Hearing impairment

Hearing impairment is a decrease in a person's ability to catch environmental sounds in partial or full volume. Some decrease in the ability to perceive and understand sounds is called deafness, and the total loss of hearing ability is deafness.

Hearing loss is divided into neurosensory, conductive and mixed. Deafness, like deafness, is of an innate and acquired nature.

Sounds are sound waves that differ in frequency and amplitude. Hearing disorders of a partial nature are manifested in the inability to perceive certain frequencies or to differentiate sounds with low amplitude.

[1], [2], [3], [4]

Causes of hearing impairment

The causes of hearing loss are of different nature:

1. Infectious diseases of the acute nature that the mother of the child was exposed to during pregnancy, which include influenza, rubella, epidemic parotitis. Elevated blood pressure in the mother during the intrauterine period of the child can also cause a violation of his hearing.
2. Abuse of the mother during pregnancy with medications (especially loop diuretics, aminoglycosides, streptomycin, gentomycin), alcoholic beverages or narcotic substances.
3. Birth trauma of a different nature and different birth deflections:
   • the weight of the baby is less than one and a half kilograms;
   • births that began before the thirty-second week;
   • insufficient oxygen during birth or prolonged retention of breathing after birth;
   • damage to the baby during labor of a mechanical nature.
4. Hereditary (genetic) hearing impairments.
5. Infectious diseases that were transferred by the child in the early age period, namely meningitis, encephalitis, measles, rubella, mumps, flu, and so on.
6. Certain diseases, which include Ménière's disease, otosclerosis, acoustic neuroma, Mobius syndrome, multiple congenital arthrogryposis can cause damage or loss of hearing.
7. Complications of chronic inflammatory processes of the ear (otitis) are also impaired hearing.
8. Constant exposure to noise for a long period of time can cause hearing loss, especially at high frequencies.
9. Acoustic injuries, namely, the presence in the areas of sudden shots and explosions.
10. The consequences of accidents and various accidents may be hearing impairment.
11. Postponed chemotherapy can also cause a decrease in hearing.
12. Age changes to which the snail and the central auditory system are susceptible. Moreover, these processes can proceed unnoticed after thirty years.

[5], [6], [7]

Acquired hearing impairment

Acquired hearing impairments are auditory dysfunctions that can occur at any age under the influence of the following factors:

• The consequences of diseases of an infectious nature, namely, meningitis, measles, mumps.
• Chronic infectious processes in the ears, which cause not only hearing impairments, but also, in some cases, life-threatening diseases, such as brain abscesses or meningitis.
• Middle otitis media, which causes accumulation of fluid in the middle ear.
• The use of ototoxic medicines for therapeutic purposes, namely, antibiotics and antimalarial drugs.
• There are injuries of the head or ear.
• The impact of a strong noise of a sudden or prolonged nature - interaction with noisy equipment, loud music and other excessively loud sounds, as well as shots and explosions.
• Degeneration of sensory cells that occur due to age-related changes.
• The presence of earwax, as well as any foreign bodies in the external auditory canal. Such problems with hearing are easily corrected by cleaning the auditory canal from such substances.

[8], [9], [10], [11], [12]

Hearing impairment in otitis

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

Otitis of the middle ear of chronic form is the main cause of hearing problems in childhood.

Otitis in children and adults is sometimes accompanied by damage to the tissues of the external and middle ear. With external otitis infection gets through small skin lesions, which are formed after damage to the auditory shell of the external ear. Such changes arise due to 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, some diseases, including diabetes mellitus, gout, hypovitaminosis and other metabolic disorders, may be factors that provoke external otitis.

The middle otitis is caused by infectious diseases of the nasopharynx, in which pathological microorganisms enter the middle ear cavity with the aid of an auditory tube. These include influenza and parainfluenza viruses, adenovirus and rhinovirus, respiratory syncytial virus, as well as pneumocampe bacteria, pyogenic streptococcus, morocell and hemophilic rod. Small children are especially prone to the occurrence of otitis media, due to the fact that the auditory tube is shorter and wider. Infection in the otitis media of the middle ear can also penetrate outside as a result of mechanical injuries and barotrauma of the tympanic membrane. Provoke the emergence of the disease and chronic infections in the nasopharynx, namely, chronic tonsillitis, sinusitis and adenoid disease.

