WAfXOH A PROGRAM 
— FOR- 
BEARING CONSERVATION 
Bureau for Handicapped Children 
Department of Public Instruction 
Madison, Wisconsin 
1943 FOREWORD 
A program for the conservation of hearing must meet several 
needs: first, it is necessary to discover the children with hearing 
impairment in order that their hearing may be conserved or im- 
proved; second, their condition must be made known to the family 
that the child may receive medical attention; third, it is necessary 
for the school to make proper adjustments, provide adequate facilities, 
and adopt appropriate techniques so that the children may benefit 
from the school’s offerings; fourth, it is necessary that our people 
know the social and economic handicaps which are produced by 
hearing deficiencies and that they shall adopt effective programs of 
prevention. Number four involves not only proper medical care but 
also the curbing of contagious diseases and a rather complete under- 
standing on the part of the parents and young people of the causes 
of deafness. 
A Program for Hearing Conservation 
The committee in preparing this material realize its incomplete- 
ness and that they have omitted number four entirely. The preven- 
tion of impaired hearing is a problem of great importance and of 
such a magnitude that it involves many agencies beyond the scope 
of the schools if it is to be successfully solved. The purpose of the 
committee was to provide some guidance to schools which are at work 
on a program of conservation of hearing. 
We wish to take this opportunity to thank the members of the com- 
mittee for the preparation of this bulletin: Dr. Robert West, Uni- 
versity of Wisconsin; V. A. Becker, Superintendent of the State 
School for the Deaf; and Joseph Rohr, Jr, formerly state supervisor 
of the state-wide hearing survey. 
Frank V. Powell, Director 
Bureau for Handicapped Children INTRODUCTION 
We know that children are different and if we are to adjust the 
school to their needs it is necessary that we know in what ways they 
differ. Hence, the emphasis in present educational practice with the 
child who seems not to be living up to his potential ability is upon a 
complete survey of his assets and liabilities. The case study approach 
to child problems has justified itself not only in rehabilitation 
of the child who is obviously maladjusted, but also in the prevention 
of maladjustments in the child who presents as yet no obvious signs 
of a serious problem. One of the ways in which children differ is in 
their hearing acuity. Beyond question, deficiencies of hearing show 
themselves as a cause for many maladjustments of children. If one 
surveys the groups of children who present educational problems, he 
finds the children defective in hearing distributed in many of these 
groups, especially in the following: speech defective, emotionally 
unstable, socially maladjusted, delinquent, and those failing to make 
satisfactory school progress. 
The responsibility for the analysis of the problems presented by 
the maladjusted school child rests, of course, upon the school admini- 
stration. The superintendent ordinarily leaves this as a responsi- 
bility for a committee of selected teachers or to a special director 
who is responsible for the case studies of the children of the system. 
This director of child study is also responsible for co-ordinating the 
activities of persons or agencies in the community upon whom the 
school must rely for help in appraising the problems of children 
being investigated. It is advisable and frequently arranged that 
these co-ordinating individuals and agencies be organized in a com- 
mittee or a child-study council. Such a committee may be made up 
of (1) the child-study director, (2) teachers of exceptional children, 
(3) the school nurse, (4) a physician representing the city or county 
medical organization, (5) a representative of the family welfare 
agencies and (6) representation from any service club, parent- 
teacher association, or other organization that may have, for the 
time being at least, a project looking toward the betterment of the 
entire educational program. Discovering the Child with Impaired Hearing 
How shall we discover the child who is handicapped by a hearing 
loss? There are several methods of selecting the one out of every ten 
children in our schools who have hearing impairment. (Most writers 
state that from 10 to 15% of all school children have some hearing 
impairment while approximately 2% have sufficient loss for it to be 
a serious handicap). No one method will be found most suitable for 
all communities because of variation in financial status, personnel, or 
other practical problems which may be present that make it impos- 
sible to use one standard procedure. Therefore, the following four 
methods for finding the child with hearing impairment are suggested 
with the hope that one of them will prove adaptable to every com- 
munity or school organization considering a program for adjusting 
the school to better meet the needs of all its children: 
Method 1 is a simple approach to the screening out of children with 
some hearing difficulty and one that can be carried on by local or- 
ganizations before the individual audiometer is actually brought in 
to detect the hearing difficulty. This approach necessitates the 
selection, according to definite criteria, of certain children by the 
local health and school authorities. The criteria are: 
(a) Teacher selection of children thought to have some hearing dif- 
ficulty as observed in the classroom. 
