Hearing Impairment Topic Categories
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- Overview - A hearing impairment is a hearing loss that prevents a person from totally receiving sounds through the ear. If the loss is mild, the person has difficulty hearing faint or distant speech. A person with this degree of hearing impairment may use a hearing aid to amplify sounds. If the hearing loss is severe, the person may not be able to distinguish any sounds.
- Reluctance to ask for accommodations - When the Americans with Disabilities Act was passed more than a decade ago, it was a landmark event. But today, under-accommodation is still a major barrier to equal employment opportunities for people with disabilities.
- Accommodations in large lectures - Some students with disabilities face challenges in large lectures. Needs vary greatly among individuals. Students are the best source of information about their needs. Scroll down for specifics about hearing impairments.
- Accommodations in computer labs - As increasing numbers of people with disabilities pursue educational opportunities that require computer use, the accessibility of computing facilities becomes even more critical. To put it simply, computer labs need to be accessible to all users. Students with disabilities need equal access to: (1) building/facilities, (2) lab staff, (3) physical space and printed materials, (4) computers and software, and (5) electronic resources.
- Accommodations in writing assignments - The writing process, which includes spelling and grammar, may also be difficult due to hearing, language, or learning disabilities.
Adults with Hearing Impairments
- Books for adults that are hearing related - A list of hearing-related books for adults.
- Adult Education and People with Disabilities - Hearing Impairments and Deafness: Adult students with hearing impairments may require accommodations and assistive devices in the classroom setting to have best access to educational programming.
- Hearing Loss: A Common Problem in Older Adults - Accurate estimates of hearing loss are very difficult to obtain. There are two main reasons for this. First, most of the research information available relies on self-reports and the inconsistent use of terms and definitions. Second, it is common for people to deny their hearing loss and/or not realize the extent of their hearing impairment. For example, many hard of hearing people have adapted well to their hearing loss and hearing aids and may not report any hearing difficulties, therefore excluding themselves from national estimates.
- List of Hearing Impairment organizations - A good place to start to get advocacy information and guidance
- Assistive Technology for Hearing Loss - To empower persons who are hearing impaired to function independently.
- Practical needs special support - List of resources relating to hearing impairment
- Know Your Rights - "Founded in 1979 by Howard E. “Rocky” Stone, the Hearing Loss Association of America (HLAA) is the nation’s leading organization representing consumers with hearing loss. The programs and events we offer are designed to focus on you—the person. HLAA strives to give people the tools they need to live more successfully with hearing loss and to show them they do not have to face hearing loss alone."
Assessment of Individuals with Hearing Impairments
- Information/Steps for infants and newborns - Universal newborn hearing testing was selected for study by HTAC based on several criteria, including: anticipated interest by the Minnesota Legislature and the broader community; the large number of persons potentially affected (all newborns, their parents, providers, and others); and questions regarding clinical effectiveness, costs, and cost-effectiveness of screening. In addition, federal law requires that all states provide intervention and educational assistance to children with disabilities, including those with hearing loss, beginning at birth to six years of age.
- Information - Universal screening programs have been implemented across the United States. Hearing loss occurs often enough in the general population to justify the legislation for universal hearing screening programs in 37 states.
- Assessing Children for the Presence of a Disability - This News Digest focuses upon the assessment process -- the ways and primary skill areas in which school systems collect information in order to determine if a child is eligible for special education and related services and to make informed decisions about that child's educational placement and instruction. By law, this process must involve much more than just giving the student a standardized test in the area of his or her suspected disability.
- Infant hearing screening - With the passage of the Newborn and Infant Hearing Screening and Intervention Act of 1999, which gives grants to states to start newborn hearing screening programs, the United States is getting the average age of identification of hearing loss down to where it should be — in infancy. The linked PDF from the Indiana state government details procedural guidelines.
- Assistive listening devices in the classroom - Many students who use hearing aids effectively in quiet environments have a difficult time following information presented in large college classrooms. In the classroom, the instructor's voice is competing with background noise, room echo, and distance. Therefore, the intelligibility of the instructor's voice is degraded by the poor room acoustics as well as the hearing loss.