During the course of external otitis inflammatory process primarily begins in the superficial layers of the auricle, and then it can develop in the surrounding tissues and tympanic membrane.

During the course of the otitis media of the middle ear, the mucous membrane begins to inflame and produce exudate (a certain fluid that is released during inflammation of the tissues). Exudate can have a serous form, which is typical for viral infections, or purulent form, which is due to its bacterial nature. The accumulation of fluid in the middle ear begins to protrude 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 disorders 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 violation of the hearing.

Otitis, which is untreated, and their constant recurrences cause the appearance of scars in the middle ear tissues, which lead to a decrease in the mobility of the auditory ossicles and the elasticity of the tympanic membrane. This causes deafness in people of different age categories. Inflammatory processes, which are of a protracted nature, 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

Hearing impairment acquired character in an overwhelming amount does not manifest suddenly. It happens, of course, that the patient shows a sudden hearing loss, progressing for several hours. Usually, hearing symptoms develop for several or many years. In this case, the first signs of hearing loss are almost invisible, and the symptoms have differences in different categories of people.

The primary symptoms of hearing loss are:

1. Increased requests of the patient to repeat again the words spoken by the interlocutor.
2. Increase the volume of the computer, TV or radio above normal volume.
3. There is a feeling that all the surrounding people speak unintelligibly and indistinctly.
4. There was a feeling that some voices became more difficult to understand, especially high ones - feminine and childish.
5. Constant strain of hearing during conversation and increased fatigue from talking with other people.
6. The termination of visits to meetings of people and other collective events. This also applies to other social events that previously delivered positive emotions.

Symptoms of hearing impairment in childhood include the following:

• Absence of reaction to external noises, both in the ordinary state, and when carried by any activity - playing, drawing, and so on.
• The lack of response to loud sudden noise during sleep in the form of awakening and the continuation of a quiet sleep.
• Impossibility to determine the source of sound.
• Lack of imitation of sounds.
• Frequent ear infections and inflammation.
• Seen problems of understanding the speech of surrounding people.
• Has a delay in the development of speech or inconsistency in the level of speech development age parameters.
• Lag from peers with participation in group games.

Congenital hearing loss

Congenital hearing impairments are such dysfunctions of the auditory system that are associated with a decrease in hearing or loss of hearing, found at the birth of a child or soon after it was born.

The causes of congenital hearing disorders include:

1. Hereditary genetic factors.
2. Non-hereditary genetic features.
3. Complications during pregnancy, which are caused by mothers having syphilis, rubella, mumps, and others.
4. The low birth weight of the newborn is less than one and a half kilograms.
5. Received asphyxiation in the process of birth, that is, a strong lack of oxygen.
6. Maternal use during pregnancy of ototoxic drugs, namely, aminoglycosides, diuretics, antimalarial medicines, cytotoxic drugs.
7. Postponed by an infant in the neonatal period, severe jaundice, which can cause damage to the auditory nerve in the child.

[13], [14], [15], [16], [17]

Genetic hearing impairment

Genetic hearing impairment can fall into two categories:

• non-syndromic (isolated),
• syndromic.

Nonsyndromal disorders include hearing loss, which does not have any other accompanying symptoms that are inherited. Such hearing impairments occur in seventy percent of cases of deafness due to heredity.

Syndromic hearing impairments are caused by a decrease in hearing in combination with other factors, for example, diseases of other organs and systems. Syndromic abnormalities occur in thirty cases of deafness due to heredity. In medical practice, there are more than four hundred different syndromes, one of the manifestations of which is deafness. Such syndromes include:

• Usher syndrome - simultaneous disturbance of auditory and visual systems,
• Pendred's syndrome - in which the deafness is combined with hyperplasia of the thyroid gland,
• Gervell-Lange-Nilsson syndrome-causes a combination of deafness and cardiac arrhythmia with the appearance of a larger interval of QT,
• the syndrome of Waardenburg - describes the violation of the auditory system in combination with the appearance of pigmentation.

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

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

In modern medicine, more than a hundred genes have been identified, which, when mutated, are responsible for hearing impairment. Each population of people has its own specific mutations that are different from other populations. But it can be noted with certainty that in about a third of cases of genetic hearing impairments the cause of such negative transformations is the mutation of connexin 26 (GJB2) gene. The European race is most susceptible to the gene mutation of 35delG.

