9 SSET & JSET (Hearing

Impairment)
• SSET &JSET (Visual
Impairment)
9 SSET & JSET (Intellectual
Disability)
*SSET
&JSET
equally Helpful For*,
Muhammad Nazir
M.ed(Sj>ledk)0dM«lfllkt
PhD Scholar

(Physical Disability)
9 Headmaster/Headmistress
9 Lecturer Special Education
PPSC & fTSC PKETARAtfOW
 \
)

\
t

L
Objective + Subjective
(One Line question answer & Precise Detail)

A complete package for Special Education Teachers

&

M.A / M.Ed Special Education

(By

Muhammad Nazir
M.Ed Spl. Edu. (Gold Medalist)
Ph.D Scholar

SOHAIB BOOK HOUSE

Opposite University of Education, College Road
Samanabad, Faisalabad. 0331-6898006/0300-9668284
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. Jt
Crux of Special Education
Title
By Muhammad Nazir
Publisher
Sohaib Book House, Faisalabad
Opposite University of Education,
College Road Samanabad, Faisalabad
0331-6898006/0300-9668284
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 PREFACE
Special Education is a dynamic field based on the delivery and evaluation
of specially designed and coordinated procedures of assessment practices, related
services intended to address the strengths and weaknesses of the individuals. This
has evolved as a significant entity within our education system. The essence of
special education is, all children no matter what weaknesses and strengths they
carry, have the right to. education which fulfills their individual needs, enable
them in line to their full potentials which eventually make them self-reliant.

The content of the book is equally designed for undergraduate and post
graduate students. It covers conceptual, behavioral, cognitive, linguistic and
pedagogical foundations on special education in general and specific disabilities
and disorders in particular. The author has explicitly covered the variety of
individual characteristics of special needs that must be taken into account in order
to provide effective educational practices. -
e

I congratulate the writer who has taken this initiative of providing people
with information on this topic, which was sorely needed. While people may
generally be aware of this field, there is not much literature available for all types
of audiences. This book, however, addresses this i problem and has set a
benchmark for further research on this field, in Pakistan. The contribution, this ■>
book makes is substantial for not only academics, but for all those people who
would like to learn about Special Education according in their own individual
capacities.

Dr. Tanzila Nabeel

Chairperson, Department of Special Education,
Allama Iqbal Open University, Islamabad.
 CONTENTS

i
■
i
t-
 Chap # Topic Page #

Hearing Impairment 1-76

1
77-136
2 Visual Impairment

3 Intellectual Disability 137-187

4 Physical Disability or Orthopedic 188-243 .

Impairment
.5 Core of Special Education 244-338

339-356
6 Key Differences

Chapter No. 1
 HEARING IMPAIRMENT
Sr# Topic Page#

1 Nutshell of the Hearing Impairment 2

'2
Basic Hearing Impairment Terminology 15
3 Hearing Loss, Its Types and Effects 23 •
4 Ear Anatomy 28
5 Etiology (Causes) of Hearing Loss 31

6 Assessment of Hearing 35
7 Treatment of Hearing Loss 45

8 Hearing Aids 49
9 Earmold 57
10 Sound and its Properties > 63
11 Auditory Masking 65 •
12 Speech and Language Disorder 67
13 Miscellaneous ' 75
 Nutshell of Hearing Impairment
Cruxj>f_S/^. "MJiducgtigii r Hearing Loss
Unit No. 1 - Hearing Loss
1. Silent/Hidden Disability is called - Air
2. Defect or damage to hearing mechanism causes -Eusta’cnian tube function
3. The middle ear is a cavity filled with - Middle ear function
4. Equalize pressure on both sides of eardrum - Fluid (check)
5. Transfer sound from eardrum to cochlea - Semicircle Canals
6. Inner ear cochlea is filled with -3
7. Another name of vestibular labyrinth is - 8th Cranial Nerve
8. Vestibular labyrinth fluid filled semicircle canals - Sound pathway ‘
9. Auditory Nerve is also called - Air Conduction
10. Outer ear, middle ear, inner ear & 8th cranial nerve
- Air Conduction
11. How do we hear normally, through
- Bone Conduction
12. Sound travel outer ear 2 middle & then inner ear
-Ototoxicity
13. Sound bypass outer, middle ear & stimulate cochlea
14. Hearing loss caused by medications is called - Higher to Lower
15 . Frequency in cochlea arranged its base to apex (top) - Higher frequencies
16. Sensorineural hearing loss affects first -Higher
17. Frequencies at the base (entrance point) of cochlea -Lower'
18. Frequencies at the apex (top) of cochlea - Cilia
19. Tiny hair-line cells in cochlea - Amplifier
20. Device that increase intensity of sound - Sensation Level
21. Level of hearing loss - level of hearing threshold -20 Pascal
22. Quietest sound a person can hear - Sinusoid
23. Waveform of pure tone at one level of frequency - Discrete area
24. Pure tones stimulate cochlea basilar membrane ' - White Noise
25. Equal energy (loudness) at all frequencies denotes - 20 Hz to 20,000 Hz
- 26. White noise usually contains the frequencies from - White Noise
27. Within the range of human hearing frequencies - Narrow Band Noise
28. Noise centered around a particular frequency - Speech shaped noise
29. A noise with more energy at low frequencies - Mechanical energy
30. Bone oscillators convert the Electrical energy into - f*ure Tone Average
 32. PTA usually contains 3 thresholds of 500,1000 & - 2000 Hz
33. Pure Tone Average is mostly at hearing loss - 70 dB
34. Sound is lateralized in the worse ear in hearing loss - Conductive
35. Sound is lateralized in the better ear in hearing loss - Sensorineural
31. PTA stands for

Cruxj)f^j)ec[qlJ^ducaJio_n
 36. Audiometer is electronic extension of same concept use in- Tuning Fork test
37. Instrument helps to find out extent & type of hearing loss- Audiometer
38. Monitoring standard working of audiometer -Audiometric Calibration
39. Test compulsory before audiometric testing - Otoscopy
40. Range of frequencies most sensitive to ear - 1000-4000 Hz
41. Man starts feel pain at minimum sound intensity - Threshold of pain
42. Quietest sound one can hear - Hearing threshold
43. Difference b/w hearing threshold and threshold of pain - Dynamic Range
44. Level of threshold of pain which is usually considered -,120'dB
45. Level of Dynamic Range - 120 dB
46. 100 Hz frequency easily heard by most has high - Test-retest reliability
47. Weakest audible sound detected is - 50% of the time
48. In threshold search method, we look for three responses - Ascending
49. Severity of hearing loss is discovered when the - Masking is done
50. Pure Tone Average (PTA) is done for - Air Conduction
51. Fluid in the middle ear causes a hearing loss via - Air Conduction
52. Otosclerosis causes a hearing loss via - Air Conduction
53. Collapsed ear canal causes a hearing loss via - Air Conduction
54. Type of noise used for.testing speech is - Speech shaped noise
55. In bone conduction sound is directly transmitted to -Cochlea
56. Bone conduction is done to check sensitivity - Sensori-neural
57. Bone oscillators are placed on forehead and - Mastoid Bone
58. Forehead oscillators are placed on -Forehead
59. In bone conduction testing, cochlea of both side is - Vibrated
60. Air Bone Gap (ABG) shows the amount of involvement- Conductive
61. Sound loses some of its momentum & energy when travel- To other ear
62. Traveling of sound from one ear to another is called - Cross Hearing
63. Cross hearing and inter-aural attenuation go .- Side by side
64. In inter-aural attenuation, sound travel to other ear - Decreases
65. Possibility of cross hearing in bone conduction . - Always
66. Masking helps to decrease ' - Cross hearing
67.. Cross hearing is not a matter in normal hearing and - Sensori-neural HL
68. Presenting noise to non-test ear to reduce cross hearing Masking
69. Masking is done to raise
the threshold of ear -Non-test ear
70. Masking usually used in
audiology -Contralateral
71. Find degree & type of hearing loss is difficult due to - Cross hearing
72. Nasal Sounds are produced by moving air through -Nose
73. Transducers suitable for collapsed ear canal are -Insert-receiver headphone
74. Presbycusis can cause hearing loss -Conductive&Sensorineural
Qyxof_Sj)SciqIJEducjitiqn
75. In speech audiometry, speech is not - Frequency specific
76. Words used in Speech Recognition Threshold - Spondee
77. Most commontest of Speech Recognition is . - Word Recognition
78. Tone be given to test ear & noise to non-test ear in - Cross hearing
79. Electronic' device use to transmit sound to ear in bone conduction- Bone Oscillator
80. Device moves skull back &forth to transmit sound - Bone Oscillator
81. Hearing that remains after a one experience hearing loss- Residual Hearing
-120-130
82. Specially responsible for hearing assessment/diagnosis - Audiologist
- 45 dB V s
83. Speech therapy services are provided by -Speech&language therapist
- 500 - 3000 Hz
- 0-25 dB
- 26-40 dB
- 41-55 dB
- 56-70 dB
- 71-90 dB
- 90+ dB
- Yes
- Pure tone
- Finger spelling

84. Loudness discomfortable level

85. Intensity level of normal discussion
86. Frequency level of normal discussion
87. Degree of normal hearing level
88. Degree of mild hearing loss
89. Degree of Moderate hearing loss
90. Degree of Moderately Severe hearing loss
91. Degree of JSevere hearing loss
92. Degree of Profound hearing loss
93. Can a sound at 0 (zero) dB heard
94. Single frequency sound is called
95. Dactyl speech is called
96. Mouth movements combine with “cues” to make sounds- Cued Speech
97. Hand shapes used in cued speech for consonant phonemes-8 Hand shapes
98. Locations near mouth in cued speech for vowel phonemes-4
99. Hearing loss caused by use of medicines/drugs - Ototoxicity
100. Drugs that effect hearing & balance system of humans -
Ototoxic drugs - Ear pain
101. Otalgia refers to the - - Otoscopy
102. Ear examination to check earwax or eardrum hole - Otoscope
103 . Device used for ear examination in otoscopy - Science of spund
104. Acoustics refer to the • - Thresholdof pain
105. Minimum sound intensity at which one start feeling - Acoustic gain
pain
106. Calculated sound without feedback is called
107. Speaker sound which re-enter again&again into microphone- Acoustic feedback
108. Decrease of sound when it travels from one ear to other- Inter-aural attenuation
109. Method to teach deaf using all means of communication- Total communication
110. Combination of sign language and spoken language1 -Simultaneous communication
111. Method that focuses speaking and speech production - Auditory-aural
112. Method that focuses hearing and listening . - Auditory-verbal
113. Teachers serve'as speech therapist in method - Auditory-aural
114. Parents serve as speech therapist in method* -Auditory-verbal
115. Trained dog used to alert deaf about sounds is called - Hearing Dog
116. Usual duration of training given to hearing dogs - 6 months to 1 year
117. Training should be given to the dog having age atleast - 6 Months
118. Hearing dog is recommended for a person having HL - About 65 dB
119,Sound with more than one frequency - Complex sound
120. Human sound is - Complex sound
121. Continuous range of frequencies b/w 2 limiting frequencies- Band
122. Noise centred around a particular frequency - Narrowband noise
123. Noise distributed in wide range of frequencies - Wideband noise
124. Noise containing more energy at lower frequencies - Speed shaped noise
125. Bone at the back of ear connected to inner ear • - Mastoid Bone
126. Study of sound -Audiology
127. Consonants are high pitched than -Vowels^
128. No. of vowel in English language -05
129. No. of consonants in English language -21
130.26 English alphabets represent - 44 Sounds
131. Consonants are spoken more softly than -Vowels
132. Ensures even distribution of sound from teacher to students - Sound Field system
133. Average of 3 thresholds at 500, 1000, 2000 Hz is - Pure tone average
134. Pure Tone Average (PTA) is done only for - Air conduction
135. Air Bone Gap is the feature of - Audiogram
136. HL stands for -Hearing Loss
137. Defect of outer & middle ear stops air to reach inner ear- Conductive HL
138. Hearing loss curable through medicine & surgery - Conductive HL
139. Loud sound helps to makes hearing possible in - Conductive HL
140. Defect in inner ear to cochlea or auditory nerve causes - Sensorineural HL
141. Hearing loss that is not curable - Sensorineural HL
142. A person carrying both Conductive & Sensorineural HL- Mixed Hearing loss
143. Hearing problem due to the problem in brain processing- CAPD
144. Central Auditory Processing Disorder -CAPD
145. One with profound hearing loss who uses sign language - Deaf
146. Complete deaf refers to - Stone Deaf
147. Who can neither hear nor speak old term refers to - Deaf Mute
148. A person with some residual hearing refers to . - Hard of hearing
149. Deafness that occurs before language development -
Prelingual deafness
150. Deafness that occurs after language development -
Postlingual deafness
151. Ability of deaf to communicate using 2 sign languages - Bilingual
152. Ability of deaf to communicate both in deaf & normal
-Bi-Bi
community- Bicultural
- Congenital deafness
153. Bilingual and Bicultural Deaf people are called
154. Deafness at the time of birth - Acquired deafness
155. One who bom normal but loss hearing later in life - Industrial deafness
156. Hearing loss due to long exposure to industrial noise -Adventitious deafness
157. Hearing loss due to injury or disease after birth - Monaural HL ,
158. Hearing loss in one ear - Binaural HL
159. Hearing loss in both the two ears - Bilateral HL
160. Hearing loss in both the two ears also called - Contra lateral HL
161. Hearing loss in opposite sides of ears - Ipsi Lateral HL
162. Hearing loss in same side of the ears
163. Threshold at each frequency within 20 dB of each other- Flat HL
164. Gradual increase of hearing loss with frequency increase- Sloping HL
165. Gradual decrease of hearing loss with frequency increase- Rising HL

- Malingering
167. Person hear sounds but pretends he is not hearing -Retrocochlear HL
168. Lesion (cut/injury) on auditory nerve causes loss - Progressive HL
169. Hearing loss that gets worse over time - Delayed-onset HL
170. Hearing loss that occurs after the baby is bom - Presbycusis HL
"171. Hearing loss usually occurs in old age - Sudden HL
172, Rapid hearing loss usually in one ear % - Anatomy
173; Study of structure of animals and their parts -2,
174. No. of temporal bone in human body - Skull
175. Temporal bone are connected to the - Temporal Bone
176. Outer and middle ears are located in - Parts of ear
177. Outer ear, Middle ear & Inner ear - Outer ear
178. Pinna and ear canal are the part of - Middle ear
179. Ear drum and Ear bones are the part of
166. Inability to hear sounds due to psychological problems - Hysterical deafness
180. Cochlea, Auditory nerve, & semicircle canals are part of- Inner ear
181. Outer visible part of the ear is called - Pinna
182. Outer ear part that works as antenna & catches sound - Pinna
183. Pinna sends the sound to the - Ear Canal
184. Average length of ear canal -25 mm
185. Average width of ear canal - 7 mm
186. One side of ear canal is connected with pinna & other - Ear drum'
187. Wax glands and hairs of ear canal protects the ear from - Worms
188. Ear canal passes sound to the - Ear drum
189. Surface area of ear drum -64.3 mm2
2Crux of SpecialJEducaJwji
190. Eardrum passes from ear canal to - Hammer (bone)
191.3 Ear bones connected with each other are called -
Ossicular chain - Ear bones
192. Smallest bones of human body are the bones of - Cochlea
193. Ossicular chain / bones pass sound to the - Malleus/Hammer
194. First ear bone connected with eardrum is called - 25 mg
195. Average weight of Hammer (ear bone) - Anvil
196; Hammer passes sound to the - Incus
197. Other name of Anvil is - 30 mg
198. Average weight of Anvil - Human teeth
199. Shape of Anvil is like a -Stirrup
200. Anvil passes sound to the - Stapes
201.Other name of Stirrup is - 3-4 mg
202. Average weight of the Stirrup is ■ - Cochlea
203. Is passes sound to the oval window of - Stirrup
204. Smallest bone of ossicular chain - Footplate
205. One side of Stirrup is called head and other called - Cochlea
206. Fluid filled, snail shaped ear organ is called - 35 mm
207. Average length of-cochlea - Hair cells
208. Important part Organ of Corti of cochlea contains - Auditory nerve
209. Cochlea passes sound to the - Round window
210. Cochlea contains 2 windows; Oval window & - 01
211. No. of cochlea in each ear - Brain
212. Auditory nerve passes sound to the - 8th Nerve
213. Auditory nerve is also called -3
214. No. of semicircle canals in the ear - Vestibular Labyrinth
215. Other name of semicircle canals - Inner ear
216. Slemicircle canals are located in -Human body balance
217. Function of semicircle canals is the - Balance
218. Damage to semicircle canals affect the human body - Eustachian Tube
219. Ear organ that maintains air pressure in middle ear - Nasopharynx
220. Eustachian Tube is connected with middle ear and -Anotia
221. Absence of pinna is called - Microtia
222. Small size of pinna is called - Aural Atresia
223. Malformation of ear canal is called -Stenosis
224. Narrowing of ear canal is called -Ear
225. Excessive production of ear wax block the - Cerumen
226. Other name of Ear wax is - Eardrum
227. Other name of tympanic membrane is - Hole in eardrum
228. Perforation of tympanic membrane means - Air Conduction ,
229. Wax in middle ear causes a hearing loss via - Atresia
230. No Ear Canal or malformation of ear canal denotes

Crux of SpecialJLdu cat

[on
231. Formation of additional bone in the middle ear Otosclerosis
Skin, mouth, lips Outer ear
Anoxia Middle ear
Lever System Otitis Externa
Prematurity Otitis Externa
Meniere’s Otitis Media
■ Screening test Otosclerosis
Screening test Before birth
Diagnostic test 3 During birth
Screening test After birth
Audiogram Toxoplasmosis
F requency/Intensity Cat Feces (potti)
-10 to 120 dB Syphilis
125-8000 Hz Penicillin
Blue colour Fetus
Red colour RebuUa
Tympanometry Red/pink rash
No Cytomegalovirus
Tympanometer No
Move eardrum Yes
232. Otitis Externa is the infection of ear
233. Otitis Media is the infection of ear -
234. Mixing of water and ear wax causes infection called
235. Usually swimmers carry the ear infection called
236. Usually fluid discharge denotes -
237. Formation of new additional bone in middle ear called -
238. Pre-Natal means
239.
Peri-Natal means -
240. Post-Natal means
241. Eating raw or uncooked meat, unwashed fruits causes -
242. Main source of Toxoplasmosis
243. Virus transmitted through sexual contact -
244. Treatment of Syphilis .
245. Syphilis is usually transmitted by pregnant mother to -
246.
German measles is also called -
247. German measles causes on human body -
248. Very severe virus that causes major disabilities
249. is there any treatment of Cytomegalovirus

