LAST UPDATED: 01/06/12
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This info pack has been put together with the help of the National Deaf Children's Society (NDCS) which supports deaf children and their families, as well as challenging governments and society to meet their needs. You can talk to an audiologist from NDCS for free one-to-one advice on the Netbuddy forum
Research suggests that as many as 40% of adults with a learning disability have a hearing loss, although for some groups this figure can be much higher. For example, hearing loss affects up to 75% of young people with Down syndrome.
Hearing problems may be unrecognised or undiagnosed because behaviours associated with hearing loss may have been thought of as being part of the learning disability, or because local audiology services are not accessible to them. Unrecognised and unmanaged hearing loss can cause or contribute to speech or language delays, difficulties learning and reading, and cause difficulties communicating with others.
Hearing loss can therefore have a significant impact and exacerbate the effects of an individuals learning disability. Some people are born with a hearing loss but for many people it develops later in childhood or as an adult.
Types and levels of hearing loss
Conductive hearing loss happens when sound cannot pass efficiently through the outer and middle ear to the cochlea and auditory (hearing) nerve. Conductive hearing loss is most common in childhood and is usually caused by 'Glue ear' (Otitis media). Glue ear is a build up of fluid in the middle ear that makes it harder for sound to pass through to the inner ear.
Glue ear causes the hearing to fluctuate and often clears up on its own without needing any treatment. However, for some children with learning disabilities glue ear may persist longer term.
Sensori-neural (or nerve) hearing loss happens when there is a fault in the inner ear (most often because the hair cells in the cochlea are not working properly) or auditory (hearing) nerve. Sensori-neural deafness is permanent. Sensori-neural deafness is most common in adulthood and is usually caused by normal wear and tear of the ear and the ageing process.
In some individuals with learning disabilities this ageing may happen much earlier than would be expected in the general population. It is also possible to have a sensori-neural and conductive hearing loss together and this is known as mixed hearing loss.
There are different levels of hearing loss that are measured in decibels (dB) and described as mild (21-40 dB), moderate (41-70 dB), severe (71-95 dB) or profound (95+ dB).
As well as hearing our ears also help us to balance. The brain uses information from the eyes (what we see), our body (what we feel) and the inner ear to balance. The semicircular canals in the inner ear are three tubes, filled with liquid and movement-sensitive hair cells. As we move, the fluid moves. This creates signals that are sent to the brain about balance.
Balance problems can occur when the organ of balance in the inner ear does not work properly (vestibular hypofunction). Children can be born with this or acquire it with illness or trauma. With hypofunction development of balance function may be delayed and this might mean that babies and young children take longer to reach developmental milestones such as sitting unsupported and walking. Older children may have difficulties with certain activities such as learning to ride a bike. This is called imbalance.
Other types of balance problem can give rise to dizziness or vertigo or episodes of unsteadiness. These can occur at any time in child or adulthood.
Possible indicators of a hearing loss
The list below contain behaviours that can indicate a problem with the ears or a hearing loss. It is also possible that they could be explained by a persons learning disability but it is worth asking for a hearing test to rule out any hearing difficulties particularly if it is noticed for the first time or it is a change from their normal behaviour:
Does not respond when called by name
Does not respond to verbal instructions or needs visual clues
Watches faces intently
Appears to hear some voices better than others (e.g. low or high pitched)
Has difficulty following a conversation in a group (e.g. when there is a change in topic of conversation)
Struggles to hear conversation in the presence of background noise
Sits very close to the television or turns the volume up loud
Is upset by loud noises
Is startled by people approaching from behind who they haven't seen/heard
Speaks very quietly or loudly, or vocalises very loudly
Breathes through their mouth and has a 'blocked nose' most of the time
Has discharging ears and/or ears have an unpleasant smell
Frequently rub or poke the ears
Problems with balance
What can be done to help?
Ask your GP for a referral to an audiology service. For children you should be referred to your local paediatric audiology service. For adults ask your GP to refer you to an audiology service that runs special clinics for adults with learning disability. Hearing tests can be carried out from birth on children and adults with all developmental abilities.
The audiologist will work with the individual, family, carers, key worker and support workers to find the most appropriate hearing tests and best way to get hearing test results. Sometimes this can mean undergoing a series of appointments. It may be necessary for some individuals to get used the audiologist, department and procedures very gradually, including getting used to having their ears touched etc. The audiologist will discuss with the individual, family and carers an Individual Management Plan for assessing the hearing and managing any hearing loss that is identified.
There is a wide range of equipment that can be helpful including:
- Hearing aids
- Radio aids or soundfield systems (specialist listening equipment mostly used in schools)
- Assistive listening devices that can be used with or without hearing aids, such as amplified headphones, amplified telephones, flashing and/or vibrating doorbells, alarm clocks and fire alarms
People with learning disabilities communicate in lots of different ways including speech, makaton or other sign language, communication systems using pictures and symbols or a combination of these. Additionally it can be helpful just to know that an individual has hearing difficulty as this means that parents, carers, teachers, family and friends can make simple adjustments that make hearing and listening as easy as possible.
Top Tips – communication
Remember eye contact and level
Make sure you are facing the person you are talking with and maintain good eye contact. Try to be get down to the same level as children, or adults who use wheelchairs, and allow some space for them to see you clearly.
Get their attention
Make sure you have the person's attention before you start to talk to them.
Consider the lighting
Use a well-lit room and don’t have your back to a window, as this creates a shadow and makes it difficult to read facial expressions or to lip read.
If you are naturally a fast talker you may need to slow down a bit, but try to speak clearly, naturally and at a normal pace.
Don’t shout as it distorts lip patterns and facial expressions, and can appear as if you are angry.
