Introduction

Hearing sensitivity is indicated by the quietest sound that an animal can detect, called the hearing threshold. In the case of humans this threshold can be accurately measured by a behavioral audiogram. A record is made of the quietest sound that consistently prompts a response from the listener. The test is carried out for sounds of different frequencies. There are also electro-physiological tests that can be performed without requiring a behavioral response. Normal hearing thresholds within any given species are not the same for all frequencies. If different frequencies of sound are played at the same amplitude, some will be perceived as loud, and others quiet or even completely inaudible. Generally, if the gain or amplitude is increased, a sound is more likely to be perceived. Ordinarily, when animals use sound to communicate, hearing in that type of animal is most sensitive for the frequencies produced by calls, or in the case of humans, speech. All levels of the auditory system contribute to this sensitivity toward certain frequencies, from the outer ear's physical characteristics to the nerves and tracts that convey the nerve impulses of the auditory portion of the brain. In humans, the term hearing impairment is usually reserved for people who have relative insensitivity to sound in the speech frequencies. The severity of a hearing loss is categorized according to the increase in volume that must be made above the usual level before the listener can detect it. In profound deafness, even the loudest sounds that can be produced by an audiometer (an instrument used to measure hearing) may not be detected. Totally Deaf comes next after profoundly deaf, these will have no reading at all. Another aspect to hearing involves the perceived clarity of a sound rather than its amplitude. In humans, that aspect is usually measured by tests of speech perception. These tests measure one's ability to understand speech, not to merely detect sound. There are very rare types of hearing impairments which affect speech understanding alone.

Defining hearing loss

When we speak of a person with normal hearing, we generally means that he has enough hearing to understand speech. Assuming that listening conditions are adequate, a person with normal hearing can interpret speech in every day situation without using any special device or techniques Hearing impairment It is a disability category labeled in IDEA indicating a hearing loss for which special education &related services are needed. Hearing loss exists on a continuum from mild to profound, and most special educator distinguish between children who are deaf & those who are hard of hearing Deaf A child who is deaf is not able to use hearing to understand speech. Even with a hearing aid, the hearing loss is too great to allow a deaf child to understand speech through the ears alone. Although a deaf may perceive some sounds through residual hearing, she uses vision as the primary modality for learning and communication.

Hard of hearing A child who is hard of hearing has a significant hearing loss that makes some special adaptation necessary. The child response to speech and auditory stimuli. In other words, the childs speech and language skills, though may be delayed or deficient, are developed mainly through the auditory canal. Children who are hard of hearing are able to use their hearing to understand speech, generally with the help of hearing aids.

Classification
There are two different types of hearing impairments, conductive hearing impairment and sensorineural hearing impairment. A third type is a combination of the two called mixed hearing loss. Hearing impairments are categorized by their type - conductive, sensorineural or both, by their severity, and by the age of onset. Furthermore, a hearing impairment may exist in only one ear (unilateral) or in both ears (bilateral). Conductive hearing loss A conductive hearing impairment is present when the sound is not reaching the inner ear, the cochlea. This can be due to external ear canal malformation, dysfunction of the eardrum or malfunction of the bones of the middle ear. The ear drum may show defects from small to total resulting in hearing loss of different degree. Scar tissue after ear infections may also make the ear drum dysfunction as well as when it is retracted and adherent to the medial part of the middle ear. Dysfunction of the three small bones of the middle ear; hammer, anvil and stapes may result in conductive hearing loss. The mobility of the ossicles may be impaired of different reasons and disruption of the ossicular chain due to trauma, infection or anchylosis may also result in hearing loss. Many of these conditions can be helped with surgery, and an air conduction hearing aid is often a good choice of treatment. However, in some cases such an aid is not possible to use. The most obvious reason is if the patient does not have any ear canals. Where to place the ear mould? A more common reason is in patients with chronic ear infections that drain continuously or start to drain when the ear canal is obstructed with an air conduction hearing aid mould. In these patients a direct bone conduction hearing device could be an excellent solution. An implant made out of titanium is placed in the bone behind the external ear and allowed to osseointegrate and an impedance-matched hearing aid can be attached. At present there are two such hearing aids on the market; the Baha 3 by Cochlear BAS and the Ponto by Oticon Medical. Sensorineural hearing loss A sensorineural hearing loss is one resulting from dysfunction of the inner ear, the cochlea, the nerve that transmits the impulses from the cochlea to the hearing centre in the brain or damage in the brain. The most common reason for sensorineural hearing impairment is damage to the hair cells in the cochlea. As we grow older the hair cells degenerate and lose their function, and our hearing deteriorates. Depending on the definition it could be estimated that more than 50% of the population over the age of 70 has an impaired hearing. Impaired hearing is the most common physical handicap in the industrialized world. Another common reason for hearing loss due to hair cell damage is noise-induced hearing loss. These types of hearing loss are often most pronounced in the high frequency range. This will often interfere with speech understanding, as it is in the high frequency range that we find the consonant sounds that are most important

