Using Test Results to Plan Management

Is the child hearing normal conversation?

 

If a child has good speech perception at normal conversational levels (45-50 dBHL) than we expect the child will hear well when 3-6 feet from the person who is speaking and when it is quiet. If she cannot hear well when close to the talker she will have problems learning. Children who cannot hear normal conversation will have difficultly learning language.

The first step is to be sure that technology is doing what it needs to do. Is the child hearing well enough? Are thresholds at a soft enough level? Is the child hearing in or near the string bean? If not, the first step is to adjust the technology settings so that the child is hearing at a sufficiently soft level.

If technology testing indicates that the child is hearing well enough with the technology but speech perception is still not good, it indicates that the child needs auditory based therapy to build auditory skills.

 

Is the child is hearing soft conversation in competing noise?

 

If a child has good speech perception at normal conversational levels (30-35 dBHL) than we expect the child will hear well when 10 feet from the person who is speaking and when it is quiet and the ability to understand soft speech will permit the child to follow conversation in the classroom.

If she cannot hear soft speech she will have problems overhearing conversation which will significantly interfere with learning. Children who cannot overhear conversation will have difficultly learning language, since incidental learning accounts for about 90% of what children learn. Again, the first step is to be sure that technology is doing what it needs to do.

Is the child hearing well enough? Are thresholds at a soft enough level? Is the child hearing in or near the string bean? If not, the first step is to set technology so that the child is hearing at a sufficiently soft level.

If speech perception at normal conversation is good but speech perception for soft conversation is poor than auditory based therapy is needed to build listening skills. If speech perception for normal conversation is poor than we cannot expect speech perception at soft conversation to be good. In addition, poor speech perception for soft speech confirms the need use of a remote microphone system in all difficult listening situations.

 

Is the child in competing noise?

 

If a child has good speech perception at a normal conversational level in competing noise (50 dBHL+5 SNR) than we expect the child will hear well in many situations. If she cannot hear in competing noise she will have problems in many situations since the world is very noisy.

Again, the first step is to be sure that technology is doing what it needs to do. Is the child hearing well enough? If a child is hearing well at normal conversation in quiet but has poor speech perception in noise than the child needs to auditory based therapy to build skills in noise.

In addition, poor speech perception skills in noise indicate for the need for a remote microphone system full time in school and in all other difficult situations.

 

Do all children need remote microphones?

 

Yes, of course. Every child with hearing loss needs an FM system. Listening with a hearing loss is very difficult. FM will improve listening for all children with hearing loss from infancy. So, check test results, and use the information to help develop a remediation plan.

 

About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 5 books, and written numerous books chapters and journal articles, and is a well known international lecturer.

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