Hearing Impairment in the Elderly

Most people with acquired hearing impairments are elderly or senile. Hearing impairment in the elderly is associated with age-related changes, which result in degenerative transformations in the hearing organs. Hearing changes due to age concern all parts of the auditory system, beginning from the auricle and ending with the zone of the auditory analyzer in the cerebral cortex.

Deafness in elderly people is a complex and complex process, which is carefully studied by specialists. The elderly hearing loss is called the term "presbiakusis" and is divided into two types:

• conductive,
• sensorineural.

The conductive appearance of senile hearing loss is caused by changes in the degenerative nature that occur in the middle ear, as well as a decrease in the elasticity of the skull tissues.

The sensory-neural kind of senile hearing loss has four subspecies, caused by various causes:

• sensory - caused by the 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 - due to atrophic changes in the vasculature, 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. Three types of hearing disorders of an age-related nature are described:

• Presbyacusis is a deafness caused by internal factors of a genetic and physiological nature,
• sotsiokusiya - deafness, which is due to external factors that contribute to severe wear of the organs of the auditory system,
• professional noise hearing loss - hearing impairment, which occurs under the influence of strong industrial noise at the place of work of the individual.

Features of children with hearing impairment

In hard of hearing children there are significant differences in psychophysiological and communicative development. These features of children with hearing impairment prevent them from developing at the same speed as peers, and also cause problems in mastering knowledge, vital skills and skills.

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

In children with hearing impairment, there may be other violations, namely:

1. Problems with the functioning of the vestibular apparatus.
2. Various visual defects.
3. Dysfunction of the brain is minimal, which leads to inhibition of the overall development of the psyche.
4. Extensive brain damage that causes oligophrenia.
5. Defects in the brain systems that lead to the appearance of infantile cerebral palsy and other movement disorders.
6. Disturbances in the functioning of auditory and speech zones in the brain.
7. Diseases of the central nervous system and the body as a whole, which cause severe mental illness - schizophrenia, manic-depressive psychosis and so on.
8. Diseases of internal organs of a serious degree (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 impairment and children, which depend on the degree of loss of the ability to perceive and process sounds:

• hearing loss, which affects children who are hard of hearing,
• deafness.

With hearing loss, the perception of speech, but only said loudly, articulate and close to the ear, is preserved. Although, of course, the capabilities of this child to full-fledged speech communication with others are limited. Deafness is different in that it perceives certain tones of speech without the ability to perceive and distinguish the speech itself.

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

The most important factors that affect the development of speech of children with hearing impairment are:

• Degree of hearing loss - children with auditory impairment speak worse as poorly as they hear.
• The age period of the onset of a pathological hearing disorder - the earlier the hearing defects arose, the harder it is to disturb speech, until the appearance of deafness.
• Conditions for the development of the child and the presence of correct psychocorrectional measures - the earlier special measures are used to develop and preserve the correct speech, the higher the effectiveness.
• Physical development of general character and mental development of the child - a more complete speech is noted in children with good physical development, good health and normal mental development. In children with weakened health (passive, flaccid children) and mental disorders, there will be significant defects in speech.

[18], [19], [20]

Classification of hearing disorders

Hearing impairment can be divided into several types:

• Conductive - arising from the blockage of any quality that appears in the outer or middle ear. In this case, sound can not normally penetrate into the inner ear.
• Neural - are due to a complete loss of brain ability to perceive and process electrical impulses. In some cases, the brain can not correctly decipher the received signals. These disorders include "auditory dissynchronization" or "neuropathy."
• Sensory - appear if there are dysfunctions of the hair cells of the inner ear. As a result, the snail can not normally pick up sounds.
• Sensoneural - combined disorders in which there are dysfunctions of hair cells, as well as large inaccuracies in the perception and processing of brain signals of sound nature. Such types of violations are persistent, because it is almost impossible to establish how a snail and brain participate in hearing loss. The greatest difficulty in the correct diagnosis is noted when examining small children.
• Mixed - these include the synthesis of sensorineural and conductive disorders. With such a hearing loss, the sound signals can not normally be transmitted from the outer and middle ear to the inner ear, and there are disturbances in the functioning of the inner ear, brain zones and neural parts of the hearing system.

