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Hearing Impairment


Susan Dalebout

Elizabeth A. Martinez
Daniel P. Hallahan


Hearing loss occurs along a broad continuum ranging in degree from slight to profound. Individuals with severe and profound hearing loss generally are characterized as deaf, whereas individuals with lesser degrees of impairment, including those with unilateral hearing loss (i.e., involving only one ear), are characterized as hard of hearing. Childhood hearing loss of any type and degree, if unmanaged, is likely to have a negative impact on the development of spoken and receptive language, the ability to read and write, and academic achievement. For example, a 1998 study of 1,218 children with minimal hearing loss showed that 37 percent had failed a grade. Similarly, studies have shown that children with unilateral hearing loss are ten times more likely than normally hearing children to fail a grade. The vast majority (94–96%) of children with hearing loss are hard of hearing rather than deaf. For these children, speech may be audible (i.e., detectable) but not intelligible enough to allow them to hear one word as distinct from another.

There are approximately 50,000 school-age deaf children in the United States, a figure representing a dramatic decline since the early 1970s. An additional 5 million school-age children are permanently hard of hearing and at educational risk. An estimated 1.5 million more suffer from conductive, usually temporary, hearing loss. Inclusion of preschool children could put the total number of children with hearing loss close to 10 million.

Historical Overview

Historically, approaches to educating children who are deaf have been based on emotion and personal philosophy rather than positive outcome; in contrast, the education of children who are hard of hearing has largely been ignored. Educational practices in the United States can be linked directly to the teachings of European educators active during the eighteenth and nineteenth centuries. Of note, in 1770 French cleric Charles-Michel de l'Épée founded a school in which he emphasized the use of sign language and finger spelling (i.e., a manual approach). Around the same time, schools were established in England by members of the Braidwood family, who emphasized the use of spoken language and speechreading without sign language (i.e., an oral approach).

In the United States, the father of Alice Cogswell, who lost her hearing at an early age, commissioned Thomas Hopkins Gallaudet to travel to Europe and learn methods for teaching deaf children. Refused help by the Braidwoods, Gallaudet learned de l'Épée's manual method. In 1817 Gallaudet opened a school in the United States based on the manual approach (now the American School for the Deaf). Gallaudet's son became president of the first college for deaf students in the United States, now known as Gallaudet University.

Oralism took root years later when another young girl from a prominent family, Mabel Hubbard, lost her hearing. In 1867 her father helped establish an oral school. As an adult, Hubbard married Alexander Graham Bell, who became a passionate advocate for oralism. During the late nineteenth century, Bell and Gallaudet often engaged in debate about the merits of the oral and manual approaches. The debate would continue well into the twentieth century.

Education of and Services for Hearing-Impaired Children

Children in the United States who are deaf or hard of hearing are legally entitled to a free and appropriate education. Federal law requires a continuum of educational options, ranging from placement in a self-contained classroom with other children who are deaf to full-time placement in a regular education classroom with normally hearing peers. Most often, the placement involves a variation or a combination of the two extremes. An alternative placement is attendance at a residential school, in which the child can participate fully in the deaf culture.

Perhaps the most important educational decision is the communication method that will be used. The choice lies with the parents, and the best decision is specific to each child and family. Most children who are deaf use one or some combination of three communication modes: American Sign Language, a manual language that is distinctly different from English (i.e., a person does not sign and speak at the same time); a system of manually coded English (i.e., a signed version of English); or hearing and spoken language. A relatively smaller number of children use Cued Speech, a system in which hand gestures enhance speechreading.

Children with hearing loss require support services in order to benefit maximally from a free and appropriate education. For example, it is essential that they receive services from an audiologist, including management of their hearing aids, classroom listening devices, and listening environments. Poor listening conditions can render a hard of hearing child functionally deaf.

Trends and Research Findings

The education of children who are deaf will be revolutionized by two dramatic changes. First, legally mandated neonatal hearing-screening programs are changing the average age at identification from approximately three years to approximately three months. Research has shown that when appropriate hearing aids and early intervention are in place by six months of age, a child is likely to have age-normal language and learning milestones at kindergarten entry. In this light, the most important educational years are the child's very first years, when the family participates in parent–infant programming. Second, cochlear implants are being made available to increasingly younger children. These surgically implanted devices convert sound into electrical current, which then bypasses much of the hearing mechanism to stimulate surviving nerve elements directly. The coded electrical current creates sensations, which the brain, with considerable listening training, can learn to interpret as sound. Research suggests that children who use cochlear implants surpass children with similar degrees of hearing loss who use hearing aids in the areas of speech recognition, speech production, language content and form, and reading.

