There has been a lot of press recently about the study conducted by Brigham and Women’s Hospital in Boston. Collected data was studied on 2,929 adolescents who took part in the Third National Health and Nutrition Examination Study which ran from 1988 to 1994 and compared the results to the 1,771 teens who took part in the same survey from 2005 to 2006.

Among the children (aged 12-19) in the first study, 14.9% showed demonstrable signs of a hearing loss, while in the latter group the percentage jumped to 19.5% – a 31% increase between the groups. Imagine, one out of every five of our children already has some level of hearing deficiency! This dramatic increase in hearing loss amongst our youngsters needs to be viewed as a real and growing threat to the educational vitality of our nation and considered as, and treated like a true public health epidemic.

We take our hearing for granted. Hearing loss is, in most cases, a very slow, transitional process, slow enough for us to develop compensating behaviors which allows us to deny the problem: we move closer to the speaker; we increase the volume of the TV, radio, or our personal music player. We do these things to persuade ourselves that we can control the problem and that the ‘loss’ is not real. It’s just that the volume needs adjusting. If we can just get the volume up to acceptable levels everything will be alright. We believe that we can live with hearing loss because everything we own, and all the people around us, have a volume control… huh?… what?… please speak a little louder and don’t mumble. Thank you so much.

Listening is our primary gateway to learning, with students spending upwards of 70% of their school day engaged in some type of listening activity. Difficulty understanding speech complicates the education process and triggers and exacerbates learning disorders.
But while hearing and listening are interconnected, they are very different and should be looked at individually. Hearing is about sounds while listening is about understanding. Hearing is one of our five senses. We hear 24/7 and even if we want to, we can’t turn it off. Our ears are sound funnels; they bring in every sound from all around us, even if we don’t pay attention to most of them.

Listening, on the other hand, requires a conscious decision. We have to want to listen; to attend to a certain sound stream – a voice, a bird, or a conversation. By choosing to listen we give ourselves the option to choose what we want to listen to – the person standing next to us or the couple that’s arguing on the park bench across the way. Unlike hearing, listening takes cognitive effort – work!

Listening is a series of complex processes that begins with hearing sounds and ends with the contextual understanding of verbal messages. As with any set of complex processes, there are barriers that can affect each step of each process. These barriers can generate cumulative, cascading issues that lead to a vague and misunderstood message. These barriers also create learning disabilities and academic deficiencies; workplace issues that greatly strain the bottom line; or relationship issues that can tear couples and families apart.

Barriers to effective listening fall into four categories: physiological (e.g., hearing loss), neurological (e.g., auditory and language processing disorders), psychological (e.g., ego, excessive self-talk, know-it-all behaviors) and external (e.g., noise, room acoustics, speaker concerns). Listening ability degrades quickly as the listening disorders and barriers build upon each other. Misunderstanding is the ultimate price.

Effective listening requires that we hear the sound stream with sufficient volume and clarity to discern the words and conceive the speaker’s meaning.

Most people believe that hearing loss is just about the reduction in sound volume. Minimal, mild or unilateral hearing loss are not ‘loudness’ problems per se, but are distortion and clarity problems which negatively impact the quality of the speech signal. In other words, we can hear people talking, but we can’t understand the words that they’re saying.
The teacher’s voice may be loud enough to be heard, but may not be intelligible. Children with minimal or mild hearing loss will respond when their names are called yet will confuse or not discern distinctive sounds needed for reading and language skills. Background noise tends to block or garble the speech signal even more and, unfortunately, classrooms are rarely designed for quiet.

For students, especially younger ones, this can be academically devastating. Learning a language requires that the words – phoneme by phoneme – be heard clearly with each sound both distinct and understandable. It is essential that a student be able to discern each part of each word that is being spoken – especially in classes where new subject matter is describe using an unfamiliar vocabulary.

Unlike our vision, there are few indicators that teachers or parents can use to determine if a child has a low level hearing loss. If a child is having trouble seeing clearly, he or she will squint or pull their books close to their face. If there is the possibility of a vision problem, the child will be brought to the school’s health services and screened. The screening is easy and painless – asking the child to read a chart or recognize objects. Once a problem has been determined, an ophthalmologist can sit the child behind a phoropter, click the lenses around and ask the child if the chart gets clearer and sharper. A relatively inexpensive pair of glasses can solve the problem.

Hearing is different. Not only are there no good indicators, but the principle solution – hearing aids – are expensive and rarely covered under most insurance programs. Without accepted behavioral indicators for minimal or mild hearing loss it often goes undiagnosed or, more often, misdiagnosed. Adolescents and even teenagers with these hearing profiles often exhibit behavior patterns that are extremely similar to ADD/ADHD: trouble paying attention; problems carrying out directions; poor listening skills; low academic performance; behavioral problems; language difficulty; difficulty with reading, comprehension, spelling and vocabulary.

Given these symptoms, most physicians will treat and medicate the youngster for an attention deficit condition. Since the child responds to the doctor’s voice, hearing loss is all too rarely considered.
Fred Bess Ph.D., from the Department of Hearing and Speech Sciences, at Vanderbilt University Medical Center points out that “persons with hearing loss are known to expend considerable efforts in processing information, especially understanding speech under poor acoustic conditions as found in most school classrooms. Such a situation increases learning effort, and at the same time depletes the energy available for performing other cognitive tasks.”