- Acoustical Surfaces Inc. - Acoustical Surfaces Inc. is a company that "specializes in classroom acoustics and complies with the national ANSI (American National Standards Institute) classroom acoustical standards. Approximately one third of all students are missing 30%-40% of all verbal communications in the classroom, making it imperative that the acoustical environment be adequately addressed. If children cannot hear and understand what is being said, they cannot learn to their full potential. While all children will benefit from good acoustics the most “at risk” children are those with hearing deficits, middle ear infections, ADHD, or CAPD and all early age children just learning to acquire the basic cognitive skills."
- Accessibility guidelines - Guidelines from the Americans With Disabilities Act
- Overview-Microsoft - Assistive technology products are specialty products designed to provide additional accessibility to individuals who have physical or cognitive difficulties, impairments, and disabilities. When selecting assistive technology products, it is critical to find products that are compatible with the computer operating system and programs on the particular computer.
- Types of assistive technology - Assistive technology products are designed to provide additional accessibility to individuals who have physical or cognitive difficulties, impairments, and disabilities. When selecting assistive technology products, it is crucial to find products that are compatible with the computer operating system and programs on the particular computer being used.
- Captioned media program - The mission of the Captioned Media Program (CMP) is to provide all persons who are deaf or hard of hearing awareness of and equal access to communication and learning through the use of captioned educational media and supportive collateral materials. The CMP also acts as a captioning information and training center. The ultimate goal of the CMP is to permit media to be an integral part in the lifelong learning process for all stakeholders in the deaf and hard of hearing community: adults, students, parents, and educators.
- American Sign Language videos - If you want to see American Sign Language (ASL) you've found your best resource! ASL Access gives you access to ASL stories and ASL lessons for all ages and stages - and more. How? Easy! You let your library, school, college, agency, or other organization know about ASL Access, and we help the staff to find and buy great ASL videos for you to borrow. Tell everyone you know about ASL Access. Get your hands on ASL!
Books and Publications
- List of Books - From goodreads.com
- Assessment and Intervention Book - Research and current practice for communicative disorders practitioners. Collection of articles reprinted from the journal Topics in Language Disorders, 1982-1990. 27 contributors.
- Counseling Children with Hearing Impairments and Their Families - 224 pages on counseling children with hearing impairments and their families
- Studies in Disorders of Communication - John Bamford, in all his audiological prowess, has helped to produce perhaps the greatest works of literature in the field of audiology.
- Impact of Hearing Impairment on Family Life - Hearing loss now strikes one in seven people but how to study the impact of hearing loss on relationships has continually baffled researchers. The authors' personal experience with profound hearing loss and her roles as wife, mother, social worker and counselor, suggest that the complexities involved might be fruitfully explored by using an intensive and repetitive interviewing technique.
- Genetics and Hearing Impairment - The auditory system extends from the pinna of the external ear to the auditory cortex of the brain, with neural interconnections to several brain centers that enable correlation of auditory information with other sensory inputs and/or mediate reflex actions.
- Diagnosis and Treatment of Hearing Impairment in Children - Updated and revised, this influential text provides a wealth of information, in a reader-friendly style, on all issues pertaining to hearing loss in children Integrates otologic and audiologic understanding of the diseases and conditions that cause congenital and acquired hearing loss Discusses effective infant hearing screening strategies, birth-related trauma, congenital hearing loss, and effective strategies for habilitation Includes new chapter on cochlear implants, including the latest developments.
- Hearing Impairment in Children - 450 pages, March 1988. A good text on hearing impairment in children
- When the Hearing Gets Hard: Winning the Battle Against Hearing Impairment - Suss, who underwent a severe hearing loss herself, frankly discusses the challenges of hearing impairment. From a motivational point of view, she recounts fascinating experiences of hearing-impaired actors, sports personalities, and business executives. On the practical side, she discusses how to cope with telephones, doorbells, driving, shopping, and participation in other public activities.
- Children with Hearing Impairment: Contemporary Trends - 401 Pages, January 1998.
- Effectively Educating Students with Hearing Impairments - 468 pages, October 1990. A good text on teaching students with hearing impairments.
- Hearing and Hearing Impairment - 653 pages, 1979. A classic text on hearing and hearing impairment
- Hearing Impairment - A guide for people with auditory handicaps and those concerned with their care and rehabilitation
- Hearing Impairments in Young Children - 239 Pages, October, 1981. A text on hearing impairments in young children.
