Course: General Introduction to the Hearing Impairment (680)

Level: M.A/M.Ed in Special EducationSemester: Autumn, 2015

Total Marks: 100
Pass Marks: 40
ASSIGNMENT No. 1
Note:
Attempt all questions. Please avoid reproducing from book, your
own analysis and synthesis will be welcome. All questions carry equal marks.
Q.1
Explain:
(20)
a)
THRESHOLD OF HEARING
Threshold of Hearing
The measured threshold of hearing curve shows that the sound intensity required to
be heard is quite different for different frequencies. The standard threshold of
hearing at 1000 Hz is nominally taken to be 0 dB, but the actual curves show the
measured threshold at 1000 Hz to be about 4 dB. There is marked discrimination
against low frequencies so that about 60 dB is required to be heard at 30 Hz. The
maximum sensitivity at about 3500 to 4000 Hz is related to the resonance of
the auditory canal.

b)

TYPES OF ENVIRONMENTAL SOUNDS

In our surroundings,
environmental Sounds.

Sources

there

are

different

sources

emitting

various

Type of Environmental Noise

Examples

Transportation

aircrafts, trains, road vehicles, vessels

types

of

Industrial buildings

factories - machineries, air-conditioning systems

Commercial buildings

office buildings - air-conditioning systems restaurants air-conditioning systems, kitchen ventilating systems

Construction sites

site formation (e.g. excavation), piling, road work,

demolition, renovation

Domestic buildings

mahjong playing, hi-fi, musical instruments

Public places

open markets, streets, parks

Products

intruder alarms of buildings and motor vehicles

Q.2
DISCUSS THE EFFECTS OF EARLY DIAGNOSIS ON THE DEVELOPMENT OF
HIC? (20)
Answer:
There are two major reasons why it is valuable to detect an HIV infection as soon as
possible after it has occurred:
1. Early detection is good for people getting tested for HIV. HIV tests that
provide an accurate result sooner after infection may significantly reduce the
anxiety of not knowing that many people feel after they think they may have
been exposed to HIV.
For those who test HIV-positive, testing early may give them a better sense of how and
when they were exposed to HIV. It may also provide them with greater opportunities to
access services and support that will help manage their health and well-being. Another
distinct advantage of early diagnosis is that people can access anti-HIV treatment
before their immune systems have been severely damaged, which can also improve
their long-term health outcomes.
2. Early detection can help prevent new HIV infections. Research
demonstrates that almost half of new HIV infections may come from individuals
who have been newly infected. This may be because people who are newly
infected have significantly higher levels of the virus in their blood and genital
tracts, which may make HIV transmission more likely to occur. People who are
newly infected are also more likely to be unaware of their HIV status. Diagnosing
HIV infection early allows a person to make more informed decisions (such as
practicing safer sex and using drugs in a safer way). Research shows that when
aware of their status, most HIV-positive people do take steps to prevent HIV
transmission.
3. Being able to detect new HIV infections earlier is not only beneficial to people
seeking testing and to the service providers offering testing services, but may
also play a significant role in preventing further transmission of HIV within the
population.
Symptoms
Most people who have become recently infected with HIV will not have any
symptoms. They may, however, have a flu-like illness within a month or two after
exposure to the virus, with fever, headache, tiredness, and enlarged lymph

nodes (glands of the immune system easily felt in the neck and groin). These
symptoms usually disappear within a week to a month and are often mistaken
for those of other viral infections. During this period, people are very infectious,
and HIV is present in large quantities in blood, semen, and vaginal fluids.
More severe HIV symptomssuch as profound and unexplained fatigue, rapid
weight loss, frequent fevers, or profuse night sweatsmay not appear for 10
years or more after HIV first enters the body in adults, or within two years in
children born with HIV infection.
Diagnosis
Your health-care provider can diagnose HIV by testing blood for the presence of
antibodies (disease-fighting proteins) to HIV. It may take HIV antibodies as long
as six months after infection to be produced in quantities large enough to show
up in standard blood tests. For that reason, make sure to talk to your health-care
provider about follow-up testing.
Prevention
Because there is no cure or vaccine to prevent HIV, the only way people can
prevent infection from the virus is to avoid high-risk behaviors putting them
at risk of infection, such as having unprotected sex or sharing needles.
NIAID urges everyone ages 13 to 64 to get tested for HIV as part of their
routine health care. Catching HIV in its early stages can make a lifesaving
difference.
Treatment
NIAID and other researchers have developed drugs to fight both HIV infection
and its associated infections and cancers. In combination with early detection
through HIV testing, available HIV therapies can greatly extend years and
quality of life, and have resulted in a dramatic decrease in AIDS deaths in the
U.S.
NIH Research to Results.
The NIH is working to find new and effective ways to prevent HIV. Research is focused
on:

Behavioral strategies designed to increase condom usage, delay sexual activity

among young people, and reduce sexually transmitted infections, which can
make people more susceptible to HIV infection.
Using HIV medicines that can treat HIV as a way to prevent infection among
high-risk groups.
Microbicidesgels, creams, or foamsthat women could use to protect
themselves against HIV.
Developing a safe, effective vaccine against HIV infection.
Drug abuse intervention and treatment programs to prevent HIV transmission
among injection drug users.

Q.3
DESCRIBE THE DIFFERENT KINDS OF DEAFNESS EXPERIENCED BY
PEOPLE IN PAKISTAN.
(20)

Answer:
It is important to understand special education and the services being offered to
individuals who are deaf in light of research conducted in Pakistan. A brief historical
background of special education as well as the educational setting, curriculum and
instructional approaches used for deaf students are explained. Moreover, the
perception of Pakistani society about deaf people and their social emotional
adjustment is highlighted. At the end the current status of special education and deaf
education is presented.
KINDS OF DEAFNESS
A comprehensive audiologic evaluation must be completed in order to determine the
types and severity of hearing loss to make appropriate recommendations for each
patient. Pure tone and speech audiometry as well as the immittance test battery must
be completed, in addition to any additional assessments necessary for an exhaustive
profile of the hearing system. A balance test called electronystagmography (ENG)
might also be needed if dizziness or imbalance is also a complaint. Some patients who
are bothered by tinnitus only might have a complete tinnitus evaluation. Finally, the
audiologic data provides a clinical foundation for recommendations on hearing aids
and other assistive devices suitable for treating the types of hearing impairments
listed below.
In general terms, there are two types of hearing loss, conductive and sensorineural. A
combination of both is also seen as a mixed hearing loss. Each is discussed below.
KINDS OF DEAFNESS

Conductive Hearing Loss

Conductive hearing loss is caused by any condition or disease that impedes the
conveyance of sound in its mechanical form through the middle ear cavity to the inner
ear. A conductive hearing loss can be the result of a blockage in the external ear canal
or can be caused by any disorder that unfavorably effects the middle ear's ability to
transmit the mechanical energy to the stapes footplate. This results in reduction of one
of the physical attributes of sound called intensity (loudness), so the energy reaching
the inner ear is lower or less intense than that in the original stimulus. Therefore, more
energy is needed for the individual with a conductive hearing loss to hear sound, but
once it's loud enough and the mechanical impediment is overcome, that ear works in a
normal way. Generally, the cause of conductive hearing loss can be identified and
treated resulting in a complete or partial improvement in hearing. Following the
completion of medical treatment for cause of the conductive hearing loss, hearing aids
are effective in correcting the remaining hearing loss.

The audiometric profile that indicates a conductive hearing loss is the presence of airbone gaps (better hearing by bone conduction than by air conduction), excellent word
recognition at a comfortable listening level, and evidence of a middle ear dysfunction
on immittance. For situations where a blockage is noted in the external ear canal,
hearing testing is deferred until the canal is cleared.
Sensorineural Hearing Loss
The second type of hearing loss is called sensorineural hearing loss. This word can be
divided into its two components - sensory and neural - to allow us more clarity in
specifying the type of hearing loss. The comprehensive audiometric assessment and
supplemental tests can yield the information needed to differentiate between a
sensory and a neural hearing loss, although they can co-exist in the same ear. Neural
hearing loss is another name for retrocochlear hearing loss.
Sensorineural hearing loss results from inner ear or auditory nerve dysfunction. The
sensory component may be from damage to the organ of Corti or an inability of the
hair cells to stimulate the nerves of hearing or a metabolic problem in the fluids of the
inner ear. The neural or retrocochlear component can be the result of severe damage
to the organ of Corti that causes the nerves of hearing to degenerate or it can be an
inability of the hearing nerves themselves to convey neurochemical information
through the central auditory pathways.
The reason for sensorineural hearing loss sometimes cannot be determined, it does
not typically respond favorably to medical treatment, and it is typically described as an
irreversible, permanent condition. Like conductive hearing loss, sensorineural hearing
loss reduces the intensity of sound, but it might also introduce an element of distortion
into what is heard resulting in sounds being unclear even when they are loud enough.
Once any medically treatable conditions have been ruled out, the treatment for
sensorineural hearing loss is amplification through hearing aids.
Mixed Hearing Loss
A mixed hearing loss can be thought of as a sensorineural hearing loss with a
conductive component overlaying all or part of the audiometric range tested. So, in
addition to some irreversible hearing loss caused by an inner ear or auditory nerve
disorder, there is also a dysfunction of the middle ear mechanism that makes the
hearing worse than the sensorineural loss alone. The conductive component may be
amenable to medical treatment and reversal of the associated hearing loss, but the
sensorineural component will most likely be permanent. Hearing aids can be beneficial
for persons with a mixed hearing loss, but caution must be exercised by the hearing
care professional and patient if the conductive component is due to an active ear
infection.

