Open Access is an initiative that aims to make scientific research freely available to all. To date our community has made over 100 million downloads. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. As PhD students, we found it difficult to access the research we needed, so we decided to create a new Open Access publisher that levels the playing field for scientists across the world. How? By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers.
We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the world’s most-cited researchers. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too.
To purchase hard copies of this book, please contact the representative in India:
CBS Publishers & Distributors Pvt. Ltd.
www.cbspd.com
|
customercare@cbspd.com
Hearing loss and mental health issues are very closely correlated. Hearing loss has a significant impact on daily communication and makes smooth communication difficult. For example, people with hearing loss have difficulty disclosing that they have a hearing loss and avoid communication. Because of these problems, people with hearing loss are also likely to experience difficulties in establishing and maintaining close interpersonal relationships. The difficulties in coping with interpersonal stress due to hearing loss, prejudice, and stigma against people with hearing loss may also have a significant impact on the occurrence of mental health problems such as depression, anxiety, and loneliness. Therefore, psychological support is a very necessary part of the mental health of people with hearing loss. This chapter discusses the relationship between hearing loss and mental health, practices and empirical studies of psychological support for people with hearing loss in Japan and future issues necessary to provide psychological support for people with hearing loss.
Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
Tomoko Sano
Josai International University, Chiba, Japan
*Address all correspondence to: katsuya@bfp.rcast.u-tokyo.ac.jp
1. Introduction
Hearing loss and mental health issues are very closely related. Hearing loss has a significant impact on daily communication, making smooth communication difficult. For example, to take the first author’s own example, the author also has hearing loss due to a rare disease called Auditory Neuropathy (AN) [1, 2]. The disease is characterized by bilateral low tone type deficits in pure tone audiometry, with a maximum intelligibility of less than 50% in pure tone audiometry, while the otoacoustic emission (DPOAE) is a normal response. Also, Auditory brainstem response (ABR) is unresponsive or abnormal. In daily life, the author has difficulty hearing low sounds and listening to speech but can converse normally in a quiet room. On the other hand, when there is noise, such as in a café, I instantly have difficulty hearing. This makes it difficult for me to fully participate in formal conversations, such as meetings at work, as well as informal conversations, such as chit-chat. As a result, the content of discussions is only partially understood. These experiences of daily life accumulate into minor stresses. These stressful experiences are difficult for people with normal hearing to imagine and understand [3].
This chapter discusses the relationship between hearing loss and mental health. First, we discuss the varying definitions of hearing impairment as an introduction, followed by a discussion of the mental health effects of hearing loss. Then, factors related to the mental health of persons with hearing loss will be discussed, including difficulty coping with interpersonal stress, prejudice against persons with hearing loss, and stigma against persons with hearing loss. These are thought to have a significant impact on the occurrence of mental health problems such as depression, anxiety, and loneliness. In addition, the practice and empirical research of psychological support for persons with hearing loss will be discussed, as well as future issues that need to be addressed in order to provide psychological support to persons with hearing loss. We argue that psychological support for people with hearing loss is very necessary to maintain the mental health of people with hearing loss.
Definitions of the term “deaf and hard of hearing” are diverse. First, there is the medical definition. Medical definitions of hearing impairment are based on hearing threshold, disease, and severity. Second, As for legal definitions, in Japan, there are laws related to disability such as Physically Disabled Persons Welfare Act. In Japan, the criteria to be legally recognized as hearing impaired are currently very strict. In Japan, it is necessary to obtain a physical disability certificate in order to be legally recognized as hearing impaired. Even the lowest grade, Level 6, has “Those with a hearing level of 70 dB or more in both ears, or those with a hearing level of 90 dB or more in one ear and 50 dB or more in the other ear.” [4] (Ministry of Health, Labor and Welfare website). This is quite a gap from the table of stages of hearing impairment and hearing thresholds in the WHO’s World Report on Hearing [5]. As a result, there are people with hearing loss in Japan who cannot obtain a physical disability certificate and do not receive welfare support, even though they have difficulty hearing in daily life and experience considerable difficulties in their lives.