All teachers of all children should know the common identifying 
characteristics of children with impaired hearing so that delay in prop- 
er placement may not further retard the child’s school progress. Some 
or all of the following may indicate deficient hearing; (i) lack of at- 
tention, (2) lack of interest, (3) tendency to withdraw from group 
discussions, (4) constant request for the teacher to repeat her questions 
—frequent use of “what” by the pupil, (5) language difficulties, (6; 
omission or substitution of speech sounds, (7) behavior problems (8) 
frequent colds, throat and nose infections, running ears, earache etc. 
These characteristics may be due also to some physical or mental 
maladjustment other than impaired hearing. Where there is overlapping 
of the above characteristics a most careful diagnosis should be made. 
(b) Teacher selection of those children with a reading difficulty, 
(c) teacher selection of children with any type of speech defect, ex- 
cept stuttering, (d) teacher selection of children who have failed to 
pass the previous semester or semesters, or have recently done poor 
scholastic work, (e) teacher selection of children thought to have some 
social or emotional maladjustment, as observed in the classroom or by 
the parents at home, (f) selection by the school health department or 
nurse, of children who have a record of a medical history of diseases 
of the ear. 
All children who have been reported for any of the above traits 
should receive a test on a pure tone audiometer. 
The advantages of preselection are that (1) it is inexpensive, (2) 
it provides education for the teacher and the nurse in the problems of 
hearing impairment, and (3) it is a method that can be employed in 
a limited organization set-up. The disadvantages of preselection are that it may fail to find some 
children who are impaired as to hearing, especially those with high 
frequency impairment. 
Method 2 first employs the technique described in method 1. 
Next, supplementing method 1, all other children in the school are 
given a quick test on a group audiometer employing a high-frequency- 
tone phonograph-record test. Children who fail this record test are 
then ready for a test on a pure tone audiometer. 
The advantages of this method are that it is more accurate than 
method 1, in that it is more likely to discover high frequency cases 
than is method 1. The disadvantages are that it may not discover all 
of those needing referral to the otologist. 
Method 3 necessitates the testing of all children with a phono- 
graph audiometer using a digit speech record. All children who fail 
this are then ready for a test on a pure tone audiometer. 
The advantages of method 3 are that every child is given a test of 
his understanding of speech. The disadvantages of method 3 are: (1) 
that this method requires a thorough organizational set-up, (2) that 
it consumes considerable time, and (3) that it may not select high 
frequency cases. 
Method -4 is a rapid “sweep” test employing a pure tone audio- 
meter. It makes no attempt to find the severity of the hearing im- 
pairment but only to establish that some does exist. All children who 
show that some hearing impairment does exist are now ready for a 
test on a pure tone audiometer (step 2). 
The advantages of method 4 are that (1) it necessitates no equip- 
ment except that used in Step 2, (2) it disturbs classes less than 
either Methods 2 or 3, and (3) it is an accurate “screen”. The dis- 
advantages of method 4 are that (1) it does not discover the word- 
deaf-auditory aphasics, and (2) it does not test the understanding 
of speech. 
Exploring the Child’s Hearing Power 
Now that the child with hearing impairment has been found, it 
will be necessary to explore his hearing powers to determine precisely 
at which frequencies he hears the most and the least. After that 
analysis has been made, the proper authorities, educational and med- 
ical, will be in a position to make recommendations relative to the 
educational placement and medical services required to meet the 
child’s needs and condition. 
The final analysis of the individual’s auditory functions should be 
made with one of the accepted Pure Tone Audiometers. The audio- 
metric readings should be recorded on a test blank, so that computa- 
tions can be transferred to an audiogram. Instruments Required for Discovering and Exploring a Child’s 
Hearing Power 
The group audiometer is an instrument equipped with multiple 
outlets for individual phones and is usually capable of testing as 
many as thirty children at a time. The records available, at present, 
to be played upon its phonograph, fall far short of ideal test 
material. The number records have the disadvantage of being merely 
of recognition of seven spoken digits. There are many good advent- 
itious cues in these records by which persons having very definite 
losses in the speech range of hearing can identify the numbers spoken. 