3CruxofSj)ecml_Edu cjitioji
250. Is Cytomegalovirus remain in body whole the life
251. Herpes Simplex causes water blisters on the .-
252. Lack of oxygen during birth causes hearing loss
253. Which system of human body is effected by jaundice -
254. Birth well before the estimated period /time
255. Excess of fluid in the inner ear which causes dizziness -
256. Test that only tells whether one have hearing loss or not-
257. Test not shows nature or degree of hearing loss
258. Test used to know nature or degree of hearing loss •
259. Just a pass or fail test is -
260. Graphical representation of hearing level is called
261. Two main components of audiogram are
262. Intensity/loudness is shown at vertical axis with level -
263. Frequency is shown at horizontal axis with level
264. Colour used for left ear in audiogram
265. Colour used for right ear in audiogram -
266. Problems and functions of middle ear are evaluated by -
267. Is tympanometry is a hearing test
4268. Tympanometry is done with the instrument
269. Pressure in middle is changed with tympanometer to -
 270. Tumors of the ear can be broken through - Radiotherapy
271. Eardrum perforation can be treated with medicine - Antibiotics
272. Anti-anxiety medicine is suggested to treat the -Tinnitus
273. Surgical treatment in which stapes is removed - Stapedectocomy
274. Surgical treatment of eardrum and ear bones - Tympanoplasty
275. Surgical treatment of perforated eardrum - Myringotomy '
276. Sureical treatment of ear bones - Ossicoplasty
277. Device that makes the sound understandable for deaf - Hearing aid
278. Cochlear implant is used the persons havin'g - Sensorineural HL
279. Cochlear implant bypass inner ear and directly stimulate- Auditory Nerve
280. Picks sound from environment, converts to-electrical signals- Microphone
281. Traditional instruments that use electronic circuitry -Analogue hearing aid
282. Hearing aid that convert acoustic signal into binary digits - Digital HA
283. Combination of analogue and digital hearing aid 1 - Hybrid hearing aids
284. Plastic piece or soft material, connect hearing aid with ear- Earmold
285. Earmold provides the - Acoustic seal
286. Earmold enhances the efficiency of - Hearing aid
287. Most useful material for to make earmold is -Silicone
288. Earmold material, more comfortable, flexible, durable - Silicone
289. Is Silicone more expensive than other materials -Yes.
290. Making additional hole other than main hole in earmold- Venting
291. Vent reduces amplified sound of hearing aid & release - Ear sound pressure
292. Types of Venting -Parallel/Diagonal/Trench
293. Creating resistance in sound vibrations in earmold tube- Damping
294. Damper is inserted in different places of - Earmold tube
295. Cotton, wool, or ball can be used as -Dampers
296. Technique used to insert the dampers • - Trial & Error
297. Enlarging earmold hole to enhance Jiigh frequency sound- Homing
298. Blueprint or design of outer ear - Ear impression
299. Ear impression is taken to make the -Earmold
300. Basic methods used for ear impression -
Manual/Syringe
301. Pressing material in pinna with hands is the method /, r Manual method
302. Making ear impression with the help of syringe is - Syringe method
303 . Suitable and effective method to take ear impression - Syringe method
304. Auriscope, light pin, tamp material, syringe are tools of - Ear Impression
305. Earmold should bp change with the increase in size of - Child ear
 306. When the earmold is broken it should be - Changed
307. Most suitable material to prepare Earmold -Silicon
308. To prepare earmold, material should be heated at -100 C°
309.
- Auriscope
- JJlock the Ear
-Ear
- Press the Ear
- Sound
- Waves
- Air/water/solid
Tool used for observation ear observation with light
310. Tamp material is used to
311. Tamp material not allowed material to enter the
312. Light Pin is used to
313. Form of energy produced as a result of vibration
314. Sound travels in the form of
315. Sound can travel through medium
316. Motion of particles of medium parallel to wave direction- Longitudinal waves
317. Motion of particles of medium perpendicular to wave direction- Transverse waves
318:No. of waves passing through particular point in one second- Frequency
319. Quality of sound determined by frequency- Pitch of
sound
320. Unit of frequency is - Hz ,
321. As the frequency increases, pitch of sound -Increases
322. Distance between two peaks (high points) is -Wavelength
323. Wavelength is denoted by - A, (Lambda)
324. Higher the wavelength, shorter the - Frequency
325. Maximum distance wave moves from its equilibrium position-Amplitude
326. Distance travelled by sound wave in per unit of time - Speed of sound
327. Sound power per unit area is called - Intensity of sound
328. Intensity of sound is also called the - Loudness of sound
329. Sound intensity level is measured in - Decibel (dB)
330. Watt per meter square is the unit of .- Intensity of
sound
331. Higher the amplitude, higher the - Intensity of sound
332. Sound quality helps distinguish different voices at same pitch- Timbre
333. Desirable, wanted or enjoyable sound - Music
334. Unwanted sound refers to the - Noise
3 3 5. A regular repeated pattern of sound or movements - Rhythm
336. Normal range of hearing / audible frequencies -20-20000 Hz
337. Inaudible sound with frequencies greater than 20000 Hz-Ultrasonic
338. Inaudible sound with frequencies less than 20 Hz - Infrasonic
339-. Ability of one sound to make other sound difficult to hear- Auditory masking
340. Sound to be detected is called -Maskee
341. Wanted or desired sound is called -Maskee
342. Other name of Maskee -Signal
343. Undesired sound that interfere desired sound -
Masker
344. Quietest audible level of signal after masker is presented- Masking threshold
345. Masking in which signal & masker is given at same time- Simultaneous
346. Signal &masker is given in same ear at the same time - Ipsilateral masking
 348. Masking in which signal &masker is not given same time -Non-simultaneous
349. Non-simultaneous
masking is also called .-Temporal masking
350. Presenting the signal
first and then masker
347. - Backward masking
351. Presenting the masker first and then signal --Forward masking
Nasal sounds
352. Echo-like sound of own voice after inserting hearing aid- Occlusion effect
- Nasal sounds
- Oral sounds
- ITP
- IEP
- IFSP
-Multidisciplinary team
- 0-3 Years
Signal &masker is given in opposite ears at same time-
Contralateral masking
353. Sound produced using the path of nose
354. N, M, ng are the sounds
355. Sound produced suing the path of mouth
356. Individualized Transition Plan

3.70. Use of grammatical rules to make sentences - Syntax

371. Measles, Mumps, & Rebulla Vaccine denoted as - MMR
372. Producing sound with the use of vocal organs - Vocalization
373. No. of vocal cord in human -2
374. Vocal cords are also called vocal folds or - Vocal Reeds
375. Vocal cords are located in - Larynx
376. Larynx protects the - Vocal Cords
377. Larynx is called - Voice Box s
378. Vocal cords vibrate to produce -Voice
379. Inability of vocal cords to move is denoted as -Vocal" cord dysfunction
380. Approximate length of male focal cord -0.75-1.00 cm
381. Approximate length of female focal cord - 0.50-0.75 cm
357. Individualized Education Plan is denoted as -AAC
358. Individualized Family Support Plan is denoted as
359. Who develop IEP & IFSP
360. IFSP is developed for the child age , ■ . ,
361. Plan that includes educational & vocational program for children- ITP
362. Early Intervention eligibility age under IDEA - 3 Years .
363. Movement of hands and 'fingers is denoted as - Fine motor
364. Movement of large muscles of the body is denoted as - Gross motor
365. Study of sound is called -Phonology
366. Study of word formation is called - Morphology
367. Smallest unit of language which gives meaning - Morpheme
368. Study of meaning of words -Semantics
369. Use of proper words/sentences according, to social setting- Pragmatics
382. Augmentative and Alternative Communication
383. AAC includes all means of communication other than - Oral communication
384. Picture Exchange Communication System is denoted as- PECS
'385, PECS is the technique of - AAC
386, Using video recording to provide model of target behavior- Video Modeling
387. Collagen injections are used to treat voice and - Speech impairment
388. Vocal cord inability to close while talking is treated with- Collagen injections
389. Speech Easy Device is used to treat - Stuttering
390. Speech impairment can be improvised with the help of - Speech Therapy
391. Labials means -Lips

- Labiodental sounds
393. Lips touch with teeth and make sound called -Lingua-dental sound
394. Teeth touch with tongue & make sound called - Alveolar sounds
395. Sounds produced by teeth ridge are called - Upper front teeth
396. Teeth Ridge is situated immediately after - Hard Palate
397. Central part of Mouth roof is called - Soft Palate
398. Lower part of the Mouth roof is called - Velum
399. Soft Palate is also called - Velum
400. What blocks or opens the nasal or oral cavity -Velar sounds
401. Sounds produced by soft palate are called - Uvula
402. Ending part of soft palate hanging in throat is called

392. Lips touch each other & make consonants sounds called- Bilabial sounds
403. Lies between mouth and food passage just above larynx-
Pharynx - 7-8 cm
404. Average length of pharynx is - Larynx
405. Situation after throat next to pharynx - Glottis
406. Open form/shape of vocal cords is called -Voice / Soft sound
407. Sound produced by vibrations of vocal cord is called -Voiceless/Hard sound
408. Sound produced without vibration of vocal cord -2
409. No. of lungs in rig cage of human body - Speech production
410. Lungs contribute to - Airflow/breath
411. Lungs control the - Speech disorder
412. Inability to produce sounds correctly or fluently - Articulation
413. Making sounds and words is the - Articulation disorder
414. Inability of speech organ to make a sound/speech - Phonic Disorder
415. Articulation disorder is also called - Stammering
416. Stuttering disorder is also called - Stuttering
417. Sounds, first letters or syllables repeated & prolonged - Stuttering
418. Disruption in'normal flow of speech - Stuttering
419. Muscle tension (rapid eye blinks, shivering of lips) - Cluttering
420. Rapid / too fast speech is related to - Machinegun speech
421. Cluttering is also called - Cluttering
422. Repeating words or sentence again & again - No
423. Is there any muscle tension in cluttering?
424. Does child gets confused while speaking in stuttering? - Yes
425. Does child gets confused while speaking in cluttering? - No
 426. Is child aware of his speech problem in stuttering? - Yes
427.1s child aware of his speech problem in cluttering? -No
428. Stuttering & cluttering both are - Fluency Disorders
429. Issues of pitch, loudness, resonance are related to - Voice Disorder
430. Infection or injury to vocal cords or larynx usually results- Voice Disorder
431. Problems 12of high/low pitch, high/low loudness, rough voice- Voice Disorder
432. Apraxia of Speech is denoted as - AOS
433. Oral-Motor Speech Disorder is also called - Apraxia of Speech
434. Brain not support motor coordination & motor planning to speak- AOS
435.1s AOS Congenital or Acquired? -Acquired
436. Damage to brain part (cerebrum) causes -AOS
437. Dysarthia is -Motor speech disorder
438. Inability of mouth, face muscles Or respiratory system - Dysarthia
439. Dysarthia is -
Neurological
440. Problem in understanding others & expressing yourself- Language disorder
CnjxojSj)eclaJ_Educatloji
441. Aphasia results from - Brain dysfunction
442. Total disruption of listening, speak, reading, writing - Aphasia
443. Damage to Broca area which affects speech production- Expressive Aphasia
444. Expressive Aphasia affects the * - Speaking & writing
445. Damage to Wernicke area which affects speech understanding-Receptive aphasia
446. Receptive Aphasia affect the - Listening & reading
447. Combination of both Expressive and Receptive Aphasia- Global Aphasia
448. Problem in recalling words, names or numbers -
Anomic Aphasia
449. Partial disruption in listening, speak, reading or writing- Dysphasia
450. Nature of Aphasia is - Severe to profound .
451. Nature of Dysphasia is -Moderate
452. Aphasia is -Total speech disruption
453. Dysphasia is -Partial speech disruption
454. Difficulty in producing the language correctly -Expressive language disorder
455. Difficulty in understanding the language correctly -Receptive language disorder
456. Who diagnose the language and speech disorder - Speech Therapist
457. Denver Articulation Screening Exam -DASE
458. Denver Articulation Screening Exam use to diagnose - Speech disorder
459. DASE assess clarity in pronunciation of children of age- 2-1 years
460. Early Language Milestones Scale 2 diagnose - Language disorder
461. Peabody Picture Vocabulary Test Revised assesses vocabulary & - Speaking ability
462. Initial masking level already produces overmasking - Masking Dilemma
463. Masking Dilemma occurs due to - Bone conduction
464. Earphone that helps to reduce Masking Dilemma -
Insert Earphones
 cation
465. Tone level further increased to increase threshold of test ear again- Overmasking
466. Tool used to identify level of sound -Sound level indicator
467. Electronic device that converts one form of energy into another- Transducer
468. Microphone, loudspeaker, antenna are called -Transducer
469. Barrier in the flow of sound through a medium -
Acoustic impedance
470. Wave form of pure tone at one level of frequency -
Sinusoid
471 . Decrease of sound amount when it travels one ear to another-Interaural attenuation
472. Sound pressure presented to one ear heard .by another ear- Cross Hearing
473. Bone oscillators change the electrical energy into - Mechanical energy
474. ENT specialist is also called -Otolaryngologist
475. Tool that uses a recorded timed speech -Speech
timing equipment
476. Most Comfortable Listing Level is, denoted as -
MCL
-40-55 dB above threshold
477. Level of MCL
478. Uncomfortable Listening Level isbenoted as - UCL
479. Loudness Discomfort Level - LDL
480. Loudest sounds that can be tolerated by young
normal listeners-LDL - 120-130 dB
- 45 dB
481. Usual level of LDL
- 500-3000 Hz
482. Intensity level of normal discussion
-Yes
483. Frequency Level of normal discussion
- Speech frequencies
484. Is there a sound at 0 (zero) dB?
- 1000-4000 Hz
485. Frequencies of 500, 1000, 2000 Hz are called
- Sensation Level
486. Ear is most sensitive between frequencies
- Cold running speech
487. Level of sound above the threshold of a person
488. Speech Detection Threshold is also called
489. Visual presentation of change of sound frequency over time-Voice Print
490. Voice Print is also called Voice Gram or -Voice spectrum display
491. Computer program Used for analysis of speech - Speech Analyzer
492. Computer program helps to analyze speech problems - Speech Analyzer
493. System of phonetic symbols developed by Alexander Bell- Visible Speech
494. Sound with more than one frequency - Complex Sound
495.1s human sound a complex sound? -Yes
496. Simultaneous Communication is called - Simcom
497. Only combination of Sign Language & Spoken Language- Simcom
498. Pakistani Sign Language is denoted as - PSL
499. Family Educational Services Foundation - FESF
500. Who introduced book‘1000 Basic Signs’for deaf -FESF
501. Who introduced book ‘5000 Basic Signs’ for deaf -FESF
- Hearing assessment
502. Base-Line Audiometery is the initial level
 *********************
Unit No. 2
Basic Hearing Impairment Terminology
1. Audiometric Calibration: It refers to the evaluation whether an audiometer
is working according to its specified standards or not.
2. Sound Level Indicator/ Sound Pressure Level Meter: A tool used to ®
identify the level of sound produced by any object (man, speaker etc.)
3. Transducer: An electronic device that converts one form of energy into
another form of energy e.g. Microphone, loudspeaker, antenna etc.
.4. Acoustic Impedance: It refers to the barrier in the flow of sou»d through a
medium.
5. Sinusoid: Wave form of pure tone at one level of l A • A - A A T
frequency. . ' V\7 \}~\J\J
6. Inter-aural attenuation: Decrease of amount of sound when it travels from
one ear to another e.g. in crossing hearing.
7. Cross Hearing: It refers to sound pressure presented to one ear heard by
another ear. :
8. Residual hearing: Refers to .the .hearing that remains after a person has
experienced a hearing loss.
9. Four Basic elements of Audiometric Testing: Pure tone/speech,
Transducers (headphone), Responses, and Interpretation of hearing loss.
10. Free field audiometry: This is a similar to pure tone audiometry test, *but
headphones are not used. This means that both ears are tested together, and
even though the test will usually be done in a soundproof room, it gives an
indication of how a person can hear in an everyday situation.
11. Tactile Response: A response to stimuli that may be caused by the feeling of
vibration of bone oscillators in bone conduction rather than hearing the actual
. sound.
12. Bone Oscillators: An electronic device which is usually placed on mastoid
bone and it moves the bone (skull) back and forth to transmit
sound to th? ear in bone conduction. Bone oscillators change the
electrical energy into mechanical energy. Bone oscillators are
placed on mastoid bone or on forehead. Due to its placement on
forehead it is also sometimes called forehead oscillator.
13. ENT Specialist. An ear, nose and throat doctor, also called an
otolaryngologist.
 14. Hearing therapists: They provide prefitting and supportive counselling,
programmes of rehabilitation, optimization and fitting of hearing aids, and
assessment for provision of assistive devices.
15. Speech and Language Pathalogist (SLP): He is responsible for providing
15
Cruxoj[Specwl_Edu cat urn
speech therapy services.
16. Audiologists: It refers to professional
responsible for prevention, screening,
diagnosing hearing, evaluation of vestibular system (balance), guidance and
counseling of persons who bom deaf, assessment and provision of hearing
aids.
17. Voice Pitch Indicator: A tool used to indicate the level of pitch -
of sound. mm
18. Speech Timing Equipment: A tool that uses a recorded timed
speech. It may also be used to record the speech for a certain time.
19. Most Comfortable Listing Level (MCL): Most comfortable listening is
typically a range, not a specific level or a single value. So most comfortable
listening level means range of frequencies where listener can understand the
tone or speech. It is 40-55 dB above threshold.
20. Uncomfortable Listening Level (UCL): This tells the uncomfortable
listening level a listener feels loud or soft.
21. Loudness Discomfort Level: It refers to loudest sounds that can be tolerated
by young normal listeners (Usually 120-130 dB).
22. Acceptable Noise Level (ANL): Amount of background noise that a listener
is willing to accept while listening to speech.
23. Intensity Level of normal discussion: Normal discussion is done at the level
of 45 dB.
24. Frequency Level of normal discussion: Normal discussion is done at the
frequencies level of 500 Hz to 3000 Hz.
25. Normal Hearing Level: It is generally 0-20 dB. It is also classified into two
categories for children and adults as under: (0-15 dB for children) (0-25 dB
for adults).
26. Zero decibel sound (0 dB): 0 dB does not mean that there is no sound. In fact
at 0 dB, softest sound can be heard by a person with normal hearing ability
approximately 50% of the time.
27. Ambient Sound Level/Background Noise Level (BNL): It refers to (
unwanted sound / noise level at a given location and time which interferes
with the sound under use.
28. Pure Tone: It refers to single frequency sound e.g. 250 Ttz dr 500 Hz etc.
29. Frequency range in normal hearing: A person with normal hearing can hear
frequencies of 20-2000 Hz.
30. Sensitive Frequencies: The ear is most sensitive between frequencies 1000 -
4000 Hz.
31. Speech Frequencies: Frequencies of 500, 1000, 2000 Hz are called speech
frequencies as most of human voice falls within this range.
32. Sensation Level (dB SL): Intensity (loudness) level of sound above the
threshold of a person. If a person has threshold level 10 dB and he / she is
detected hearing loss at 50 dB. His/her sensation level would be 40 dB. Level
of hearing loss - level of threshold = Sensation Level. 50 dB - 10 dB = 40 dB.
33. Dynamic Range of Human Hearing: It refers to the difference between the
quietest sounds we can hear (the threshold of hearing-0 dB) and the sounds
that are so loud that they cause pain (the threshold of pain-120dB) 0 dB - 120
dB = 120 dB.
34. Threshold: It refers to softest sound that can be heard at each frequency
approximately 50% of the time. ^ W^^ j' J oiJ ^
35. Threshold of Pain: It refers to minimum sound intensity at which a person
starts to feel pain. It is usually considered 120 dB.
36. Threshold Search Method for Air Conduction: Every time the listener
raises his / her hand to indicate the sound, decrease tone by 10 dB for the
same frequency. If he/she can’t hear it then increase it by 5 dB for the same
frequency. (Looking for 3 ascending responses).
37. Speech Reception Threshold (SRT): The minimum intensity in decibels at
which a patient can understand 50% of spoken words; used in tests of speech
audiometry. Also called speech recognition threshold. It is also called
threshold of hearing (TOH). Spondee words are used in SRT (Words having
two syllables pronounced with equal stress and effort (baseball, hotdog etc.)
,38. Speech Reference Level/Speech Detection Threshold (SDT): It is also
called cold running speech.
39. Acoustic: Science of sound.
40. Acoustician: A scientist who works in the field of acoustics.
41. Discrimination Score (DS): Score obtained by the listener/participant.
42. Speech Spectrum Display (Spectogram/voice print/voice gram): Visual
representation of change of frequencies of sound over
time.
43. Speech Analyzer: A computer program used for
analysis of speech. It helps to analyze the deficiency / problems of speech and
helps to improve it.
44. Dactyl Speech: Finger spelling.
t

