Start with the Brain and Connect the Dots - The Logic Chain

Hearing First commissioned Dr. Carol Flexer, Distinguished Professor Emeritus of Audiology, University of Akron. I am so fortunate to have first met Carol in my junior year at the U of Akron. Carol took me under her wings, guided and coached me and I studied under her throughout graduate school, my CFY and the early years of my career. I am still learning from her today. 

 Dr. Carol Flexer has gathered, analyzed and synthesized the latest supporting research surrounding how children with hearing loss develop literacy through LSL. As a result of her work, a white paper has been created that features a logic chain comprising of research to connect the dots between basic brain biology and the development of literacy during elementary school.

Download the document to read the research and learn how children with hearing loss develop literacy through Listening and Spoken Language (LSL).

The Family That Paved the Way for Me Supporting Families of Children with Hearing Loss

AGBELL Convention June 2014 Orlando

As an undergraduate student at the University of Akron, I met Charlie and Betty Lim the parents of Stacey a 15 month old who set their goal for their daughter to learn to listen and talk. They introduced me to Helen Beebe and Doreen Pollack, Auditory-Verbal pioneers in the US who exploited the belief that most “deaf” children had some remaining hearing that coupled with the advent of wearable hearing aids, allowed auditory teaching so that children who were deaf or hard of hearing could learn to listen, to process verbal language, and to talk.

I spent numerous Sunday afternoons at the Lim’s home watching reel-to-reel tapes of Helen and Doreen in therapy and then trying to mimic the lessons with their daughter Stacey. Soon, Dr. Carol Flexer (www.CarolFlexer.com) today a world-renowned audiologist came to the University of Akron who studied under Doreen Pollack and the rest is history.

Stacey's parents introduced me to AVT in about 1980 and changed my life and so many families I have walked beside over the years. I have been able to impact countless lives based on the unwavering commitment of this family. 

Stacey and I enjoying lunch in Los Angeles

Today, Dr. Stacey Lim is a guest blogs for

Supporting an Auditory Verbal Family 

By Jane Madell On April 7, 2015 

Today’s blog is written by Stacey Lim, Au.D., Ph.D., CCC-A. Dr. Lim, a licensed audiologist, is an assistant professor of audiology at Central Michigan University. She was identified with hearing loss at the age of 10 months and was fitted with her first pair of hearing aids a month later. She received a cochlear implant at the age of 18. After receiving her bachelor’s degree in Communication Sciences and Disorders from the College of Wooster with a minor in German Language and Literature, she spent a year in Germany on a Fulbright Scholarship. When she returned to Ohio, Dr. Lim received her Au.D. from the Northeast Ohio Au.D. Consortium (NOAC) and her Ph.D. from Kent State University, with specializations in early intervention, pediatric audiology, cochlear implants, and educational audiology. Dr. Lim’s research specialties are literacy, cochlear implants, and aural rehabilitation.

According to the Joint Committee on Infant Hearing, identification and intervention of hearing loss in children should occur by six months of age (2007). Pediatric audiologists play an important role in working with these children’s families by providing information about hearing loss and all the available communication approaches.

The time after a child is diagnosed with hearing loss is overwhelming for parents, who may just be beginning to learn about hearing loss and the various types of intervention. Providing parents with information and resources will empower them to choose the best options for their family.

One such option is the auditory-verbal approach, which is based on early identification of hearing loss and early intervention of hearing loss (AGBell, 2007). In the auditory-verbal approach, early intervention of hearing loss includes fitting the child with appropriate technology, such as hearing aids or cochlear implants, and with auditory brain development via family-focused, auditory-based language learning. Research has suggested that with the early use of hearing aids and/or cochlear implants, along with a targeted language intervention program (e.g., the auditory-verbal approach), children have the potential to develop age-appropriate language skills.

