Hearing tests

Hearing loss is usually only identified if children are tested as part of a hearing screening program or referred for testing by teachers or parents. However, a number of factors limit the operational effectiveness of regular hearing screening programs.

Conductive hearing loss fluctuates over time so testing must be regular. The effectiveness of a screening program also depends on trained staff and equipment that needs regular maintenance. Health staff may find it difficult to find the time needed for hearing screening. This is especially so when middle ear disease, despite the longer term problems caused by conductive hearing loss, is often seen as a relatively 'minor' health problem.

However, the major educational and social consequences associated with conductive hearing loss mean that the identification of a child's conductive hearing loss is a critical issue. It is one that will remain a problem while this work depends largely on screening being carried out by health professionals who seldom have the training, the reliable equipment and most of all the time that is need to run regular screening programs.

In these circumstances, the people who are most concerned about the consequences of conductive hearing loss (parents and teachers) need some simple and reliable way of checking on a child or children who may have hearing or listening difficulties.

Speech reception tests are designed to test the ability of a child to respond consistently to spoken instructions given in a quiet voice.

The hearing test game: 'Blind Man's Simon Says' is a simple and informal speech reception test that can be organized by one adult on a regular basis, as a simple hearing test for school groups or individual children.

This quick and informal hearing test was trialed at a Darwin school. The hearing of the Aboriginal students at the school was also tested formally in other ways.

First, the hearing of the students was initially screened in a sound proof booth (1000 & 4000 Hz at 20dB). Students who failed this screening were given a full hearing test using pure tone audiometry and tympanometry. Before these tests, the students played 'Blind Man's Simon Says' and their performance was recorded using a video camera. A teacher who did not know any of the children, then watched the video recording and, on the basis of the behavior exhibited by the children during the game, identified the students who might have a hearing loss.

The criteria for the decisions about hearing impaired behavior are set out in the instructions for The hearing game; 'Blind Man's Simon Says' speech reception test).

The following table contrasts the number of students who were identified as possibly having a hearing loss during the 'Blind Man's Simon Says' informal speech reception game with the number of those students who were subsequently found to have a hearing loss during the full hearing tests.

Table 1: The accuracy of the 'Blind Man's Simon Says' hearing screening game

Identified with a hearing problem during the speech reception game
Subsequently passed (failed) full hearing assessment tests (audiometry and tympanometry)
Hearing loss in both ears (identified by full hearing assessment)
1 (16)
Hearing loss in one ear (identified by full hearing assessment)
1 (1)
Passed formal hearing assessment
* Note: Of these seven, three had also failed the screening test.

These results indicate that the informal speech reception test identified nineteen of the twenty one students who were found to have a hearing loss in one or both ears. Of the two students not initially identified during the informal speech reception test (Simon Says), one was found to have a mild hearing loss at some frequencies in one ear and the other was found to have a mild hearing loss in both ears (average; 29dB left ear, 27dB right ear). This student's hearing loss appeared to have been 'masked' during speech reception testing (Simon Says) because she was tested in a group of students who had more severe levels of hearing loss and was not tested in a group that included children with normal hearing. It is important to have children with normal hearing in each group as a reference point for the responses of other children.

These results suggest that the 'Blind Man's Simon Says' informal speech reception test is a simple and effective method that can be used to identify children who may have a hearing loss.

One advantage of speech reception testing is that the communication difficulties of students with a hearing loss are immediately and demonstrably apparent. The ability to provide simple proof of the loss of hearing to others is important as parents and teachers may otherwise ignore the results of hearing tests because the longer term potential effects of the hearing problems on communication and education are not immediately apparent.

The results of hearing tests are usually presented in the form of an audiogram. Audiograms do not present information on hearing loss in a particularly meaningful way they use terminology (slight, mild, moderate) that tends to minimize potential concerns about levels of hearing loss that may, in the longer term, have major communicative and educational implications - especially for Aboriginal, Maori and Pacific Island students who also face other linguistic and cultural challenges. Their cultural differences can mask the identification of hearing loss. These issues are explained further in 'the eyes have it' section in the ear troubles training material.

In conclusion, The hearing game; 'Blind Man's Simon Says' is a useful tool as an informal speech reception test. It can show the results of hearing loss in a meaningful way to parents and teachers when used in conjunction with formal hearing tests. However, as a test, it is most likely to be useful when working with children who do not have easy access to audiological services. In the absence of regular or any technical screening, it is a tool that teachers and parents can use to identify students who may have a hearing problem.

Parents and teachers must recognize and know about the issues associated with poor hearing so that they can act to avoid the negative educational and social consequences of hearing loss for the children in their care. The communication problems that result from unidentified hearing loss can have a major effect on the way children relate to their parents, their teachers and their peer group.

The 'masking' effects of cultural differences make it particularly important that we find a simple method that we can use to identify hearing loss among Aboriginal, Maori and Pacific Island children. The simple 'Simon Says' speech reception test described on this website may help people to identify the children who have hearing problems and, I hope, lead on to a better understanding of the educational and social consequences of conductive hearing loss.

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