Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
PHYSICAL FACTORS 7 means of a hearing aid is likely to follow. The case studies indicated that in cases where the family is either uncertain or unaware of the cause, the difficulty of adjustment to a hearing aid appears to be in creased. In those cases where the family suffers from strong guilt TABLE II: CAUSE OF HEARING LOSS AS GIVEN IN CASE HISTORY REPORT Distribution of Causes According to Users and Non-Users of Aid Using Aid Not Using Aid Focalized infections Mastoiditis . . ......... . ......... . 4 Ear abscess . . . ................ . .. 4 Systemic diseases Scarlet fever . . . . . . . . . ... . . . . . . . . 1 Colds . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 Measles ... . .. ......... . .. ....... 2 Chicken pox .................... . Birth injury . .. .. . . ...... .. .. ........ . 2 1 Hereditary ..... .. .... . .... .. ..... . . .. 5 6 Accident .. . . . . . . .. . . . . ... . . . . . . . . . . . 1 Cause unknown or not given . . ........ 4 Total .. .. ..................... 2 5 13 feelings because the defect "runs in the family" the child may be deprived of an opportunity to make a normal adjustment and may suffer as a result of the parents' fear that the family disability may be discovered. This case illustrates the result of guilt feelings on the part of the parents with its concomitant penalties inflicted on the child : The Case of Howard Howard is a phlegmatic, stocky boy of thirteen. His speech is so poor that it is difficult to understand him, and he talks in monosyllables. The mother first noticed that Howard was hard of hearing when he was three, but a long history of deafness on the paternal side had prepared her for the possibility of deafness in her immediate family. One boy of seventeen has normal hearing. The father is a physician and the family appears to have a substantial income.
8 LEARNING TO USE HEARING AIDS Howard has always been a problem to his parents. When he was a little boy, he had great difficulty in getting along with other children because he always wanted to be the leader. He used to quarrel and fight with children to such an extent that finally his parents placed him in a private boarding school. However, they worried so much about his being away from home and about the inability of others to understand his shortcomings that, affer a year, they brought him home and placed him in a public school. When Howard was nine years old, he was given a hearing aid through the National Research Council Study. His parents were eager to have him try it and said that they thoroughly approved of his wearing it. His mother thinks that it helps him tremendously in school. Moreover, his antagonistic behavior toward other children ceased and for the first time children began to play with him and to seek his companionship. In their endeavor to make Howard's life a normal, happy one his parents take him along on visits to friends and relatives, and to the opera and the theater. For the past two years, Howard's mother has not allowed him to wear his aid outside of school hours. She says that she feels it is to the family's detriment if her husband's patients and their friends are con stantly reminded of Howard's hearing loss. Therefore, Howard has been told to take off his aid as soon as he comes from school. His school is so far from home that he does not associate with his schoolmates after school. During school hours, when he is wearing his aid, he gets along well with the other children and the other children make a special effort to look after him. Howard has never shown any self-consciousness about the aid in school and the other children accept it without question. His mother de scribes long periods of irritability and unhappiness at home, during which Howard remains in his room with a book. On the other hand, his teacher reports that Howard is a cheerful, cooperative child in school. He is at the head of his class in geography and seems to take special delight in partici pating in group play. In this case, it is obvious that the boy is suffering because his parents seek to conceal from the public an awareness of what they consider a hereditary disability. Howard needs his aid and is a well-adjusted, happy youth with it; without it, he becomes irritable, morose and unhappy. As a result of such parental attitude toward a hereditary disability, the boy is torn by the conflict between parental pride and his own need for com panionship. GENERAL HEALTH AS A FACTOR Most of the children seemed to be healthy, although the group appeared to have a general tendency toward respiratory ailments. The data indicate that the children using hearing aids enjoyed bet ter health, on the average, than the group who were not using
PHYSICAL FACTORS 9 them. Nineteen aid users said that they always felt. well and they did not complain of any illness. Only six aid users had any illness within the preceding five years. In terms of per cent, about 78 per cent aid users reported that they usually felt very well. The group of thirteen childreJ]. who were not using their aids had quite a different story. Six said they were usually well and rarely had to stay home on account of illness, but seven (or more than half of them ) reported that they often did not feel well, but suffered from headaches, colds, and other minor ailments. Al though it is difficult to generalize from such meager data, it would appear that the aid users as a group did have fewer illnesses than the no-aid users. As an example, the mother of one aid user said: ..Jane's health is so good that she never goes to the doctor. She