45. Visible Speech: It is system of phonetic symbols developed by Alexander

Bell in 1867 to represent sounds.
(Non-Vocal) D X) 3 O U U 13 tS Cl O d
p «h f t *h U» ft 0* *h yh k
(Vocal) p a a o o i w a M f f l o Q
b w v d r l z d h zb ]T g
46. Cued Speech: Cued Speech is a visual mode of ^edSpee^
communication in_^which mouth movements of speech
combine with “cues” to make the sounds (phonemes) of (uQ \_jJJ
traditional spoken languages look different. Cueing allows
users who are deaf, hard of hearing or who have language / communication
disorders to access the basic, fundamental properties dff spoken languages
through the use of vision. It uses a small number of hapdshapes, known as
cues, (representing consonants) in different locations near the mouth
(representing vowels), as a supplement to speech-reading. It is similar to sign
language but not a sign language. Cued uses 8 handshapes for consonant
phonemes and 4 locations near mouth for vowel phonemes.
47. Sign Language: It is a language which chiefly uses manual communication to
convey meaning, as opposed to acoustically conveyed sound patterns. It can
involve simultaneously combining hand shapes, orientation and movement of
the hands, arms or body, and facial expressions to express a 'speaker's
thoughts. The best way to leam sign language is to communicate with the deaf
practically or teaching deaf students. Two best books on Pakistani Sign
Language (PSL) have been designed by Family Educational Services
Foundation (FESF) titled as ‘1000 Basic Signs’ & ‘5000 Signs’.
48. Ototoxicity: Hearing loss caused by medications.
49. Ototoxic Drugs: Drugs affecting the ear and balance system of human.
50. Otalgia: It refers to ear pain.
51. Otoscopy: Ear examination performed to check the presence of earwax and
hole in the eardrum with the help of otoscope.
52. Needed Acoustic Gain (NAG): It refers to level of sound one needs without
feedback. • P.A.G. = Potential Acoustic Gain

53. Acoustic Gain/Potential Acoustic Gain

K’d-.e D. (■'/ I.ouctsiw-AM
(PAG): It refers to calculated sound without .•A
\

feedback. PAG (level of sound) increases

with the decrease, of distance between listener
and speakers/source and decreases with the ■ Wi Mii;iC;:nouv

increase of distance. It is determined with the -.rJ

help of formula.
54. Feedback / -Audio Feedback / Acoustic /■..v

Feedback/ Larsen Effect: It refers to the

sound produced by the speakers which re-enters
again and again into the microphone and thus
create trouble for listener to comprehend the
speech.
55. Teaching Method of Deaf:
i. Total Communication (TC): It is an approach or philosophy of educating
children with hearing loss by using all means of communication (oral,
written, visual, sign language, gestures, lip reading, speech reading, finger
spelling, body language AV aids etc.) depending on the needs of the
children. Children in TC programs typically wear hearing aids or cochlear
implant. The main goal of TC is to maximize / optimize, the language
development of the individual child. It is a philosophy rather than
methodology.
-C \

ii. Simultaneous Communication (Simcom): It is a methodology rather

than philosophy. It is often confused with TC but it is only ci combination
of Sign Language and Spoken Language.
iii. Auditory-Aural/Oral Method: This teaching approach does not use sign
language, but instead teaches the Language through residual hearing and
speech. It focuses on the speaking and speech production. Primary
 Teacher is speech therapist.
iv. Auditory-Verbal Method: This teaching approach also does not use sign
language, but instead teaches the Language through residual hearing and
speech. It focuses on the hearing and listening than speech production.
Parents are primary teacher than speech therapist.
56. Curriculum for Deaf: Curriculum for elementary classes of Hearing
Impaired Children has been developed. It is based on pre-reading, pre-writing
and pre-arithmetic skills. It also consists of basic religious knowledge and
character building. Necessary modification and adjustments in Normal School
Curriculum of Class 11 o V has been made for hearing impaired children and
it is being implemented in Federal Government Special Education Centres,
Provincial Government Centres and NGOs. Work on necessary modifications
and adjustments in Middle School Curriculum of ordinary school for Hearing
Impaired Children is in progress. Teaching methodology for Hearing Impaired
children is through direct experience, visual aids, written language, spoken
language, sign language. Emphasis is on language teaching with short and
easy sentences. National language is used in teaching emphasis is on visual
aids. However, Pakistani Sign Language is also used.
57. Hearing Dogs for the Deaf: A hearing dog is trained to alert
an individual who is deaf or hard of hearing to various
sounds such a telephone ring, doorbell, alarm clock, kitchen
timer, tea-kettle whistle, and baby cry. Hearing dogs give their
human partners a greater feeling of safety and security, and they
provide wonderful companionship. Usually 6 months to year
training is imparted to a dog of at least 6 months old. Mostly 18
months to 3 years old dogs are placed with deaf partners. The
training of dog usually costs 20,000 dollars and above. Hearing dog is
recommended for a person having about 65 dB hearing loss usually at the age
of 18 years and above. Dog of any race/breed can be trained by the training
companies. Deaf partner must notice the movements of hearing dog and
analyze its alertness. Companies also impart placement training to the dog and -
deaf partner at home for 3 to 5 days.
58. Decibel (dB): It refers to the unit of Intensity or Loudness of sound. Deci is
used here for 1/10 and bel for Abraham Graham Bel. Combination of Deci
and bel is Decibel.
 59. Sound Pressure Level (SPL): It is a level of sound. It is measured in dB,
SPL is measured with the help of Sound Pressure Meter. Nicolosi, Herryman
and Kresheck (2004) explained following decibel levels:_____________,______
Range of SPL SPL Sound Source
(dB)
Faint (20-30 dB) 20 Watch ticking
30 Whispering, library
Moderate (40-60 dB) 40 Leaves rustling, refrigerator
50 Average home, neighborhood street
60 Normal conversation, dishwasher,
microwave
Very Loud 70 Car, alarm clock, city traffic
(70-80 dB) Garbage disposal, noisy restaurant, vacuum
80
cleaner, outboard motor
Extremely Loud 90 Passing motorcycle, lawn mower
(90-110) 100 Blow dryer, diesel truck, subway train,
helicopter, chain saw
110 Car horn, snow blower
Painful (120-140) 120 Rock concert, prop plane
130 Jet engine 100 feet away, air raid siren
140 Shotgun blast
60. Complex Sound: It refers to sound with more than one frequency. Human
voice is complex sound.
61. Noise: It refers to unwanted sound. A sound becomes noise when it interferes
with normal activities)- such as sleep or conversation. A noise can be pleasant
(music) or unpleasant (hammer strike) depending upon the listener’s activity,
attitude and past experience.
62. Colour Noise: Colour noise is a filtered noise, not a pure noise. This is
usually used for masking, relaxation, to enhance the focus and it helps in
 White Noise: It refers to energy (loudness) at all frequencies OR energy per
frequency.
Pink Noise: It refers to equal energy Blue Noise: Blue Noise is the inverse
per octave. Pink noise is a noise in ■ of pink noise. It also refers to equal
which volume is reduced to 3 dB at energy per octave but volume is
each octave to have an equal energy increased to 3 dB per octave NOT
at each octave. decreased as in pink noise.
(Octave mean difference between 100
Hz and 200 Hz is one octave, between
400 Hz and 800 Hz is also one
octave, and between 500 Hz and WOO
Hz is also one octave. We hear music
in octaves).
Brown Noise/Red Noise: Brown Violet Noise: Violet Noise is the
noise refers to equal energy per inverse of Brown Noise. It refers to
octave. It is a noise in which volume equal energy per octave but volume is
is reduced to 6 dB per octave. increased to 6 dB per octave NOT
decrease as in brown noise.
Narrowband
Signal

between two limiting frequencies.

64. Bandwidth: Range of frequencies usually in
standard sizes.
65. Narrow Band Noise: It is a noise centred Broadband
Signal

around a particular frequency. It is used in

masking. . • yj-
66. Wide Band Noise/Broadband Noise: Noise t
whose energy is distributed over a wide
section of the audible range as opposed to Narrowband Noise.
67. Mastoid Bone: Bone at the back of ear connected to inner ear.
68. Speed Shaped Noise: It is a noise which contains more energy at low
frequencies than high frequencies. It is always used for testing speech.
69. Audiology: Study of sound or hearing mechanism.
70. Base-Line Audiometery: Initial level hearing assessment.
71. Sound Field System: A sound field system is
a sound system (speakers) for schools that
improves the learning environment for the
entire class by improving the sound r
environment in the classroom. Designed
specifically for speech sounds, these systems
greatly enhance speech understanding. Sound
field ensures an even distribution of sound from
the teacher, the students and any multimedia _
equipment. With a sound field system, the <S\ •
students sitting in the back of the classroom hear the teacher and other
students equally as well as the students sitting in front. This helps all students
. hear what is being said and improves their attentiveness, participation,
comprehension and concentration.
72. Vowels and Consonants: There are 5 vowels and 21 consonants in
26 English alphabets. These 26 alphabets represent 44 sounds. Vowels fall in
the "louder" ranges. Consonants are higher-pitched than vowels. Consonants
are spoken more softly than vowel. ,
73. Pure Tone Average (PTA): The average of three thresholds at 500 Hz, 1000
Hz, and 2000 Hz. That is mostly at 70 dB hearing loss. PTA is only done for
air conduction. •
74. Air Bone Gap (ABG): It is an important feature of audiogram. In audiometry
testing when a person has conductive defect of middle ear usually
otosclerosis, there may be sizeable difference between air conduction and
bone conduction audiograms, so called Air-Bone Gap (ABG).
* * Sfc & * £ * $ $ & Hfi if: * * * * jfc * * $
Unit No. 3
Hearing Loss. Its Types & Effects
TYPES OF HEARING LOSS: There are 4 types of hearing loss:

1. Conductive Hearing Loss (CHL): Any defect or damage to outer or middle

ear which not let the sound reaches inner ear. Air conduction stops. It is
considered below 60-70 dB because on exceeding 70 dB, bone conduction
starts occurring. It is curable through medicine and surgery. Conductive
. hearing loss is a matter of loudness and loud sound helps to hear effectively.
2. Sensori-neural Hearing Loss (SNHL): Any defect or damage to inner ear
which may affect the cochlea, auditory nerve (VUIth Nerve) or auditory
pathway. It is. not curable. No air conduction or bone conduction occurs.
Although outer and middle ear function properly. It is a matter ' of
understanding. A person with SNHL usually hears the sound but not
understand it.
3. Mixed Hearing Loss: A person carrying both the conductive hearing loss and
sensori-hearing loss at one time. No air conduction and no bone conduction. It
is not curable. '
4. Central Auditory Processing Disorder (CAPD): Children with CAPD
typically have normal hearing. CAPD
occurs when the brain has problems
processing the information
contained in sound, such as
understanding speech and working
out where sounds are coming from.
People with normal hearing quickly
interpret what they hear but
children with CAPD mix up the
words. CAPD is the problems in
understanding the sounds of spoken
language not the meanings of what being said. 2-7% children have CAPD.
Normal child hearing: "‘7011 me how the chair and the couch are alike.”
CAPD child hearing: “Tell me how a cow and hair are like.”
 CAPD Causes: The exact causes of CAPD are still unknown. Research
suggests possible links to several factors. These include premature birth or
low birth weight, head trauma, chronic ear infections and lead poisoning.
Diagnosis: A trained audiologist, psychologist or speech therapist can
diagnose CAPD with the help of listening comprehension skills including
hearing loss tests.
CAPD Treatment:
It includes speech therapy, repetitive training of listening comprehension,
removing noise in near surroundings, front seating of children in class, sound
proof environment, use of speakers or headphones etc. »
CAPD Symptoms:
It include following:
• Auditory discrimination: The ability to notice, compare- and distinguish
between distinct and separate sounds. The words seventy and seventeen
may sound alike, for instance.
• Auditory figure-ground discrimination : The ability to focus on the
important sounds in a noisy setting. It would be like sitting at a party and
not being able to hear the person next to you because there’s so much
background noise/chatter.
• Auditory memory: The ability to recall what you’ve heard, either
immediately or when you need it later.
• Auditory sequencing’. The ability to understand and recall the order of
sounds and words. A child might say or write “ephelant” instead of
“elephant,” or hear the number 357 but write 735.
DETECTING TYPE OF A HEARING LOSS
1. Conductive Hearing Loss Detection: When air conduction tests show a
hearing loss, but there is no loss identified with bone conduction tests, there
may be a conductive loss.
2. Sensorineural Hearing Loss Detection When both air and bone conduction
results show hearing loss at the same level, the loss is considered
sensorineural.
3. Mixed Hearing Loss Detection: If different degrees of hearing loss are found
via air and bone conduction testing, the loss is mixed.
DEGREES OF HEARING LOSS
(WHO! 0-25 dB (Decibel)
1. Normal Hearing Loss 26-40 dB
2. Mild Hearing Loss 41-55 dB
3. Moderate Hearing Loss 56-70 dB
71-90 dB
90+dB
4. Moderately Severe Hearing Loss
5. Severe Hearing Loss
6. Profound Hearing Loss
 i
EFFECTS OF HEARING LOSS
1. Intellectual Effects: (Poor educational performance, poor, recognition, poor
memory, poor vocabulary). '
2. Psychological Effects: (Ego & Self liking, suspect feO t^SLS), low self-
esteem, insecurity, poor self-concept, depression, fatigue, tension).
3. Social Effects: (Isolation, Poor Communication problems, loss of friendship)
4. Language.Development Effects: (Delay in Listening, Speaking, Reading &
Writing)
5. Effects in Daily Living Skills: (Delay in daily living skills i.e-. eating,
sleeping etc.)
6. Physical Development Effects: (No any noticeable effect)
7. Effects on Educational opportunities: Deaf children rarely receive any
schooling (WHO Media Centre, 2015) and their education is often neglected /
effected by the parents, siblings and school staff due to hearing loss.
8. Effects on Vocational Rehabilitation: Deaf people have much higher
unemployment rate. Whereas employed deaf people have low grades as
compares to normal employees (WHO Media Centre, 2015).
HEARING LOSS TERMINOLOGY
1. Hearing Impairment: Any defect or damage to hearing mechanism which
causes hearing loss. It can be mild to moderate and severe to profound.
2. Deaf: A person who has profound hearing loss and uses sign language.
3. Stone Deaf: Refers to complete deaf.
4. Deaf Mute: Old term for individual who can neither hear nor speak, usually
bom with severe hearing loss (Nicolosi, Herryman, & Kresheck, 2004).
5. Hard of Hearing: A person having some residual hearing (partial hearing).
Their hearing loss ranges from mild to severe. They usually communicate
with spoken language and benefit from hearing aid and other assistive devices
(WHO Media Centre, 2015).
6. Pre-Lingual Deafness: Deafness which occurs before the speech or language
development.
7. Post-Lingual Deafness: Deafness which occurs after speech or language
development.
8. Bilingual: Individuals, who are Deaf, are considered bilingual if they are able
to communicate effectively in two languages e.g. (American Sign Language
and British Sign English).
9. Bi-Bi: Bilingual and Bicultural Deaf people are called Bi-bi.
10. Bicultural: Deaf are considered bicultural if they are capable of functioning
 in both the Deaf community and the majority culture.
11. Congenital Deafness: Deafness at the time of birth (Those who bom deaf).
12. Acquired Deafness: One who bom normal but later acquired deafness due to
illness or accident.
13. Industrial Deafness: Hearing loss as a result of relatively long exposure to
industrial noise.
14. Adventitious Deafness: After birth hearing loss due injury or disease.
15. Disabling Hearing Loss: It refers to hearing loss greater than 40 dB in better
hearing ear in adults and greater than 30 dB in better hearing ear in children.
360 Million 5% people in the world have disabling hearing loss (WHO Media
Centre, 2015).
16. Monaural Hearing Loss / Unilateral Hearing Loss/Single Sided Deafness
^ (SSD): Hearing loss in one ear.
17. Binaural Hearing Loss: Hearing loss in both the two ears.
18. Bilateral Hearing Loss: Hearing loss in both the two ears.
19. Contra-lateral Hearing Loss: Hearing loss in opposite sides of the ear.
20. Ipsi-lateral Hearing Loss: Hearing loss irt'same side of the ear.
21. Flat Hearing Loss: It refers to threshold at each frequency within 20 dB of
each other.
22. Sloping Hearing Loss: It refers to the gradual increase in hearing loss with
the increase of frequency.
23. Rising Hearing Loss: It refers to the gradual decrease in hearing loss with the
increase of frequency.
24. Hysterical Deafness: A person cannot hear sounds due to psychological
problems & issues.
25. Malingering: A persons hear sounds but pretends he is not hearing.
26. Retrocochlear Hearing Loss: It refers to the hearing loss occurs as a result of
lesion on auditory nerve.
27. Progressive Hearing Loss: Hearing loss that gets worse over time is known
as acquired or progressive hearing loss.
28. Delaved-Onset Hearing Loss: Hearing loss that develops after the baby is
bom is called delayed-onset hearing loss.
29. Presbycusis/Age Related Hearing Loss: It is a hearing loss which gradually
occurs in most individuals as they grow older. 30-35% adults at the age of 65
years have presbycusis. It affects one out of three persons at the age of 65
years whereas one out of two persons at the age of 75 years. Hearing aid and
skill of speech reading is helpful in management. It is a progressive hearing
1
loss.
30. Sudden Sensorineural Hearing Loss (SSHL)/Sudden Deafness: Refers to
Rapid loss of hearing usually in one ear - either at once or several days.
Diagnosis’. It is-diagnosed with pure tone audiometry. If the test shows the
loss of 30 dB on three consecutive frequencies, it is diagnosed as SSHL.
Others tests (blood test, MRI test or balance testsv can also be suggested for
SSHL.
Signs of SSHL:
i. Many people notice that they have SSHL when they wake up in morning.
ii. Others notice it when they use phone with the effected ear.
iii. Some notice a loud, alarming "pop" just before their hearing disappears.
iv. People with SSHL often become dizzy have ringing in their ears (tinnitus),
or both.
Causes of SSHL:
i. Infectious diseases
ii. Trauma, such as a head injury
iii. Autoimmune diseases such as Cogan’s syndrome
iv. Ototoxic drugs
v. Blood circulation problems
vi. A tumor on the nerve that connects the ear to the brain
vii. Neurologic diseases and disorders, such as multiple sclerosis
viii. Disorders of the inner ear, such as Meniere’s disease.
Treatment of SSHL:
i. Steroids such corticosteroid (tablets/injections).
ii. Antibiotics .
**********************
Unit No. 4
Ear Anatomy
1. Anatomy: Study of structure of animals and their parts.
2. Temporal Bone: Every human body has two temporal bones at the
lateral sides of head (right and left). Temporal bone contains the
middle and inner ear.
3. Parts of Ear: Three parts (Outer Ear, Middle Ear & Inner Ear)

