So how different does sound appear for a person with hearing loss? Here is an audiogram that would help to understand moderate, severe and profound hearing loss.
The image is self explanatory, but here is a little help. The x-axis has the frequency increasing from left to right and the y-axis has loudness increasing from top to bottom. The various pictures in the audiogram gives an idea of where speech sounds and environmental sounds fall in the entire spectrum of our hearing. The top part has soft sounds like leaves rustling, water dripping etc. while the middle portion has the speech sounds and the bottom part has the loud sounds like lawn mover and band music. When the sounds of speech are plotted in an audiogram, it takes the shape of a banana and is referred to as the ‘speech banana’ (seen in yellow above).
A person with normal hearing can hear all of these sounds. A person with mild hearing loss (look at the right end to see ‘MILD’ written vertically) will have trouble hearing sounds above that level but can comfortably hear sounds below that. A person with moderate hearing loss (look at the right end for ‘MODERATE’) will have trouble hearing sounds above that level but can comfortably hear sounds below that level and so on. For someone with ‘SEVERE’ hearing loss, all of the speech sounds are pretty difficult and as for PROFOUND, even the seemingly loud sounds are not quite audible.
At 19 months, Adith was diagnosed with a mild to moderate hearing loss in the left ear and a moderate to severe loss in the right ear. Though challenging, I think he would have done pretty well with hearing aids because his left ear was not that bad. However, subsequent evaluations (hearing checks are recommended every 6 months) indicated a drastic drop in the hearing levels and soon his right ear was pronounced severe to profoundly deaf across all frequencies. His left ear also showed a steady decline in hearing but it was good in some frequencies, which enabled him to understand speech in quiet. In February 2016, a test confirmed that his left ear had also dropped to ‘severe’ range for high frequencies (above 4000 Hz) which made it very hard for him to hear sounds in that spectrum namely ‘f’, ‘s’,and ‘th’ (refer above chart) through either ear clearly. For the last few months, he often forgets to turn on his right HA and when asked, would casually say, “they are not working” which clearly indicated that he received no benefit from his right HA.
Overall, this decline in hearing had a direct impact on the development of his speech and also his ability to understand and follow directions because he would miss out on parts of sentences. When in doubt, he would promptly ask “what?”/ “what did you say?” / “ha?” and get the instruction clarified but I knew where we were going. I could easily foresee him missing directions in future classrooms, losing track of conversations in a group and hearing only broken words when there was some background noise. We had made the choice that he would be part of the hearing world by talking and not by signing but with this degree of loss, it seemed almost unfair – like asking him to run a marathon with just one shoe, not impossible but quite toilsome.
When we realized that the loss was progressive, we enquired about cochlear implants and came to know that the candidacy criteria for cochlear implants was somewhat rigid. It is only when hearing aids prove to be of no benefit that cochlear implants are recommended. And as per tests, Adith did have the ability to distinguish words and repeat multi syllable words, which meant his HAs were still helping him at large. I was initially puzzled by this criteria because his hearing aids were just helping him to ‘get by’ and it was almost certain that he was going to struggle when mainstreamed to a public school. However, when I learned more about implants I understood why – it is something that stays for life and there is no going back because it knocks out the residual hearing in the ear. It would be done only as a last resort.
There are days when he asks for repetitions and looks lost but then there are other days where he does extremely well and behaves just like a hearing child. He sometimes responds appropriately during bath time and while in the bed before going to sleep without his hearing aids and it surprises me! He has begun to say ‘f’ correctly in most places now and I believe it is only a matter of time before he says ‘s’ and ‘l’ correctly. I am hopeful of him having clear speech through ongoing speech therapy but not sure if anything can be done about him missing out on others speech. I cannot expect everyone to be always empathetic of his situation while conversing with him.
For now, we are just trying to give him an optimal environment at home, giving him space to grow and encouraging him to ask for clarification when he needs it. All of us have challenging phases in our lives and we hope things will fall in place at the right time!
PS: Since I started writing this post, some events have occurred which actually has to be included herein. However, I feel its a little too early to write about it, so it has to be in another post :).