The test falls far short of being either a test of auditory acuity or a 
test of understanding of speech. Records are available of a test by 
continuous tones arranged in simple patterns that one can identify 
and record upon his blank. Two of the parts of this test are apparent- 
ly correlated highly with the results of the individual audiometer. The 
rest of the test seems inadequate and misleading in its scores. The 
disadvantages of these records is that they do not uncover the child 
having a good ear but lacking the ability to interpret what he hears. 
Insofar as this test measures any auditory function, it assays the 
acuity of hearing. 
Many experimental records have been produced involving spoken 
words. No good records of this type have yet been produced for 
general distribution. If one desires to make for his own use such 
recordings, they should be graduated in intensity from a very faint 
to a very high level of amplification, and should involve words in 
the working vocabularies of persons tested, these words being em- 
ployed in connected speech in conversational style. 
It goes without saying that the phonographs upon which these 
records are to be played should be mechanically rugged. There are two 
basic circuits involved in these phonographs. One circuit involves a 
crystal phonograph pick-up and phones, while the other uses magnetic 
pick-up and phones. Each has its advantages and disadvantages. 
The magnetic pick-up and the magnetic phones are more rugged and 
will stand more abuse than the crystal type. The magnetic units 
may, however, get out of calibration after long use. Since the instru- 
ment continues to function, the tester may be misled into assuming 
that he is getting accurate results. The crystal units are more likely 
to go completely bad when they are out of adjustment, hence, they 
give clear indication of their defective condition. One great dis- 
advantage of the crystal units is that exposure to high temperature 
and humidity will disintegrate the crystal. Leaving the instrument 
near a hot radiator or lying in the bright sun or even packed in a 
car standing in a sunny parking lot in the summer, will damage 
the instruments. These considerations should be known by the persons 
selecting and using these group audiometers. 
There are a number of individual audiometers on the market. In 
selecting one, several considerations should be kept in mind. First, ruggedness: if the instrument is to be carried about from place to 
place it is important that the chassis be mechanically rugged. This 
ruggedness of construction should be demanded even though it may 
somewhat reduce the portability of the instrument. Second, if the 
machine is to be used for sweep testing, the controls should be so 
constructed that changing from one frequency to the next can be 
accomplished conveniently and accurately. Third, if the instrument 
is to be used in areas not provided with electric power or in buildings 
not equipped with convenient outlets for electrically-powered sets, 
a battery-equipment set should be selected. Fourth, the electrically- 
powered sets employ an amplifier using several vacuum tubes. These 
tubes change in their operating characteristics as they get older, thus 
the sets give misleading results. The battery-powered set is usually 
more constant in its output than the electrically-powered sets. 
A frequent check of the tubes with the electrically-powered sets is 
an absolute necessity, hence, a ready access to the vacuum tubes is a 
desirable feature of such instruments. Fifth, if one chooses the 
electrically-powered set, one should make sure that the set will oper- 
ate on the power supply available. Some sets operate on AC as well 
as DC lines, others operate only on DC lines. Sixth, some audiometers 
have checking devices by which the instrument may be calibrated at 
the beginning of each testing period. Some have calibrations for inten • 
sity levels, and some for frequency levels. The more of these checks 
the instrument possesses, the more accurate will be the results if 
the tester takes the trouble to use them. If, however, the tester does 
not employ these checks, the results on these instruments will be less 
accurate than on instruments that have fixed calibration. Seventh: an 
individual audiometer may be equipped either with a magnetic phone 
or a crystal phone. The same considerations should be kept in mind 
in selecting the type of phone as have been suggested above for 
phones employed in the group audiometer. Eighth: it is sometimes 
disconcerting for the purchaser of an audiometer to discover that 
the decibel ratings on his instrument are not in intensities equivalent 
to those on an audiometer on another make. The fact that the man- 
ufacturers of audiometers have not brought their instruments to a 
standard calibration may seem to some an important consideration 
in the selection of an audiometer. As a matter of fact, it is a very 
minor factor. It is only important to know how the audiometer one is 
employing compares in its intensity levels with other audiometers in 
general use, so that the tester may make comparisons between his 
audiograms and those that others obtain on other instruments. If the 
output of an audiometer varies, in each of the frequencies tested, 
through a sufficient range of intensity beginning well below the av- 
erage threshold of hearing and approaching within at least 30% of 
the threshold of pain, the audiometer may be regarded as quite satis- 
factory in its intensity output and will be serviceable in any prac- 
tical survey of hearing. There is today no recognized “correct” standard of decibel rat- 
ings. Accuracy of frequency and purity of wave form are much more 
important than standardization of intensity levels. Of course, the 
changes from one level of intensity to another, five decibels above 
or below it, should be accurately calibrated, but there may be consid- 
erable variation in the level of the zero points of itensity. 