Semicircle Canals

Auditory-

Pinna
Outer Ear Middle Ear Inner Ear
1. Pinna 1. Eardrum (Tympanic Membrane) 1. Cochlea
2. Ear Canal 2. Ossicular chain / Ear Bones 2. Auditory Nerve
(Hammer, Anvil, Stirrup) 3. Semicircle Canals
Pinna 4.
(Auricle): Outer visible part of
ear situated at 30 degree of
the head. It is made of cartilage (LA Lower part of pinna is
called lobule. Pinna is connected with ear canal. Pinna serves as
antenna and catches sounds and sends to ear canal.
5. Ear Canal: Average Length - 25 mm. Average Width -
7 mm. One side connected with pinna and other side with
eardrum. It contains wax producing glands and hairs to
protect ear from worms and other things from damage. It
passes sound to eardrum.
 Eardrum (»JJJ U Very sensitive oval shaped organ
of the ear. Surface area is 64.3 mm2. Takes sound from
ear canal and passes on to Hammer (bone).
7. Ossicular Chain: These are three ear bones connected with each other. These
are smallest bones'of human body. They pass sound to cochlea.
a. Hammer: Its shape is like a hammer. It is also called Malleus. Its one side
is connected with eardrum and other with Anvil. Its weight is 25 nig. It
passes sound pressure to Anvil.
b. Anvil: Its shape is like teeth. It is also called Incus. Its- one side is
connected with Hammer and other with Stirrup. Its weight is 30 mg. It
passes sound pressure to Stirrup. .
c. Stirrup: It is also called Stapes. Its one side is connected with Anvil and
other with Oval Window of Cochlea. Its weight is 3-4 mg. Its one side is
called head and other footplate. It is smallest bone of all. It passes sound
pressure to Cochlea.
8. Cochlea: Snail shaped organ of ear. It is filled
with watery liquid. Its 35 mm long. It makes
2.5 turns on its axis. Its important part is Organ
of Corti which contains hair cells. Its one side
1
is connected with stirrup via oval window and
other with Auditory Nerve. Vibrations coming
from stirrup are passed on to auditory nerve. It
contains two windows (Round window & Oval window). Cochlea of both
sides of the ear very close and when a tone in bone conduction is presented to
one cochlea then another cochlea vibrates similar to other.
9. Auditory Nerve (8thNerve): Nerve fibres coming from cochlea make a bunch
which is called Auditory Nerve. One side is connected with Cochlea and other
with brain. Auditory Nerve passes sound to the brain.
10. Semicircle Canals/Vestibular Labyrinth: There are 3 semicircle canals in
inner ear. These are not involved in hearing process of the ear rather they
maintain balance of human body. Any damage to semicircle canals will affect
the balance of the body. •
11. Eustachian Tube: It links the middle ear with nasopharynx (nose part). It
maintains the pressure of air in the middle ear. Excessive air pressure coming
from ear is released from the nose and sometimes excessive air pressure
coming from nose is-released from the ear.
ROUTES OF SOUND CONDUCTION
There are two routes of sound conduction:
1. Air Conduction Route (AC): Normally a person hears sounds from air
conduction route. In this process Pinna of the ear catches the sounds and
passes.on to ear canal. Ear canal sends sound to eardrum. Eardrum vibrates
and pushes hammer. Hammer strikes Anil and Anvil moves Stirrup. Stirrup
passes on sound to cochlea via Oval window. Cochlea passes sound to
auditory nerve. Auditory nerve sends sound to brain. In air conduction
process, outer and middle ear should be functional.
2. Bone Conduction Route (BC) j'j' J* O'f -In case
outer and middle ear are defective, then sound is transmitted to the cochlea
through bone of the skull. In bone conduction process intensity and frequency
of sound should be moderate enough to move the skull. At the frequency of
1600 Hz, skull moves from all the four directions.
***************************
Unit No. 5
Etiology (CausesTM Hearing Loss
CAUSES OF CONDUCTIVE HEARING LOSS
Conductive hearing loss occurs due to defect in outer or middle ear. Main
causes are: ■ *
1. Congenital Malformation of Outer and Middle Ear: By birth defect
2. Protruding Ears(cM jS jfj): Pinna not catches sound properly.
3. Anotia(^ ^ ^ l"): Absence of pinna.
4. Microtia: Small size of pinna or underdeveloped pinna.
5. Aural Atresia: Malformation of parts of outer and middle ear especially
ear canal. It denotes sometimes no proper ear canal.
6. Stenosis (U# IS ^L***); Narrowing of ear canal.
7. Collapsing of Ear Canal ^
8. Cerumen (Ear Wax): Excessive production of ear wax blocks the ear.
9. Turner of Ear Canal((.p>-j a^ull‘w3ciU“):
10. Foreign bodies in external auditory canal: (Coin, match stick)
11. Perforation of Tympanic Membrane: Hole in the eardrum.
12. Otitis Externa (OE): It is also called swimmer’s ear. It is an
inflammatory (<_£j^) outer ear infection. It can occur in
auditory canal or pinna or both. It causes swelling, pain, fluid
discharge, eczema in the ear, and hearing loss. It is usually
classified into following 6 types:
a. Acute 4iffu.se OE: (Most common form typically
seen in swimmers due. to mix of water and bacteria or ear wax)
b. Acute localized OE: (Infectionof hair follicle)
^J iA

c. Chronic OE: Same as acute diffuse but with longer duration of

more than 6 weeks.
d. Eczematous OE: Eczema jU.)
e. Necrotizing OE: Infection that extends into the deeper tissues near
the external auditory canal.
f. Otomycosis: Fungal infection in the ear.
Its treatment includes medications (antibiotics, antifungal agents,
surgery, discharge of fluid, incision)
* 13. Otitis Media: Middle ear infection and usually occurs due to defect in
Eustachian Tube. Ear inflammation (swelling) occurs. Otorrhea-occurs
(UJ S-UJ). Otalgia occurs (Ear pain). Otitis Media can be treated with
antibiotic drugs or by surgical treatment Myringotomy. In myringotomy,
fluid from middle ear is drained by inserting a Tympanostomy tube by
cutting eardrum. There are three types of Otitis Media:
a. Otitis Media with Effusion (OME): (Middle ear is filled with
fluid as Eustachian tube stops draining fluid of ear in the throat).
b. Otitis Media without Effusion: Not fluid filled.
c. Otitis Media with Perforation: Eardrum is perforated (hole*).
Other subtypes of Otitis Media are as under:
a. Acute Otitis Media (0 to 21 Days)
b. Sub*Acute Otitis Media (22 Days
to 08 Weeks) •
c. Chronic Otitis Media (More than 08
Weeks)
14. Fracture of TempoAl Bone
15. Otosclerosis: Formation of new additional bone in middle ear especially
on.stapes ('-»' o*4 AJW'I* ur“ <-«■* a1-5 ^^j-1)
CAUSES OF SENSORI-NEURAL HEARING LOSS
Sensori-neural hearing loss occurs due to defect in only inner ear (cochlea
or auditory nerve). It is usually considered incurable. Causes are:
PRE-NATAL CAUSES (^JW J> ttf) '
1. Genetic Causes:
L Autosomal Dominant Gene (u& V /^ei)* causes 7%
- If father has brown eyes and mother has blue eyes but baby has brown
eyes, in this case father gene is dominant. Main types are:
a. Waardenburg Syndrome (gene) (affects hearing, pigmentation-
skin/hair color) '
b. Branchio-Oto-Renal Syndrome (Throat to neck bronchi defects-pits or
tags on outer ear)
c. Stickler Syndrome (Flat facial appearance with hearing, vision & joint
problem)
d. Teacher Collins Syndrome (affects face bones formation)
ii. Autosomal Recessive Gene (ct& u-'h**) causes 90%
if father has brown eyes and mother has blue eyes but baby has brown
eyes, in this case mother gene is recessive. Main types are:
a. Usher Syndrome (affects hearing and vision)
b. Alport Syndrome (Kidney, hearing and vision.problem)

4CruxofSjyecMJEducatian
5~j*i — —
~ -
— — — —
— —
 c. Jervell & Lange-Neilsen Syndrome (cause bilateral sensorineural HL)
d. Pendered Syndrome (Goiter disease occur which enlarge thyroid gland
in throat like butterfly shape at base of neck and causes sensorineural
bilateral hearing loss).
iii. X-linked Gene (causes 3%): A female baby cell gets two X chromosome
one X' chromosome from father and other X from mother. Sometime one
defective 3C chromosome is transferred to the female baby. This defective
gene or chromosome causes hearing loss. .
2. Use of drugs by pregnant mother: Excessive use of streptomycin or
chloromycin etc.
3. Accident: Accident can damage brain of fetus which can cause hearing loss.
4. Viral Infections to pregnant mother: These viral infections are very fatal for
fetus. These are: „•
a. Toxoplasmosis: It is an infection results from gondii parasite! It occurs
due to eating raw or partly cooked meat of lamb, unwashed fruit or
vegetables. Main source is cat. It also occurs due to ingesting (eating) cat
feces (potti) while cleaning gardens and hand to mouth contact. It affects
immune system of fetus of mother carrying the toxoplasmosis. Treatment
includes sulfadiazine, clindamycin^spiramycin. A
b. Syphilis: Primarily syphilis is transmitted through sexual
contact. Pregnant woman transmits to its fetus. It damages
central nervous system. It can be diagnosed by blood' tests.
Treatment includes “penicillin and steroids (medicine)” (Dhingra
&
Dhingra, 2014).
c. German Measles (Rubella)®^*®-: It is also called three days measles. It is
caused by rubella virus. Rubella means little red. Virus can go inside the
body through breath. It causes red or pink rash on the body. No specific
treatment but vaccination of girls before marriage is recommended,
d. Cytomegalovirus (CMV): This virus mostly causes hearing loss than
other disabilities. No treatment available. A vaccine is currently milder
investigation in USA. Its symptoms usually remain hidden. It spreads from
person to person through fluids such as blood, saliva, urine, semen and
breast milk. Once CMV is in a person body, it remains there for life! It .cari -
cause major disabilities.
e. Herpes Simplex Virus (HSV): A person passes on to other through
saliva, sharing drinks or sexual contact. ’ Symptoms include watery blisters
on the skin, mouth and lips. No specific treatment usually antibiotics like
Acyclovir and valacyclovirare used.
f. AIDS or HIV: It affects human immune system. Carrying mother
transmits to the fetus which causes hearing loss.