With guidance from hearing health care professionals such as audiologists, auditory-verbal therapists (AVTs), and speech-language pathologists (SLPs), the families of these children are well-positioned to develop their children’s auditory brain. The question we, as pediatric audiologists, should always keep mind is: How can we support families who are in auditory-verbal programs? As audiologists, we can facilitate auditory brain development from an early age, as it is a critical foundation onto which language, literacy, and social skills are built.

1) Overview of Auditory Brain Development

The critical language development years occur in early childhood, while neural connections are being built in a highly plastic brain. With cumulative practice, neural connections are strengthened and solidified for certain types of input. Research suggests that there is a sensitive time period for meaningful language learning (Houston, Stewart, Moberly, Hollich, & Miyamoto, 2012). Data from prelingually deafened adults who received their cochlear implants in adulthood have found that performance on auditory-based tasks appears to be associated with early exposure to auditory-based intervention such as the auditory-verbal approach (Teoh, Pisoni, & Miyamoto, 2004).

If a child’s brain fails to receive auditory exposure, it will not develop the connections that are associated with auditory skills or the auditory perception of spoken language. An auditory-based intervention program undertaken during the early language development years generally reduces the amount of cortical reorganization (Teoh et al., 2004). In other words, the areas of the brain that are associated with auditory function are not re-assigned to other senses (such as vision).

In a typical auditory-verbal program, the audiologist, AVT, SLP, and parents work together as a team to expand a child’s language base and auditory skills development. The audiologist first lays down the technological foundation for a solid auditory base for the auditory-verbal child by selection, fitting, and monitoring hearing aids, cochlear implants, and FM systems. According to the Scope of Practice for Audiologists by ASHA (2007) and AAA (2004), audiologists may also have additional responsibilities in other aspects, including auditory training and rehabilitation (AAA, 2004; ASHA, 2004) as well as collaboration with partners in the child’s language development (ASHA, 2004).

2) Early identification and intervention:

Early access to the child’s auditory brain creates greater opportunities for the development of age-appropriate spoken language skills. Newborn hearing screening programs can identify infants who may have hearing loss within the first few days of life. The goal of hearing technology is to provide a way for sound to reach the brain with as clear a signal as possible, so that sound and speech can be processed by the brain. In this capacity as audiologists, we ensure that children are fitted appropriately and early.

Spoken language development in children requires more than just wearing hearing aids. Children with normal hearing have access to sound 24/7, but children with hearing loss have access to sound only when they are wearing their hearing devices. Children are still in the process of developing the top-down processing skills that adults possess as a result of years of cumulative listening practice. To overcome this challenge, children with hearing loss need to be taught how to attach meaning to new auditory information that is being provided through their hearing aids. As audiologists, we can work with families and other professionals (e.g., the child’s auditory-verbal therapist and/or speech-language pathologist, early interventionist) to ensure that appropriate hearing technology is selected for the child and to help create spaces that are optimal for meaningful auditory language learning. One way is to help parents create acoustically salient, language-rich environments. Another way is to encourage parents to provide their children with rich, complex spoken language.

3) Continued support and diagnostics

The audiologist’s role includes the provision of audiological assessments, diagnosis, and treatment throughout childhood (AAA, 2004; AGBell, 2014; ASHA, 2007). Because it is so critical to provide auditory information to the developing brain of a child who is deaf or hard of hearing, the audiologist should evaluate this child’s hearing on a regular basis, noting whether there is any change in hearing. If there is a change in hearing ability, there are several potential solutions, which may include re-programming the child’s hearing aid or cochlear implant device or selecting a more appropriate form of hearing technology.

To evaluate the quality of the auditory signal provided through these hearing devices, audiologists should use a combination of functional testing and electroacoustical analysis. Thus, audiologists can determine if the hearing aids are set appropriately, and whether or not the child is able to hear and understand the auditory input from hearing technology.

