Supports+for+Students+with+Hearing+Impairments


 * Amplification **

Amplification plays a major role in the education of deaf and hard of hearing students. Amplification involves the use of hearing devices such as hearing aids, FM systems and cochlear implants to enhance student’s reception of speech. The technology which a student uses to aid their hearing is chosen based on the needs of the individual student and observations from supports at the school such as audiologists who will consult with the parent (Educator's Resource Guide, 2009, p. 13). Other factors which influence the technologies that will best suit students’ needs include: degree of hearing loss, type of hearing loss, and the shape and size of the individuals’ ears (Educator's Resource Guide, 2009, p. 13).

If amplification systems have been recommended to a student it is important to ensure that the student consistently uses that system. Support teams should be educated on the use of and care of amplification systems which their students’ may be using. Communication between teachers’, support teams and the student’s family should be open to ensure the amplification system is the best possible support for the student. If a student gets new amplification supports it is important to communicate this so that other technologies being used can be upgraded to match students’ new devices (Educator's Resource Guide, 2009, p. 13).

The following pages will focus on three of the main amplification systems which are used in the education of deaf or hard of hearing students’: Hearing Aids, Cochlear Implants and FM Systems. Hearing Aids **

A hearing aid is an electronic device which amplifies sound. Hearing aids will amplify both speech and background noises. Hearing aids do not restore normal hearing. Listening environments should be quiet and work best within a six foot range of the speaker and the listener. As the background noise and distance between the speaker increases the effectiveness of a hearing aid is greatly decreased. Hearing aids need to be worn consistently to ensure that they are helping the student and daily checks of the hearing aid should be done to ensure proper working order (Educator's Resource Guide, 2009, p. 14).

There are several hearing aid options for children such as in-the-ear hearing aids, behind-the-ear hearing aids, bone anchored hearing aids (BAHA), Contralateral Routing of Signal (CROS) and a body aid. Behind-the-ear ** The behind-the-ear hearing aid is the most popular type of hearing aid, as it allows the greatest flexibility in fitting. The hearing aid sits at the top of the students’ ear and amplified sounds are routed to the ear through tubes and an ear piece/ear mould. This type of hearing aid is often used with profound hearing loss and can be used with other amplification devices. Behind-the-ear hearing aids are very flexible in their ability to be programmed with other devices (Canadian Academy of Audiology, 2006). In-the-Ear ** This type of hearing aid is very popular with adults but has several drawbacks for children. It fits completely in the ear and outer ear canal. Since young children’s ears are continually growing, hearing aids need to be re-cased and re-shelled to fit the students’ ears. While they are re-cast, students are often left without amplification for several days. In-the-ear aids cannot be used with FM systems and are not compatible with most other systems and are not suitable for profound hearing loss (Canadian Academy of Audiology, 2006). Bone Anchored Hearing Aid (BAHA) ** These types of hearing aids are meant for individuals with malformed ears and no ear canal, or individuals with chronic ear infections which do not allow for traditional ear moulds. The BAHA system is surgically implanted and conducts sound through direct bone vibrations. There are three parts to the BAHA: a titanium implant, the abutment and the sound processor (Educator's Resource Guide, 2009, p.14). Minor surgery is required for the aid to be implanted. Individuals must wait three to six months after surgery before the sound processor can be worn to ensure that the implant properly integrates with the bone (Educator's Resource Guide, 2009, p.14). The processor is easily attached and removed from the abutment. Care needs to be taken to ensure the abutment is clean to avoid infection around the implant.

Children five years of age and younger are not recommended candidates for the BAHA system, as their skulls are not thick enough. A device called the BAHA Softband can be used for children under the age of five. The Softband is an elastic band which fits on the skull with a snap to fit the sound processor into.

