SUPPORT TEAM FOR DEAF CHILDREN
Interim Head of Low Incidence Team and Sensory Service
Interim Team Leader – Support Team for Deaf Children
Early Years’ Co-ordinator
Specialist Teachers of the Deaf
Specialist Multi-Sensory Impairment Teacher
Teacher for Children with Additional and Complex Needs
Early Years Teacher
Specialist Early Years Practitoners
Educational Audiology Officer
Department of Children's Services
0-25 SEND Inclusive Education Service
Low Incidence Team and Sensory Service
Support Team for Deaf Children
3rd Floor, Margaret McMillan Tower
Bradford BD1 1NN
Pupils supported by the team
The Team supports the following deaf children from diagnosis (which can be as early as 6 weeks of age) to 19 years old:
- Those with a sensori-neural loss who are hearing aid wearers
- Those with a permanent bilateral hearing loss
- Those with a permanent unilateral hearing loss
- Those with Auditory Neuropathy Spectrum Disorder (ANSD)
- Those with a diagnosis of Auditory Processing Disorder (APD)
More information can be found in the Range Guidance, linked to the Bradford Graduated Response
Support is not provided for those with a temporary conductive hearing loss.
Range of Services
The Team provide qualified and experienced teachers of the deaf to work with both pre-school and school-aged deaf children/students and their families.
The aim of this support is to ensure that the individual needs of deaf children are met within the context of home and school. These needs are identified in partnership with the pupil, parents, teachers and other professionals.
The Team provides:
· Support and information for families to enable them to make informed choices for their deaf children in relation to language development, communication options and educational pathways,
· Support for pupils in mainstream and special schools to access the curriculum
· Support and training to teaching staff and Teaching Assistants
· Contribution to Stages of Assessment and IEP formulation
· Speech audiometry and other assessments as necessary
· Liaison with other agencies
· Advice on classroom acoustics and the need for additional auditory equipment such as radio aids and soundfield systems
· A teacher of the deaf and Specialist Practitioner who speak Panjabi/Urdu
· Deaf Instructor support for pre-school deaf children
· Parent-Toddler Groups that include courses for parents and carers
· Deaf awareness and introductory sign language courses for parents and carers
· Resources which include library, videos, DVDs, information booklets and leaflets
Referrals to the team
Referrals come direct to the Team from Local Health Trusts. For children identified through the Newborn Hearing Screening Programme the Early Years Co-ordinator or Team Leader attends the hospital clinics when the hearing loss is confirmed to parents. Schools
with concerns about a pupil’s hearing are recommended to ask the family to take the child to the GP or ask the school nurse to see the child to determine whether a referral to an ENT consultant is necessary. All referrals will normally receive a response within
10 working days and within 24 hours in the case of a pre-school child.
Parents and schools are also able to refer a child or young person directly to the service using the referral form linked below.
Low Incidence Team Referral Form
The Support Team for Deaf Children
Advice sheets for teachers and support staff
Organisations and useful publications
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How the ear works
The outer ear (pinna) collects sound waves and funnels them down the ear canal. These sound waves cause the eardrum to vibrate, and these vibrations are carried across the middle ear by the small bones (ossicles)
to the oval window and into the cochlea. The cochlea is filled with fluid and contains thousands of tiny hair cells. The vibrations moving the membrane of the oval window cause a wave action in the cochlear fluid and, depending on the frequency of the vibrations,
trigger movement of particular hair cells. The movement of the hair cells creates a small electrical charge which is carried along the auditory nerve to the brain where these signals are interpreted as sound.
If any part of our hearing system is damaged our hearing will be affected, causing a temporary or permanent deafness.
Types of deafness.
This arises when there is a problem within the outer or middle ear, such that sound waves cannot effectively be conducted across them. The most common type of conductive deafness in young children is ‘glue ear’ (otitis media). This occurs when there is a
build up of fluid within the middle ear as a result of the eustachian tube becoming blocked. The incidence of glue ear peaks at 2 and 5 years of age but these problems are generally resolved by the time a child is 7/8 years. In cases where individual occurrences
are long-standing, grommets may be inserted into the eardrum to allow it to drain. Many conductive losses are temporary and for those that are not, surgical intervention or hearing aids might be necessary.
Ear infections and language development
This is when there is a problem in the inner ear, generally because the hair cells in the cochlear are not functioning properly. The result is that sounds need to be louder before they can be perceived and are distorted. A sensori-neural loss is permanent.
