Our Sources

Our sources can be found within the "Helpful Links" section of this blog.

In addition, we used information found in a popular Aural Rehabilitation textbook:

Tye-Murray, N. (2004). Foundations of Aural Rehabilitation (3rd edition).
     Clifton Park, NY: Delmar Learning.

Help For Parents

Parents of children with hearing loss report a wide range of emotions in response to the diagnosis. Remember that what you are feeling is not wrong or unusual. It's natural to feel sad, angry, and even guilty. However, with some research and perhaps counseling, you will be able to come to a healthy acceptance.

If you are feeling overwhelmed, talk to your audiologist or health care provider about referring you to a counselor with experience helping parents of children with hearing loss.

Dealing with your own emotions will help you to be the best advocate for your child that you can be!

~~~~~~



Welcome To Holland

by

Emily Perl Kingsley

I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel.  It's like this......

When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy.  You buy a bunch of guide books and make your wonderful plans. The Coliseum.  The Michelangelo David.  The gondolas in Venice.  You may learn some handy phrases in Italian.  It's all very exciting.

After months of eager anticipation, the day finally arrives.  You pack your bags and off you go.  Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."

"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy!  I'm supposed to be in Italy.  All my life I've dreamed of going to Italy."

But there's been a change in the flight plan.  They've landed in Holland and there you must stay.

The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease.  It's just a different place.

So you must go out and buy new guide books. And you must learn a whole new language.  And you will meet a whole new group of people you would never have met.

It’s just a different place.  It's slower-paced than Italy, less flashy than Italy.  But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips.  Holland even has Rembrandts.

But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there.  And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned."

And the pain of that will never, ever, ever, ever  go away... because the loss of that dream is a very very significant loss.

But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.

c1987 by Emily Perl Kingsley. All rights reserved

Aural Rehabilitation

The goal of aural rehabiliation is to alleviate the difficulties assosiated with hearing loss and to minimize the consequences. Regardless of which listening device you choose for your child, it is essential that he/she receive aural rehabiliation in order to maximize the benefits.

(Missed the information on listening devices? See Part 1, Part 2, and Part 3)

Goals and Targeted Skills

• Auditory training
• Structured and unstructured listening practice
• Comunication strategies training
• Teaching strategies that minimize communication difficulties
• Speech-Language therapy (particularly important for children!)
• Training that emphasizes developing strategies to monitor one's own speech production and developing vocabulary, syntax, and pragmatics.
• Speechreading Training
• Training speech recognition via both auditory and visual channels 
• Inservice training
• Specialized training for other professionals who interact with your child, such as teachers and caretakers.

Accessing Aural Rehabilitation Services
Aural rehabilitation can be provided by an audiologist, a speech-language pathologist, or a teacher for children who are deaf and hard of hearing.

Aural Rehabilitation services for your child may be provided by:

• Schools
• Private Clinics
• University Clinics
• Hospitals
• Birth-to-Three services

Ask your physician or audiologist about services in your area.

In addition, the American Speech-Language-Hearing Association (ASHA) provides a directory of speech and hearing professionals. Click here to find someone near you who can help.

Listening Devices: Part 3- Assistive Listening Devices

Assistive Listening Devices (ALDs) are used in conjunction with a hearing aid or cochlear implant. They help the user in specific listening situations such as in a lecture hall or in a noisy restaurant, where the hearing aid or cochlear implant are not adequate.

When ALDs May Be Needed
If there is an excess of any or all of the following:

• Ambient Noise: noise that is present in a room when it is unoccupied such as open windows, buzzing lights, or piped-in music.
• Reverberation: Echoes caused by high ceilings, hardwood floors, or unadorned plaster walls.
• Background Noise: Noises other than what the user wants to hear such as rustling paper, shuffling feet, extraneous conversations occuring in a classroom while the teacher is talking. 

Types of ALDs

• Wireless Systems
• FM System- utilizes radio waves to transmit sound from the source to the user.
• Personal FM trainer: The speaker wears a microphone and the sound is transmitted directly to the user's receiver
• Sound-field FM system: The speaker wears a microphone, but the sound is transmitted by loudspeakers that are positioned throughout the room.

• Infrared System- similar to FM systems, but use infrared signals instead. The signals cannot travel through walls, affording more privacy.
• Induction Loop Systems- A room is looped with a wire that broadcasts electromagnetic energy. This is picked up by a hearing aid when the telecoil is activated. Some cochlear implants are also able to benefit from looping.

• Hardwired Systems- These connect the sound source to the listener by actual wire. They are most often used for listening to television, radio, or music.They have the disadvantage of requiring the listening to be tethered to the sound source.

Other Technology

