How can a Speech Language Therapist Help my Child with Hearing Loss?

The role of the speech language therapist is to facilitate communication and teach strategies for the child to acquire language including both comprehension and expression. Another task is to improve speech abilities for effective communication to take place. In fact speech therapists world-wide are commonly known as communication therapists.

Although it may be obvious for some, it is significant to point out the differences between speech and language. Children particularly those with hearing loss, have difficulties to acquire a language, let alone to speak. For this reason, early diagnosis of the hearing loss, good quality amplification and early intervention are essential. Together with the speech and language therapist, a lot of effort and practice needs to be done if the child still has not grasped a language. Secondary to this the therapists work on clear speech production. Depending on the child’s preferred mode of communication and preferred language, the therapy sessions occur being it both verbal (speech) or visual (signs) communication.

Besides promoting and monitoring good hearing amplification, during speech therapy sessions, it is indispensable for the speech therapist to keep in mind communication goals. Therapy goals depend on the child’s strengths and weaknesses and every child is very different hence the goals are child specific and need to be very flexible. Ideally total communication is used as it works best for most. This means that both visual and auditory communication strategies are enforced during intervention sessions. Research has taught us that signs enhance production of speech and not the other way round. In fact many parents who have hearing babies opt to teach them baby signing at a very early stage and the results are extraordinary. This should be no less for children with hearing loss.

For sessions to be beneficial it is also crucial to work within a multidisciplinary team; the parents and other family members, school staff such as LSAs and teachers, other professionals involved and last but surely not least the child himself/herself!

The speech therapist can do a lot for children with various degrees of hearing loss, but unless he/she works within a team the outcomes are minimal. It is strongly suggested that parents discuss issues and concerns with their therapist in order to build goals together. They should move forward together in the same direction. At the end of the day the speech therapist’s duty is to provide support to the child and of course the family in order to facilitate successful communication strategies and positive social well-being. Every child is unique and so is the therapy process.

Ms Rita Portelli is a qualified Speech Language Pathologist and Sign Language Interpreter . She completed a Degree in BSc. (Hons) Communication Therapy at the University of Malta and is currently completing a Masters Degree in Disability Studies.

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How can I deal with Tinnitus?

Tinnitus is the perception of sound in the ears with no external sound source. This can take various forms, such as buzzing, ringing, hissing or clicking. Although many people may experience it in some form or other throughout their lifetime, it is only when it becomes more frequent and bothersome that it starts becoming a problem.

Medical help should be the first stop for someone with this issue to make sure that there are no underlying medical problems that need to be addressed. In many cases the tinnitus is not a direct threat to health, in the sense that it may be related to age, hearing loss or injury and does not require any significant medical intervention. That said, it may still be a significant cause of stress for the patient suffering from this condition. If you, or a person close to you, suffer from this condition, it is important to acknowledge that it is absolutely normal to feel stressed. Stress is a big factor in how tinnitus is perceived and it is not beneficial to get stressed about the fact that you got stressed in the first place. This should be the starting point from where you do something about what you are feeling. Some options include:

– Hearing aids: In some cases, there might be a hearing loss. Because of this, the tinnitus is perceived to be louder in the absence of sound. Simply correcting the hearing loss might be enough to reduce the perception of tinnitus.

– Use of sound: Keeping a fan or radio on, or using a noise generator (which produces background noise such as white noise of other constant sound) introduces noise which may make the tinnitus sound quieter.

– Psychological help: Counselling and Cognitive behavioural therapy are useful in accepting and dealing with the tinnitus by giving you tools to deal with the condition.

– Specialised programmes: Programmes such as Tinnitus retraining therapy are therapies specifically catering for tinnitus.

– Relaxation techniques: Use of breathing techniques, meditation and activities such as yoga and tai chi may help reduce overall levels of stress and affect tinnitus perception.

– Support groups: Finding groups (local or online) where you can discuss what you are feeling might be a way for you to accept and understand your condition a bit more. However, it is important to keep in mind with this option that you should be very careful of using untested treatments just because someone suggested them (especially online). In such cases, always seek advice from a trained professional.

As seen above, there are various options and while some may be beneficial, others might not be the right option for you. So it’s important to try different treatments or combinations of treatments until you find the right one for you. Do consult with an audiologist. The important thing is not to get discouraged when the first thing you try does not work. With tinnitus, one should understand and accept that it is a process. We are all unique in our own way, there might not be a quick fix, but it’s just a matter of slowly finding what works for you.