used to have headaches, but she hasn't complained of them since she got her aid.'' In contradistinction to the description of good health of the aid gr�up, several illuminating statements from the no-aid users indi cate the type of illness incurred by this group. One boy had a siege of pneumonia six years ago. Three years later he fell down and fractured his skull. When he came to see the worker, he carried his arm in a sling as a result of a break s�ffered in a recent fall. One girl had fractured her skull as the result of a fall, and her mother said she often cried in her sleep. Two of the children appeared to have some glandular imbalance, since both were noticeably obese, slow in movement, and complained of being constantly tired. In both these cases, the school principals had suggested medical treat- , ment, but the parents had done nothing about it. . While a number of the children had speech defects, poor tonal quality and faulty articulation, there appeared to be little relation ship between speech defects and wearing hearing aids. Fifty-six per cent of the aid users spoke with relatively few perceptible speech defects, while 44 per cent had marked speech defects. All had had speech instruction at some time and many were still at tending speech clinics either in their own schools or at the New York League for the Hard of Hearing. Four parents of aid users said that they had noticed improvement in the speech of their chil dren since the use of the aid, while the other parents attributed speech improvement to constant instruction. It is interesting to
10 LEARNING TO U SE HEARING AIDS observe that ten of the children who were not wearing their aids had no obvious speech defects, while three spoke in a monotone, lisped, or had a high-pitched voice. Nine children in the total group reported that dark, rainy weath er seemed to affect their hearing and that summertime improved their ability to hear. Many expressed c�ncern over catching cold in the winter because their hearing appeared to get much worse as a result of such illness. Weather conditions did not appear to affect ability to hear with an aid, however, and to the aid users, weather made little difference. In those cases susceptible to weather changes, the children reported that they merely turned up the volume of their aids when their hearing diminished, and thus compensated for any additional loss. TABLE III: USE OF HEARING AID AS RELATED TO PER CENT OF HEARING LOSS Per Cent of Hearing Loss for Each Subject 5* 4 3 2 1 0 96.8 40.3 59.5 84.7 60.3 65.9 87. 6 20.6 36.8 80.6 57.2 60.4 79.5 32.8 17.2 50.7 55.8 72. 6 28.6 14.0 39.9 48.6 63.8 2 1.3 34.8 35.4 23.3 3 1. 1 32.2 24.0 29.8 20.4 21.3 20.4 14.6 9.0 8.2 0.0 N=6 2 5 4 8 13 * Extent of use: 5-Aid used at all times. 4-Aid used during school and some outside activities. 3-Aid used during school and some rare outside activities. 2-Aid used only during school. l-Aid used infrequently. o-Aid never used.
PH Y S I C A L FACTORS 11 AMOUNT AND CHARACTER OF LOSS AS A FACTOR A study of Table III on page 10 suggests that the amount and character of loss' are. significant faCtors in determining the extent of use of a hearing aid. With one exception, the group making maximum use of aids had hearing losses exceeding 60 per cent. Their losses ranged from 63.9 per cent to 96.8 per cent. These chil dren wore their aids because they urgently needed them in order to carry on normal daily activity. The case of Sally is a good illustration of felt need as a reason for accepting an aid : The Case of Sally Sally is a pretty, dark-haired girl of sixteen, who seems to be eager to talk with people and wants to be well liked. She is quite vivacious and communicative. She wears her aid well concealed underneath her long hair, but she·voluntarily displayed her instrument to the worker in order to demonstrate how cleverly she was able to hide it. She is very happy to wear it at all times and she is extremely grateful for the opportunities the aid has provided. As she expressed it, "It is much better than when I was small. I felt dumb before, but I don't feel dumb any longer." Since she could never understand what the teacher was talking about she was very shy in school. She felt uncomfortable and conspicuous be cause she sat in the front of the room and the teacher singled her out for slow reiteration of the class assignments. Her poorest subjects were English and spelling. She attributed this to the fact that she did not know what the teacher said and could never hear her dictate the words during English and spelling lessons. She could hear sounds of music and singing, but could not understand speech. She thought that she did not do as well in school as children with normal hearing, but she frankly admitted that she was unable to judge her own intellectual capacities. She said that she was not sure whether she would have done any better if her hearing had been normal because she had no indication as to what her real abilities are. Sally was delighted when she was told that she was going to be given a hearing aid. She felt that it would present a solution to her problem of not being able to communicate with other people. She anticipated progress in school and increase in her opportunities for making friends. After she received her aid, she began to develop many more friendships and, as a result, gained confidence in herself. For the first time she could hear everyone talking and could distinguish the sound of different voices. ⢠All losses have been estimated according to decibel loss for speaking tones at frequen cies of S12; 1024; 2048; 4096 cycles per second.
