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Management of Unilateral Hearing Loss for Audiologists and Speech Pathologists. Joey Ford, M.S., CCC-A Megan Friedman M.S., CCC-SLP, LSLS Cert. AVEd. 1978 Northern & Downs Hearing in Children.
Joey Ford, M.S., CCC-A
Megan Friedman M.S., CCC-SLP, LSLS Cert. AVEd
Individuals with Disabilities Education Improvement Act of 2004 (IDEA)
Typically under Part C children 0 to 3 years with UHL qualify for services whether they have a slight delay, none at all, or a severe delay
Under Part B (section 619) children 3 to 5 years with UHL only qualify for services if their scores fall 1.5 and sometimes 2 standard deviations below normal limits
Often times children with UHL do not qualify for services just at the time when the listening environment and academic needs are becoming more difficult
There is no standard set of diagnostic tests at this time for UHL.
The following are suggestions and should be completed over multiple sessions depending on the age of the student
Sit on hearing ear side for best results
Review of most recent audiogram
CELF-4-overall language evaluation
Subtests and item analysis
“swiss cheese” students
PLS-4—overall language evaluation for younger listeners
Cottage Acquisition Scales for Listening, Language & Speech (CASLLS) ~ Sunshine Cottage School for Deaf Children—Criterion Referenced overall language evaluation
Integrated Scales of Development (from Listen Learn and Talk by Cochlear)
Auditory Skills Curriculum Model (John Tracy Clinic)
EOWPVT—expressive vocabulary test
PPVT-IV—receptive vocabulary test
Conversation/language sample with/without noise
Communication abilities: turn taking, providing enough details, staying on topic, etc.
Audition assessment (with/without background noise)
Model for listening ~ detection, discrimination, identification, comprehension (Estabrooks, 1998).
Listening check using Ling 6 sounds at a distance of 30, 12, and 6 ft. with and without background noise
Informal 1-3 step direction tasks
1-4 item memory/critical element task
Ability to detect and localize sounds
Ability to discriminate between suprasegmentals/prosodic features (pitch, intensity, duration, rate, stress) (Ling, 1976, 1989)
Ability to discriminate between 1 vs. 2 vs. 3 syllable words
Ability to discriminate between words that differ in initial/final consonants by manner, voicing, place (in sentences is easier)
Auditory Perception Test for the Hearing Impaired—Susan Allen
Test of Auditory-Perceptual Skills-3 (TAPS-R)—standardized auditory processing test
Auditory Processing Abilities Test (APAT)--standardized
Pediatric case history form
Do they communicate with peers? Have many friends?
Are they often fatigued?
In general how well do they listen? Do they often misinterpret conversations? Can they follow discussions at the dinner table?
How do they handle noisy environments? (restaurant, sporting events, cafeteria)
Are they able to localize in different environments?
How are their grades?
Other factors to consider
Co-occurring developmental disabilities
Abundance of language stimulation in the home
Quality of child care environment
Recurrent otitis media with effusion
Avoiding a certain class or activity (especially large group situations) because it is too difficult to hear/understand what others are saying
Fatigue, less energy, complaints of headaches, pains, etc. especially in noisy environments
Limited understanding of humor (riddles, jokes, idioms, slang).
Gives up easily • Daydreaming
Misbehaves to get attention typically because they are frustrated
May be aggressive towards peers
Makes fewer initiations with peers
Inappropriate interactions with peers
May miss part or all of a conversation and therefore misinterpret the message, which may lead to a misunderstanding
Isolate themselves in large group activities
Quick change in emotions (sudden crying to giggling)
Appears to have selective hearing
When the student is unsure of what to do, especially when given multi-step directions, they will watch and follow peers.
The student may have difficulty listening and completing a task at the same time.
Sounds are often audible to the child, but many times the sound or messages, particularly speech sounds, are not intelligible or understood
Students have to be trained to advocate for their needs and understand and recognize when they are missing a message and how they can receive the message in a better way.
There is a lack of published guidelines for working with infants and children with UHL
Some one-on-one therapy and some group therapy every week depending on needs of student.
Some auditory-oral training for the SLP would be ideal.
Students must consistently wear/use their hearing devices as long as they are beneficial to the student and programmed appropriately.
Therapist typically sits on the side of the child’s hearing ear unless the therapy session is specifically targeting working on listening in noise.
Ask “What did you hear?” to check for understanding and have the student repeat back word definitions and/or directions
Do not accept one word answers (“tell me in a sentence”)
Speak naturally in a clear voice, at a regular rate. Don’t exaggerate!