Mr Nicholas Desira is in the final stages of becoming a fully qualified audiologist after training in the UK at the University of Southampton. Nicholas is particularly interested in the use of assistive listening devices and vestibular disorders but is passionate about all aspects of audiology.

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The Subtitler: A Job Description

The subtitler is responsible for subtitling the transcribed audio version of any audio-visual material which needs subtitles to be displayed on a visual medium. The subtitles can be either intralingual (transcribed text then turned into subtitles) or interlingual (transcribed text then translated before being turned into subtitles) and either created in advance, or partially prepared or fully created in real-time in the case of a non-recording.

Before work on a subtitling solution actually starts, one must carefully identify and analyse ‘the three main pillars of subtitling’, which determine the success or failure of the created solution – audience, purpose, and context.

No subtitling solution is equally adequate to any two target audiences with different auditory levels. Hence this calls for a tailor made solution to either:

  • The hearing;
  • The deaf using an oral language as their mother tongue;
  • The Deaf belonging to linguistic minority groups that use a sign language as their first language; or
  • The hard of hearing having residual hearing and can therefore share the experience of sound and of the world of hearers to different degrees.

With one of the above audiences in mind, setting a purpose provides a context, and vice-versa. Just like the sign language interpreter (SLI), the subtitler uses the tailor-made subtitles to bridge the gap between any of the target audiences and any speaker one can think of, hence the infinite situations in which they can be used.

Subtitles as an educational means imprint on our minds a classroom environment; and as an entertaining means, a cinema, a living room or a bedroom desk, where one or more people are watching a movie, a program, or a music video respectively; just to mention a few.

The resulting benefits are immeasurable; subtitles in any context are excellent and have the potential to help educate and improve the children’s ability to learn and read, helping them improve other skills whilst developing new ones. However, they are equally useful to people of various ages all with a different story.

The subtitler has to reflect and complement all this through the actual subtitles and the way they are presented, paying special attention to the different reading speeds, the editing levels of the transcribed text and the different ways in which each of the above audiences relate to sound (speech, sound effects and music), whilst being constrained by the available time and space.

Some of the questions a subtitler must ask when working on the subtitles are: Is it better to present the subtitles…

  • with this particular number of CPL (characters per line) or with that number of CPL?
  • on one line or two lines?
  • joined together as one subtitle, left as they are, or split into two or more?
  • at this particular time, slightly before, or slightly after?
  • for this amount of seconds or for that amount of seconds?
  • flashing in and flashing out, or floating in and floating out?
  • in a sans-serif font or another?
  • using bold, italics and/or underlined or not?
  • in a smaller or a larger font size?
  • in a colour instead of another?
  • with or without a background, and in what colour?
  • identifying speakers using a particular colour or using a special marker?
  • identifying music using musical instruments, the song and the singer/band, or by giving a description of the melody?
  • reduced to fit the time and space constraints, leave them as they are, or even possibly fit more information if the time and space allow it?
  • for some even more extra seconds to enhance readability or will that hinder coherence with the audio-visual elements?

Upon completion, the subtitles are then finalised and delivered to the end user, helping him/her achieving his/her goals. Should any subtitles be needed for any kind of audio-visual material, one can send an e-mail to Reuben De Gabriele on

Reuben De Gabriele, a graduate in Master of Arts in Translation and Terminology Studies, has subtitled season 1 of the Maltese TV drama Strada Stretta and is currently working on season 2. Updates as to when the subtitled episodes are online will be posted on the Facebook pages of A Silent World and Deaf People Association – Malta.

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Back to School

It’s back-to-school for most students on Monday in Malta. Do you have a son or a daughter who is deaf or hard of hearing? Do you have a Deaf student in class?
Advice for Parents
For parents who have Deaf children, going back to school involves more preparation than simply buying new pencils and fresh sheets of paper.
– Do meet with the teachers and with the head of school. Give them as much details as possible about hearing loss, to help them understand how best to communicate with & teach your son/daughter.
– Ensure that your child is seated in the front row to be able to read the teachers’ lips clearly.
– Do consider a Sign Language Interpreter as they will greatly help Deaf students to excel in class (promise!). Children who are deaf or hard of hearing can excel in class like their hearing peers, if provided with the right resources. 
– Do book a check up with an audiologist if needed. 