especially in noisy surroundings. Head trauma, ear infections, tumours and ototoxic drugs such as gentamycine are other reasons for sensorineural hearing loss. Hair cells that are damaged cannot be replaced with any surgical procedure, though research with stem cell treatment is presently ongoing in many institutions. The clinical application of this will however not yet be available for many years. Protection from noise exposure is at present the only way to reduce the hair cell damage. Conventional air conduction hearing aids are often prescribed for patients with sensorineural hearing loss. The outcome with modern types of hearing aids is often excellent, but speech understanding could still be a problem in demanding situations. Total or near total sensor neural deafness could be the result of congenital malformations, head trauma or inner ear infection. In patients with total or near total deafness, an air conduction aid could not be used even if the drum and middle ear are normal. For these patients a cochlear implant could be a treatment option. This means that a thin electrode is placed into the cochlea and is stimulated electrically through a small microprocessor under the skin behind that ear. Mixed hearing loss Mixed hearing loss is a combination of the two types discussed above. Chronic ear infection that is a fairly common diagnosis could result in a defect ear drum and/or middle ear ossicle damages. Surgery is often attempted but not always successful. On top of the conductive loss a sensory component is often added. If the ear is dry and not infected an air conduction aid could be tried, but if the ear is draining a direct bone condition hearing aid is often the best solution. If the conductive part of the hearing loss is more than 3035 dB an air conduction device could have problems overcoming this gap. A direct bone conduction aid like the Baha or the Ponto could in this situation be a good option.

Age of onset
The age at which hearing loss occurs is crucial for the acquisition of a spoken language. Prelingual deafness Prelingual deafness is hearing impairment that is sustained prior to the acquisition of language, which can occur as a result of a congenital condition or through hearing loss in early infancy. Prelingual deafness impairs an individual's ability to acquire a spoken language. Children born into signing families rarely have delays in language development, but most prelingual hearing impairment is acquired via either disease or trauma rather than genetically inherited, so families with deaf children nearly always lack previous experience with sign language. Cochlear implants allow prelingually deaf children to acquire a spoken language with remarkable success if implantation is performed within the first 24 years.[3] Post-lingual deafness Post-lingual deafness is hearing impairment that is sustained after the acquisition of language, which can occur as a result of disease, trauma, or as a side-effect of a medicine. Typically, hearing loss is gradual and often detected by family and friends of affected individuals long before the patients themselves will acknowledge the disability.[citation needed] Common treatments include hearing aids, cochlear implants and learning lip reading.

Post-lingual deafness is far more common than pre-lingual deafness. Unilateral and bilateral hearing impairment Patients with Unilateral Hearing Loss or Single-Sided Deafness (SSD) have difficulty in:

hearing conversation on their impaired side localizing sound understanding speech in the presence of background noise.