Children who benefit from early intervention and improved hearing technology, including cochlear implants, are likely to enter kindergarten ready for the educational mainstream. In the absence of additional disabilities, and with appropriate support services, it is possible that these children may never require special education placements and will choose to use sign language only if it is their cultural preference.


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According to Lou Ann Walker, "the first real efforts to educate deaf people began around 1550 when Pedro Ponce de León, a monk from Spain, taught deaf children in a monastery in San Salvador" (p.11). Seventy years later, Juan Pablo Bonet, a follower of Ponce de León, published the first book on the education of people who are deaf. In it he explained that he used a one-handed manual alphabet to build language. In 1700 Johann Ammons, a Swiss doctor, devised a method to teach speech and lipreading (now more accurately referred to as speechreading) to people who are deaf. In the mid-1700s, schools for deaf children were established in Scotland, Germany, and France. Teaching methods, according to Walker, focused, for the most part, on a combination of oralism–teaching students speech and speechreading–and manualism–teaching students a manual alphabet. Schools for the deaf did not reach the United States until 1817, when Thomas Hopkins Gallaudet, a divinity student, and Laurent Clerc, a deaf student of the National Institute of France, opened the American School for the Deaf (originally named the Connecticut Asylum for the Education and Instruction of Deaf and Dumb Persons) in Hartford, Connecticut. Many teachers trained at the American School, which focused on American Sign Language.

The controversy surrounding how to teach children with hearing impairment, sometimes referred to as the oralism-manualism debate, began centuries ago and continues into the twenty-first century. Opponents of oralism contend that denying children sign language is tantamount to denying them a language to communicate. However, children who can learn language orally are better prepared for a hearing world. Most educational programs at the turn of the twenty-first century involve a total communication approach–a blend of oral and manual techniques; however, some members of the deaf community contend that it is inadequate, and they prefer a bicultural-bilingual approach, whereby students learn about the history of deaf culture after learning American Sign Language and English. A controversial piece of this approach is the focus on American Sign Language–a true language that has evolved over generations but one that does not follow the same word order as spoken English. Proponents of American Sign Language contend that it is natural, fluent, and efficient, whereas signing English systems, which correspond with spoken English, are cumbersome and awkward. To date, however, few public schools use American Sign Language.

Regardless of teaching method, students with hearing impairment experience difficulties acquiring the language of the hearing society. Educators pay very close attention to the age of onset of the hearing impairment and the degree of hearing loss because each is closely associated with the severity of language delay. The earlier the hearing loss occurs and the more severe the hearing loss, the more severe the language delay. For many years, professionals believed that deficiencies in language among individuals with hearing impairment were related to deficiencies in intellectual ability; this is not the case. Unfortunately, results of research indicate that students with hearing impairment are behind their hearing peers in terms of academic achievement. Reading is the academic area most affected, wherein students with hearing impairment experience only one-third the reading growth of their hearing peers. They also lag behind their peers in mathematics. According to 1999 figures from the National Center for Health Statistics, "approximately 1.3 percent of all school-age students, ages six to twenty-one, who received special education services during the 1996–1997 school year were served under the disability category of hearing impairment" (Schirmer, p. 20). It is important to note, however, that estimates of the number of children with hearing impairment can differ markedly depending, for example, on definitions used, populations under investigation, and accuracy of testing.

Students with hearing impairment receive services in a variety of settings, from the general education classroom to residential schools. Parents and many professionals have not embraced the current controversial trend toward policies of inclusion (i.e., placing students with disabilities in general education classrooms for most or all of the school day). They caution that the general education classrooms are not necessarily the most appropriate placement for students with hearing impairment. However, some students with hearing impairment experience academic and social success in general education settings. This indicates that the preservation of the continuum of placements, whereby placement decisions can be made on individual bases, is in the best interest of students with hearing impairment.


HALLAHAN, DANIEL P., and KAUFFMAN, JAMES M. 2000. Exceptional Learners: Introduction to Special Education, 8th edition. Boston: Allyn and Bacon.

SCHIRMER, BARBARA R. 2001. Psychological, Social, and Educational Dimensions of Deafness. Boston: Allyn and Bacon.

WALKER, LOU ANN. 1994. Hand, Heart, and Mind: The Story of the Education of America's Deaf People. New York: Dial Books.



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