The Operator of an Audiometer 
Particular attention should be given to the personal qualities of 
the audiometric technician. Just as only certain types of individuals 
make successful doctors or lawyers, so is it highly essential that the 
audiometrician have certain specific personal qualities, such as the 
following: {1) an abundance of patience (2) understanding of the 
child: a. his nervousness, b. his copying or cheating, c. his language, 
d. his general responsiveness, his health and fatigue (3) conscien- 
tious regard for accuracy (4) ability to make the child feel at ease. 
The audiometrician must be willing to efface completely his own 
importance in the testing situation and assume so impersonal a role 
that the child will feel no fear of making honest and immediate re- 
sponse to the test situation. The operator should so conduct himself 
as to seem to the child to be merely the operator of the instrument 
and not the judge or critic of the child being tested. 
The testing of school children by means of audiometric instruments 
should be entrusted only to adequately trained people. This prep- 
aration is in part measured by the credentials possessed by the tester. 
These should include a teacher’s license and a college diploma, in 
the earning of which the student pursued courses in speech correction 
or education of the deaf; and in connection with which actual 
training and experience in the use of audiometers was afforded the 
student. In some instances the testing can be done by nurses and 
other professional workers who have had backgrounds that would 
enable them to understand the problems of the deaf and who have 
had considerable practical experience with audiometers. It is impor- 
tant, however, that persons entrusted with the program of- testing 
for school adjustment purposes be directly responsible to the school 
system and conduct the testing in such a manner as to furnish the 
school with information of special value to the system. Hence, it is 
usually best that the testing be done by a licensed teacher. 
The status of a child’s hearing represented in the form of a curve 
on the proper blank provided is called an audiogram. (See the 
“sample audiogram” of an illustrative case). 
What is an Audiogram? 
How to Read an Audiogram 
A. The “level” of an individual’s hearing impairment can be de- 
termined by reading the scale at the right or left of the chart. Referring to the printed audiogram chart, note that we have div- 
ided it into four levels. The space above the first dotted, curved line 
indicates “within the normal range”. The second dotted, curved 
line determines the limits of the “slightly impaired” area, and so on 
to the bottom dotted, curved line that sets the limits of “total im- 
pairment.” 
B. The “profile” of an individual’s hearing impairment can be 
determined by reading the scale at the bottom of the chart. This 
is divided into sections by 7 heavy lines. It is understood there might 
be more pitches and thus more sections, according to the type of aud- 
iometer used. The vertical lines indicate the pitches of the test 
tones. Low frequencies are placed to the left, high frequencies to the 
right and the medium frequencies between. 
The curved lines are for right and left ears of a typical case. 
Noting the “level” of the audiogram for the right ear, the reader will 
see that, up to the high frequency section, the individual’s hearing 
falls within the normal range. The balance of the line indicates 
slight hearing impairment at the pitch of 4096 and severe hearing 
impairment at the frequency of 8192. This person has “high fre- 
quency impairment”. 
The value of an audiogram is that it shows at a glance the “level” 
and “profile” of an individual’s hearing impairment. To the eye of 
the trained teacher this becomes highly significant. 
Note: Three types of handicap are frequently confused: the 
deaf, the feeble-minded, and the auditory aphasiacs. An audiogram 
will help to classify the type of handicap and will assist in making 
a proper educational adjustment. 
Problems of High Frequency Impairment 
Consonants are a class of high frequency speech sounds that are 
characterized by constriction or closure at one or more points in the 
breath channel. Consonants are given either with voice or breath 
(b, p) (z, s) (zh, sh) (d, t) (th, th) (v, f) (g, k) (j) (ch) 
(h). Phonetically, w, y, 1, m, n, ng, and r are classed as semi- 
vowels. Most consonant sounds are produced largely within the 
high frequency range—that is, a pitch range between 2000 and 8000 
(Note audiogram). High frequency impairment on an audiogram is 
indicated when there is a drop or dip in the right end (past 2048) 
of the hearing line for either or both ears. 
