Prevalence, Definitions, and Characteristics

Individuals with hearing impairments make up .11% of the school-age population, and 1.2% of the students served under IDEA (U.S. Department of Education, 2005). Hearing impairments range in severity from mild to moderate to severe to profound, with the greatest educational distinctions occurring between hard of hearing and deaf. Individuals classified as hard of hearing can hear speech tones when wearing hearing aids, while persons who are deaf cannot hear even with hearing aids.

The age that a child loses hearing affects the degree of language delay and development. Children who are born with deafness have congenital hearing losses (prelingual) and more difficulty with language development than those who acquire deafness after age 2 (postlingual).

Pure tone audiometers are used to assess hearing ability. Tones with different pitches (or frequency measured in Hertz [Hz]) and volume (measured in decibels [dB]) are presented via headphones, and individuals raise their hand when they hear a sound. Levels of hearing impairment are classified along a continuum, with reference to zero dB indicating the quietest sound a person with normal hearing can detect. Individuals with slight hearing losses (27–40 dB) may not have difficulty in most school situations. Individuals with mild losses (41–55) may miss up to 50% of classroom discussion if voices are faint or faces cannot be seen. Individuals with moderate losses (56–70 dB) can understand only loud speech, and may have limited vocabularies. Individuals with severe losses (71–90 dB) may be able to hear loud voices within one foot from the ear, and speech is likely to be impaired. Individuals with profound losses (> 90 dB) may hear some loud sounds, but are more likely to sense vibrations, and may rely on vision rather than hearing as a primary vehicle for communication (Heward, 2006). Specialized tests are needed to accurately assess the cognitive and academic functioning of individuals with hearing impairments (Owens, Metz, & Haas, 2003).

Causes of hearing impairments include heredity, prenatal infections such as maternal rubella, ear infections, meningitis, head trauma, prematurity, and oxygen deprivation. Impairments can be conductive, meaning the outer or middle ear along the passageway are damaged; sensorineural, referring to inner ear damage; or they can be a combination of the two (Owens, Metz, & Haas, 2003).

Many children with hearing impairments have academic and cognitive deficiencies or developmental lags due to difficulties processing language (Meadow-Orlans, 1990). Some children experience social-emotional functioning difficulties due to communication difficulties (Luterman, 1996).

Educational Programming

An ongoing debate exists over what should be considered the best approach for teaching individuals with severe hearing impairments. Some advocate total communication (Owens, Metz, & Haas, 2003), which involves using speech (lip) reading, gestures, and sign language, or both oral and manual methods. Teachers using total communication rely on the structure of the English language, and speak while signing during communications with students who are deaf. Some advocate the use of only oral approaches, eliminating any manual components used in total communication. Teachers using only oral approaches rely heavily on parental and family involvement as well as auditory, visual, and tactile methods of presentation. Finally, others advocate using only sign language or manual approaches. These individuals advocate the exclusive use of sign language because they maintain that a unique “culture of the deaf” exists among those who communicate with sign language. They believe that when individuals with hearing impairments are taught only to speech read or use oral techniques, they are denied full participation in the culture of the deaf (Owens, Metz, & Haas, 2003; Reagan, 1990). Individuals from this position say they are not disabled, but that they are part of another cultural group composed of individuals who are deaf.

Several signing systems are in use today, including the American Sign Language (ASL), Fingerspelling, and Signing Exact English. All systems use manual signs made with the hands and fingers to represent words, concepts, and ideas. However, they are based on different systems. The American Sign Language (ASL) is a visual-spatial language, is not phonologically based like English, and is the official language of the culture of the deaf in the United States. ASL has its own rules of semantics, syntax, and pragmatics, and vocabulary (Owens, Metz, & Haas, 2003). Fingerspelling is a manual alphabet of 26 distinct hand positions used to represent each letter in the English alphabet. Fingerspelling is especially appropriate for unfamiliar words such as proper names. The following In the Classroom feature displays sample sign language positions and fingerspellings. Some teachers use Fingerspelling while speaking to students with hearing impairments. Signing Exact English is a system that employs components of ASL, but attempts to use correct English usage for facilitating the learning of reading and writing literacy skills in English for students who are deaf. No clear research evidence exists to promote one approach over the other in teaching students who are deaf. Therefore, it is likely that this debate will continue into the future.