Advice for Teachers
Keep in mind that Deaf students have as much potential as the other students if they are helped with the right resources. It can be a great challenge for you to make the lesson accessible. However, the challenge can be easily eliminated. Here are some tips:
– It will be easier for the student to follow the lesson if sitting at the front.
-It is very important that when you are talking, you are facing the Deaf student. Avoid talking while walking around the class or while writing on the whiteboard, as the student needs to read your lips easily.
– Do try using as much visuals as possible, like powerpoints or videos, to make it easier for the student to understand the lesson. The other students will love the visuals too.
– If you are showing a video, use subtitles. If the video you want to show has no subtitles, pause the video every now and then, to explain what is being said.
– If you are doing group discussions, do ensure the Deaf student can see what everyone is saying by having everyone sit in a circle with no obstructions blocking the view of the other participants. You can also repeat or rephrase for the Deaf student to ensure that the student is following.
– Taking notes can be difficult as the deaf or hard of hearing student will be unable to read your lips while writing at the same time. In this case, you can tell the Deaf student to just listen without taking notes. The student can then make a copy of the another student’s notes. Otherwise you can give the student a copy of your notes.
– If the student is still lagging behind, do ask the student, the student’s parents, the head of the school, or even the Deaf People Association – Malta or the Gozo Association for the Deaf for more information on how you can help the Deaf student in class, before it’s too late.
– Do suggest to the Deaf student or his/her parent a sign language interpreter, as they can help to make the lesson more accessible.

Best of Luck with this new scholastic year! 🙂



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What does a sign language interpreter do?

A sign language interpreter converts the spoken language to sign language and vice versa. The interpreter has to listen, understand and memorise the content of the original language and accurately convey the message in sign language. The same goes when the sign language user is using sign language to communicate; the interpreter converts what s/he sees into spoken language. Therefore, the interpreter is the bridge that a speaker and a signer need to communicate.

Interpreting can be during a one-to-one conversation or group setting. It can take place in various areas such as education, health, court and law, employment, media, and social and leisure activities. Depending on the situation, the interpreting can be:

Simultaneous – the interpreter immediately converts what is being said to sign language. This is used in situations like conferences, group settings and education.

Consecutive – the speaker will pause after each sentence and wait while the message is interpreted in sign language. This is used more during one-to-one conversations, such as medical appointments.


Due to the variety in appointments, the interpreter has to be well prepared. The agenda and speeches of conferences/lectures can be useful for preparation. These will help the interpreter to be familiar with the topic and terminology that will be used. Therefore, the interpreter can deliver a better, clearer and effective interpretation, the same as the speaker. Some organisations are afraid to send speeches or presentation beforehand because of security or confidentiality reasons. However, a sign language interpreter is bound by the Code of Ethics which covers both confidentiality and also impartiality in any task.

Team interpreting

An interpreter can either be seen working on her/his own or within a team. This depends on the type and length of the assignment. For example during conferences, which require simultaneous interpreting, two interpreters are assigned for a task. This is because interpreting is an exhausting job in both the mental and physical senses due to the great amount of attention and energy needed. Therefore, it will be very difficult for one interpreter to maintain a high-quality interpreting over a long period of time. In this scenario, one interpreter will be signing and the other will be helping the signing interpreter by giving cues such as repeating names, figures and dates. Also, the interpreters will change after some time to have a fresher mind and avoid mistakes.

Interpreting service in Malta

The interpreting service in Malta is mainly offered by Aġenzija Sapport for Deaf individuals who use Maltese Sign Language. The service is also available for individuals/entities who would like to make their services or events more accessible to service users.  To contact or book a sign language interpreter, one can send an email on Further information about Sapport services is available on

Maris Bonnici is a qualified Sign Language Interpreter at Aġenzija Sapport.

Image result for interpreter sign language

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How does hearing loss affect communication?

What is the relationship between hearing, speech and language?

Hearing is important for speech and language development, communication, and learning. Children listen to others speak for approximately a whole year (even a little more) before they can actually start to speak. Unfortunately, many children with listening difficulties in Malta and in Gozo are not identified until a language delay becomes obvious.

The earlier hearing loss occurs in a child’s life, the more serious the effects would be on the child’s speech development. Similarly, the earlier the problem is identified and intervened, the less serious the ultimate impact.

There are four major ways in which hearing loss affects children:

  • Hearing loss causes delay in the development of receptive communication skills (what the child can understand), and expressive communication skills (what the child can say).
  • Communication difficulties often lead to isolation and challenging behaviour due to the child’s frustration when he/she cannot understand what is happening or what is expected of him/her or when he/she is not understood.
  • The hearing difficulty causes learning problems that result in reduced academic achievement.
  • It may have an impact on vocational choices if the child remains unsupported.

Signs of a Hearing Loss

The following indications can be a sign of hearing loss. When in doubt do check with an audiologist.