Because the damage is located inside the cochlear, a hearing aid can only do so much to help. Whilst an aid can make speech sounds louder they cannot make them clearer and speech will always be distorted to some extent.
A child with a sensori-neural hearing loss can also have a conductive loss such as glue ear. In this case they have a
For more information, download ‘Understanding Deafness’ from NDCS.
Auditory Processing Disorder (APD)
APD is a condition whereby a child, when tested, has hearing within normal limits and yet may struggle to understand speech, particularly in noisy conditions.
What are some of the symptoms of APD?
Children with APD can have difficulties:
• Understanding when listening
• Expressing themselves clearly using speech
• Remembering instructions
• Understanding spoken messages
• Staying focussed
Some children with APD behave as if they cannot hear. Hearing, and listening,
in noisy places can be especially difficult for many children with APD.
Pupils with APD may benefit from the following:
- being seated near the front of the class, close to the teacher
- being able to see a speakers face clearly
- instructions being given clearly, in smaller chunks and at a slower pace than normal
- having background noise kept to a minimum
- having written and other visual cues to support their hearing of speech
- some pupils may benefit from a particular type of radio aid whereby the teacher wears a transmitter and their voice is transmitted directly to the pupils ear canal.
For more information please click on the link below:
Institute of Hearing Research leaflet on APD
There are a variety of hearing tests which can be used, depending on a child’s age and stage of development. Screening tests can be done with a new-born baby to see if it is likely there is a hearing loss. If there is no positive response they can be referred
on to an audiologist who will carry out more detailed tests.
Hearing tests are designed to give us, as far as possible, detailed information of the quietest sounds an individual can hear (their threshold of hearing), for each ear, across a range of frequencies important for speech.
The most commonly used tests are detailed below.
This is commonly used as part of the newborn hearing screening programme. A healthy ear produces a faint response when stimulated with sound. This response can be recorded and lets the tester know if the baby needs to be referred for further assessment.
Lack of a positive response can be due to birth fluid remaining in the ear canal or to high levels of background noise in the area where the baby is being tested.
Auditory brainstem response
This is commonly used when there is no clear response using otoacoustic emissions. Children must be still and quiet whilst this test is carried out and for young babies it will be done whilst they are asleep. For older children, light sedation or a general
anaesthetic are generally required. Three electrodes are placed on parts of the skull and sounds are introduced into the ear canal via headphones or insert earphones. The electrodes can detect a response to these sounds being sent through the cochlea and along
the auditory nerve to the brain.
Visual response audiometry
This is suitable for children from approximately 6 – 30 months of age. Using an audiometer, sounds of different intensity (loudness) and frequencies (pitch) are played through insert earphones, headphones or speakers. When a sound is played the child is
encouraged to turn their head to look at a visual ‘reward’. Once conditioned, the reward is delayed until the child turns in response to a sound, demonstrating that they have heard it.
Pure tone audiometry
This is the gold standard of hearing tests as it can give us all the information we need about a child’s or adult’s hearing. It can be used with children as young as three years of age. Young children are encouraged to perform an action when they hear a
sound (e.g. put a man in a boat) whilst older children and adults will be asked to press a button. Wearing insert earphones or headphones, air conduction testing is carried out which shows the status of the whole hearing system i.e. outer, middle and inner
ear. Using bone conduction, where a vibrator is placed on the mastoid bone behind the ear, the inner ear alone is tested. Any difference between the results of these two tests can show whether a hearing loss is conductive, sensori-neural or mixed.
An audiogram is a graph showing an individuals threshold of hearing. Along the X axis are the frequencies tested, from low to high, and along the Y axis the intensity of the sounds, generally from -10 to 120. Frequencies are measured in Hertz (Hz) and intensities
(on an audiogram) in decibels of hearing loss (dBHL). Normal hearing is between 0 and 20dBHL, where 0dBHL is the average quietest sound which can be heard by young healthy adults with good hearing. Results for the right ear are marked with a red circle and
those for the left with a blue cross. Bone conduction results are marked with a triangle.
An audiogram showing normal hearing is reproduced below.
Degrees of hearing loss
If a child or adult is diagnosed with a hearing loss, the degree of that loss is classified as mild, moderate, severe or profound. The degree is calculated by taking the average of the threshold levels obtained at 250, 500, 1000, 2000 and 4000Hz in
the better ear. Many children have a hearing loss in one ear and normal hearing in the other, in which case they are classified as having a unilateral hearing loss.
