Hearing Impairments





  • Recognize the definition of hearing impairments.
  • List the characteristics of hearing impairments.
  • List some major accommodations for students with hearing impairments.
  • Identify some problems with the definition of hearing impairments. 
  • Describe problems caused by the definition of hearing impairments as they relate to placement, service, and funding.
  • Read history, characteristics, terminology, and notes in this section.


Hearing Impairments - Definition

Hearing impairment is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance."

Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."

Sound is measured by loudness or intensity (measured in units called decibels, dB) and its frequency or pitch (measured in units called hertz, Hz). Impairments in hearing can occur in either or both areas, and may exist in only one ear or in both ears. Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most greatly associated with speech. Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf for the purposes of educational placement.

Classroom Accommodations
A good source of information for accommodation can be found on a Florida State University web site.

General Comments
A deficiency in hearing. The degrees hearing loss can be classified as: From an educational standpoint, hearing impairment has been divided into "deaf" (a hearing loss of 70 db or greater in the better ear), and "hard of hearing" (defined as a hearing loss of 35 to 69 degrees in the better ear)

The majority of students with disabilities attend regular classes or spend increasingly more time in regular education classrooms than in the past.  Although there have been commendable changes in the attitudes and collaborative efforts of special and regular education personnel, most of these changes have been related to individual students.  As more and more diversity of the student population occurs in classrooms as the result of inclusion efforts, more change will be expected of the regular education classroom teacher.  However, regular education classroom teachers did not choose to be special education teachers, have not taken special education coursework, and do not feel prepared to provide for special education students.  There is a potential problem because legal requirements demand accessibility for instruction provided in the regular education classroom for special education students.

Tasks of the Student.  The student's role is attention and compliance (Ausubel, 1963, 1968).  In a typical classroom the learner must exert a great deal of attention (a difficult task), comprehend terms the teacher uses (a more difficult task), impose order on the incoming temporal stream of information, make judgments about the quality and significance of the information, attempt to write down or remember as much as possible, and memorize for later reproduction the information presented.  For any pupil this can be challenging, but for many students with disabilities it may be impossible under normal classroom conditions.  Clearly the ability to understand instruction is of critical importance.  Many students with disabilities cannot survive poor instruction, a rapid pace of instruction, or loss of auditory and visual signals in the environment.
CUED SPEECH....is a visual communication system which, in English, uses eight handshapes in four locations ("cues") in combination with the natural mouth movements of speech to make all the sounds of spoken language look different. 

Assessment of the Instructional Environmental

The instructional tasks of the teacher and the ability of students to profit from instruction depend on the quality of presentation and the ability for everyone to hear and understand.  While there has been considerable investigation of teacher  presentations in classrooms in the process-product research tradition, such investigations have not also accounted for the ability of certain students to hear, see, understand presentations of the classroom teacher.  Many students who are disruptive, withdrawn, frustrated, or resigned to failure may be unable to see and hear clearly in the classroom.  There are two general concerns of particular importance to instructional accessibility for students with disabilities in the regular classrooms: (a) the acoustical characteristics of the classroom and (b) the use of appropriate visual formats  to enhance instructions.

Noisy environment.  Classrooms are extremely noisy, a factor almost completely ignored in research on effective teaching.  Although difficulty in listening and understanding speech in school band rooms or cafeterias is obvious, it is generally not recognized by educators that other instructional environments are less than ideal for listening (Crandell, 1993).  Research shows that noise in most classrooms exceeds levels recommended for effective instruction (Crum & Matkin, 1976).  There is evidence that excessive noise can have a deleterious effect on learning. Research with populations with auditory disorders, learning disabilities, developmental delays, attention deficit disorders, and typical students indicates that they are negatively influenced by high levels of common classroom noise (Blake, Field, Foster, Platt, & Wertz, 1991; Crandell, 1993; Flexer, Millin & Brown, 1990; Ray, Sarff, & Glassford, 1984).  Implementation of inclusion will create greater diversity in cognitive ability, sensory ability and learning styles of students within classrooms (McCollister, Larrabee, & Ellis, 1994), and this should elevate concern about classroom milieu.