Third, there is the sociocultural definition. This definition is related to whether the first language is sign language or spoken language, whether or not they use their hearing, and how they define themselves in terms of their level of hearing. Based on the sociocultural definition, there are two types of people: Deaf people who use sign language and do not use their hearing, and hard-of-hearing people who use speech and use their hearing. The hard-of-hearing can be further divided into different groups according to the type of hearing loss and the time of onset of hearing loss, such as those with partial hearing loss and those with unilateral hearing loss (Figure 1).
Figure 1.
Definitions of “deaf and hard of hearing”.Note. APD: Auditory Processing Disorder, LiD: Listening Difficulties.
Hearing loss makes it difficult to hear speech and environmental sounds, which affects interpersonal relationships, communication, work, safety, hobbies, and many other areas [6]. According to Manchaiah and Stephens [6], hearing loss negatively or positively impacts daily life, but the negative impact is more common than the positive impact. Mental health-related effects noted include increased communication difficulties, decreased interpersonal relationships, and avoidance and withdrawal from social situations.
Hearing loss has been shown to be associated with overall mental health. A study Kobayashi’s study [7] using data from the Ministry of Health, Labour and Welfare’s “2007 National Survey of People’s Lives” for those aged 20–39 found that the group with hard of hearing who reported hearing difficulty had worse mental health. In a study of adult hard-of-hearing people [8], the degree of mental health was lower for those with hearing loss than for those with normal hearing, but the stage of the physical disability certificate was not associated with mental health. Interestingly, in a study that examined deaf and hard-of-hearing students [9], the degree of mental health was higher for deaf students than for hard-of-hearing students. In other words, the more severe the degree of hearing loss, the worse the mental health was not necessarily. The findings suggest that other factors associated with hearing loss play a greater role in the mental health of people with hearing loss than the degree of hearing loss itself.
Next, as for other measures of mental health, various measures of depression, self-esteem, anxiety, loneliness, and general well-being have been examined for their relationship to hearing loss. The results show that hearing loss is also associated with these mental health indicators.
As for depression, adults with hearing loss have higher depression than persons without hearing loss, but there is no difference in depression between those with and without a physical disability certificate [10], older persons with hearing loss are associated with depression [11], and meta-analysis also associated hearing loss with depression [12].
It has also been shown to be associated with anxiety and stress in older people with hearing loss [11]. In addition, hearing loss has also been associated with higher loneliness [13] and anger [14] and is associated with various mental health factors. In addition, tinnitus associated with hearing loss was also associated with depression and anxiety in a large study of a general adult sample [15]. Thus, both general and specific associations have been found between hearing loss and mental health.
As for the association with other psychiatric disorders, in a cohort study using a Korean nationwide representative sample [16], patients with sudden sensorineural hearing loss had a higher risk of affective disorders, specifically depression and anxiety disorder but not bipolar disorders. Hearing loss has been shown to be associated with mood disorders, but the degree of association is thought to vary by type of mood disorder. With regard to the association between hearing loss and developmental disabilities, some studies have examined the association with Attention Deficit Hyperactivity Disorder (ADHD). According to Solemani et al. [17], who examined the incidence of ADHD in children with hearing loss and children with normal hearing, the authors found a high prevalence of ADHD in children with hearing loss compared with normal hearing peers.
On the other hand, a study of deaf and severely hard-of-hearing patients [18] found higher rates of impulse control disorder, ADHD, and pervasive developmental disorder but lower rates of anxiety disorder, bipolar disorder, and substance abuse disorder compared to hearing patients. Although these results indicate an association between hearing loss and psychiatric disorders, it is possible that the prevalence of various psychiatric disorders may differ depending on the degree of hearing loss. The next section provides an overview of the factors involved in the mental health of persons with hearing loss.
4. Factors related to the mental health of people with hearing loss
The mental health of people with hearing loss is considered to be influenced in a multilayered manner by individual and social factors. In other words, it can be divided into factors related to the individual person with hearing loss and factors related to the society surrounding the person with hearing loss [3]. Social factors include the number and type of consultation institutions, accessibility, opportunities for contact with people with hearing loss and deafness, and social capital, as well as prejudice and stigma against people with hearing loss [3]. On the other hand, issues faced by people with hearing loss include the type and degree of hearing loss, hearing loss-specific stress experiences, stress coping strategies [3, 19], and stigma awareness [20, 21]. This section provides an overview of factors associated with the mental health of people with hearing loss and presents the authors’ research examining stress specific to hearing loss, as well as prejudice and stigma consciousness.
