Today’s blog is written by Stacey Lim, AuD. PhD, CCC-A. Stacey  is an assistant professor of audiology at Central Michigan University. Her areas of specialty are pediatric and educational audiology, cochlear implants, and aural rehabilitation. Stacey is co-curator of a museum exhibition, (dis)ABLED BEAUTY: the evolution of beauty, disability, and ability, which focuses on creatively and artistically designed apparel, assistive devices, and prostheses for people with disabilities. She was born with bilateral, profound hearing loss, and currently wears a cochlear implant and hearing aid, and her preferred hearing aid color is purple.

 

by Stacey Lim, AuD

 

Why does fashion matter? Sometimes, fashion may be thought of as frivolous and superficial. But consider this: How do you express your own personality and identity in a way that is immediately tangible? Often times, it is through the types of clothes we choose to wear, the colors that we pick out—and in doing so, we are able to make ourselves as visible or invisible as we choose to be.

Hearing loss is one of the most invisible disabilities and has had a significant amount of negative stigma or stereotypes surrounding it. The “hearing aid effect” has been associated with the perception of people with hearing loss as less intelligent, having lower achievement, having an undesirable personality, and to be considered less attractive (Cienkowski & Pimentel, 2001). Because of the persistent negative stereotypes surrounding hearing loss, a large number of hearing aids have, historically, been designed in a way to conceal hearing loss. Examples of these were hearing aids that were disguised as jewelry or eyeglasses, or were made to be more invisible. Some of these hearing aids, including a large number of hearing aids available today, are designed to blend in with one’s hair color or skin color.

As children with hearing loss grow up, they begin to develop their own social identities and how they feel about their own hearing loss. Blood (1997) has found that other children’s perceptions of a classmate’s hearing loss can be influenced by how the child with hearing loss views him or herself. In other words, if the child views his or her hearing loss in a negative way, others may view that hearing loss negatively, too. Moreover, adolescents may select hearing devices based on how they think their peers perceive them (Kent & Smith, 2006). Thus, peer acceptance can contribute to the child or adolescents’ desired appearance, which influences their own level of self-esteem. Adolescents with hearing loss will often times dress like “hearing students” (Van Gurp, 2001) to better fit in with their peers. Fashion has been a way for students with disabilities to develop their own sense of self-worth, belonging, and peer acceptance (Kidd, 2006).

Parents can be influential in a child’s own self-perception—it is not uncommon for parents to be concerned about the appearance of hearing aids and how others may view their children due to their hearing aids (Sjoblad et al., 2001). Interestingly, social support has been associated with hearing aid usage (Singh, et al., 2015). In supporting a child with hearing loss, then, it may well be critical for a parent to encourage the child to pick out the colors of his or her earmolds and hearing aids, and to be excited about those color choices. In doing so, parents can set the stage for the child to develop a stronger sense of self-confidence, comfort, and hearing aid ownership. Even children begin to develop a sense of self-esteem based on appearance at a young age, which can influence their own self-esteem as they get older (Harter, 2000).

Being able to be open about one’s disability, and to show it off confidently and proudly to their peers, reduces the amount of self-stigmatization (Corrigan, et al., 2013) and can potentially reduce the amount of negative perceptions from others. As a result, individuals are more likely to be stronger advocates for their own needs. This may well include children with hearing loss, as we want them to develop into independent adults who are able to advocate for their own needs in school, the workplace, and recreational activities.

Rather than blending in, hearing aids can stand out and become fashion statements that shout loudly and clearly: I have a hearing loss, and I am proud of who I am because of my hearing loss.

There are different ways for children, adolescents (and even fashionable adults) to flaunt their hearing aids and cochlear implants! Some come in different colors of the rainbow. Different earmold manufacturers have different color options for earmolds, and some will have options to mix in glitter or different color combinations. Although not as well-known, earmold tubing may be available in different colors besides clear and skin-tone. In addition to choosing colorful hearing aids or cochlear implants, there are other options available. What follows is a non-exhaustive list of different options for customizing hearing aids even further.

  • Some of these include items such as Hayleigh’s Cherished Charms (http://www.hayleighscherishedcharms.com), which were designed by a teen who has hearing loss and wears hearing aids. These charms slide over the tubes of hearing aids and come in various designs. There are also tube twists that are available in different colors, which can be put on earmold tubing. Some of Hayleigh’s designs can also be worn on cochlear implants as well.

 

  • For something functional and colorful, EarGear (gearforears.com) is another option. These are made of an acoustically transparent fabric, which protect hearing aids and cochlear implants from dust and moisture. These can also be ordered with cords that can be clipped to one’s shirt—something perfect for an active child or a teen who likes sports.

 

  • Hearing Aid Headbands (hearingaidheadbands.co.uk) are another functional and cute option. These are custom-designed headbands that are designed to hold hearing aids or cochlear implant processors securely on one’s head.

 

  • The Hear Clip (thehearclip.com) is decorative jewelry that can be attached to hearing aids, cochlear implants, or auditory osseointegrated implant systems (e.g., BAHA™ devices). There are ear cuff and earring options. Another jewelry option is Hearrings (www.hearrings.co.uk) which are Swarovski crystal accessories that slide over earmold tubing.

