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Back to basics
Hearing and hearing impairments


The ability to hear provides a significant, and purposeful, connection to the environment and the people in it. Through the ear, a child—even prenatally—receives the sounds that help establish links to people, events, and activities. A child with a hearing impairment cannot rely on sound as the primary channel for receiving and sending essential communication messages.


How we hear
The outer ear—the visible external structure—is the auricle. Sounds enter the auricle and funnel down the auditory canal to the sound-amplifying eardrum.

The middle ear is on the inner side of the eardrum. There, three tiny bones, the malleus (hammer), the incus (anvil), and the stapes (stirrup) amplify the sound further. Combined, the outer and middle ear make sounds more than 180 times louder.

The inner ear controls the sense of balance. One part, the cochlea, is filled with fluid and hair cells. The cochlea sends signals to the brain through the auditory nerve. The brain translates these nerve signals into the sounds we understand.


Hearing limitations and loss
There are two types of hearing impairments: Conductive and sensori-neural. Conductive impairments result from a physical or functional malady in the outer or middle ear that prevents sounds from traveling to the brain. The impairment might be caused by an obstruction like a bean or earwax, for example, by damage from infection, or by an injury. Sensori-neural impairments occur in the inner ear where nerve cells or pathways to the brain don’t function properly, resulting in incomplete, garbled, or diminished sound.

Some people have both types of hearing loss, some only one. Sometimes only one ear is involved and sometimes both. Some hearing losses are temporary and can be regained by treating an infection, for example, while some are permanent. All types require special attention to maximize developmental opportunities.


Identifying children with a hearing loss
According to developmental milestones, infants respond to sound and turn to look for the source. Toddlers and preschoolers steadily develop speech by mirroring the sounds of words they hear in the environment; they build vocabulary as well as clarity and complexity of sentences.

If a child in your program shows signs of a hearing impairment, alert the child’s parents to the possible need for medical attention. Children from birth to age 3 can access services from the Early Childhood Intervention (ECI) program. Children older than 3 years may qualify for services through their local school district.

Each year more than 12,000 babies are born with a hearing loss. Typically the cause is unknown. In the past, when babies were more separated from family interactions and conversations, a hearing loss might have gone unnoticed for years. Today most babies have a hearing screening soon after birth, usually before leaving the birthing center or hospital. This Universal Newborn Hearing Screening can help make sure children get needed services at an early age. Early identification and intervention can help ensure children develop the communication and language skills needed through life.


Working with children with hearing loss
Children with hearing loss differ from other children only in their ability to learn through sounds. Most activities appropriate for children without disabilities are also appropriate for children with hearing impairments.

For infants:
Provide visual stimulation. Rotate mobiles and pictures often to foster the baby’s interest and curiosity.
Offer materials with different textures to encourage tactile stimulation and build background knowledge.
Communicate—with song, body language, and conversation. Your gestures help babies understand even if your voice isn’t clear.
Expose babies to a wide variety of sounds. Children with and without hearing impairments need to practice listening.

For preschoolers:
Use visual aids. Pictures, displays, and other hands-on materials are important for every preschooler’s development.
Keep the room well lit. Try to keep your face in the light so children can see your mouth and hand movements easily.
Avoid excessive noise that could be confusing to a child with impaired hearing.

For everyone:
Recognize the risks of loud noise. Levels higher than 85 decibels can damage hearing. If you need to raise your voice to speak to someone an arm’s length away, the noise level is too high. You can test noise levels with many smart phone apps.
Work to protect hearing by avoiding exposure to loud noises, including music. Adjust volume levels and avoid wearing ear buds and headphones for prolonged periods; they amplify sounds excessively.
Use ear protection against environmental noises like airplane engines and when using tools like lawnmowers, hair dryers, and woodworking tools.