Hearing impairment

Hearing impairment is a reduction in a person's ability to perceive sounds in the environment, either partially or completely. Some reduction in the ability to perceive and understand sounds is called hearing loss, and a complete loss of the ability to hear is called deafness.

Hearing loss is divided into sensorineural, conductive and mixed. Deafness, like hearing loss, can be congenital or acquired.

Sounds are sound waves that vary in frequency and amplitude. Partial hearing loss is the inability to perceive certain frequencies or differentiate sounds with low amplitude.

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Causes of hearing loss

The causes of hearing loss are of different nature:

1. Acute infectious diseases to which the child's mother was exposed during pregnancy, which include influenza, rubella, and mumps. High blood pressure in the mother during the intrauterine period of the child can also cause hearing loss.
2. Maternal abuse of medications (especially loop diuretics, aminoglycosides, streptomycin, gentamicin), alcoholic beverages or narcotics during pregnancy.
3. Birth injuries of various nature and various birth abnormalities:
   • the baby's weight is less than one and a half kilograms;
   • labor that begins before the thirty-second week;
   • insufficient oxygen during birth or prolonged breath holding after birth;
   • mechanical damage to the infant during childbirth.
4. Hereditary (genetic) hearing impairment.
5. Infectious diseases that the child suffered from in early childhood, namely meningitis, encephalitis, measles, rubella, mumps, flu, and so on.
6. Certain medical conditions, including Meniere's disease, otosclerosis, acoustic neuroma, Moebius syndrome, and arthrogryposis multiplex congenita, can cause hearing impairment or loss.
7. Complications after chronic inflammatory processes of the ear (otitis) can also include hearing impairment.
8. Continuous exposure to noise over long periods of time can cause hearing loss, especially at high frequencies.
9. Acoustic trauma, namely, being in areas of sudden gunfire and explosions.
10. The consequences of accidents and various incidents can be hearing impairment.
11. Chemotherapy can also cause hearing loss.
12. Age-related changes that affect the cochlea and central auditory system. Moreover, these processes can proceed unnoticed after thirty years.

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Acquired hearing loss

Acquired hearing loss is a dysfunction of the auditory system that can occur at any age under the influence of the following factors:

• Consequences of infectious diseases, namely meningitis, measles, mumps.
• Chronic infectious processes in the ears, which cause not only hearing loss, but also, in some cases, life-threatening diseases such as brain abscesses or meningitis.
• Otitis media, which causes fluid to build up in the middle ear.
• The use of ototoxic drugs, namely antibiotics and antimalarial drugs, for therapeutic purposes.
• Existing head or ear injuries.
• Exposure to loud noise of a sudden or prolonged nature – interaction with noisy equipment, loud music and other excessively loud sounds, as well as gunshots and explosions.
• Degeneration of sensory cells that occurs as a result of age-related changes.
• The presence of earwax, as well as any foreign bodies in the external auditory canal. Such hearing problems are easily corrected by cleaning the ear canal from such substances.

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Hearing impairment due to otitis media

Otitis is an inflammatory disease of different parts of the ear, which is accompanied by fever, intoxication and severe pain. In some cases, otitis causes permanent or temporary hearing loss.

Chronic otitis media is the leading cause of hearing problems in childhood.

Otitis in children and adults is sometimes accompanied by damage to the tissues of the outer and middle ear. With external otitis, the infection penetrates through small skin lesions that form after damage to the auditory auricle of the outer ear. Such changes occur as a result of mechanical deformations, as well as chemical and thermal burns. The causative agents of the disease in this case are staphylococci and streptococci, as well as Pseudomonas aeruginosa, Proteus, and so on. At the same time, factors provoking external otitis can also be some diseases, namely diabetes mellitus, gout, hypovitaminosis and other metabolic disorders.

Otitis media is caused by infectious diseases of the nasopharynx, in which pathogenic microorganisms enter the middle ear cavity through the auditory tube. These include influenza and parainfluenza viruses, adenovirus and rhinovirus, respiratory syncytial virus, as well as pneumococcus bacteria, pyogenic streptococcus, moraxella and hemophilus. Small children are especially susceptible to otitis media, due to the fact that their auditory tube is shorter and wider. Infection with otitis media can also penetrate from the outside due to mechanical damage and barotrauma of the eardrum. Chronic infectious processes in the nasopharynx, namely chronic tonsillitis, sinusitis and adenoid disease, also provoke the development of the disease.