Range of deafness
Mild deafness - people who are hard of hearing may have a little difficulty
following speech in certain circumstances, especially if there is a lot of
background noise, but can generally cope if the environment is favourable.
Moderate deafness - people with moderate deafness have some difficulty in
following speech in most settings, but can generally get a lot of help from
wearing a hearing aid.
Severe deafness - people with severe deafness hear no speech without the
help of a hearing aid.
Profound deafness - people who are profoundly deaf hear no speech, even
with the benefit of a hearing aid.
Q.4
POINT OUT THE DIFFICULTIES FACED BY THE TEACHER OF THE DEAF IN
EDUCATIONAL PERFORMANCE OF THE CHILDREN. SUGGEST THEIR SOLUTIONS
ALSO. (20)
Answer:
Teachers of regular schools
It was found that the teachers of the regular schools did not know much about
different aspects of deafness. Many teachers felt tense about how they would make
the deaf child understand their teaching. One teacher felt that the only place for the
deaf child was a special school and that the special school should not create problems
for the teachers of regular schools by encouraging integration. The other teachers
expressed sympathy for the deaf children, as they were different from normal children.
They felt that since deaf children have communication problems, it would be difficult
for them to understand the teaching, and to mix with other normal children. Bilek (5)
cites some reactions of teachers of regular schools, "How can I help a deaf child
without special training", "We are not specially trained - we need to know more", "If
hearing is their problem, how can I help?" Such reactions reveal that it is important to
work with the teachers of regular schools in order to broaden their experiences with
deaf children, so that they are able to facilitate the children's adjustment in their
school. Demonstration of hearing aids and the discussions, instead of lectures, helped
the teachers to understand the deaf child's position better. They were also encouraged
to ask many questions about communication patterns, and their problems, function,
and use of hearing aids and so on. All teachers felt that these programmes helped to
increase their knowledge about deafness.
Classmates of the integrated deaf child in regular schools
The responses from the classmates showed that they had some ideas about deafness
due to the impact of the media. The programme gave them an in-depth understanding
of deafness. Many children informed the author that they were happy to have learned
all this in an interesting way. They had a number of queries about the deaf child,
regarding the use and function of hearing aid and communication problems. They felt
that it was educative and that they would like to help the deaf children when they
need help. They also requested that similar programmes be started for other types of
disabilities. This programme also made one girl aware of her grandmother's problem
and thereby created a feeling of concern in her to help deaf people. The news about

the interesting programmes for the classmates of deaf children spread all over the
school and many other classes also requested the programmes to be repeated for
them. This experiment showed that it was more effective to create a desire among the
hearing children to help the disabled child rather than to pressurise them by
moralising.
Difficulties faced by teachers and their solutions:
Teachers need to make special considerations when teaching hearing-impaired
children. Much of the consideration involves common sense that sharpens through
close collaboration with the student, the students family, and the speech language
pathologist (SLP). The student and students family can certainly offer the teacher
support on a daily basis through constructive criticism of what is or isnt working for
the child in the classroom. The following are suggestions by Hall, Oyer, & Haas (2001)
for teaching hearing-impaired children:

Ensure the child has an optimal hearing and listening environment in the
classroom;
There should be minimal distance between the teacher and the child to
facilitate lipreading;
Face the child during all oral communication;
Ensure there is good lighting to reinforce clear sight of visual aids;
Dont exaggerate pronunciation as this will deter understanding;
Use as much visual information as possible to reinforce auditory information
provided;
Keep environmental noise to a minimum to keep from interfering with
listening devices; and
Teachers should frequently check to see that the listening devices are working
properly.

