9. CHILDREN WITH AUDITORY HANDICAPS Kirk (1972) described children with auditory handicaps as having difficulty hearing in one or both ears or may not hear at all. Professionals and laymen alike have used various terms: "hard-of-hearing," "deaf," "deaf-mute," "deafened," "partially deaf," and "partially hearing." Streng et al (1958) gave the following definitions: The child who is born with little or no hearing, or who has suffered the loss early in infancy before speech and language patterns are acquired is said to be deaf. One who is born with normal hearing and reaches the age where he can produce and comprehend speech but subsequently loses his hearing is described as deafened. The hard of hearing are those with reduced hearing acuity either since birth or acquired at any time during life (p. 9). Hearing loss is generally measured by an audiometer using standards agreed upon internationally, such as the ISO standard (International Standard Organization) (Davis and Krantz, 1964). Kirk (1972) listed the following variables to be considered in describing the deaf and hard of hearing. Because of this multidimensional nature of the problem any classification is incomplete unless it takes into account all variables, such as (1) degree of hearing loss, (2) age at onset, and (3) type of hearing loss. The Illinois Commission on Children (1968) after reviewing studies on prevalence estimated that 1 to 3 percent of school children have a hearing impairment severe enough to warrant medical or special educational attention. They estimated that 1 in 1000 are deaf. For the classroom teacher, it is important to be aware of some of the symptoms which may be misinterpreted, such as those displayed by (1) the child who ignores, confuses, or does not comply with directions; (2) the child who daydreams a great deal; (3) the child who is educationally retarded; (4) the child with a slight speech defect; (5) the child who is "lazy"; (6) the child who seems dull; and (7) the child is always asking "what?" (p. 246). The most accurate method of testing is with an electric pure-tone audiometer, which produces pure tones of known intensity. Two dimensions, frequency and intensity, are necessary for evaluating a hearing loss. Frequency refers to the number of vibrations, or cycles, per second of a given sound; the greater the frequency, the higher the pitch. Intensity refers to the relative loudness of a sound. To determine an individual's level of hearing it is necessary to know what intensity of sound is needed to cross his threshold of hearing at each of the frequency levels. Routine audiometric procedures cannot be used with infants and young children, but clinical testing of young children can be accomplished by electrodermal and other procedures in audiology clinics, including EEG audiometry and operant conditioning audiometry. These techniques are often used for other hard-to-test individuals such as the severely mentally retarded and psychotic (Bricker et al., 1968). Hearing loss in a young child is detected by informal means such as observing his behavior and ability to react to sounds in his environment or by the more structured but informal methods described by DiCarlo (1964). Prenatal infections and toxic conditions in the mother may create auditory defects in the child. The viruses of mumps and influenza, especially during the first tri-mester of pregnancy, may cause degeneration of important nerve cells that result in deafness. German measles (rubella) afflicting the mother during the first three months of pregnancy often has quite serious effects. The National Communicable Disease Center (Hicks, 1970) reported that the rubella epedemica of 1964-65 caused deafness in over 8,000 children. The Johns Hopkins Study (Hardy, 1968) reported on 199 children who were diagnosed as having been subjected to the rubella virus. Some diseases specific to the functioning of the auditory mechanism may occur at any stage in life, including the period, in utero. In otosclerosis, spongy bone is formed in the middle and inner ear, occasionally at birth but usually not until later in life. Some malformations are present at birth, such as abnormalities of the external auditory canal which prevent sound from being carried into the mechanism of the inner ear may be arrested (Kirk, 1972, p. 247). Childhood diseases take their toll in hearing defects but their frequency and severity have been lessened by modern advances in immunization and antibiotics. At one time, such infectious diseases as scarlet fever, mumps, diphtheria, whooping cough, measles, typhoid fever, pneumonia, and influenza accounted for a great deal of deafness. Davis and Fowler (1960) stated, "Pus in the middle ear is a more frequent cause of hearing loss than any other except perhaps senility." Concussions on certain parts of the head may cause temporary or permanent loss of hearing. Subjection to prolonged high-frequency sounds may have a traumatic effect on the nervous mechanism of the inner ear, resulting in hearing loss. It has been found that certain ototoxic antibiotics, such as streptomycin, neomycin and others, produce side effects of hearing loss (McGee, 1968). Kloepfer, Laquaite, and McLaurin (1970) found that 46 to 60 percent of all cases of severe hearing loss are genetically determined. Defects in hearing may occur in many different forms. Basically, these defects are of two main types: (1) conductive losses, and (2) sensory-neural or perceptive losses. A conductive hearing loss is one which reduces the intensity of sound reaching the inner ear where the auditory nerve begins. This type of defect seldom causes a hearing loss of more than 60 to 70 decibels, since there will be still be available the vibrations carried by the bone to the inner ear. A sensory-neural or perceptive hearing loss is caused by defects of the inner ear or of the auditory nerve transmitting the impulse to the brain. Sensory-neural hearing loss may be complete or partial, and it may affect some frequencies.