General Information Of Hearing Impairment

Hearing is the ability to perceive sound. A person suffering from hearing impairment has difficulty in perceiving or identifying sound clearly due to auditory problems. The impairment may be unilateral or bilateral.

The degree of hearing loss can be classified into five levels as listed below


Difficult to identify soft sound such as whispering.


Unable to hear clearly what others are saying during conversation. Hearing aids are necessary.

Moderately to Severe

Unable to clearly hear loud noises such as telephone ring.


Can only hear very loud noises and sounds such as shouting or vacuum cleaner noise.


Difficult to perceive any sound.

Symptoms of  Hearing Impairment

During infancy

  • 1-3 months old no response to sudden sound such as banging of door or ringing of doorbell.
  • 4-6 months old Unable to locate the sound source.
  • 7-9 months old do not look at the person being mentioned.
  • 10-12 months old no response to their names being called or frequently used words or phrases, e.g. “No”.

During childhood

  • Delayed response to sound.
  • Cannot hear clearly what others are saying.
  • Show difficulty in locating the sound source.
  • Pay more than usual attention to speakers’ facial expression and lip movement while listening.
  • Give irrelevant answers or misinterpret instructions.
  • Request for repetition during conversation.
  • Show poorer ability to understand speech ` in a noisy environment.
  • Tend to turn up the sound volume of television.
  • Incorrect pronunciation.
  • Delayed language development.
  • Poor attention in class.
  • Frequent use of gestures to express themselves, e.g. pointing to what they want.
  • Easily irritated as a result of communication difficulty.
  • Parents should be alert to the possibility of hearing impairment if their child shows the above signs, and seek medical advice as soon as possible.

Causes of  Hearing Impairment

Congenital factors

  • Heredity.
  • Viral infection during pregnancy, e.g; rubella infection.
  • Congenital defects such as anomalies of the ear, nose or throat.
  • Premature birth, birth asphyxia, excessive bilirubin, etc.

Acquired factors

  • Excessive earwax.
  • Eardrum perforation.
  • Middle ear effusion or infection.
  • Otosclerosis or ear ossicle dislocation.
  • Sequelae of childhood diseases such as measles and meningitis.
  • Head or ear trauma.
  • Prolonged exposure to loud noise.
  • Medication that may lead to hearing damage.

Affect of Hearing Impairment on Children’s Development


Delayed language development with unclear speech and incorrect pronunciation.

Emotion and behavior

Easy to have emotional and behavioral problems as a result of difficulties in verbally expressing himself/ herself.


Lack of self-confidence with poor self-image for being always mistaken to be slow in response.

Social interaction

Socially excluded by peers due to poor comprehension and expression, or actively avoid social contact and communication.

Academic performance

Academic performance being affected due to difficulty in receiving the correct messages.

Can hearing impairment be cured?

This depends on which part of the auditory system is affected. If the impairment is incurable, the child may need to use a hearing aid or receive a cochlear implant, depending on the nature of the lesion. With the help of appropriate auditory and speech training, even children with severe hearing impairment could gradually show improvement in response to sound.

How can children’s hearing be protected?

  • Cover the ears in noisy environment, such as construction sites where pile drivers are used, and avoid staying in such places for too long.
  • Do not shout directly at children’s ears.
  • Do not play loud music to the child for prolonged periods.
  • Do not bottle feed infants lying on their backs to avoid back flow of milk into the nasopharynx, leading to otitis media.
  • Be careful in the use of prescription drugs.
  • Seek immediate treatment in case of high fever or upper respiratory tract infection.
  • Do not hit or slap children on their ears. Avoid picking ears or putting foreign objects into ear canals. Those with family history of congenital hearing          impairment should seek genetic counseling. Women should ensure that they have received rubella vaccination before pregnancy.