Classroom Adaptations for Students with Hearing Impairments

Students with hearing impairments can benefit from instruction in general education classes if specific adaptations are made. Specific accommodations vary depending upon the degree of hearing impairment and whether students have interpreters to accompany them throughout the school day. If you have a student with hearing impairments in your class, establish classroom emergency procedures for use during fire and tornado drills. Many fire alarms can be equipped with a light that flashes while the bell rings, alerting students with hearing impairments. Consider assigning a peer assistant who can pass along information that comes from the announcement system and who can be a buddy during any emergency situations. In addition to these guidelines, consider the following strategies (see also Pakulski & Kaderavek, 2002; Stewart & Kluwin, 2001):

  • Adapt the physical environment so students are seated close enough to the front of the class to maximize their hearing and enable them to read speech. They should also be able to turn to face other students while they are speaking. Because hearing aids are extra sound-sensitive, loud or irritating noises should be avoided. Consider choosing a room with carpeting and located away from noisy school areas, such as the cafeteria and gym.
  • Use technology, including hearing aids, television captioning, adapted telephone equipment (TTY), computer-assisted instruction, and the Internet. When appropriate, use FM sound systems, which include cordless microphones for teachers, and receivers that attach to hearing aids for students. Pass your microphone to classmates who are speaking in a class discussion so they can also be heard.
  • Use visuals such as illustrations, diagrams, pictures, and three-dimensional models to introduce vocabulary and concepts and enhance comprehension.
  • Use language cards that contain vocabulary and illustrations of concepts and definitions that can accompany verbal presentations and be used to preteach. Encourage students to maintain personal dictionaries of their language cards.
  • Create authentic experiences by connecting new language and knowledge to real-world experiences in a context relevant to the student’s linguistic and experiential background.
  • Reiterate major points, write out assignments, or write down questions on overhead transparencies or the chalkboard. Give students outlines or closing summaries as handouts. Repeat questions or answers that other students contribute, to enable hearing impaired students to fully participate in class. Sequence steps or procedures on written cards and place them in clear view.
  • Use hand signals or devise a signaling system to denote transitions or allow students with hearing impairments or interpreters to review questions, answers, and concepts.
  • Alert students as to when to look or listen and position yourself so students with hearing impairments can clearly see your face, without shadowing from backlighting or the reflection of glaring light.
  • Use a “listen, then look, then listen” sequence of instruction, so students can focus on your face as you speak, then focus on the other aspects of the lesson separately, then focus on your face again. Say, for example, “Now, I’m going to pour the oil in with this water” (listen); then pour the oil (look), then say, “I poured the oil into the water. Who can tell me what happened?” (listen).
  • Repeat information from the school public address system to ensure students have understood the announcements.
  • Plan for interpreters. Interpreters often assist students who are deaf, by translating lecture information, tutoring, and assisting special and regular education teachers (Salend & Longo, 1994). Extra space, including chairs or desks, may be required for interpreters to be near students with hearing impairments. Since interpreters are typically adults and taller than your students, check to see that all children have a clear view of important classroom information. Prepare your students for the interpreter and clearly explain the roles and functions the interpreter will have while in your classroom. Schedule time alone with the interpreter to discuss your typical classroom procedures, materials, and routines. Remember that an interpreter cannot proceed at the same pace as your verbal presentation, and you need to slow your rate of presentation accordingly.
  • Work with family members. Parents and other family members have an important influence on students with hearing impairments, with respect to such activities as going out and interacting with people, joining sports and other recreational activities, and monitoring and assisting homework (Stewart & Kluwin, 2001). Work with family members to help them prioritize and encourage important activities.

Adapt Evaluation

Testing and evaluation modifications for students with hearing impairments might include providing individual testing times in separate rooms, and extending the time limit as necessary. Remember to allow sufficient time for interpreters during oral testing situations. Allow students to draw illustrations of concepts. Use performance-based testing measures and identification formats whenever possible.