Teachers need to be sensitive to the social, academic, and emotional challenges a

child with hearing loss has in any given day. Extra energy is required in interpreting
information through lipreading that would otherwise be simply heard by children
without a hearing loss. There are extra steps in processing audio information that a
hard of hearing student needs to take in order to fully comprehend. The student with a
hearing device will use more energy in having to concentrate on sound from a direct
source like a teacher while blocking out environmental noise like the humming of lights
or air conditioners. A student with hearing loss will therefore expend much more
energy coping than a student without hearing loss.
Teachers need to be sensitive to the reality that there is usually more than one visual
thing happening at one time like a teacher talking while expecting students to take
notes of the lecture. Expecting a hearing impaired student to read lips and take notes
at the sam e time is not realistic. The main notes could be provided to that student
beforehand so that the student can focus on lip reading the lecture. Volunteer

notetakers could be assigned to support hearing impaired students

in the higher grades or university where notetaking is done on a
daily basis. Many hard of hearing students will also be required to
take more work home to prepare themselves for class material to be
covered the next day.
Hall, Oyer, and Haas (2001) suggest that teachers support hard of
hearing students by frequently checking to ensure the child
understands information provided in class. They provided an
alternative suggestion in assigning a hearing peer to assist the
hearing impaired child to be an active participant in school activities
for those times the teacher is preoccupied with other students.
Another suggestion was for the teacher to learn to read the childs
facial expressions in order to have feedback about his/her
understanding of material presented. This particular suggestion
takes some time as the teacher gets to know the student better
(p.147). In cases when the student doesnt understand what was
said, rephrasing with additional words relevant to what you want to
say can provide cues to aid speech comprehension. When
rephrasing, use words central to the main idea of the
communication. For example, if you are saying, You can get your
coat from your locker now, and the student doesnt understand, you could say,
Everyone is getting ready for the bus; you can get your coat from your locker now
(Kaveravek, 2002, p.16).
Schools havent extensively addressed environmental noise in the classroom despite
research revealing classroom acoustics as a problem. Too many classrooms have
been found to be excessively noisy and not appropriate for the learning of a hearingimpaired child using amplification (Ross, Brackett, & Maxon, 1991; Crandell, &
Smaldino, 1996). Background noise proves to have the greatest effects on the hearing
ability of children with mild hearing losses (Anderson, 1999). Therefore, teachers need
to be acutely aware of their teaching environment and adapt accordingly if possible.
Adaptations can start with basic things like ensuring heating and air conditioning
systems, fans, and lights are all working properly to alleviate unnecessary vibrations or
hums in the class (Kaderavek, 2002, p.16). Anything the teacher can use to absorb
noise in the classroom becomes an asset for a hearing-impaired child.

Teachers need to maintain close communication with the SLP in

order to receive guidance and consultation that can help in
increasing the childs success in the classroom. The teacher
should be fully informed about a hearing-impaired childs
performance standards and potential in order to develop a
program with realistic goals for the child to achieve (Hall, Oyer, &
Haas, 2001, p. 147).
Hearing impaired students face many challenges in our audio
saturated world. Educators need to be aware and sensitive to
those challenges when developing school programs. Ignorance of
these challenges only leads to frustration for the hearing
impaired student that could lead to classroom management
problems for the teacher. Environmental noise is one of those
challenges that schools need to address more seriously because
interferes so much with support for hearing-impaired students.
Teacher
awareness
comes
from
maintaining
close
communication with the student, the parents, the SLP, and
community agencies. This communication is imperative in
developing proper support services for the child.

it

Overall, there has been substantial progress in assistive technology and support
services that offer hearing impaired people and organizations a much wider range of
options to choose from when designing therapeutic goals to facilitate their lives.
Q.5
HOW IS MEASUREMENT OF HEARING CARRIED OUT AND RECORDED?
EXPLAIN WITH EXAMPLES.
(20)
Answer:
How is hearing measured?
Hearing is an important sense for most animals. However, all animals do not hear all
sounds. For example, humans can't hear the sound a dog whistle makes, but dogs can
hear that sound. Most marine mammals can hear sounds that humans can't hear.
What sounds we, or a marine animal, can hear depends on thefrequency of the sound
and the intensity of the sound. For humans, the sounds we hear best are those used
in conversation. The sounds animals hear best are critical for survival like the sounds
of predators, prey, and mates.
You may have had a hearing test. The person being tested sits in a very quiet room
with headphones. Sounds are played at different frequencies and intensities, and the
person indicates when they hear a tone. This is called a behavioral hearing test

