Conductive Hearing Loss Impacts on hearing, listening and language for ESL students Supporting Student Learning: It's E

1. Conductive Hearing LossImpacts on hearing, listening and languagefor ESL studentsSupporting Student Learning: It's Everybody's Business SSD Hearing Team Hearing Team Coordinator – Denyse Bainbridge Alice Springs/Barkly – Craig Rawlinson Arnhem – Lynnette Rosenberg Katherine – Denyse Bainbridge Darwin – Christine Walmsley Palmerston - Liz Fisher

2. Anatomy of the Ear

3. Anatomy of the Ear Ossicles: Semicircular Canals Pinna Hammer, Anvil, Stirrup Auditory (or Cochlear) Nerve Vestibule External Auditory Canal Cochlear Inner Ear Tympanic Membrane (Ear Drum) Outer Ear Middle Ear Eustachian Tube (to nose and throat)

4. Conductive Occurs in outer and middle ear Fluctuating Mild - Moderate Medical treatment Amplification Sensori-Neural Occurs in inner ear Permanent Mild – Profound Cochlear Implant Amplification Sign Language Types of Hearing Loss Mixed Loss Auditory Processing PD Available to schools

5. Middle Ear Problems

6. Middle Ear Problems Otitis Media • Otitis media is a complex chronic disease in the NT • Has associated preventable hearing loss ranging from mild to severe • Indigenous babies are high risk for chronic deterioration (worst hearing) • Extended periods of hearing loss beginning at 2-3 months of age • Cumulative factors increase disabling consequences including poverty, overcrowding, pre-lingual onset, support (home and education) and bilingual ESL home environment • Otitis media deteriorated state is established during early childhood (<3 years) but hearing loss may continue if still active causing • No clinical evidence of improved prevalence of hearing loss and otitis media for generations in NT Normal Air air filled and intact eardrum Chronic perforation Effusion Fluid filled and intact eardrum Chronic Pus (CSOM) staph and pseudomonas Acute Infected fluid and bulging eardrum Acute & perforated

7. NT audiology assessment information Environment – acoustics, amplification & strategies Australian Institute Health Welfare (AIHW) data on child health check follow up from NT Emergency Response June 07 Individual amplification, classroom acoustics and ISA 1447 1132 670 573 343 16 Number Children NTER Audiology Data 3165 total children tested (35%) 42% referrals 1244 referrals DET

8. Middle Ear Problems Eustachian Tube Dysfunction

9. Middle Ear Problems Otitis Media

10. Middle Ear Problems

11. Audiometric Report PD Available to schools

12. Audiograms • Audiogram is a graph • Shows threshold of hearing ie softest sound that a person can hear at that pitch Frequency Pitch Hertz (Hz) Intensity Loudness Decibels (dB)

14. Fletcher • Speech spectrum • Where sounds in isolation approximately occur • Examples of where environmental sounds occur

15. Low Frequencies Low Frequencies - Hertz (Hz) 125 250 500

16. Low Frequency Low Frequencies 125 Hz, 250 Hz, 500 Hz ah, e, a, u, o, n, v, r, j This is wht it’s like t hv a l frqunc lss.

17. Audiogram

18. Middle Frequencies Middle Frequencies – Hertz (Hz) 1000 2000

19. Middle Frequencies • Middle Frequencies 1000 Hz, 2000 Hz d, l, m, z, q, w, This is at it’s ike to have a oss in the ile freencies

20. Audiogram

21. High Frequencies • High Frequencies 4000 Hz, 8000 Hz • Sounds h, s, t, sh, ch, k, p, f, th

22. High Frequencies • High Frequencies 4000 Hz, 8000 Hz h, s, t, sh, ch, p, f, th i i wa i ik o av a i requeny los

23. Audiogram

24. Intensity of Sound • Loudness is measured in decibels (dB)

25. normal hearing mild loss moderate loss moderately severe loss severe loss profound loss

26. Audiometric Report Mild (20-40dBHL) - Difficulty with hearing quiet speech - Amplification may assist - Should be able to hear 2/3 of speech – all vowels and most loud consonants - Difficulty with listening if classroom environment is noisy

27. Audiometric Report Moderate (41-70 dBHL)  - May have difficulty understanding conversational speech - Should benefit from hearing aids - Should hear about1/2 of the speech area, most vowels and louder consonants - Difficulty with listening if classroom environment noisy - May use lip reading to assist with understanding

28. Audiometric Report • AGI – Australian Government Intervention • Different format of report • Easier to identify hearing problems • May get this format in remote communities PD Available to schools

29. Categories of Hearing Loss cont. Sensori-neural Hearing Loss only Severe (71 – 90dBHL) - May hear loud voices close to ear but will have difficulty understanding speech without a hearing aid - Sign language may be beneficial to assist with language learning - Can hear virtually no speech sounds without amplification Profound Hearing Loss (91dBHL onwards) - May have limited awareness of loud conversation only with hearing aids - Sign language may be beneficial to assist with language learning - May be able to learn to use hearing aids effectively to help understand speech through lip reading - May be able to hear sounds, but not identify them through hearing aids

30. Fletcher • Speech spectrum • Where sounds in isolation approximately occur • Examples of where environmental sounds occur

31. Classroom Acoustics Sound or Noise? • What is sound? Sound is what we hear. Sound may be pleasant or unpleasant. Sound is measured in dB and travels in waves. • What is noise? Noise is unwanted sound. • How is sound in a room measured? Sound Level Meters give a reading in dBs. PD Available to schools

32. Classroom Acoustics • Signal to Noise Ratio (SNR) • Description The SNR is the difference between the intensity of the signal and the intensity of the background noise. For a student to hear well the teacher’s voice should be about 15 to 20dB louder than the background noise. The greater the SNR the better. Younger children need a better SNR than older children. • Measurement First measure the level of background noise using a sound level meter. Next measure the teacher’s voice while talking to the class at a distance of about 2 metres.

