A Primer for Mainstream Educators
October is Audiology Awareness Month and a fitting time to remind our community that audiologists can offer a wealth of insights to help caregivers and teachers establish high-quality listening and learning environments for children with hearing loss.
Understanding the interplay among the different hearing devices students use (e.g., cochlear implants, hearing aids or bone-conduction hearing systems), the assistive technology in place and the physical characteristics of a classroom is extremely helpful for mainstream educators and will contribute to a smoother, happier learning experience for all.
The Three Most Common Types of Hearing Technology for Children who are Deaf or Hard of Hearing
First off, Katie Donoghue, AuD, CCC-A, audiologist at the Clarke Hearing Center in Northampton, MA, reminds us, “For all hearing devices, it’s important to remember—they’re not a hearing cure.” The devices are meant to improve and optimize a user’s access to sound, not remedy their hearing loss.
Here are the three most common hearing devices used by children who are deaf or hard of hearing:
Hearing Aids
When a person with hearing loss has some access to sound through the cochlea, hearing aids may be used to maximize that access. A hearing aid is an electronic, battery-operated device that amplifies sound to improve listening comprehension. It collects sounds from the environment via a microphone, amplifies those sounds and then directs the amplified signal into the user’s ear through a tiny speaker. Children are typically fit with a type of hearing aid known as a behind-the-ear (BTE) hearing aid. Today’s technology enables hearing health professionals to fit even very young babies with hearing aids that meet their needs.
When children can receive them: It is important to provide infants who are deaf or hard of hearing with hearing aids as early as possible, ideally within 1-2 months of age, to maximize the early growth of the auditory brain that happens in response to stimulation from the environment.
Cochlear Implants (CIs)
Cochlear implants provide those with profound, total and sometimes severe hearing losses with greater auditory access to speech than a hearing aid. A cochlear implant is a surgical implant that sends sound waves directly to the wearer’s auditory nerve, bypassing any damaged parts of the ear. There is an internal portion and an external portion which sits behind the user’s ear and connects magnetically through the skin to the internal portion. An implant does not restore or create normal hearing, but it can give an individual who is deaf or hard of hearing access to sound, particularly the sounds of speech.
When children can receive them: Cochlear implants are FDA-approved for use in eligible children beginning at nine months of age.
Bone Conduction Hearing Systems (BAHAs & BCHAs)
Bone-conduction hearing systems send sound through the bones of the skull to the inner ear. There are two common types of these systems: surgically implanted bone-anchored hearing aids (BAHAs) and nonsurgical bone conduction hearing aids (BCHAs).
With a BAHA, the wearer receives a small implant in the bone behind their ear. Once healed, an external processor attaches to it magnetically.
When children can receive them: The FDA has approved surgically implanted BAHAs in children aged five years and older who meet the candidacy criteria. Children under five, who are not yet candidates for surgery, can wear BCHAs on a soft band around their head (following the recommendations of their audiologist).
Learn more on Clarke’s About Hearing Technology page.
Tips for Managing Students with Hearing Tech in Mainstream Classrooms
Katie notes that because children who are deaf or hard of hearing often do so well in a mainstream classroom, the adults supporting them can forget about their hearing loss. She shares some tips to remember their daily and ongoing needs.
For students with CIs, Katie notes that if the devices are off or not working, the child essentially can’t hear anything, while students with hearing aids may still have some access to sound — although how much access will vary widely. On the other hand, hearing aids don’t always provide the same high-quality access to sound that CIs do.
And bone-conduction hearing aids can pose certain challenges in large, loud spaces, so teachers should be aware that these are instances a child may struggle.
“Bone-anchored hearing aids can have difficulty processing background noise, so in noisy environments like the gym or cafeteria, communication strategies become imperative to ensure the student remains connected to their surroundings,” she notes.
Some strategies Katie recommends are getting the student’s attention before giving instruction, speaking face-to-face within six feet of the student, providing expectations (e.g., time limits or directions) before entering the noisy environment and confirming understanding of any information given before moving on.
Teachers should also be mindful that younger students may not be able to explain when something is wrong with their sound access. “There are also social and emotional issues students can deal with that will change as well as they go through school,” she says. “They may feel like they’re different. And for kids who are later identified, they’re likely still processing the loss and learning how to use the equipment.”