During the course of otitis externa, the inflammatory process first begins in the superficial layers of the auricle, and can then develop in the surrounding tissues and the eardrum.

During the course of otitis media, the mucous membrane begins to inflame and produce exudate (a certain fluid that is released during tissue inflammation). The exudate may be serous, which is typical for viral infections, or purulent, which is due to its bacterial nature. The accumulation of fluid in the middle ear begins to bulge the eardrum outward and in some cases leads to its rupture. All of the above features of the course of otitis media are the cause of hearing impairment in people of different ages.

Severe inflammation leads to impaired mobility of the auditory ossicles, which causes a decrease in the perception of sound waves and is a hearing impairment.

Otitis that is not treated properly and its constant relapses cause the appearance of scars in the tissues of the middle ear, which lead to a decrease in the mobility of the auditory ossicles and the elasticity of the eardrum. This causes hearing loss in people of different age groups. Inflammatory processes that are protracted can penetrate into the inner ear and affect the auditory receptors. Such deformations lead to the appearance of deafness in the patient.

Symptoms of hearing loss

Acquired hearing loss does not manifest itself suddenly in the vast majority of cases. Of course, it does happen that a patient develops sudden hearing loss that progresses over several hours. Usually, symptoms of hearing loss develop over several or many years. At the same time, the first signs of hearing loss are practically unnoticeable, and the symptoms differ in different categories of people.

The primary symptoms of hearing loss are:

1. Increased requests from the patient to repeat words spoken by the interlocutor.
2. Increasing the volume of your computer, television, or radio beyond its normal volume.
3. The feeling that everyone around you is speaking incoherently and indistinctly.
4. The feeling that some voices have become more difficult to understand, especially high ones – women’s and children’s.
5. Constant strain on the ears when talking and increased fatigue from talking to other people.
6. Stop attending gatherings and other group events. This also applies to other social events that previously provided positive emotions.

Symptoms of hearing loss in children include the following:

• Lack of reaction to external noises, both in a normal state and when engaged in some activity - playing, drawing, and so on.
• Lack of reaction to loud sudden noise during sleep in the form of awakening and continuation of calm sleep.
• Inability to determine the source of the sound.
• No imitation of sounds.
• Frequent ear infections and inflammations.
• Observed problems in understanding the speech of people around you.
• Having a delay in speech development or a discrepancy between the level of speech development and age parameters.
• Lagging behind peers when participating in group games.

Congenital hearing impairments

Congenital hearing impairments are dysfunctions of the auditory system that are associated with hearing loss or decreased hearing, detected at birth or shortly after birth.

Causes of congenital hearing loss include:

1. Hereditary genetic factors.
2. Non-hereditary genetic traits.
3. Complications during pregnancy caused by the mother's history of syphilis, rubella, mumps, and others.
4. Low birth weight – less than one and a half kilograms.
5. Asphyxia during birth, that is, a severe lack of oxygen.
6. Maternal oral use of ototoxic drugs during pregnancy, namely aminoglycosides, diuretics, antimalarial drugs, cytotoxic drugs.
7. Severe jaundice suffered by an infant during the neonatal period can cause damage to the child's auditory nerve.

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Genetic hearing impairment

Genetic hearing loss can fall into two categories:

• non-syndromic (isolated),
• syndromic.

Nonsyndromic hearing loss is hearing loss that has no other accompanying symptoms that are inherited. Such hearing loss occurs in seventy percent of cases of deafness caused by inheritance.

Syndromic hearing impairments are caused by hearing loss in combination with other factors, such as diseases of other organs and systems. Syndromic impairments occur in thirty cases of deafness caused by heredity. In medical practice, more than four hundred different syndromes have been recorded, one of the manifestations of which is deafness. Such syndromes include:

• Usher syndrome is a simultaneous disorder of the auditory and visual systems,
• Pendred syndrome - in which hearing loss is combined with hyperplasia of the thyroid gland,
• Jervell-Lange-Nielson syndrome - causes a combination of deafness and cardiac arrhythmia with the appearance of a longer QT interval,
• Waardenburg syndrome - describes a disorder of the auditory system combined with the appearance of pigmentation.

