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Hearing Impairment

More than one million children in the United States have some form of hearing loss. At some point in their career, most educators will work with a child who is hearing impaired. Therefore, it is imperative for educators to understand what a hearing loss is and how to make necessary adaptations within the classroom to allow the hearing impaired child to flourish. In almost every school system in the United States, the Internet and other technology have become an integral component of the curriculum

While most children do not have trouble accessing the Internet or other technologies, hearing impaired children will undoubtedly encounter greater accessibility challenges. It is important for educators to understand how technology within the classroom can benefit the hearing impaired child. However, teachers must also understand that technology can also create barriers for those with disabilities.

Once educators fully understand the impacts of technology on the hearing impaired child they will be able to make their classroom more accessible for all students. Making the classroom more accessible for the hearing impaired child can only be accomplished if the educators understand hearing loss and the restrictions that a hearing loss may impose on an individual. Only once the teacher understands what a hearing loss is, may they begin to comprehend how technology can benefit the hearing impaired individual and in some cases hamper or restrict learning for the person with a hearing disability.

In order to make the classroom accessible for hearing impaired individuals it is necessary for teachers to understand the different types of hearing loss. Hearing impairment is often referred to as the invisible handicap. To explain, a hearing loss is not visible and it is often overlooked and misunderstood. Once educators fully understand what a hearing loss is, they will then be able to make the curriculum within their classroom more accessible to all individuals.

What is a hearing impairment?

Hearing impairment is best defined as a lack or reduction in the ability to hear clearly due to a problem somewhere in the hearing mechanism. A hearing impairment can occur in the outer, middle, or inner ear along the pathway to the brain (National, 43). A complete audiological assessment consisting of many tests will best determine and specify the type of loss a child has. Once the loss has been determined parents and educators will be able to help their child develop the necessary skills needed to develop speech and language skills and communicate effectively.

Early detection of a hearing loss is imperative so invention and treatment can be established immediately. Parents and teachers of a child with hearing impairment must be educated. Understanding a child's hearing loss will help the child flourish and develop the necessary skills to adapt to their hearing loss.

One must understand how the ear works in order to understand the type of loss a child has. To explain, "sound travels through the air in the form of waves of varying frequency. The frequencies of these waves determine the pitches of the sound that is heard. Sound waves are channeled into the external ear canal where they are transmitted to the middle ear, which consists of the eardrum and three small bones in the ear cavity.

This part of the ear serves as an amplification system. The middle ear compensates for the loss of the intensity of sound as it travels from the air medium of the middle war to a fluid medium within the inner ear known as the cochlea. Sound travels as waves of fluid to a specific area depending on the frequency of the sound in the cochlea. The fluid movement then causes the tectorial membrane to vibrate against the hair cells, which then stimulates the auditory nerve.

The auditory nerve is responsible for transmitting the sound stimuli to the auditory center in the brain. The components that make up the sound and speech that are heard are coordinated and sent to higher centers of the brain for interpretation''

Classifications of hearing loss

There are three types of hearing loss: conductive , sensorineural , and mixed . A conductive hearing loss is a result of damage to outer or middle ear. Conductive losses are not severe and often times can be surgically corrected. A person with a conductive loss may reap great benefits from hearing aids. A sensorineural hearing loss is a result of damage to the hair cells of the inner ear or nerves. This type of loss ranges from mild to profound and is permanent.

. In other words, surgery cannot be performed to correct a sensorineural hearing loss. Often times, hearing aids are not helpful either. While the aids may amplify sounds, the sounds are still distorted. A mixed hearing loss simply means that the hearing problem occurs in the outer or middle ear and inner ear.

Degrees of hearing loss

There are different degrees of hearing loss. Below is a chart that lists and classifies the degrees of hearing loss according the dB range in which sound is heard.
  • Degree of hearing loss- dB range
  • Normal Hearing- 0-20dB
  • Mild Hearing Loss- 20-40 dB
  • Moderate Hearing Loss- 40-65 dB
  • Severe Hearing Loss- 65-90dB
  • Profound Hearing Loss- 95 and up dB
Down syndrome symptoms vary from person to person and can range from mild to severe. However, children with Down syndrome have a
widely recognized appearance.
The head may be smaller than normal and abnormally shaped. For example, the head may be round with a flat area on the back. The
inner corner of the eyes may be rounded instead of pointed.

Common physical signs incude:

  • Decreased muscle tone at birth
  • Excess skin at the nape of the neck
  • Flattened nose
  • Separated joints between the bones of the skull (sutures)
  • Single crease in the palm of the hand
  • Small ears
  • Small mouth
  • Upward slanting eyes
  • Wide, short hands with short fingers
  • White spots on the colored part of the eye (Brush field spots)
Physical development is often slower than normal. Most children with Down syndrome never reach their average adult height.
Children may also have delayed mental and social development.

Common problems may include:

  • Impulsive behavior
  • Poor judgment
  • Short attention span
  • Slow learning
As children with Down syndrome grow and become aware of their limitations, they may also feel frustration and anger.