There are many other products available to people with hearing loss. These are useful in situations when the person is not wearing his/her hearing aid or cochlear implant, such as while sleeping.

• Vibrating or flashing alarm clocks
• Doorbells hooked to lamps that flash when it is rung
• Flashing light smoke detectors
• Telephone ring signaler that causes a lamp to flash
• Text display systems for telephones
• Closed captioning for TV and movies

Listening Devices: Part 2- Cochlear Implants

Cochlear implants are becoming an increasingly popular choice for babies born with severe to profound hearing loss (Click here to learn more about hearing loss). Implantation of CIs is a surgical procedure, so it's important to learn as much as you can before you make a decision.
Technology and How They Work
This link below is a video that is a great introduction to how normal hearing works and how cochlear implants can help those with hearing loss. It also explains the technical information and the implantation process.

Introduction to Cochlear Implants

The "Helpful Links" section below the archive provides several more links to informative websites (such as Advanced Bionics, ASHA, and Mayo Clinic).

Who Are They For
Currently, Cochlear Implants (CI) are approved for use in babies 12 months or older who have severe to profound hearing loss that is not remediated by hearing aids. To prove candidacy, an individual must use hearing aids for a period of time and show no benefit from them. For babies 12 to 18 months, this trial period is 6 months. Click here to learn about hearing aid styles and here to learn about technology available. If it is documented that a baby is showing signs of delayed language skills even with the hearing aid, then he/she will be eligible for a CI. Further candidacy requirements include good general health and enrollment in an aural rehabilitation program (missed our post about aural rehab? Click here to learn more). Once candidacy is established, the you will work with a team of specialists to plan the surgery.


Other Considerations
There is much debate on the use of cochlear implants. Parents should take the time to learn about the advantages and disadvantages of cochlear implants before making this decision as well as other options available.

• Advantages
• Cochlear implants can give your child the ability to recognize auditory signals, even if he/she has a profound loss.
• Many children who are implanted gain language skills equal to that of their hearing peers.
• This is an area of fast growth- there are new technologies being developed every day!
• Disadvantages
• It involves surgery, which can be scary for parents and children
• Any residual hearing in the ears will be lost-- when the cochlear implant is not on, the child will not be able to hear anything at all.
• CIs do not "cure" deafness. The child will still require speech therapy and aural rehabilitation therapy in order to understand the signals he/she receives from the device.
• Other options
• There is a strong Deaf community in the United States. People who identify with this culture embrace their deafness and do not seek remediation. By communicating through ASL, speechreading, and writing, these individuals thrive in their jobs and communities. For more information, click the link to go to the website of the National Association of the Deaf and Hard of Hearing

Cost
The average cost of implantation is $40,000. However, the cost you pay will depend on your coverage and deductible rates. The state of Wisconsin requires that insurance companies cover cochlear implants for children under 18 years. Click here to view the bill and click here for more information about laws and financial assistance in Wisconsin.

Listening Devices: Part 1.1- Hearing Aid Technology

This is a supplementary post to our Listening Devices: Part 1- Hearing Aids.

All hearing aids are not created equal! Here is a run-down of the technological add-ons available. Please note: not all of these are available for every style of aid.

Digital/Analog
Analogue hearing aids work by converting sound waves into electrical waves, which gives an accurate sound reading. Digital hearing aids are more technologically advanced and produce an exact duplication of sound. As may be expected, the sound quality provided by digital hearing aids is much higher than that provided by analogue hearing aids. Of course, this boost in quality is reflected in a boost in price!

On-Off Control
As you may have guessed, this turns the hearing aid on or off. Sometimes this is incorporated into the volume control wheel. When an on-off switch is not present, the hearing aid is activated by inserting the battery.

Audio Input
This allows an audio signal directly from the signal source (like a television or radio). It requires an audio boot which is most commonly found on a BTE hearing aid.

Microphones
Omnidirectional: This type of microphone picks up sound from all directions.

Unidirectional (sometimes just called "directional"): This type of microphone picks up sound coming from a specific direction (often directly in front of the user).

Some newer hearing aids are equipped with both types of microphones and the user can choose to switch between them depending on the circumstances.

Telecoil (a.k.a. T-coil or Audiocoil)
This is an induction coil within a hearing aid that enhances telephone communication. It functions by bypassing the hearing aid microphone. It is able to pick up the electromagnetic signals emitted by the telephone receiver. Use of a telecoil minimizes acoustic feedback, providing better-quality sound. Some hearing aids have an on-off switch for the telecoils and some will automatically switch in response to holding the telephone to the ear.

Volume Control
This allows the user to adjust the level of the amplification signal he/she is receiving.

Remote Control
This can be used to adjust the properties of the hearing aid (such as microphone direction). It can also be used to switch hearing channel, adjust the volume, and to turn it on and off. This is very helpful with a small device.