If we take into account the type of inheritance of hearing dysfunctions, they can be divided into the following types:

1. Autosomal recessive, which accounts for seventy-eight percent of cases.
2. Autosomal dominant, which accounts for twenty percent of cases.
3. X-linked, which accounts for one percent of cases.
4. Mitochondrial, which accounts for one percent of cases.

Modern medicine has identified more than a hundred genes that, when mutated, are responsible for hearing impairment. Each population of people has its own specific mutations that differ from other populations. But it can be noted with confidence that approximately in a third of cases of genetic hearing impairment, the cause of such negative transformations is a mutation of the connexin 26 (GJB2) gene. The Caucasian race is most susceptible to the 35delG gene mutation.

Hearing loss in the elderly

Most people with acquired hearing loss are elderly or old. Hearing loss in the elderly is associated with age-related changes, which result in degenerative transformations in the hearing organs. Age-related changes in the hearing organs affect all parts of the auditory system, from the auricle to the auditory analyzer zone in the cerebral cortex.

Hearing loss in the elderly is a complex and comprehensive process that is carefully studied by specialists. Senile hearing loss is called "presbycusis" and is divided into two types:

• conductive,
• sensorineural.

Conductive hearing loss in senile patients is caused by degenerative changes in the middle ear and decreased elasticity of the cranial tissue.

Sensorineural hearing loss in presbycusis has four subtypes, caused by different reasons:

• sensory - caused by atrophy of the hair cells of the organ of Corti,
• neural - associated with a decrease in the number of nerve cells present in the spiral ganglion,
• metabolic - caused by atrophic changes in the vascular strip, weakening metabolic processes in the cochlea,
• mechanical – associated with atrophic transformations of the main membrane of the cochlea.

Some experts adhere to a different classification of senile hearing loss. In this case, three types of age-related hearing loss are described:

• presbycusis is a hearing loss caused by internal factors of a genetic and physiological nature,
• sociocusia - hearing loss caused by external factors that contribute to severe wear and tear of the auditory system,
• occupational noise-induced hearing loss is a hearing impairment that occurs as a result of exposure to loud industrial noise at an individual's place of work.

Characteristics of children with hearing impairments

Children with hearing impairments have significant differences in psychophysiological and communicative development. These features of children with hearing impairments prevent them from developing at the same rate as their peers, and also cause problems in acquiring knowledge, vital skills and abilities.

Hearing impairment in children significantly reduces the quality of speech formation and verbal thinking. At the same time, cognitive processes and cognitive activity also experience a deficit in improvement and development.

Children with hearing impairments may also have other disorders, namely:

1. Problems with the functioning of the vestibular apparatus.
2. Various visual defects.
3. A minimal degree of brain dysfunction that leads to inhibition of the general development of the psyche.
4. Extensive brain damage that causes oligophrenia.
5. Defects in brain systems that lead to cerebral palsy and other movement disorders.
6. Disorders of the functioning of the auditory and speech areas of the brain.
7. Diseases of the central nervous system and the body as a whole that cause severe mental illnesses - schizophrenia, manic-depressive psychosis, and so on.
8. Severe diseases of the internal organs (heart, kidneys, lungs, digestive tract, etc.), which generally weaken the child’s body.
9. Serious social and pedagogical neglect.

There are two types of hearing loss in children, depending on the degree of loss of the ability to perceive and process sounds:

• hearing loss, which affects children with hearing impairments,
• deafness.

In cases of hearing loss, speech perception is preserved, but only when it is spoken loudly, articulately and close to the ear. Although, of course, the child's ability to fully communicate with others is limited. Deafness is characterized by the fact that certain tones of speech are perceived without the ability to perceive and distinguish speech itself.

Various hearing disorders in childhood lead to inhibition and distortion of speech development. However, researchers noted the following fact: if severe hearing loss occurs at a time when the child has already mastered reading and writing skills to a good degree, the disease does not lead to speech development defects. Although in this case, various disorders associated with pronunciation are noted.