In quiet conditions, speech discrimination is approximately the same for normal hearing and those with unilateral deafness; however, in noisy environments speech discrimination varies individually and ranges from mild to severe. A similar effect can result from King-Kopetzky syndrome (also known as Auditory disability with normal hearing and obscure auditory dysfunction), which is characterized by an inability to process out background noise in noisy environments despite normal performance on traditional hearing tests. See also: "cocktail party effect", House Ear Institute's Hearing In Noise Test. One reason for the hearing problems these patients often experience is due to the head shadow effect. Newborn children with no hearing on one side but one normal ear could still have problems.[4] Speech development could be delayed and difficulties to concentrate in school are common. More children with unilateral hearing loss have to repeat classes than their peers. Taking part in social activities could be a problem. Early aiding is therefore of utmost importance.

Causes
The following are some of the major causes of hearing loss. Age Presbycusis, the progressive loss of ability to hear high frequencies with increasing age, begins in early adulthood, but does not usually interfere with ability to understand conversation until much later. Although genetically variable it is a normal concomitant of aging and is distinct from hearing losses caused by noise exposure, toxins or disease agents.[5] Long-term exposure to environmental noise Populations of people living near airports or freeways are exposed to levels of noise typically in the 65 to 75 dB(A) range. If lifestyles include significant outdoor or open window conditions, these exposures over time can degrade hearing. The U.S. EPA and various states have set noise standards to protect people from these adverse health risks. The EPA has identified the level of 70 dB(A) for 24 hour exposure as the level necessary to protect the public from hearing loss and other disruptive effects from noise, such as sleep disturbance, stress-related problems, learning detriment, etc. (EPA, 1974).

Noise-induced hearing loss (NIHL) typically is centered at 3000, 4000, or 6000 Hz. As noise damage progresses, damage starts affecting lower and higher frequencies. On an audiogram, the resulting configuration has a distinctive notch, sometimes referred to as a "noise notch." As aging and other effects contribute to higher frequency loss (68 kHz on an audiogram), this notch may be obscured and entirely disappear. Louder sounds cause damage in a shorter period of time. Estimation of a "safe" duration of exposure is possible using an exchange rate of 3 dB. As 3 dB represents a doubling of intensity of sound, duration of exposure must be cut in half to maintain the same energy dose. For example, the "safe" daily exposure amount at 85 dB A, known as an exposure action value, is 8 hours, while the "safe" exposure at 91 dB(A) is only 2 hours (National Institute for Occupational Safety and Health, 1998). Note that for some people, sound may be damaging at even lower levels than 85 dB A. Exposures to other ototoxins (such as pesticides, some medications including chemotherapy, solvents, etc.) can lead to greater susceptibility to noise damage, as well as causing their own damage. This is called a synergistic interaction. Some American health and safety agencies (such as OSHA-Occupational Safety and Health Administration and MSHA-Mine Safety and Health Administration), use an exchange rate of 5 dB. While this exchange rate is simpler to use, it drastically underestimates the damage caused by very loud noise. For example, at 115 dB, a 3 dB exchange rate would limit exposure to about half a minute; the 5 dB exchange rate allows 15 minutes. While OSHA, MSHA, and FRA provide guidelines to limit noise exposure on the job, there is essentially no regulation or enforcement of sound output for recreational sources and environments, such as sports arenas, musical venues, bars, etc. This lack of regulation resulted from the defunding of ONAC, the EPA's Office of Noise Abatement and Control, in the early 1980s. ONAC was established in 1972 by the Noise Control Act and charged with working to assess and reduce environmental noise. Although the Office still exists, it has not been assigned new funding. Many people are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children's toys, transportation, crowds, lawn and maintenance equipment, power tools, gun use, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. If one is exposed to loud sound (including music) at high levels or for extended durations (85 dB A or greater), then hearing impairment will occur. Sound levels increase with proximity; as the source is brought closer to the ear, the sound level increases. Genetic Hearing loss can be inherited. Both dominant genes and recessive genes exist which can cause mild to profound impairment. If a family has a dominant gene for deafness it will persist across generations because it will manifest itself in the offspring even if it is inherited from only one parent. If a family had genetic hearing impairment caused by a recessive gene it will not always be apparent as it will have to be passed onto offspring from both parents. Dominant and recessive hearing impairment can be syndromic or nonsyndromic. Recent gene mapping has identified dozens of nonsyndromic dominant (DFNA#) and recessive (DFNB#) forms of deafness.