Lack of media.  While teachers talk a great deal, they do not use  technology and media in classrooms to support their presentations to the benefit of student comprehension (Joyce, Hersh, & McKibbin, 1983).  Instructional media have long been viewed negatively by teachers and considered disruptive to classroom harmony (Dodge, H., Brogdan, R., Brogdan, N. & Lewis, R. 1974).  Teachers rarely use any form of media, including overhead transparencies, models, tapes, videos, or even pictures in books and magazines (Heinich, Molenda, & Russell 1989).  Teachers have been slow to adopt the use of technologies in classrooms, keeping traditional instructional methods based on oral presentation (Peck & Dorricott, 1994).  Successful use of media by teachers depends upon training (Kanning, 1994).

There are many views and controversy about the shared responsibilities of special and regular teachers in inclusion.  The details of how services shall be shared by personnel is still evolving.  Nonetheless, a general strategy is urgently needed to improve the chances for success of disabled pupils in the inclusion model, no matter who the teacher may be.  As a matter of theoretical and practical concern, improving classroom milieu can benefit disabled pupils included in mainstream classes without substantially changing what teachers do.

Considerable attention has been placed on changing the attitudes of mainstream teachers and providing them with inservice training to accommodate students with disabilities.  But Bloom (1980) reported that attitudes and other traits of teachers, such as training and test scores related to fields of teaching, have negligible correlations with student learning.  To improve learning, the focus should be on teaching and learning conditions of pupils, one of which is the milieu of the classroom.

As Anastasia (1976) cautioned, behavior of students does not occur in a vacuum, because the particular environmental context determines the nature of responses.  Learning is greatly the result of an interaction of respondent and situational variables.  Almost all of the attention is focused on the student and not the surrounding environment or the teacher's behavior.  Seldom is there a probe of the situational factors that can interfere with learning (Wallace & Larsen, 1978; Ysseldyke & Christenson, 1987).  It is a central hypothesis of this proposal that many problems of disabled pupils in inclusion classrooms are caused and/or worsened by unacceptable environmental and instructional conditions.

The acoustical environment of instructional areas is seldom considered, evaluated, or monitored.  Crum and Matkin (1976) reported that virtually all classrooms they examined were unacceptable for hearing by students with hearing disorders.  Graham and Fraser (1993) reported that the reception of sound signals in students with multi-sensory impairments is so degraded in classrooms that there is a need for considerably increased intensity levels for students to hear the voice of the teacher.    McCollister, Larrabee, and Ellis (1994) examined the parameters of sound in classrooms and reported that noise is common, making it difficult for students to attend to a teacher's spoken message.  There is emerging evidence that classrooms create adverse learning conditions due to high levels of classroom noise  (Blake, Field, Foster, Platt, & Wertz, 1991; Crandell, 1993; Flexer, Millin & Brown, 1990; Ray, Sarff, & Glassford, 1984).

Signal-to-Noise Ratio.  In spoken communication the voice is referred to as the signal and competing sounds are referred to as noise.  The relative intensity of the signal compared to noise is expressed as the signal-to-noise ratio.  For example, if the teacher's voice is 60 decibels (dB) and the background noise is 54 dB, the signal-to-noise ratio (S/N) would be 6 dB.  Conversely, if the elements are reversed, the S/N would be -6 dB (McCollister, Larrabee, & Ellis, 1994).
Reverberation.  Reverberation is defined as a sound's echoing or reflecting from alternating surfaces with the effect of "smearing" a signal,  The time for the sound to diminish in intensity from its original level by 60 dB is the reverberation time (Berg, 1986).  The longer the reverberation time, the more adverse will be the listening conditions (Finitzo, 1988), and this is worsened by typical hard surfaces in classrooms.

Teacher-Student Distance. Another important acoustical element in the classroom is the distance between the teacher and the student.  The farther away the student from the teacher, the less the S/N ratio.  While it might be recommended that this distance for students with hearing loss, as well as pupils with other conditions, should be no more than six feet (Ling, 1989), the constant movement of teachers and students in the classroom make this difficult to achieve.
Visual Quality.  As indicated previously, teachers do not use technology and media in classrooms to support their presentations (Joyce, Hersh, & McKibbin, 1983), and they tend to view media  negatively (Dodge, H., Brogdan, R., Brogdan, N. & Lewis, R. 1974).  Teachers rarely use any form of media, including overhead transparencies, models, tapes, videos, or  even pictures in books and magazines (Heinich, Molenda, & Russell 1989).  For any child, and particularly those dependent on multiple sources of information, this is extremely detrimental to achievement.