The most important factors that influence the speech development of children with hearing impairments are:

• Degree of hearing loss - children with hearing impairments speak worse to the extent that their hearing is poor.
• Age period of occurrence of pathological hearing impairment – the earlier hearing defects occur, the more severe the speech impairment, up to the appearance of deafness.
• The conditions of the child’s development and the presence of correct psychocorrectional measures – the earlier special measures are applied to develop and maintain correct speech, the higher the effectiveness.
• General physical development and mental development of the child - more complete speech is observed in children with good physical development, good health and normal mental development. Children with poor health (passive, lethargic children) and mental disorders will have significant speech defects.

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Classification of hearing impairments

Hearing impairments can be divided into several types:

• Conductive - caused by blockage of any quality that occurs in the outer or middle ear. In this case, the sound cannot penetrate normally into the inner ear.
• Neural – arise as a result of the brain’s complete loss of ability to perceive and process electrical impulses. In some cases, the brain cannot correctly decipher the signals received. These disorders also include “auditory dyssynchronization” or “neuropathy”.
• Sensory – appear if there are disturbances in the functioning of the hair cells of the inner ear. As a result, the cochlea cannot normally detect sounds.
• Sensorineural - combined disorders in which there are dysfunctions of hair cells, as well as large inaccuracies in the perception and processing of sound signals by the brain. These types of disorders are persistent, because it is almost impossible to establish how the cochlea and brain participate in hearing loss. The greatest difficulty in making a correct diagnosis is noted when examining small children.
• Mixed - these include a synthesis of sensorineural and conductive disorders. With this type of hearing loss, sound signals cannot be transmitted normally from the outer and middle ear to the inner ear, and there are also disturbances in the functioning of the inner ear, brain areas, and neural parts of the hearing system.

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Preobrazhensky's classification of hearing impairments

In modern practice, there are several classifications of hearing disorders. One of the most popular is the classification of hearing disorders by Professor B. S. Preobrazhensky. It is based on the level of perception of oral loud speech and speech spoken in a whisper. The study of the perception of loud speech is necessary due to the fact that it contains elements of whispered speech, namely, voiceless consonants and unstressed parts of the word.

According to this classification, there are four degrees of hearing impairment: mild, moderate, significant and severe. Mild is characterized by the perception of spoken language at a distance of six to eight meters, and whispered language at a distance of three to six meters. Moderate hearing impairment is diagnosed when spoken language is perceived at a distance of four to six meters, and whispered language at a distance of one to three meters. Significant hearing impairment is determined by understanding spoken language at a distance of two to four meters, and whispered language at a distance of from the auricle to one meter. Severe hearing impairment is distinguished by understanding spoken language at a distance of up to two meters from the auricle, and whispered language at a distance of half a meter.

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Conductive and sensorineural hearing impairments

Conductive hearing loss is characterized by the presence of a deterioration in the conductivity of sounds due to defects in the outer or middle ear. Normal conductivity of sound signals is ensured only by a properly functioning ear canal, eardrum, and ear ossicles. With any disorders of the above organs, a partial decrease in hearing is observed, called deafness. With partial hearing loss, there is some deterioration in the ability to perceive sound signals. Conductive hearing loss allows speech to be recognized if the individual has the opportunity to hear it.

Conductive hearing loss occurs due to:

• obstruction of the auditory canal,
• anomalies in the structure and functioning of the middle ear, namely the eardrum and/or ear ossicles.

Sensorineural hearing loss is caused by defects in the functioning of the inner ear (cochlea), or by a malfunction of the auditory nerve, or by the inability of certain areas of the brain to perceive and process sounds. In the first case, there is a pathological deformation of the hair cells, which are located in the organ of Corti of the cochlea. In the second and third cases, sensorineural hearing loss occurs due to pathology of the VIII cranial nerve or parts of the brain that are responsible for the auditory system. At the same time, a disorder in the functioning of exclusively auditory areas of the brain is considered a fairly rare phenomenon, which is called central hearing loss. In this case, the patient can hear normally, but with such low sound quality that he cannot understand the words of other people at all.