4.1 Communication difficulties
The first factor that should be mentioned as a factor related to the mental health of people with hearing loss is the difficulty in communication due to hearing loss [22]. Hearing loss makes communication difficult because of the difficulty in hearing speech. As a result, it has a wide-ranging impact on relationships with close and important others, such as spouses and family members. Many effects of communication difficulties have been identified, including decreased social interactions, negative effects on mood, and dissatisfaction [23]. Communication difficulties also affect stress coping strategies. For example, avoidance-focused coping behavior, such as avoiding participating in conversations, is indicated to lead to depression [24].
4.2 Quality of life (QOL)
The next factor related to the mental health of persons with hearing loss is quality of life (QOL). Poor quality of life is associated with the degree of hearing loss [22]. Hearing loss affects almost every aspect of daily life, for example, forcing people to sacrifice social and leisure activities they feel they can no longer do or enjoy [23]. In addition, while there is no significant relationship between measured objective hearing loss and quality of life, activity and participation limitations due to hearing loss in daily life were significantly related to quality of life [25]. Low quality of life is thought to lower life satisfaction and affect mental health.
4.3 Stresses specific to hearing loss
The communication difficulties described above are one of the most common stress events experienced by people with hearing loss. Another stressful event is the low quality of life that results from the inability to fully participate in social and leisure activities due to hearing loss. These hearing loss-specific stress events experienced by people with hearing loss because of their hearing loss are also related to the mental health of people with hearing loss.
Katsuya investigated the stress experienced by people with hearing loss in Japan [10]. The results of a survey of 453 people with hearing loss showed that respondents with physical disability certificate due to hearing impairment had a higher number of items that they “experienced” than those without (Table 1).
Item
Experience rate
It was difficult to hear (or not hear) someone with a low voice or who spoke too fast.
95.50
I had difficulty hearing the sound on TV or radio.
94.48
Had difficulty hearing (or could not hear) someone speaking from a distance.
93.05
Had difficulty hearing (or could not hear) broadcasts at train stations or inside buildings (department stores, event venues, etc.)
92.97
It was difficult to hear a person wearing a mask.
92.95
It was difficult to understand (or could not hear) broadcasts in trains, busses, and other vehicles.
92.79
I had difficulty understanding (or could not understand) the sound through a microphone or speakers.
92.78
I had difficulty hearing conversations in places where the surroundings were not quiet.
92.74
I had difficulty hearing (or did not understand) conversations at the reception desk, ticket counter, or cash register.
92.12
Table 1.
Stress events experienced by a high percentage of people with hearing loss [10].
Thus, stress events specific to hearing loss were shown to be commonly experienced by people with hearing loss in their daily lives. Although each individual event is considered relatively slight in comparison to suffering a serious illness or experiencing bereavement, the daily accumulation of these stress events is thought to exacerbate mental health.
4.4 Prejudice against people with hearing loss and stigma consciousness among people with hearing loss
Various prejudices against people with hearing loss still persist and can affect their perceptions, feelings, and behaviors. In Japan, the word “hearing loss” evokes images such as “sign language,” “hearing aids,” “not being able to understand conversations,” “not being able to hear music,” “troublesome,” “pitiful,” and “inconvenient” [26]. Such social images are taken up by people with hearing loss themselves, and are thought to influence their own perception and behavior. The negative image of hearing loss may affect the person with hearing loss by negatively influencing their perception of themselves and making them reluctant to engage in social activities.
In addition, stigma is one of the elements of social image that can cause negative reactions. The one of important issue of stigma has been pointed out as stigma consciousness [20], which is the concern that others may view them with stigma. The authors hypothesized that stigma consciousness might also be involved among people with hearing loss, so they created a Japanese version of a scale to examine stigma consciousness among people with hearing loss and investigated its actual status [21]. The Hard of Hearing version of the Stigma Consciousness Scale consists of items such as “Stereotypes about people with hearing and listening problems do not affect me personally.” (reversal item). The relationship between stigma consciousness among people with hearing loss, measured by these items, and attitudes toward prejudice toward people with disabilities was examined.