Auditory-verbal practice also includes an ongoing evaluation of progress in the program, to ensure that the child meets language development milestones. In addition to continued monitoring of auditory access, collaboration with the auditory-verbal therapist or speech-language pathologist can determine if a lack of progress in an auditory-verbal program may be due to other issues (e.g., developmental issues, auditory neuropathy). Our work as partners includes developing an appropriate remediation plan or referral plan to acquire the appropriate services. Other outcomes of this evaluation could also be to determine if a different communication approach would be more appropriate for the child’s language development.

4) The audiologist as a partner

Audiologists should collaborate with other professionals to identify populations at risk for speech and/or language impairments (AAA, 2004; ASHA, 2007). Our roles extend further than identifying disorders that affect later communication outcomes. We also need to work together as a team with the AVT, families, and any other stakeholders in the child’s development (e.g., educators, speech-language pathologists).

By working as partners in the auditory-verbal child’s auditory brain development, the child can have the best opportunities for language learning. If the parents’ desired outcome is spoken language, they can be coached about the importance of wearing hearing technology during the child’s waking hours, so that auditory information is continually being accessed.

One of the most important partners in this collaboration is the child’s family. When we work in close collaboration with parents, we are ensuring that they become advocates for their child’s needs, so they can be involved in activities at school and outside school (e.g., Girl Scouts or Boy Scouts). Each audiologic appointment should be considered an opportunity for educating the parents and child. Their knowledge of hearing loss and of their hearing devices, strategies, and related issues becomes part of the family’s advocacy skills.

This advocacy begins with understanding their child’s hearing loss and the impact it has on language development and the types of accommodations (e.g., closed captioning, FM systems) or educational plans (e.g., IEPs or 504 plans) that may be necessary. This advocacy will spill over into educational settings, because a major goal of auditory-verbal therapy is mainstreaming. To support the child’s success in a mainstream educational environment, the audiologist, AVT, and parents can work with school personnel to educate them about the child’s hearing loss and ways to ensure that the child has appropriate access to information in the classroom. This could include, for example, in-services about the child’s FM system and working to incorporate access to auditory information on the IEP (e.g., a written transcript of the morning PA announcements, writing homework assignments on the board, acoustically treating the classroom). By being ensured of receiving as much access to information in the school environment as other children do, the child with hearing loss is in a better position to be a successful student, and will gain knowledge that will translate to inclusion in a majority hearing society.

Working with an auditory-verbal child and family can certainly be rewarding. As an audiologist supporting the family’s spoken language goals, one can see progress being made because audiologists are partners in the child’s language and auditory development.

Many of these guiding ideas and concepts in auditory-verbal intervention translate well into our work as pediatric audiologists. Not only are we well equipped to understand hearing loss, but we are also in an excellent position to educate parents and other professionals about hearing loss and its long-term implications on language learning and academic success. After all, any parent’s goal in raising children—including those who are deaf or hard of hearing—is for them to grow up to be independent adults capable of functioning in a complex society.

References

AG Bell Academy for Listening and Spoken Language. (2007). Principles of LSLS. Retrieved from http://www.listeningandspokenlanguage.org/academydocument.aspx?id=563

American Academy of Audiology. (2004). Scope of practice. Retrieved from
www.audiology.org/resources/documentlibrary/Pages/ScopeofPractice.aspx.

American Speech-Language-Hearing Association. (2004). Scope of practice in audiology. Retrieved from
www. asha.org/policy.

Houston, D. M., Stewart, J., Moberly, A., Hollich, G., & Miyamoto, R. T. (2012). Word learning in deaf children with cochlear implants: effects of early auditory experience. Developmental Science, 15(3), 448-461.

Joint Committee on Infant Hearing. (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120(4), 898-921.

Teoh, S. W., Pisoni, D. B., & Miyamoto, R. T. (2004). Cochlear implantation in adults with prelingual deafness. Part II. Underlying constraints that affect audiological outcomes. The Laryngoscope, 114(10), 1714-1719.