- Serving all Learners with Hearing Impairment - Ms. English has written a very concise and useful book for audiologist and educators. Very few people have been able to link more clearly than she the impact of hearing loss on education and how that hearing loss makes educational attainment that much more difficult for these children. Not only does she talk about the responsibilities of audiologists, but also of parents and educators in making learning more accessible for students who are deaf or have varying degrees of hearing loss.
- Screening for Hearing Impairment in Young Children - Written for a professional readership, this book offers practical guidance on hearing screening to facilitate the identification of hearing impairment in children at the earliest possible stage. It contains a description and evaluation of the methods for different age groups, and practical guidelines on how to conduct each test, supported by illustrations and photographs.
- Case Studies in Clinical Rehabilitation Assessment and Hearing Impairment - Guidelines from the national association of the deaf (1987)
Causes of Hearing Impairments
- How Common is Hearing Loss and What Causes It? - Approximately 28 million Americans have a hearing impairment. Hearing loss is one of the most prevalent chronic health conditions in the United States, affecting people of all ages, in all segments of the population, and across all socioeconomic levels.
- What Causes Hearing Loss? - Hearing loss can occur at any age and for a variety of reasons.
- Causes and Types of Hearing Impairment - The following medical conditions are some of the possible causes of Hearing impairment as a symptom. There are likely to be other possible causes, so ask your doctor about your symptoms.
- Hearing loss causes - While some hearing loss is expected due to aging, most premature hearing loss is caused by exposure to excessive sounds, some chemicals and consumption of some medications. This table lists the main "offenders" in each category.
- Age-Related Changes in Hearing - Age-related hearing loss, called presbycusis (pre-bih-KU-sis), usually occurs gradually and affects both ears equally. Presbycusis is most commonly associated with changes in the inner ear, typically involving the loss of some of the tiny receptor hair cells found in the snail-shaped cochlea.
- Pendred Syndrome - Pendred syndrome is a genetic disorder that causes early hearing loss in children. It also can affect the thyroid gland and sometimes may affect a person's balance. The syndrome is named after Vaughan Pendred, the physician who first described individuals with the disorder.
- Slide presentation - Students with hearing impairments may experience associated social and psychological difficulties. The more severe the impairment, the greater the chance for isolation and a difficult adjustment.
Classification/Types of Hearing Impairments
- Mild hearing loss - Having been profoundly deaf since birth, I can not claim to have a good personal understanding of mild hearing loss. However, I am aware that a mild hearing loss, if not identified and treated, can harm speech and language development in young children, and can have an impact on communication with people.
- Types and diagnosis of hearing loss - You or your child have been diagnosed as having a hearing loss. What type of hearing loss is it? The type and degree of hearing loss determines the method of treatment for the hearing loss.
- Unilateral hearing loss - In a deaf/HOH community where most people have enough hearing loss to need hearing aids or cochlear implants, unilateral hearing loss appears to get little attention. Who are the people with unilateral hearing loss? They are the ones who can hear normally in one ear, but the other ear is impaired.
- Disorders of the outer ear - Outer ear disorders rarely cause permanent deafness or hearing impairment.
- Disorders of the middle ear - The middle ear contains the eardrum (tympanic membrane) and three bones called the malleus, incus, and stapes (hammer, anvil, and stirrup), collectively known as the ossicles. Sound waves striking the eardrum cause the three bones to strike a fluid-filled portion of the inner ear called the cochlea, where the sound waves are transformed into nerved impulses by the movement of the fluid.
- Disorders of the inner ear - The inner ear (ear labyrinth) contains the cochlea, which have previously been described, and the auditory nerve, which transmits impulses concerning sound and balance to the brain.
- Little-Known Hearing and Ear Disorders - A few of the less common causes for hearing loss.
- Resources - Resources related to learning disabilities in the deaf/hard of hearing population compiled by Steven Thomas Hardy, M.A. and William Kachman Ph.D., NCSP Kendall Demonstration Elementary School Gallaudet University.
- References - A list of references compiled by Caroline Bowen, PhD, a speech-language pathologist.
- Resources - From the National Association of the Deaf, this page is dedicated to deafness and hard of hearing resources.
- General strategies - Have students sit closer to the lecturer. Look directly at the student. Speak slowly, naturally, and clearly. Slowing down slightly may help. Do not exaggerate your lip movements or shout. If you have a mustache, keep it well trimmed...
