Perception of Hearing Loss by Graduate Students of Speech-Language Pathology

Transcription

1 Mary Aguila-Vinson Jennifer Lister Theresa Hnath-Chisolm Patricia Blake-Rahter University of South Florida, Tampa Perception of Hearing Loss by Graduate Students of Speech-Language Pathology Hearing loss classification terminology provides a convenient and concise method of describing hearing loss for audiologists. The Goodman scale is a hearing loss classification scale that has been widely used to describe audiometric findings for both children and adults (Goodman, 9; Haggard & Primus, 999). The scale uses seven categories based on the pure-tone average (PTA), the average of hearing thresholds at 00, 000, and 000 Hz. As detailed in Table, the category terms for children extend from normal to ABSTRACT: The influence of presentation modality on the perception of hearing loss by graduate students of speech-language pathology was evaluated. Three levels of hearing loss (mild, moderate, severe) were introduced in two presentation modalities: (a) hearing loss classification term and (b) audio simulation of hearing loss. Following the presentation of hearing loss, the future speechlanguage pathologists rated the potential communication difficulty that a child with that loss might have in the classroom. Participants predicted significantly greater difficulty when presented with the simulated hearing loss than when presented with the classification term for the same degree of hearing loss. Results indicate that the standard method of classifying hearing loss may result in an oversimplification of the communication impact of hearing loss by future professionals. KEY WORDS: hearing loss, children, speech-language pathologist, hearing loss classification terminology profound, with ranges of PTAs assigned to each. The Goodman scale is described in and used throughout introductory and advanced texts written for audiology and speech-language pathology students (e.g., Martin & Clark, 000; Northern, 99), which contributes to its widespread use. Because factors such as speech understanding, etiology, configuration, and progression are not represented by such terms, the authors of the texts caution against describing a hearing loss using the terms alone as they may be misleading to clients and their families. Despite this caution, the terms are often used by professionals to describe a hearing impairment without accompanying information regarding the potential communication, academic, social, and emotional impact associated with the hearing loss. According to Northern and Downs (99), a child with a mild hearing loss will not hear short unstressed words and less intense speech sounds such as voiceless consonants. The child with a mild loss will exhibit inattention as well as mild speech and language delays. A child with a moderate hearing loss will miss most speech sounds presented at a normal conversational level and will exhibit definite inattention and language, learning, and speech problems. The child with a moderate loss will have particular difficulty with abstract concepts and grammatical rules. For a child with a severe hearing loss, language and speech will not develop without intervention. This child cannot hear normal conversation without amplification. Although the hearing loss classification terms were developed based on clinical and educational observations CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume 0 Fall 00 NSSLHA 0 09-/0/0-00

2 Table. Hearing loss classification terms as identified by Goodman (9) and adapted by Clark (98). Terms are based on the pure-tone average (PTA), the average of air conduction thresholds at 00, 000, and 000 Hz. PTA (db HL) Classification term < Normal Slight 0 Mild Moderate 0 Moderately severe 90 Severe > 90 Profound (Goodman, 9), the terminology has not been standardized and does not appear to reliably predict the impact of the hearing loss on the communication, academic, or language performance of children (e.g., Davis, Elfenbein, Schum, & Bentler, 98; Haggard & Primus, 999; Martin & Clark, 000). In fact, hearing thresholds as indicated by the pure-tone audiogram have often been shown to have little correlation with the ability to understand everyday speech or self-ratings of hearing handicap (Martin & Clark, 000). Therefore, descriptive terminology based on such thresholds may convey little meaning. This is especially true of the lower categories (i.e., slight, mild). The terms slight and mild convey an impression of negligible communication impact, an impression that is at odds with the significant communicative and educational disadvantage experienced by children who suffer such losses (Tharpe & Bess, 999). Approximately % to % of school-age children have permanent mild to profound bilateral hearing loss, and this number increases to.% when all forms of hearing loss are included (Bess, Dodd-Murphy, & Parker, 998; McDowell & Johnson, 00). Inadequate descriptors of the effects of hearing loss on a child s communication and education functioning should be of concern to the professionals who counsel parents, teachers, and other professionals. Often, this professional will be the audiologist. Clinical experience suggests that audiologists sometimes limit themselves to hearing loss classification terminology in discussions with other professionals as well as in the form letters and reports that are placed in student files. For example, in an informal survey of audiologists, Konkle (99) found that when asked What do you mean by a mild hearing loss compared to a moderate or severe problem? most respondents noted ranges of pure-tone thresholds that are classified as mild, moderate, severe, or profound. In addition, the ranges of hearing loss varied among the audiologists to the extent that it was possible for the same hearing loss to be classified differently depending on who made the classification. Although descriptive classification terminology may be convenient, it results in an oversimplification of the potential communication difficulties that children may face. Konkle (99) recommended minimizing this confusion by specifying the potential impact of a hearing loss in the professional reports sent to parents, teachers, and others involved with the child. In a study of Georgia educators, Blair, EuDaly, and Benson (999) found that teachers at all grade levels had little understanding of their students hearing loss despite the fact that all of the teachers had received audiologic reports and form letters describing the hearing loss using classification terms. Approximately half of the teachers who received an audiologic report actually recalled receiving the report. Of those who did remember receiving the report, less than half indicated that they understood the information in the report. Very few teachers received information via direct contact with an audiologist. The teachers in the Blair et al. study made several suggestions for improving audiologic reports: (a) use lay terms (no jargon); (b) make the reports short and concise; and (c) provide practical, personalized suggestions for the classroom. Though not all audiologists limit themselves to classification terms, using measures such as the articulation index to describe hearing loss (Pavlovic & Studebaker, 98), overuse of the terms among professionals does exist. It is apparent that hearing loss classification terminology, although convenient to the audiologist, is relatively unhelpful to other professionals. Although the audiologist is often the professional providing the information regarding the degree of hearing loss and its implications, in many school settings, it is the speech-language pathologist (SLP) who must clarify the audiologic information for teachers and others interacting with the child. Thus, it is important that SLPs have an accurate perception of the effects of hearing loss. An alternative to the use of hearing loss classification terminology is to have parents and professionals listen to simulations of various degrees of hearing loss. A number of simulations are available via audiotape, compact disc, and Internet sound files. These simulations provide a listener with normal hearing with an approximation of the listening difficulties experienced by individuals with hearing loss. Typically, simulations of mild, moderate, and severe losses are created by simple filtering of an ongoing speech stimulus within certain (usually high) frequency bands. This provides a simulation of the attenuating aspects of hearing loss but fails to demonstrate other characteristics of sensorineural hearing loss such as poor resolution of intensity, duration, and frequency. Despite this fact, simulations remain a powerful counseling tool. In a recent study, Haggard and Primus (999) examined parents impressions of the impact of slight, mild, and moderate hearing losses when they were (a) given the Goodman descriptive terms, (b) provided with a percentage value of hearing loss based on the guidelines provided by the American Academy of Otolaryngology-American Council of Otolaryngology (AAO-ACO, 99), and (c) placed in a sound-treated booth where they listened to a simulated hearing loss. The results revealed that predicted communication difficulty was lower when the parents were given the terms and percentage values associated with a particular hearing loss than when they were provided an audio simulation of the same hearing loss. When asked to assign descriptive terms and percentage values to the simulated hearing losses, parents used terminology and percentage values that were of greater magnitude than those designated by the Goodman scale and the AAO-ACO. 0 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume 0 Fall 00

3 These results suggest that current hearing loss descriptors (slight, mild, and moderate) may result in underestimation of hearing handicap by the layperson. It is unclear if this pattern would hold for the higher level terms (severe, profound) that may convey more grave communication consequences. Also, the interpretation of the current descriptors by non-audiologist professionals is unknown. Despite the fact that hearing loss classification terminology has been used for many years, the terms are only loosely tied to communication ability, and it has been shown that the layperson often underestimates the communication impact of slight, mild, and moderate hearing losses (Haggard & Primus, 999). In addition, there is no information available regarding the interpretation of the higher level terms (severe, profound) or interpretation of the terms by SLPs or speech-language pathology students. Speechlanguage pathology students represent the future of the profession as well as the level of hearing loss education that is present in current graduate programs. They also represent a population in which change may most easily be effected. Therefore, their interpretation of hearing loss classification terminology is of interest. Haggard and Primus (999) studied the influence of presentation modality (hearing loss classification terminology vs. hearing loss simulation) on parental predictions of children s communication difficulties for three degrees of hearing loss (slight, mild, and moderate). Motivated by Haggard and Primus (999), we explored this issue in a different population and included a higher category of hearing loss (severe) in addition to the categories of mild and moderate. Specifically, we examined the influence of presentation modality on predictions of children s communication difficulties in the classroom by speech-language pathology graduate students for mild, moderate, and severe hearing losses. METHOD Participants Forty-six first-year graduate students in speech-language pathology from the University of South Florida (USF) participated in this study: students between the ages of and (mean age = years) and student aged years. USF is a large urban university with a total enrollment of,000 and a graduate speech-language pathology enrollment of 0. All participants were native speakers of English and had no previous significant knowledge of or exposure to hearing loss. All participants passed a pure-tone hearing screening at 00, 000, 000, and 000 Hz at 0 db HL in each ear. Each of the participants received extra credit points in one graduate course for their participation. Instrumentation A Grason-Stadler (Madison, WI) GSI- audiometer (calibrated to ANSI 99 standards), Telephonics (Farmingdale, NY) TDH-9 headphones, and double-walled sound-treated booth were used for the standard hearing screening. Mild, moderate, and severe high-frequency hearing losses were simulated using Sound Hearing (Collins, 989), an audiotape recording of various pure tones and filtered speech. The track used in this study consisted of 0 monosyllabic words that had been low-pass filtered at levels representative of the three degrees of hearing loss. The speech was initially attenuated to approximately db HL across the frequency range. For the mild simulation, an additional 0 db of attenuation was added at 00 and 000 Hz and an additional 0 db of attenuation at 000 Hz, with attenuation increasing above 000 Hz. For the moderate simulation, attenuation was increased (relative to the mild simulation) by 0 db at 0 Hz and by 0 db at 00 and 000 Hz, increasing above 000 Hz. For the severe simulation, attenuation was increased (relative to the mild simulation) by 0 db at 0 Hz and by db at 00 and 000 Hz, increasing above 000 Hz. Different words were used for each simulation. The audiotape was played from a Sony (New York) stereo cassette deck player (Sony Dolby, B-C NR) and routed through the audiometer. A biologic calibration of all equipment was performed before testing each participant. Although only representative of one aspect of hearing loss (frequency specific attenuation), this type of filtered recording is easily accessible by non-audiologist professionals via catalog or Internet and is therefore likely to be easily incorporated into the practice of such professionals. The Sound Hearing tape is one such simulation. However, other excellent simulations may be found on the Internet (e.g., hlsimulation/ or audio.htm). A questionnaire composed of nine communication-related tasks (see Appendix), developed by Haggard and Primus (999), was used to gauge hearing loss perception. The nine communication-related tasks span a wide range of activities and situations, and at the same time are very typical of the environment of a school-aged child. Task deals with spoken language, Tasks and deal with language learning, Tasks deal with speech perception, Tasks and 8 deal with sound localization, and Task 9 deals with musical ability. Procedure Each participant was examined in a single session lasting approximately 0 min. During this session, participants were seated in a conventional audiometric sound-treated booth. All participants were required to pass a pure-tone hearing screening before participation in the experimental study. For the experimental portion of the study, the participants were presented with a hearing loss classification term or a hearing loss simulation. For the term condition, participants were verbally given terms associated with each of the three degrees of simulated hearing loss (mild, moderate, and severe). The order of presentation of the three terms was counterbalanced across participants. For the simulation condition, participants were seated in the sound-treated booth. The simulation was presented Aguila-Vinson et al.: Perception of Hearing Loss 0

4 through a loudspeaker located at ear level, approximately. m from the subject at a conversational speech level of 0 db HL (after Haggard & Primus, 999). Although Haggard and Primus also mixed noise with the filtered speech, the hearing loss simulations used in the present study were presented in quiet to be representative of most commercially available simulations. Each subject listened to three simulations of hearing loss (mild, moderate, and severe). The order of presentation for the three simulations was counterbalanced across the participants, and no participant received the simulations in the same order that they heard the corresponding terms. The order of the two presentation conditions (term and simulation) was also counterbalanced across participants. Following each presentation of hearing loss classification term or hearing loss simulation, participants used a -point scale (ranging from, not difficult, to, very difficult) to rate the potential difficulty that a child with a particular loss would have in the classroom using the questionnaire (see Appendix). The participants were instructed to use points between the seven labeled points. RESULTS Figure shows the average ratings for each hearing loss condition in the two presentation conditions (term and simulation). Predicted difficulty increased with degree of hearing loss for both presentation conditions. For each hearing loss condition, participants predicted greater difficulty when presented with the simulation than when presented with the term. However, the difference in predicted difficulty between the two presentations narrowed as the degree of hearing loss increased. Because the rating scale consisted of seven equivalent units and participants used values between those indicated on the printed scale, the data may be described as interval in nature. Therefore, a three-way repeated measures analysis of variance (ANOVA) was used to examine the main effects of hearing loss condition (mild, moderate, severe), presentation condition (simulation, term), and nine communication tasks. As detailed in Table, all of the main effects and interaction effects were statistically significant (p < 0.000). In addition, an ANOVA with one between-subjects factor (order) and three within-subject factors (hearing loss condition, presentation condition, and communication task) revealed that presentation order did not influence the participants responses for any of the nine communication tasks (p = 0.). Tukey post hoc analyses were used to explore each of the significant main effects revealed by the three-way ANOVA (Table ). For the significant main effect of hearing loss, the analysis revealed that the participants predicted significantly greater difficulty for the severe hearing loss condition than for the moderate and mild hearing loss conditions (p < 0.000), collapsed across presentation condition. The predictions for the mild and moderate loss were also significantly different from each other (p < 0.000), collapsed across presentation condition. Figure. Average predicted communication difficulty for each hearing loss condition, collapsed across communication task. Black bars represent predictions in the term condition and gray bars represent predictions in the simulation condition. Standard error bars are shown for each column. Predicted Difficulty Term Simulation Mild Moderate Severe Degree of Hearing Loss For the significant main effect of presentation condition, the participants predicted significantly greater difficulty for the simulation than for the term condition (p < 0.000), collapsed across hearing loss condition. Across communication tasks, the predictions appeared to fall naturally into four major categories: speech perception, language topics, localization, and musical ability (Figure ). As mentioned, Task dealt with spoken language, Tasks and dealt with language learning, Tasks dealt with speech perception, Tasks and 8 dealt with sound localization, and Task 9 dealt with musical ability. Examination of the Tukey post hoc analysis of the main effect of communication task revealed that, across three of the communication task categories (speech perception, language, localization), ratings were significantly different from each other (p < 0.0), but within each of these categories, task ratings did not differ significantly (p > 0.0). Figure illustrates this categorization, with speech perception tasks receiving the highest ratings followed by language, musical ability, and localization, respectively. As indicated by Figure, the ratings for the musical ability task (Task 9) were not significantly different from those for the language tasks (p > 0.0) but were significantly different from the ratings for the speech perception and localization tasks (p < 0.0). Tukey post hoc analyses were also used to explore each of the significant interactions. An analysis of the interaction between hearing loss condition and presentation condition revealed a significant difference in predicted difficulty between the two presentation conditions for the mild and moderate hearing loss conditions (p = 0.000), but not for the severe hearing loss condition (p = 0.8). Although the ANOVA revealed significant interactions between hearing loss condition and communication task and 08 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume 0 Fall 00

5 Table. Three-way repeated measures analysis of variance (ANOVA) of the predicted communication difficulty for the three hearing loss conditions (mild, moderate, severe), the two presentation conditions (simulation, term), and the nine communication tasks. Asterisks indicate statistically significant effects. Effect df effect MS effect df error MS error F p level η p Hearing loss <0.000* 0.90 Presentation... <0.000* 0. Communication task <0.000* 0.8 Hearing loss Presentation <0.000* 0.0 Hearing loss Communication task <0.000* 0. Presentation Communication task <0.000* 0.8 Hearing loss Presentation Communication task * 0. Figure. Average predicted communication difficulty for each communication-related task, grouped by task category and collapsed across hearing loss and presentation conditions. Black bars represent predictions for the speech perception tasks, dark gray bars represent predictions for the language and musical tasks, and light gray bars represent predictions for the localization tasks. Within each similarly shaded group, predictions did not differ significantly. However, across shaded groups, predictions differed significantly. Predicted Difficulty Rating Task Task Task Task Task Task Task 9 Task Task 8 Speech Perception Tasks Language Tasks Musical Localization Tasks Task between presentation condition and communication task, exploration of this interaction revealed that the pattern of responses as revealed in Figure was similar for each communication task (see Figure ). A Tukey post hoc analysis of the three-way interaction among hearing loss condition, presentation condition, and communication task revealed that, for the severe hearing loss condition, the effect of presentation condition was significant only for Task (p < 0.000). For all other tasks in the severe condition, ratings for term and simulation did not differ significantly (p > 0.0). For the mild and moderate conditions, the effect of presentation condition was significant for all tasks. DISCUSSION The purpose of this investigation was to examine the influence of presentation modality on the perception of mild, moderate, and severe hearing loss by speech-language pathology graduate students. The perceptions of future SLPs were of interest because this population had not been included in earlier investigations, despite the fact that they often work with children with hearing impairments in the school systems. Research suggests that laypersons often misinterpret the impact of slight, mild, and moderate hearing loss as typically described using hearing loss Aguila-Vinson et al.: Perception of Hearing Loss 09

6 Figure. Average predicted communication difficulty for each communication-related task across hearing loss condition. Dark gray bars represent predictions in the term condition and light gray bars represent predictions in the simulation condition. The communication task is indicated at the top of each graph and standard error bars are presented for each column. Predicted Difficulty Predicted Difficulty Predicted Difficulty Predicted Difficulty Speaking Clearly to Others Learning Names of Objects Mild Moderate Severe Mild Moderate Severe Learning to Read Playing on a Sports Team Mild Moderate Severe Mild Moderate Severe Understanding in Noise Hearing on the Telephone Mild Moderate Severe Mild Moderate Severe Understanding Quiet Speech Predicted Difficulty Predicted Difficulty Predicted Difficulty Predicted Difficulty Predicted Difficulty Hearing a Fire Alarm Mild Moderate Severe Mild Moderate Severe Playing a Musical Instrument Mild Moderate Severe 0 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume 0 Fall 00

7 classification terminology (Haggard & Primus, 999). This may be due to the fact that these particular terms (slight, mild, moderate) convey an impression of negligible effects (Tharpe & Bess, 999). Although widely used by audiologists and other professionals, this terminology falls short in conveying the communication, language, and academic impact that a hearing loss can have on a child (e.g., Davis et al., 98; Bess et al., 998; Haggard & Primus, 999; Martin & Clark, 000). The results of this investigation indicate that the standard method of classifying hearing loss may result in an inaccurate estimation of the communication impact that a hearing loss might have for a child. The pattern of results identified by Haggard and Primus (999) in the layperson also applies to future professionals who are likely to encounter children with hearing loss in their practice. The impact of hearing loss covers a wide range of academic, language, social, and emotional issues. Northern and Downs (99) stated that children with mild hearing losses will miss unstressed and voiceless speech sounds in normal conversation and will experience mild speech and language delays. Children with moderate hearing losses will miss most conversational speech sounds and will experience problems learning abstract concepts and grammatical rules. For a child with a severe hearing loss, language and speech will simply not develop without intervention (Northern & Downs, 99). In studies of social and emotional development, children with varying degrees of bilateral and unilateral hearing loss demonstrate dysfunction in several areas, including selfesteem, social support, aggression, and stress (Bess & Tharpe, 98; Bess et al., 998; Davis et al., 98; Tharpe & Bess, 999). However, it is the impact of milder forms of hearing loss that is so often underestimated (Tharpe & Bess, 999). Children with hearing impairments are not only predisposed to poorer social and emotional health, but are also at a greater risk for grade retention. The high retention rate for children with hearing loss imposes a financial burden on the education system. Of the roughly 8 million schoolage children in the United States (McDowell & Johnson, 00),,,000 (.%) will have some form of hearing loss and,9,000 (.%) will have what is often termed minimal (slight to mild bilateral, unilateral, or high frequency) hearing loss (Bess et al., 998). Among those with minimal hearing loss, 99,00 (%) are projected to fail at least one grade (Bess et al., 998). Assuming it takes approximately an average of $,00 (McDowell & Johnson, 00) to educate a child for year, the total expense for grade repetition among children with minimal hearing loss alone surpasses billion dollars. In the present study, three levels of hearing loss (mild, moderate, and severe) were introduced using two presentation conditions: (a) hearing loss classification term and (b) simulated hearing loss. Following each presentation of hearing loss, the participants rated the potential communication difficulty that a child with that loss may have in the classroom using a -point scale. The participants rated potential difficulty for communication-related tasks that fell naturally into four categories: speech perception, language topics, localization, and musical ability. In general, participants predicted significantly greater difficulty when presented with the simulated hearing loss than when presented with the term for the same degree of hearing loss. In fact, many participants expressed surprise when the term associated with each simulation was revealed. These findings are similar to those of Haggard and Primus (999), who studied parents perception of slight, mild, and moderate hearing loss across the same nine communication-related tasks, using a -point rating scale. For mild and moderate hearing loss (the categories also used in the present study), the research of Haggard and Primus (999) showed the same pattern of results as seen in the present study. Interestingly, the rating differences observed between the two presentation conditions were larger in the Haggard and Primus (999) study than in the present study (Figure ), indicating that the future SLPs made more conservative predictions following the simulations (and more liberal predictions following the terms) than did the parents studied by Haggard and Primus (999). This is likely reflective of the educational background of the future SLPs; although none had listened to hearing loss simulations before this study, they had been exposed to the hearing loss classification terminology. Unlike the Haggard and Primus (999) investigation, the category of severe hearing loss was included in the present study. A different pattern of results was observed for this condition as indicated by the three-way interaction. Specifically, in the severe hearing loss condition, only one task (learning names of objects) was rated Figure. A comparison of average predicted communication difficulty from the present study and that of Haggard and Primus (999). Circles represent predictions in the term condition and squares represent performance in the simulation condition. Open symbols represent data from Haggard and Primus and filled symbols represent data from the present study. Haggard and Primus did not use the term severe ; therefore, data from the present study for the severe hearing loss condition are not presented. Aguila-Vinson et al.: Perception of Hearing Loss

8 significantly higher in the simulation condition than in the term condition. For the eight other tasks, the difference between the predictions in the two presentation conditions was not significant. A possible explanation is related to the rating scale itself (i.e., there was no available rating greater than ). For the speech perception tasks in particular, the ratings for the severe condition were very close to. Therefore, a ceiling effect is possible for those tasks. Or perhaps the term severe conveys an impression of communication impact that is more accurate than that conveyed by other terms (mild and moderate). If so, then perhaps the terms mild and moderate should be modified to better represent the associated communication impact. The terms significant, noticeable, serious, and/or difficult may be considered. effective educational tool for the graduate students who participated in this study. These results should not be seen as a reflection of a specific speech-language pathology program, but as a potential reflection of speech-language pathology students nationwide. The master s program in speech-language pathology at USF includes a course requirement to listen to simulated hearing losses (the students who participated in this study had not yet met that requirement). This serves to help the students appreciate various degrees of hearing loss and understand what it would be like to miss a portion of or all of a speech signal. A better understanding of hearing loss and its impact on communication will not only serve to strengthen graduate programs, but will help future professionals deliver a higher level of service to children with hearing loss. CONCLUSION The findings in this investigation demonstrate the discrepancy between the initial impression of a hearing loss based on its definition and that based on a simple simulation of that loss. The use of a single term descriptor does not accurately convey how the loss will impact a life communicatively, academically, socially, and emotionally. As an audiologist, the primary goal is not only to identify a hearing loss, but to follow the rehabilitation of the child with a hearing loss to make sure the proper steps are taken to ensure that a proper communication environment is in place. This includes the promotion of speech and language development, as well as social understanding of hearing loss by SLPs, educators, classmates, and parents. Audiologists who limit themselves to classification terminology may perpetuate the overuse of technical jargon to other professionals such as SLPs and teachers. Research has shown that these terms convey little information to teachers of children with hearing loss (Blair et al., 999). These results suggest that, when audiologists use hearing loss classification terms, they may not be effectively communicating the practical implications of hearing loss. Such terms, although convenient, are not always meaningful to the non-audiologist professional. The suggestions of Blair et al. (999) must be reiterated: Audiologists should avoid the use of technical jargon and should always include information regarding the student s specific needs in their reports. The findings also have implications for future training of SLPs in the form of graduate course work and/or continuing education. A simple simulation of hearing loss such as the one used here represents one way to educate SLPs and teachers of children with hearing impairments regarding hearing loss. Such simulations are available on audiotape and compact disc as well as on the Internet. It should be noted that these simulations are most often created by simple filtering and provide a simulation of the attenuating aspects of hearing loss. Not represented are other characteristics of sensorineural hearing loss such as poor resolution of intensity, duration, and frequency. Despite these facts, hearing loss simulation proved to be a very direct and REFERENCES American Academy of Otolaryngology-American Council of Otolaryngology. (99). Guide for the evaluation of hearing handicap. Journal of the American Medical Association, (9), American National Standards Institute. (99). American national standard specification for audiometers (ANSI S.- 99). New York: Author. Bess, F., Dodd-Murphy, J., & Parker, R. (998). Children with minimal sensorineural hearing loss: Prevalence, educational performance, and functional status. Ear and Hearing, 9, 9. Bess, F., & Tharpe, A. (98). An introduction to unilateral sensorineural hearing loss in children. Ear and Hearing,,. Blair, J., EuDaly, M., & Benson, P. (999). The effectiveness of audiologists information sources for classroom teachers. Language, Speech, and Hearing Services in Schools, 0, 8. Clark, J. (98, July). Uses and abuses of hearing loss classification. Asha,, Collins, S. (989). Sound hearing. Eugene, OR: Garlic Press. Davis, J., Elfenbein, J., Schum, R., & Bentler, R. (98). Effects of mild and moderate hearing impairments on language, educational, and psychosocial behavior of children. Journal of Speech and Hearing Disorders,,. Goodman, A. (9). Reference zero levels for pure-tone audiometers. Asha,,. Haggard, R., & Primus, M. (999). Parental perceptions of hearing loss classification in children. American Journal of Audiology, 8, 8 9. Konkle, K. (99, April). Classifying terms, degrees of hearing sensitivity. Hearing Instruments,. Martin, F., & Clark, J. (000). Introduction to audiology (th ed.). Needham Heights, MA: Allyn & Bacon. McDowell, L. M., & Johnson, F. (00). Public elementary and secondary education statistics: School year Washington, DC. (NCES 00-) CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume 0 Fall 00

9 Northern, J. (99). Hearing disorders (rd ed.). Needham Heights, MA: Allyn & Bacon. Northern, J., & Downs, M. (99). Hearing in children (th ed.). Baltimore: Williams & Wilkins. Pavlovic, C., & Studebaker, G. (98). An evaluation of some assumptions underlying the articulation index. Journal of the Acoustical Society of America,, 0. Tharpe, A., & Bess, F. (999). Minimal, progressive, and fluctuating hearing losses in children. Characteristics, identification, and management. Pediatric Clinics of North America,, 8. Contact author: Jennifer Lister, PhD, CCC-A, University of South Florida, Department of Communication Sciences and Disorders, 0 E. Fowler Avenue, PCD 0, Tampa, FL 0. jlister@chuma.cas.usf.edu Aguila-Vinson et al.: Perception of Hearing Loss

10 APPENDIX. HAGGARD AND PRIMUS (999) QUESTIONNAIRE USED IN THIS STUDY Subject# Condition: Stimulation / Term Degree: MLD MOD SVR Directions: With special attention to the hearing loss just simulated, rate how difficult you feel the following situation would be for your client/patient if he/she had this hearing loss. The higher the number on each scale, the greater the difficulty indicated. Please feel free to select numbers between those shown. I. Speaking Clearly to Others II. Learning Names of Objects III. Learning to Read IV. Playing on a Sports Team V. Understanding Friends or Teachers in Noisy Environments VI. Hearing on the Telephone VII. Understanding Quiet Speech VIII. Hearing a Fire Alarm IX. Playing a Musical Instrument CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume 0 Fall 00