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Developing empathy for hearing-impaired students: can you hear what I hear?


Hearing loss in school-aged children may be problematic for both the individual student and the teacher. Millions of dollars are spent each year for treating a health condition called otitis media (OM). Otitis media, the most common cause of hearing loss, affects approximately 5% of children under age 18 experience a hearing loss. In the United States, three of every 1,000 children have educationally significant hearing loss. (4) While many hearing-impaired students develop compensation skills, classmates need to be aware of the challenges of poor hearing and how even a subtle hearing loss can impact lives.

Content Information for Teachers

Any or all of the following content may be shared with students. The amount and depth of information shared depends on the age of the students and the intent of the teacher. Content information may be taught before or after the Unfair Hearing Test.

The teacher begins with a basic anatomy lesson about the ear and its structures. The ear is divided into three major segments. The outer ear consists of the auricle, the external auditory canal, and the tympanic membrane or ear drum. The middle ear consists of three tiny bones called ossicles (hammer/malleus, anvil/incus, and stirrup/stapes), the oval window, and the two eustachian tubes. The inner ear consists of the vestibule, the semicircular canals, and the cochlea.

Each structure of the ear serves a vital physiological function. The auricle collects sound waves channeling them into the smaller auditory canal and creating more intense waves that are passed along until they hit the tympanic membrane. The tympanic membrane turns the sound waves into minute vibrations. These vibrations are moved through each of the small middle ear bones to the oval window. The oval window serves as a switch, distributing the vibrations to the cochlea and the semicircular canals. Inside the cochlea, fluid is set in motion by the vibrations sent from the oval window. The fluid rubs against minute hair-like projections called cilia. The cilia pass information to the auditory nerves connected to the back of the cochlea and the auditory nerves take the sound messages to the brain to be interpreted. The eustachian tubes connect the back of the throat and nasal cavity to the vestibule area of the middle ear. The eustachian tubes allow air into the middle ear to equalize pressure on either side of the ear drum so it does not burst. (2)

The ear may be damaged or become infected at many points along this pathway. Symptoms of Otitis externa, an infection of the outer ear, include inflammation, itching, pain, and a feeling of fullness that may occur when water, sand, dirt, or other debris get into the auditory canal. A common name for this inflammation is "swimmer's ear." Other things contributing to otitis externa are bubble baths, soaps, shampoos, and allergies. Inserting any foreign object (coloring crayon, pencil eraser, rocks, beans, etc.) can also create a hearing loss by blocking the sound waves as they enter the ear. These types of hearing loss are temporary and are referred to as conduction hearing loss.

Earwax also contributes to external auditory canal problems. A protective substance, earwax serves to filter dust and helps keep the ears clean. Earwax is normally liquid, self-draining, and seldom causes problems. Children have a lot of earwax. Once in awhile, earwax will build up, harden and cause some discomfort and hearing loss. Cleaning the ear canal with a cotton swab increases the risk of compacting earwax.

Otitis media occurs in the middle ear. Fluid or pathogenic organisms from the throat enter the eustachian tubes and travel to the middle ear space. When this occurs, pressure from fluid build-up, along with infection and inflammation, may cause the eardrum to become red, inflamed, and painful or uncomfortable. In addition, swelling of the eustachian tubes may prevent air from entering the middle ear and create a vacuum which creates an environment conducive to an ear drum rupture. Otitis media is more common in young children because they have shorter, more horizontal eustachian tubes. Otitis media occurs frequently in conjunction with a cold or other respiratory infection. Both disorders may impair the ability to hear. (2,3)

Sensorineural hearing loss or inner ear problems are a result of damage or defects to the oval window, cochlea, or the auditory nerve. Some people are born with inner ear defects while others incur changes caused by loud noises, diseases, or natural aging. (6) When a student is exposed to extremely loud sounds (eg, explosion) or loud sounds over a long period of time (eg, snowmobiling, riding a go-cart, or loud music) the risk of noise-induced hearing loss (NIHL) increases. NIHL occurs in the inner ear when the tiny hair-like nerve cells are damaged and become less sensitive to sound. (6) Students with this type of hearing loss, while often not completely deaf, frequently hear ringing, hissing, or clicking noises. They may be overly sensitive to loud noises and unable to hear regular conversation. (2)

Teachers should be aware of the variety of hearing loss and conditions of the ear that make classroom work more difficult for students with hearing problems. Development of appropriate classroom strategies is helpful in minimizing disruptive classroom behaviors and in developing empathy toward those with hearing loss.