Listening Devices: Part 1- Hearing Aids

Need some background information? Read this first!

Hearing aids are a viable option for many types of hearing loss. Here is some information about hearing aid choices and benefits that will help you make the best decision for your child.

Styles

• Behind-the-Ear (BTE)

• This style can be used for all degrees of hearing loss.
• BTE Hearing Aids can include an earmold or simply a tubing system.
• Advantages:
• The earmold can be remade relatively inexpensively as the child grows. 
• Good for use with children with chronic otitis media, as they do not occlude the ear canal.
• Safer for small children than small devices.
• Less feedback
• Easy to clean
• In general, fewer repairs needed
• Large size means it can be fitted with many technological options
• Disadvantages
• Cosmetics: the BTE styles is rather large.
• In-the-Ear (ITE)

• This style can be used for mild to severe hearing loss.
• ITE Hearing Aids are made to fit the shape of the individual's ear canal.
• Advantages:
• The position of the microphone enhances amplification
• The placement of the receiver means less gain is required
• Not as susceptible to wind noises
• Disadvantages:
• As the ear grows, these will need to be remade.
• Not a good choice for young children.
• In-the-Canal (ITC)

• This style can be used for mild to severe hearing loss.
• ITC Hearing Aids are made to fit the shape of the individual's ear canal.
• Advantages:
• The position of the microphone enhances amplification
• The placement of the receiver means less gain is required
• Not as susceptible to wind noises
• Cosmetic: not very noticeable
• Disadvantages:
• As the ear grows, these will need to be remade.
• Not a good choice for young children.
• Completely-in-the-canal (CIC)
• No picture available- not visible from the outside!
• This style can be used for mild to severe hearing loss.
• Advantages:
• Easy to insert and remove
• Better sound quality
• No occlusion effect (caused by the blocking the ear canal by other styles)
• Elimination of wind noise
• Better sound localization
• Less electronic gain needed
• Cosmetic: Virtually invisible to others
• Disadvantages:
• So small that often technological options are not available
• High maintenance: wax build-up

Cost

Hearing aid costs depend highly on the style desired and the additional technology included. They can range from $400- $3,000. In general, the smaller the device, the more expensive it will be. Additional features and battery life are also a factor. It's important to talk with your audiologist to find the right combination of technology and value.

Insurance coverage varies by provider, and coverage mandates for insurance companies varies by state. Currently, the state of Wisconsin requires that insurance companies offer coverage for 1 set of prescribed hearing aids for children under 18 years every 3 years. Click here to view the bill. Check with your insurance provider and state laws to make sure you are getting appropriate coverage. Click here for more information about laws and financial assistance in Wisconsin.

Other Options

There is a strong Deaf community in the United States. People who identify with this culture embrace their deafness and do not seek remediation. By communicating through ASL, lip-reading, and writing, these individuals thrive in their jobs and communities. For more information, click the link to go to the website of the National Association of the Deaf and Hard of Hearing

Hearing Loss Types and Causes

To make informed decisions, it's helpful to understand your baby's specific hearing loss. Every child has a unique profile, but here are the basic facts.

Conductive Hearing Loss

• A conductive hearing loss involves the outer and/or middle ear. This includes the pinna (the part of  the ear you can see), the external auditory canal, the tympanic membrane (the ear drum), and/or the ossicles (the three tiny bones in the middle ear).
• Causes: There are many reasons a child may have a conductive hearing loss.
• Otitis Media- more commonly known as an ear infection. When they are chronic, the child is at risk for a hearing loss.
• Otitis Externa- an infection of the external auditory canal.
• Atresia- the child is born without an external auditory canal or a very small/narrow canal.
• Microtia/Anotia- the outer ear is very small or absent.
• Otosclerosis- the stiffening of the ossicles, often due to chronic otitis media.
• Ruptured or perforated tympanic membrane- a tear or hole in the ear drum. Can be caused by otitis media or trauma.
• In some cases, is required in addition to the use of listening devices. Click here to learn more about ear surgeries.
• This type of loss will NOT be helped by cochlear implants! However, there are other options available. Click the links to learn about hearing aids, hearing aid technology, and assistive listening devices.

Sensorineural Hearing Loss

• A sensorineural hearing loss involved the cochlea and/or auditory nerve.
• Causes: As with a conductive loss, there are many reasons a child may have a sensorineural loss.
• Prenatal
• Infections
• Rh factor complications- mom's blood creates anitbodies to baby's blood
• Fetal Alcohol Syndrome
• Anoxia- lack of sufficient oxygen
• Maternal diabetes
• Perinatal
• Anoxia
• Cochlea damage with forceps (this is quite rare)
• Postnatal
• Ototoxic drugs- some life-saving antibiotics can cause damage to the cochlea 
• High fever
• Influenza, meningitis, measles, mumps, rubella, encephalitis
• Genetics
• 50% of congenital hearing loss in children is thought to be due to genetics
• In 25% of cases, the causes are unknown
• 90% of children with severe to profound hearing loss have parents with normal hearing
• This type of loss can be helped by cochlear implants, hearing aids, and assistive listening devices.