Because of various characteristics of consonants, different degrees 
of high frequency impairment may cause varying grades of hearing 
and speech difficulties. (Note audiogram). To illustrate, in the case 
of high frequency impairment: 
Deficiencies in the high-frequency range of hearing handicap the 
hearer in two ways: (1) They prevent his perceiving sounds that are 
low in intensity; and (2) they prevent his distinguishing between 
sounds, which, though loud enough to be perceived, are different from each other mainly in high frequency elements. In the broad sense, 
hearing of a sound involves both the perception of a sound and the 
distinguishing of that sound from all other similar sounds. Thus 
only those totally impaired in the high-frequency range would be un- 
able to perceive the sound of v as in vow, but even those “slightly im- 
paired” would have difficulty in distinguishing between vow and thou. 
The sound elements that are most difficult to perceive are naturally 
the voiceless sounds. In approximate order of their difficulty, they 
are: h, th, f, k, t, p, s, sh, and ch. (The groups of sounds that present 
Normal 
hearing 
Audiogram 
Hearing Loss (Sensation Units* 
Hearing Loss (Percentages) 
the most difficulty in distinguishing one from others in the group 
are (again in approximate order of difficulty) : th, f; th, (voiced), v; 
k, t, p; g, d, b; s, sh; z, zh.) Thus the sounds that stand first in 
these two lists would be the first to be lost in the hearing of a person 
with progressive high-frequency deafness, and, as his loss becomes 
greater and greater, he loses more and more sounds until he can no 
longer distinguish between even such words as ruse and rouge. 
For practical classification we may say that: (1) under condi- 
tions of ordinary conversation, a person who is “slightly impaired” in the high-frequency range will have difficulty in hearing the sounds 
h, th, f, k, t, and p, except when these sounds are stressed as at the 
beginnings of words or phrases; (2) a person who is “severely im- 
paired” will have difficulty in hearing these same sounds and also s, 
sh, ch, th, (voiced) v, g, d, b, z, and zh; and (3) a person who is 
“totally impaired” in the high-frequency range will be wholly unable 
to hear any of these consonants. 
The accompanying chart displays these sounds in terms of the 
approximate percentage of hearing loss at which each of the conson- 
ants will disappear. A person whose loss has exceeded one of these 
limits will be able to “hear” the consonant in question only by lip- 
reading, by context, or by interpreting from the adjacent sounds what 
consonant was spoken. 
It should be recognized that, since the young child probably will 
reproduce the sounds that he hears used, his difficulties in speech 
with the high frequency consonants will be in direct ratio to the 
“level” of the high frequency end of his hearing line. Lastly, it 
should be remembered that the audiogram may change from time to 
time to show changes in hearing. 
Survey Follow-up 
Once the child with hearing impairment has been located, the 
next step is to attempt to adjust him emotionally, medically, and 
educationally. Therefore, the success of a hearing impairment survey 
will be dependent largely upon the thoroughness of the follow-up 
program. 
Since the subject of the follow-up is the child, and the end in 
view is his proper adjustment to his heai’ing impairment, every ef- 
fort should be directed toward the realization of that objective. 
Every school organization will have its own local methods of inter- 
relationships, referral techniques, recommendations, and the filing 
and distribution of such data. The solving of follow-up problems 
should, therefore, first involve the child and secondly, the practical 
local situation. 
Since the school is an organization that probably can most efficient- 
ly co-ordinate the activities of follow-up, it is felt that the school 
should be responsible for the following suggested approaches which 
are dependent on local problems and should thus be locally adminis- 
tered : 
A. Routing of data to the proper persons or agencies. 
1. Data: (a) findings, (b) explanation of their educational 
significance, (c) solicitation of co-operation, information 
or recommendations. 
2. Suggested persons or agencies: (a) family, (b) physi- 
cian, (c) health department. B. Collection of information gathered or produced by suggested 
persons oi agencies. 
1. From the family: (a) attitude of family toward medical 
treatment, (b) economic resources for medical adjustment, 
(c) information relative to child’s physical and emotional 
check-up. 