[21], [22], [23], [24], [25]

Classification of Preobrazhensky hearing impairment

In modern practice, there are several classifications of auditory disorders. One of the most popular is the classification of hearing disorders by Professor BS Preobrazhensky. It is based on the level of perception of oral loud speech and speech, whispered. The study of the perception of loud speech is necessary due to the fact that it contains elements of whisper 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. An easy degree is characterized by the perception of spoken speech at a distance of six to eight meters, and whispered from three to six meters. Moderate degree of hearing loss is diagnosed when spoken language is perceived at a distance of four to six meters, a whisper is from one to three meters. A significant degree of auditory disorders is determined by understanding spoken language at a distance of two to four meters, and a whisper speech - from the auricle to one meter. Severe degree of auditory disorders is allocated in the case of understanding spoken language at a distance from the auricle to two meters, and whispering - from complete misunderstanding to discrimination at a distance of half a meter.

[26], [27], [28]

Conductive and sensorineural hearing impairment

Conductive hearing impairments are characterized by a worsening of the conduction of sounds due to defects in the outer or middle ear. Normal conductivity of sound signals is provided only by properly functioning auditory meatus, tympanic membrane and earbone. In case of any violations of the above mentioned organs, there is a partial decrease in hearing, called deafness. With partial hearing loss, there is a certain deterioration in the ability to perceive sound signals. Conductive hearing loss allows you to recognize speech if an individual is able to hear it.

Conductive hearing impairments result from:

• impassability of the auditory canal,
• anomalies in the structure and functioning of the middle ear, namely the tympanic membrane and / or ear pits.

Sensorineural hearing impairments are caused by defects in the functioning of the inner ear (cochlea), or by a malfunction in the proper functioning of the auditory nerve, or by the lack of the ability of certain brain zones to perceive and process sounds. In the first case, a pathological deformation of the hair cells is observed, which are located in the corti's organ of the cochlea. In the second and third cases, sensorineural hearing impairments are caused by the pathology of the VIII cranial-cerebral nerve or the brain regions that are responsible for the auditory system. In this case, a fairly rare phenomenon is the disruption of the functioning of exclusively auditory zones of the brain, which is called the central hearing disorder. In this case, the patient can hear normally, but at such a low quality of sound that he can not understand the words of other people at all.

Sensingural disorders of the auditory system can lead to deafness of various degrees - from low to high, as well as to hearing loss in full. Experts believe that sensorineural hearing loss is most often caused by pathological changes in the functioning of the cochlear hair cells. Such degenerative changes can be both congenital and acquired. With the acquired transformations, they can be caused by infectious diseases of the ears, or noise injuries, or a genetic predisposition to the appearance of anomalies in the auditory system.

[29], [30], [31], [32]

Violation of phonemic hearing

Phonemic hearing is the ability to distinguish between language phonemes, 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; of them are the structural components of speech - morphemes, words, sentences.

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

Violations of phonemic hearing are found in children and adults. The causes of the violation of phonemic hearing in children are as follows:

1. Absence of the formation of acoustic images of individual sounds, in which phonemes can not differ in sound, which causes, when speaking, the replacement of some sounds by others. Articulation is not fully adequate, because not all sounds a child can pronounce.
2. In some cases, the child can articulate all sounds, but at the same time, he does not know how to distinguish what sounds he needs to pronounce. In this case, the same word can be pronounced by the child in different ways, because the phonemes are mixed, which is called mixing phonemes or interchange of sounds.

In case of hearing impairment, the child has a sensory dyslasia, which means that it is impossible to pronounce sounds correctly. There are three forms of dyslalia:

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

Acoustico-phonemic dyslasia is characterized by the presence of defects in the design of speech with the help of 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 disorders of the auditory system, that is, there is no hearing loss or deafness.

Violation of the phonemic hearing in adults is due to local brain lesions, namely:

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

Light cases of sensory temporal aphasia are characterized by the understanding of individual words or short phrases, especially those that are used daily and refer to the constant routine of the patient's day. In this case, a disorder of phonemic hearing is observed.

Severe cases of sensory aphasia are characterized by complete incomprehension of speech by a sick person, words cease to have a meaning for him and turn into a combination of incomprehensible noises.