- Professional presentation - The Americans with Disabilities Act (ADA) requires that materials and information be available in alternate formats whenever possible and reasonable to do so. It is a good idea to assume that there will always be people in your audience who have difficulties seeing your material or hearing your presentation. When you make your presentation accessible to persons with hearing or vision loss, everyone in your audience will benefit.
- Sign language 101 - Whether you are a beginner, or a more experienced signer, there is something here for you. Find resources on learning sign language or options for practicing your sign language
- American Sign Language - American Sign Language (ASL) is a complete, complex language that employs signs made with the hands and other movements, including facial expressions and postures of the body. It is the first language of many deaf North Americans, and one of several communication options available to deaf people. ASL is said to be the fourth most commonly used language in the United States.
- Signwriting - Sign language is helpful and fun. Too bad it can't be written. Or can it? A written form of sign language using graphical symbols to represent the signs, called SignWriting, was developed in 1974 by the Center for Sutton Movement Writing.
- Signwriting overview - Expressing yourself and having fun with sign language.
- Classroom acoustics - Typical kid whispering, giggling, and laughter aside, the average classroom is loaded with noises that can be distracting for a hard of hearing student trying to learn. Awareness of the importance of improving classroom acoustics - managing the classroom noise - is increasing as studies show that improvement results in measurable gains in learning/speech perception (student behavior may also improve).
- Growing up deaf-classroom issues - The classroom ghost. That is what I felt like at times in the mainstream classroom as a deaf child, bereft of any interpreters and often without notetakers.
- Cued speech - Cued Speech is another means of communication that may make it possible for a deaf child to pick up English language skills. I myself do not know cued speech, but do know that parents who have used cued speech have been generally pleased with it.
- Deaf children with learning disabilities - One of my best deaf friends in college did not graduate from Gallaudet with me in 1987. What kept her from graduating? At that time, Gallaudet required all students - no exceptions - to pass certain courses. My friend had a learning disability that prevented her from being able to pass the required course. I will never forget the day she told me tearfully that she would not be able to graduate.
- How Deaf People Experience Music - "Rhythm helps the children learn language," my child's teacher explained, when I expressed surprise that the deaf children were going to music classes. I shouldn't have been surprised. There are (and were) deaf musicians, and research has been done into music and the deaf.
- Strategies for Teaching Students with Hearing Impairments - Over time, the average hearing impaired student, as compared to students with normal hearing , shows an ever increasing gap in vocabulary growth, complex sentence comprehension and construction, and in concept formation. Hearing impaired students often learn to "feign" comprehension with the end result being that the student does have optimal learning opportunities. Therefore, facilitative strategies for hearing impaired students are primarily concerned with various aspects of communication.
- Strategies for communication between the hearing and the hearing-impaired - The strategies for communication with HOH (hard-of-hearing) persons and with profoundly/totally deaf persons are different. This document covers both.
- Welcoming the Child with Hearing Impairment into Child Care - Just because a child has a hearing loss doesn’t mean the child is deaf. For every child that is completely deaf there are at least 10 children with partial hearing. Most of these hard of hearing children learn to speak, develop language, and learn in school using their hearing rather than sign language.
- Info - Hard of Hearing and Deaf Students: A Resource Guide to Support Classroom Teachers
- Captioned media programs online - The mission of the Captioned Media Program (CMP) is to provide all persons who are deaf or hard of hearing awareness of and equal access to communication and learning through the use of captioned educational media and supportive collateral materials. The CMP also acts as a captioning information and training center. The ultimate goal of the CMP is to permit media to be an integral part in the lifelong learning process for all stakeholders in the deaf and hard of hearing community: adults, students, parents, and educators.
- Disability related terms - A glossary of disability related terms from the University of Washington
- Teaching Deaf or Hard of Hearing Students - Educators that teach deaf or hard of hearing students must familiarize him or herself with the special requirements the student will need. There are many students that may be classified as deaf or hard of hearing that attend mainstream classes. These students may use a cochlear hearing implant, may read lips, or other forms of technology to communicate. It is important for educators to realize that the use of a cochlear implant does not..
- Hearing Impairment: definition from Project IDEAL.
