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How can athletic trainers communicate with and treat athletes with hearing loss

This is an excerpt from Clinical Foundations of Athletic Training and Sports Medicine 2nd Edition by Leamor Kahanov,Ellen K. Payne.

By Monique Mokha, PhD, LAT, ATC, CSCS and Leamor Kahanov, EdD, ATC, LAT

Deaf Athletes and Athletes With Hearing Loss

In the United States, many people who are deaf often do not consider themselves disabled, but rather members of a subculture of American society. As such, leaders of Deaf sport have chosen to dissociate from disability sport. Person-first terminology is typically not supported by these athletes. The preferred terminology is “Deaf,” with an uppercase D.

• The term Deaf (capitalized) is associated with people who share the same social structures, cultural views, and history and use American Sign Language (ASL) as their primary mode of communication and who do not equate deafness with disability.⁶⁶
• The term deaf (lower case) is a broad term used to identify persons who have some level of hearing loss which is often called “hard of hearing” to identify people who have a milder form of hearing loss but can still communicate efficiently with the hearing community. Lower case “deaf” can also be persons who are Deaf
• Hearing loss is a general term that describes people who are hard of hearing or deaf. The term previously used for hardness of hearing was hearing impaired, but this term is now considered an insult to the Deaf community because it emphasizes disability.

Deafness is a condition in which a person is unable to understand speech using the ears alone, with or without a hearing aid. An athlete who cannot detect the sound of a barking dog would have a severe to moderate hearing loss. Placing your fingers in your ears creates about a 25 decibels (dB) conductive loss. Hearing loss can range from mild to profound and is classified as one of three types.

• Conductive: hearing loss due to problems in the ear canal, eardrum, or middle ear (e.g., perforated eardrum, impacted earwax, foreign object, allergies, otitis media)
• Sensorineural: hearing loss due to problems in the inner ear, usually nerve related (e.g., head trauma, tumors, viral diseases such as measles or herpes simplex)
• Mixed: hearing loss caused by conductive damage in the outer or middle ear and sensorineural damage in the inner ear (e.g., head trauma, tumors, unintended side effects from medications)

To be eligible for participation in Deaf sports, athletes must have a hearing loss of 55 dB or greater. Deaf athletes are not classified according to the severity of hearing loss, and hearing aids are not permitted during competition.

Communication

People who are Deaf are at the greatest risk of miscommunication with hearing people. Therefore, communication is the primary factor related to the care of Deaf athletes and needs to be initially addressed during the preparticipation examination.⁶⁷

In addition to the standard preparticipation examination history, ask the following additional questions during an examination with a Deaf athlete:

• Has the hearing loss progressed? Has it worsened, stayed the same, or improved with aids?
• At what age did the hearing loss occur?
• What method of communication does the athlete prefer (e.g., sign language, speech reading)?
• Does the athlete use hearing aids or have cochlear implants?
• Does the athlete use earplugs during swimming and water activities?
• Does the athlete have a history of ear infections?
• Is the hearing loss associated with balance problems or vertigo?

General communication considerations for Deaf athletes are as follows:³⁴

• Maintain eye contact and face the athlete to facilitate speech or lip reading; even the most skilled speech readers will understand only about 30%of what is said.
• Orient the athlete to all aspects of the facility, paying special attention to exits and fire evacuation procedures.
• Speak normally if the athlete uses a hearing aid.
• Do not pretend to understand the athlete’s speech if it is unclear to you; instead, ask for repeats.
• Use facial expressions, body language, gestures, and common signs such as thumbs up or down for “OK” and “not OK.”
• Use instant texting, email, or other similar electronic methods to communicate.
• Demonstrate any technique before performing it on an athlete.
• Use strobe fire alarms or other visual alerting devices in the facility so that the athlete has notification in the case of an emergency; point out these systems to the athlete.
• Use video, computer movie files, or other visual media as another form of demonstration.
• Loud or constant music or background noise, even at low levels, reduces hearing aid effectiveness and may even cause the athlete to develop headaches.
• Use visual and tactile cues.
• Avoid visual noise, such as extra physical or visual movements behind a person who is speaking.
• Learn basic ASL.

Medical Concerns for the Deaf Athletes

A variety of hearing aids exist for the Deaf. Hearing aids do not clarify or make speech sound clearer; they simply amplify sound. The four basic types of hearing aids worn are as follows:

1. On the chest or body
2. Behind the ear
3. In the ear
4. On the eyeglasses

The practitioner is responsible for determining alternative techniques for communication. ATs working with Deaf athletes should know the ASL alphabet and a few common signs. The alphabet (figure 20.2) and common signs, as well as many videos, are available on the Internet to help you sign accurately.

Cochlear implants are recommended for those people for whom a hearing aids are ineffective. The implants are surgically placed in the inner ear and are activated by an external speech processor worn on a belt or in a pocket. A microphone is worn externally behind the ear as a headpiece (figure 20.3). Sound is translated by the speech processor into distinctive electrical signals that travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The auditory nerve is stimulated and information is transmitted to the brain, where it is interpreted. Newer models do not have external wires. Although cochlear implants are not promoted by the National Association for the Deaf, they are increasingly implanted in children with sensorineural hearing loss. The external apparatus should be removed during exercise to reduce the chance of electrostatic discharge. Athletes with cochlear implants must also stay away from plastic or rubber mats, balls, and equipment to prevent electrostatic discharge from damaging the electrodes.

Once communication barriers, type and care of hearing aids or implants, and any related conditions (e.g., balance problems, ear infections) have been addressed, the provision of sport health care will be comparable to that for athletes who are not deaf or hard of hearing.

More Excerpts From Clinical Foundations of Athletic Training and Sports Medicine 2nd Edition

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