No two people with a hearing loss experience the loss exactly the same way. There are several types of hearing loss and factors that determine the impact of the hearing loss. Language acquisition is affected (when deafness occurs prior to language development, roughly two years of age). Because the usual means of acquiring language through auditory means is affected by hearing loss, what needs to happen is 'visual' learing in place of 'auditory' learning. A student's ability to learn language is dependent on several factors:

• age of onset
• type of hearing loss
• residual hearing
• exposure to and ease of primary language acquisition
• absence of cognitive processing disorders

Deaf people vary widely in their hearing and language abilities. Understanding the nature and extent of the hearing loss and how it affects the student is imperative in providing appropriate accommodations. Often the best source of learning what accommodations are needed is to ask the student who needs the accommodation. Communication styles are determined by such variables as:

• age of onset of the loss
• type of hearing loss
• the age training began for any residual hearing
• type of training provided
  

Reprinted with permission from Dennis Cokley

Most deaf people use one or more visual methods for communication. American Sign Language (ASL) is a language with its own grammatical structure and syntax. American Sign Language is the preferred language amoung deaf people. There are other sign systems such as manually coded English (MCE) which combines fingerspelling and sign language following the syntax of English. Other sign systems are LOVE and SEE1 and SEE 2. See the prior diagram for the continuum of various sign language modalities.

Some deaf people with little or no usable hearing communicate by speech and lipreading rather than sign language. Others who are deaf with some usable hearing have learned to benefit from both visual and auditory communication, with emphasis on auditory skill development, speechreading, and speech training. They may use oral-aural communication, which uses a combination of speechreading / lipreading, usually with amplification (personal hearing aids or Assistive Devices).

Another method of communication may be Cued Speech, a visual communication system with hand cues; or they may use Simultaneous Communication, which combines sign language and speechreading in English word order. Another approach is Total Communication, which utilizes every communication modality available to the person (speech, lipreading, sign language, fingerspelling, etc.). In some cases, profoundly deaf persons have had excellent speech training which gives them the appearance of being less deaf than they are.

A person who is hard of hearing perceives sound less well than the average person but has sufficient residual hearing to benefit from auditory-based methods of communication, sometimes with visual supplements. Some people who are severely hard of hearing have learned to use oral-visual communication, combining speech, speechreading, use of personal hearing aids, cochlear implants and other devices. Others with mild or moderate losses use minimal amplification, such as amplified telephones. Many others have hearing losses so mild that they do not seek accommodations. Most losses are present at birth, while others lose their hearing ability due to illness or accident.

The term hearing impaired, objectively, refers to anyone having some level of hearing impairment which results in receiving less sound, ranging from very slight loss to profound deafness. It is often used in this context to refer to any amount of hearing loss. Other terms frequently used in documenting hearing disability are:

• pre-lingual deafness, incurred before spoken language had developed (usually before the age of two).
• post-lingual deafness, incurred after early exposure to and use of the spoken language (usually after the age of two).
• prevocational deafness, a severe and profound degree of hearing loss before the age of 19

Age of onset refers to the actual age the hearing loss is determined and therefore, what communication modes are implemented.

Threre are three basic types of hearing loss: sensori-neural deafness (nerve deafness), and conductive and mixed loss. With the sensori-neural loss, the ability to understand speech is thwarted due to the breakdown of communication from the cochlea to the brain along the nerve. A person with this loss may be able to hear sounds, but has great difficulty discriminating speech sounds. Speech is garbled and muffled. Amplification does not make speech clearer for someone with a nerve loss. The brain will continue to receive garbled messages.

Conductive hearing loss means that the loss is attributed to faulty sound transmission within the middle ear. The bone, malleus, and incus are responsible for sending the sound waves to the inner ear. (See diagram below). An Individual with a conductive hearing loss benefits well from amplification in most cases and has a varying range of hearing and speech discrimination ability. Hearing aids most often are helpful in assisting conductive hearing loss due to the need for amplification if the fault is in the middle ear mechanism.

A mixed hearing loss indicates the presence of both sensori-neural and conductive hearing losses. This individual would have a middle ear mechanical fault and nerve transmission damage from the cochlea to the brain.

Speechreading (or lipreading) may help to clarify speech sounds. It is not always the case, as deaf people vary in their ability to lipread. Approximately 30 percent of spoken speech is seen on the lips. Lipreading skills rely heavily in being able to fill in the remaining 70 percent of gaps using visual cues (non-verbal communication). Having a general idea of the subject matter being discussed and possessing adequate English language skills contribute to the success of lipreading. This is a skill and it is determined by many contributing and individual factors.

Most often, hard of hearing individuals who can benefit from amplification, find hearing aids to be helpful. Deaf people, with little or no hearing, usually do not. Assistive Listening Devices (ALD) are another method that works by amplification of sound which benefits someone who is able to hear and understand speech if its loud enough and clear enough. Basically, the ALD works in the same way as a hearing aid, allowing speech sounds to be controlled by the user in terms of volume control. (See glossary at the end of the chapter for definition of ALD).

The basics for its use is: The instructor or speaker wears a lapel mike with a transmitter and the student wears a receiver and magnetic coil along with the personal hearing aid that picks up the radio waves as the speaker speaks. Background noise is reduced, allowing the wearer to hear only the speech of the speaker, greatly enhancing the probability of understanding what is being said. Background noise is the main culprit of hard of hearing individuals. Personal hearings aids amplify all sounds, not just speech sounds. (Various types of ALD’s can be found in the heading under ALD).

Another method of communication can be real time captioning. This is more often used in large audiences rather than on an individual basis. When the speaker talks an individual with the necessary equipment, very similar to a court room reporter steno machine, types into the machine which converts the typed message into words which are then projected onto a large screen. The audience can read the message of the speaker immediately after it is spoken. For an individual with good reading ability, this is a good communication tool. Also, it is a good alternative for someone who needs visual communication but does not possess sign language skills, thus cannot benefit from an interpreter.

Although real time captioning is primarily used in larger audiences, and often seen in conjunction with simultaneous interpreting, a similar approach can be utilized in a classroom or meeting room. A smaller screen allows a single or few individual(s) to read what is being discussed. This works essentially the same way as the larger scaled captioning. If a projected screen is not needed, a simple computer screen will work. The deaf or hard of hearing individual will sit alongside the captioner and read the message. In most cases, a laptop computer is used for easy proximity and portability.

Lastly, is the national dual party relay system. Mandated by the ADA, each state is required to have a relay system whereby deaf, hard of hearing and speech impaired individuals can access the telephone system. This relay system allows communication between people who can hear and people who cannot hear or speak over the regular phone. Basically, it is a three-way communication system where the operator has access to both the phone and the typed messages from a TTY user. Whatever the TTY user types out is relayed by voice to the hearing individual on the other end and vice versa. The diagram on page 5 shows how the system works.

Each state has a toll free (800) number accessible for both TTY callers and voice phone callers. The relay program is sponsored by phone customers in each state by a very small charge each billing statement. This in turn is a free service to all users, 24-hours a day, 365 days per year. (See the appendix in the back of the book for Relay numbers in your area).