Do You Hear What I Hear?
Living and Learning
with Conductive Hearing Loss/Otitis Media Kit
WA Department of Education
Impact of Otitis Media is Multi-Factorial
Age at which the child experienced the first incidence of
Number of incidences under the age of 12 months
Access to good medical intervention
Access to certain types of interactions within the family
Access to audiology and speech pathology
Child’s general health
Oral Language is fundamental …
Speaking and listening provide the foundation for all
language learning and underpin the successful development
of reading and writing skills.
Proficiency in speaking and listening contributes to
children’s abilities to learn effectively in all learning areas.
First Steps: Oral Language Developmental Continuum
Cultural Considerations
Language is the repository of the speakers’ cultural knowledge
and reflects their world view. When we devalue a language we
devalue everything contained within and reflected by it.
The Western school system is set up to reflect a literate
tradition. It assumes all children come to school knowing how
to work with language in a de-contextualised manner. We
need to be aware that children may come to school with rich
language experiences from predominately oral traditions and
Impact of CHL on Speech
and Language Development
Hearing children learn the basics of language passively, by hearing it. This
avenue is not open to children with hearing losses.
Creates a barrier for normal speech development and phonological
Causes delays in the development of a child’s first language and any
additional language, particularly when the hearing loss begins at a very
young age:
Poor vocabulary and semantic organisation
Expressive and receptive language difficulties – language structure, word
endings, grammar, word order etc.
For Aboriginal children, diminished auditory experiences can affect
opportunities for learning about culture, law, relationships, etc. (Clarke,
Impact of CHL on Comprehension
‘Oral comprehension’ relates to the ability to understand the meaning of
what is spoken. Comprehension is dependent upon context, previous
knowledge and experience, sentence length, concepts and attention.
(adapted from Health Department of WA Teacher Modules, 2000)
A child with CHL or a history of CHL probably has:
Difficulty with lengthy or complex instructions
An underdeveloped vocabulary including concepts and
descriptive terms (e.g. in Preprimary will not understand concepts
such as location [over/under…] or size, and descriptive terms [colour,
Difficulty with some questions (e.g. in Preprimary can’t
understand ‘wh’ questions [who, what, when, where])
Impact of CHL on Semantics
Semantics refers to the link between our thoughts and ideas and the
vocabulary and concepts we use to express these thoughts. Semantic
organisation describes how we organise incoming information in order to
make sense of and later retrieve it.
(adapted from Health Department of WA Teacher Modules, 2000 ; Holt & Spitz, 2000)
In Preprimary, a child with CHL or a history of CHL probably:
Has a vocabulary of less than 1500 words
Speaks in sentences of < 3 to 5 words
Doesn’t use language socially
Is slow to learn words and concepts (due to ‘fuzzy’
Impact of CHL on Semantics
Other indicators may be :
Difficulty integrating new information with existing
Limited conceptual understanding
Under-developed receptive and expressive vocabulary
Difficulty retrieving words
Difficulty generating ideas related to a topic
Conversational difficulties
Impact of CHL on Syntax
Syntax or grammar refers to the way we organise words into sentences.
Grammatical rules tell us which words should come before or after others,
the word endings we should use and the way words combine to form
(adapted from Health Department of WA Teacher Modules, 2000 ; Holt & Spitz, 2000 ; Owens 1992)
Problems with forming linguistic categories such as plurals
and tenses
Grammatical errors and unusual word order
Incomplete sentences
Restricted use of describing words (adjectives/adverbs) and
connectors (but, then, because, so …)
Impact of CHL on Narrative
(Oral Texts) Skills
Narratives/Oral texts encompass such genres as stories, reports,
procedures, explanations, recounts and news telling. The common feature
of these genres is the linguistic structures that are used to tell and retell a
series of events in time order.
(Adapted from Health Department of Western Australia Teacher Modules, 2000 ; Holt & Spitz, 2000)
The Western-style narrative structure tends to be linear in
nature and uses a distinct model that may be difficult to
understand for Aboriginal and other CALD students. If a child
has hearing problems they are likely to have additional
problems with story grammar and descriptive vocabulary.
Impact of CHL on Phonological Processing
Phonological processing relates to the ability to use the sounds of a language to
process oral and written language, which allows us to form phonological codes
and access a word stored in our brain’s lexicon. Phonological awareness skills
(explicit awareness of sound structure and ability to manipulate structure of
words) are dependent on phonological processing skills.
Need to hear words to learn words – to ‘map’ words to objects
car? ar? bar? tar? …
Absence of second sound in two-letter blend (eg frog, block)
Absence of unstressed syllable(s) (banana, dinosaur, balloon)
Poor discrimination and identification of sounds
Impact of CHL on Phonological Processing
Australian English speech sounds with which ESL/ESD
speakers frequently are not familiar:
t, d, th
a, e, ir, ai
f, v, b, p, k, g
o, o-e, oo/u, u-e
s, z, sh, ch, j
u, i-e, oi, ai
ee, i, e, a
o, oar, ar, oi, ir
a, ar, u, ow
(Adapted from Making the Jump,
Catholic Education, Kimberley, 1997)
Consider the similarities between these sounds (voice, placement of lips
and tongue). If a child can’t hear a sound correctly he/she will have
considerable difficulty learning to say it correctly, particularly if he/she is
reliant on visual differentiation.
Impact of CHL on Metalinguistic Skills
Metalinguistics refers to the ability to use language to think, talk about, reflect
on and manipulate units of language.
Don’t know how to play with sounds and words, eg rhyming
Don’t know what a ‘word’ is so have difficulty understanding
word boundaries and segmenting sentences into words:
“Ontheweekend”, “smorning”
Impact of CHL on Metalinguistic Skills
Difficulty manipulating words within words (eg take ‘sun’
from sunshine); syllables in words (eg take ‘ing’ from doing);
sounds in words (eg boat has 3 sounds: b / oa / t; take ‘c’ from
coat); and blending sounds to make words (eg s – t – o – p)
Poor understanding that words are arbitrary symbols of a
language system – words usually don’t contain any hint of
their meaning
Problems working out how communication breaks down
Impact of CHL on Pragmatics
Pragmatics relates to the use and functions of language for communication.
Pragmatic awareness is the knowledge of conversational rules and includes
both verbal and non-verbal aspects.
(adapted from Holt & Spitz, 2000 ; Owens 1992)
Children with a hearing difficulties may have problems with:
Entering into a group, requesting, responding and taking
Initiating conversations
Understanding subtle social rules
Accepting others points of view and others’ feelings
Monitoring the listener
Impact of Hearing Loss on Socialisation
Children with hearing difficulties, however, are also likely to
present with social and emotional challenges due to:
Their own frustration and/or the frustration of their peers
Just not “getting it” i.e. the subtleties and unwritten rules of
social exchanges
Summary of Educational Impact of CHL
More than three infections under the age of 12 months is a significant risk factor
Even without a current ear infection children can still suffer the effects of a
history of conductive hearing loss
Poor ability to discriminate sounds in words and to hear words in words;
difficulty chunking words into individual parts; and relationship between own
sound repertoire and written alphabet is tenuous
Language learning difficult; frequently have restricted content, vocabulary,
language and confidence; prediction as a reading strategy is not functional
except with simple or familiar texts
Poor foundation for literacy and without help will fall further behind every year
Socialisation difficulties and behaviour problems are likely
The most debilitating aspects of deafness are secondary to the hearing
impairment itself