Person having
a hearing test. The device in their hand is used to signal when they hear a tone. Image
from National Institute of Heath.
Behavioral hearing tests are conducted on animals that can respond if they hear a
sound. In many instances, however, animals cannot respond, such as newborn babies
or untrained animals. Another method for measuring hearing is by recording electrophysiological responses of the auditory system. The response of the auditory
system is estimated based on the electrical activity of different parts of the central
(brain) auditory system. Small electrodes placed on the surface of the animals head
record the voltage produced when sounds of different frequencies and intensities are
played. To actually test the ear itself, an electrophysiological test of the cochlea (inner
ear), called an Oto-acoustic Emission" test or OAE, can be conducted. In this test, a
probe that contains a microphone and a speaker is placed in the ear. Sounds are
generated by the probe and sounds the come back from the cochlea are recorded.

An
electro-physiological
hearing
(www.dhss.mo.gov/NewbornHearing/)

test

on

newborn

baby.

These types of hearing tests determine what frequencies and sound levels can be
heard at the time of the test. This information can be displayed in an audiometric

curve (see figure below). An audiometric curve shows the range of sounds that
humans can hear, with frequency on the x-axis and sound level or intensity on the yaxis. In the figure below, the hearing of many individuals has been summarized to
show the sounds that humans with normal hearing are able to hear (light green area),
in the context of where human speech falls (dark green area).

An audiometric curve shows the range of sounds that humans can hear. It is bound
on the bottom by the hearing threshold and at the top by the perception limit.

(/www.neuroreille.com/promenade/english/sound/sound.htm)
The softest sound that an animal can hear at a specific frequency is called the hearing
threshold. In the audiometric curve above, the hearing threshold defines the lower
limit of what can be heard. Anaudiogram, or hearing curve, shows the sound level
required for an animal to just detect sounds across the frequencies that it can hear.
Audiograms are often displayed differently for humans than for other animals. Human
audiograms often plot the threshold of hearing relative to a standardized curve
representing normal hearing. Therefore, the units of the y-axis are decibels hearing
level, cited as dB HL. Below is an audiogram for a human. The red Os represent
hearing in the right ear, the blue Xs represent hearing in the left ear. Normal hearing
is classified as being between -10 dB HL and 15 dB HL.

A human hearing curve showing hearing loss above 500Hz in both the right (red "O"s)
and left (blue "X"s) ears. Image adapted from OSHA.
As humans get older, it is common to lose hearing at higher frequencies. The graph
below illustrates hearing loss for an older person. The green shaded area represents
the hearing loss, indicating that louder sounds are needed at these frequencies in
order for the person to hear them. The greater the number, the higher the degree of
hearing loss. The blue area of the graph is called the speech banana. It shows the
frequencies and sound levels of typical speech sounds.

An audiogram showing the area of typical hearing loss in an older person (green
region). The blue region is called the "speech banana" and shows the area of common
parts of speech.
Of people aged 23 to 44 years old, 23% have some hearing loss. This increases to 43%
for people 65 years old and older. Typically, only people under the age of about 20
years old can hear at 17,000 Hz or higher. You can test the highest frequency you can
hear at this website: http://www.ultrasonic-ringtones.com/. You can also hear what it
sounds like to have mild and moderate age-related hearing loss at this website:
http://facstaff.uww.edu/bradleys/radio/hlsimulation/
An audiogram for a beluga whale is shown below. It is different from the human
audiogram because sounds are plotted relative to a reference pressure of 1
microPascal. The shaded region above the curve represents sounds that a beluga can
hear. Below the curve, sounds are inaudible; that is, they cannot be heard by beluga
whales. The lowest point on the curve indicates the frequency where the animal can
hear best, about 40,000 Hz for beluga whales as shown in the figure below.

Hearing threshold curve for the beluga whale. The vertical y-axis is relative (threshold)
intensity in dB re 1 Pa. The horizontal x-axis is the frequency of sound on a
logarithmic scale in Hz. The lowest point on the curve indicates the frequency where
the animal can hear best, about 40,000 Hz for beluga whales, as shown in the pink box
on the x-axis.
Every hearing animal has a best frequency range of hearing. This range usually has
some practical biological and/or energetic significance. For example, humans hear best
in the frequency range of speech because it is most important for us as apex predators
to hear and understand one another. For the beluga whale, the frequency of best
hearing occurs at the upper end of their communication range and the lower end of
their echolocation range.