2. From the physician: (a) report on medical examination, 
(b) recommendations. 
3. From the Health Department: (a) school health record. 
4. From the school: (a) educational record. 
C. Local child study conference—analysis of facts collected and 
decisions relative to child adjustment. The members of such 
a conference may be: (a) parents, (b) physician, (c) schoo? 
nurse, (d) teacher, (e) principal, (f) child guidance director, 
(g) mental hygienist; 
The facts to be collected by the conferences should be 
pertinent data obtained from: (a) the family, (b) the phys- 
ician, ((c) the health department, (d) the school; 
The decisions to be made involve: (a) medical treatment, 
(b) educational adjustment; and a report on the decisions of 
the conference should be made to: (a) the parents, (b) the 
physician, (c) the local school department, (d) the health 
department, (e) the State Department of Public Instruction, 
Bureau for Handicapped Children. 
The Adjustments of the School to Meet the Needs 
of the Child 
School administrators and teachers are interested in the problem 
of hearing impairment when they are once made aware of its pres- 
ence in their school. They are often confused by technical terms 
in reports, and often do not know what to do about a child who has 
some hearing difficulty. 
Teachers and administrators should be supplied with a usable 
terminology and should be offered suggestions for educational hand- 
ling of those children with a hearing impairment, so that they can 
approach the problem intelligently. 
Each group of children has been set up on a basis of the amount 
of hearing that is usable to the child, rather than the percentage of 
loss as shown on the audiometer. For example, instead of saying 
that a child has a “20% hearing loss”, it is recommended that this 
case be referred to as having “80% hearing”. Thus, the four groups 
are defined in terms of the amount of hearing still retained rather 
than in terms of a hearing loss. 
In an attempt to solve the problem of effectively supplying the 
school person with the information necessary to recognize, classify 
and handle cases of impaired hearing and in place of speaking of 
all children with hearing impairment as deaf or hard of hearing, we are suggesting these four classifications: (a) those with Normal 
Hearing Range (those with 80% hearing or more), (b) Slightly 
Impaired (those who have 60% to 80% hearing), (c) those 
who are Severely Impaired (who have 30% to 60% hearing), (d) 
those who are Totally Impaired (who have 0 to 30% of their hearing). 
Composite Hearing—audiograms of the individual’s right and left 
ears often show complementary profiles so that, when used together 
the composite audiogram shows a curve that is nearer the normal 
than either one of the ears taken independently. Therefore, all hear- 
ing percentages are based on an analysis of the “composite hearing”. 
The percentages used in the four classifications will be determined 
by testing 128 d.v. through 8192 d.v. Percentage of hearing indicates 
the percentage of hearing left as calculated in the light of our pres- 
ent knowledge. 
Classroom or Educational Adjustments 
It’s difficult to classify children into hearing groups. Hearing, like 
all other child factors, is highly individualistic. All classification of 
children in schools is largely for administrative purposes and should 
not be permitted to interfere with proper child development. There are 
so many factors involved in hearing that its individualistic aspects 
can not be overemphasized-, they are as varied as those of intelligence. 
These classifications are based solely on the measurable functions of 
auditory acuity and do not include other factors such as intelligence, 
visual acuity, age at onset of hearing impairment, efficiency of the 
auditory association areas of the brain, and home training in lan- 
guage. 
In all cases where a child is to remain in a public school with 
hearing children, a careful explanation should be made to the teacher 
as to the nature of the problem and the best way for her to handle it 
in her particular classroom. Two children having the same amount of 
usable hearing may require entirely different educational adjust- 
ments. The following paragraphs are suggestive and may prove help- 
ful in adjusting the school to a child. 
Normal Range—most of these children do not require any special 
attention as far as educational procedure is concerned, although a 
few of them might be placed in the front of the room. If the defi- 
ciency has a tendency to be progressive, an otologist should be con- 
sulted from time to time, and individual hearing tests should be given 
at least once a year. 
Slightly Impaired—all children in this group should be placed in 
the front of the room. Most of them can remain in a public school, 
especially those whose speech and language habits had been formed 
before the impairment took place. Those children whose impairment 
occured at birth or in infancy will usually profit from lipreading and, 
if speech defects have come as a consequence of the hearing impair- 
ment, speech correction; and it is usually advisable to place children of the latter group in j pecial class. High school and university stu- 
dents in this classification invariably can get along where they are. 