 

  • Hearing aid and cochlear implant manufacturers also may have stickers that are available, which can be adhered onto the devices—and which can easily be changed for a different design, color, or pattern. Parents can speak with their audiologist or the hearing aid manufacturer to see if the manufacturer has different stickers available especially for their children’s hearing aids.
  • In addition, SkinIts, which are adhesive designs that can be stuck onto hearing aids or cochlear implants are available. Some that are available include:
  • Phonak SkinIts (also includes FM receivers and transmitter options: http://phonak.skinit.com/
  • Another idea for decorating hearing aids can also include using pony beads or larger beads on earmold tubing. Others have used decorative washi tape or nail stickers on the side of the hearing aids. Stick-on rhinestones can also add a little glitz for fancy occasions! A few things to keep in mind if using washi tape or nail stickers: Take care not to cover microphones, buttons, or switches. Do not use nail stickers that use water or acetone for removal of the stickers. Do not use nail polish, paint, or glue on hearing aids or cochlear implants.

 

In this case, fashion is not frivolous. As Mimi Shulman (jewelry designer with hearing loss, and designer of Ear Wear) said in a documentary for the (dis)ABLED BEAUTY exhibition (www.facebook.com/disabledbeauty), she designed Ear Wear (hearing aid jewelry) so that others would “see that we’re human, we have a sense of humor…they [hearing aids] can be fashion statements to us. It’s to take the stigma away.”

 

References

Blood, I. M. (1997). The hearing aid effect: Challenges for counseling. Journal of Rehabilitation63(4), 59-62.

Cienkowski, K. M., & Pimentel, V. (2001). The hearing aid ‘effect’revisited in young adults. British journal of audiology35(5), 289-295.

Corrigan, P. W., Kosyluk, K. A., & Rüsch, N. (2013). Reducing self-stigma by coming out proud. American journal of public health103(5), 794-800.

Harter, S. (2000). Is self-esteem only skin-deep? The inextricable link between physical appearance and self-esteem. Reclaiming Children and Youth9(3), 133.

Kent, B., & Smith, S. (2006). They only see it when the sun shines in my ears: Exploring perceptions of adolescent hearing aid users. Journal of Deaf Studies and Deaf Education11(4), 461-476.

Kidd, L. K. (2006). A case study: Creating special occasion garments for young women with special needs. Clothing and Textiles Research Journal24(2), 161-172.

Singh, G., Lau, S. T., & Pichora-Fuller, M. K. (2015). Social support predicts hearing aid satisfaction. Ear and hearing36(6), 664-676.

Sjoblad, S., Harrison, M., Roush, J., & McWilliam, R. A. (2001). Parents’ reactions and recommendations after diagnosis and hearing aid fitting. American Journal of Audiology10(1), 24-31.

van Gurp, S. (2001). Self-concept of deaf secondary school students in different educational settings. Journal of Deaf Studies and Deaf Education6(1), 54-69.

For children with hearing loss to succeed in classroom they need a variety of skills. And learning those skills needs to start when hearing loss is identified – hopefully within the first few weeks. So lets talk about what we think needs to be learned.

 

Detection and Discrimination

In order for children to succeed in the classroom they need to hear what is happening in the classroom. They need to know if the teacher is calling their name and be able to turn and respond. They need to be able to understand what the teacher is saying. If she asks for the blue truck our child with HL needs to know what that is and to respond. They need to understand conversation and be able to follow 2-3 step directions by first grade and more as they get older.

 

Discrimination skills

For children to learn, they need to be able to discriminate vowels (which is usually relatively easy for children with hearing loss) but they also need to be able to understand consonants because, in fact, consonants carry most of the detail of information. It is essential to discriminate phonemes that are not similar (shoe/door) and phonemes that are similar (cap/cat or top/cop or cot/got/hot/tot). We need to be sure that children can discriminate in both initial and final position.

 

Discriminating in Noise

Wouldn’t it be great if classrooms were quiet? If children on the playground or in the lunchroom could easily hear? Well, they are not, so we need to be sure that children hear well in those conditions. We need to provide practice listening in noise so they children have the opportunity to build those skills

 

Using the discrimination skills to learn

We are not developing discrimination skills just to develop them. We are using auditory skills to get information. This includes listening to the teacher, building vocabulary, and developing critical thinking skills. We have to have auditory skills to develop vocabulary, and vocabulary is the first step in developing critical thinking skills. Children need to be able to listen to a story, follow the detail, answer questions about the story, and learn from discussion about the story. It is important that we help children use their auditory skills to develop critical thinking.

 

So what is our goal?

  • First, children need to be well fit with technology so that they can hear what they need to hear to learn.
  • We need to remember to use remote microphone technology as needed (and they are needed a lot.)
  • We need to work on developing auditory skills so that children can use audition to learn
  • We need to remember that the goal of good auditory skills is learning language so most of the work we do with children needs to be directed at language development
  • Language development is complex and it needs to include teaching children to think about what they hear. We need to help children understand and answer questions, they need to think about what they hear and be able to ask questions to get clarification.

 

When does listening therapy stop?

This is a complicated question. In my view it can’t really stop. It may take a back seat for awhile but, in my experiences, as language and academic skills get more complicated, work on listening often takes a back seat to other language activities. Be careful. We need to keep an eye on what a child with hearing loss is able to do. Listening skills need to be monitored constantly. Evaluation every three years is not enough. Audiologists can help. Since audiologists see children at least annually (and hopefully more often, audiologists can do very specific and complex speech perception testing in quiet and in noise, monaurally and binaurally, which would provide critical information. If a child shows problems listening, reinstate some listening therapy.