12 LEARNING TO U SE H�A R I N G AIDS She described her reactions to the aid in this manner: "I want to hear what people are laughing about. People used to laugh and I didn't understand why they were laughing. Now I'd rather wear the aid and hear every thing, than not wear it and miss anything." She does not seem to be aware of other people's curiosity or inquisitiveness-"Everyone forgot about it fast." She has become accustomed to her aid and cannot bear to think of life without .it. Sally sa1d that with her aid she heard sounds that she did not know . had existed. For example, she said that she heard children laughing in the street when she was sitting in the house, and she described the thrilling experience of hearing the voices of children for the first time. She also was able to hear people moving about in the apartment above her. One of her neighbors played a saxophone, and she said it was a new experience to hear the so1.1nd of that instrument. She humorously added that during all the years she had been washing and drying dishes she had never known that they rattled. Her school work has improved noticeably, especially in English and spelling. At present she is attending a vocational high school, where she is studying typing and bookkeeping. She assists in the school office, and her teachers speak with much pride of her ability as a typist. Although Sally is still shy and withdrawing in her manner, she is try ing to overcome this. She said that as time went on she hoped that with continued use of her hearing aid her life would be the same as that of girls with normal hearing. Occasionally she goes out on "dates" with young men, but she always tells them that she is hard of hearing and is wearing a hearing aid. She would like to work as a typist in an office and is sure that she will wear her aid when she works. ' Since Sally had been unable previously to achieve any of the satisfac- tions that she desired because of her hearing loss, her felt need for the aid has facilitated her present adjustment to it. All 'the children making maximum use of their aids have similar . histories. Their losses were so marked that they welcomed the ex perience afforded them of overcoming their handicaps and there fore cooperated without reservation. Three children, however, with losses as severe as those of the group mentioned above, were not making as advantageous use of their aids even though they, too, felt the need for them. In two cases the parents, because they feared public opinion, would not allow their children to wear aids outside of school hours, and the third child refused to wear an aid as a form of rebellion against his parents. From Table III it appears that extent of use of the aid is some-
PH YSICAL FACTORS 13 what related to amount of hearing loss. Th� group in general seem to be competent judges of how much they need their aids and govern their use accordingly. A trend is evident. toward diminu tion in amount of time the aid is used as the percentage of hearing loss becomes less. It should be noted, however, that hearing aids were used by children where losses were not extreme. One child with a hearing loss of 23.3 per cent used an aid all the time ; three. pupils with losses of approximately 2 1 per cent used an aid some or' much of the time ; and one with a loss of 14 per cent employed the aid during school. Obviously, factors other than sheer hearing need enter into the decision to use or to discard the aid. For those subjects, however, who make infrequent or no use of their aids, no relationship exists between amount of use and extent of hearing loss. The losses for the no-aid group ranged from no loss to a loss of 65.9 per cent. Since they were first given aids in 1941, three children had improved to such a degree that their hear ing was considered normal or close to normal. The rest needed aids but were influenced to reject them by various factors in spite of their obvious need. Elimination of the three pupils whose hearing had apparently improved to a point that made the aids unnecessary gives a total group of thirty-five, divided into twenty-five pupils who made some use of the aid, and ten pupils, or 28 .6 per cent, whd' discontinued the use of the aids or rejected t.hem from the beginning. EFFECT OF THE APPEARANCE OF THE CHILD AS A FACTOR Awareness of personal appearance assumes an importance in ado lescence that is usually not felt by the younger child. For the ado lescent girl, any deviation in appearance which sets her unfavorably apart from other girls or prevents her from looking and acting in keeping with accepted standards of attractiveness, or which makes boys avoid her, will be considered a potential hazard. For the ado · lescent boy, the need _for looking masculine and for doing things having prestige value among other boys, as well as wanting to be popular with girls, is of primary importance. Characteristic ado lescent attitudes toward appearance must be considered as a prob�
14 L E A RNING TO USE H E A RING A IDS able factor in determining children's attitudes toward wearing hearing aids. When a girl approaches adolescence, her desire to look as at tractive as possible and to be like the rest of the girls seems to out weigh in importance her need to make an adjustment to a physical handicap. In the beginning of the Hearing Aid Study twenty-one girls had been given aids. Nearly half . o f that number had dis continued wearing them as soon as they reached adolescence. Sev eral girls stated that they could not wear stylish clothes because of the bulkiness of the batteries and microphone. Their mothers re ported that the girls were especially sensitive about the protrusion of the microphone at a time when they were beginning to show development of the breasts. In these girls, the normal self-con sciousness caused by physical maturation was increased to such an extent by wearing hearing aids that they preferred to get along without an instrument rather than be conspicuous. The mothers of these girls encouraged them in their rejection of their aids, for as one mother stated : "It doesn't look nice for a young girl to have so many bulges." Another mother said : "I used to d ress her in middy blouses and skirts, so the aid wouldn't show, but now she is a young lady and must dress the part." . A girl who had always concealed the wires of her aid under her hair complained that she wanted to pin up her hair in the latest fashion and therefore had had to discontinue wearing an instru ment.because the wires showed. One girl who left off her aid after wearing it to school for several months was amazed by the questions of children as to how she had acquired such slimness overnight. As a consequence she never wore the aid again. Mrs. N. thought her daughter had reached an age when "it is too hard for a young girl to have to wear an instrument" and en couraged her to get along without it. Mrs. B. said that her daughter had made real progress with an aid, but that recently she had stopped wearing it. Although the child attributed her failure to wear it to the fact that she needed some new batteries, she still did not wear it after the batteries had been renewed. According to Mrs. B., "That wasn't the reason at all.
P H Y SI C A L FACTORS 15 Mary is growing up and has become more self-conscious about it." Each one of the ten girls who had rejected her aid mentioned the fact that she was influenced by her desire to improve her ap pearance. Some said that they were growing up, others that they were too big, still others .claimed that they could not wear the kind of clothes they liked. Of the seventeen boys who had been given aids, only three were not wearing them at all. None of these boys indicated in any way that he was at all concerned over the way the aid made him look. From their case histories, it appears that influences other than per sonal appearance were responsible for discontinuing the use of the aids. It is important to note, in respect to the age factor, that as many adolescent girls continued to wear their aids as had discarded them. From such evidence, it appears that specific physical and emotional concomitants of adolescence, rather than adolescent age in and of itself, operated as deterrents to acceptance of an aid. Those girls who had rejected their aids upon reaching adolescence were influ enced by the normal adolescent behavior pattern, in which they de sire to make the best possible appearance. Those girls who were still wearing their aids were influenced by much stronger factors than the generally accepted adolescent urge to look their best and to avoid being conspicuous in any unfavorable way. Eight girls, who were fifteen years old or over, had all stop ped wearing aids whe.n they were approximate ly fifteen years of age. It must be pointed out, however, that this age also coincided with their entrance into high school. New social pressures rather than the age, per se, may be the important factor. To summarize, sex differences are evident in the decision of ado lescent boys and girls to wear hearing aids, since approximately 50 per cent of the girls had rejected their aids as compared with 1 9 per cent o f the boys. A contributory factor influencing the girls is their adolescent drive to look like all other girls. Because they are self-conscious about their appearance and their newly acquired maturity, they refuse to wear anything which might place them in an unfavorable light. The boys do not seem to be influenced to any degree by the conspicuousness of a hearing aid, and in their case other factors must be affecting their decisions.
