Hearing Loss and Cochlear Implants: What SLPs Need for the Praxis

Hearing is one of the Big Nine, and the Praxis 5331 expects SLPs to read an audiogram, classify a loss, and know what amplification and cochlear implants can and can't do. You don't need audiologist-level depth — you need the classification rules and the management implications.

Reading the audiogram

• Frequency (250–8000 Hz) runs left to right; intensity in dB HL runs top (soft) to bottom (loud).
• O = right air conduction, X = left air conduction, < / > = bone conduction.
• Air-bone gap of more than 10 dB indicates a conductive component.

Type of loss — the three-way rule

• Conductive — bone conduction normal, air conduction reduced, air-bone gap present. Outer/middle ear: otitis media, cerumen, otosclerosis, perforation.
• Sensorineural — air and bone both reduced, no gap. Cochlea or auditory nerve: presbycusis, noise exposure, ototoxicity, congenital.
• Mixed — both reduced and a gap.

Degree: normal ≤25 dB (≤15 dB in children), mild 26–40, moderate 41–55, moderately severe 56–70, severe 71–90, profound 91+.

Tympanometry in one paragraph

• Type A — normal middle ear pressure and compliance.
• Type As — shallow, stiff system (otosclerosis).
• Type Ad — deep, flaccid (ossicular discontinuity, monomeric TM).
• Type B — flat: effusion (normal ear canal volume) or perforation/patent tube (large volume).
• Type C — negative pressure, eustachian tube dysfunction.

Screening and early identification

Universal newborn hearing screening uses otoacoustic emissions (OAE) and auditory brainstem response (ABR). The EHDI 1-3-6 benchmark is a common item: screen by 1 month, diagnose by 3 months, intervene by 6 months. Note that OAEs are typicallypresent in auditory neuropathy spectrum disorder while the ABR is abnormal — the classic dissociation.

Amplification and implants

• Hearing aids amplify sound; they help most losses but cannot restore damaged cochlear resolution, so clarity in noise often remains poor.
• Cochlear implants bypass damaged hair cells and stimulate the auditory nerve directly. Candidacy: severe-to-profound sensorineural loss with limited benefit from well-fit hearing aids. They require an intact auditory nerve.
• Bone-anchored devices for conductive/mixed loss or single-sided deafness.
• Remote microphone / FM-DM systems — the single most effective classroom accommodation for signal-to-noise ratio, and a frequent correct answer on school items.

Implants do not produce instant typical speech. Outcomes hinge on age at implantation, duration of deafness, consistent device use, and intensive auditory-verbal or listening-and-spoken-language therapy.

Communication approaches — stay neutral

Know the options and respect family choice: auditory-verbal, auditory-oral, cued speech, total communication, and ASL/bilingual- bicultural. The exam rewards family-centered, informed choice and cultural respect for the Deaf community; it penalizes answers that push one modality as universally superior.

Implications SLPs are tested on

• Chronic otitis media in early childhood → fluctuating conductive loss → phonological and vocabulary delays. Very common in cleft palate; see cleft and resonance.
• High-frequency loss disproportionately affects fricatives and morphological markers (/s, z, θ, f/, plurals, possessives, third person).
• Every speech-language evaluation includes a hearing screening — omitting it invalidates the workup.
• Presbycusis in older adults compounds cognitive-communication testing; rule out hearing before diagnosing comprehension deficits, especially in dementia cases.

Reinforce with the audiology basics guide and the audiology question set.