When—if ever—is a child who successfully uses bilateral hearing aids a candidate for cochlear implants? Hear Better? Never Say Never

Today's post can be found at: The ASHA Leader, March 2015, Vol. 20, 36-42 

Written by: Kristin Vasil Dilaj, AuD, PhD, CCC-A; Jennifer Cox, AuD, CCC-A

Hearing aids provide excellent audibility for children with moderate-to-severe hearing loss, but for some children, the benefit of hearing aids is limited compared with what implants can provide. CIs have the potential to provide equal audibility for soft sounds across the entire speech frequency range, an achievement not always possible with hearing aids.

Courtesy of Advanced Bionics LLC

Nine-year-old Ethan was born with a bilateral moderate-to-severe sensorineural hearing loss and has worn behind-the-ear hearing aids since he was a few months old. He earns high grades in regular education, speaks intelligibly, and has age-appropriate speech and language scores. Though he generally perceives speech well, he struggles to discern novel words with high-frequency speech sounds, and shows significant difficulty hearing in noise. He also lacks the speech clarity of other children with similar hearing loss—his voice is loud, and his fricatives and affricates are distorted.

Even though Ethan’s hearing aids are helping, could a cochlear implant allow him even better access to sound, and make listening and talking easier for him?

Just five or 10 years ago, cochlear implants were thought to be suitable only for children with very severe or profound hearing loss. Because he is progressing with his hearing aids, Ethan would likely not have been considered a good candidate for implantation.

Today, he would.

The change is due not only to relaxed implant criteria, but also to the fact that children with CIs are functioning exceptionally well in difficult listening environments, meeting age-appropriate goals for speech, language and academics, and listening to more complex stimuli such as music. It is possible that in some cases, children with CIs may surpass the progress made by children with hearing aids. When testing and observation suggest that the benefits of a CI may be superior to the child’s current functional performance with well-fit hearing aids, that child would be considered for an implant.

However, parents of successful hearing-aid wearers may be reluctant to opt for CIs because of risks such as loss of residual hearing. I often hear: “She is doing OK with her hearing aids.” Despite the potential benefits of CIs, this concern is valid, and it is also well-established that the earlier CIs are implanted, the higher the chance for success. Therefore, implanting a child who already receives benefit from hearing aids may not seem to be a reasonable recommendation, unless there is a sudden change in hearing.

The question, therefore, for clinicians and parents of older children who use bilateral hearing aids may be, “Can the child function even better with a cochlear implant?”

Courtesy of Advanced Bionics LLC

Current candidacy

For children ages 2–17, the criteria for CIs include a severe-to-profound hearing loss and limited benefit from binaural amplification, according to ASHA policy documents. “Limited benefit” is demonstrated through performance with hearing aids in the sound booth using tones and word-recognition tasks presented in an auditory-only format. When children meet this criteria, the decision to implant may be easy at any age.

In many cases, however, older children with binaural amplification have benefitted from hearing aids for many years. They may have received auditory-based therapy and possess excellent speech and language skills. They often fall outside of the traditional candidacy criteria in performance on word-recognition tasks. Their success in that area may be due to excellent audibility with the hearing aids, familiarity with the task, and well-developed top-down processing that allows them to fill in the gaps.

In a quiet setting, these students may appear to function quite well. However, in comparison with children with CIs, students with severe hearing loss and hearing aids may be less able to detect sounds at all frequencies (especially high frequencies), may have limited access to soft conversational speech, may experience more difficulty listening in noisy environments, and may exert more listening effort to communicate in a mainstream environment. In my experience, this functional difference in performance between groups is often noted by parents and educators.

Could it be better?

The decision-making process is unique to each family. Ethan and his parents learned what the implant was, spoke with many children and adults with CIs about their experiences, and investigated surgeons. Ultimately, they decided to go forward with the procedure.

The initial transition can be a jolt. After implantation, at his initial CI stimulation in December 2014, Ethan said, “I can’t understand you! Can I put my hearing aid on?” Even though he was able to respond with just the implants, he disliked the sound—it was an emotional appointment. A week later, however, after using only his cochlear implant processor, he was able to understand speech with no visual cues. Today, his speech perception of novel words is excellent, his speech clarity has improved, and the volume of his voice has decreased. Ethan’s prognosis of being a successful CI user is excellent.