Cut the noise
Try to make sure that background noise is kept as low as possible. A room that is carpeted or that has curtains will help cut down the effects of noise in a room.
Don't be afraid to use gestures and facial expressions to support what you say.
A clear face
While speaking don’t smoke, eat or block the view of your face. Keep beards or moustaches trimmed and also remember that glasses and sunglasses can make it difficult to maintain eye contact.
When in a group, speak one at a time and indicate when a different person starts speaking. Make sure you make it clear when there is a new topic of conversation.
Range of vocabulary
Some words or signs may not be easily understood or may not be in the vocabulary of the listener. Try a different word or sign with the same meaning.
Take your time
Always give plenty of time for the person to respond to anything you say. Pause between sentences and check the listener has understood you, and that you have understood them.
Encourage them to stop you if they don’t understand what you are saying.
Top Tips – aids & devices
Hearing aid retainers
If the wearer regularly takes out their hearing aids and throws them away
try 'hearing aid retainers' which attach the hearing aids with elastic and a
clip to the back of the clothing. If the hearing aids are removed from the
ears they won't get lost as they are still attached and hanging down their
back out of reach.
Try making wearing hearing aids part of the wearers dressing and undressing routine. Put the hearing aids in when they get up and take them out when they go to bed. If it is part of their normal routine they are less likely to remove them during the day and risk losing them.
Choose your colour
NHS hearing aids and ear moulds come in different colours so the wearer can choose what they would like and are more likely to want to wear them.
Rob was given a cochlear implant which had a coil that had to stay on his
head. We spent 18 very painful months replacing this coil up to 200 times a day, as he did not want to wear it. Then someone told me to buy nipple tape from Claire's accessories (designed for bra-less see-through outfits!) It has changed our lives. The coil stays on ALL day.
Our daughter (2 years old) wears hearing aids in both ears but the moulds
always fell out, if you rub a small amount of vaseline onto the moulds, making sure its just a small amount as not to block them, it helps them to stick into the ears for longer.
Wig tape for hearing aids
Use wig tape (double-sided sticky tape that is skin-friendly) to stick
hearing aids to the back of ears. Cut about 5mm of tape and stick longways down the side of the hearing aid that will face the back of the ear. Then put the hearing aids on and gently press the ear against the tape.
Wearing a hearing aid and glasses can put a lot of pressure on the skin
behind the ear, which can get red and sore. We tried so many different types of cushioning/padding, but they were unsightly or wouldn't stay in place. Then we found Scholl self adhesive moleskin. It's meant for shoes, so it stays firmly in place, but can easily be cut to size and stuck on the inside arm of the glasses. It's soft enough to reduce the friction but it's also beige so it doesn't stand out. Available from most pharmacies.
Eczema in Ears/dry skin
Eczema inside his ears was really driving my son crazy, we found olive oil drops helped alleviate his distress.
Hearing and Learning Disabilities (HALD)
HALD is a special interest group for professionals who work in ENT and audiology services. Their website contains example information leaflets developed for adults with learning disabilities about audiology appointments, including easy read language as well as photos and symbols including:
- using and looking after hearing aids
- ear infections
- how people can help
Foundation for People with Learning Disabilities
The Foundation for People with Learning Disabilities has published Good health care for all: What can I expect from the NHS? that provides practical hints and tips for people with learning disabilities, family carers and anyone who supports a person with learning disabilities on how to go about using the NHS, what to expect, real life examples of challenges and how they can be overcome as well as some advice about how to get help and some useful contacts to get more information. It is available to download for free from:
General Medical Council's Learning Disabilities website
The General Medical Council (GMC) has launched a new website which aims to help doctors provide better care for people with learning disabilities by:
- identifying the issues
- highlighting patient perspectives
- showing how to put GMC guidance into practice.
The website expands on the guidance in Good Medical Practice and Consent and demonstrates how it applies to practices when treating patients with learning disabilities.
National Deaf Children's Society
NDCS publishes a range of information written for parents of children who have a hearing loss with other additional needs:
- Deaf children with additional needs includes sections on understanding additional needs, professionals you may meet, getting a diagnosis, communication, hearing aids, parenting tips, choices for your child, safety, your child’s emotions, independence, time for yourself, support from others, and useful resources.
- What are you feeling (A guide to developing emotional vocabulary for children who are deaf and may have learning difficulties) uses a combination of signs and Widgit to help children find a way to manage their feelings safely.
- Down’s syndrome and childhood deafness written for parents of children with Downs syndrome as a high percentage of children also have some degree of hearing loss.
- Vision care for your deaf child explains the importance of getting your child's eyes tested, the types of tests available, common eye conditions, and the things to think about before your child has their vision checked.
- Communicating with your deaf child is a comprehensive guide that aims to answer the many questions parents have asked about how to best support their child’s language and communication development. The guide describes the basics of language and communication development and gives some practical advice about how you can encourage positive development in natural ways in everyday routines. It also looks at the different ways in which deaf children and their families might choose to communicate and explains what you will need to consider when making choices about communication approaches for your child and family.
- Balance and balance disorders factsheet is a factsheet for parents containing information about the balance system, balance testing and balance disorders.
They can all be ordered free-of-charge from their Freephone Helpline or downloaded from the website www.ndcs.org.uk
Further information and advice
For further information on any aspect of hearing loss, equipment, or accessing audiology and hearing tests contact:
For children - National Deaf Children's Society (NDCS)
Freephone Helpline 0808 800 8880 (Monday to Thursday 9.30am-9.30pm and Friday 9.30am-5pm)
For adults - Action on Hearing Loss (formally the RNID)
Information Line 0808 808 0123 (Monday to Friday 9.00am-5.00pm)
Netbuddy is not responsible for the information provided in these info packs or any of the activities suggested.