- PAHCS starts hearing screening of newborns - While babies with hearing impairments may look normal, if they don't get help, they might not sound normal later in life. If a hearing disability goes without notice and without treatment, a child may pass crucial months without hearing the outside world, processing its sounds, and learning the language of humans. They may fail to learn to communicate and fall well behind their age peers.
- Information on the diagnosis of hearing impairments - Genetic forms of hearing loss must be distinguished from acquired (non-genetic) causes of hearing loss. The genetic forms of hearing loss are diagnosed by otologic, audiologic, and physical examination, family history, ancillary testing (such as CT examination of the temporal bone), and molecular genetic testing.
- Hearing loss in children - "Children with hearing loss can have delayed language and speech development. Understand the importance of early intervention for children with hearing loss." From healthyhearing.com.
Frequently Asked Questions
- FAQ on TTY - Frequently asked questions on using and communicating with TTY devices
History of the Field
- History of hearing aids - Somewhere up in the attic, there is something that really belongs in a museum. What is it? It is my old body-worn hearing aid from early childhood. Body aids were already on their way out at the time that I had to wear them. However, when I was a child hearing aid technology had not yet advanced enough for profoundly deaf children to be able to wear behind the ear aids.
- History of closed captioning - The earliest days of captioning on television meant open captioning, with the words printed directly on the screen. Open captioning began with the French Chef on PBS (1972).
- History of the cochlear implants - If you have seen a cochlear implant, you may wonder how such a device came to be. The history and development of the cochlear implant, a modern tool for hearing, actually spans centuries.
- History of Gallaudet University - Fall 1986: Gallaudet College became a University! I was a senior there then, but missed the historic ceremony because I had fallen asleep in my dorm room exhausted after working literally all night on a special edition of the Buff and Blue student newspaper to commemorate the occasion.
- History of sign language - What we call American Sign Language actually has roots in Europe. One version of its history has it beginning in Italy. It is also known that in the 18th century, the Abbe De l'Epee of France developed an early form of sign language that contributed to American Sign Language.
- History of the TTY - A deaf scientist, Robert Weitbrecht, is credited with the development of the TTY in the 1960s. The earliest TTYs were huge hunks of metal with printer paper coming out of them. I remember seeing one in the home of a family friend in the early '70s, and being quite impressed. These early TTYs are now antique, and can only be found in places such as the Smithsonian.
- People in deaf history - An extensive list of people in deaf history
- Effects of hearing loss - It is well recognized that hearing is critical to speech and language development, communication, and learning. Children with listening difficulties due to hearing loss or auditory processing problems continue to be an underidentified and underserved population.
- Cochlear implants - Districts have offered fewer traditional sign language classes to students with cochlear implants because of a high interest in speech-based courses. The cochlear implant includes a speech processor that is attached to the outside of the ear. The implant itself is planted deep inside the inner ear to bypass damaged nerves, but it doesn't amplify sound. It converts audio vibes into electric pulses, then zips those waves directly to the brain.
- Deaf people and cerebral palsy - Deaf people with cerebral palsy have been a part of my life ever since elementary school, when I neither understood cerebral palsy nor knew the name. When I was in the fourth grade, there was a deaf girl named Lisa. Lisa had difficulty walking but I thought she was the same as me because her cerebral palsy was not that severe.
- Deaf people with Autism - Sometimes, deafness is misdiagnosed as autism and vice versa. Other times, a child will turn out to be both deaf AND autistic. Deaf children with autism are rare, but do exist.
- Deafblindness -"Children are considered to be deaf-blind when the combination of their hearing and vision loss causes such severe communication and other developmental and educational needs that they require significant and unique adaptations in their educational programs."
- Deafness and balance problems - Balance depends on nerve signals from three systems -- eyes, legs/torso, and inner ear balance organs -- that comprise our vestibular system. These nerve signals, which go to the brain, help us to stay upright. However, if something goes wrong with one of these three systems, it can make us lose our balance.
- Deafness and intellectual disabilities - Often, the same conditions that cause deafness may also cause mental impairment.
- National Center for Hearing Assessment and Management - The goal of the National Center for Hearing Assessment and Management (NCHAM - pronounced "en-cham") at Utah State University is to ensure that all infants (newborns) and toddlers with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational, and medical intervention.
- Hearing Health Magazine Online - Founded in 1958, Deafness Research Foundation is the leading source of private funding for basic and clinical research in hearing science. DRF is committed to making lifelong hearing health a national priority by funding research and implementing education projects in both the government and private sectors.
