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ISSN : 2241-4665

Ημερομηνία έκδοσης: Αθήνα 27 Ιουνίου 2018

«Διαταραχές ακοής. Προβλήματα  Όρασης»

της Δρ. Ευθαλίας Τσεγγελίδου


« Hearing impairment. Visual impairment »


Dr. Efthalia Tsengelidou


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Η παρούσα μελέτη αποτελεί  τμήμα της  διδακτορικής μου διατριβής που πραγματοποίησα το 2013. Η μελέτη αναφέρεται στις  λειτουργικές βλάβες του ενός ή και των δύο αυτιών που είναι   τα αίτια των ακουστικών αδυναμιών που έχουν συνήθως παιδιά  που δυσκολεύονται να ακούσουν καθώς και στα προβλήματα όρασης τα οποία  αποτελούν μια κατάσταση που κινείται ανάμεσα σε δυο διαμετρικά αντίθετες καταστάσεις, όπως η κανονική όραση από την μια και η απόλυτη οπτική δυσκολία, η τύφλωση, από την άλλη.


This study is part of my doctoral dissertation in 2013. The study refers to the functional lesions of one or both ears that are the cause of auditory disorders that children usually have hearing difficulties. The study also refers to aspects of view that constitute a situation that moves between two contradictory situations, such as the normal vision of the primary and absolute visual difficulty, the deficiency, on the other.


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Hearing deficiency (impairment)


Deaf-psycho-pedagogy, as an independent science, studies the particularities of the psycho-physical development of children with auditory dysfunction and the appropriate compensatory, instructive-educational and rehabilitative means for the formation of their personality and their full inclusion in the social-professional climate (Stănică, Popa et al. 2001).

In order to name people with hearing disabilities, a notional palette is used in both the scientific and the usual language. For example: deaf-mute, deaf-speaking, deaf, hearing deficient, auditory dysfunctional, deprived of hearing, hearing impaired, dull of hearing.

Initially, the term deaf-mute was used and referred to people who lost their hearing before acquiring verbal language (up to the age of 2-3 years). When it was ascertained that between deafness and mutism there was no indestructible connection, the word deaf-mute was split by hyphen. Deaf-speaking Tennen refers to de-muted hearing deficiency and dullness of hearing. The person deprived of hearing is the hearing deficient with hearing residues. Total deafness (loss over 90 dB) is called anacusis.

We mention that in the Anglo-Saxon literature, the term deafness is used for all hearing impaired, and in the modern literature, the term deprived of hearing is also used for all hearing impaired, considering that those with losses over 90 dB still have some hearing remains.

Deafness is usually the result of malformations or anatomical-physiological disorders. It creates difficulties for the exercise of the organs, which naturally, for the listener, participate in verbal expression: lungs, larynx and supraglottic cavities. Deafness also creates difficulties for voice formation as it does not have the conditions to produce it in the larynx, to strengthen itself in the cavities of the respiratory apparatus.

Deafness, auditory dysfunction does not have a detrimental effect on the general psycho-physical development of the child by itself, but by mutism, that is, by the lack of language as a means of communication and operational tool on a conceptual level.

The tracking and early diagnosis of deafness is the first alarm signal of the family for the organization of hearing education, language and communication learning, exercise of cognition and the entire mental potential of the child.

Deafness, congenital or acquired at a very young age, before acquiring language, is negatively reflected on the psycho-physical development of the child, unless early educational-compensatory preventive measures are taken, along with the observation of the critical moment (trauma).

In the absence of verbal communication, it is noted that a slow and specific rhythm is introduced in order to adapt to environmental conditions, not only for psychological development. At the same time, the postponement of attention towards the hearing impaired and the beginning of de-mutism at a higher age, increase the gap between the deaf child and the child who hears. By prosthesis, the hearing impaired is helped to eliminate or avoid the possibility of a major gap between its development and that of the listener.

Progress on school knowledge, social skills and emotional development depends on linguistic development. Because the hearing-impaired child loses so much from the incidental conversation, it will be deficient both in general knowledge and vocabulary. As most of our thoughts are expressed in words, the classic expression of its ideas will often be difficult, creating the false impression of mental retardation.

Self-confidence will develop more slowly, and therefore the child may also exhibit emotional uncertainty.

Care must be taken to ensure that no child withdraws from the group due to failure or frustration, or due to discriminatory practices.

The child will have to learn to live with its disability in the society, and therefore over-protection would not be of any help, although the child often tends to isolate itself and also feels the need for a sympathetic understanding. Calibrated protection, encouragement, and appropriate support for self-image creation are required.

Hearing deficiency varies from case to case in relation to the place and depth of the lesion, hearing deficiency is determined by classical measures and more precisely by modern measurements with the help of devices called audiometers.

By audiometric measurements, audible thresholds are controlled at different intensities expressed in decibels and at different frequencies expressed in hertz (double vibrations).

Normal hearing perceives the sounds at an intensity of 0 to 20 and even 30 decibels. Sound perceptions at intensities over 20 dB indicate mild, average and severe hearing loss (mild, moderate and severe deprivation of hearing), and deep loss at over 90 dB (deafness and anacusis) even in the case of deep deafness (anacusis), by means of prosthesis, minimal hearing remains can be used, but only if the deaf is aware of the presence of auditory sensations.

Degrees of the hearing impaired

·         0 - 20 dB – Normal hearing – can hear the conversation without difficulties

·         20 - 40 dB – mild hearing deficiency – Mild deprivation of hearing. Can hear the conversation if it is not too far away or faint.