Hasselbring (1994) discussed the "curricular embellishment" approach using the existing curriculum and embellishing it with media.  This permits the teacher to proceed as usual, which reduces tensions about making dramatic changes in the inclusion classroom to accommodate students with disabilities.  Hasselbring maintains that instructional opportunities can be enhanced with  media, basing the approach on learning theory pertaining to the enhancement of listening comprehension.

Creating a "mental model" during a lesson is greatly enhanced if a student has visual images to help generate mental images (Glenberg, Meyer, & Lindem, 1987; Johnson-Laird, 1983; McNamara, Millin & Bansford, 1991).  An example of information that can support mental-model construction is the simple use of visual illustrations.  Computer generated materials using "presentation graphics" are simple to create, can be electronically stored, and can be used repeatedly by the teacher in subsequent lessons and classes.  This is a simple but important innovation because students rely on extra linguistic information to support learning, such as visual context.

Too much reliance in the classroom on oral presentation can defeat the instructional goals of the teacher, but oral presentation may be enhanced if the lesson is accompanied by visual illustrations.  Any kind of visual information presented by the teacher to accompany the lesson can support the major points presented, maintain attention, and improve comprehension.  Graphics, actual scenes, pictures, and large text fonts can produce higher achievement and assist students in generating mental frameworks of knowledge.  Kemp and Smellie (1989) contend that the following outcomes can be achieved with use of media for instruction:

   Content can be selected and better organized.
   Instruction can be more standardized.
   Interest in instruction can be higher.
   Learning can be more interactive.
   Instructional time can be reduced.
   Quality of learning can be higher.
   Instruction can be more mobile.
   Attitudes of learners can be enhanced.
   The instructor's role can be enhanced.
Visual and Acoustical Qualities. Students with multi-sensory impairment find poor acoustics doubly difficult because they are unable to associate the sound with the source (Graham and Fraser, 1992).  For students with reduced sight, any visual displays, glare or movement will be distracting and reduce concentration on important stimuli.  Students with good hearing but limited sight will find conditions adverse, even if acoustics are high and visual cues are low.  Students with learning disabilities, comprehension problems, and poor attention will find concentration difficult under either conditions of poor acoustics, poor visual displays, or a combination of inadequate visual and acoustical qualities.  For all students the interaction of poor acoustical and visual qualities of lessons can be detrimental to attention and learning.

While teachers may be prepared to provide students with a variety of accommodations and management approaches, they do not have the knowledge, sills or technology to reduce or eliminate the effects of noise generated within and outside the classroom.  For hearing impaired and other students, noise is a pervasive problem interfering with understanding the teacher and following classroom routines.  Additionally, instructions presented orally are not frequently accompanied by graphic illustrations.  Amplified sound and use of presentation graphics, relatively low-cost devices, may dramatically enhance classroom instruction for all students in the classroom.  The proposed study will investigate the effects of these low-cost enhancements in mainstream classrooms.

Modification of the Classroom Environment

The majority of classrooms fail to meet minimal recommendations for noise levels and reverberation times (Berg, 1993; McCollister, Larrabee, & Ellis, 1994).  To improve the acoustical quality of classrooms, a list of renovations can be implemented (Berg, 1993).  These include closing windows, replacing noisy light fixtures, isolating noise created by instructional equipment, reduction of ventilation noise, and the addition of carpets, drapes, and other materials to absorb sound (Crandell, 1993; Brase, 1988; Soyer & Houdet, 1986; Moodley, 1989).  While this would be desirable, it is unrealistic to believe that most schools are going to use a limited school budget for renovations.