Sensorineural hearing loss can result in varying degrees of deafness, from low to high, as well as total hearing loss. Experts believe that sensorineural hearing loss is most often caused by pathological changes in the functioning of the hair cells of the cochlea. Such degenerative changes can be either congenital or acquired. In acquired transformations, they can be caused by infectious ear diseases, noise injuries, or a genetic predisposition to the appearance of anomalies in the auditory system.

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Phonemic hearing disorder

Phonemic hearing is the ability to distinguish phonemes of a language, namely to analyze and synthesize them, which is expressed in understanding the meaning of speech spoken in a certain language. Phonemes are the smallest units of which any language consists; they form the structural components of speech - morphemes, words, sentences.

There are differences in the operation of the hearing system when perceiving speech and non-speech signals. Non-speech hearing is a person's ability to perceive and process non-speech sounds, namely musical tones and various noises. Speech hearing is a person's ability to perceive and process the sounds of human speech in their native or other languages. In speech hearing, phonemic hearing is distinguished, with the help of which phonemes and sounds responsible for the semantic load of the language are distinguished, so that a person can analyze individual sounds of speech, syllables and words.

Phonemic hearing disorders occur in children and adults. The causes of phonemic hearing disorders in children are as follows:

1. Lack of formation of acoustic images of individual sounds, in which phonemes cannot be distinguished by sound, which causes the replacement of some sounds by others when speaking. Articulation is not complete enough, since the child cannot pronounce all sounds.
2. In some cases, a child can articulate all sounds, but at the same time, cannot distinguish which sounds he needs to pronounce. In this case, the same word can be pronounced by the child in different ways, since the phonemes are mixed, which is called phoneme mixing or sound substitution.

When speech hearing is impaired, a child develops sensory dyslalia, which means the inability to pronounce sounds correctly. There are three forms of dyslalia:

• acoustic-phonemic,
• articulatory-phonemic,
• articulatory-phonetic.

Acoustic-phonemic dyslalia is characterized by the presence of defects in the design of speech using sounds, which is caused by the inability to fully process the phonemes of the language due to anomalies in the sensory link of the speech perception system. At the same time, it should be noted that the child does not have any hearing system disorders, that is, there is no hearing loss or deafness.

Impaired phonemic hearing in adults is caused by local lesions of the brain, namely:

• sensory temporal aphasia,
• sensory aphasia of the nuclear zone of the sound analyzer.

Mild cases of sensory temporal aphasia are characterized by the understanding of individual words or short phrases, especially those that are used daily and are part of the patient's regular daily routine. In this case, there is a disorder of phonemic hearing.

Severe cases of sensory aphasia are characterized by a complete lack of understanding of speech by the sick person; words cease to have any meaning for him and turn into a combination of incomprehensible noises.

Sensory aphasia, expressed in the damage of the nuclear zone of the sound analyzer, not only leads to a violation of phonemic hearing, but also to a severe speech disorder. As a result, it becomes impossible to distinguish the sounds of oral speech, that is, to understand speech by ear, as well as other speech forms. Such patients lack active spontaneous speech, have difficulty repeating heard words, and writing under dictation and reading are impaired. It can be concluded that due to the violation of phonemic hearing, the entire speech system is pathologically transformed. At the same time, these patients have preserved musical hearing, as well as articulation.

Conductive hearing loss

Conductive hearing loss is caused by the inability to conduct sound normally through the ear canal due to problems in the outer and middle ear. The characteristics of conductive hearing loss were described in the previous sections.

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Diagnosis of hearing loss

Diagnosis of hearing disorders is carried out by various specialists – audiologists, otolaryngologists.

The hearing test procedure is as follows:

• The patient first of all undergoes a consultation with an audiologist. The doctor performs an otoscopy, that is, an examination of the outer ear together with the eardrum. The purpose of this examination is to identify or refute mechanical damage to the auditory canal and eardrum, as well as pathological conditions of the ears. This procedure does not take much time, and it is absolutely painless.

Very important during the examination are the patient's complaints, which can describe various symptoms of hearing loss, namely the appearance of slurred speech when communicating with other people, the occurrence of ringing in the ears, and so on.