An individual hearing aid is advised for those mature enough to take 
care of it, especially those whose hearing remainders are nearer 60% 
than to 80%. 
Severely Impaired—this group have lost much of their sensory ways 
of learning facts and so present a real school problem and require 
special facilities and techniques. These children (a) should be receiv- 
ing training in a special class (a day school or residential school for 
the deaf), (b) should have daily access to a group hearing aid over 
an extended period until it has been definitely proven that they do 
not have sufficient hearing to justify continued use of the instrument, 
and (c) an individual aid should be provided for those who can profit 
by it when they are mature enough to take care of the instrument. 
Totally Impaired—if the children in this group are to be educated 
they (a) must be trained in a special class (a day school or residen- 
tial school for the deaf), (b) should have daily access to group hear- 
ing aid over an extended period until it has been definitely proven 
that they do not have sufficient hearing to justify using the instru- 
ment, and »,c) individual aids should be provided for those who can 
profit by them when they are mature enough to take care of the 
instruments. 
It is not a good educational policy to house these groups in the 
same classroom. 
General Suggestions to Public School Teachers 
1. The child with impaired hearing who is to remain in the public 
school should be seated near the center of the room in a front 
seat. This position will enable him to see his teacher’s face and 
to hear her voice more easily. 
2. The child should be encouraged to watch the face of the teacher 
whenever she is talking to the class. 
3. The teacher should try to face the child with impaired hearing 
as much as possible when she is speaking to the class. She 
should try to give all important instructions from a position 
fairly close to the child and with a normal amount of light 
on her face. 
4. The teacher should avoid using excessively loud speech or ex- 
aggerated lip movements in speaking to the child with a hear- 
ing impairment. 
5. The child with hearing impairment should be encouraged to 
watch the faces of children who are participating in class 
activities. 
6. If a choice of teachers is possible, the child with a hearing im- 
pairment should be placed with the teacher who enunciates 
clearly. 
7. We are likely to overestimate the hearing efficiency of the child 
with hearing impairment because when he is paying close atten- tion he apparently hears quite well. It is to be remembered 
that this child is hearing at the expense of greater effort than 
the child expends who has normal hearing. It is to be expected 
that it will be difficult to hold the attention of the child with a 
hearing impairment. 
8. A severe hearing impairment that lasts over a period of time 
tends to result in a dull, monotonous voice and inaccurate dic- 
tion. Therefore, that child should be encouraged to speak clearly. 
Keeping the child “speech conscious” will help him to resist 
the usual damage to the voice that a severe hearing impairment 
produces. 
9. Interest in music should be encouraged, especially participation 
in vocal music. 
10. Since a hearing impairment is a defect which affects the lan- 
guage processes, the child should be encouraged to compensate 
by a more active interest in all language activities; reading, 
spelling, original writing, etc. 
11. The child should be carefully watched to be sure that he is not 
withdrawing from the group or that he is not suffering a per- 
sonality change as the direct result of his impaired hearing. 
12. All special considerations that are shown the hearing impaired 
child should he handled so as not to call attention to the defect. 
13. The nurses and teachers should be especially vigilant in noting 
common colds, influenza, throat and nose infections, tonsillitis, 
running ears, etc., in the hard of hearing child. If at all poss- 
ible, these conditions should be prevented. When they do occur, 
they should receive medical attention as quickly as possible. 
14. The child’s hearing should be tested on an individual audio- 
meter at least once a year. 
The selection of a hearing aid for children in whose cases such 
instruments are feasible, should not be left to the unadvised and 
these brief comments are added here as a help to teachers from whom 
advice may be sought. The selling of hearing aids is highly com- 
petitive; and the parents must be protected against zealous persu- 
asion. One should know what to expect of a hearing aid, and what 
faults to guard against. The characteristics of an ideal hearing aid 
are as follows: 
Hearing Aids 
Lightness and inconspicuousness. The instrument should be so 
engineered that it can be worn without inconvenience and without 
attracting undue attention to the wearer’s defect. However, the 
smallness of the instrument should not be achieved at the expense 
of ruggedness and acoustic efficiency. It is a matter of history that 
when spectacles were first worn the wearers felt ill at ease because 
they attracted unfavorable attention. The public has now become 
used to the spectacles and will, no doubt, some day become as used 
to hearing aids. The hearing aid must be so engineered as to compensate as ac- 
curately as possible for the individual auditory characteristics of 
the wearer. It thus must be engineered to fit his own audiogram. 
