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Quotes from Carol Flexer


Flexer, Carol Ann. Facilitating Hearing and Listening in Young Children. San Diego: Singular Publishing Group, 1980. This is the 1999 Updated Verson.

The Quotes on this page are from the 1980 version and include the page reference at the end of the quote. We encourage you to buy this book. For further information about the author, please visit Carol Flexer's Web Page.

        There is no good substitute for hearing. If there was, hearing problems would pose no unique educational dilemmas. Hearing impairment of any type and degree is problematic (Bess, 1985; Northern & Downs, 1991). Even a slight hearing impairment can interrupt a child's language-learning process and interfere with his or her development....if a child cannot hear speech sounds clearly, or if a child does not have the skills to listen, or if the learning environment does not allow instruction to be heard clearly, any testing or intervention that uses speech as the vehicle for interaction is likely to fall far short of its projected goals. Therefore, an infant or child's hearing sensitivity and listening ability, and the quality of the learning environment, cannot be ignored or assumed; they must be known and optimized.        (p.2)
        The most unconscious function of hearing is the primitive level which carries the auditory background, sounds that serve to identify a location. A hospital sounds different than a school. Typically, we do not think about these sounds; however, if a location does not sound as expected, we become uneasy. If you have ever entered an empty hospital or school, you have probably felt a bit anxious.
        Biological sounds are also heard at the primitive level. Sounds like breathing, swallowing, chewing, heart beat, and pulse furnish proof that we are indeed alive and functioning. People who suddenly lose their hearing have been known to experience acute psychosis due to feelings of disconnectedness with the environment, time and their own bodies.
        Less dramatically, a new hearing aid or assistive listening device alters the wearer's auditory background by amplifying sounds previously not heard. This change in auditory background may make a wearer nervous and anxious without understanding why. Certainly, a baby or young child cannot explain that an altered auditory background may be a factor causing him or her to resist amplification. Yet, as professionals, we should be sensitive to the fact that there is often an adjustment period to amplification (typically, at least 1 month), due in part to the user's altered auditory background.        (p.11)
        A child with a hearing impairment, even a mild or unilateral impairment, cannot casually overhear what people are saying, or the events that are occurring (Davis, 1990). Children with normal hearing often seem to passively absorb information from the environment and to constantly have little antennae to pick up every morsel of information. A child who has a hearing problem may seem oblivious to environmental events, "out of it," not to know what is occurring, unconnected to his or her environment, or have to be told everything.
        Because of the reduction in signal intensity and integrity with distance, a child with a hearing problem may have a limited range or distance of hearing; that child may need to be taught directly many skills that other children learn incidentally.        (p.13)
        Further implications of reduction of distance hearing include lack of access to the redundancy of spoken information that occurs in day-to-day transactions and lack of access to social cues (Conway, 1990). Much information children learn is not directed to the child, yet this tangential information is important for them to learn.        (p.13)
        Beware of underestimating the barrier that any type and degree of hearing impairment presents to the casual acquisition of information from the environment (Ross, 1991). Hearing impairment of any type and degree is a barrier to incidental learning.        (p.14)
        There are approximately 40 million school children in the United States, and at least 8 million of them have some degree of hearing impairment (Berg, 1986a; Davis, 1990; Ross, Brackett, & Maxon, 1991). Consequently, when a persistent minimal, mild, or moderate hearing impairment is recognized for the disabling condition it is (Bess, 1985; Dobie & Berlin, 1979; Northern & Downs, 1991), children with hearing impairment represent the largest single population of school children requiring special services (Hull & Dilka, 1984).        (p.16)
        The actual incidence of minimal, mild, and moderate hearing impairment, most often caused by otitis media with effusion may be much higher than school screenings lead us to believe (Anderson, 1991; Ross, 1991). Hearing screening environments in schools typically have less than ideal levels of ambient noise; therefore, hearing tends to be screened at 20 to 35 dB HL (Anderson, 1991). As a consequence of environmental conditions, school screenings may miss many children who are at risk for academic failure because even a 15 dB hearing impairment poses a significant problem for the young child who must learn crucial word-sound distinctions (Dobie & Berlin, 1979; Northern & Downs, 1991).        (p.17)
        When 15 dB HL is used as the criterion for identifying an educationally significant hearing impairment, the incidence increases dramatically. For example, a study conducted in the Putnam County, Ohio school district found that, in the primary grades, 43% of the students failed a 15 dB HL screening on any given day and about 75% of the primary-level children in a class for children with learning disabilities failed a 15 dB HL hearing screening (Flexer, 1989).        (p.17)
        Hearing and listening form the invisible cornerstones of spoken communication. Infants and toddlers spend much of their day engaged in active or passive listening activities as a means of obtaining information from their environments. The need for all children to be able to hear clearly must not be underestimated (Berg, 1986a).        (p.18)
        No hearing impairment is too slight not to warrant hearing management, and no hearing impairment is too great to neglect the value of accessing residual hearing.        (p.41)
