Invisible Pervasive Handicap in the Classroom

By Linda S. Remensnyder, Au.D.

One Third of Young Children Affected:  Recent research confirms that, on any given day, one third of all children, kindergarten through third grade, have impaired hearing/listening. 

The vast majority of these statistics reflect children missed in hearing screenings.  Their ranks are comprised of so-called “normal hearing children” who experience greater speech-recognition difficulties in classroom noise and reverberation than previously suspected. These subtle hearing deficits cause the affected child to experience an invisible handicap—a handicap comprised of not being able to hear well consistently.

These kindergarten and primary grade children have slight or “minimal” hearing loss for a variety of reasons. Causes can be as innocuous as occluding ear canal wax or as serious as otitis media (fluid accumulation behind the eardrums). Otitis media (middle ear fluid) ranks second to the common cold as the most common health problem in young children.  Ear infections, which have increased by 224% since 1975, cause five million school days to be missed annually and half of all episodes are undetected by parents or teachers. Even the ventilating tubes resorted to in serious cases can become plugged by infection or debris and cause hearing deficits.

These “minimal” hearing loss statistics also reflect youngsters who have allergies causing them to be chronically “stuffed up”, bilateral high frequency hearing loss in ranges not screened in hearing screenings, or unilateral hearing losses in which excellent hearing is limited to one ear.  They reflect youngsters with developmental delays, articulation disorders, or dyslexia.  Students who have central auditory processing disorders (CAPD), attention deficit disorders (ADD), and behavioral problems also fall into this category.  In addition, the slight hearing impairment statistics include children for whom English is not their primary language because language comprehension requires sustained effort.

A “Minimal” Condition with Maximal Consequences: A “minimal” hearing loss, which requires neither medical intervention nor hearing aids, does not constitute a minimal handicapping condition with minimal consequences, especially during the younger elementary school years when the child’s brain is assimilating and developing language.  Hearing is the acknowledged bridge to reading and to future academic performance and this critical period to learn language is time-locked (generally considered age 0 through 7).

Children with minimal hearing losses experience problems hearing faint or distant speech and the esteemed educational audiologist, Carol Flexer, calculates that these children are missing more than 25% of classroom instruction. What 25% of the speech signal do these children miss?  They miss the soft intensity sounds -- the endings of speech, the sibilants (s, sh, ch) and the fricatives (f, th).  They miss the subtleties of speech -- the plurals, the tenses, and the possessives/auxiliaries.  They miss the innuendoes and the asides, the responses from fellow classmates in the back of the classroom, and they miss the whispers.  And they definitely miss what the teacher is saying when the room is noisy, when other classmates are conversing, or when the teacher’s back is facing them.

It is believed that 90% of a young child’s knowledge is attributed to incidental reception of conversations around him or her.  Thus, learning and understanding are hindered even with the slightest hearing difficulty.

How, then, are these children with “minimal” hearing loss able to learn language when language is learned by hearing it in full context? They’re not -- they’re handicapped by their inability to hear consistently well.

It is important to keep in mind that the classroom is a difficult listening environment. Chatting students, humming air conditioners, squeaking desks, and outside traffic contribute to a level of background noise that distracts from the teacher’s voice.  The problem becomes even more significant when the noise echoes off uncarpeted floors in rooms with high ceilings and hard desks and windows.

In addition, Dr. Flexer also believes that “children are not short adults; they bring a different ‘listening’ to a learning situation.”  Research has documented that children do not develop an adult-like capacity to recognize speech in noise until approximately 13 to 15 years of age.  The central auditory system of children is not neurologically mature until a child is about 15 years old.  Thus levels of classroom noise and reverberation can deleteriously affect the speech perception of those younger than 15 even if the children do possess normal hearing sensitivity.

IMPACT of an Enhanced Signal and Improved Acoustics:  Research has confirmed that if the teacher wears a lapel microphone and if her or his voice is amplified via suspended speakers placed in each of four corners of the classroom, all children are able to hear better and all children benefit (even those who already wear hearing aids).  These sound field systems simply make it easier to understand or focus on the teacher’s voice. 

Teachers who use these systems have less vocal strain, are less fatigued at the end of the school day, and require fewer sick days off.  More importantly, the ability of all children to hear an enhanced speech signal has resulted in improvements in reading (comprehension and test scores), fewer discipline and behavioral problems, and increased classroom participation.

The trend is to place these sound field systems in all kindergarten and primary grade classrooms.  Strides are also being made in terms of classroom acoustics insuring that new construction and planned renovations take into account the need to limit ambient noise levels.  PTA’s and school fund-raisers are providing funding for the technology to promote optimal hearing. Parents can make it happen and make the future brighter (and more audible) for all.
______________________________________________________________________

Linda S. Remensnyder, Au.D., holds her Doctorate from the University of Florida, Gainesville.  She has two private practices in Audiology--the original office, located the medical campus of Condell Medical Center, was established in 1980.  A satellite was opened five years ago in Gurnee.  Both offices are located in the northern suburbs of Chicago.  In addition to hearing assessment (all age brackets) and amplification, Dr. Remensnyder has special expertise in Audiologic Rehabilitation.  She teaches very popular classes on how to live with hearing loss.  The classes focus on patient empowerment.  Techniques such as managing the communication environment, methods to improve communication with family members, and assertiveness training when communicating with others are discussed.   

Contact Information:  Linda S. Remensnyder, Au.D., Doctor of Audiology
                               President:  HEARING ASSOCIATES, P.C.
                               755 S. Milwaukee Avenue, Suite 189
                               Libertyville, IL 60048
                               Phone:  847 680-7580
                               Email:  URHearing@aol.com