Hearing Impairment

What is a hearing impairment?

A person with a hearing impairment has a full or partial loss of the ability to hear and discriminate sounds. This is due to an abnormality in the structure and/or functioning of the ear. A Hearing Impairment is described in terms of the degree of hearing loss (e.g. mild to profound) and the type of hearing loss (e.g. permanent – sensori-neural, not permanent – conductive hearing loss, or a mixed hearing loss which is a combination of both). Hearing Impairment can be caused by the following:

Genetic factors (e.g. hearing loss in the family).
Infections during pregnancy (e.g. cytomegalovirus, rubella, herpes or syphilis), toxins consumed by the mother during pregnancy or other conditions occurring at the time of birth or shortly thereafter.
Premature birth
Childhood infections (e.g. measles, chicken pox).
Head trauma after birth.
Otitis Media (i.e. middle ear infection) due to nasal congestion.

What are the common features of a hearing impairment?

Speech sound system is delayed and the child is not developing sounds appropriately.
Frequent or re-occurring ear infections.
A family history of hearing impairment.
Difficulties attending and listening.
Delayed language skills
Performing poorly at school.
Lack of response to loud, sudden noises.
Poor coordination

Common difficulties often (but not always) experienced by the child with a hearing impairment?

Language delay/disorder
Speech delay/disorder
Sensory processing
Attention and listening difficulties
Behavioural difficulties
Gross motor difficulties due to middle ear dysfunction affecting balance.
Difficulties with reading and spelling.

Occupational Therapy approaches and activities that can support the child with a hearing impairment and/or their carer’s include:

Child’s abilities: Observing the child during play and formal assessment to determine the child’s abilities with gross motor (whole body) tasks and what they find difficult and then making recommendations for management.
Devise goals: Setting functional goals in collaboration with the child, parents and teachers so that therapy has a common focus beneficial to everyone involved.
Educating parents, carers and teachers about Hearing Impairment, the age appropriate skills a child should be demonstrating and providing management strategies/ideas to assist the child in the home, at school and in the community.
Sensory processing: Improving sensory processing to ensure appropriate attention and arousal to attempt the tasks as well as ensuring the body is receiving and interpreting the correct messages from the muscles in terms of their position and relationship to each other.
Multi-sensory approach: Using a multi-sensory approach to learning new skills.
Modelling tasks visually and using hands on adjustment techniques to aid body awareness for the child.

Management strategies that help support the child with a hearing impairment (at preschool, school and/or home):

Referral to an ENT (Ears, Nose and Throat Specialist) or audiologist for grommets or hearing aids.
Providing those involved with the child information about the child’s level of understanding so that the language used is at an appropriate level for the child to understand.
Set up an individualised plan with parents/carers that have small achievable speech and language goals to help develop the child’s language skills.
Provide the child with strategies to manage situations when they don’t understand (e.g. teaching them to put up their hand when they don’t understand, teaching some standard questions to ask when needed).
Liaison with educational staff to provide information to be incorporated into an education plan and/or implementing ideas/suggestions/activities to help improve the child’s speech and language skills and ability to access the curriculum.
Use fun play-based activities or games to help motivate the child to learn.
Use simple and concise information.
Use visuals to supplement auditory language (e.g. pictures, signs, gestures).

Speech Therapy approaches and activities that can support the child with a hearing impairment and/or their carer’s include:

Speech and language assessment to determine the child’s speech (i.e. articulation) and language (i.e. understanding and use of language) skills to develop appropriate management strategies.
Daily activities: Providing parents with interaction strategies to develop language which can be implemented during daily activities within the home.
Multi-sensory approach: Using a multi-sensory approach (e.g. sight, taste, smell, touch) to learn new words and concepts.
Child’s interests: Using the child’s interests to help develop their language skills.
Fun games: Using fun play-based activities or games to help motivate the child to learn.
Visuals (e.g. pictures, words) can be used to help understanding and use of language where appropriate.
Books: Teaching about the use of books and stories to aid language development.
Articulation: Improving articulation of specific speech sounds within words.
Alternative forms of communication: Developing alternative ways of communicating (e.g. sign language, the Picture Exchange Communication System (PECS), voice output devices).
Liaising with educational staff and other professionals involved in the child’s care regarding the nature of the difficulties and ways to help the child to access the curriculum.

Why should I seek therapy for my child with a hearing impairment?

Diagnosis alone is NOT the solution. It simply opens the door to getting the help that is needed by arming all involved with the relevant information.

The ‘help’ still needs to be provided. The help that is provided (at least from a therapy perspective) will reflect:

First and foremost what medical intervention is needed.
What the parents/teachers/carers biggest concerns are for the child (i.e. what are the most significant functional challenges).
The specific areas that are problematic to the child (which will vary even within children with the same diagnosis).
The capacity of the child’s environments to meet the child’s needs.

If left untreated the child with a hearing impairment may have difficulties with:

Following instructions within the home, kindergarten or school environment.
Vocabulary whereby a child cannot clearly get their message across due to limited word knowledge.
Learning to talk, speech intelligibility and clarity.
Self esteem and confidence when they realise their skills do not match their peers.
Bullying when others become more aware of the child’s difficulties.
Self regulation and behaviour as the child is unable to regulate themselves appropriately to settle and attend to a task for extended periods of time.
Accessing the curriculum because they are unable to attend to tasks long enough to complete assessment criteria.
Anxiety and stress in a variety of situations leading to difficulty reaching their academic potential.
Academic performance: Developing literacy skills such as reading and writing and coping in the academic environment.
Academic assessment: Completing tests, exams and academic tasks in higher education.

More specific implications of not seeking treatment will be influenced by the common difficulties that are most influencing your individual child.

For more information see the relevant fact sheets under areas of concern or refer to the other relevant resources section below.

What does the diagnosis of a hearing impairment really mean for the child?

Diagnoses are used to label a specific set of symptoms that are being experienced by a child.

This label then helps to narrow down and specifically tailor what:

Other issues commonly occur simultaneously.
Medication might be appropriate.
Therapies might help the child (e.g. Medical, Occupational Therapy, Speech Therapy, Psychology).
Course of intervention (medical and/or allied health) might be and what outcome might be expected (prognosis).
Can be done to help the child.

A diagnosis helps the child and their carers (parents, teachers, health professionals, carers) to:

Access information about the relevant cluster of symptoms.
Communicate the salient features of the child’s challenges to all people involved in the child’s care.
Possibly interpret certain behaviours differently in light of the diagnosis.
Obtain information about what can be done to help the child.
Determine specifically where and how to help the child.
Access funding or services that might not otherwise be accessible.