  • A child shows lack of attention to sounds (birth–1 year)
  • Doesn’t respond when you call his/her name (7 months–1 year)
  • Doesn’t understand or respond to a simple direction/question (1–2 years)
  • Shows delays in speech and language development (birth–3 years)

What You Can Do

Children identified with a hearing loss who begin speech therapy services early may be able to develop language (spoken and/or signed) on a par with their hearing peers. If a hearing loss is detected in your child, early family-centered intervention is recommended to promote language (speech and/or signed depending on family choices) and cognitive development. An audiologist, as part of an interdisciplinary team of professionals, will evaluate your child and suggest the most appropriate intervention program. A hearing test for children can be done at the ENT department at Mater Dei hospital, at the Gozo general hospital, or in private clinics. Baby signing has become quite popular even in Malta. This can help augment the language until the child is tested, fitted with the necessary hearing device, and learns to listen through his/her new hearing device. Later on, the family may decide to learn Maltese Sign language as an added language and means of communication. A speech therapist can help guide the parents on how to communicate and interact with their child even before the child is expected to start speaking. This helps the child build his/her listening skills and make the most of his/her learning opportunities. Speech and language therapy sessions aim to stimulate language development whether spoken and/or signed.

Sharon Mifsud is a qualified Speech Language Pathologist and Sign Language Interpreter . She completed a Degree in Communication Therapy at the University of Malta and is currently completing a Masters Degree in Disability Studies. 

speech therapy

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What to expect at an audiology appointment

Before getting to the stage of an audiology appointment, most patients will have already seen a GP or an ENT doctor. However, you (or your child / relative) may have suspected the presence of hearing loss for months or even years. Whatever the case, having to go to an audiologist to have your hearing checked may be causing you some stress. I hope that with a bit of information on what a typical session would look like, you’ll feel more at ease.

The first thing to expect when you go in to an appointment is some exchange of information. This may start with the audiologist reading a referral letter that you brought in or your patient file (if in a hospital). The audiologist may then ask you more about what you are experiencing. This may include general queries such as how you are coping with your hearing loss and which situations you are struggling with or even specific questions like whether you can communicate using the phone or  whether you are able to hear the door bell. It’s important that you answer honestly and as fully as you can. Even though testing will be done later, these questions may help the audiologists determine what your needs are, especially with regards to treatment options.

Once that is done, most audiologists will normally test your hearing. This is done using a test known as pure tone audiometry (or PTA in short). This test requires you to sit in a quiet environment wearing headphones and are given a hand held button. The audiologist will then play a tone (a short ‘beep’) in one ear, at which stage you press the button if you can hear the sound. This should be started at a level that you can comfortably hear, so don’t worry, you will have time to adjust to this test. The audiologist will then vary the loudness of the tone until you cannot hear it anymore. The audiologist repeats this using different frequencies (pitch) and does this for the other ear as well. This test gives an indication of the quietest sound you can hear at different frequencies and is used as the main measure of your hearing.

There are also variations of PTA that the audiologist may use in your appointment, including the use of a band that vibrates sound directly to your inner ear (known as bone conduction PTA) and doing PTA with white noise being presented to the other ear (known as PTA with masking). These two variations help determine what type of hearing loss you have and also to isolate each ear better.

Although PTA and the above variations are the main tests, sometimes tympanometry may also be done, which measures your middle ear pressure. This involves having a rubber insert being placed in your ear. You are not required to do anything for this test except avoid talking or swallowing during the measurement. When the measurement starts, you will feel a bit of pressure in your ear which should not be uncomfortable or painful. The measurement is quite short and the whole procedure normally takes 2-4 minutes for both ears.

Normally, no further testing is done at this stage. The audiologist may discuss the results with you directly, or else forward the results to your GP/ENT (depending on where your audiologist is working). In case the audiologist discusses the results with you directly, this may involve a discussion with you on what your options might be. This may include options such as alternative communication strategies (lip reading, sign language or even techniques such as facing a person when talking to them), assistive listening devices and hearing aids. You may require time to decide what you want to do, which is normal. However, if you decide that you want hearing aids, some audiologists may also give you the option of having your ear mould done in the same appointment. This involves having putty placed into your ear canal which then hardens, taking the shape of your ear.

At the end of the day, it is important to remember that the audiologist is there to help you through this potentially difficult process. Hopefully, with this information you feel a bit more prepared for your first appointment, but if you have any more questions, audiologists are normally very happy to discuss things with you during appointments.

Nicholas Desira
 is in the final stages of becoming a fully qualified Audiologist after training in the UK at the University of Southampton. Nicholas is particularly interested in the use of assistive listening devices and vestibular disorders but is passionate about all aspects of audiology.

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