• Conducting tonal audiometry, which requires recognizing various sounds that differ in frequency and volume. As a result of the examination, a tonal audiogram appears, which is a characteristic of auditory perception that is unique to this person.
• Sometimes it is necessary to conduct speech audiometry, which determines the percentage of words that a person can distinguish when they are pronounced at different volumes.

Tonal and speech audiometry are subjective diagnostic methods. There are also objective diagnostic methods, which include:

• Impendancemetry or tympanometry, which allow diagnosing disorders in the middle ear. This method allows recording the level of mobility of the eardrum, as well as confirming or refuting the presence of pathological processes in the middle ear.
• Otoacoustic emission recording assesses the condition of hair cells, which helps to determine the quality of the cochlea's functioning in the inner ear.
• Registration of evoked electrical potentials determines the presence or absence of damage to the auditory nerve or areas of the brain responsible for hearing. In this case, a change in the electrical activity of the brain in response to the sent sound signals is recorded.

Objective methods are good for examining adults, children of any age, including newborns.

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Treatment of hearing impairment

Treatment of hearing loss is carried out using the following methods:

1. Prescription of medications.
2. Use of certain methods of surdological and speech therapy nature.
3. Constant exercises for auditory and speech development.
4. Use of hearing aids.
5. Using the recommendations of a neuropsychiatrist to stabilize the child’s psyche and emotional sphere.

Speech therapy for hearing impairment

Speech therapy work in case of hearing impairment is of great importance, since hearing-impaired children have speech disorders related to pronunciation. Speech therapists organize classes in such a way as to improve the child's articulation and achieve natural pronunciation of words and phrases. In this case, various speech therapy methods of a general nature and those chosen specifically, taking into account the individual characteristics of the child, are used.

Physical therapy for hearing impairment

There are a number of exercises that are used in case of pathologies of the auditory canal in order to improve its functioning. These include special exercises for breathing, as well as with the tongue, jaws, lips, smiling and puffing out the cheeks.

To improve hearing acuity in hearing-impaired children, special exercises are used that train the quality of sound perception.

Treatment of phonemic hearing disorders

Treatment of phonemic hearing disorders in children is carried out in a comprehensive manner:

• Special speech therapy exercises are used to develop the quality of speech perception and pronunciation in children.
• A special speech therapy massage is shown, which is done to the articulatory muscles. Such massage is performed with the help of special probes and normalizes muscle tone for correct pronunciation of sounds.
• Microcurrent reflexology - activates the speech zones of the cerebral cortex, which are responsible for understanding speech, the ability to correctly structure sentences, for a developed vocabulary, good diction and the desire for communicative contact.
• Special logorhythmic exercises are used in groups and individually.
• General musical development is shown, which includes singing, exercises to develop a sense of rhythm, musical games and learning to play musical instruments.

Raising children with hearing impairments

Parents raise children with hearing impairments as a way to rehabilitate the child. The first three years of a child's life are of great importance for the formation of correct mental and other processes, as well as the child's personality. Since at this time children mainly spend time with their parents, the correct behavior of adults is of great importance for the correction of the child's developmental defects.

It is clear that in this case, parental care for the baby requires a lot of time and effort. But it should be noted that there are often cases when parents of a hearing-impaired child were able to carry out the rehabilitation of the baby under the supervision of an experienced teacher of the deaf.

It is important for a hearing-impaired child to have direct speech contact with parents, as well as joint activities. The volume of speech signals during communication should be sufficient to ensure the child's understanding of speech. Constant and intensive auditory training, which is the basis of the rehabilitation process, is also important. It should be noted that a hearing-impaired child should have the opportunity to communicate not only with his or her parents, but also with other normally hearing and normally speaking people.

The upbringing of such children should be carried out in accordance with the recommendations and under the supervision of deaf psychologists and deaf teachers. At the same time, parents should use the correction methods recommended by specialists.

Teaching children with hearing impairments

Education of children with hearing impairments should be carried out in special preschool and school institutions. In these institutions, competent specialists will be able to provide the correct correctional assistance, as well as apply the correct teaching methods for these children. In general schools, the child will be assisted by specialists working in special classes or groups organized for such children.