Implications of Federal Legislation.  Four federal legislative acts that pertain to facilities are P.L. 94-142, Section 504 of the Rehabilitation Act of 1973, P.L. 99-457, and P.L. 101-336,   Although IDEA 97 did not specifically mention or deal with facilities, its basic intent was to ensure that every handicapped child would be afforded a free and appropriate education in the least restrictive setting, which inherently requires accessibility to programs.  Section 504 of the Rehabilitation Act of 1973, is explicit, stating that "no otherwise qualified handicapped individual in the United States, as defined in Section 7 (6), shall, solely by reason of his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance" (P.L. 92-112, 1973).  The regulations implementing Section 504 of the Rehabilitation Act of 1977 are also explicit in their relationship to facilities.  A major subsection of the regulations focuses on program accessibility (Federal Register, 1977, Sec. 504, Sec. C, 84.21).  This means that school buildings as will as instruction must be accessible to students with disabilities to such an extent that the programs required for students with disabilities are accessible.

While Section 504 regulations do not require that every classroom or school building be accessible, the specific educational programs that are appropriate for students with disabilities must be accessible, and under inclusion this means the regular classroom.  For construction started after the implementation date of Section 504 (June 3, 1977), regulations require that it be designed so as to make all or part of the facility accessible to students with disabilities.  In designing new construction, recipients are required to comply with accessibility standards of the American National Standards Institute (Sec. C, 84.23). P.L. 99-457, passed in 1986, was an amendment to P.L. 94-142.  This law lowers the age of mandatory services for students with disabilities to ages 3-5 years.  This law has been extended with passage of the Individuals with Disabilities Education Act Amendment of 1991, or PL 102-119.  As a result of programs for young children, and because of the differences and needs of very young children and infants, there could be implications for classroom space and design.

P.L. 101-336, the Americans with Disabilities Act, was passed in 1990 and is a basic civil rights law for persons with disabilities.  As the implications of The Americans with Disabilities Act (ADA) become fully realized in public education, schools are likely to be required to consider classroom environmental factors as contributing variables to access.  The relevance of ADA to school buildings may be more significant than simple accessibility issues.  Title I of the Act addresses reasonable accommodations and essential functions.  Title III addresses "readily achievable" accommodations, reasonable modifications, and provision of auxiliary aids and services.  IDEA 97 guarantees "that all children with disabilities have available to them . . . a free appropriate public education which emphasizes special education and related services designed to meet their needs."  One change that may have implications is expansion of the definition of "special education" to include "instruction conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and instruction in physical education."   The implication may be that regular classroom instruction that does not meet the needs of included children may be questioned, in other words the environment and instructional methods of the teacher. If noise in the classroom is such a serious problem for disabled learners, schools may be forced to renovate classrooms to reduce noise and otherwise improve the conditions of learning.

The special needs of students with disabilities may imply the soundproofing of walls and the use of carpet and other floorings and acoustical ceiling tiles to reduce outside noises that might prove distracting or interfering.   There are economical ways to make such changes that can improve the learning environment substantially.

Inexpensive Acoustical Improvement.  A relatively inexpensive way to implement an acoustic treatment, create a favorable signal-to-noise ratio, and improve amplification of the teacher's voice is to employ classroom soundfield FM (Frequency Modulated) systems.  A soundfield FM system consists of a transmitter and speakers placed strategically around the classrooms.  The teacher wears a transmitter and the signal is superimposed on a radio frequency or electromagnetic signal.  There is less loss of loudness over the distance between the teacher and student, allowing the voice to be perceived louder (McCollister, Larrabee, & Ellis, 1994).

Expectation that amplification can be beneficial is based on a few studies with various populations of pre-school and young children having various disabilities.  Most studies have involved small numbers of students.  Students with unilateral hearing loss, other listening or attending difficulties, and normally hearing students may benefit from soundfield FM amplification (Graham & Fraser, 1992; Black, Field, Foster, Platt, & Wertz, 1991).  Reports have supported FM soundfield amplification in improving students with disabilities' performance of word identification tasks by increasing the teacher's voice by 10 dB (Flexer, Millin, & Brown, 1990), and achievement gains for learning students with disabilities may be higher for those with amplified sound than comparable subjects without amplification (Berg, 1993).  Acoustical modification in the classroom has improved performance of students with sensorineural hearing loss (Crandell, 1993) and with unilateral hearing loss (Cargill & Flexer, 1991). Children with histories of otitis media have shown shorter test-taking time under conditions of amplification (Flexer & Savage, 1993), and children with histories of otitis media and learning disabilities have shown increased academic achievement test scores with amplification (Ray, Sarff, and Glassford, 1984).