Cruxj>j'Sj>^c[q!Jiducatiqn
PERI-NATAL CAUSES, *Sj0 ' /
1. Anoxia/Hypoxia/Asphyxia: (lack of oxygen to baby during birth can
damage central nervous system and cause hearing loss).
2. Jaundice:^Ji- It affegts the liver system and can cause hearing loss.
3. Prematurity:^1-^ j' cl* .
4. Rhesus Factors: Also called RH Factors. If fetus is carrying positive
rhesus blood cells but mother is carrying negative blood cells, then while
mixing blood of mother and fetus, it starts generating antibodies which
destroy red cells of blood. It causes hearing loss. Treatment includes
vaccination.
5. Low Birth Weight: Poor nutrition of mother, unhygienic conditions
causes it. ^
6. Unskilled Nurses. Untrained nurses.
POST-NATAL CAUSES (^JWiMvy ' .
1. Meningitis:^ ji5 J*. It is the swelling of brain membrane. Symptoms
include fever, headache, neck stretch, dizziness, vomiting. Severity of
hearing loss depends on the severity of infection.
. 2. Use of Ototoxic Drugs: (Streptomycin, neomyein, kanamycin,
gentamycin, Cisplatin).
3. Transverse Temporal Bone Fracture (^ CJ ^ O^).
4. Noise Trauma (o*^ Vlj ^ ^ j>-): Severe and
continuous noise of factories, machines, headphone or tape recorded jsr
explosion cause noise trauma: Mainly it is divided into two types
(Dhingra & Dhingra, 2014):
a. Acoustic Trauma: A hearing loss caused by very brief exposure to
very intense (high level) sound i.e. gun fire, explosion or powerful
cracker which may reach or cross 140 dB level of sound.
b. Noise Induced-Hearing Loss: A hearing loss caused by chronic
(continued) exposure to less intense sound (lo\p sound) i.e. noise of
factories, machines etc. It comprises of following types:
i. Temporary Threshold Shift (TTS): Hearing loss which occurs
immediately after exposure to noise and recovers soon from an
interval to 2 weeks. »
ii. Permanent Threshold Shift (PTS): Hearing loss which occurs
after exposure to noise and does not recover at all.
5. Viruses: (Toxoplasmosis, Syphilis, Rubella, Cytomegalovirus, Herpes
Simplex Virus, AIDS & HIV).
v
6. Brain Damage.
7. Meniere’s: Excess of fluid in the inner ear which causes dizziness.
Unit No. 6
Assessment of Hearing .
ASSESSMENT TEST
Assessment test is conducted to explore the following:
a. Nature of hearing loss (conductive, sensori-neural or mixed)
b. Degree of hearing of loss (Mild, Moderate, Severe or Profound)
c. Background History of Hearing Loss (Cause, Time & Age of onset etc.)
TYPES OF ASSESSMENT TESTS '
There are two types of tests used for the assessment of hearing loss:
1. Screening Tests
2. Diagnostic Tests
Screening Tests
Screening tells whether a person is having hearing loss or not. It is just a
pass and fail test. This test does not tell the nature or degree of hearing loss.
SCREENING TESTS FOR NEONATE (NEWBORNS
Neonate screening tests are applied in first few days after the birth of baby
(4 days onward): -
1. Otoacoustic Emissions'(OAE) "
A miniature (^Lw-?-) earphone and microphone i:
are placed in the ear, sounds are played by earphone iQg •*< ^ ^
and a response is measured by microphone. If a baby *V
hears normally, an echo is reflected back into the ear
canal and is measured by the microphone. When a
baby has a hearing loss, no echo can be measured on the
OAE test. This
..test can measure the hearing of a sleeping baby. OAE test provides
information about how the hair cells of the cochlea are working by
measuring the responsi veness of hair cells to a series of clicks produced by
a tiny speaker inserted into the ear canal. Most often this test is used to
evaluate hearing for people who are unable to respond to a traditional
hearing test (such as infants).
2. Auditory Brainstem Response (ABR)
It is also called Brainstem Auditory Evoked ?
Response (BAER). Sounds are played to the baby's ^ ^
ears by earphone. Band-aid like three electrodes are
placed on the baby's head to detect responses. This test
measures how the hearing nerve responds to sounds and can identify
 35 ClUxofSjteciqlJ^ducatiqn
babies who have a
hearing loss. This
test can also measure the hearing of a
t sleeping baby. Most often ABR is used to test hearing for people who
are
•3.
unable to respond for audiometry (such as
infants).
Auditory Response Cradle (ARC) ‘
ARC consists of a trolley like a cradle
used for
babies. It also contains microprocessor and
electronic
system. It takes 3 to TO minutes to complete. It
presents the sound of 85 dB to the ears of baby and
monitors his/her physical reactions (head turning, head
jerking, starling^W- ^-Tt), body motions, respiratory
responses ^ o*^). It also monitors the physical reactions of
baby when no any sound is presented. It compares the physical reactions
of baby when the sound is presented and when the sound is not presented
and thus detects hearing loss.
SCREENING TESTS FOR CHILDREN AND YOUNG ADULTS
1. Distraction Test
This test is applied to the children having age 6 months to
18 months. It is usually applied by two trained health visitors or nurses. A
sound proof room should be used for the test. Mother while sitting on the
ground, make the child sit on her feet/knees. One health visitor sits in front
of baby and shows some toys to him/her. Other health visitor sits behind
the baby at the distance of 3 feet. When child starts looking at the toys
meanwhile other health visitor presents sound stimulus. If the child is
distracted by the sound and turns his/her head to hear the sound, it means
he/she is having'-hearing. Sound stimulus is presented at different
frequencies to assess the hearing accurately. If child fails to respond in a
test then after 15 days, same test is again applied. If child fails again to
respond, then he/s'he is referred to an Audiologist or Specialist. ' ^
2. Cooperative Test
 This test is applied to the children having age 18 Months to
30 Months. Firstly, a test applier establishes rapport with the child and
gains- his .trust so that child may feel comfortable while conducting the
- test. When child starts cooperating with the test applier, test applier can
ask the child to count the coins, insert the balls in basket or name the given
toys etc. from a distance of 3 feet. When child responds, test applier
assesses child’s hearing. A sound of 30 dB is presented two times to check
the child’s response in each ear.
3. Performance Test
This test is applied to the children having age 30 Months to
40 Months. Firstly, child is trained in performing an act or playing a game.
Test applier asks the child to perform an act (put pegs in board or toys in
basket) when he/she listens some certain words like GO or OK. Test
applier remains out of vision (<J*?-j' ^ At the distance of 3 feet,
GO or OK sound of 30 dB is presented twice in each ear. The response of
child is recorded and hearing is determined. If child fails to perform
action, it means he/she is having defective hearing.
4. Pure Tone Audiometery
It is same like performance test. The difference is that it presents
the sound through audiometer rather than a .test applier. Child is properly
trained first. A headphone is placed on both ears of the child. Child is
asked to perform an action like (press button or raise hand) on hearing a
sound (GO or OK). If the child raises the hand on listening the sound,
< he/she passes the test. Pure Tone means checking the hearing at every
single frequency. As it is not possible to check the child at every single
frequency so experts recommend to check voices of frequencies 500 Hz,
1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. The sound is presented twice in
each ear. The level at which child responds, called his/her hearing level. If
child responds at 30 dB, it will be considered child’s hearing level.
5. Finger Friction Test
It is a screening test to detect hearing loss quickly. Put your
forefinger and thumb of each hand at the external auditory canal of each
ear. Rub the finger and thumb together on one side and then the other; ask
the patient to tell you when the sound is heard.
6. Whisper Test
In whisper test, ear canal of nOntest ear is blocked. Examiner
whispers a statement by standing 2 feet away from the patient and asks
patient to repeat it. If patient does not respond correctly at various sounds
of whispering then hearing loss is detected. Each ear is separately is
examined. If patient reads the lip then examiner can stand behind the
patient to prevent it. ,
7. Watch Test
* Patient is asked to close his/her eyes. He/she is asked to plug his
nontest ear with finger. A ticking watch is hold near the test ear of the
patient and it is moved away until the patient stops hearing the ticking
sound of the watch. The distance at which patient stops hearing is noted
and same procedure is adopted with another ear and results are compared.
8. Tuning Fork Tests/Beside Tests/Office Tests
It consists of following four tests:
i. Weber's test
This test compares bone conduction of both the ears (Pal & Pal,
2001). A 512 Hz tuning fork is struck against the knee or elbow and
placed in the midline of the patient's forehead. If the sound is louder
on one side than the other, the patient may have either an ipsilateral
conductive hearing loss or a contralateral sensorineural hearing loss. If
sound is heard better in defective ear, it is a conductive hearing loss.
But if sound is louder in normal ear, then it is. sensorineural hearing
loss in defective ear. -
ii. Rinne’s test
This test compares air conduction and bone conduction of same ear .
(Pal & Pal, 2001). This uses a tuning fork of 256 Hz or 512 Hz. A
heavy tuning fork is preferable as a light one can produce a sound that
fades too rapidly. It produces a sound level of 90 dB when struck
against the knee or elbow. To test air conduction, hold the tuning fork
directly in line with the external auditory canal. When testing bone
conduction, place the stem of the tuning fork against the mastoid bone,
using firm pressure. Hold the patient's head steady with your free
hand. When patient stops hearing the sound of tuning fork he/she
raises finger then it is taken close to the own ear by examiner to check
whether tuning fork stops vibrating or not. When air conduction is
longer and louder than bone conduction it is reported as Rinne-positive
and denotes normal or sensori-neural hearing loss.
iii. Schwabach Test:
This test compares the patient's bone conduction to that of the
examiner’s. If the patient stops hearing before the examiner, this
suggests a sensorineural loss. If the patient hears it longer than the
examiner, this suggests a conductive loss. Examiner must be having
normal hearing for this test.
iv. Bing Test
 A tuning fork is struck and placed on the patient’s mastoid bone .
* tip. The examiner alternately occludes (close) the patient’s external
meatus (opening of ear canal). If the patient has normal hearing or a
sensorineural loss, he or she will notice a change in intensity with
occlusion. If the patient has a conductive hearing loss, he or she will
notice no change.
DIAGNOSTIC TESTS
Screening test only tells whether a child has defective or normal hearing
but it does not help to know the degree and nature of hearing loss of the child
whereas diagnostic test helps to know the degree and nature of hearing loss.
Diagnostic tests include, following: •
1. Pure Tone Audiometery Test: Pure Tone audiometery test helps to explore
degree and nature of hearing loss in following way :
a. Degree of Hearing Loss: The child is seated on a chair in front of test
applier in a sound proof room.. A headphone is placed on his/her ears.
Firstly he is trained to response on hearing certain sounds presented
through audiometer. Child may be asked to response by pressing a button
of bulb on hearing a sound. After proper training, the degree of hearing
loss is determined. If the child responds at 25 dB, it will be his/her degree
of hearing loss. The degree of hearing loss of each ear is shown on the
audiogram. For right ear, red ink and round symbol (o) is used on
audiogram. For left ear, blue ink and cross symbol (x) is used.
b. Nature of Hearing Loss: Nature of hearing loss is determined by air
conduction or bone conduction:
i. By Air Conduction: In air conduction, sound is
presented through headphone to the ears by using ^ 1
audiometer. Sound presented by audiometer moving
through ear canal strikes with eardrum. Eardrum pushes
the sound to ear bones which pass on the sound to
cochlea. Cochlea passes sound to auditory nerve which presents sound
to brain. If the child responds at different frequencies, then child
hearing is considered normal but if the child is not responding, it is
difficult to identify the “nature of hearing loss whether is existed in
outer, middle or inner ear! In this case, bone conduction is used.
ii. By Bone Conduction: If testing reveals a hearing
loss, a bone vibrator is used instead of headphone to
determine hearing by bone conduction in order to
determine the type of hearing loss. This device sends
sounds directly to the inner ear, bypassing the outer
 , . and middle ear. Vibrator is placed on the back of ear (Mastoid). If the
sounds are heard better by bone conduction, the hearing loss is
conductive in nature and is likely located in the outer or middle ear. If
the sounds are heard equally with the earphones and the bone vibrator,
the hearing loss is sensorineural in nature. A combination of conductive
& sensorineural hearing loss (mixed hearing loss) also may be present.
2. Impedance Bridge Test: Impedance means
resistance An Electroacoustic impedance
Bridge machine is used in this test. This machine is
used to determine whether outer or middle ear is
working properly and in which part hearing loss
exists. A probe is commonly.used in this test,
having rubber tip on its head. This rubber tip is
inserted into the ear canal of the child. This probe contains three thin tubes
in it. One tube is connected with sound producing body. Second tube is
connected with microphone which measures the returning sound from the
ear. Third tube is connected with air pump used to control air pressure in
the ear. The reflected sound is measured by microphone and it tells the
level of conductive hearing loss of the child.
3. Beksey Audiometery Test: Self
Recording audiometry is called Beksey
Audiometry introduced by George von
Bekesy in 1947 as an improvement over
manual audiometry. The basic idea
behind the Bekesy audiometer is that the
patient records his own threshold
automatically on an audiogram blank.
When the audiometer is turned on, a pure tone of very low frequency
comes into the earphone, and a motor causes the frequency to move
slowly upward. At the same time another motor causes the tone to become
gradually louder. As soon as the patient hears the tone he pushes a button.
This reverses the loudness motor and the tone becomes gradually fainter.
As soon as the patient doesn’t hear the tone any more he releases the
button. This reverses the loudness motor again and the tone gets gradually
louder. The patient keeps doing this over and over; pushing the button
when he hears the tone, and releasing the button when he doesn’t hear it.
All this time the frequency is moving slowly upward. In order to make
permanent record of these threshold crossings over the entire frequency
range, a recorder pen is attached to the loudness motor driver. It writes, out
the threshold crossings on a audiogram form moving slowly under it. The
audiogram form moves along at the same rate as the frequency of the pure
tone to which the patient is listening. When the test is over, the patient has
traced out his threshold from low to high frequency in the form of a zig-
zag line on the audiogram form. ■
 /
SPEECH DISCRIMINATION TESTS FOR HEARING
Speech tests are applied at the children having age 30 months and above.
A child with hearing loss face problems in listening speech sounds. Speech test
tells the level of speech attainment of a child. Mostly following tests are used:
1. Kendal Toy Test: It is a first speech discrimination test. It is suitable for a
child having age^2.5 years. Three sets of 15 toys (generally recognized by the
child) are used in the test (10 toys for the test and 5 for distraction):
Test Items: Knife, Bath soap, Tin, Bus, Pipe, Car, Board, Pen
Distraction Items: Wheel, Jar, Comb, Pin, Duck
Test applier keeps the toys on the table and asks the
child to name each toy. This is done to know whether
child knows the toys or not. Then keeping him/herself out
of vision, at the distance of 3 feet, test applier asks the
child to pick the toy and put into the tray. Test applier
' names all the toys and child has to put them in tray one by one. If child fails to
respond correctly, it means child is having hearing loss. Sound level indicator
is used to check the level of sound produced by the test applier.
2. McCormic Toy Discrimination Test: This test was developed by Professor
Barry McCormick in 1977. This test consists of 14 paired words which are
generally recognized by children from an early age. It is ideal for children
with a mental age of 2 years plus. Each word in the list has a matching item in
the set and a paired item with a similar vowel, but differing consonants.
 TREE KEY
SHOE SPOON
COW . HOUSE
PLANE PLATE
HORSE FORK
DUCK . CUP
MAN ■ LAMB

Child is asked to identify each toy lying on the table, any toy not identified
are removed from the test. The child is placed in front of the toys and asked to
“show me the ....”. This is requested at differing sound levels and a child with
normal hearing should be able to discriminate between items at a listening
level of 40 dB(A). The criterion for passing this test is when a child gives four
correct responses out of five requests. Current recommendations are that any
child who cannot pass the test at 40 dB(A) should be referred to a specialist
Audiology Centre., Parents and teachers can immediately see the natural
confusion which can arise when a child has a slight Hearing difficulty.
List 1 List 2 List 3 List 4 List 5 List 6
Bee Dog Ghost Bed Door Gate
Train Tree Key Pig Pen. Cheese
Flag Star Fox Horse Fish Frog
Shop Slide Hat Sweet Snake hand
Witch Leaf Ring Whale Wall Leg
Man Nest Moon Man Knife nine

3. Manchester Picture Test (MPT)

This test was first developed in 1957 by Mr. Watson and has long
been regarded as the most comprehensive picture test for children and
young adults. This test is similar to Kendel Toy Test and it only replaces
the toys with pictures. The test consists of six lists containing 6 words
each. Each word is represented on a card of four pictures, i.e. test word
and three distracters. MPT is used mainly with older children for whom
the toy tests are not thought to be appropriate. Test Lists are:
Any of the 6 lists can be chosen for the test. All the test words
within a list are tested at the same level. This is a single sheet of paper
showing 4 pictures representing the test word and three distracter pictures
in a square. The child is required to identify the correct picture. For
example': from list 1, word ‘Bee’ can be mixed with three distract words
Queen, Three, Feet. In order to achieve a “Pass” at any level a score of
5 or 6 out of 6 (83% or greater) must be obtained. If the test is being used
to screen hearing the test level should be 40 dB.
4. Speech Audiometry Test
 This test is applied at the age of 7 years. Already recorded words
like chair, table, water or air etc. are presented through headphones to the
ear of the child at different levels. After listening, child repeats each word,
and test applier checks the word spoken by the child. Test applier can allot
30 marks for producing 10 words completely but if child speaks only two
syllables like ‘ir’ of word air, test applier allots 2 marks arid if child speaks
only ‘r’, then test applier allots 1 mark. If child does not produce any
letter, then no any mark is allotted. 7S0 1500 ' 3050 6900
!S
The audiogram is a graphical
display of the hearing test. The two main 0
10
components that are shownin audiogram
are frequency and intensity. These results * ”
are displayed for each ear. § *
Intensity/loudness is shown from -10 to § 40
120 dB at vertical axis whereas 1
f *,
frequency is shown from 125 to 8000 Hz i
, 70
at horizontal axis. In audiogram, blue g
colour is used for left ear whereas red | w
colour is used for right ear. IW

U9
129
SYMBOLS USED IN AUDIOGRAM
 Type of Conduction Masked/Unmasked Left Right
Ear Ear
> Unmasked X O
Air Conduction Masked □ A
No Response a *
Unmasked (Mastoid) > <
Masked (Mastoid) ] [
Bone Conduction Unmasked (Forehead)
r ,1
Masked (Forehead)

' No Response £
Sound Field (use of speakers instead of headphone) s S
Aided Sound Field (using hearing aid) (Binaural) 'A 'A
Aided Sound Field (using hearing aid) (Monaural) V H
Cochlear Implant Sound Field ci ■ CI
Loudness Discomfort Level ■4? *

BMB8———w ~ •
TYMPANOMETRY
Tympanometry is not a hearing test. Tympanometry evaluates problems
and functions of middle ear. It helps to evaluate the following:
a. Movement of eardrum, malleus, incus and
stapes
b. Detect fluid in ear canal (otitis media)
c. Detect wax in ear canal
d. Stiffness of eardrum
e. Perforation (hole) of the eardrum
f. Presence of otosclerosis (additional bone in
the ear).
g. Tumor in the middle ear
h. Problem with Eustachian Tube
First ear is examined with the help of otoscope to Perforated
Tympanum

ensure that ear is not blocking with the wax. Then probe
of tympanometer is placed into the ear canal and pressure
is released. This test changes the air pressure in the ear to
FluW ' j
Accumulation / Vl;,..........
make the eardrum move back and forth and it generates
the pure tone. Measurement of the movement of the
\ 1
eardrum at various pressures and reflected sound is noted Pressure difference

in a tympanogram. Pressure inside the middle ear can

vary between +50 to -150 decapascals (daPa). Decapascals are
a measurement of
air pressure.
THEORIES OF SPEECH PERCEPTION
Speech perception refers to the processes by which humans are able to
interpret and understand the sounds used in language. The study of speech
perception is closely linked to the fields of phonetics and phonology in linguistics
and cognitive psychology and perception in psychology.
1. Motor Theory of Speech Perception: When we hear spoken words we sense
that they are made of auditory sounds. The motor theory of speech perception
. argues that behind the sounds we hear are the intended movements of the vocal
tract (sound producing organ) that pronounces them.
2. Direct Realistic Theory of Speech Perception: Objects of speech perception
are articulatory rather than acoustic events.
3. Fuzzy-Logical Model of Speech Perception: People remember speech sounds
in a probabilistic or graded way. People can use match & fit technique to relate an
object with its probable category. From Penguin or Parrot, Parrot can be
categorized as bird which is mostly fit.
4. Exemplar Theory of Speech Perception: It claims that listeners store
information for both word- and talker-recognition. Listener uses store information
or memory to perceive the sound.
 Treatment of Hearing Loss
TREATMENT OF CONDUCTIVE HEARING LOSS
Treatment of Conductive Hearing Loss is done in following four ways:
• Medicine
• Radio Therapy .
• Operation/Surgery
• Hearing Aids
1. Medicine
i. Foreign Body in the Ear: Doctor can remove foreign body from ear canal
by flushing water, suction, or by using forceps (u^).
ii. Wax in Ear: Can be removed by flushing canal/by using special instrument.
iii.Infection: Infection in the middle ear like Otitis Media is treated by using
antibiotics.
Eardrum Perforation: Treated Vith antibiotics.
v. Tinnitus ^ u>W): Anti-Anxiety medicine is suggested. Avoiding
smoking and stimulants like tea and coffee also help to reduce tinnitus.
vi. Vertigo j*-*): Anti-Anxiety medicine is suggested.
2. Radiotherapy^^ ^
Tumors(tA^j)of the ear can be broken/renioved by using radiotherapy.
3.Operation/Surgery: Following two type of surgery is done:
• Stapedectomy & Tympanoplasty
i. Stapedectomy: In middle ear, a new bone takes birth (otosclerosis), which
effects the movement of stapes (bone of middle ear). It causes conductive
hearing loss. This can be treated by removing Stapes and connecting Incus
directly to the Oval window of cochlea with a tube. OR it can be treated by
making a hole in the stapes and a wire is inserted in this hole which is
connected with Incus from other end! This way movement of bones is
regularised. This surgical treatment can be very harmful.
ii. Tympanoplasty^^ IS JJ' *4^^ It has 2 types of surgery:
a. Myringoplasty ^ ^ u^) : Treatment of
 perforated eardrum by surgery is called myringoplasty. By using
microscope, eardrum holes are scratched and medicine (Fascia) is
applied for the treatment. Fascia is applied by using Underlay Technique
(applying from middle ear side) OR Overlay Technique (applying from
ear canal side).
b. Ossiculoplasty^^ 15 ^5 Treatment of
middle ear bones by surgery is called ossiculoplasty.
Three bones (Incus, Anvil, Stapes) are repaired. If these
bones are not repairable then bones are transplanted
from a dead body’s ear. This surgical treatment can be very harmful.
4. Hearing Aids: Hearing aids are used to receive, amplify and direct the sounds
to brain using air conduction route for conductive hearing loss. Hearing aids
malces the sound understandable. - ,