In kindergartens for children with impaired hearing, corrective work is carried out with children starting from one and a half to two years. The focus of pedagogical influence is the general development of the child, namely his intellectual, emotional-volitional and physical characteristics. At the same time, all those areas that need to be developed in ordinary, well-hearing children are involved.

The educational process with children with hearing impairments is aimed at a lot of work on speech development, its pronunciation component, as well as correction of residual hearing and development of verbal and other thinking. The educational process consists of individual and group lessons, using choral recitations with musical accompaniment. Then, speech development lessons are connected, in which amplifiers and hearing aids are used.

Literacy training for these children begins at the age of two. The work is purposeful and ongoing – children learn to read and write using printed letters. Such teaching methods allow for the development of speech perception at a full level, as well as a normal level of speech reproduction (as in healthy children) through writing.

Rehabilitation of children with hearing impairments

The main task of deaf psychologists and teachers of the deaf working with children with impaired hearing is to reveal their compensatory capabilities and use these mental reserves to fully overcome hearing defects and obtain the necessary education, full socialization, and inclusion in the process of professional activity.

Rehabilitation work with children with impaired hearing should be carried out fully and begin as early as possible. This is due to the fact that from early and preschool age, children with these problems lag behind their peers. This is manifested both in the insufficient level of development of activity and in the ability to communicate with adults. It can also be noted that children with impaired hearing experience incorrect formation of individual psychological experience, as well as inhibition in the maturation of certain mental functions and significant deviations in the formation of general mental activity.

For the successful rehabilitation of hearing-impaired children, the preservation of the intellect and cognitive sphere, as well as other sensory and regulatory systems, is of great importance.

In surdopedagogy there is a stable point of view that the possibilities of rehabilitation of deaf and hard of hearing children have virtually no limits. This does not depend on the severity of the hearing defect, early diagnostics of hearing impairment and the same correction of pedagogical and psychological nature are important. The most important time for rehabilitation is considered to be the age from birth to three years.

The main corrective moment is speech development, which helps to avoid deviations in the formation of mental functions.

Working with hearing impairments

People with hearing impairments need a type of professional activity that requires minimal communication with other people, reliance on vision rather than hearing, and a lack of rapid behavioral and speech reactions.

Jobs for people with hearing impairments may include the following professions:

• PC operator
• Web designer
• Programmer
• Service center specialist for equipment repair
• Hardware control specialists for equipment at industrial enterprises
• Accountant
• Archivist
• Storekeeper
• Cleaner
• Street cleaner

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Prevention of hearing loss

Timely prevention of hearing loss in more than half of cases can lead to the preservation of hearing in a child or adult.

Preventive measures include the following:

1. Conducting immunization activities against infectious diseases, which include measles, rubella, mumps and meningitis.
2. Immunization of adolescent girls and women of reproductive age against rubella before conception.
3. Carrying out diagnostic procedures with pregnant women in order to exclude the presence of infections: syphilis and others.
4. Careful control of the use of ototoxic drugs by a physician; the independent use of these drugs without a prescription from a specialist is not allowed.
5. Conducting early hearing screening in newborns at risk:
   • having deaf close relatives,
   • born with very low birth weight,
   • suffered from asphyxia at birth,
   • those who suffered from jaundice or meningitis in infancy.
6. Early examination allows for a correct diagnosis and timely initiation of appropriate treatment.
7. Stopping (or at least reducing) exposure to long-term loud noise, both in the workplace and at home. Preventive measures at work include the use of personal protective equipment, as well as raising awareness among workers about the dangers of long-term excessive noise and developing laws and regulations regarding loud noise exposure.
8. Severe hearing impairment, as well as hearing loss due to chronic otitis media, can be prevented with timely diagnostics. Examination at the early stages of the disease will allow timely application of conservative or surgical treatment methods, which will be able to preserve the patient's hearing.

Prognosis of hearing loss

The prognosis for hearing loss depends on the degree of damage to the auditory system, as well as the patient's age and the stage at which hearing abnormalities were detected. The earlier hearing system abnormalities are detected and the younger the patient, the better the prognosis for restoring or maintaining hearing organs in an acceptable condition. With mild hearing loss, this can be done much more easily than with severe hearing loss. Also, genetic hearing loss is practically impossible to correct without special intervention or wearing certain hearing aids.

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