Unilateral Hearing Loss in the Classroom

 

Many students who receive itinerant services, either direct or consult, from an itinerant teacher for deaf/hard of hearing students, have a unilateral hearing loss.

 

Possible effect on understanding language and speech:

         

Child can "hear" but will have difficulty understanding in certain situations, such as hearing faint or distant speech, especially if weaker ear is closer to the person speaking.

Will usually have difficulty localizing sounds and voices using hearing alone. The unilateral listener will have greater difficulty understanding when environment is noisy and/or reverberant, especially with normal ear toward the overhead projector or other sound source and poor hearing ear toward the teacher.

Exhibits difficulty detecting or understanding soft speech form the side of the poor hearing ear, especially in group discussions.

 

Possible psychosocial impact:

 

Child may be accused of selective hearing due to discrepancies in speech understanding in quiet versus noise.

Social problems may arise as child experiences difficulty understanding in noisy cooperative learning, lunch, or recess situations.

May misconstrue peer conversations and feel rejected or ridiculed.

Child may be more fatigued in classroom setting due to greater effort needed to listen, especially if class is active or has relatively poor acoustics.

May appear inattentive, distracted, or frustrated, with behavior or social problems sometimes evident.

 

Potential educational accommodations and services:

 

Allow child to change seat locations to direct the better ear toward the most effective listening position.

Student is at risk for educational difficulties as half of students with unilateral hearing loss experience significant learning problems.

Often have difficulty learning sound/letter associations in typically noisy kindergarten and first grade settings. Educational monitoring is warranted.

Children with unilateral hearing loss (UHL) can be at risk for academic, speech-language, social, and emotional problems, and often require special services to address these needs. Approximately 16 to 19 out of every 1,000 school-aged children have UHL (Brookhauser, Worthington, & Kelly, 1991).

Children with UHL do not have the advantages of binaural hearing, and consequently have difficulty localizing sounds, detecting/understanding speech directed to the impaired side, and understanding speech in noisy and/or reverberant environments (Bess et al, 1986).

Based on available evidence, the Center for Childhood Communication (CCC) at The Children's Hospital of Philadelphia (CHOP) has established the following guidelines for the management of children with UHL.

Audiologic Evaluations

A complete comprehensive audiologic evaluation during the initial assessment includes: air and bone conduction threshold assessment, speech reception thresholds, measures of word recognition ability, tympanometry, ipsilateral and contralateral acoustic middle ear muscle reflex threshold assessment, and evoked otoacoustic emission testing. In addition, children are administered several functional outcome measures (SIFTER, Preschool SIFTER, CHILD). Frequency-specific auditory brainstem response (ABR) evaluation is completed for young children who cannot be tested reliably with behavioral measures; high-level click-ABR is used to determine whether the UHL is sensory or neural.

Medical and Non-Medical Evaluations

Evaluations by specialists in otolaryngology, ophthalmology, genetics, speech-language pathology, and early intervention are recommended. A neurologic evaluation is recommended when retrocochlear hearing loss is suspected. All families are provided resources including written materials on strategies to help their child at home and at school.

Candidacy for Amplification

Criteria for hearing aid (ear-level, advanced technology; DSL prescriptive approach) candidacy include:

  • children 3 years of age or older (younger children are considered candidates for amplification only when ear and frequency-specific threshold information is available)
  • mild to moderately severe (25 to 65 dB HL) sensory or permanent conductive hearing loss in one ear
  • useable word recognition in the affected ear

FM systems are recommended for all children with UHL including those with severe to profound hearing loss or poor word recognition abilities. Bone conduction and CROS (contra-lateral routing of signal) systems are not standard recommendations, but may be considered on a case-by-case basis if deemed appropriate.

Unilateral Hearing Loss: Tips for Parents

Infants with unilateral hearing loss are being identified within the first few months of life subsequent to the newborn hearing screening test before hospital discharge. Approximately 2 babies in every 1000 births have a unilateral hearing loss. There are many strategies parents can use to enhance their child's listening skills. There are also specific changes than can be made to the home environment to make listening easier for your child.

"Why does a unilateral hearing loss make it more difficult for my child to hear?"

  • Hearing in noise: The important sound, often the speech of the caregiver, is harder to hear and not as clear.
  • Finding or localizing a sound: For most children, it is difficult to find a sound when you don't hear the same way in each ear
  • :Language development: Children say what they hear. If a child doesn't hear speech clearly, it may be more difficult for the child to develop clear speech.
  • Attending to auditory information: Soft voices and deep voices may be more difficult for a child to understand.

What strategies can I use at home to make listening easier for my child?

  • Move away from noises when you want your child to listen to you.
  • Position your baby so that the normally hearing ear is directed toward the sound you want the child to hear.
  • When you want your child to hear you, notice if there are other sounds around you. Try to make the environment quieter so that your child will hear you better.
  • When you are talking to your baby, minimize the distance between you. Come even closer in a noisy environment.