Present information, questions, etc. auditory first (hand cue use = a cue to listen!) and then use a visual cue if the student still needs help to understand.
Practice listening in noisy situations (outside, with door open, with radio on, with 2 speaker babble, with 4 speaker babble)
Allow listening breaks if a glazed / flat expression, or inappropriate social behaviors occur
Conduct the Ling 6 (ah, oo, ee, sh, s, m) “test” twice daily to check for proper function of hearing devices
During therapy sessions be sure to get the student’s attention before giving directions.
Ask open-ended questions (To please teachers they will answer yes/no questions with “yes”)
Paraphrase and reword directions etc. if the child does not understand the first time
Incorporate reading as often as possible and be sure to point out new vocabulary and discuss objects in several different ways (synonyms/antonyms).
Encourage the student to be responsible for personal things (including trouble shooting hearing aids, Baha and FM) as well as a responsible listener.
They need to be made accountable for what their peers and teachers say as well as what they themselves produce verbally.
Have the student present on their FM system and hearing devices to the class (i.e. make a power point or demonstrate how their devices work)
A child with a unilateral hearing loss requires close observation and daily informal evaluation to determine their areas of need.
Often times they appear to be functioning at a high level compared to children with greater losses or at a moderate to low level compared to their hearing peers.
They still have difficulty with basic language structures, word meaning, and/ or speech sounds that are often passed over or not noticed in a larger classroom environment or in a group therapy situation.
Students must be encouraged to advocate for themselves at all times. The following are suggestions for students to use throughout their daily activities and should be a part of therapy goals:
*Classroom Behaviors: Strategies for learning in a large group
Focus on your teacher and listen.
Watch the teacher.
Watch whoever is talking.
Raise your hand and wait your turn.
Stay on topic.
Join in group responses.
Use a repair strategy if you don’t understand or you didn’t hear, or check with your neighbor to find out what you missed.
If you can’t see, move.
Sit the correct way.
Keep your hands to yourself.
Repair Strategies: Asking for repetition
Can you repeat that?
I didn’t understand you.
Will you tell me again?
What did you say?
I didn’t hear you.
I don’t know what you said.
Repair Strategies: Asking for clarification
I didn’t understand you.
Can you say that clearer?
Can you say it slower?
Did you say ______?
Did you say “cat” or “bat”?
Can you come closer to me?
Repair Strategies: Asking for more information
What does ____ mean?
I don’t know what ______ means.
Can you tell me what you’re talking about?
Who are you talking to?
From: Self Advocacy: A Curriculum For Creating Independence ~ Carrie Bauza, M.S. --Child’s Voice School
Guide and encourage other staff members to learn more and work with you regarding the strategies on how to best work with the student and what behaviors to look out for
Have a mini inservice at the beginning of the school year to prepare the faculty on how to use equipment.
Have the classroom teacher fill out a questionnaire at the beginning, middle and end of the school year to help monitor classroom behaviors and impressions of student (SIFTER—Screening Instrument for Targeting Educational Risk—K. Anderson).
Ensure there is an understanding of school and classroom rules and that your expectations are the same for all students.
When there are consequences for inappropriate behaviors, check for understanding
Speak one-on-one with student to check for comprehension during instructional times (when possible)
Try to get the student’s attention by calling his or her name before giving instructions/directions (allow noise level in room to decrease—then repeat instructions if necessary).
Have a nonverbal cue that can be used to regain attention (tap on the shoulder followed by eye contact) if the student seems inattentive so that they know to watch whoever is talking.
The teacher repeats answers from other students (saying the name of who asked the question as well) so that the student with hearing loss is sure to hear the answer and better able to participate in group discussions.
Present spelling words and directions in short sentences during test time to help the student discriminate between words
Language and speech should be integrated throughout curriculum, daily routine and individual therapy.
Allow for pre-teaching at home
Provide a list of vocabulary words, spelling words, and upcoming assignments for each subject area, new unit or story that can be reviewed at home—ex. Parents or SLP can check that the student is discriminating between spelling words before the test is given (cake/take etc.)
Have parents explain new words or phrases that are abstract at home so the student is already familiar with terms when they are learning at school.
If possible provide a set of books at home
Classroom Buddy-ex. tell the student when it’s time to line up at the end of recess or it was page 124 in our reading book
Use captioning during movies or videos
Write assignments and directions on board after presenting auditorily (don’t write on board and talk at the same time).