The first gene mapped for non-syndromic deafness, DFNA1, involves a splice site mutation in the formin related homolog diaphanous 1 (DIAPH1). A single base change in a large Costa Rican family was identified as causative in a rare form of low frequency onset progressive hearing loss with autosomal dominant inheritance exhibiting variable age of onset and complete penetrance by age 30.[6]

The most common type of congenital hearing impairment in developed countries is DFNB1, also known as Connexin 26 deafness or GJB2-related deafness. The most common dominant syndromic forms of hearing impairment include Stickler syndrome and Waardenburg syndrome. The most common recessive syndromic forms of hearing impairment are Pendred syndrome, Large vestibular aqueduct syndrome and Usher syndrome. The congenital defect microtia can cause full or partial deafness depending upon the severity of the deformity and whether or not certain parts of the inner or middle ear are affected. Mutations in PTPRQ Are a Cause of Autosomal-Recessive Nonsyndromic Hearing Impairment.[7]

Disease or illness

Measles may result in auditory nerve damage Meningitis may damage the auditory nerve or the cochlea Autoimmune disease has only recently been recognized as a potential cause for cochlear damage. Although probably rare, it is possible for autoimmune processes to target the cochlea specifically, without symptoms affecting other organs. Wegener's granulomatosis is one of the autoimmune conditions that may precipitate hearing loss. Mumps (Epidemic parotitis) may result in profound sensorineural hearing loss (90 dB or more), unilateral (one ear) or bilateral (both ears). Presbycusis is a progressive hearing impairment accompanying age, typically affecting sensitivity to higher frequencies (above about 2 kHz). Adenoids that do not disappear by adolescence may continue to grow and may obstruct the Eustachian tube, causing conductive hearing impairment and nasal infections that can spread to the middle ear. AIDS and ARC patients frequently experience auditory system anomalies. HIV (and subsequent opportunistic infections) may directly affect the cochlea and central auditory system. Chlamydia may cause hearing loss in newborns to whom the disease has been passed at birth. Fetal alcohol syndrome is reported to cause hearing loss in up to 64% of infants born to alcoholic mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the excess alcohol intake. Premature birth results in sensorineural hearing loss approximately 5% of the time. Syphilis is commonly transmitted from pregnant women to their fetuses, and about a third of the infected children will eventually become deaf. Otosclerosis is a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss. Medulloblastoma and other types of Brain Tumors can result in hearing loss, whether by the placement of the tumor around the Vestibulocochlear nerve, surgical resection, or platinum-based chemotherapy drugs such as cisplatin. Superior canal dehiscence, a gap in the bone cover above the inner ear, can lead to low-frequency conductive hearing loss, autophony and vertigo

Neurological disorders Neurological disorders such as multiple sclerosis and strokes can have an effect on hearing as well. Multiple sclerosis, or MS, is an autoimmune disease where the immune system attacks the myelin sheath, a covering that protects the nerves. Once the myelin sheaths are destroyed there is no possible way at present to repair them.