Many different medical conditions are seen in people with Down syndrome, including:

  • Birth defects involving the heart, such as an atrial septal defect or ventricular septal defect
  • Dementia may be seen
  • Eye problems, such as cataracts (most children with Down syndrome need glasses)
  • Early and massive vomiting, which may be a sign of a gastrointestinal blockage, such as esophageal atresia and duodenal atresia
  • Hearing problems, probably caused by regular ear infections
  • Hip problems and risk of dislocation
  • Long-term (chronic) constipation problems
  • Sleep apnea (because the mouth, throat, and airway are narrowed in children with Down syndrome)
  • Teeth that appear later than normal and in a location that may cause problems with chewing
  • Underactive thyroid (hypothyroidism)

Signs and tests

A doctor can often make an initial diagnosis of Down syndrome at birth based on how the baby looks. The doctor may hear a heart murmur when listening to the baby's chest with a stethoscope.
A blood test can be done to check for the extra chromosome and confirm the diagnosis. See: Chromosome studies Other tests that may be done include:
  • Echocardiogram to check for heart defects (usually done soon after birth)
  • ECG
  • X-rays of the chest and gastrointestinal tract
Persons with Down syndrome need to be closely screened for certain medical conditions. They should have:
  • Eye exam every year during infancy
  • Hearing tests every 6 - 12 months, depending on age
  • Dental exams every 6 months
  • X-rays of the upper or cervical spine between ages 3 - 5 years
  • Pap smears and pelvic exams beginning during puberty or by age 21
  • Thyroid testing every 12 months


There is no specific treatment for Down syndrome. A child born with a gastrointestinal blockage may need major surgery immediately after birth. Certain heart defects may also require surgery.

When breast-feeding, the baby should be well supported and fully awake. The baby may have some leakage because of poor tongue control. However, many infants with Down syndrome can successfully breast-feed.

Obesity can become a problem for older children and adults. Getting plenty of activity and avoiding high-calorie foods are important. Before beginning sports activities, the child's neck and hips should be examined.

Behavioral training can help people with Down syndrome and their families deal with the frustration, anger, and compulsive behavior that often occur. Parents and caregivers should learn to help a person with Down syndrome deal with frustration. At the same time, it is important to encourage independence.

Adolescent females and women with Down syndrome are usually able to get pregnant. There is an increased risk of sexual abuse and other types of abuse in both males and females. It is important for those with Down syndrome to:

Be taught about pregnancy and taking the proper precautions Learn to advocate for themselves in difficult situations Be in a safe environment If the person has any heart defects or problems, check with the physician about the need for antibiotics to prevent heart infections called endocarditis.

Special education and training is offered in most communities for children with delays in mental development. Speech therapy may help improve language skills. Physical therapy may teach movement skills. Occupational therapy may help with feeding and performing tasks. Mental health care can help both parents and the child manage mood or behavior problems. Special educators are also often needed.

Support Groups

National Down Syndrome Society - www.ndss.org

National Down Syndrome Congress -- www.ndsccenter.org

Expectations (prognosis)

Persons with Down syndrome are living longer than ever before. Although many children have physical and mental limitations, they can live independent and productive lives well into adulthood.

About half of children with Down syndrome are born with heart problems, including atrial septal defect, ventricular septal defect, and endocardial cushion defects. Severe heart problems may lead to early death.

Persons with Down syndrome have an increased risk for certain types of leukemia, which can also cause early death.

The level of mental retardation varies from patient to patient, but is usually moderate. Adults with Down syndrome have an increased risk for dementia.


Airway blockage during sleep Compression injury of the spinal cord Endocarditis Eye problems Frequent ear infections and increased risk of other infections Hearing loss Heart problems Gastrointestinal blockage Weakness of the back bones at the top of the neck

Calling your health care provider

A health care provider should be consulted to determine if the child needs special education and training. It is important for the child to have regular checkups with his or her doctor.


Experts recommend genetic counseling for persons with a family history of Down syndrome who wish to have a baby. A woman's risk of having a child with Down syndrome increases as she gets older. The risk is significantly higher among women age 35 and older. Couples who already have a baby with Down syndrome have an increased risk of having another baby with the condition. Tests such as nuchal translucency ultrasound, amniocentesis, or chorionic villus sampling can be done on a fetus during the first few months of pregnancy to check for Down syndrome. The American College of Obstetricians and Gynecologists recommends offering Down syndrome screening tests to all pregnant women, regardless of age.


1. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 2007 Jan;109(1):217-227. [PubMed] 2. AAP Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2001 Feb;107(2):442-449. [PubMed] 3. Davidson MA. Primary care for children and adolescents with Down syndrome. Pediatr Clin North Am. 2008;55:1099-1111. [PubMed] 4. Simpson JL, Otao L. Prenatal genetic diagnosis. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics:Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 7. Review Date: 10/18/2010. Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.