySeverity
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Etiology DefinitionIdentifies the area of the auditory pathway
or brain that is affected.Conductive loss is in the outer or
middle ear. Sensorineural loss is in either the outer ear, the
cochlea or the auditory nerve.
Based Approach, 3e
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SeveritySeverity of hearing loss ranges from mild to
profound.Typically defined using decibels (dB):-10 dB to 15
dB: Normal hearing16–25 dB: Slight loss26–40 dB: Mild
loss41–55 dB: Moderate loss56–70 dB: Moderately severe
loss71–90 dB: Severe loss>91 dB: Profound loss
Based Approach, 3e
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What Are the Defining Characteristics of Prevalent Types of
Adult Hearing Loss?Conductive SensorineuralMixed
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Conductive Hearing LossDefining characteristicsLess common
among adults than among children. Occurs when sound is not
conducted efficiently through the outer and/or middle
ear.Results in an attenuation of the sound. Creates a sense of
fullness or plugged ears.Causes a slight to moderate loss of
hearing in one or both ears. Amenable to medical or surgical
intervention.
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Causes and Risk FactorsCauses Cerumen blockageForeign
objects Otitis mediaDamage to outer- or middle-
earOtosclerosisRisk FactorsAccidents and traumaReduced
mental capacity (e.g. dementia and Alzheimer’s
disease)TermsMyringoplastyStapedectomy
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Sensorineural Hearing LossDefining characteristicMost common
type of hearing loss in adulthood.Results most often from

damage to the outer or inner hair cells of the cochlea. Outer hair
cell damage often results in difficulty with hearing acuity.Inner
hair cell damage results SNR loss. Results in both a decrease in
acuity and a loss of clarity, especially in noise.Person may
experience recruitment and/or tinnitusTreated with
amplification or other types of intervention.
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Causes and Risk FactorsCausesPresbycusis - a degeneration of
the inner ear and other auditory structures as a result of the
normal aging processNoise exposureFactors which influence
impact of noise exposure: The intensity of the noiseThe length
of exposure The use of hearing protectionThe recovery time
between exposuresOther forms of damage to the cochlea
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Causes and Risk Factors, Cont.Ototoxicity Common cause of
inner-ear damage Meniere’s Disease Long term disorder caused
by overproduction or underabsorption of endolymph, a fluid that
circulates in the inner earLabyrinthitisShort-term infection that
is treated medically VertigoDizziness Acoustic
NeuromasTumors on the auditory nerve

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Mixed Hearing LossDefinitionA combination of a permanent
reduction of sound and a temporary loss of hearing from a
conductive component.Can be the results of otitis media or a
buildup of cerumen with a sensorineural loss.
Based Approach, 3e
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How is Hearing Loss Identified?The assessment
processAudiometric screeningComplete hearing
evaluationAssessment for hearing aidsAural habilitation
assessmentThree categories of assessment tools: Observation
and self-assessment Conventional audiometryObjective
measurement
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The Importance of Accurate DiagnosisNegative consequences of
mismanaged hearing loss can affectGeneral well-
beingLifestyleInterpersonal relationshipsEconomic livelihood
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How Is Adult Hearing Loss Treated in Evidence-based
Practice?Human auditory system remains plastic throughout
life.Most effective treatment approach for adult hearing loss is
an individualized and comprehensive plan.CounselingFitting of
amplification devicesAural rehabilitatio n
Based Approach, 3e
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Limitations of Current ApproachesMost hearing aid recipients
received information focused on:Audiogram results
(78%)Reasons for the specific hearing aid selection (79%)Care
of the hearing aid (79%)Care of the hearing aid battery
(67%)Hygiene for the hearing aid and earmold (60%)Other
types of information was neglected:Involving spouses and
family (21%)Consumer resources and self-help groups
(195)Strategies to improve communication (17%)Strategies to
deal with hearing loss at work (13%)

Based Approach, 3e
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Assistive Technology
Hearing aidsDigitalBehind-the-ear (BTE)In-the-ear
(ITE)Directional microphones
Based Approach, 3e
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Assistive Listening Devices (ALDs)Telephone amplifiersStrobe-
light doorbellsAmplified or lighted fire alarmsTV earsVibrating
alarm clocksFM systems
Based Approach, 3e
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Cochlear ImplantSurgically implanted deviceCochlear
implantsMiddle-ear or mastoid implantsBrain-stem
implantsOptimal candidatesPostlingual deaf with moderately

severe to profound, bilateral SNRMarginal or no speech-
perception benefit from aidsGood health with no physical
abnormalities of head and neckAccess to optimal education and
rehabilitation services following implantation
Based Approach, 3e
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Aural RehabilitationLiving Well with Hearing LossExamine
communication breakdownsGoals of Aural
RehabilitationEvaluating communication partners’ roles in
conversationDetermining whether social rules are broken
Teaching strategies to facilitate communication and repair
breakdowns effectively
Based Approach, 3e
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Building Treatment PlansFive areas of rehabilitation (e.g.
FACES)Family/significant other participationAuditory skill
buildingConversation strategiesEducation and counselingSpeech
reading and visual cuesEducation topics regarding hearing
aidsFunction, use, and maintenanceUnderstanding of hearing
loss and impact on communicationRealistic expectations for
instrumentationSocial, emotional, and psychological
underpinnings of hearing loss

Based Approach, 3e
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Early Identification and InterventionScreening for hearing
lossExample questions:Does a hearing problem cause you to
attend religious services less often than you would like?Does a
hearing problem cause you to have arguments with family
members?Does a hearing problem cause you difficulty when
listening to the TV or radio?

Communication Sciences and Disorders A Clinical Evidence-Ba

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