TREATMENT OF SENSQRI-NEURAL HEARING LOSS

In this modem time, sensori-neural hearing loss cannot be - treated
perfectly. However following measures can help improve the hearing loss: '
1. Nicotinic Acid dr Histamine Drip
Sensorineural hearing loss wfyich occurs suddenly due to obstruction (£>jiSj)m
blood supply, can be treated by using Nicotinic Acid or Histamine Drip.
2. Antibiotics
Infection can be treated by antibiotics.
3. Surgery:
In Meneries, discharge of fluid from oval window or round window of
cochlea, can be stopped by the surgery.
4. Cochlear Implant (Cl):
Cochlear Implant is a surgically implanted electronic device which
provides sense of sound to profoundly deaf children or adults who get little or no
benefit from heating aid:
Cl provides
hearing to the persons Speech prooeesor
Transmitter j Microphone Transmitter

whose hair
cells of damaged.
cochlea are implant
Cochlear damaged
bypasses the inner
portions of
ear (cochlea) and Electrode* Cochlea
directly stimulate the
auditory nerve. Signals.
generated by the
implant are senf>to the brain via auditory nerve. Cochlear implants have external
(outside) parts and internal-(surgically implanted) parts that work together to
allow the user to understand sound. These parts are:
External Parts:
a) Microphone
Picks up sound from environment & sends to speech processor.
b) Speech processor
, A computer that analyzes and digitizes the sound signals and sends them
to a transmitter.
c) Transmitter
A coil held in position by a magnet placed behind the external ear, it sends
sound signals to Receiver (internal parts of cochlea).
Internal Parts (Surgically Implanted Parts):
a) Receiver
It converts the signals into electric impulses and sends them through an
internal cable to electrodes.
b) Electrodes
Electrodes are surgically implanted in the cochlea. The electrodes
stimulate the fibers of the auditory nerve, and sound sensations are
perceived, by the brain. Quantity of electrodes used in cochlear implant
depends on its type.
Operation •
First, a small area behind the ear may' be shaved and cleaned. Then, an
incision (cut) is made in the skin behind the ear and the surgeon drills into the
mastoid bone, creating a pocket for the receiver, and then into the inneftear where
the electrode array is inserted into the cochlea. Very carefully internal parts’arts
installed and incision is closed. After 1-4 weeks of healing, external parts are
attached and Cl is activated.
\

- i. Suitable age: 1 year and above.

ii. Time of Surgery. 1.5 to 5 Hours.
iii. Patient Stay at Hospital. Patient can go back home same day or can stay
for 1 to 2 days. '
iv. Post Implantation Therapy: After cochlear implantation, proper auditory
'training and speech therapy of the child is done. Auditory training of a
congenitally deaf may continue for the years. A professional like speech
therapist or teacher helps in auditory training.
v. Cautions: Remove the external parts before showering or swimming or
 before MRI test. Scuba diving is totallyf not allowed. It is a risky surgery.
vi. Cost: It is very costly, usually its cost starts from 30,000 $ US Dollars to
, 1,25,000 Sin USA. <•
PREVENTION (PREVENTION IS BETTER THAN CURE)
Half of all cases of hearing loss can be prevented through primary
prevention. Some simple prevention strategies include .(WHO Media Centre,
2015):
1. Noise induced hearing loss can be prevented by removing the person from
the no.isy environment. ^ J j>“)
2. Use of ear plugs and noise-cancelling earphones and headphones.
3. Immunizing children against childhood diseases, including measles,
meningitis, rubella and mumps, (tilj&l UJU. LSJS ^ihlK UJ^)
4. Immunizing adolescent girls and women of reproductive age against
rubella before pregnancy. ^ J** UH> ^ JJ1 OJ£J* i^W)
(UljSJ ^^ LS^
5. Screening for and treating syphilis and other infections in pregnant
women.
^-3jJ IjjJ dfijjj IS l_ya\jXk\ Sj s mi O l «.l (jia (JJjIjS. /»1*IA)
(^-J t%Sj Jijia-o ^_U1 jjjjjLtu ,
6. Improving antenatal / prenatal (before birth) and perinatal (during birth)
care, including promotion of safe childbirth.
7. . Healthy ear care practices.
8. Screening of children for otitis media, followed by appropriate medical or
surgical interventions.
9. Avoiding the use-of particular / harmful drugs for hearing.
10. Referring high risk infants for proper management.
11. Early intervention of children with hearing loss.
12. Avoid loud volume of radio, TV, Music etc. (NHS Choice, 2015).
13. Avoid recreational activities like riding snowmobile, hunting or listening
to rock concerts for long period of time (Mayo Clinic, 2015).
14. Early management of Meniere (excess of fluid in inner ear) can help to
prevent progressive hearing loss and dizziness/vertigo.
 Hearing Aids
Hearing Aid: An electronic device that makes the sound louder so that a person
with hearing loss can listen, communicate and participate in daily activities in a
better way. It makes the speech more intelligible <J4a).
COMPONENTS OF HEARING AID
The components of a hearing aid are held together in a protective case
often made of plastic. Basic components are given
below: Receiver
(internal)
/■■
1. Microphone: Picks the sound from / Ki-,. Microphone

1. —-—““ (internal)

Transverse waves are transmitted through the solid

only..
PROPERTIES OF SOUND: Basic physical properties
of sound are as under:
1. Frequency: Number of waves passing through a
particular point in one
second. OR Number of cycles per unit time. Frequency determines the pitch of
sound. Pitch of sound increases as the frequency increases. Frequency is denoted
by letter Unit of frequency is Hz. .
V
1
A
Where V is velocity (speed) of wave and X (lambda) is wavelength. The higher
the frequency, shprter the wavelength.
2. Wavelength: The distance between two Vt!av«tenath
peaks (high points) is called wavelength. It is
denoted by X (lambda). The higher the
wavelength, shorter the frequency.
K--
X
~f
Trough
 v=/
4. Speed
5. Intensityof Sound: Distance travelled by sound
of Sound/Volume/Loudness: Sound wave in = velocity
:
frequency
per unitperofunit
power timearea
is called speed
is called of sound.
intensity l (dB )= lOlog = wavelength
Its unit Itmeter
of sound. per
x
10
issecond. It istodenoteS
related by ‘V’.
loudness. Sound intensity level is L4J
measured in Decibel (dB). Its unit is watt per meter S'
square. Higher the amplitude, higher the intensity or
loudness.
6. Timbre of Sound (Sound Quality): Quality of sound that helps to distinguish
different voices of different people or sounds of different musical instruments
(piano, lute, drum) at the same pitch and loudness. Sound of different musical
instruments at same pitch and loudness can be distinguished.
3. Amplitude (j^tfj): The maximum distance a wave
moves’^Sfom its
equilibrium position (From center to peak).
1. Music (Regular sound): Desirable or wanted
sound. A person, who listen music, enjoys it.
2. Noise (Irregular sound): Undesirable or
unwanted sound. It puts bad effects on human
feeling.
3. Rhythm: A regular repeated pattenrof sound or
movements (tones in a sequence).
RELATED TERMS: ■ * * . ' * * *' • '
Compression/Compression Waves: A compression is a region in a longitudinal

wave where the particles are closest INFRA SOUND ' ULTRASOUND
together.
Rarefaction/Rarefaction Waves: A
rarefaction is a region in a longitudinal
wave
where the particles are furthest apart.
Rofoioctiop compressions

Normal Sound/ Acoustic/ Audible

frequency: Sound having frequency
range 20-20000 Hz. This range of
frequency is audible (cjc-U^ J/i).
Ultrasonic Sound: Refers to inaudible
sounds having frequency greater than
20000 Hz or 20 KHz.
Unit No. 11
Infrasonic Sound: Refers to inaudible sounds having frequency less than 20 Hz.
Auditory Masking
AUDITORY MASKING 04*1 l*J jS jlji ^ IS jljt <-SL!) ; it is the ability of one
sound to make another sound hard/difficult to hear. Masking occurs in daily
routine life when sound comes from different sound sources, every' sound try to
mask other. In noisy environment sound masking occurs most. Usually loud
sound masks the weaker sound.
AUDITORY MASKING (Another definition): The term masking refers to
noise presented to the non-test ear to keep it “busy," preventing it from hearing
the sound presented to the test ear. The sound is a noise, which sounds like static,
but has tonality. By properly presenting masking noise to the non-test ear, you can
ensure that you are testing the ear to which the pure tone is presented.
• Maskee/Signal (jlji *. Sound to be detected is called Maskee or
Signal. It is a desired and wanted sound.
• Masker: Undesired, unwanted or interfering sound is called Masker.
• Unmasked Threshold: The quietest audible level of signal presented
without masking.
•„ Masked Threshold: The quietest audible level of signal after the masker
is presented.
MEASURING MASKING: If a signal is presented at the level of 20 dB, and
then a masker is presented at the level of 40 dB. The difference between signal
and masker is the level of masking.
Masking Level/ Amount of Masking = Level of Masker - Level of Signal
40 dB - 20 dB =20dB
The amount of masking is also called the difference between masked threshold
and unmasked threshold.
TYPES OF MASKING: There are two types of masking:
1. Simultaneous Masking: It is masking in which signal and masker is given at
the same time. There are two types of Simultaneous Masking:
i. Ipsilateral Masking (Same side): The masking in
which signal and masker is given in the same ear at
the same time. It is also called Monaural Masking.
 ii. Contralateral Masking (Other/Opposite side): The masking in which
signal and masker are given in opposite ears at the same time.

2. Non simultaneous Masking/Temporal Masking: The masking in which

signal and masker is not given at the same time but after little duration. There are
two types of temporal masking:
i. Backward Masking/Pre-masking • The masking
in which firstly signal is presented and then masker is presented. Although
signal and masker are not presented at the same time inspite of that,
masking occurs.
ii. Forward Masking/Post-Masking (J&« ur* ; The masking
m which firstly masker is presented and signal is presented.
RELATED TERMS
1. Plateau Method of Masking: Masking nontest ear (NTE) with progressively
greater amounts of sound until threshold does not rise.
2. Shotgun Method of Masking: Displaying noise to NTE by over or
undermasking.
3. Occlusion Effect: When a person fills the outer portion of
his/her ear canal with an object (hearing aid etc.), then he/she * '
perceives echo-like sound of his/her own voice which is
denoted as occlusion effect. This is caused by the bon§
conduction of vibrated object inserted into the ear canal.
Occlusion effect can be controlled by using deeply fitting hearing aids or by
using large vent in earmold of about 2 mm diameter.
4. Undermasking: In masking procedure, when the tone continues to be heard
in the masked ear despite the noise since the tone level is below the threshold
of the test ear.
5. Over Masking: In masking procedure, when the level of tone- is further
increased and it increases the threshold of test ear again.
6. Masking Dilemma: It occurs when the initial masking level already produces
overmasking (because of bone conduction). Insert earphones helps to reduce
masking dilemma.
7. Minimum Masking Level: The minimum level of noise that is needed in the
 non-test ear to eliminate its response to the test signal.
8. Maximum Masking Level: The maximum level of noise that can be used in
the non-test ear that can be used that will not change the true threshold or
response in the test ear, ^
******************
 Speech and Language Disorder
SPEECH ORGANS: Speech
organs include following:
1. Lips (Labials): Lips
touch with each other and make
consonants sounds called
bilabial sounds (p, b). Lips
touch with teeth and make
sound called * labiodentals
sounds (f, v). Lips also help
shape different other sounds of
vowel and consonants.
2. Teeth: Teeth touch with
tongue and make sound called
lingua-dental sound (1, the).
3. Tongue: Tongue comprise of
four parts; tip, front/blade, back
and root. It form different
shapes and with the help of
other organs makes sounds. Gotti*
4. Roof of Mouth: It comprises of
three parts: (a. Teeth Ridge/Alveolar Ridge-
situated immediately after upper front teeth. Sounds produced by teeth ridge are
called alveolar sounds i.e. t,d, b. Hard Palate- It is central part of the roof, c. Soft
Palate/Velum- It is a lower part of the roof of mouth. It is used to block or open
the nasal or oral cavity. Sounds produced by it are called velar sounds i.e. k,g).
5. Nasal Cavity/Oral Cavity: Nasal cavity produces Te5thRidge
sound with the nose and oral cavity produces sound
with oral path (mouth). Nasal cavity sounds include; m,
n, ng.
6. Uvula: It is the ending part of soft palate. Its shape is
like a tip hanging in the throat.
7. Pharynx: It lies between the mouth and food passage
just above larynx. It is 7-8 cm long.
8. Larynx/Voice Box: It is situated next to throat after
the pharynx. It protects vocal cords.

Uvula
9. Vocal Cords: Two elastic membranes situated in larynx are called vocal cords.
They come close to each other, vibrate and produce sounds. Glottis is the open
form/shape of vocal cords. Sound produced by the vibrations of vocal cord is
called voiced sound/soft sound, whereas sound produced without vibration of
vocal cord is called voiceless sound/hard sound.
10. Lungs: Two lungs are situated in the rib cage of our body. They control
airflow/breathe coming in and out and contribute to speech production.
SPEECH DISORDERS
The problem which makes a person unable to produce sounds correctly or
fluently is called speech disorder.
1. Articulation Disorder/ Phonic Disorder/ Phonemic Disorder (Making
incorrect words) :Articulation means making
sounds and words. The lips, teeth, tongue, jaw, and palate (roof
of the mouth) need to move together to make shapes to speak
words or sounds. The problems in these organs sometimes can
make a person speak incorrectly. Errors in pronunciation of words are
articulation disorders. There are four types of Articulation Disorders which
are best remembered by ‘SODA’ (Substitution, Omission, Distortion,
Addition): ^
a. Substitutions (replacing the words) ^ j* Jatill ^iau);
Replacing “w” with “r” and saying “wabbit” for “rabbit.”
b. Om/.w/o«j?(shorten the words) (Uj* <U1JJ ^):Omit a sound in a
word /saying “at” for “hat” or “Ango” for “Mango”).
Distortions(UjS Chi ^ jjj):Producing sounds in unusual manner,
(saying “Shiip” for “Ship”).'
d. Additions (extra sound adding) (UJ 5U Jail Jail ^.^Ik*): (saying
“Buhlack” for “Black”, or “Dohug”for “Dog”.
2. Stuttering Disorder/Stammering jS uajja.
(Uljiji;
Major effects of cluttering are as under:
1. Sounds, first letters or syllables are repeated.
2. Sounds, first letters or syllables are prolonged.
'3.. Disruption in normal flow of speech.
4. Child puts’ break in speech and speaks in blocks (pieces).
5. Child shows muscle tension i.e. rapid eye blinks or shivering of lips during
speech »s jjl &>ji £=h).
Child is aware of the speech problem and gets confused and feels shy.
6. It is also called Fluency disOraer or disfluency.
7.

i Cruxof_SpedaJ_EducjiJi
68
jm
First Letters/ Syllable Repetition: Child repeats the first
letters or syllable i.e. “on-on-on a chair”, "un-un-under” or
"o-o-open”.
First Letters / Syllable Prolonged: Child prolongs the first
letter or syllable i.e. mmmm-morning, wwwww-walk. ,
Word Disruption: Child produces in-understandable
words i.e. “I um went um to um the um store.”
3. Cluttering Disorder:
t' jor effects of cluttering are as under:
i. Rapid / too fast speech^jf j f j f ) . Also calle
‘machine gun’speech.
ii. Irregular speech( 'jljj syU2 .
iii. Poor Grammer ^ j^J*) .
iv. Poor sentence construction (Lj£ .
v. Word or phrase (sentence) repetition i.e. I want, I want, I want OR I love, I
love, I love (Not the first letter/syllable repetition as in stuttering).
vi. Child starts the sentence well but confuses in between the sentence.
vii. Effects of cluttering are also seen in the writing and typing.
viii. No muscle tension (as in stuttering).
ix. Child is not aware of speech problem and does not bother, not confused.
x. Use of interjections words />iM), at the start or in between the
sentence (uh, um, well, right etc.)
xi. Word omission (I to Lahore FOR I went to Lahore)
xii. Sloppy handwriting.
xiii. It is also called Fluency disorder or disfluency.
Note: A person can have stuttering and cluttering at one time. Stuttering and
Cluttering, both are the Fluency Disorders.
4. Voice DisorderUKJ jlji (j&i (issues of pitch, loudness,
 resonance due problem in vocal cords or larynx). Voice disorder refers to
abnormal production or absences of vocal quality, pitch, loudness, resonance, or
duration. Mostly it occurs due to the infection or injury to vocal cords or larynx of
a person. It creates problems of high pitch/low pitch, high loudness/low loudness,

Cyax of SpecialJ/ducaJiqn

harsh/rough voice or breathy voice.

