Late September 2018
The job of hearing devices is to improve the audibility of speech, allowing students to perceive much more of verbal instruction and all other spoken communication more fully. By funneling more audible speech information into the brain, the student is able to access more of the curriculum. For our hard of hearing students, hearing devices can be considered the gateway to their educational and social success. For the impact of hearing loss to be minimized optimally, students who are hard of hearing need well fit hearing aids or implants, the devices need to function appropriately, and the student needs to be willing to use the devices in school, and preferably all waking hours. Each of these can be a significant challenge that is a barrier to student success.
Challenge 1: Well-Fit Hearing Devices
One of the results of the 2015 Outcomes of Children with Hearing Loss Study1 was that well-fit HAs reduce risk and provides some degree of protection against language delay. Greater aided audibility is associated with better language outcomes in preschool. HAs are well-fit when speech is made as audible as possible by closely matching gain to prescriptive targets, the latter of which is dependent upon the child’s degree and configuration of HL. Another finding of this broad study was that 31% of children who are hard of hearing had hearing aids that were not fit to optimize speech perception. Just because a child is wearing hearing aids does not mean that he is perceiving speech as optimally as possible. Results indicated that optimized audibility made positive contributions to children’s language and auditory development, even for the children with mild hearing loss. Children receiving the most benefit from their HAs (i.e., greatest aided audibility after controlling for the influence of unaided hearing) demonstrated a positive language growth pattern, showing steady improvement in standard scores from age 2 to 6 years. In contrast, children receiving the lowest benefit from hearing aids showed no change in standard scores over the same time period. By 6 years of age, there was a cumulative difference between these groups of two thirds of a standard deviation. In addition, aided audibility was positively associated with multiple measures of word recognition in quiet from ages 2 to 6 years and in noise for 7- to 9-year-olds. Children with greater aided audibility had better auditory development outcomes and speech recognition abilities than children with lower aided audibility across a wide range of ages and outcome measures. These conclusions support the inclusion of aided audibility in the model as a factor that moderates the impact of HL on children’s outcomes.
What Can YOU Do?
1. Obtain consent from the families of students on your caseload to be in touch with their audiologists. Having routine consent to contact the audiologist about the child’s hearing levels and amplification devices will save time if questions arise about how well the child appears to be perceiving speech.
2. Invest the time to identify a child’s level of access to speech under typical school conditions. There is no replacement for the critical information obtained by doing a Functional Listening Evaluation. Students with typical hearing score 95%+ in quiet and 90%+ in noise If a student has been trained to routinely respond to Ling sound audibility checks, take the time to perform the ELFLing, which systematically identifies the ability to perceive the Ling sounds at different distances. If you only have a few minutes, at least do the Iowa Medial Consonant Test, which is a fast check of audibility for specific consonant sounds. If a child has 25-70 dB hearing levels and has worn hearing aids for some time, then a 100% score is expected.
3. Hearing aids should be fit so that students with hearing loss of 70 dB or better can perceive all of the speech phonemes in quiet from 3 feet without watching the speaker’s face. If you have a student who does not seem to be able to do this, bring the issue to the attention of the family and audiologist. If hearing devices are the gateway to learning, removing any barrier to that gateway can only benefit the student’s performance.
Challenge 2: Ensuring that Hearing Devices are Functioning