“It is only up from here for Ethan,” his mother says. “Pre-implant, if we were at a raucous family event, we would have to talk loudly and repeat his name to get his attention. Twenty-two days after Ethan’s surgery, on Christmas Eve in a small house of 30-plus people, I spoke his name in moderate voice from one room away, and heard him say, ‘Yeah?’ It hit us that he’d truly heard us. That moment was life-changing.”

Some families may opt for a second implant. Eight-year-old Farah is a bilateral CI user. The decision to implant her first ear was stressful, but clear-cut. Farah had worn bilateral behind-the-ear hearing aids successfully soon after birth. Her audiologist, speech-language pathologist, and parents began considering a CI when Farah was 4—they were concerned that although Farah had good access to speech and language, her abilities had plateaued. The choice was solidified following a gradual drop in Farah’s hearing that moved her from borderline to well within the CI candidacy range, and the family decided to pursue a CI for her first ear at 5.

This initial CI decision was straightforward, but the decision to implant the second ear was more complicated. Farah was extremely successful with her first CI and became a bimodal user, wearing both her speech processor and hearing aid during all waking moments. For her hearing-aid ear, she was a borderline candidate for a CI; she had a moderately severe to severe sensorineural hearing loss and her word recognition scores were high with the hearing aid. The family was concerned that pursuing a CI in this ear might sacrifice the residual hearing she had, leading to more difficulty hearing in the future.

Farah used an FM system, performed well academically, and was socially active in her mainstream elementary school. After two years of using the initial CI, Farah noticed she had more difficulty understanding soft speech and speech at a distance with the hearing aid, and that her overall ease of listening with the implant was significantly better than with the hearing aid.

Farah was considered a successful bimodal hearing aid user, but could she do better with a second implant? The team decided she could.

Farah received her second CI at 8, and immediately following activation, she completed open-set speech-recognition tasks, even though the sound was “funny.” Following three weeks of regular programming sessions and therapy focused on the “new” ear alone, she had improved word-recognition scores and was wearing and relying on her second implant regularly.

Courtesy of Advanced Bionics LLC

Why implant later?

Hearing aids provide excellent audibility for children with moderate-to-severe hearing loss, but for some children, the benefit of hearing aids is limited compared with what implants can provide. CIs have the potential to provide equal audibility for soft sounds across the entire speech frequency range, an achievement not always possible with hearing aids.

For many children, a CI results in better audibility of soft high-frequency sounds such as /f/ and /s/, which can affect speech perception, speech production and a child’s ability to perceive and use grammatical markers in running speech. Access to more sound also can mean enhanced bottom-up processing: Because the signal is clearer and more robust, students may need to rely less on top-down processing, leading to less listening effort and less “filling in the blanks,” and enhancing overall ease of listening.

Cochlear implants can provide equal audibility for soft sounds across the entire speech frequency range, an achievement not always possible with hearing aids.

Maximizing success

Implanting later in a child’s life results in new challenges. At older ages, children have more control over use and retention of a device and the environments in which they are listening. And because they have had hearing-aid experience, they will form immediate opinions regarding sound quality. As a result, it is crucial to establish a solid rehabilitation plan ahead of time with the child and family. The following supports will encourage acceptance and enhance success for the newly implanted ear.