The student may need additional wait time before answering question or following directions especially if they have a right side loss.
Use thick window treatments (thick materials)
Area rugs if there is no wall-to-wall carpet
Avoid hard surfaces whenever possible (corkboard)
Use tennis balls or rubber tips on the bottoms of chairs
Use soft seating (bean bag chairs) in play or leisure areas
Use creative artwork such as decorated egg crates, material or rug strips and Styrofoam balls hung from the ceiling to dampen noise levels
Try to keep doors and windows closed
Parents attend a therapy session once a week where they are coached and guided on how to carry-over strategies, techniques, sounds, etc. at home.
Encourage parents to become aware of their child’s listening environments and how to manage them
Reduce “technology” noise in house (TV, background music etc.)
Talk into hearing ear and keep loud noises away from hearing ear
Raise your voice slightly and face the child when at a greater distance (walking a child in a stroller)
Play listening games and expand the child’s vocabulary by using multiple adjectives etc.
Involve siblings, family members and friends to practice group activities and games so the child gets more experience with different voices, contexts and distance listening.
Narrate your daily routine and get your child’s attention and make sure that the child is able to listen before talking to them and starting a conversation.
Safety issues with localization.
Encourage parent-to-parent support: Providing parents with contact information for organizations of parents with children who have UHL (list-serves can be helpful)
Keep a notebook that can go between home and school where both parties can ask questions and/or share concerns if face to face meetings or a phone call are not options
Present an unbiased list of intervention approaches that includes information about speech and language development, functional auditory skill development, amplification and visual forms of communication
Share any changes in behavior/health/hearing, social-emotional
Parents get nervous when the SLP or Teacher says everything is fine every day.
The parents may often feel that you might be missing something or not catching issues that may be affecting the students overall education.
Sequencing multi-element directions with more difficult concepts (Sit down at your desk, get out your reading book and turn to page 10 or Put the thick blue square behind the empty jug) in noise
Listening to a story one time with no visual cues in noise and
Identifying necessary vs. unnecessary information from stories
Retelling the story/summarizing in sequence using 5 or more sentences
Identify the main idea
Identify the main idea
Imitating a 7-9 word sentence including morphological markers (‘s, s, past tense etc.) without changing word order or omitting any words or word structures.
Identifying 4-5 critical elements in noise. (i.e., Put the bluesquarebehind the emptybasket)
Developing an ability to use their auditory feedback loop by attempting to self-correct articulation and syntax errors in spontaneous verbal productions in structured tasks
Increasing the ability to listen the first time in noise.
Increasing the ability to paraphrase remarks of other speakers in noise.
Discriminating between vowel sounds (mit vs. met or win vs. one)
Asking for repetition, clarification or more information from peers or adults, using repair language, during class discussions when she doesn’t understand (e.g. I didn’t hear, Could you repeat?, I didn’t understand a word., I heard you say _____., Can you tell me what you’re talking about?, What does ____ mean?).
Asking for repetition, clarification or more information from the teacher/therapist when she does not understand a word, direction, or assignment during class time.
Identifying when listening conditions are not optimal and advocating for themselves (ex. Shutting the door, changing seating positions, asking for repetition or clarification)
Demonstrating an ability to troubleshoot problems with Baha, hearing aid and/or personal FM system and notifying teacher/parents/therapist when equipment is not working properly.
Explaining how equipment works to peers and adults.
Increase the ability to understand figurative language (idioms/homophones/jokes)
Identifying novel vocabulary words and asking for a definition/looking them up in a dictionary
Understanding 10 new vocabulary words per reading unit.
Developing her ability to do the following during conversation in the classroom and in a one-on-one setting:
Taking 10 turns
Providing appropriate/sufficient details/info.
Checking for listener comprehension (e.g. Do you understand? Do you know what I mean?)
Attending to listener feedback
Providing information in a logical order
Understanding when the topic has changed
Asking appropriate questions in response to a topic
Increasing vocal intensity to a 5 on the Likert Scale (1-5)
Using 10 new vocabulary words per reading unit.
Discriminating between first and then producing the following sounds in all positions of words.
/b/ vs. /d/
/m/ vs. /n/
Producing the following sounds in all positions of words in conversation with 90% accuracy.
/s/ (decrease nasalization)
Tools for Schools by Advanced Bionics
The Listening Room (Hearingjourney.com by Advanced Bionic)
Agbell.com (Alexander Graham Bell Association/AG Bell Academy)
www.cochlear.com (Cochlear Americas)
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