5. Apraxia of Speech (AOS)/OraI-Motor Speech Disorder:
Child brain does not support for motor coordination and motor
planning to speak words. Child feels difficulty in producing
words because he. feels difficulty in moving muscles (lip, jaw,
tongue). Rearranging the words i.e. “topato" “totapo” for
"potato ”. It is an acquired disorder not a congenital disorder. It occurs due to the
damage'to cerebrum (brain part). Child is willing to perform the task but brain
does not support. , .
6. Dysarthria: It is a motor speech disorder in which the
, muscles of the mouth, face or respiratory system may become
weak or have difficulty moving. It results from neurological
injury of motor component of motor speech system. It creates
problems of pitch, volume, timing, vocal quality.
LANGUAGE DISORDERS
Language disorder means having trouble in understanding (receptive
ianguage) others and expressing (expressive language) him/herself.
1. Aphasia: Due to brain dysfunction ~
. person with aphasia faces follow
problems:
a. Comprehension (Listening)
b. Speaking
c. Reading
d. Writing
It is caused by head injury, infection, stoke or tumor of brain. Aphasia is a total
disruption of understanding the speech or producing speech. There are four types
of Aphasia:
a. Expressive Aphasia: Damage to Broca Area which affects speech
production (speaking & writing).
b: Receptive Aphasia: Damage to Wernicke Area which affects speech
understanding (listening & reading).
c. Global Aphasia: Combination of both Expressive and Receptive Aphasia.
a. Anomic Aphasia. Problem in recalling words, names or numbers.
2. Dysphasia: Dysphasia is moderate (partial) disruption in comprehension,
speaking, reading or writing.
3. Expressive Language Disorder (Difficulty in producing the language): It
means a child has difficulty conveying information in speech, writing, sign
language or gestures. The child may not use correct grammar, may produce very
short phrases and sentences, and may have a small vocabulary.
4: Receptive Language Disorder (Difficulty in understanding the language):
It means a child has difficulty getting information in listening and reading. The
child may not understand the spoken words and have trouble in reading. Child has
trouble in understanding speech, following directions and discriminating similar
sounds. Child often asks repetition or clarification.
4. Auditory Processing Disorder (APD)(UjS /*i JS UJJ'J' ^ £UJ>):
A child with APD can't process the information he hears because his ears and
brain don't fully coordinate. Child hears the sound but his brain not interpret it
correctly. Children with APD may exhibit a variety of listening and related
complaints i.e. difficulty in understanding speech in noisy environments,
following directions, and discriminating (or telling the difference between)
similar-sounding speech sounds. Sometimes they may behave as if a hearing loss
is present, often asking for repetition or clarification.
CAUSES OF SPEECH / LANGUAGE DISORDER
It may include following:/*
1. Hearing Loss
2. Vocal cord damage *
3. Vocal cord paralysis
4. Brain damage
5. Muscle weakness
6. Respiratory weakness
7. ADHD
8. Oral Cancer
9. Developmental Disorder (e.g., Autism)
10. Genetic Syndrome (e.g., Down Syndrome)
11. Neurological Disorder (e.g., cerebral palsy)
DIAGNOSIS OF SPEECH / LANGUAGE DISORDER
Speech Therapist with the help of different tests diagnoses the speech or
language disorder, following can be used for the diagnoses:
1. Denver Articulation Screening Exam: It is most commonly used test to
diagnose speech disorder. It evaluates clarity in pronunciation in children of
age 2-7 years. It is 5 minute test uses various exercises to assess speech.
2. Early Language Milestones Scale 2: It determines child’s language
development, This test can quickly identify delayed speech or language
disorders.
3. Peabody Picture Vocabulary Test Revised: This test measures a person’s
vocabulary and ability to speak. The person will listen to various words and
 choose' pictures that describe the words. This test is not useful for children
with severe Mental Retardation and Blindness.
TREATMENT OF SPEECH / LANGUAGE DISORDER

1. Speech-Language Therapy
It is a treatment for those children who face difficulties with communication,
drinking, eating, swallowing, respiratory problems (breathing disorder). Speech
Language Pathologists (SLPs) assess speech, language, cognitive-communication,
and oral/feeding/swallowing skills to identify types of communication problems
(articulation; fluency; voice; receptive and expressive language disorders, etc.)
and the best way to treat them.

2. Computer Based Instruction

The use of computer technology (e.g., iPads) and/or computerized programs
for teaching language skills, including vocabulary, social skills, social
understanding, and social problem solving is helpful to improve speech problems
of the children.

3. Video-Based Instruction (also called Video Modeling)

It is the use of video recording's to provide a model of the target behavior or
skill. Video recordings of desired behaviors are observed and then imitated by the
individual. The learner’s self-modeling can be;videotaped for later review.

4. Medicine
Different type medicine is used to treat speech disorder e.g. Collagen
Injections. Collagen injections are used to treat voice and speech impairment.
Certified ENT can help to provide this treatment. Collagen injections help to build
up vocal folds that don’t close completely while talking. Collagen injections are
directly injected into focal cords and its effects lasts for 6 months and then must
be re-injected.

5. Speech Easy Device

This device is used to treat stuttering. It is small electronic device on the ear
(similar to hearing aid). .
6. Augmentative and alternative communication (AAC) includes all forms of
communication (other thamoral speech) that are used to express thoughts, needs,
wants, and ideas. We all use AAC when we make facial expressions or gestures,
use symbols or pictures, or write. People with severe speech or language problems
rely on AAC to supplement existing speech or replace speech that, is not
functional. Special augmentative aids, such as picture and symbol communication
boards and electronic devices, are available to help people express themselves.
This may increase social interaction, school performance, and feelings of self-
worth. AAC users should not stop using speech if they are able to do so. The
AAC aids and devices are used to enhance their communication. One of its
techniques is Picture Exchange Communication System (PECS). Therapists,
teachers and parents help the ■ ______ ^
child or adult build a ■ , |* #| ,j»<*| Q*.
•vocabulary and consistently ^ §f II S'
articulate desires, I wont
............ 1 see thank yaw *"* ,
'

through pictures. This system ^ dnnk biscuit apple ^8cake

SLo ^0crisps bananas
dririk legk'».
can be taught and used at. .^ ______ “S
home, in the classroom and a ■ 8 Bi’ii
|jg|
variety of other settings. book sand sajbricks
w pens form puzzle 'W
Vocabulary of the child is ESSfS ^
/—\ % « % gf*
L. trousers .coat
developed and he/she is asked ii
(£3 Bk
to exchange word with picture , *S|b jumper
■— sock
hat * «. -^
, ,, , ,, shoe jumper trousers .coot sock not
i.------------------------------------------------------------------ e. when we call apple, the ——-*-=—-—--------------------------
:——----------------------------------------------------------------------------- —1 *—
child should show apple picture etc.
RELATED TERMS
1. Vocal Cords/Vocal Folds/Voice Reeds: Vocal Cords
are the small bands of the muscles within the larynx.
Everyone has two vocal cords in his/her larynx (voice
oox). Vocal cords vibrate to produce voice. If one or both
vocal cords are unable to move (vocal cord dysfunction)
then a person can experience voice problems including
swallowing and breathing issues as well. Speech therapy
and deep breathing techniques can help in the treatment
of vocal cord dysfunction. Approximate length of male
focal cord is 0.75-1.0 om while female is 0.50-0.75 cm,
whereas length of vocal cords of children is shorter than
adults.
2. Vocalization (Uji j>j>) : It refers to the process of producing sound with
the use of vocal organs. - '.
3. Visual Speech Technology/ Lip Reading ,
Machine: Scientists have invented a Lip Reading
’ Machine in England (University of East Anglia)
which reads the lips and helps in noisy environment. It
will also be helpful for the people with hearing/speech
impairment and will help in lip reading of the subjects of CCTV footage videos to
solve the crime. This visual speech technology has been created by Dr. Helen L.
Bear and professor Richard Harvey!
4. Parts of Speech: There are 9 parts of speech. They are articles, nouns,
pronouns, adje'ctives, verbs, adverbs, conjunctions, prepositions, and interjections.
5. Morphemes: Smallest unit of‘language that convey meaning (car, bat,
cat etc.).
6. Nasal Sounds: Sound produced by moving air through nose (M, N, Ing).
7. Oral Sound: Sound produced by moving air through mouth (escaping from
nose) (a, b, c,d etc.).
8. Components of Language: These are as follows:
i. Phonology. The study of sound is called phonology. It means how different
letters produce sound. (TH in Three and There sounds differently, TH in
This and Thin also sounds differently).
ii. Morphology (Understanding the word formation)'. The study of word
formation is called morphology. The smallest unit of language which gives
meaning is known as morphemes (teach, drive, beauty, help etc.). These
morphemes can be used to make more words (teach-teacher, drive-driver,
beauty-beautiful-beautifully, helping).
iii. Semantic (Meaning) : The study of meaning of words is called semantic. (In
a sentence “All kings are male”, it means King is male not a female-queen, a
person can understand meaning of the word or sentence, he can also
understand queen is a female, or water is a liquid, wood is solid).
iv. Pragmatics (Use of social and appropriate language) : The use of proper,
 words or sentences according to social setting.. (Proper = Leave the room,
Improper = Get out of the room), (Proper=Drink Water, Tmnr 0pfc: - Drink
Anger).
v. Syntax (Use of grammatical rules): Syntax refers to use of grammatical
rules to make sentences or phrases. It is necessary to put the noun, verb,
adjective or adverb correctly. (I eat breakfast, correct of use of grammatical
rules) (Eat I breakfast, incorrect).
 ***l***** *******
MISCELLANEOUS
1. Loudest sound can be tolerated by normal listener, is Loudness Discomfort
Level.
2. 40-55dB loudness level above threshold is most comfortable loudness level.
3. It; is uncertain to know which cochlea is being tested during in unmasked
bone conduction.
4. A person’s response without tone presentation in speech audiometery is False
positive.
5. 2 syllables words with equal stress & effort (baseball, hotdog etc.) are called
Spondee Words.
6. There is 40 dB loss of energy while wearing supra-aural headphones in the
calculation of inter-aural attenuation in air conduction.
7. There is 70 dB loss of energy while wearing insert receivers in the calculation
of inter-aural attenuation in air conduction.
8. There is 0 dB loss of energy while wearing bone oscillators in the calculation
of inter-aural attenuation in bone conduction.
9. Interaural attenuation of a person with large head is greater than a person
with small head.
10. In air conduction, amount of interaural attenuation depend upon the head size
and quality of Transducer (microphone).
11. In air conduction (AC), when a person does not hear a sound of 30 dB at
1000 Hz then loudness of sound will be raised at what level 50 dB.
12. tn threshold search method in air conduction, if a listener raises his/her hand
every time to indicate the sound then tone will be decreased at the level
10 dB.
13. In threshold search method in air conduction, if a listener cannot hear sound
then tone will be increased at the level 20 dB.
14. In bone conduction testing, if a tone of 30 dB is presented to right ear
cochlea, the level of tone received by left ear cochlea would be 30 dB.
.15. In bone' conduction testing (with mastoid placement) it is unimportant to
test which ear first (better or worse).
16. Masking of opposite ear is very necessary to detect hearing loss in bone
conduction testing (with mastoid placement).
17. If the ABG shows that hearing by air conduction is poorer than hearing by
bone conduction with a gap greater than 10 dB, then we know that the
hearing loss can be Conductive or Mixed.
18. If the ABG shows that hearing by air conduction's equal to hearing by bone
conduction, then we know that the hearing loss can be Sensori-neural or
Normal.
19. A response to stimuli that may be caused by the feeling of vibration of bone
oscillators in bone conduction rather than hearing the actual sound Tactile
Response.
20. In persons with severe hearing impairment, at highest limits of audiometer it
becomes almost impossible to know whether response is tactile or auditory.
21. If hearing sensitivity is considerably better in one ear than in the other, then
you can assume cross hearing is occurring.
 *******************
Chapter No. 2

VISUAL IMPAIRMENT

L
\ L
 Sr# Topic Page #
1 Nutshell of the Visual Impairment 78
2 Basics of Visual Impairment 91
3 Causes / Conditions of Visual Impairment 93
4 Refractory Errors/Disorders 99
5 Eye Anatomy 100
6 Anatomy of Eye Muscles 104
'7 Consequence of Visual Impairment 105 ,
8 Vision Assessment 106
9 Diagnosis of Visual Impairment 108
10 Treatment of Visual Impairment 111
11 Curriculum for Children with Visual 114
Impairment
12. Education for Children with Visual 115
13 Impairment
Braille 117
14 Teaching Daily Living Skills 119
15 Developing Communication Skills ■ 121
16 Assistive Technology 122
17 Orientation & Mobility Skills 124
18 Physical Activities and Games 126
19 Miscellaneous 129