This is a system which is designed for individuals with unilateral hearing loss or hearing losses where one ear has more severe hearing loss than the other. The poorer ear has a microphone placed on it, while the other ear has a hearing aid to which the signal is relayed (Canadian Academy of Audiology, 2006). Body Aid ** The body aid is a system in which the student wears the hearing aid in a harness or pocket with a cord leading from the hearing aid to the ear mould. This was once the most popular choice for children as it allowed children to have access to powerful hearing aids. With the development of more powerful hearing aids, the body aid has continued to become a less popular option and is now being phased out. The cords are prone to breakages and the hearing aid does not provide the best auditory signal when worn on the body (Canadian Academy of Audiology, 2006). Cochlear Implant **
 * Contralateral Routing of Signal (CROS) **

A cochlear implant is a device which is surgically implanted into the inner ear and stimulates the auditory nerve. Cochlear implants are useful for individuals who experience profound sensorineural hearing loss and have experienced little benefit from hearing aids (Educator's Resource Guide, 2009, p.15). The implants do not restore normal hearing, but do improve access to sound. Components ** The cochlear implant consists of an internal device and an external device.

The internal device consists of a magnet, receiver and band of electrodes. The internal device is inserted surgically through an incision behind the ear. The magnet and receiver are secured in place under the skin and a hole is drilled into the inner ear. The electrodes are placed through this hole and securely placed into the cochlea. The implant remains under the scalp of the individual (Educator's Resource Guide, 2009, p.15).

The external device consists of the microphone, speech processor, transmitter and batteries (NIDCD, 2009). Sound is picked up in the microphone and sent to the speech processor where it is converted to an electric signal (NIDCD, 2009). A transmitter then sends the sound through the scalp to the internal device which relays the signal to the electrodes. The electrodes stimulate the auditory nerve and the brain interprets this as sound. Cochlear implants take several months to program once they are surgically implanted (Educator's Resource Guide, 2009, p.15).

Individuals wearing cochlear implants often wear a hearing aid in the other ear. This is called bimodal hearing. The hearing aid picks up low frequency sounds which the cochlear implant does not always pick up. Hearing aids and cochlear implants work together to provide as much sound information as they can. Another common procedure today is to implant two cochlear implants, one in each ear. This is called bilateral implantation. Bilateral implantation can provide advantages in sound localization and speech discrimination (Educator's Resource Guide, 2009, p.15).

Candidates for cochlear implants must be eighteen months or older, have severe-profound hearing loss, no medical reasons which would complicate surgery, have little or no benefit from amplification and display psychological and motivational suitability (NIDCD, 2009). Other factors include having access to a proper educational setting which emphasizes auditory learning. Finally, families need to be willing to take part in extensive pre and post implant assessment and training issues (Canadian Academy of Audiology, 2006).
 * Candidacy **

Cochlear implants are a very controversial issue within the deaf community, as individuals who receive them are viewed as turning their back in their culture. Cochlear implants do not restore hearing, but they do improve access to sounds which can help improve speech. The surgery is risky, as the implant is located very close to nerves which control facial movements and taste. Complications during surgery can result in loss of taste as well as facial paralysis (Snider, 2008). Cochlear implants only work when turned on and cannot be worn in water or hot environments such as saunas (Snider, 2008). FM Systems ** FM systems are used to enhance the use of hearing aids and cochlear implants. Complications such as reverberation, background noise and distance can make students with hearing aids or cochlear implants have trouble hearing in the classroom (CDHH, 2007). FM systems help to deal with these complications. Personal FM systems and sound field FM systems are the two types which are commonly used in the classroom.

The personal FM system uses a microphone, transmitter and receivers to send the teacher’s voice to hearing aids and cochlear implants through an FM radio wave. The teacher has a microphone and transmitter located on his/her person and the receiver attaches to the student’s hearing aid or cochlear implant through an adapter called an AI boot or an audio shoe. Students’ hear the teacher as if they were right next to them, thereby overcoming the problems of distance and background noise (Educator's Resource Guide, 2009, p.18).

The sound field FM system uses a microphone and transmitter to send the teacher’s voice to speakers in the classroom. This system is meant to benefit students with mild hearing loss or unilateral hearing loss, as it allows the teacher’s voice to be heard equally throughout the classroom. This system is also louder than the background noise. Personal FM systems can be linked with a sound field FM system if both are required within the classroom. Personal FM systems are recommended for students with cochlear implants (Educator's Resource Guide, 2009, p.18).

There is also an infrared sound field system (CDHH, 2007). This system used a microphone, transmitter, receiver and speakers. This system uses infrared rays to send sound from the source to the receiver. This system is beneficial as it keeps the signal within the classroom so it does not interfere with other systems. All receivers in an infrared system must be on the same channel as the transmitter (CDHH, 2007).

