What are the main types of hearing loss by location?

There are three main types of hearing loss by location: Conductive Hearing Loss affects the outer or middle ear (eardrum, ossicles) and is often reversible; Sensorineural Hearing Loss affects the inner ear (cochlea) or auditory nerve and is generally permanent; and Mixed Hearing Loss, which is a combination of both conductive and sensorineural types.

How is hearing loss classified by degree according to BIAP?

The BIAP classification categorizes hearing loss into four degrees: Mild (20-40 dB) where soft or distant voices are poorly perceived; Moderate (40-70 dB) where speech is perceived only if loud and hearing aids are needed; Severe (70-90 dB) where only loud sounds are perceived and hearing aids are essential; and Profound (>90 dB) where there is no perception of speech and an implant is often proposed.

What is the difference between pre-lingual and post-lingual hearing loss?

Pre-lingual hearing loss occurs before language acquisition (0-2 years), which significantly impacts natural language development. Post-lingual hearing loss occurs after language acquisition, meaning the individual has already developed language skills before losing their hearing, making rehabilitation typically easier.

What role do speech therapists play in cochlear implant cases?

Speech therapists play a central role in supporting deaf individuals with cochlear implants. They provide rehabilitation services to help patients learn to interpret the new auditory signals, develop listening skills, and improve speech and language development. They work with patients whether they use hearing aids, cochlear implants, or sign language.

How does hearing loss impact language development?

Hearing loss affects the development of spoken language when not addressed early. The impact depends on the degree of loss, timing of onset, and early intervention. Children with congenital or pre-lingual hearing loss face greater challenges in natural language acquisition, while those with post-lingual loss may have better outcomes due to their existing language foundation.

When is a cochlear implant typically recommended?

A cochlear implant is often proposed for individuals with profound hearing loss (>90 dB) where there is no perception of speech and traditional hearing aids provide insufficient benefit. Cochlear implants have revolutionized the management of severe to profound hearing loss by providing direct access to hearing through electrical stimulation of the auditory nerve.

Hearing Loss and Cochlear Implants: A Complete Guide for Speech Therapists

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Hearing Loss and Cochlear Implant: Complete Guide for Speech Therapists

Hearing loss affects the development of spoken language when not addressed early. The cochlear implant has revolutionized the management of severe to profound hearing loss by providing access to hearing. The speech therapist plays a central role in supporting deaf individuals, whether they are fitted with hearing aids, implanted, or users of sign language.

👂 Resources for Supporting Hearing Loss

Visual aids, communication tools, listening exercises

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Types of Hearing Loss

By Location

Conductive Hearing Loss: impairment of the outer or middle ear (eardrum, ossicles). Often reversible (otitis, earwax).
Sensorineural Hearing Loss: impairment of the inner ear (cochlea) or auditory nerve. Generally permanent.
Mixed Hearing Loss: combination of both types.

By Degree (BIAP Classification)

Degree	Hearing Loss	Impact
Mild	20-40 dB	Soft or distant voice poorly perceived
Moderate	40-70 dB	Speech perceived if loud, hearing aids needed
Severe	70-90 dB	Only loud sounds are perceived, hearing aids essential
Profound	>90 dB	No perception of speech, implant often proposed

By Onset Timing

Congenital: present at birth
Pre-lingual: before language acquisition (0-2 years)
Peri-lingual: during acquisition (2-4 years)
Post-lingual: after language acquisition

Screening and Diagnosis

In France, neonatal hearing screening has been systematic since 2012. It allows for early intervention, crucial for language development.

Screening Tests

Otoacoustic Emissions (OAE): tests the functioning of the cochlea
Auditory Brainstem Responses (ABR): tests sound transmission to the brain

Audiological Assessment

Tonal Audiometry: measures hearing thresholds by frequency
Speech Audiometry: evaluates speech understanding
Impedance Audiometry: assesses the eardrum and middle ear

Hearing Aids and Cochlear Implants

Conventional Hearing Aids

Hearing aids amplify sound. They are indicated for mild to severe hearing loss when there is still usable residual hearing. Different types exist: behind-the-ear, in-the-ear.

Cochlear Implant

The cochlear implant is an electronic prosthesis that bypasses the defective cochlea to directly stimulate the auditory nerve. It consists of an external part (microphone, processor) and a surgically implanted part.

Indications: severe to profound bilateral hearing loss, insufficient benefit from conventional prostheses. Can be implanted as early as 12 months in children.

Results: variable depending on the age of implantation, duration of hearing loss, rehabilitation. Early implants (before 2 years) yield the best results for the development of spoken language.

Impact of Hearing Loss on Language

Without access to hearing, the development of spoken language is significantly impacted. Hearing loss affects:

Speech Perception: difficulties in hearing and discriminating sounds
Phonology: delays or disorders in phonological awareness
Articulation: sound production altered due to lack of auditory feedback
Vocabulary: slowed lexical learning
Morphosyntax: difficulties with less prominent grammatical elements
Pragmatics: conversational difficulties (turn-taking, prosody)
Written Language: impact on reading acquisition

💡 The Importance of Early Intervention

The early years of life are a critical period for language development. Early fitting or implantation (before 2 years), combined with intensive rehabilitation, often allows for language development close to normal.

Speech Therapy Rehabilitation

Objectives

Develop listening skills and auditory discrimination
Develop spoken language (comprehension and expression)
Work on speech (articulation, intelligibility, prosody)
Support the learning of written language
Support overall communication

Approaches

Auditory Training: training the ear to perceive, discriminate, identify sounds
Verbo-tonal Method: uses the body and rhythm to facilitate perception
Lip Reading: learning to use visual cues from speech
Multimodal Approach: combining hearing, lip reading, Cued Speech, French Sign Language according to needs

Post-implant Specificities

Adjustments: collaboration with the medical team to optimize settings
Intensive Auditory Training: learning to interpret the new signal
Regular Follow-up: continuous adaptation according to progress

Modes of Communication

Oralism: communication in spoken French, with or without Cued Speech
French Sign Language (LSF): complete visual-gestural language
Cued Speech (LPC): manual code that complements lip reading
Bilingualism: LSF + spoken/written French
Total Communication: all available means

The choice of communication mode belongs to the family, informed by professionals. The speech therapist supports regardless of the choice.

Our Downloadable Tools

👂 Auditory Discrimination

Exercises to train the perception and discrimination of sounds.

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💬 Communication Pictograms

Visual aids to support communication.

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🖼️ Daily Imagery

Images to develop vocabulary with visual support.

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🎶 Phonological Awareness

Adaptable exercises to work on sounds.

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Frequently Asked Questions

📌 Can a child with an implant develop normal language?

With early implantation (before 2 years) and intensive rehabilitation, many children develop spoken language comparable to that of hearing individuals. However, results are variable and depend on many factors: etiology, age of implantation, family involvement, quality of rehabilitation. Extended speech therapy follow-up is generally necessary.

📌 Does the cochlear implant replace speech therapy?

No, on the contrary. The implant provides access to sound, but the brain must learn to interpret this new signal. Speech therapy is essential after implantation, often intensive at first (several sessions per week), then regular over several years. Without rehabilitation, the benefits of the implant are very limited.

📌 Should a child with an implant learn LSF?

It is a family choice. Some families opt for an exclusive oralist approach, others for bilingualism (LSF + spoken French). LSF can be a valuable support, especially while waiting for the implant or if the implant is removed (failure, bath, sleep). Research shows that LSF does not hinder the development of spoken language.