        People with normal hearing typically require an S/N (Signal-to-Noise) ratio of +6 dB for the reception of intelligible speech. Due to the auditory distortion of the hearing loss itself, persons with a hearing problem need an S/N ration of +20 dB (Finitzo-Heiber & Tillman, 1978; Hawkins, 1984). Due to reverberation, noise, and changes in teacher position, the average classroom S/N ratio is only +4 or +5 dB, and it may be 0 dB, which is less than ideal even for children with normal hearing (Berg, 1986b, 1993).        (p.96)
        Even in a front-row center seat, the loss of critical speech information is substantial for a young child who is in the process of learning language and acquiring knowledge. Obviously, the most sophisticated of hearing aids cannot re-create those aspects of the speech signal that have been lost during transmission across the physical space.
        The importance of being close to the speaker, either physically or through the use of a remote location microphone for the purpose of obtaining a complete speech signal, was demonstrated by the RASTI study. As soon as any pupil in the classroom or infant or child in a learning situation moves further away than 6 inches from the speaker's mouth, the speech signal begins to degrade. Data input precedes data processing. Thus, if a child does not receive a complete speech signal, that child is being denied access to spoken communication.        (p.98)
Tips to Remember about Children's Hearing Aids        (pp.99-105)
  • If hearing impairment exists in both ears, two hearing aids should be fitted, one for each ear. Binaural fitting is the rule, not the exception.
  • Behind-the-ear aids typically are more appropriate than body aids even for infants and toddlers, because they can use special earmolds and can better attach to assistive listening devices such as TM systems.
  • Hearing aids should be worn during all waking hours within 1 month of fitting (if not sooner), augmented by the necessary assistive listening devices.
  • Hearing aids should have a strong telecoil for attaching to assistive listening devices. All of a child's listening and learning environments must be considered when fitting amplification to the child; the hearing aid alone will not be sufficient.
  • Hearing aids should have internal adjustments for flexibility (tone control to change the amount of low frequency amplification and power adjustments to allow for more or less signal strength). As a hearing impairment becomes more precisely defined following repeated hearing tests, the hearing aid should be able to be adjusted accordingly. In addition, fluctuating hearing impairments need adjustable hearing aids.
  • A listening check must be performed on the hearing aid at least once a day by parents and/or teachers who have normal hearing (Busenbark & Jenison, 1986). Hearing aids break, and a malfunctioning hearing aid is of no value to anyone, especially to a child with a hearing impairment. It is no secret that over 50% of amplification devices checked in school programs are malfunctioning at any given time (Bess & McConnell, 1981)
  • Battery problems are responsible for the majority of hearing aid malfunctions. Unlike watch batteries, the tiny hearing aid batteries last only a few days to a week in a high power hearing aid. Battery life depends on the power output of the hearing aid and on how often the hearing aid is actually worn.
  • Earmolds -- custom-made earpieces that direct the sound from the hearing aid into the ear -- are crucial to appropriate hearing aid fit (Byrne, 1986). Not only must they be comfortable (usually made of soft material for children), but they can be modified to allow better sound transmission. The earmold can shape incoming sound. For example, a horn-shaped earmold will enhance high frequency transmission. An "open" earmold allows some of the low frequencies to filter back out of the ear, as well as letting air into the ear canal, an important consideration if the child has ear infections or ventilating tubes in his or her ears. If earmolds do not fit well, feedback can occur. Feedback is that high pitch annoying squeal that comes from hearing aids. Finally, children's earmolds may need to be remade often to accommodate growing ears and to obtain an appropriate fit.
  • Amplification typically should emphasize the high frequencies, if the child has any high frequency residual hearing. The higher frequencies carry the acoustic energy necessary for discrimination of consonant sounds, consonants are necessary for intelligibility of speech. Low frequencies, however, are also important for suprasegmentals and vowels and should not be deleted. The relationship between low- and high-frequency amplification needs to be carefully evaluated (Ling, 1989).
  • Visual deviancy and stigma issues should be considered when fitting amplification devices (Flexer & Wood, 1984). Equipment can be fitted in an attractive and interesting manner; harnesses are not necessary. Technology should facilitate, not intimidate, communicative interactions.
  • Aided as well as unaided audiograms must be obtained to provide data about speech sounds that are audible with and without amplification.
  • In addition to unaided and aided audiograms, real-ear probe microphone measurements should be obtained whenever possible. Computerized probe-microphone hearing aid analysis allows the evaluation of hearing aid fittings through the use of a soft silicone tube that is inserted into the ear canal while the hearing aid and earmold are in place. The resulting analyses enable the audiologist to know the aided response and amplified signal intensity in the child's ear canal (Feigin & Stelmachowicz, 1991). The procedure should not cause discomfort, but the infant or child must sit still, and measurement parameters (such as depth of the probe tube in the ear canal) must be controlled. Note that real-ear measurements should be obtained in additions to, not instead of, aided thresholds plotted on an audiogram.
  • Repeated aided and unaided hearing tests (including real-ear measurements) and electroacoustic amplification checks should be an integral part of the habilitative program, occurring every 3 months until the age of 3 (Matkin, 1981); Nevitt & Brelsford, 1987).