- List of National Organizations - From ASHA (American Speech-Language-Hearing Association).
- Hearing Industries Association - "The Hearing Industries Association (HIA) was formed in 1955 and serves as a forum for hearing aid manufacturers, suppliers, distributors, and hearing health professionals. Our members are responsible for the majority of the over 3 million hearing aids that are purchased in the United States on an annual basis. Today, HIA remains the only association in America to represent hearing aid technology. The Association provides companies a unique platform to communicate on hearing health and technology issues."
- National Association of the Deaf - The mission of the National Association of the Deaf is to promote, protect, and preserve the rights and quality of life of deaf and hard of hearing individuals in the United States of America.
- Acoustic Neuroma Association - We are a patient member organization, providing information and support to persons diagnosed with or treated for acoustic neuroma and other benign tumors of the cranial nerves.
- Association of Late Deafened Adults - ALDA was formed in Chicago, Illinois in 1987. Most of those that gathered there were total strangers who had never met or talked to another deafened person, yet they found themselves wonderfully comfortable with one another. There was an unspoken feeling of understanding and patience with each other's communication difficulties. The marvelous sense of fellowship lasted and led to more social gatherings and self help support groups, which swiftly evolved into the Association of Late Deafened Adults (ALDA).
- Alexander Graham Bell Association - The Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell) is a lifelong resource, support network and advocate for listening, learning, talking and living independently with hearing loss.
- Children of Deaf Adults - CODA: Children of Deaf Adults is a non-profit organization for the adult hearing sons and daughters of deaf parents.
- National Black Deaf Advocates - The Mission of the National Black Deaf Advocate is to promote the leadership development, economic and educational opportunities, social equality, and to safeguard the general health and welfare of Black deaf and hard of hearing people.
- Hearing Loss Association of America - HLAA (formerly SHHH, or Self Help for Hard of Hearing People) is the nation’s largest organization for people with hearing loss. HLAA exists to open the world of communication for people with hearing loss through information, education, advocacy and support.
- Facts sheet - From WHO, the World Health Organization.
- Deaf parents with hearing children - Deaf parents of hearing children have a unique set of challenges. This article from verywellhealth.com lists some resources that may help.
- Children of Deaf Adults - CODA: Children of Deaf Adults is a non-profit organization for the adult hearing sons and daughters of deaf parents.
- Back to school advice - Some tips for helping your hearing impaired child in school.
- Schools for the deaf and hard of hearing - There are schools for deaf and hard of hearing students across the nation. Here is an alphabetical list by school name.
- Adopting A Deaf Child: What We've Learned So Far: -One family's story of adoption.
- Home schooling -Resources for those who are homeschooling their deaf child, from a2zhomeschooling.com.
- Postsecondary school concerns - The number of students with disabilities entering and completing postsecondary education has increased dramatically in the last decade, yet people with disabilities are still underrepresented in the employment arena. A 1994 poll commissioned by the National Organization on Disability shows that only twenty-nine percent of those with disabilities of working age are employed full- or part-time as compared to seventy-nine percent of those without disabilities. Of the group of people with disabilities, seventy-two percent reported they would like to be employed.
- Work related information - As a high school student, you may think that you have plenty of time to decide on your career path and to acquire the skills you will need to market yourself successfully. Some people believe that completing an academic program will guarantee them a job. This is not always true. What can you do to make yourself attractive to a future employer?
- PDF file on the prevalence of hearing impairments - Congenital hearing loss, at a rate of approximately 3 per 1,000 births, occurs more frequently than other conditions for which newborns are routinely screened and for which early detection has proven to be beneﬁcial [March of Dimes, 2003].
NIDCD Outcomes Research in Children with Hearing Loss - From the National Institute on Deafness and Other Communication Disorders/National Institutes of Health (NIDCD/NIH): "The primary objective of this article was to describe recruitment, data collection, and methods for a longitudinal, multicenter study involving children with bilateral mild-severe hearing loss. The goals of this research program were to characterize the developmental outcomes of children with mild to severe bilateral hearing loss during infancy and the preschool years. Furthermore, the researchers examined how these outcomes were associated with the child’s hearing loss and how home background and clinical interventions mediated and moderated these outcomes."