Examples of audiograms showing different degrees of hearing loss are shown below.
A moderate hearing loss A severe hearing loss
A profound hearing loss
This link will allow you to listen to a variety of hearing loss simulations.
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Most children who are diagnosed with a hearing loss are issued with hearing aids by their Local Health Trust. These are generally post aural (behind-the-ear) hearing aids though some may need bone anchored (Baha) hearing aids.
Post aural hearing aids
These are digital aids which can be programmed to match the level of hearing loss in each ear. Hearing aids for the right ear are marked with a red spot and those for the left with a blue spot. It is very important that these are worn in the correct ear.
Pupils requiring hearing aids have impressions of their ears taken in the hospital and these are used to make individual
earmoulds. As a child grows, so their ears get larger and they will need new moulds making. For very young babies and toddlers new moulds may be needed every four to six weeks. For older children new moulds will be required less often. Exposure
to the sun makes the moulds and tubing become hard and yellowed, necessitating new moulds. Staff from the Support Team for Deaf Children cannot repair hearing aids or make new earmoulds. The responsibility for these lies with the parents. If a pupil’s hearing
aids are broken, or they are whistling because the moulds are too small, you should contact the parents and ask them to visit the hospital as soon as possible.
Modern hearing aids can have more than one programme: e.g. a start-up programme for 3600 listening in everyday general situations; a listening-in-noise programme where the hearing aid uses directional microphones, picking up
sounds from the front but limiting the amplification of sounds from behind the wearer; a programme for listening to music etc. These additional programmes can be added as the hearing aid wearer becomes able to select the most appropriate programme for a particular
As good as modern hearing aids are, they do have limitations. They are designed for hearing speech when in 1:1 or small group situations. The microphones are effective within a radius of two metres. Beyond that distance their ability to amplify sounds is
greatly reduced. In addition, hearing aids will amplify all sounds picked up by the microphones, not just speech. They therefore make all background noises louder, and the wearer can still have difficulty perceiving and understanding the different
sounds of speech. Pupils with hearing aids may therefore benefit from the use of a radio aid when they are a distance from the speaker.
Inserting a new battery
Bone Anchored Hearing Aids BAHAs
A boneanchored hearing aid is an implanted hearing aid that transmits sound via bone conduction, bypassing the ear canal and middle ear. Sound is conducted through the skull to stimulate the cochlea directly. Conventional bone anchored devices consist of
a titanium implant, an external abutment and a detachable sound processor. A different type uses an implanted magnet with a magnetic detachable sound processor. They are suitable for those with a conductive hearing loss, some of those with a mixed hearing
loss, and those with a unilateral hearing loss.
Bone anchored hearing aids can be worn attached to a softband (headband) which is suitable for children to benefit from the hearing aid without the need for surgery, or for an individual to trial a bone anchored hearing aid prior to surgery.
There are three suppliers of bone anchored devices in the UK:
Cochlear Europe, Oticon Medical and
Models of hearing aids used in Bradford
Audio Input Shoes for Bradford Hearing Aids
Attaching audio input shoe to Eterna
Removing audio input shoe from Eterna
Naida Hearing Aids
Nios Hearing Aids
Checking a Hearing Aid
Hearing aid maintenance equipment for schools
Inserting An Earmould
Connecting to computers
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What is a cochlear implant?
A cochlear implant is a special type of hearing aid, providing a sensation of hearing for deaf children and adults. They are suitable for children who have a permanent, severe to profound hearing loss, who even with modern, powerful hearing aids are unable
to hear the full range of speech sounds.
Traditional hearing aids work by amplifying sounds in the outer ear and sending these sounds through to the cochlea. Vibrations set up within the cochlea generate a series of small electrical impulses which travel via the auditory nerve to the brain. Cochlear
implants provide a sensation of hearing by changing sounds into an electrical signal and sending this to a series of electrodes implanted within the cochlea, stimulating the auditory nerve and sending the signal on to the brain.
What does one look like?
A cochlear implant has two major parts; one external and one surgically implanted in the skull. The external part comprises a microphone, speech processor, lead and transmitting coil. The internal part consists of a receiver and an electrode array which
is placed inside the cochlea.
When are children implanted?