Without the myelin to protect the nerves, nerves become damaged, creating disorientation for the patient. This is a painful process and may end in the debilitation of the infected person until they are paralyzed and have one or more senses gone. One of those may be hearing. If the auditory nerve becomes damaged then the infected person will become completely deaf in one or both ears. There is no cure for MS.[8] A stroke occurs if there is a clot in the brain, and blood is unable to get to a section of the brain. Within minutes the oxygen-deprived cells begin to die, causing serious damage to the human body. Depending on what nerves are damaged, one of the side effects can be deafness.[9] Medications Some medications cause irreversible damage to the ear, and are limited in their use for this reason. The most important group is the aminoglycosides (main member gentamicin) and platinum based chemotherapeutics such as cisplatin. Some medications may reversibly affect hearing. This includes some diuretics, aspirin and NSAIDs, and macrolide antibiotics. Others may cause permanent hearing loss.[10] Extremely heavy hydrocodone (Vicodin or Lorcet) abuse is known to cause hearing impairment. Commentators have speculated that radio talk show host Rush Limbaugh's hearing loss was at least in part caused by his admitted addiction to narcotic pain killers, in particular Vicodin and OxyContin.[11] Exposure to ototoxic chemicals In addition to medications, hearing loss can also result from specific drugs; metals, such as lead; solvents, such as toluene (found in crude oil, gasoline[12] and automobile exhaust,[12] for example); and asphyxiants.[13] Combined with noise, these ototoxic chemicals have an additive effect on a persons hearing loss.[13] Hearing loss due to chemicals starts in the high frequency range and is irreversible. It damages the cochlea with lesions and degrades central portions of the auditory system.[13] For some ototoxic chemical exposures, particularly styrene,[14] the risk of hearing loss can be higher than being exposed to noise alone. Controlling noise and using hearing protectors are insufficient for preventing hearing loss from these chemicals. However, taking antioxidants helps prevent ototoxic hearing loss, at least to a degree.[14] The following list provides an accurate catalogue of ototoxic chemicals:[13][14]

Drugs
o antimalarial, antibiotics, anti-inflammatory (non-steroidal), antineoplastic, diuretics Solvents o toluene, styrene, xylene, n-hexane, ethyl benzene, white spirits/Stoddard, carbon disulfide, fuels, perchloroethylene, trichloroethylene, p-xylene Asphyxiants o carbon monoxide, hydrogen cyanide Metals o lead, mercury, organotins (trimethyltin) Pesticides/Herbicides o paraquat, organophosphates

Physical trauma There can be damage either to the ear itself or to the brain centers that process the aural information conveyed by the ears. People who sustain head injury are especially vulnerable to hearing loss or tinnitus, either temporary or permanent. I. King Jordan lost his hearing after suffering a skull fracture as a result of a motorcycle accident at age 21.

Characteristics of hearing impaired individuals

Hearing impaired children shows the following distinct behaviors as compared to normal children Lack of attention Turns or cocks head Uses gestures Lack of speech development Works best in small groups Monotone quality in voice Acts out Difficulty in following directions Preoccupied with things, not people Imitates others Responds to noises instead of words Reluctant to participate orally Motor Characteristics e.g. o May have a balance problems may in turn cause developmental delays and motor ability delays. These balance problems occur as a result of vestibular damage, not deafness. o May have a difficulty of motor speed (i.e., the time it takes the child to process information and complete a motor act).

Post-Secondary education of hearing impaired

During last 2 decades following passages of individuals with disabilities education act (IDEA), educational programme at the local & state level has increased dramatically. The primary goal of the legislation and subsequent reform was to ensure that all students share equal opportunities and assess to the samegeneralcurriculum. According to US department of education (1997), three times the number of young

people with disabilities are now enrolled in colleges & universities, however the department of education also acknowledges that many children with disabilities remain excluded from the general curriculum.