How can I speak to my baby to make my words clearer?

  • Make your speech a little louder by getting closer to your baby.
  • Provide visual clues when you speak or make a sound by letting your baby see your lips. Be sure there is good lighting, and add gestures.
  • Get your child's attention and then start to talk.
  • Provide occasional pauses in what you say to allow more time for your baby to understand the message.
  • Place more emphasis on key words in a phrase.

Parents can carefully observe their child and note any warning signs that hearing loss is affecting development. Consider these tips:

  • If your child has an ear infection, go to your doctor right away. An ear infection may make it harder to hear in the good ear.
  • Have your child's hearing tested on a regular basis as recommended by your audiologist.
  • Have an assessment of speech, communication, language and functional hearing every 6 months to check your child's development in these areas.
  • Obtain help from an early interventionist who can teach your family specific techniques to help your baby hear.
  • Learn some strategies to develop good listening skills in your child (called auditory training)

 

UNILATERAL HEARING LOSS TIPS

P       PREFERENTIAL SEATING:  GOOD EAR TOWARDS SPEAKER

Allow child to change seat locations to direct the normal hearing ear toward the primary speaker.

Movement from one area of a room to another as activities change is also part of preferential seating.  This allows access to his/her peers both auditorally and visually.

Obtain student's attention prior to speaking (specially in noisy situation) Difficult for student to localize direction of sound/speech. 

3.    Face the student when using a blackboard and visual aid, even when wearing a microphone for an FM system.  Speak clearly and in a natural tone of voice.  Do not speak while walking around the room.

 Use visual aids as much as possible. Use the board, maps, charts, illustrations and captioned movies.

 Check for comprehension frequently.  Do not accept a nod or a smile as an indication of understanding. 

 Emphasize important information such as test directions, assignments, projects or schedule changes by writing details on the chalkboard and or providing handouts.

  Assign a "peer" buddy to assist keeping the student on track.

 Please remember the student will not be able to hear students who are seated far away when correcting homework or test papers.  Give the student the answer sheet to correct his/her work.

 Please provide context clues when giving spelling test.

FACTS ABOUT Unilateral Hearing Loss

A unilateral hearing loss affects only one ear. The amount of loss in that ear can range from mild to total hearing loss. If the loss is mild, it is still possible to hear some sounds, but if the hearing loss is total, even very loud sounds will not be heard in that ear.

 

Affects of a Unilateral Hearing Loss

Because one ear still has normal hearing, a child will hear well in most situations, but may experience problems with the following:

Although some children with unilateral hearing loss receive benefit from the use of a hearing aid, a standard hearing aid may not be helpful when the hearing loss is more severe.

Causes of a Unilateral Hearing Loss

A unilateral hearing loss can be present at birth or it may develop later in life. It may be hereditary or caused by problems during pregnancy or delivery. Among the causes are illnesses (such as meningitis and mumps) and serious ear infections.

When a unilateral hearing loss is suspected, it is important to see an audiologist for a complete hearing evaluation to determine the exact degree and type of hearing loss. It is also important to see an otolaryngologist, a physician who specializes in diseases of the ear. The doctor will determine if the hearing loss is medically treatable and whether or not it is associated with any other health problems.

Affects of a Unilateral Hearing Loss on School Performance

Many children with unilateral hearing loss do well in school and their performance remains unaffected by the loss. However, recent studies suggest that 25-35% of children with unilateral hearing loss are at risk for failing a grade in school.

These children may be distractible or have a limited attention span. They may also have problems following directions or show signs of fatigue as the school day progresses.

Your child's teacher should be made aware of the hearing loss so that classroom performance can be closely monitored. If hearing problems are causing academic problems, an involved teacher can help to make sure that this is discovered as soon as possible.

In the classroom, your child's normal hearing ear should be closest to the teacher or main sound source. This might mean changing seats for different classroom activities.

Limiting background noise will make it easier for your child to hear and understand speech. Common noise sources in classrooms include air conditioners, fans, heating units, doors, group work by other children, computer terminals, and pencil sharpeners. Any noise in a classroom is made worse by the reverberation or "echo" caused by hard floors and walls.

If you and your child's teacher feel your child is having difficulty hearing in school, there are assistive listening devices that might help. The audiologist will be able to discuss this with you in detail.

Unilateral Hearing Loss and a Child's Safety

A unilateral hearing loss makes it difficult to tell what direction sound is coming from. For this reason, it is important to teach your child to rely more on vision than on hearing in hazardous situations. Teach your child to look carefully both ways before crossing the street. Put rear-view mirrors on your child's bicycle to help him or her detect approaching vehicles.

Unilateral Hearing Loss and the Child's Better Ear

In most cases of unilateral hearing loss, the better ear stays the same. It is important, however, to take precautions to protect your child's hearing. There are several steps you can take: