Child Profile: Hearing How Hearing Works My biggest concern(s) about my child's hearing is/are: I want to speak to my child's team about the following concerns related to his/her hearing: Concern(s): Hearing Problems Type of Hearing Impairment Look in medical reports, audiological evaluations, and speech and communication reports from your school to find information you do not know. Check the hearing problems/losses that apply, and add information to describe the problems/losses more accurately. My child has a conductive loss. My child has a sensorineural loss that is: Mild (20-40 db) Moderate (40-70 db) Severe (70-90 db) My child has a processing problem. My child has other physical problems that impact his/her hearing. They are: Physical Problem Impact on Hearing
In case of an emergency with my child's ears, if I cannot be reached, contact: First Name Last Name Phone Address Relationship Hearing Professionals Doctors My child's Ear, Nose, and Throat (ENT) doctor is: First name Last name Phone My child's audiologist is: First name Last name Phone The other doctor(s) who takes care of my child's ears is/are: First name Last name Phone Specialty
Impact of Combined Vision and Hearing Loss What My Child Hears My child does not respond to any sound, but may respond to the vibration caused by sound. My child responds to voices, especially men's voices, women's voices, children's voices. My child does not always respond to a voice when there are other sounds in the room. My child responds to environmental sounds, such as a(n): door slamming big truck engine lawn mower/vacuum dog barking piano telephone airplane water running television/radio My child prefers his/her right ear left ear to listen to a sound. My child will go to sleep or close his/her eyes in a very noise place. My child turns in the direction of a sound when he/she hears it. My child does not use his/her voice at all except when fussing or crying. My child knows when a sound starts and stops. My child can make these vowel sounds: a e i o u. My child can make these consonant sounds: My child likes funny voices, songs, or words that have interesting pitch or rhythm patterns (e.g., "Okey-Dokey," "I'm Popeye the sailor man. Toot! Toot!"). My child can imitate a rhythm pattern he/she has heard (e.g., baaaa, ba, baaaaa). My child can imitate a pitch pattern he/she has heard (e.g., high, low, high). My child can make his/her voice loud or soft. My child's hearing seems to be getting better since we learned he/she is hearing impaired. My child's hearing seems to be getting worse since we learned he/she is hearing impaired.
Examples of sounds my child hears: Sound Time of Day Visual Environment Background Noise My child's favorite sound is: Sounds that bother my child include: My child's greatest strength related to how he/she uses his/her hearing or lack of hearing is: My child's greatest need related to how he/she uses his/her hearing or lack of hearing is: Other information about my child's hearing includes:
Hearing Loss Adaptations and Devices Adaptations Improve the signal to noise ratio by reducing noise during important instructional times (e.g., adding soundproofing materials, turning off radios and TVs, working in a room alone with the child). Make sure the child is wearing appropriate amplification devices and that they are working properly. Call attention to key words by reducing the length of phrases or adding an interesting pitch or rhythm pattern. Call attention to important environmental sounds during a learning experience. Position the child so he can see the speaker in order to support speech reading and signed or cued speech reception. Devices Hearing aid(s) FM system Vibrotactile aid Cochlear implant(s) Bone-conduction aid TTY Captioning Alarm/Alerting Devices CART My child wears/uses his/her hearing device(s) daily. My child has a problem wearing or using his/her hearing device(s).