There are many ways to develop sensitivity to hearing loss. One exercise is to speak softly at various times in the classroom forcing students to struggle to hear and understand what is being said. Another is to create an atmosphere in which you continually talk with your face and mouth facing away from the children. We may also "mouth the words" we are saying without actually providing sound. Many students do not realize that we tend to determine what is being said by reading lips, observing facial expressions, and observing body language. When we are deprived of one or more of these supplementary methods we may find ourselves unable to determine what is being said. (1) A more intentional way students can develop understanding about hearing loss is through participation in a structured simulation or role play exercise.

Step 1. Using the Unfair Hearing Test (League for the Hard of Hearing--Unfair Hearing Test /audio.htm) (5) recorded simulation: students hear a list of words that are read three times. The first list is not loud enough, the second list has some high frequency tones omitted, and the third list contains a high-frequency boost. Though the word lists are identical, students will find themselves "hearing" and then writing a variety of words with each reading.

Step 2. At the conclusion of the exercise ask students to identify how they felt when they could not hear well. Students may indicate they were upset, felt dumb, or thought the "test" was unfair. They also may state they were worried or frustrated.

Step 3. To help students better understand the impact of hearing loss, pose the following questions to the class: What did you do to try to hear better? (leaned forward, cupped an ear, listened harder) How would you feel if you suffered a hearing loss? (left out, angry, sad, lonely) How might you be excluded from normal classroom activities if you were hearing impaired? (not be able to hear assignments, follow directions, or hear jokes) How do you think students compensate for a hearing loss? (talk louder, ignore others, pretend they heard, ask a lot of questions, and watch the speaker's lips) How could you work more effectively with a hearing-impaired student? (speak directly toward them, speak slower and louder, repeat words, use gestures, and learn sign language)

Step 4. Ask students to write a one-page summary of what they learned and how they think a hearing loss would affect their lives.

Assessment Criteria

1. Students should be able to identify two feelings they experienced when they could not understand the words in the Unfair Hearing Test.

2. Students should be able to name one way a hearing-impaired student might be excluded from normal classroom activities.

3. Students should be able to describe one way hearing-impaired students compensate for hearing loss.

4. Students should be able to summarize in a paragraph how a hearing loss would affect their lives.

5. Students should be able to list two ways they could work more effectively with a hearing-impaired person.

Lesson Extension

Students may be asked to research diseases/conditions of the ear, how to protect ears and prevent hearing loss, or types of treatments available for those with hearing loss.


(1.) Anspaugh DJ, Ezell G. Teaching Today's Health. San Francisco. Calif: Person Benjamin Cummings; 2004:83.

(2.) Burnie D. The Concise Encyclopedia of the Human Body. New York, NY: Dorling Kindersley; 1995:72-73.

(3.) Kemper D, Wiss CA, Schneider S. Heathwise Handbook: A Family Self-Care Mammal for You and Your Family. Boise, Idaho: Healthwise Publications; 1999:178-186.

(4.) The Prevalence and Incidence of Hearing Loss in Children. Available at:

(5.) League for the Hard of Hearing--Unfair Hearing Test. Available at:

(6.) Hearing Loss. Available at:

Susan E. Clark, MS, Instructor and Internship Coordinator, (; Molly S. Wantz, EdS, Professor Emeriti, (; and Rebecca A. Brey, PhD, Associate Professor, (; Dept. of Physiology and Health Science, Ball State University, Muncie, IN 47306.
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Title Annotation:Teaching Techniques
Author:Clark, Susan E.; Wantz, Molly S.; Brey, Rebecca A.
Publication:Journal of School Health
Geographic Code:1USA
Date:Feb 1, 2005
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