Technology Accessories to Ensure Access to Sound
In the classroom, there are three main categories of devices to optimize students’ access to sound. Students may use
- an on-ear, personal hearing assistive technology (HAT) system
- a soundfield HAT system
- a small clip-on microphone that comes with most hearing devices
“On-ear HATs are the gold standard – they provide the best quality sound,” Katie says, and they can also be used to pass among students if there’s a group discussion. But they are more expensive, and some students feel self-conscious about using them. Children with sensory issues may also resist having to wear another on-the-ear device to use the HAT.
Another option is a soundfield. Katie notes they are a little more affordable, more discreet and can be used for more than one student in a classroom. But they only amplify sound and don’t send the speaker’s voice directly to the hearing device, so the sound quality is not as good as it would be with a HAT. “With a soundfield, we can’t control what’s going on between the speaker and the listener, so crosstalk or background noise is still an issue,” Katie says. “With an on-ear system, we essentially cut out the space between the teacher and student by sending the teacher’s voice directly into the student’s head.”
Katie adds that sometimes families use the small, clip-on microphones since they are the most affordable option and tend to be discreet. “They are great to use at home, or in school as a backup, but in general they’re less reliable and don’t filter background as well,” she says. “Plus, they have a smaller range, and the connection reliability is not as good.”
Classroom Modifications and Strategies to Ensure Access to Sound
There are also no-tech ways to help create a better hearing environment in the classroom. Mainstream teachers may be familiar with things like putting tennis balls or similar sound-dampening devices on chair legs. Other options, such as ensuring the child isn’t sitting next to an HVAC vent or a hallway door are less obvious. An audiologist can make a list of recommendations specific to the classroom and the student in question.
“For example, teachers often think a student needs preferential seating — we like to refer to it as strategic seating,” says Katie. “But it’s about more than just having them sit up front. You want them to be in that sweet spot of not being near a vent or window and having a sightline to the teacher and their peers for things like group discussions.
“We also want to make physical changes where possible to prevent sound reverberation,” she continues. “Curtains on the windows, fabric coverings on bulletin boards, rugs, these are all fairly simple ways to reduce background noise.” However, she notes that most schools require fire-resistant fabric to be used which can be harder to find and more expensive.
In some cases, a specific classroom may have a more significant issue with background noise. For example, a classroom that’s near the music room, cafeteria or a particularly busy hallway. In those cases, Katie recommends using draft stoppers to block noise coming in at the doors and acoustic tiles for the walls.
Optimizing Access—A Team Effort
Of course, the final piece in making sure a classroom is a good listening environment is making sure the teacher understands what the student needs. Teachers who haven’t worked with a student with hearing loss before may be unsure about how they’ll need to adapt their teaching methods.
The good news is, it’s less a matter of overhauling their techniques so much as it’s being more mindful of good teaching techniques. “So much of it is just small things like getting the student’s attention before speaking to them, facing the class not the whiteboard when speaking, and having turn-taking policies in place to avoid crosstalk,” says Katie. “Classrooms can be controlled chaos, but just being more mindful and intentional about these strategies goes a long way.”
The student has a role here, too. First and foremost, Katie notes it’s vital that the student’s hearing equipment is working correctly and being worn.
Students should also have age-appropriate self-advocacy skills so they can let the teacher know if they missed something or need a change. Teachers can help students develop these skills by recognizing that students with hearing loss are working harder — to both hear the information and then process it — so it’s worth checking in from time to time to ensure they understood everything. “Not all students process their hearing loss the same way,” adds Katie. “Some are okay with fielding questions or asking for repetition and others are more reluctant. It’s important to have a game plan for how they’ll address their hearing loss with other students and teachers.”
Thanks to tremendous advancements in hearing technology, students who are deaf or hard of hearing can thrive in a mainstream classroom. It’s essential to work with an audiologist who can help students, their families and their educational teams fine-tune the classroom into the best possible hearing environment so those students can meet their full potential.
Learn more about the Clarke Hearing Center in Northampton, MA, and Clarke’s Mainstream Services (now available virtually as well as in-person).