Nutshell of Visual Impairment

1. Any defect or damage to visual mechanism causes - Visual Impairment
2. VIC stands for -Children with visual impairment
3. Do VIC can damage their eyes by using them too much?- No
4. Impairment that have both legal and education definition- Visual impairment
5. Profound visual impairment is called -Blindness
6. Moderate to Severe vision loss is related to - Low
Vision
7. Visual impairment is classified on Education Basis and - Legal Basis
8. Most visual impairments of school age children are - Congenital
9. Many students who are blind have -Additional disabilities
10. Condition almost always associated with photophobia - Albinism
11. Albinism is also called -Achromia
12. Partial / total absence of pigment in eyes, hairs, skin -Albinism
13. Deficits in the production of melanin causes - Albinism
14. Substance in body that gives colour to skin, hairs & eyes- Melanin
15. Opaque or cloudy lens due to trauma or age related to - Cataracts
16. Cataract results from the damage to the -Lens
17. Loss of lens transparency - Cataract
18. Dim light should be used if Cataract is located in the center of- Lens
19. Brighter light should be used if Cataract is located in peripheral part of-Lens
20. Lens block light from reaching retinal receptors in - Cataract
21. Cataract is the condition in which spot is appeared in. -
Pupil of eye - Blindness
22. Untreated glaucoma results in - Glaucoma
23. Ocular support problems result in - Glaucoma
24. Blocked aqueous humor is related to - Glaucoma
25. Eye pressure caused by fluid blockage - Glaucoma
26. Sneak thief of sight is called - Glaucoma
27. Excessive pressure buildup in aqueous humor causes - Acute Glaucoma
28. Closed Angle Glaucoma is called - Chronic Glaucoma
29. Open Angle Glaucoma is called - Optic Nerve
30. Increased pressure of fluid due to Glaucoma damages - Peripheral vision
31. Glaucoma causes the loss of -Open angle glaucoma
32. Glaucoma mild in nature -Closed angle glaucoma
33. Glaucoma severe in nature - Open angle glaucoma
34. Fluid is drained slowly/partially at Trabecular - Open angle glaucoma
meshwork -Closed angle glaucoma
35. Drainage point is open but narrow that slows fluid flow -Closed angle glaucoma
in ■Macular Degeneration
36. Flow of fluid is block/stopped at Trabecular meshwork ■Macular Degeneration
in
37. Fluid is not allowed to flow / drain in glaucoma
38. MD stands for
39. Damage to central part of retina (macula)
40. Area of best central vision -Macula
41. Small area of retina contains special cells sensitive to light- Macula.
42. Yellow area in the center of retina -Macula
43. Macula means -Spot
44. Macular Degeneration affects - Central Vision
45. Macular Degeneration is the leading cause of vision
loss in- Older People Drusen
46. Yellowish deposits in macula called -DryMD
47. MD results due to presence of drusen in macula - DryMD
48. Mild form of MD - Dry MD
49. 85-90% cases of MD are related to - Wet MD
50. 10-15% cases of MD are related to - Blood vessels
51. Wet MD results from the growth of abnormal - Retina
52. Abnormal blood vessels leak the fluid or blood in -Vision Loss
53. Leakage of blood of fluid in retina causes - Wet MD
-Ocular Motility disorder
56. Rapid, repetitive, involuntary jiggling of eyes related to- Nystagmus
54. Severe form of the MD is Eye movements
55. Strabismus and Nystagmus are -Reading
57. Nystagmus people usually not aware of their - Vertical
58. Nystagmus causes inability to fixate on objects and Nystagmus
59. Up and down eye movement is affected in -Horizontal Nystagmus
60. Side to side eye movement is affected in -Tortional Nystagmus
61. Circular eye movement is affected in - Misalignment
62. Strabismus causes'the eyes - Strabismus
63. Inability of both eyes to focus together -Unilateral strabismus
64. Misalignment of same eye -Alternating strabismus.
65. Misalignment of both eyes - Strabismus
66. Squint is the characteristic of - Strabismus
67. Oculomotor problems are related to - Strabismus
68. Imbalance of eye muscles is related to -Cross Eyed
69. Esotropia is called - Wall Eyed
70. Exotropia is also called -Esotropia
71. Inward deviation of eyes relative to one another -Exotropia
72. Outward deviation of eyes relative one another - Esotropia
73. Inward eye movement is related to - Exotropia
74. Outward eye movement is related to - Hypotropia
75. Downward eye movement is related to - Hypertropia
76. Upward eye movement is related to - Exotropia
77. Opposite of Esotropia -Turn
- Inward
- Outward
78. Trop means
79. Eso means
80. Exo means
- Downward
89. Cortical Visual Impairment is also called - Upward
-Cognitive visual impairment
90. Dysfunction of visual cortex (brain part) is related to - CVI - Coloboma
91. Difficulty in processing of information by brain is - Coloboma
92. Complete or partial absence of Iris - Congenital
93. Aniridia is rare condition usually present -Neurological disorder
94. Lack of eyes - Cortical blindness
95. One or both eyes not developed during pregnancy in -Visual processing disorder
81. Hypo means
82. Hyper means
83. A hole in the structure of the eye is related to -CVI
84. A cleft or gap in some part of eye such as retina, lens - Aniridia
85. Coloboma is - At birth
86. Cortical Visual Impairment (CVI) is - Anophthalmia
87. Old term used for CVI - Anophthalmia
88. Cortical Visual Impairment is also called - No
96. Is there any cure of anophthalmia? - Microphthalimia
97. One or both eyes are usually small in - Not / Absent
98. Ano means - Small
99. Micro means - No
100. Is there any cure of microphthalmia? - Aphakia
101. Absence of the lens of the eye is . - Eye focus
102. Absence or damage to lens affects - Amblyopia
103. Reduced visual acuity in one eye - Amblyopia
104. Lazy eye refers to - Amblyopia;
105. Brain ‘turns off one eyg in - Amblyopia
106. Eye condition that usually affect one eye - Hemianopia
107. Blindness in one half of the visual field - Left or Right
108. Which side is affected by Hemianopia - Hemianopsia
109. Hemianopia is also called -Charles Bonnet syndrome
110. People realize that images they are seeing are not real • -No
111. Is there any cure of Charles Bonnet Syndrome
12. Color most difficult for a color blind person to
distinguish- Red and Green - Cones
113. Eye part responsible for detecting colour - Colour blindness
114. Inability of eyes to recognize different colours - Congenital
115. Colour blindness is - Colour blindness
116. Monochromatism - Cones
117. Colour blindness results from the damage to the
118. Poor dolour contrast sensitivity results from damage to- Cones
119. Colour blindness is not real form blindness but difficulty in-Color perception
120. Colour blindness is more.common -Males
121. Absence or malfunctioning of cone cells or retina causes- Color blindness
122. Nerve at back of eye carry messages from retina to brain- Optic Nerve
123. Allows brain to process visual information it
receives - Optic Nerve - Occipital lobe
124. Optic nerve is connected to brain lobe -ONH
125. Optic Nerve Hypoplasia - ONH
126. Underdevelopment of optic nerve causes -Not known
127. Exact cause of Optic Nerve Hypoplasia is - Optic nerve atrophy
128. Degeneration of optic nerve cause - Retinoblastoma
129. Tumor in retina causes blindness is related to - Retinoblastoma
130. Eye cancer begins in retina is related to - Young Children
131. Retinoblastoma mostly affects the
132. White colour in center circle of eye (pupil) is related to- Retinoblastoma
133. ROP stands for -Retinopathy of prematurity
134. Eye condition of retina that affects premature babies -ROP
135. Underdeveloped blood vessels grow into retina in - ROP
136. What caused underdevelopment of blood vessels in retina- High oxygen level
137. In ROP, weak development of blood vessels damage or - Detach Retina
13 8. ROP results severe loss of -Vision
139. Retinitis Pigmentosa is the inherited and -Progressive condition
140. Retinitis Pigmentosa causes visual loss -Progressive
141. Eye disease related to black pigmentation - Retinitis Pigmentosa
142. Photoreceptor cells (rods & cones) die in eye condition- Retinitis Pigmentosa
143. Retinitis Pigmentosa causes < - Night Blindness
144. Loss of peripheral and spotty vision is related to - Retinitis Pigmentosa
145. Most common visual problems are the result of errors of- Refraction
146. Major role of Cornea is in the process of - Refraction
147. Process of bending light rays that is part of vision - Retraction
148. Myopia, Hyperopia, & Astigmatism are - Refraction Errors
149. Irregularities in shape/size of eyeball/comea/lens causes- Refraction Errors
150. Light rays focus in front of retina ' ■ - Myopia
151. Light rays focus in beyond retina -Hyperopia
152. Near Sightedness is the characteristic of -Myopia
153. Far Sightedness is the characteristic of -Hyperopia
154. In Myopia, only those subjects seen clear which are held- Close to Eyes
155. In Hyperopia,' only those subjects seen clear which are held- Far from Eyes
156. In Myopia, Distance vision is -Blurred
157. Myopia is common in , -Children
158. Hyperopia is common in -Adults
159. Lens helpful in Myopia -Biconcave
160. Lens helpful in Hyperopia - Convex
161. Surface of cornea or lens are cylindrical nor spherical, causes - Astigmatism
462. Eye not focus properly due to uneven curvature of comea-
Astigmatism - Astigmatism
163. Blurred vision caused by an irregular cornea or lens - Presbyopia
164. Loss of near vision with age - Close work
165. Presbyopia causes inability to focus on . • - Presbyopia
166. Eye condition that eventually develops in everyone - Less Resilient
167. In Presbyopia, eye lens become - Anisometropia
168. Difference in refractive error of two eyes is related to - Sclera
169: What helps eye maintain its shape? - Sclera
1 70. The‘Wliite’of the eye - Corneal dystrophy
171. Loss of transparency of cornea is related to - Cornea
172. Transparent, curved part of front of eye -Cornea
173. Transparent, outer layer of the eye that protects it - Cornea
174. When light passes through, it hits first with
17 5. Transparent outer part of eyeball transmit light to retina- Cornea
176. Anterior means : -Frontal
177. Posterior means -Later
178. Clear, transparent fluid that fills anterior eye chamber - Aqueous humor
179. Part of eye that produces clear fluid called aqueous humor- Ciliary body
180. Anterior cavity of eye is filled with - Aqueous humor
181. Posterior cavity of eye is filled with - Vitreous
humor
182. Which canal drains the aqueous humor from eye
- Schlemm
183. Gel keeps eyeball from collapsing b/w lens and retina - Vitreous humor
184. Colourless, soft gel material fills the eyeball behind lens-Vitreous humor
185. Maintain eye pressure and hold lens & retina in place - Vitreous humor
1
186. From cornea light enters - Aqueous humor
187. Watery liquid that fills the front chamber of eye - Aqueous humor
188. Aqueous humor is located behind the - Cornea
189. Aqueous humor passes light to the - Lens
190. Pigment portion of the eye is - Iris
191. Coloured, circular eye part that controls size of pupil - Iris
192. Coloured part of the eye with pupil in center - Iris
193. Pain felt in the Iris is called - Iridalgia
194. An incision (cut) into the Iris is called - Iridotomy
195. Any disease of Iris is called - Iridopathy
196. Hole in the center of the coloured Iris - Pupil
197. Organ that expand and contracts to admit light to eye -Pupil
J98. Controls the amount of light enter into the eye - Pupil
- Anisocoria
- Widening of pupil
- Lens^,
- Lens
- Lens
199. Unequal size of pupils
200. Dilation of pupil means
201. Light bending structure of eye
202. Ciliary body contains muscle that control the shape of
203. Part of eyes located behind the Iris and pupil
204. Part of eyes that focus light on retina - Lens
205. What connects lens to ciliary body - Suspensory ligament
206. Lens of eyes become thick when ciliary muscles -Relax
207. What controls the shape of lens - Ciliary muscles.
208. Absence of lens causes light sensitivity and loss of - Visual acuity
209. Absence of lens is called - Aphakic
210. Visual receptors are - Rods and cones
211. What contains visual receptors? - Retina
212. What contain rods and cones of eye? - Retina
213. Any disease of retina is called - Retinopathy
214. Inside lining of the eye is called - Retina
215. Second cranial nerve is called - Retina
216. Third and innermost layer of eye is called -Retina
217. Light-sensitive membrane that covers back wall of eyeball - Retina
218. Sensitive and important to dim light - Rods
219. Important in colour vision and visual acuity - Cones
220. Are red cells of retina responsive to colours? -No
221. Rod cells are mainly located in peripheral areas of -Retina
222. Cones cells are mainly located in central areas of - Retina
223 . Used to repair detached retina < - Laser retinpexy
224. Light rays focus on retina - Normal eye
225. Light rays focus in front of retina - Myopia
226. Light rays focus beyond retina - Hyperopia
227. Rods and cones detect the -Photons
228. Neurons in retina responsible for colour vision - Cones
229. Responsible for light and dark discrimination -Rods
230. Black and white light is detected by - Rods
231. Inner layer/inner tunic of the eye is - Retina
232. Photoreceptor cells of retina - Rods & Cones
233. Cone-shaped in front of skull that contains eyeball -Orbit
234. Sensory tunic of the eye - Retina
235. Sends electrical pulses to brain through optic nerve - Retina
236. Response speed of cones is faster than - Rods
237. Cones are less sensitive to - Low Light
238. Rods are more sensitive to - Low Light •
239. A yellowish small central area of retina rich with cones- Macula
240. Most sensitive part of the retina is - Fovea
241. Cones are located inside ' - Fovea
242. Rods are located outside the - Fovea
243 . Centre of Macula - Fovea
244. A tiny pit in Macula is called - Fovea

83 Crux of Special Education

245. Vision provides by Fovea is -Very Clear
246! Middle layer of eye ball contains blood vessels - Choroid
247. What provides blood to entire eye? - Choroid
248. Vascular membrane between retina and sclera -Choroid
249. What provides oxygen and feed retina? - ChorSid
250. Nerve carries neural impulses from eye to brain -Optic Nerve
251. What passes messages from retina to brain -OpticNerve
252. Optic Nerve is also called -2nd Cranial Nerve
253. Brain part that process visual information - Visual Cortex
254; Visual Cortex is located in brain lobe - Occipital Lobe
255. Visual Cortex is located in which direction of head - Back
256. Damage to visual cortex causes -Cortical visual impairment
257. Inner lining of eyelid -Conjunctiva
258. Mucous membrane lining the eyelid is called - Conjunctiva
259. Conjunctiva Covers the front portion of - Sclera
260. Conjunctiva prevents the eye from - Drying Out
261. Area where optic nerve meets eye - Optic disc
262. Optic disc is also called - Blind spot
263. Optic disc is also called - Optic Nerve Head
264. Thick ring of tissue that encircles the lens - Ciliary body muscle
265. Ciliary body muscle produces clear fluid called - Aqueous humor
266. Canal that drains aqueous humor - Schlemm Canal
267. Thin fold of skin that covers and protects the eye - Eyelid
268. No. of skeletal surround the eye -06
269. Eye muscles controls the - Eye Movement
270. Lateral Rectus Muscle moves the eye - Outward
271. Medial Rectus Muscle moves the eye - Inward
272. Inferior Rectus Muscle moves the eye -Downward & Inward
273. Superior Rectus Muscle moves the eye -Upward & Inward
274. Inferior Oblique Muscle moves the eye - Upward & Outward
275. Superior Oblique Muscle moves the eye -Downward&Outward
276. Blindism’ and 'Blind mannerism’ are older terms of - Repetitive behavior
277. Intelligence of VIC is equal to - Normal population
:
278.-VIC face difficulty in maintaining - Relationships
279. Social development of VIC is - Poor
280. Repeating movement of heads, fingers, hands - Steryotype behavior
281. Reading speed is slow down by - Visual impairment
282. Functional Vision Assessment - FVA
283. How an individual uses his vision to perform a task - FVA
284. Visual efficiency in daily activities is assessed by - FVA
285. Visual acuity is^the distance vision, not a - Reading ability

.84 Crux of Special Education

 Visual acuity can be measured by chart
286. Snellen chart was developed in - Snellen chart
287. Snellen chart was developed by - 1862
288. How well one uses his residual vision is - Dutch opthamalogist
289. Snellen chart is used to measure - Visual efficiency
290. Child ability to differentiate colour - Distance acuity
291. Inward eye movement in order to focus on near object - Colour perception
292. - Convergence
293. What provides depth perception? - Binocular vision
294. Vision using both the eyes - Binocular vision
295. Preferable use of one eye in routine workings - Eye preference
296. Preferred eye is used due to better - Visual acuity
297. Assess position of object in space in relation to other objects- Depth perception
298. Area child sees to the sides, above, and below - Visual Field
299. Outer area of a person’s visual field - Peripheral vision
300. Snellen Chart is placed 6 meters away from the - Patient
301. Healthy vision scores of visual acuity - 6/6
287. Used to check fluid pressure in eye to evaluate glaucoma- Tonometer
'303. Amsler grid is used to check -Macular Degeneration
304. Slit means - Illuminate
305: Slit lamp is the - Microscope
306. Slit lamp is used to illuminate and magnify the - Eye parts
307. Global Positioning System -GPS
308. Device that can read street signs for VIC -GPS
309. Device that can announce traffic signals for VIC -GPS
306. Abnormally large distance between the two eyes -Hypertelorism
31*1. Chorioretinitis is caused by - Congenital virus
312. Opthamalogist - Eye doctor
313. Pediatrician - Child’s doctor
314. Medical doctor who is eye specialist - Opthamalogist
315. Professional who measures vision & can prescribe
316. corrective lenses- Optometrist
317. One who fills prescription of opthamalogist or optometrist for glasses- Optician
318. Environmental adaptations can facilitate the use of - - Teaching skills
319. Residual vision - Congenital
320. Specific physical guidance and touch is crucial in - Adventitious
321. Visual impairment occurs at the birth - Cause of condition
322. Visual impairment occurs after birth - Orthoptics
323. Etiology describes the
324 Vision therapy is also called
325 Manual tool used by VIC for mathematical calculation - Abacus
326 . A tactile method of reading for VIC - Braille
. Compton words or letter combinations related to - Braille contractions
 327. Acuity.of 20/200
after correction with glasses - Legal blindness
328. Acuity of20/70 to 20/200 after correction with glasses - Low vision
329. Unable to read a print . Blindness
330. Able to read a print - Low vision
. 331 .Narrow field of vision - Tunnel vision
332. Person with good central vision but poor peripheral vision- Tunnel visionmucles
Extraocular
Extraocular mucles
: O & M
- Early age
- Orientation
- Orientation
- Mobility
- Efficiently
-No
Louise Braille lost his eyesight due to -
Childhood accident
333. Six external muscles of the eye called
334. Muscles that control eye position and movement
335. Orientation and Mobility
336.0 & M skills should be taught to VIC at an
337. Knowing where you are in space
338. Knowing your position is
339. Moving through spaces
340. Blind persons use their hearing more
341. Do students write words letter by letter in Braille?
342. Do students write words shortly (contractions) in Braille?- Yes
343. Most school age VIC are -Congenital
344. Visual impairment have both legal and educational definitions- Yes
345. Slate and stylus is more portable than - Perkins brailler
346. How well a person can use sight - Visual efficiency
347. Sharpness of response to visual stimuli - Visual acuity
348. Limitation in the width of visual field - Tunnel vision
349. Other name of restricted centred vision is - Tunnel vision
350.
356. AT helps visually impaired to support their vision 350.
357. Close-Circuit Television - Visual input devices
- CCTV 350.
358. Uses television to increase size of object or print
- CCTV 350.
359. Width of area, a person can see
- Field of vision 350.
360. Field of vision is measured in
- Degrees 350.
3 61. The study of the eye
-________
Opthamalogy 350.
362. Second layer of the eyeball is called
350.
363. Structure carries rich supply of blood to vital parts of eye- Chloroid Tract
- Uveal
350.
364„ Repeated behavior that serve no apparent constructive function-
350.
Stereyotype
350.
365. Directly evaluate student’s efficiency in using his eyes-Functiona! vision
350.
assessment
350.
366. Protective cone-shaped cavity in the skull is called - Orbit or Socket
350.
367. Who opened first U.S school for blind in 1821 -GridleyHowe
350.
350.
Degree of vision visually impaired person still able to use- Residual vision
^ ^ R Remaining vision after visual impairment - Residual vision 'J
352. Mental map people use to move through environment -Orientation
353. Ability to move safely and efficiently from one place to another-Mobility
354. Assistive technology ~ ' -AT 6

6 AT that allow people to use touch to gain information - Tactile input devices
 368, Who developed mobility & orientation system in 1944 - Richard Hoover
369. Range in which objects can be seen centrally or peripherally- Visual field
Near Vision
355. 370 Test Rosenbaum Pocket Vision - Distant Vision
Screener used to test
371. Snellen Chart is used to test - Blind
372. Unable to read large print even with magnification - Partially sighted
373. Can read print using large print or magnification Hearing and vision
374. Distance senses are
375. Process of being able to understand what is being seen - Visual perception (
376. Integrating visual information with past experience - Visual memory
377. Recognition, matching and categorization is related to -Visual discrimination
378. Ability to imagine people, objects - Visual imagery
379. If the field of vision is less than 20 degree, person is - Legally blind
380. Early intervention for young visually impaired are - Home based
381 . CCTV can be moved from class to class? - No
382. Optical aids are used for students
with - Low vision
383. Visual acuity no better than 20/70 in better eye after correction- Partially Sighted
384. Partial visual impairment is classified as - 20/70 to 20/200
385. Legal blindness is - 20/200 or worse
386. Amount of vision up, down, left, right while seeing straight- Visual field
387. Receives no useful information through sense of vision- Totally blind
388. Primary means of learning for totally blind are - Tactile & auditory
389. Primary means of learning for functionally blind are - Tactile & auditory
390. Primary means of learning for low vision - Vision
- Residual vision
391. Useable vision of an individual is
-Photophobia
392. Sensitivity to light ■ Literacy medium
393. Student’s preferred method of reading & writing
394. Methods a student uses w,ith sensory channels for learning- Literacy
Media
395. Legal definition of blindness is based on visual acuity & - Visual field
396. A person with restricted vision to 20 degree or less - Legally blind
3 97. Totally
398. Has functionally blind some residual vision ■ Yes
399. Adventitious means - Acquired
400. Poor blood supply brain called - Ischemia
401. Low vision is also called - Partially sighted
409. Abbreviation used in Braille called - Contractions
402. Eyes ability to move - Ocular Motility
410. Contractions enhance the speed of - Reading/writing
403. A six-keyed device for writing Braille called - Brailler
411. Searching desired object from different objects - Scanning
404. Knowing where you are (space)? - Orientation
412. Visually following a moving
405. Moving from one place to another safelystimuli - Tracking
- Mobility
413. Orientation and mobility training should
406. Sighted person helps visually impaired to travel be taught at - An early age^
- Sighted guide
414. effectively
407. How Failing to see visible uses
a person objects
hiswhen attention is elsewhere- Inattentional blindness
vision - Visual efficiency
408. Optical to tactile
415. Oculus Dexterconverter
is called . - Right Eye.
- Opticon
416. Oculus Sinister is called -Left Eye
417. Each eye or both called - Oculus Uterque
418. Simultaneous inward movement of eyes toward each other- Convergence
419. Drooping (loose) of upper eyelid usually due to paralysis- Blepharoptosis

436. Light cannot pass through the substance is called - Opaque

437. Blind read with, their fingertips on raised dots of system- Braille

blind/functionally blind/low vision 3 types of VI described by- IDEA

420. Blephar means