• Pre-surgical counseling and support. It is important that the family understands the risks of implanting—including the possible loss of residual hearing—and the possible benefits. Current surgical techniques facilitate preservation of residual hearing, but it is not guaranteed. Counseling on realistic expectations is also critical. Initially, sound through the implant may seem distorted, annoying and dissonant, and the child may resist wearing the CI because of the difference in sound quality. The family and the child need to understand that this is a normal part of the process and that perseverance is essential.
• Strategic scheduling. It may be beneficial to schedule the cochlear implant surgery so that the initial stimulation is during the summer or a school vacation. This timing allows the school-age child to use the processor by itself for longer periods of time in environments that require fewer auditory demands.
• A concrete retention plan. If given a choice, children may initially prefer use of the opposite ear (hearing aid or initial cochlear implant) alone. But from the day of the initial stimulation, the new CI should be worn all the time with the contralateral device added as the situation demands. During academically and socially demanding situations, both devices should be worn. This transition can be difficult for the parents to enforce—they need support from the team.
• Audiologic rehabilitation. As soon as the new implant is activated, students must participate in audiologic rehabilitation to reinforce progress and build confidence. It is critical that the focus be on what the student is already able to do rather than on what the student is missing. The importance of building confidence—beginning at the initial stimulation—cannot be overstated. Because of their previous auditory experiences, this group may show rapid improvement in speech perception, but lag in confidence and acceptance with the new device.
• Regular programming sessions and subsequent hearing aid adjustments. The audiologist and SLP should follow the child closely. To maximize CI performance and overall speech perception in the bimodal/bilateral condition, students require adjustments to their older device in conjunction with new CI programming.
• Family support. In-clinic support from professionals and support from other families and children facilitate the transition to the CI.

It should be noted that CIs may not be the best option for many children and their families, espcially if they do not have a strong support system in place. For an older child to be successful, CI implantation requires extensive pre- and post-implant counseling, professional collaboration, realistic parental and child expectations, and appropriate post-implant audiologic rehabilitation.

Ethan and Farah were already excellent hearing-aid users, successful in a mainstream environment, and functioning well socially. The CI was considered because they were struggling more than their peers who use CIs. Functional testing in quiet and in noise, in addition to the audiogram and word-recognition testing, supported candidacy in these cases. Both families observed other students with CIs and indicated there was a noticeable difference in “ease of listening” in both quiet and difficult listening situations, compared with what their child experienced.

It is important for professionals working with children with hearing loss to understand that although speech perception and detection testing provide valuable information, for some students using hearing aids the question may be, “Can this child do even better?” When the answer is “yes,” it is not too late to recommend CIs.

Sources

American Speech-Language-Hearing Association. (2004). Cochlear implants [Technical Report]. www.asha.org/policy/

American Academy of Audiology. (2015). Cochlear implants in children. Retrieved from http://www.audiology.org/publications-resources/document-library/cochlear-implants-children

• Kristin Vasil Dilaj, AuD, PhD, CCC-A, is an audiologist at The New England Center of Hearing Rehabilitation. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. kvdilaj@gmail.com
  
• Jennifer Cox, AuD, CCC-A, is an audiologist at The New England Center of Hearing Rehabilitation. jennifer3280@hotmail.com
  
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• © 2015 American Speech-Language-Hearing Association

Plug-in an Individuals Hearing Thresholds - Hearing Loss Simulator

Here is a hearing loss simulator, where you can plug in an individual's thresholds.

http://www.cdc.gov/niosh/mining/works/coversheet1820.html

 NIOSH Hearing Loss Simulator

The NIOSH Hearing Loss Simulator is a software training and communication tool for promoting hearing loss prevention. It allows a user or trainer to demonstrate the effects of noise exposure on hearing without experiencing an actual noise-induced hearing loss.

HLSim is a Windows®-based program that displays a "control panel" for playing sounds while adjusting the simulated effects of noise and aging. A simulated individual's age (in years) can be entered along with the years of exposure to noise (in A-weighted decibels). The effects are shown visually on the frequency band control panel and sound level display screen while the user listens to the audio playback.

This completely rewritten version of HLSim adds compatibility with the latest 32 and 64-bit Windows® operating systems and now supports mp3 sound files and other popular audio file formats.

Prerequisites:

• Windows Installer 3.1 or later;
• Pentium 1 GHz or higher with at least 512 MB RAM;
• Minimum disk space: 32 bit version - 850 MB, 64 bit version - 2 GB

Installation instructions:

• Download the appropriate ZIP archive (32 bit or 64 bit)
• Unpack it into a temporary folder and run Setup.exe.