·         40 - 70 dB – average hearing deficiency – Average deprivation of hearing. Can hear the conversation from very close and with difficulties. Requires prosthesis

·         70 - 90 dB – severe hearing deficiency – Severe deprivation of hearing. Can hear sounds, voice and some vowels. Requires prosthesis.

·         Above 90 dB – deep hearing deficiency - Deafness (anacusis). Hears very strong sounds – but also causes painful sensations. Requires prosthesis with special prosthesis. (Buică 2004)

Types of deafness are established in relation to the place where the trauma is installed: deafness of transmission; deafness of perception; mixed deafness.


Deafness of transmission

Causes: ear or middle ear malformations, middle ear infections (otitis, mastoiditis), glue, ventilation disorder in the Eustachian tube, faults of the tympanum and ossicular chain (stapes, anvil, hammer, oval window), otosclerosis.

Characteristics: C.O. normal hearing; C.A. diminished hearing (reduced hearing to an intensity of up to 60-70 dB). Requires surgery. Requires prosthesis with very good results: loud voice slightly diminished, whispered voice strongly diminished. Better perception for high sounds in relation to low-pitched sounds.


Perception-type deafness (Sensorineural deafness)

Causes: damage to the inner ear (membranous, bone labyrinth, Corti's organ, basilar membrane), lesions on the nervous tract or the cerebral cortex in the hearing area: lesions may be based on chromosomal abnormalities, bacterial infections, encephalopathy, traumas, biochemical or neurological disorders, drug intoxications, etc.

Characteristics: C.O. and CA. diminished hearing.

No surgery is required; requires prosthesis with special devices. It requires intense classical orthophonic education. Hearing loss may exceed 120 dB, the whispering voice and the loud voice are both diminished, and acute sound perception is faulty.

Mixed deafness

Causes: otospongiosis, chronic otitis media, operative sequelae after petromastoid extirpation, cranial trauma, endemic cretinism, congenital syphilis, heredo-degenerative diseases, etc...

Characteristics: Mixed deafness has both curable (prosthesis) and perceptual transmission characteristics; null perception for acute sounds and reduced perception for low-pitched sounds.


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Visual deficiency (impairment)


The psycho-pedagogy of the visually-impaired, as a scientific discipline, studies the problems of psychological knowledge and educational guidance of blind and partially sighted people as well as the process of social recovery.

The object of the study is similarly conceived by other authors, with the distinction that they give a certain name to the domain: Typhlo-psycho-pedagogy (aetiology (Greek): tiflos-blind, logos-science); which can be divided into two branches: typhlo-psychology and typhlo-pedagogy.

Classification of visual impairments is necessary for school and professional orientation, adaptation of the means of education to the specificity of the deficiency, organization of the recovery actions.

There are various possible criteria for classification, used according to the recovery or didactic purpose pursued. Such criteria are, for example:

·         the organic cause of the deficiency (the underlying diseases);

·         its congenital or acquired character;

·         Impaired visual parameters, mainly (visual acuity, field of view, chromatic sensitivity, etc.).

There is also a classification according to the severity of the professional incapacity, used by the Medical Labour Commission of Experts.

An important criterion for the classification of the blind may be the moment when the deficiency occurs. A congenital deficiency or a deficiency which occurred in the first year of life causes the subject to be totally deprived of visual representations. When the deficiency occurs at an advanced age, the problem of the shock caused by new situation is raised. It is also interesting the sudden or slow way in which the deficiency is installed.

We start from the principle that blind and partially-sighted pupils should enjoy the same rights, the same equal development opportunities like all other children.

The handicap is not only the pursuit of the organic deficit, but also a social product. We must act to prevent and remedy maladjustments which occur in inadequate social-educational conditions. We need to find ways to meet the special educational needs of children with visual impairments.

In the historical evolution of the education of the blind, the climax is the emergence of the Braille system adapted to the tactile-kinaesthetic perception.

Vision is a functional system whose sub-functions cooperate in building visual perception.

The main functional indexes of vision are: visual acuity, visual field, luminescence and contrast sensitivity, chromatic sensitivity, depth perception, visual localization, dissociation capability, and rapidity of the perceptive act.

Classification of visual impairments can be done according to different criteria. For our course, the most important is the one suggesting whether a child should be directed to a regular school, a school for individuals suffering from amblyopia, or a school for the blind. The time (age) at which the deficiency occurs is also a criterion with important consequences for pedagogical work.

Classification according to visual acuity:

         Mild amblyopia (visual acuity: 0, 5 (1/2) - 0, 2- 1/5).

         Average amblyopia (visual acuity: 0, 2 (1/5) - 0, 1(1/10).

         Strong (serious) amblyopia: (visual acuity below 0, 1 (1/10).

         Relative blindness (practical) - 0-0,005 (1/200) – perceives the movements of hands and light

Compete blindness – does not perceive light at all (Buică 2004).

Classification depending on the modification of visual functional indexes:

·         Conditions that decrease visual acuity

·         Conditions which determine the decrease if the visual field:  the apparition of scotoma    -   portions where the visual function is not active - for example, the blind spot, which corresponds to the optic papilla or the optic disc

·         Hemianopsia – the lack of a visual semi-field at each eye

·         Conditions that cause alteration of the visual field

·         Conditions that cause binocular vision disturbances (for example, Strabismus)

·         Conditions that cause darkness and light adjustment disorders

·         Chromatic sensitivity disorders (for example, Chromatodysopia - lack of green or red perception, - Daltonism - blindness for red, Achromatism - when the individual cannot distinguish any colour). (Buică 2004)


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