Research has shown that the earlier a child is implanted, often now between the ages of 1 and 2 years, the greater the benefit. Bilateral implants are now becoming increasingly common.
Implants are carried out by regional cochlear implant centres, staffed by surgeons, audiological scientists, teachers of the deaf and speech and language therapists. The implant team will assess children to see if they meet audiological and personal criteria
which might include some or all of the following:
- They have a permanent severe to profound hearing loss
- They are unlikely to benefit from the use of traditional hearing aids
- There are no contra-indications for surgery
- The child has established good hearing aid use which suggests they will wear the implant
- The child is able to co-operate in testing, allowing the implant to be ‘mapped’ (tuned in)
- Parents and local professionals are willing and able to support the child in the use of the implant
What is the process?
A child is assessed at an implant centre and if a cochlear implant is agreed the child requires surgery for the internal parts to be implanted. After approximately four weeks, allowing time for the wound to heal,
the child returns to the implant centre for it to be ‘switched on’. Mapping (or tuning) the implant requires the child to be able to respond when a sound is ‘heard’. The audiological scientist will seek to establish a ‘map’ whereby, for each of the active
electrodes, a threshold and comfort level are established. A threshold level is the lowest electrical level which results in the child being aware of a sound and the comfort level the highest electrical level which results in a sound being heard as loud but
not uncomfortably so. This ‘map’ will be refined over successive visits to the centre as the child becomes more familiar with the implant and his/her awareness of a range of sounds.
Yorkshire Cochlear Implant Service
Basic Guide to Operating Nucleus Freedom Processor
Troubleshooting the Freedom Processor
British Cochlear Implant Group
Handbook for Educators Med-El
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Radio Aids (FM systems)
Listening in school can be problematic as hearing aids are not designed for that situation. There are three major issues:
- The distance between the pupil and the teacher (hearing aids are only effective up to 2 metres)
- Hearing aids pick up and amplify those sounds which are closest to them, which is not necessarily the teacher’s voice
- High levels of background noise and/or reverberation make it more difficult for a pupil to hear and concentrate on what the teacher is saying
Radio aids help to alleviate these problems as they allow the pupil to hear the teacher’s voice as if they were standing next to them.
A radio aid consists of two parts
- A transmitter worn by the speaker (generally the teacher)
- A receiver worn by the pupil
The teacher’s voice is transmitted via radio waves directly to the pupil’s hearing aid(s) on a specific frequency. It is important that if two or more pupils are using a radio aid in different classrooms that they are each on a different frequency. If there
are occasions when pupils need to be on the same frequency, for example for an assembly, then the radio aids can be set up to allow frequencies to be changed by the pupil or their teacher.
Transmitters need an aerial to send the signal. This may be incorporated into the microphone lead or it may be a separate wire which hangs down from the transmitter. It is important that these are fully unwound in order for the signal to
Many receivers now are very small and attach to the bottom of the hearing aid via an audio input shoe. Each type of hearing aid has its own unique audio input shoe. As the receiver is very small it does not have its own battery source but
draws from the hearing aid battery. The hearing aid batteries will therefore not last as long as when no radio aid is used.
Attaching audio input shoe to Eterna
Removing audio input shoe from Eterna
Fitting a shoe and receiver
It is important that the radio aid is effectively managed by the teacher.
- It should be switched ON whenever the pupil is being taught, either as part of the whole class or in a small group.
- It should be switched OFF whenever the teacher is not speaking to the pupil directly or as part of a group.
- Leaving the transmitter switched on inappropriately means that the pupil is constantly being distracted by the teacher talking to others.
Connecting the radio aid to other equipment
It is possible to connect an audio lead to the transmitter. The other end of the lead can then be plugged into any device with a headphone socket e.g. a computer, keyboard or cd player. This allows the pupil to hear a much better quality sound.
Radio aid models issued by STDC
Wearing EasyLink & ZoomLink transmitters
Wearing an Inspiro transmitter
EduLink User Guide
Radio Aid loan form for Schools
NDCS Radio Aid Guide
NDCS Radio Aid factsheet
NDCS Quality Standards for FM
Otto Discovers FM
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Advice sheets for teachers and support staff
Advice for pupils with a mild hearing loss
Advice for pupils with a conductive hearing loss
Advice for pupils with a mixed hearing loss
Advice for pupils with a unilateral hearing loss in their right ear
Advcie for pupils with a unilateral hearing loss in their left ear
Advice for pupils who wear hearing aids
Advice for pupils who use a radio aid
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Classroom Acoustics: A Brief Guide
Information on Classroom Acoustics to Support Quality First Teaching
Pupil Interview and Noise Survey for School Staff
NDCS Acoustic Toolkit - Introduction
NDCS Acoustic Toolkit - Schools Noise Survey
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What is a soundfield system?
