Los Angeles Unified School District Division of Special Education

Los Angeles Unified School District

Division of Special Education

Schools for All Children

Audiologic Resource Unit

Donnalyn Jaque-Antón

Associate Superintendent

Audiometry or Audiology ?? Types of Hearing Loss Degrees of Hearing Acuity Reading the Audiogram Educational Implications of Hearing Loss The Unfair Hearing Test Help for Students with Hearing Loss ARU Services The ARU Referral Process The DHH Referral Process Contacts Acknowledgements Resources

Overview

Educational Audiology Program

Audiologic Resource Unit (ARU)

LAUSD System: Audiometry and Audiology

Audiometry– Student Health

& Human Services– Travels to schools

– Screens hearing

– Refers to audiology (ARU)

as needed

Audiology– Division of Special Education

– Works in a permanent sound booth

– Provides comprehensive evaluation of hearing

– Refers to DHH as needed

LAUSD System: Audiometry and Audiology

Audiometrists go to schools and screen the hearing of students

If the student fails this hearing screening…

She/he may be referred for a more comprehensive audiological evaluation by an Educational Audiologist in a sound room (at the ARU)

Types of Hearing Loss

Conductive

– Usually not permanent

– Often treated medically

– Left untreated, loss may become permanent

– Affects outer and middle ear

Conductive loss =

Problem in outer and/or middle ear

Types of Hearing Loss

Sensorineural

– Permanent hearing loss

– Affects inner ear (sensory), and/or

– Auditory nerve (neural)

Sensorineural loss

= problem with inner ear

(cochlea) and/or nerve

Types of Hearing Loss

Mixed Hearing Loss: combination of

– sensorineural (permanent)

AND– conductive (usually temporary)

Mixed lossProblem in outer and/or middle ear

along with problem with inner ear and/or

nerve

Degrees of Hearing Loss

Normal Hearing ~ 0-15

decibels

Minimal (Borderline) ~ 16-25

decibels

Mild ~ 26-40 decibels

Moderate ~ 41-70 decibels

Severe ~ 71-90 decibels

Profound ~ 91+ decibels

Audiogram (graph of hearing status)

low pitch high pitch

(FREQUENCY) soft

loud

= RIGHT EAR threshold of hearing

= LEFT EAR threshold of hearing

(DECIBELS)

soft

loud

Frequency (pitch)Low pitch High pitch

Loudness (decibels)

Average conversational speech level

= RIGHT EAR

(Remember red/round

= RIGHT)

Student can hear sounds BELOW the line

Student will have difficulty hearing sounds above the line

Student can hear sounds BELOW the line

Student will have difficulty hearing sounds above the line

= LEFT EAR

= LEFT EAR

= RIGHT EAR

You may see both ears on the same audiogram

This audiogram indicates a mild to moderate loss in the right ear

and a moderate to profound loss in the left ear.

Child detects complete speech signal even at soft conversational level

Good hearing does not preclude auditory processing problems

Educational Implications of Normal Hearing

Educational Implications of Minimal (Borderline) Loss

Child with a cold or the consistent mouth breather…

May have difficulty hearing– Faint or distant speech– At a distance – If classroom is noisy

May miss portions of fast-paced interactions May fatigue more easily because of listening

effort

Educational Implications of Fluctuating (conductive) Loss

Hearing ability may change daily Typical of listening with fluid behind

eardrum Can “hear” but misses fragments of the

message May be accused of “daydreaming” or “not

paying attention” Speech and listening/attention skills may

be affected if child experiences chronic fluctuating hearing acuity before age 7 years

Educational Implications of Mild Loss

Degree of difficulty experienced depends on– Noise level in classroom– Distance from teacher (speaker)– Configuration of hearing loss

May miss portions of fast-paced interactions and classroom discussions

Student often accused of– Not paying attention– Hearing when s/he wants to

Increased fatigue from listening effort

Educational Implications of Moderate Loss

Difficulty understanding conversational speech at a distance of 3 feet – Needs face to face communication– Needs structure and vocabulary controlled