33. Acoustic Measurements Type of measurements The amount of ambient noise (35dB) The reverberation of sound (0.4 sec) The audibility of the teachers voice (+ 15db signal/noise)

34. Classroom Acoustics • Sources of background noise include: • traffic and aircraft • playgrounds • corridors • adjacent classrooms • maintenance work /leaf blower/mower • classroom equipment • fans • air-conditioners • fridges/running taps • computers • radio / CD player • chairs without stoppers on the legs Background Noise 45 dBA is the maximum level recommended by Australian Standard for an empty classroom - AS2107. (35dBA in the United States)

35. Classroom Acoustics Reverberation • Reverberation is one factor that contributes to background noise in the room. • It is the reflection of sound from surfaces in a room. • Hard surfaces reflect sound more. • Soft furnishings such as carpet and curtains can reduce reverberation and noise in a room. If your school is being refurbished please consult with the hearing team.

36. Classroom Acoustics Distance • The distance between the teacher and student directly affects % of speech discrimination by the child. • Seating arrangements should be carefully considered by teachers. • An ideal seating configuration is a semi circle or u shape formation so that students can see the teachers face clearly as well as that of other students.

37. Classroom Acoustics Consequences of noise • Teacher vocal fatigue • Teacher repeating instructions • Teacher and student stress • The room seems noisy even when students are on task • Learner short attention span and high distractibility • Poor classroom behaviour • Poor academic performance

38. Classroom Acoustics Classroom Strategies • Reduce background noise. • Establish clear and defined listening protocols in your room • Ensure you do not stand in front of a window. The glare from the window casts your face into shadow and makes speech reading difficult • Don’t talk and write on the board at the same time • Encourage a circle formation when students are sitting on the floor • Gain students’ attention first by auditory and visual cues before speaking • Speak clearly and naturally, rephrase rather than repeat directions when necessary • Avoid tasks that require divided attention • Use visual aids wherever possible • Ensure instructions are understood by asking questions such as “What do you need to do now?” rather than “Did you hear me?” • Do not give too many instructions at once - be aware of the auditory memory of your students

39. Hearing or Listening? • What is the difference between hearing and listening? • What percentage of the school day do we expect children to spend listening? 45% of the school day is engaged in listening activities

40. Hearing is not understanding

41. Conductive Hearing Loss • Speaking and listening provide the foundation for all language learning and underpin the successful development of reading and writing skills • First Steps: Oral Language Development Continuum • The effect of inaccurately hearing sounds and words makes it very difficult to understand language, especially if it is their second language • ‘Do you hear what I hear?’, Living and Learning with Conductive Hearing Loss, Otitis Media. DYHWIH? PPP

42. Language Differences • Spoken English and Australian Aboriginal languages have some key differences in their structure and sounds • The differences add to the challenges children face in learning English as a second (or foreign) language

43. Impact of Hearing Loss on Socialisation Children with a hearing impairment are likely to present with social and emotional challenges due: • Their own frustration and/or the frustration of their peers • Avoidance • Just not ‘getting it’ i.e. the subtleties and unwritten rules of social exchanges Children with a hearing impairment might: • Lack confidence • Low self-esteem • Lack resilience • Overcompensate

44. AuditoryStrategies • Rhymes • Jingles • Silly verse • Raps • Songs • Rhythm – clapping, drumming • Nonsense syllables • Fingerplays • Tongue Twisters • Listening Games • Barrier Games

45. Visual Strategies • Gesture, facial expression, body language • Demonstrations, modelling • Videos (captioned), smartboards, pictures, photos, posters • Labels, flashcards • Charts, diagrams, maps, lists, timetables, flowcharts • Signing, symbols, cued articulation, PECS

46. Conductive Hearing Loss • All school staff can make a difference to the learning of students with a hearing loss if they encourage and support a whole of school approach focusing on these five areas: • Acoustics and amplification • Ear Health [especially for students with/or at risk of CHL] • Identification and management of hearing loss • Classroom support • Program sustainability [at the school level] PD Available to schools

47. Listening in noiseis like trying to read in the dark Northern Territory 2010 Hearing Health for Indigenous School Children

48. You wouldn’t teach a class in the dark . . .why would you teach a class in noise? Hearing Health for Indigenous School Children Northern Territory 2010

49. Hearing Tests 1800 826 500 Telscreen - Australian Hearing test over the phone 8922 7110 NT Hearing Service – Cas Plaza