Raising and Educating a Deaf Child

International experts answer your questions about the choices, controversies, and decisions faced by the parents and educators of deaf and hard-of-hearing children.

Question from G.P., North Carolina

My granddaughter, now 5 years old has bi-lateral microtia and wears a bone-conducting hearing aid. She does not say many words that we can understand. I would like to know what she hears while using the hearing aid. Are the sounds different than what a hearing person hears?
Up until about 1 year ago, when she started school, her parents did not put the hearing aid on her very often.. How can I help her to use verbal language along with ASL? She “talks” all the time and expects you to understand her and does not sign while talking. (again the parents have not seen the “need” to learn sign language, so she only gets to use it with me, her aunt and at school – at home just jesters ). I really want to start working with her to help her develop language that everyone will understand.

Question from G.P., North Carolina. Posted January 4, 2011.
Response from Linda J. Spencer - SUNY Geneseo

Bilateral Microtia means that there is some type of deformity on the pinnae of each ear, or in laymen’s terms… that the outer ear is too small or irregular in shape.  Many times Microtia is also linked with ATRESIA, which is the narrowing of the ear canal.  I suspect that might also be what is also going on with your grand-daughter, if she has a bone-conduction hearing aid.  We use the outer portion of our ears AND the ear canal to  to capture the acoustic waves of sound.  When there is an issue with the outer ear, that is the source of a CONDUCTIVE hearing loss. In the case of Conductive hearing loss, hearing aids are usually  very helpful,  For your grand-daughter, the bone conduction hearing aid is delivering the vibrations of sound to the small bones in the ear (the ossicles), which should allow her to hear the sounds of speech fairly well. Without her hearing aids, however the maximum conductive hearing loss is from 40 to 60 dB and this usually translates to a moderate-to- severe hearing loss without the aid. If she spent the first several years of her life without the aids, this is most likely why her speech and her language skills are delayed.

It is extremely important that she has her aid on at all time. With the aid ON,  she should be able to hear enough speech that her oral language skills should be able to develop.  Here is a website that will give you an idea of what she should hear with her aid ON and with it off (assume she even has a mild loss with it on):  http://www.betterhearing.org/hearing_loss/hearing_loss_simulator/index.cfm With the aid off however, she is at a huge disadvantage.

Secondly, given that I do not know the cause of the Microtia, I must also wonder if your granddaughter has been evaluated by a developmental team of physicians, educators, speech-pathologists, audiologists and learning specialists.  Sometimes Microtia is also associated with syndromes that may have additional learning issues or other physical issues.  If this evaluation has not been done, I would recommend this to be done as soon as possible so that her educational programming can be optimized.  Also, there are surgical treatments for microtia that can aid both the physical, psychological and listening issues related to the condition.

If the above evaluations have been completed and you are still wanting to help with her language and speech development, my advice to you is to first encourage your granddaughter to wear her aid all waking hours.  In order to stimulate oral language, she will need to learn to listen to language.  Read to her. Read short books that have repetitive language and salient pictures.  Talk to her.  Talk using sentences with 4 to 6 words, and have her repeat sentences back to you.  Use context…that is set up situations that are familiar. Use rouetines. For example, if you are cooking… Name all the ingredients, have her name them back to you. Have her watch and listen as you clearly speak simple directions. Say them and have her repeat them after each step. “Put 1 cup of WATER in the bowl. ” (have her repeat)  “NEXT we will pour in FLOUR.” (have her repeat) “Now we will stir it together.” (have her repeat) If you are going to use ASL, I would first use the Oral English language, then sign the message using ASL.  It is not really possible to speak and use ASL at the same time, so you will speak in English, making sure she can SEE you and WATCH your lips as you speak.  When you SIGN to her, you also need to make sure she is WATCHING you as wel