Audiologists In The Schools

Audiologists in the Audiologists in the SchoolsSchools

Audiologists in the Audiologists in the SchoolsSchools

Kirsten Marconi-Hutkay, Au.D., CCC-AKirsten Marconi-Hutkay, Au.D., CCC-AEducational AudiologistEducational Audiologist

Stark County Educational Service CenterStark County Educational Service Center

Overview• What is an Educational Audiologist?• Qualifying for Services• Audiology Overview

– Anatomy– Hearing loss– Audiogram

• Hearing Aid/Cochlear Implants: Pieces & Parts

• Assistive Listening Devices• IEP Considerations• What’s new in Stark County

What does an Educational Audiologist do?

• Hearing conservation• Audiologic

assessments• Assistive technology

recommendations and fittings

• Classroom assessments of acoustics and recommendations

• Auditory processing assessments and recommendations

• Hearing screenings• Aural habilitation• Inservices• Counseling• Support• And so much more!!

How Does a Child Qualify?

• “Blue Book Laws”1. An average pure tone hearing loss of 50dB

or greater for the frequencies 500, 1000 & 2000 Hz for the better ear

2. An average PTA (pure tone average) of 25dB which has an adverse effect on educational performance related to documented evidence of:

• More severe HL during developmental years• Hx of chronic medical problems resulting in

fluctuating hearing (ex: chronic ear infections)• Delay in diagnosis, provision of amplification,

and/or initiation of special programming

How Does a Child Qualify?

• “Blue Book Laws” (con’t)3. Hearing loss of greater than 25dB for the

frequencies of 1000-8000 Hz in the better ear with poor auditory discrimination that has an adverse effect on education.

Audiology 101Auditory System

Outer Ear• Pinna• Ear canal

Middle Ear• Tympanic Membrane• Ossicles

– Malleus– Incus– Stapes

Inner Ear• Cochlea• Semicircular Canals• Auditory Nerve

Pinna

Ear Canal

Ossicles

Semicircular Canals

Auditory Nerve

Tympanic Membrane

Cochlea

Eustachian Tube

Hearing Loss• When we are describing a

hearing loss, we must consider two factors:

1. Type2. Degree

Types of Hearing Loss

1. Conductive2. Sensorineural3. Mixed


• Conductive: Occurs because there is a problem in the outer or middle ear. Sound (voices, music) is too soft. Can usually be medically or surgically treated, but is sometimes permanent. – Will benefit from amplification and assistive listening

devices.

– Ex: Perforated TM (eardrum), Impacted wax, otitis media (ear infection).


• Sensorineural: The problem is in the inner ear (cochlea or 8th cranial nerve). Sound is not only too soft, but also distorted. Can not be treated medically or surgically, resulting in permanent hearing loss. Will benefit from amplification, cochlear implant(s), assistive devices and aural rehabilitation. – Ex: Noise induced, ototoxic meds,

infections/illnesses, genetic, trauma, anatomical malformation of cochlea or cranial nerve.


• Mixed: Combination of a conductive and sensorineural loss. – Ex: noise induced loss and an ear infection

Degree of Hearing Loss

• Normal• Mild/Minimal• Moderate• Moderately-Severe• Severe• Profound

Audiogram

Normal

Mild

Moderate

Moderately-Severe

Severe

Profound

Example of a Hearing Loss

XOXO

OX

O

X

XO O

X

Key

X = Left Ear

O = Right ear

Moderate sloping to Profound Sensorineural Hearing Loss

Audiogram

X = Left Ear

O = Right Ear

Experience a Hearing Loss!“Unfair Spelling Test”

Available from Garlic Press Simulates various degrees of hearing loss Helps educators and administrators and even parents understand the

impact the hearing loss has on listening and thus, academic success

1. Bath2. Pearl3. Sour4. Mouse5. Learn6. Wheat7. Vine8. Tape9. Hedge10. Mood

Amplification Options

Hearing Aids: Pieces & Parts

• Most hearing aids

have the same parts:– Program switch– Volume control– Battery compartment– Earhook– On/off switch– Microphone(s)

• Earmolds:– Tubing– Sound bore– Vent (maybe)

MicrophoneEarhook

Program switch

On/OffBattery Compartment

Tubing

Sound Bore

Hearing Aids:• Hearing aid can’t and won’t restore normal hearing!

• Hearing aids can only AMPLIFY sounds; they can not prevent or eliminate the distortion resulting from the hearing loss.

• Just because the child hears you doesn’t mean that they understand you. Even with hearing aids, a child with a hearing impairment is putting forth much more effort than a child with normal hearing to keep with daily activities. They have to “work” to listen.

•“Did you hear what I said?”

•“Can you tell me what I said?”

• Hearing aids run on batteries that must be changed periodically. The teacher or speech-language pathologist (or the child) should have extra batteries on hand in case of an emergency.

Hearing Aids

How Do I Know it’s Working?!?

* Ling 6 Sound Test* Hearing Aid Checklist

Troubleshooting 101: *Does it need a new battery?*Is it clogged with wax?*Is it turned on? (Should be in the “M” position)

~The Ling 6 Sound Test~

This test allows for a quick and easy way to check and see that your student is able to hear sounds within his/her range of hearing! It also helps you as a teacher to get an idea of your student’s DISTANCE OF

HEARING -or- EARSHOT.

These are the “Ling 6 Sounds”Ah MmOo ShEe Ss

Each morning, before class, say these sounds to the student. Make sure that they are not able to read your lips. Continue saying the

sounds while gradually moving further away. Note the greatest distance that they are able to hear and repeat the sounds.

Helpful Hints:

* Switch around which sounds you say…don’t say them in a predictable pattern each day

* TAKE CARE TO PRODUCE EACH SOUND AT NORMAL CONVERSATIONAL LOUDNESS!! Don’t increase your intensity as you increase your distance.

