Listening to Learn

A Guide for Teachers Supporting Children with Glue Ear

With kind permission from Oticon

Listening is important for learning. However, for some children, listening can be hard work and tiring due to a hearing loss caused by a temporary condition commonly known as glue ear. A buildup of sticky fluid in the middle ear reduces how effectively the little middle ear bones transfer sound vibrations from the eardrum to the inner ear, resulting in a mild to moderate hearing loss and muffled speech sounds.

"Middle ear filled with fluid"

Glue ear is more common in the winter months and sometimes associated with coughs and colds. Children often grow out of glue ear, and it is less likely to occur over the age of 8 years. Symptoms often fall into these four areas:

• Hearing: Difficulty hearing speech, mishearing instructions, asking for repetition, wanting the volume turned up, not responding to their name when called.
• Speech: May be unclear, delayed, or louder/quieter than normal.
• Behaviour: May become frustrated or withdrawn and prefer to play alone because they are not able to hear clearly. Listening will be hard work, so they may tire easily.
• Attention: Difficulty concentrating and attending to speech, particularly in noise.

The Ossicles

The middle ear contains three tiny bones (the ossicles), called the malleus (hammer), incus (anvil), and stapes (stirrup), which are the smallest bones in the body.

Glue ear usually resolves without intervention, but when a hearing loss persists, the following interventions may be considered:

• Monitoring and Support
• Hearing aids
• Grommets
• Auto-inflation

Find out from the family what you may need to do to support these interventions in school.

Top Tips for Teachers

Listening with glue ear is hard work. Speech sounds muffled and unclear, leading to misunderstanding and frustration. Your pupil may find it hard to concentrate, be easily distracted, and find listening very tiring. Here are some simple steps that you can take to make a real difference and help your pupil to listen and learn:

1. Get your pupil’s attention before starting to talk to them.
2. Listening in background noise will be difficult. Reduce background noise.
3. Check that your pupil with a hearing loss has understood the lesson.
4. Get closer and speak clearly; avoid speaking from a distance and shouting.
5. Ensure that your pupil is seated at the front, closest to you.
6. Discuss with your pupil what helps them to listen and what they find difficult.
7. Encourage your pupil by giving extra clues and repeating instructions.
8. Use gestures, signing, pictures, or visual aids to reinforce communication as needed.
9. Make sure your face can be clearly seen for lip reading.
10. If glasses are needed, ensure they are worn.

Create a Calmer Classroom

Classrooms are typically very busy and noisy environments, which can make it difficult for a pupil to listen and follow a lesson. Background noise has a greater impact on children’s speech perception and listening comprehension than adults, with high levels of noise affecting a pupil’s progress.

Klatte, M., Lachmann, T. and Meis, M. (2010) ‘Effects of noise and reverberation on speech perception and listening comprehension of children and adults in a classroom-like setting.’ Speech Perception and Understanding 12. pp. 270-82.

Children are not able to make sense of the words they have missed, as their brain’s auditory network is not fully developed.

Cole, E. B., Flexer, C. (2011) Children with hearing loss, developing listening and talking. San Diego, CA: Plural Publishing.

Classrooms often have high ceilings, hard floors, and lots of windows, resulting in a challenging listening environment. Echoey rooms are noisy, making it harder to listen. Softer surfaces are better than hard as they absorb sound. Taking the following steps to improve the listening environment will help your pupil to listen and learn:

• Reduce background noise and get closer.
• Softer surfaces are better than hard as they absorb sound.
• Close doors and windows where possible, to reduce external noise.
• Turn off unnecessary noisy equipment.
• Use carpets, rugs, bean bags, cushions, curtains, and blinds to absorb sound, reducing echo.
• Wall displays help to absorb sound too.
• Use tablecloths and table coverings when using equipment on tabletops.
• Place foam in pen pots.
• Put felt pads on chair legs.
• Be aware of the level of noise in your classroom, asking pupils to stop talking when necessary.

Very noisy and echoey classrooms ideally need acoustic improvement to make it easier to listen and hear speech clearly. Special acoustic panels can be placed on walls and ceilings to absorb sound, reduce echo, and improve the listening environment.

Resources

With sincere thanks to Pella Erskine-Tulloch, an experienced paediatric audiologist who identified the need for this booklet.

Glue Ear Together provides clear and concise information on the Glue Ear Together website. www.glueeartogether.org.uk

‘Hear Glue Ear’ is an award-winning App that provides parents with advice about glue ear. It includes audiobooks, songs, and listening games to help support speech and language and develop listening skills. www.hearglueear.co.uk

www.ewing-foundation.org.uk