Communication characterized by– Delayed receptive and expressive language– Limited vocabulary– Articulation errors

Educational Implications of Moderate-Severe Loss

Communication significantly affected Marked difficulty in verbal communication in

both one to one and group situations Social interaction is increasingly difficult Communication may be characterized by

– Delayed receptive and expressive language– Limited vocabulary– Articulation errors

Possible impact on self-esteem

Educational Implications ofSevere Loss

May hear loud noises one foot from ear

If loss is pre-lingual in onset, oral language and speech may not develop spontaneously or will be severely delayed

If hearing loss is progressive or sudden, speech may deteriorate

Educational Implications of Profound Loss

Most students cannot depend solely on listening for communication access

Degree and configuration of loss will affect speech skills

If loss is pre-lingual in onset, oral language and speech will not develop spontaneously or will be severely delayed

If hearing loss is progressive or sudden, speech may deteriorate

Unfair Hearing Test

Children with Hearing Loss Need …Our Help!

Early intense intervention is essential for receptive and expressive language development

Students need appropriate and consistent amplification for all their waking hours from an early age

Classroom acoustics need to be arranged to the student’s advantage… (think about things that make it easier for YOU to hear in a group situation)

Help for Students with Hearing Loss

Flexible/preferential classroom seating Amplification/FM systems

– Personal hearing aids– Personal FMs– Classroom speaker system– Personal speaker system

Acoustic modifications of classroom

Audiologic Resource Unit (ARU) Services

Provides audiologic evaluations for any child residing within the geographic boundaries of LAUSD, infant to age 22

Educational Audiologists provide designated instruction and services (DIS) to Deaf and Hard of Hearing Special Day Programs to – Ensure properly functioning amplification systems

– Support teacher in developing skills for use of residual

hearing

Audiologic Resource Unit (ARU) Services

Provides resource to DHH Itinerant Program regarding– Residual hearing – Amplification systems

Provides counseling to parents regarding – Hearing loss– Amplification– Services and resources available to the student

Audiologic Resource Unit (ARU) Services

Provides professional development to District staff and outside agencies

Refers for possible assistance through California Children’s Services (CCS) for coverage of hearing aids and hearing health care services

Referral Process For Students with Suspected Hearing Loss

Begins with a referral to the ARU If...

– Student fails hearing screening (at school, by Audiometry)

OR– Student has an audiogram from outside facility

OR– Student has known hearing loss

OR– Parent/school requests audiologic evaluation

LOS ANGELES UNIFIED SCHOOL DISTRICTDIVISION OF SPECIAL EDUCATION

AUDIOLOGIC RESOURCE UNIT(213) 241 - 8258

REFERRAL FOR ARU SERVICESStudent Name: _______________________________________ Birth date: ________________Address: ____________________________________________ Home Phone: ______________Parent/Guardian: _____________________________________ Work phone: ________________School: ___________________________ Loc.District: _______ Home language: _____________

REASON FOR REFERRAL Failed hearing screening (Date____________) D HHitinerant assessment; 3rd Year (Date ________________) Hearing loss suspected

Comments___________________________________________ Student is receiving special education services No YesIf yes, please specify program: Special Day Class _________________(Please attach a copy of

current IEP) Itinerant DHH ___ LAS ___ RSP ___ APE ___ VH ___ Comments:________________________________________________________________________

Fill in all identifying informationInclude reason for referralIdentify special education services student is receiving, if anyInclude any other information to assist the audiologist

PERTINENT HEALTH INFORMATION: (per health office)MEDICAL chronic ear infections PE tubes Other _________________________________ under private medical care; Physician ________________________________________Comments: ____________________________________________________________________

AUDIOLOGICHas the student had a recent AUDIOLOGIC evaluation? No Yes If yes, Date/Location____________________________and please forward a copy of evaluation to: AUDIOLOGIC RESOURCE UNIT

AMPLIFICATION STATUS: Does the student have hearing aids? No Yes, Right_______ Left________ Dispenser______________________________Is the student using amplification on a consistent basis? No YesComments: ______________________________________________________________________

Student’s health history has important implications for referral process…. please fill this out as fully as possible

Information from outside service providers is essential to appropriate diagnosis and management of hearing impairments…if they have had private hearing tests please attach a copy!