It is basically a low powered public address system. It comprises a microphone connected to a radio transmitter, an amplifier and a number of loudspeakers (generally 4) placed around the room. The speaker’s voice (usually the teacher’s) is amplified and
fed through the loudspeakers. The teacher is able to talk at a normal conversational level, yet their voice is heard at a constant level by all pupils in the class, irrespective of where they are sitting. Soundfield systems are used widely throughout the United
States, and are increasingly finding favour in this country. A number of schools in Bradford have installed such systems and are pleased with the results.
Why are these necessary?
There are mainly three reasons why we might experience difficulty in hearing a speaker.
- Speaker-listener distance. The level of a teacher’s voice (or any source of sound) decreases as we move further away. Pupils near the front may be able to hear comfortably but not so those at the back of the class. Teachers can only compensate for this
by raising the level of their voice. As teachers move around the room pupils will find it easier/harder to hear.
- Reverberation times. Many classrooms have very poor acoustics. Hard floors, large area of glass, high ceilings and few soft furnishings lead to high reverberation times (echo). This affects our ability to understand speech.
- Signal-noise ratio. Levels of background ‘noise’ (anything that stops or interferes with being able to hear a particular sound clearly) tend to be high. Such noise can be from within the classroom, from adjacent halls/corridors and/or environmental noise
What are the benefits?
A soundfield system can help in reducing the effects of the three factors highlighted above, though if the acoustics in a classroom are particularly bad this should be treated first before installing a soundfield system..
For the teacher: Research shows that a soundfield system greatly reduces the amount of vocal effort required to make him/herself heard over the level of background noise. This leads to a subsequent reduction in the frequency and severity of voice/throat
problems and therefore time off. Teaching unions have recognised vocal strain as a problem for teachers generally.
For the pupils: ALL pupils will benefit. Research has shown benefits for the following groups of pupils:
- Children with a hearing loss, particularly those with a conductive loss.
- Children with Attention Deficit Hyperactivity Disorder (ADHD).
- Children with Central Auditory Processing Disorder (CAPD).
- Children for whom English is an additional language.
- Younger children who are still developing language.
- Children with ‘glue ear’ or some level of hearing loss.
Many people have reported that the use of a soundfield system has led to a reduction in overall noise levels in the classroom which can to some extent alleviate poor acoustic conditions.
Where can I get more information?
Please see the websites listed below. These include a number of companies who produce soundfield systems.
If you would like to discuss the use of these systems, please contact Sue Marsden, Head of Team
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Organisations and Useful Publications
National Deaf Childrens Society
The NDCS provide support and information for deaf pupils, their parents/carers and for professionals working with deaf babies, children and young people in homes and schools.
Membership is free to all those listed above and you can join quickly and easily online - just click on the link above. Once you are a member there are a wide variety of publications which you can order or download. Some of those
which may e useful are listed below.
Bone anchored hearing aids
Bullying and deaf children
Cochlear implants: a guide for families
Deaf children with additional needs
Deaf friendly nurseries and pre-schools
Deaf friendly schools
Deaf friendly teachers training pack
Deaf friendly teaching
Down’s syndrome and childhood deafness
Glue ear: a guide for parents
Individual education plans
Playtime and deaf children
Starting secondary school
Tips for communicating with deaf children
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Ling 6 Sounds
The Ling 6 sounds are a quick and easy way to check that a child's hearing aids or cochlear implant are working. The sounds have been chosen because they span the frequency range important for speech. With your mouth
hidden (to prevent lip-reading) you make the sounds in a random order and the child is required to point to the correct picture. Children can learn how to do this in a short time and it can then be used for daily checks. It is necessary to establish a baseline
of which sounds a child is able to hear. If, on later testing, a child is unable to correctly identify a sound which previously they had shown they could, then it is possible that the aid is faulty. Older pupils can be asked to repeat the sound rather than
point to the picture.
Advice for settings working with young children who have a hearing loss:
Early Years Support Ideas