The software can be downloaded from this page, or ordered on CD. The download archive also includes the NIOSH Hearing Loss Simulator Instruction and Training Guide.

Audience: Trainers, workers, and hearing loss professionals

Terms Related to Auditory Rehabilitation

This blog post was adapted from an article entitled, 

“Hearing Related Terms You’ll Hear in Cochlear Implant Therapy”

by Donna Sperandio, Head of Rehabilitation at MED-EL

You can read the original article HERE

http://www.medel.com/blog/hearing-related-terms-cochlear-implant-therapy/

If you’ve just received a hearing implant there might be a bunch of hearing related terms, words, and definitions that you’re just learning about for the first time. Or even if you’ve had an implant for a while one term that you’re not familiar might just pop up.

This can happen when you’re going through rehabilitation sessions or talking with your hearing specialists like audiologists, therapists, or teachers of the deaf. So, I wanted to put together this list of the technical hearing related terms and jargon that your specialists might use.

How You Interact With Sound

1. Listening: paying attention to any sound, or making an effort to hear a specific sound
2. Hearing: being able to perceive sound
3. Detection: being able to notice the existence of a sound
4. Discrimination: telling the difference between one sound and other sounds
5. Speech: the physical process of making a sound with the lips, tongue, and other speech organs
6. Language: a system of symbols or sounds used to communicate thoughts, emotions, and more

Hearing Related Terms

1. Babbling: producing vocal sounds that repeat the same syllable (like “ba-ba”) or use a sequence of similar syllables (like “ba-ma-ba-ma”)
2. Body language: using gestures, facial expressions, or body movements to communicate physically either instead of, or as well as orally
3. Chronological age: how old someone is as measured from their date of birth
4. Communication: conversing or exchanging information through social interaction
5. Consonants: the letters and sounds of a language that are not vowels, and which require the speaker to completely close his or her throat, mouth, or lips; b, f, m, and t are examples of consonants in the English language
6. Consonant-like sounds: a baby’s first sounds, before and during their babbling phase, which sound like consonants but are not perfect yet
7. Decibel: a measurement of the loudness of the sound, like if it’s loud or soft, often abbreviated to “dB”
8. Environmental sounds: all non-speech sounds that exist in everyday life, like the telephone ringing, birds chirping, or traffic noise
9. Expressive language: spoken or signed language used to convey thoughts, intentions, or emotions
10. Frequency: a measurement of the pitch of sound, like if it’s a high-pitch or low-pitch sound, often expressed in Hertz (Hz)
11. Fitting: the process of setting the cochlear implant audio processor’s program so that it is customized to its user, sometimes called “programming” or “mapping”
12. Gesture: moving a part of the body to communicate, like pointing at an object
13. Hearing age: how long someone has been wearing an effective hearing loss solution, like a hearing aid or hearing implant, is often used to give a more accurate representation of someone’s auditory development than their chronological age
14. Hearing aid trial: the 2–3 month test period where someone tries out their hearing aids to find out if they are an adequate hearing loss solution
15. Implicit learning: learning something that is not being obviously demonstrated or taught directly
16. Intensity: another way of saying “loudness”
17. Jargon: the variety of syllables said by infants which sound like speech, and which contains sounds and syllables, but is not a real language
18. Oral language: the same thing as a spoken language
19. Phoneme: the shortest unit of sound that can be recognized, like /k/ or /t/, phonemes are the building blocks of syllables and words
20. Pre-verbal stage: when babies and infants interact with their environment with babbling, jargon, or vocalizing instead of real words
21. Prelinguistic: the time before someone develops spoken language
22. Syllable: a unit of a word; for example there are three syllables in processor (pro-cess-or) and two in water (wa-ter)
23. Utterance: a continuous vocalization or phrase
24. Vocalization: any sound a person produces