Student’s performance provides valuable information for establishing testing conditions… we may need two audiologists to test this student reliably

Remember… although you know the student, the educational audiologist has only the information you provide

STUDENT PERFORMANCE: (per classroom teacher)SPEECH & LANGUAGEIs a speech/language problem suspected? No Yes If yes,

Comments____________________________________________________________________

ACADEMICS Above grade level At grade level Below grade level Comments:_________________________________________________________

ATTENTION Good work habits Completes assignments Short attention span Easily distracted Follows oral directions Comments:_________________________________________________________

BEHAVIOR Well-behaved Cooperative Helpful Easily frustrated Behaves inappropriately Relates well with peers Interacts with peers inappropriately Comments:_________________________________________________________

Referred by ________________________________ Date ___________________

School DesigneeReceived by ________________________________ Date ___________________

Audiologic Resource Unit

Referral Process for DHH Services

Based on the hearing evaluation, the ARU determines whether

– Student has normal hearing, ending DHH referral process

– Student’s hearing loss may adversely affect academic performance and/or access to the core curriculum, necessitating a referral to DHH for assessment to determine eligibility for DHH services

ARU will

– Complete a report of each student tested

– Complete page 1 of “Request for Special Education Assessment” and

ARU will mail the above to– School– DHH Office

Referral Process for DHH Services

Referral Process for DHH Services

School will:

– In order to make sure all areas of parental concerns are addressed the school will assist parent in completing page 2 of Request for Special Education Assessment: “Student Information Questionnaire”

– The school will generate Assessment Plan within 15 days, including all areas of suspected disability

Referral Process for DHH Services

School will– Check areas specific to DHH assessment

• Academic-DHH assessor• Communication-DHH assessor and/or speech-language

pathologist• Health-nurse/doctor

– Send copy of signed Assessment Plan and Student Information Questionnaire to DHH Program, Beaudry-16th Floor

Referral Process for DHH Services

When signed Assessment Plan is received the DHH Assessor will contact school to arrange DHH Assessment to determine if

– Hearing loss impacts access and progress in standards based core curriculum

– Hearing loss impacts communication skills adversely affecting educational performance

Referral Process for DHH Services

Once all assessments are completed, school will – Contact all committee members– Schedule and complete IEP within 50

day time-line

Student’s eligibility, determination of services and placement will be discussed at the IEP Team Meeting

For Assistance Please Contact

Audiologic Resource Unit

333 South Beaudry Avenue-16th Floor

Los Angeles, California 90017

(213) 241-8053

Marilyn Geffeney, Coordinator, ARU / DHH

(213) 241-8225

Roe Saxman, Senior Audiologist

(213) 241-8258

Authors – Marilyn Geffeney, Coordinator ARU / DHH– Roe Saxman, Senior Educational Audiologist– Sandy Keaton, Educational Audiologist– Patty Klein, Educational Audiologist– With input from the

Audiologic Resource Unit Educational Audiologists

Technical Assistance– Kate Brandon, Coordinator in Instructional Initiatives – Daniel Gumarang,Instructional Technology Advisor

Acknowledgements

Resources

• American Academy of Audiology (AAA)audiology.org

• American Speech-Language-Hearing Association (ASHA) asha.org

• Educational Audiology Association (EAA) edaud.org

• California Academy of Audiology (CAA) caaud.org

Disclaimer: These sites have been chosen for educational and professional purposes. LAUSD does not endorse of guarantee any information contained in these sites.

Getting Through, recording from Zenith Radio CorpHearing Loss Simulation, Med Rx Inc.