In some cases this would involve merely a general amplification of 
all of the sounds of speech. In some, it would require a suppression 
of some of the sounds with an accentuation of others. This special 
engineering cannot be accomplished satisfactorily without an actual 
trial of the instrument on the ear of the person who is to use it. A 
large part of the fitting must be the “cut and try” process. The 
first step in this fitting process is usually the making of a cast for 
a plastic earpiece to fit the shell of the user’s ear. After this has 
been provided, the parents should insist that the competing sales- 
men submit their aids to a rigorous trial so that the best possible 
instrument can be selected. The plastic earpiece has a standard 
attachment that will fit all of the acceptable audicles. In a few cases 
the bone-conduction receiver may be used. This type of instru- 
ment needs no plastic earpiece. But the bone-conduction receiver 
must not be decided upon unless it is clearly evident that this 
type would be superior in acoustic efficiency to the receiver mount- 
ed in the shell of the ear. All too often patients are fitted (or 
misfitted) with bone-conduction receivers because of the relative 
inconspicuousness of this type. Acoustic efficiency must not be sac- 
rificed to vanity. 
The hearing aid should be provided by a company that has 
servicing facilities readily available to the user of the aid. The 
parent should take into consideration, therefore, the distance to the 
nearest servicing center for the hearing aid that is offered them. In 
selecting the hearing aid, the purchaser would do best in the long 
run to buy this aid of a company selling him service rather than 
merely an artificial ear. The buying of a hearing aid should not be 
like the buying of a ton of coal. The intrinsic cost of the parts 
of which the hearing aid is constructed is relatively small. The 
company furnishing the aid should be expected, therefore, to fur- 
nish not only these parts, but also the service that will make those 
parts most efficient in compensating for a defect of hearing. 
The cost of operation is also an item that must be investigated. 
The chief cost is battery-supply. Some audicles consume much 
more current than others. The salesman should be questioned 
strictly as to the problem of battery costs. This battery cost can 
often be reduced by providing a large battery for use at the child’s 
desk in the school and a lighter battery for use when the child 
is moving about from place to place. If this economy is contem- 
plated, the salesman should be asked to provide outlet connections 
permitting the interchangeable use of these batteries. 
The acoustic efficiency of the hearing aid can not be tested ac- 
curately by trial and error methods allowing the user to judge as 
to which, of the various instruments, is the best one. He usually has become accustomed to a distorted form of speech so that he 
is not a good judge as to how a well compensated hearing aid 
should sound. He is likely to err then in making his selection of 
a proper aid. The best testing of such an aid can be done only 
in the laboratory under controlled conditions. After the aid has 
been fitted, a training period is often required, before the user 
can employ it efficiently. 
The cost of the instrument is an item that should be considered, 
although there is little relationship between cost and efficiency. 
In purchasing automobile tires you “get just about what you pay 
for”. It is not always so with hearing aids. In the purchasing 
of some hearing aids you pay more of your money for advertising 
and distribution costs than for the audicle itself. The purchaser 
should also remember that as with spectacles, the cost will often 
depend upon the complexity of the defect for which the aid is 
to compensate. 
For the use of school children there are two general types of 
hearing aids—those equipped with a carbon microphone and trans- 
former, and those equipped with a low output microphone with a 
vacuum tube amplifier. The use of the vacuum tube instrument is 
increasing, although in many cases the carbon type is quite adequate 
The parents should beware of any argument that one type is su- 
perior to the other. Each type has its uses. Some children may be 
fitted with one and some with the other. 
Printed by the classes in Printing of the Wisconsin State School for the Deaf, Delaran SCHOOLS 
Antigo 
Appleton 
Ashland 
Delavan 
Eau Claire 
Fond du Lac 
Green Bay 
Kaukauna 
Kenosha 
La Crosse 
Madison 
Manitowoc 
Marinette 
Marshfield 
Milwaukee 
New London 
Oshkosh 
Racine 
Rice Lake 
Sheboygan 
Shorewood 
St, Francis 
Superior 
, Wausau 
Wisconsin Rapids