16 LEARNING TO USE HEARING AIDS PHYSICAL FEATURES OF THE AID ITSELF AS A FACTOR Thirty-five_ subjects referred to some type of physical discom fort, yet ultimate acceptance or rejection of the aid appeared to be unrelated to such causes. Only three boys reported that from the very beginning they felt comfortaJ?le with their instruments. The rest went through a period of physical adjustment that took approximately two to three months. It is of importance to observe that even though physical discomfort was described by both the parents and the children as a deterrent to wearing the aid, not one subject directly attributed his failure to wear it to this cause. Al though the children were conscious of the physical difficulties that wearing aids entailed, such reasons apparently bore little weight in influencing their decisions to wear them permanently. There were no differentiating responses as to type of discomfort between aid users and no-aid users. The same dislikes were given by both groups. The heat from the batteries during the warm sum mer months was most frequently mentioned. Nine children said that they suffered from the heat, yet only five children stated that they had to discontine wearing aids during summer for this reason, returning to them as soon as the weather grew cooler. One child in the no-aid group said that the aid had been too hot in the summer, but did not give that reason for discarding it. The next most frequently stated dislike was the weight of the instruments, which impeded freedom of movement and prevented the children from actively participating in games and sports. Noise, bulkiness, and fear of breakage were each mentioned four times. Dizziness and nausea were reported by two children. One girl required medical treatment for constant nausea, but after a week of bed rest, she adjusted to her aid and now finds it indis pensable. Another girl who complained of dizziness ·and nausea said that it took her two months to become accustomed to her aid. During this period she frequently shut it off because the unfamiliar sounds confused her. She experimented until she learned that her instrument could be used most advantageously by carrying both the microphone and the batteries in a portable leather case, di rected toward the speaker. She thus avoids skin irritation from the
P H Y SI C A L F A C T O RS 17 vibration of the microphone and from the heat of the batteries. Her aid has become so necessary to her that she never ventures from home without it. One boy objected to his aid because the micro phone soiled his skin. In still another case, a boy reported that at first he feared that he might get an electric shock. One girl said that she was afraid that her aid might whistle and attract attention. Some of the frequent comments are especially revealing: "It was uncomfortable at first and hurt me occasionally. I alternated the sides I wore the batteries on every day." "It made me feel one-sided." "It was too heavy." "It was noisy and made me nervous." "The friction of the earpiece caused a sore." "The aid was noisy and rubbed against my skin until it was irritated. Then my father bought a strap to hold it on and it felt much better." "The aid felt heavy and even though I heard better, it was uncomfort able. When I grew bigger, it felt much better." "The aid wasn't comfortable-it was too heavy and the batteries got too hot. My ear hurt after I removed the earpiece. I often suffered from headaches caused by the noise. My ability to hear increased but the noises were distracting." In evaluating the statements in regard to physical reactions to ward the aids, the conclusion may be drawn that most subjects found some physical discomfort. It is significant, however, that the initial discomforts subsided within a maximum period of three months, followed by a progressive rise in physical adjustment to the aids. During this period the parents were instrumental in facil itating and overcoming the physical difficulties. The mothers co operated in many ways. They made special garments for accom modating microphones and batteries, and kept the ear pieces clean. They encouraged the children to wear loose-fitting clothing in order to prevent irritation. While physical maladjustment may be considered a contributory cause to rejection of an aid, since all subjects mentioned some dis comfort, nevertheless no subject gave physical discomfort as a basic reason for rejection. The physical factors of size, weight, fear, or pain, although mentioned by the subjects, were satisfactorily
18 LEARN I N G TO USE H E A R ING A I DS adjusted to within a reasonable period of time, and in no case were of sufficient importance to prevent any subject from wearing his instrument. Such evidence suggests that for this group the influ ence of the physical factors of the aids may be considered negligible in determining their acceptance, since adequate physical adjustment was made within a relatively short period of time and since no child gave physical discomfort as the reason for refusing to wear an aid. This does not mean, however, that attention should not be given to improving the physical _features of hearing aids and im proving the character and availability of information about the best possible physical adjustment to them. In many instances, bet ter information and guidance might have greatly reduced the dis comforts of the introductory stages of aid wearing. III. Intelligence as a Factor To study intelligence as a factor in influencing the use of a hear ing aid, it was important to choose a test making minimum demand on hearing ability. The chronological age range of the group ( 13 years to 18 years ) was also a consideration. For diagnostic as well as fact-finding purposes it was deemed desirable to secure measures of both verbal and performance ability. Because the Wechsler Bellevu� Intelligence Scale not only provides information in regard to mental status but lends itself especially well to analysis of spe cific abilities, both verbal and performance in nature, it was chosen as the instrument for evaluating the intellectual status of this group. The test takes approximately one hour to administer, dur ing which time the examiner has ample opportunity for carefully observing each subject's reactions to a variety of situations. In this investigation both adolescent and adult scales were used and both performance and verbal I Q's were computed. When a test is used on subjects differing from the standardiza tion population from which the norms derive, the validity of the results must be taken into account. An effort was made to have every subject perform to the fullest extent of his ability. Those