Sensory aphasia, expressed in the defeat of the nuclear zone of the sound analyzer, not only leads to a violation of the phonemic hearing, but also to a serious 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 do not have active spontaneous speech, it is difficult to repeat the words they heard, the letter under dictation and reading is broken. We can conclude that due to the violation of the phonemic hearing, the whole system of speech is pathologically transformed. In these patients, the ear for music is preserved, as is the articulation.

Conductive hearing impairment

Conductive hearing impairments are caused by the impossibility of its conduction in normal form through the auditory passage due to disorders in the outer and middle ear. The features of conductive hearing loss were described in the previous sections.

[33], [34], [35]

Diagnosis of hearing loss

Diagnosis of hearing impairments is carried out by various specialists - audiologists, audiologists, otorhinolaryngologists.

The hearing test procedure is as follows:

• The patient, first of all, is consulted by a hearing therapist. The doctor performs otoscopy, that is, examination of the external ear along with the tympanic membrane. The purpose of this examination is to identify or disprove the mechanical damages of the ear canal and tympanic membrane, as well as the pathological conditions of the ears. This procedure does not take much time, besides it is absolutely painless.

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

• Carrying out tonal audiometry, in which it is necessary to recognize different sounds that differ in frequency and loudness. As a result of the examination, a tonal audiogram appears, which is only a given person's inherent characteristic of auditory perception.
• Sometimes it is necessary to conduct speech audiometry, in which the percentage of words that a person can discern at a different loudness of their utterance is established.

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

• Impedanceometry or tympanometry, which allows to diagnose disorders in the middle ear. This method allows you to fix the level of mobility of the tympanic membrane, as well as confirm or deny the presence of pathological processes in the middle ear.
• The registration of otoacoustic emission evaluates the condition of the hair cells, which help establish the quality of the inner ear's cochlea.
• The registration of evoked electrical potentials determines the presence or absence of damage to the auditory nerve or brain areas responsible for hearing. At the same time, changes in the electrical activity of the brain are recorded on the transmitted audio signals.

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

[36], [37], [38], [39]

Treatment of hearing impairment

Treatment for hearing loss is done using the following methods:

1. Appointment of medicinal products.
2. Use of certain methods of speech and speech therapy.
3. Constant exercises of auditory and speech development.
4. Application of hearing aid devices.
5. Use of the recommendations of the psychoneurologist for the stabilization of the psyche and the emotional sphere of the child.

Logopedic work in case of hearing impairment

Logopaedic work in case of hearing impairment is of great importance, since speech-impaired children associated with pronunciation are observed in hearing impaired children. Speech therapists organize classes in such a way as to improve the articulation of the child and to achieve the natural utterance of words and phrases. At the same time, various speech therapy methods of a general nature are used and chosen specifically, taking into account the individual characteristics of the child.

LFK in case of hearing impairment

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

To improve the acuity of hearing in deaf children, special exercises are used that train the quality of perception of sounds.

Treatment of phonemic hearing disorders

Treatment of the violation of phonemic hearing in children is carried out in a complex way:

• Special speech therapy exercises are used that develop the quality of speech perception and speech in children.
• A special logopedic massage is shown, which is done by articulatory muscles. Such massage is carried out with the help of special probes and normalizes the tone of the muscles for correct pronouncing of sounds.
• Microcurrent reflexotherapy - activates the speech zones of the cortex of the cerebral hemispheres, which are responsible for understanding speech, the possibility of correct structuring of sentences, for developed vocabulary, good diction and the desire for communicative contact.
• Special logarithmic exercises are used in groups and individually.
• The general musical development is shown, which includes singing, rhythmic rhythm training, music games and learning to play musical instruments.

Raising children with hearing impairment

The upbringing of children with hearing loss is carried out by parents, as rehabilitation of the baby. Great importance for the formation of the correct mental and other processes, as well as the personality of the child have the first three years of his life. Since at this time babies generally spend time with their parents, correct behavior of adults is of great importance for correcting defects in child development.

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

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

The upbringing of such children should take place in accordance with the recommendations and under the supervision of surdpsiologists and surdopedagogists. In this case, parents should apply corrective methods, which are recommended by specialists.