        An audiologist should be involved in the recommendation and fitting of all hearing aids and assistive listening devices.        (p.105)
        A 3-year study of sound-field amplification revealed the following preliminary results (Osborn, Graves, & Vonder-Embse, 1989):        (p.107)
  • The proportion of students requiring special services decreased after 3 years with amplified classrooms;
  • Amplified kindergarten classes scored significantly higher on listening, language, and word analysis tests than did children in unamplified classrooms;
  • According to formal classroom observations, students in amplified classrooms had better on-task behaviors than students in unamplified classrooms;
  • As reported by principals, in amplified classrooms, there were fewer teacher absences due to fatigue and laryngitis;
  • Teachers in amplified kindergarten classrooms tended to use less repetition and rephrasing in their instruction'
  • The study began with 17 sound-field units; 3 years later, 47 units were in use because teachers wanted them, parents demanded that their children be placed in amplified classrooms, and administrators were convinced that student performance improved.

        Classroom amplification facilitates the reception of consistently more intact signals than signals received in an unamplified classroom, but signals are not as complete as those provided by using a personal FM unit (Leavitt, 1991).        (p.110)
        Based on information currently available, the following populations appear to benefit most from sound-field amplification:        (pp.111-112)
  • Children with past and current histories of otitis media with effusion;
  • Children with unilateral hearing impairments;
  • Children with minimal sensorineural hearing impairments who do not wear hearing aids;
  • Children with central auditory processing or attention difficulties but with normal peripheral hearing sensitivity;
  • Preschoolers, kindergartners, and first graders with normal hearing sensitivity who are in the crucial stages of developing academic competencies.
        Three practical advantages of appropriately installed and functioning sound-field equipment for target populations are that classroom amplification requires no overt cooperation from the child, the technology is not stigmatizing for any particular child, and equipment function or malfunction is immediately obvious to everyone in the room (Anderson, 1991).
        If speech is being used as the means of communication, instruction, or intervention, there is no instance where hearing does not matter. Unless the instructor is able to serve as the amplifier by speaking in a full, clear voice into the ear of the child at all times, some form of amplification technology will be necessary. No hearing impairment is insignificant, no age is too young, and no disability is too severe to consider the use of amplification.        (p.130)


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