Acoustic Issues in the Classroom ** Understanding speech and having access to speech to improve listening, language and learning skills is vital to success for individuals with hearing loss. The classroom can be a noisy environment and this can make it challenging for students with hearing loss to learn. The three main obstacles to speech access in the classroom are background noise, reverberation and distance from the person speaking(Educator's Resource Guide, 2009, p.17). Today’s hearing and amplification devices have improved greatly they cannot completely remove all obstacles to speech understanding.

Ambient noise is present in most classrooms and hearing aids pick up this noise. In many classroom environments, the ambient noise may be louder, or just as loud, as the teacher’s voice and hearing aids alone cannot distinguish the teacher’s voice. The comparison of speech to noise level is called the signal-to-noise ratio and distinguishes between the primary voice and background noise. Students with hearing loss need the speech signal to be substantially louder than the noise from the classroom in order to provide an adequate learning environment (Educator's Resource Guide, 2009, p.18). Distance ** For students with hearing loss, distance is a major obstacle to understanding speech. The further the student is from the teacher, the less intense the speech signal is, thus making it more difficult for the student to hear properly as background noise will often remain the same. Students need to be within one to two meters of the teacher in order to have maximum speech understanding (Educator's Resource Guide, 2009, p.18). This is not always possible within the classroom. ** Reverberation ** Reverberation occurs when sounds bounce off objects within the classroom and cause the teacher’s voice to be muffled or masked. When this happens, speech clarity can be reduced. The signal-to-noise ratio can increase, making speech difficult to understand. Ceiling tiles, small carpeted areas and devices to muffle feet and chairs will improve acoustic characteristics of the classroom (Educator's Resource Guide, 2009, p.18).
 * Background Noise **

Some examples of alternative technologies which can be beneficial within the classroom include closed captioning, cell phones, video conferencing, and speech to text software. Closed captioning can be used when showing a movie within class or is commonly used when watching television(Graham, 2010). LCD projectors have been developed which can display closed captioning within the classroom (Graham, 2010).
 * Alternative Technologies **

Cell phones are another example of a technology which can be used within the classroom. Student’s can type in messages using the text function of the phone to communicate with other students’ or with teachers’. Cell phones can also be used to communicate emergency alerts such as fire alarms or other emergencies to students’ (Graham, 2010). Video conferencing can also be used to get deaf or hard of hearing students’ to communicate with other deaf or hard of hearing students’ (Graham, 2010).

Finally, for students’ with profound hearing loss speech to text software is very beneficial. This software allows students’ who struggle with hearing to read what is being said to the class and keep up with the classroom (Business Week, 2010). This can also fill in gaps for students’ who struggle to pick up everything that is said within the classroom, by putting everything the teacher says to text for the student to read.

Organizations ** Below are some organizations which act as resources and provide support to individuals who are deaf or hard of hearing.
 * Supports (Peer and Personal, Organizations) **

Central Speech and Hearing Clinic: [|www.centralspeech.ca] Deaf Centre Manitoba Inc. (DCM): [|www.deafmanitoba.net] Manitoba Association of Visual Language Interpreters (MAVLI): [|www.mavli.com] Manitoba Deaf Association (MDA) CAEDHH—Manitoba (CAEDHH—MB): [|www.caedhh.ca] Manitoba Cultural Society of the Deaf (MCSD): [|www.deafmanitoba.net] Society for Manitobans with Disabilities: [|www.smd.mb.ca] Manitoba School for the Deaf: [|www.msd.winnipeg.mb.ca]


 * Peer**

The most important support peers can provide to deaf or hard of hearing students’ is to include them. Ensuring that deaf students’ are included in conversations and what is happening in the class can go a long way to benefitting the students’ wellbeing. Providing opportunities for students’ to work in groups together and share their ideas with the rest of the class is another way to provide peer support, as deaf students’ get to communicate with peers their own age (Graham, 2010).

Peers can also act as a peer note taker for deaf or hard of hearing students’. Designating a student from the class to share their notes with a student suffering from hearing loss allows the student to focus on listening and picking up what the teacher is saying rather than focusing on writing everything down.