Although costs may vary, FM units and soundfield units range between 1 and 5 percent of the cost of special education placement for individual students in public education (Cargill & Flexer, 1991).  Due to the promise of advantages for improvements in S/N ratio, reduced reverberation, and distance effects, there is a renewed interest in examining and studying FM systems, which, in turn, may generate more technological improvements of the systems for educational applications (Lewis, Feign, Karasek, & Steimachowicz, 1991; Davis, 1991).

While promising, further research is necessary.  Children with otitis media and other forms of mild hearing loss need to be aggressively identified, there needs to be better, ongoing collaboration among various personnel in education and related fields, the most appropriate classroom intervention strategies need to be isolated and developed, and the auditory and/or cognitive mechanisms responsible for diminished speech recognition must be identified (Crandell, 1993).  While information received in the auditory channel is an important, but overlooked factor in the typical classroom, another variable is the nature and amount of visual illustrations that can be used by the teacher to support mental models of information.

Inexpensive Informational Media.  Productive use of media applications by teachers is seriously lacking (Hancock & Betts, 1994). One way to greatly improve media used by the teacher is use of inexpensive presentation graphics on microcomputer.  One application is "Microsoft PowerPoint," which is available on both Windows and Macintosh.  PowerPoint provides easy development of presentation, multimedia, and graphics.  It is easy to learn, and it is powerful.  It is a sophisticated presentation program that can create electronic slide shows, traditional 35-mm slide shows, overheads, paper handouts, or a combination of these.  "Wizards: is an outstanding feature of PowerPoint. Like all other Microsoft Office products, PowerPoint uses Wizards extensively to make creating and formatting documents easier, and one of PowerPoint's Wizards, AutoContent actually creates a basic presentation, complete with slide titles.

The advantages to the classroom teacher should be enormous.  The teacher can simply tell the Wizard what the lesson is going
to be about, and then the type of presentation to give, and a format will automatically appear.  PowerPoint prepares a presentation with a title for each slide and offers suggestions on appropriate text for each slide.  PowerPoint's helps in the choice of a template for slides.  Templates are the master formats that determine how slides look.  The teacher can choose from several types of templates, including those for black-and-white overheads, color overheads, 35-mm slides, and onscreen presentations via computer.  PowerPoint comes with 165 high-quality templates.

After creating text and a template, the teacher can select from PowerPoint's large array of slide transitions and builds. The easiest way to include these effects is to switch to Slide Sorter View, which can be done by clicking on the Slide Sorter button on the status bar.  In Slide Sorter View there is a thumbnail of each slide.  Here the teacher can select individual slides, groups of slides, or all the slides and assign transitions and builds.  A transition is a special effect PowerPoint employs between slides; a build is an effect employed between bullet points on the same slide.  Transitions can make
an electronic onscreen presentation more interesting, and builds allow introduction of points in the presentation one at a time. PowerPoint has 46 different transitions, which include vertical and horizontal blinds, box in and out, dissolve, fade through black, wipes, splits, and random.  And there are 31 build effects, making visual illustrations interesting.

On PowerPoint's status bar is a button for each of the program's views, so switching between them is fast. The
status bar has buttons for Slide View (which shows an individual slide full screen), Outline View (which allows work in a presentation outline form), Slide Sorter View, Notes Pages View (which puts the slide at the top of the page and a section at the bottom to hold notes on the slide), and Slide Show.

Although PowerPoint's strength is creating traditional presentations, the teacher can easily include multimedia elements too.  With a Windows or Macintosh AV (AudioVisual), the teacher can embed a sound object in a file and have it play when the slide is shown, and video clips can be used, created by the teacher or loaded from CD-ROMs.  With appropriate printers, the teacher can print color slides or black-and-white paper handouts.


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