What is a Career?
The following definitions are important to an understanding of 'career' as a concept. A JOB is a paid position requiring a group of specific attributes and skills that enable a person to perform tasks in an organisation either part-time or full-time for a short or long duration. An OCCUPATION is defined as a group of similar jobs found in different industries or organisations. A CAREER is the sequence and variety of occupations (paid and unpaid) which one undertakes throughout a lifetime. More broadly, 'career ' includes life roles, leisure activities, learning and work. CAREER DEVELOPMENT is the process of managing life, learning and work over the lifespan. CAREER GUIDANCE is an inclusive term that has been used to describe a range of interventions including career education and counselling, that help people to move from a general understanding of life and work to a specific understanding of the realistic life, learning and work options that are open to them. Career guidance is often thought to incorporate career information, career education and career counselling The context for career decision-making When developing and presenting career education programs it is important to be aware of the context in which career development and career decision-making occur. Career decision-making is not simply matching a person to an occupation. There are many influences that impact on a person's career decisions. The following table lists these influences. Individual variables Self-concept Health Values Gender Interests Skills Age Beliefs Aptitudes Ethnicity Disability Sexual orientation Physical attributes World of work knowledge Social context Family Peers Community groups Media Socio-economic status Environmental context Political decisions Education institutions Geographical location Employment market Workplace Globalisation Historical trends Other factors Time perspective (past, present and future) Chance Change over time Recursiveness Interdependence of influences

MCEETYA definition of career education

The Australian Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) defines career education as: The development of knowledge, skills and attitudes through a planned program of learning experiences that will assist students to make informed decisions about their study and/or work options and enable effective participation in working life. Career education encompasses: learning about the world of work, its changing nature, the general expectations of employers, and the demands of the workplace developing self-awareness in relation to interests, abilities, competencies and values developing awareness and understanding of occupational information and career pathways developing skills in decision-making which can be applied to career choices Acquiring the skills necessary to implement the career decisions made.

What Is Career Planning?

Career planning is the lifelong process of investing resources to achieve your career goals. Career planning is not a singular event but a continuing process that is a necessity for adapting to the changing demands of the 21st Century economy. Whether we are in the early phase of our work life or are a workforce veteran, we have probably heard the term career planning. We have also probably heard that in the future we need to be responsible for our careers. What we may not have been told is what career planning is and how we do it! Career planning uses concepts similar to good financial planning. A good rule of thumb to keep in mind is that a disciplined investment, made on a regular basis, yields a greater return. Although the tactics will vary, career planning focuses on two key investment assets to manage throughout our working years, our personal lifelong learning and our network of relationships. Lifelong learning It is often surprising to realize how much of our day-to-day work is now based around technology. Computers and other scientific advancements have radically altered the way in which we conduct work. Even more amazing is the realization that there are more scientists alive today than ever before and the projected rate of change will increase tenfold in our children's lifetime. The ramifications of these advancements and innovations will ripple swiftly through the economy, obsolescing many businesses and catapulting others into the limelight. How well we are able to adapt to these ongoing innovations will be directly related to how current we keep our knowledge and skills. Consider how to vary your investments in time, energy and resources. Examples might include: credentialed coursework (locally or through distance learning), topical courses for certificates, joining cutting edge projects, attending conferences, or staying current in professional reading. Network of Relationships As we have moved to an information and service economy, relationships have become an increasingly critical asset. Not only do our relationships help us accomplish our day-to-day tasks with colleagues, vendors, customers and competitors, these relationships will be the source of information about how fields and

industries are evolving. We also have relationships outside of our work environments that may be affiliated with our hobbies, children, and spiritual or community networks. These personal and professional relationships will transcend specific companies, industries and communities. How we interact, respond and connect in all our relationships will impact our present performance and future opportunities. Very little is accomplished in isolation. Networking uncovers more than 70% of current job openings. Keeping connected and knowing how to build good relationships are more important than ever before. These skills can be developed in applied communication courses, mastering contact planning software, effective listening and genuine desire to get to know people better. Lifelong learning and relationship planning form the backdrop of successful career planning. Creating a vision and plan are also essential to guiding informed investment decisions and establishing annual goals. The career vision we establish should be broad enough to be flexible, but specific enough to be actionable. This career vision, built on a profile of our unique traits, directs our choices to develop what we need to be satisfied and be able to successfully contribute in different work environments over the years. To maintain our adaptability and employability, habitually establishing annual learning goals and nurturing our relationships are the keys to productive career planning.