Teaching children with hearing impairment

Training of children with hearing impairment should be carried out in special pre-school and school institutions. In these institutions, competent specialists will be able to provide correct correctional assistance, as well as apply correct teaching methods for these children. In mass schools, the child will be assisted by specialists who work in special classes or groups organized for such children.

In kindergartens for children with hearing loss, corrective work is carried out with the kids, ranging from one and a half to two years. Attention pedagogical impact is the overall development of the child, namely his intellectual, emotional-volitional and physical characteristics. At the same time, all the spheres that need to develop in ordinary, well-hearing children are involved.

The educational process with children with hearing impairment is directed to great work on the development of speech, its pronunciation component, as well as correction of residual hearing and the development of verbal and other thinking. The educational process consists of individual and group sessions, the use of choral recitations accompanied by music. Then lessons are added for the development of speech, in which amplifiers and hearing aids are used.

Literacy in these children begins at the age of two. At the same time, the work is done purposefully and constantly - the kids are taught to read and write using printed letters. Such teaching methods allow the development of speech perception at a full level, as well as the normal level of speech reproduction (as in healthy children) through writing.

Rehabilitation of children with hearing impairment

The main task of surdpsihologov and surdopedagogists dealing with children with hearing impairment is the disclosure of their compensatory capabilities and the use of these mental reserves to fully overcome hearing defects and to obtain the necessary education, full socialization, as well as inclusion in the process of professional activity.

Rehabilitation work with children with hearing loss should be conducted fully and begin as early as possible. This is due to the fact that from the early and preschool age there is a gap in children with these problems from their peers. This is manifested in the insufficient level of development of activities, and in the possibility of communication with adults. It can also be noted that in children with hearing loss there is an 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 children with hearing impairment, the preservation of the intellect and the cognitive sphere, as well as other sensory systems and regulatory systems, is of great importance.

In the faculty of pedagogy there is a stable point of view that the possibilities for the rehabilitation of deaf and hard of hearing children have practically no borders. This does not depend on the degree of severity of the hearing defect, the early diagnosis of hearing impairment and the same pedagogical and psychological correction are important. The most important time for rehabilitation is the age of birth to three years.

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

Dealing with hearing impairment

People with hearing impairment need this type of professional activity, where minimal communication with other people is required, reliance on eyesight, not on hearing, lack of prompt reaction of behavior and speech.

Work for people with hearing impairment can include the following professions:

• PC operator
• Web Designer
• Programmer
• Specialist of service centers for equipment repair
• Specialists in hardware control of equipment in industrial enterprises
• Accountant
• Archivist
• Storekeeper
• Cleaner
• Janitor

[40], [41], [42]

Prevention of hearing impairment

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

Preventive measures include the following:

1. Carrying out immunization measures 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. Implementation of diagnostic procedures with pregnant women in order to exclude them from having infections: syphilis and others.
4. Carrying out careful monitoring of the doctor using ototoxic drugs; inadmissibility of independent use of these medicines without the appointment of a specialist.
5. Conduct an early hearing test in newborns at risk:
   • having deaf close relatives,
   • born with very low weight,
   • affected asphyxia at birth,
   • who had recovered jaundice or meningitis in infancy.
6. An early examination allows you to correctly diagnose and timely begin proper treatment.
7. Termination (or at least reduction) of exposure to prolonged strong noises, both at the workplace and at home. Preventive measures at work include the use of personal protective equipment, as well as raising the awareness of workers and the danger of prolonged excessive noise and the development of laws and regulations for severe noise effects.
8. Severe hearing impairment, as well as its loss due to chronic otitis media of the middle ear can be prevented with the help of a timely diagnosis. Examination in the early stages of the disease will allow us to apply conservative or surgical methods of treatment in time, which will save the patient's hearing.

Forecast of hearing impairment

The prognosis of hearing loss depends on the degree of damage to the auditory system, as well as the age of the patient and the stage of detection of abnormalities in hearing. The earlier the anomalies of the auditory system are fixed and the younger the age of the patient, the better the predictions for the restoration or maintenance in an acceptable state of the work of the hearing organs. With light degrees of hearing impairment, this can be done much easier than with severe degrees of impairment. Also, genetic hearing impairments are practically unverifiable correction without special intervention or wearing of certain hearing aids.

[43], [44], [45], [46], [47], [48], [49], [50], [51], [52]