As a result, it might be expected that children with even low level hearing loss will often be tired, frustrated and may “act out” as a result of their frustrations.

With few, if any, reliable indicators of low level hearing loss it is important for parents and school personnel to be hyper-aware of any of the behavior patterns that may indicate that a child has a hearing problem.

Many school districts, which used to screen children in the K-3 grades, have dropped their hearing screening program. Quoting from the NYC Department of Education website,
“The Office of School Health has discontinued hearing screening in elementary schools. This decision follows the recommendation of The United States Preventive Services Task Force, the group charged by the federal government with making recommendations on screening and preventive health services.

“The reasons behind this recommendation are as follows:
There are no high quality research trials which demonstrate that hearing screening in this age group leads to better functional or educational outcomes.The vast majority of children who fail a hearing screen have hearing loss due to fluid in the middle ear or wax in the external ear canal. These are temporary conditions.

“In addition, because of the State requirement for universal neonatal hearing screening, (since 2000) most severe hearing deficiencies are detected in infancy. This is important because the impact of hearing loss is greatest in the 0-3 age group when children are acquiring basic languageskills.”


Ear infections are the most common illnesses in babies and young children. The infection creates a fluid buildup in the middle ear that can be intensely painful, bring on elevated temperatures and cause parents considerable concern. The fluid presses on the ear drum and causes a hearing loss, often equal to pressing one’s fingers into the ears. While temporary, the fluid can linger for weeks after the child’s temperature returns to normal and the pain subsides. The hearing loss continues until all the fluid disappears – generating varying levels of hearing loss as the infection runs its course. Throughout this time the child has reduced hearing abilities and difficulty with both listening and learning.

The fact is, according to researchers at Michigan State University “every teacher in the early elementary school can expect to have one-fourth to one-third of his or her students without normal hearing on any given day.”
Consider a child learning language and attempting to learn the sound of a specific word that is being repeated several times over two or three days. Each time the word is pronounced it sounds different due to the variants of the back pressure on the ear drum caused by the fluid. This is terribly confusing to the learner and enlarges the database of phonetic sounds and meanings so that later, when a similar word is heard, the student has to (subconsciously) match what is heard to the database of what has been heard before and then associate the sounds with a known object or concept. The enlarged database could cause the child to be slow in his or her response, causing the teacher – and classmates – to label the child as slow.
Dr. Bess reported on a study where 37% of children with hearing loss failed at least one grade, compared to a district norm of about 3%. Dysfunctional listening triggered learning problems in these children that included; lack of understanding, trouble with vocabulary, word usage skills and storytelling abilities. Children with even a minimal hearing loss are 4.3 times more likely to experience trouble in communication, than children with normal hearing.

Hearing loss can be classified into two broad categories: conductive and sensorineural. Conductive hearing loss is generally caused by blockages in the outer ear (ear wax or objects lodged in the ear canal), otitis media – fluid buildup caused by ear infections or other causes, or damage to the Ossicular chain (the three small bones in the middle ear). In a great majority of cases, conductive hearing loss can be treated and reversed, bringing back the full range of the individual’s hearing.

Sensorineural hearing loss is caused by damage to the small hair cells in the inner ear. These hair fibers convert the sound energy into neural impulses which go to the brain. Once damaged, these hair cells lose their ability to convert the sounds to electrical impulses that the brain can work with. Although there is much research in process regarding regenerating these hair fibers, as of today sensorineural hearing loss is not able to be reversed. The damage done to one’s hearing is permanent.
More than 90% of all hearing loss is sensorineural. By far the largest contributor to this is noise. The human hearing system is easily and irreparably damaged by noise. The hair cells in the middle ear can tolerate no more than 85dB for 8 hours. This is roughly the noise volume you hear standing on the curb roughly 5 yards away from a busy street. Every 3dB increase in sound intensity halves the amount of time our ears can tolerate the sounds before damage occurs. Very loud noises in the range of 130-140dB – even a onetime event – can cause permanent hearing loss. This might be a gun fired close to the ear or even the activation of a car’s air bag during a motor vehicle accident.

An unscientific study I performed at a community college in California showed the risk of personal music players to the students’ hearing. I asked students who were listening to music through earbuds to remove the right earbud and place it on my sound pressure meter. I was astounded that the average sound intensity was approximately 104dB. At this level, damage begins to occur after only 7.5 minutes – roughly the length of two songs.

Many people use personal music players to create their own ‘silence’ as they try to drown out the noise around them. In general, they have to play their music at a level 10dB higher than the outside noise. This almost immediately puts them at risk of damaging their hearing system.

Noise induced hearing loss (NIHL), as other forms of sensorineural hearing loss, cannot be reversed. But it is not auto-degenerative. In other words it can be held in place without further degradation. The trick is to lower the volume of the noise – or music – we subject ourselves to.

Dysfunctional listening is a student achievement inhibitor on many levels: educationally, socially and personally. Although it may seem obvious that if a student has difficulty discerning words they will have trouble in school, there is little focus on hearing acuity or even listening skills training at any level in our schools.
A big problem that we have is that we do not know how much hearing is necessary for adequate language and literacy development. But we now know that one in five of our children have a hearing loss that can and will affect every aspect of their futures.

So what? We need to take our hearing and listening abilities much more seriously than we have been.
Alan R. Ehrlich is the president and founding director of The Center for Listening Disorders Research – A NJ Non-Profit Corporation and is vice-president of the International Listening Association. He can be reached at