* Take care not to increase the length of the sounds.

How will I know if his/her hearing has changed?!?

* Depending on the hearing loss, hearing for that day, ambient room noise and hearing aid efficiency, most of the vowels should be heard out to 15 feet and beyond. Due to their weak acoustic energy , the “sh” and “s” will be detected at closer distances (if at all)

3/6/08

Ling 6 Sound Test ~ Recording Form

Date Distance (ft.)

Ah Oo Ee Mm Sh S

3/5/08 15 ft.

X X

18 ft.

3/7/08 20 ft.

3/8/08 20 ft.

Additional Info:• Phonak

– www.phonak.com– eschooldesk

• www.phonak.com/professional/eschooldesk

• FM support for teachers, SLPs, AuDs, etc.

• Oticon– www.oticonus.com

Cochlear Implants

• What is a cochlear implant?– A medical device for severely to profoundly deaf individuals who

gain little or no benefit from hearing aids and assistive listening devices.

• How is it different from a hearing aid?– Hearing aids amplify sound. To a person with severe to profound

hearing loss, amplification won't provide much hearing because sound is still being delivered through a damaged part of the ear.

– A cochlear implant doesn’t make sounds louder – it bypasses the damaged part of the ear and sends sound directly to the auditory (hearing) nerve to provide a clearer understanding of sound and speech.

• Does a cochlear implant restore normal hearing?– No, an implant will not restore normal hearing-nothing can. A

child using an implant will typically have thresholds in the mild hearing loss range…(remember the spelling test?) Also, it sounds different. They aren’t hearing an acoustic signal, but an electric signal.

Cochlear Implant

Cochlear Implants

•3 Manufacturers

o Cochlear Corporation www.cochlear.com

o Advanced Bionics www.advancedbionics.com

o MedEl www.medel.com

Aren’t hearing aids & cochlear implants

enough?• Not always. • Assistive Listening Devices overcome obstacles such

as:

– Background noise– Distance– Reverberation

• Which are found in all classrooms!

Assistive Listening Devices

• Can be used with hearing aids and cochlear implants• If more than one student with hearing loss in the same

classroom, can “sync” all of the hearing aids/cochlear implants so that they are all on the same frequency.– Same frequency= ONE microphone!!

Assistive Listening Devices• Lots of different types of

systems– FM Systems– Infrared Systems– Hard wired – Wireless– Classroom

• Permanent• Portable

– Personal

• Similar Components:

1. Microphone- worn by the teacher/therapist 2. Speaker/Receiver- for the students - Connected to hearing aid or distributed throughout the classroom

Infrared Wireless System

• Lightspeed• Classroom system

– Speaker that transmits teacher’s voice throughout the classroom

• Wall mounted• Speakers in the ceiling

Phonak Wireless FM System

• Personal system• Must be on a specified frequency• Two parts

– Teacher’s Microphone– Student’s Receiver

• Couples to the bottom of hearing aid/cochlear implant

– Audio shoe (w/ aid)– Receiver

What?!?!?

When in doubt...• Contact your area rep!• Phonak

– www.phonak.com– 1-888-777-7333 (Main)– 1-888-777-7316 (FM)– Deb Edwards

• Regional FM Product Specialist

• Lightspeed– www.lightspeed-tek.com– 1-800-732-8999

IEP Considerations• Preschool

– Soundfield/Classroom amplification– Will benefit from personal amplification

system coupled to hearing aid(s)/cochlear implant.

** NOT FOR ALL KIDS AT THIS AGE**

– Teachers/Staff must be inserviced at the beginning of the school year.

• Daily listening checks of the equipment• Change batteries• Pieces and parts

– Consultation with Educational Audiologist

IEP Considerations

• Elementary School– Teachers/Staff also need to be inserviced annually.– Soundfield or personal amplification system– Classroom/Test taking accommodations

• Extended time• Preferential seating• Pre-tutoring new vocab/concepts

– Important for student to start caring for equipment.• Responsibility of daily listening checks and batteries

fall on the students– Consultation with Educational Audiologist

IEP Considerations• Middle School

– Teacher/Staff/Coach inservices– Daily checks of equipment– Classroom/test taking accommodations– May start seeing the “social” aspect of their hearing

loss• Although may start earlier• Become introverted• In denial of hearing loss or need for

equipment/accommodations– Keep an eye on them!!


IEP Considerations• High School

– Get thinking about after graduation!– Services out there for students with hearing

loss.• Help pay tuition, ALDs, etc

– BVR (Bureau of Vocational Rehabilitation)– Office of Accessibilities

– Tons of scholarships!• Sertoma• Quota International• Alexander Graham Bell Association


What’s Going on in Stark County??

• SPEAK Auditory Oral Preschool– Stark Project for Educating Audition in Kids– For children whose parents have chosen spoken

language as the primary means of communication for their child

– All of our kids wear hearing aids and/or cochlear implants

– Public preschool program– Follow ODE guidelines– Children receive highly specialized instruction in

speech, language and auditory skills– Teacher is certified in Oral-Deaf Education


• HIT IT– Hearing Impaired Teens, Interacting Together– Middle school and high school students with

hearing loss who live in Stark County (except those attending Canton City)

– Support group– Learn about their hearing loss, and meet other

kids with hearing loss, discuss issues they may be facing in a non-threatening environment.


• Sound Beginnings– Sponsored by Quota International of Massillon– Provides financial assistance for the initial set

of hearing aids to any child (age 3 and under) who is diagnosed with permanent hearing loss, regardless of income.

– Ensure every child with a hearing loss has appropriate and optimum hearing aid amplification as soon after diagnosis in order to begin early intervention services.

Health & Medicine

Audiologists In The Schools