The results showed that those with higher stigma consciousness were more likely to consider discrimination and prejudice against people with disabilities and people of a particular gender in general, and did not considered these discriminations and prejudices to have improved over the past five years [21]. In the future, the Japanese version of the Stigma Awareness Scale for People with Hearing Loss that was created should also be used to examine the effects on mental health.
5. Psychological support for people with hearing loss
5.1 Various forms of support for people with hearing loss
Psychological support for people with hearing loss takes various forms [3]. The first is support from specialists, that is, doctors, nurses, speech-language pathologists, licensed psychologists, and social workers. Second, support from nonprofessionals, that is, family, friends, and community members. Social support from familiar people is effective in many ways, including predicting satisfaction with hearing aids [27]. Coping behaviors [23] made between people with hearing loss and their partners [23] have been noted to play a necessary role in acceptance without denial [28] of hearing loss, participation in social activities, and commitment to the social situation.
Third, there is support from people who have the same hearing loss. Self-help group activities among people with the same problem of hearing loss are active in Japan. For example, there are consultation meetings held by associations of people with hearing loss and deaf people around Japan, workshops to understand the stress of hearing loss [19], and activities by voluntary groups of people with hearing loss and listening difficulties. The psychological and social support provided by these individuals with hearing loss functions to enable them to give and receive social support that meets their needs, to broaden their repertoire of coping behaviors for stress related to hearing loss, and to expand their interpersonal relationships.
In the next section, the authors will introduce a practical activity for people with hearing loss called “Kikoe Cafe” [29, 30, 31, 32].
5.2 “Kikoe Cafe,” a social meeting for people with hard of hearing and listening difficulties
The authors have been running the “Kikoe Cafe” [29, 30, 31, 32], a social meeting for people with hard of hearing and listening difficulties since 2018 (“Kikoe” means “hearing” in Japanese). The aim of this group is to “share feelings and wisdom among people with hearing difficulties”. The meeting is open to anyone with hard of hearing or listening difficulties, regardless of where they live, the degree or causes of their hearing loss, their age, or whether or not they have a physical disability certificate. Also, family members and siblings of persons with hard of hearing or hearing loss and supporters of persons with hearing loss have participated in the program. To date, 39 sessions have been held at different locations and in different formats (face-to-face or online). At “Kikoe Cafe,” people with hearing loss do not just meet but also discuss and dialog with each other on specific themes.
“Kikoe cafe” serve two main functions [32]: First, they serve as a place to obtain social resources. In Japan, there are large regional differences in the psychological and social support and medical care systems for people with hearing loss. By sharing the wisdom, ideas, and information that people with hearing loss living in various regions have with each other, it will be possible for people with hearing loss to effectively use social resources that will enhance their quality of life.
The second point is its role as a place where informal communication is possible. People with hearing loss have difficulty participating in informal communication, such as chatting during work. This makes it difficult for them to participate in conversations, and they are likely to feel lonely and alienated. The Kikoe Café uses a real-time subtitling service to enable participants to follow the conversation, allowing them to participate in informal communication. The Kikoe Café provides an opportunity for participants with hearing loss to participate in conversations without being left out.
The authors believe that from these places where people with hearing loss gather, it could be possible to deliver a “hard-of-hearing” culture of people with hearing loss who utilize their hearing and devise ways of communication in their daily lives. In other words, a unique “hard-of-hearing” culture that shares a means of communication and a way of thinking about communication that is different from both the culture of normal-hearing people and the Deaf culture [33, 34]. “hard-of-hearing” culture may be less visible than “Deaf culture” due to the diversity of hearing characteristics, problems that they have, and coping strategies. Therefore, there is a need for a place to share and publicize the voices of people with hearing loss.
Future issues to be addressed with regard to support for people with hearing loss are as follows. First, it is necessary for specialists in psychological support and social work to expand the scope of their activities not only in hospitals that treat diseases related to hearing loss, such as otolaryngology, but also in local communities, such as elderly people’s clubs. Second, it is necessary to grasp the actual situation of the support needed by people with hearing loss and to jointly create the necessary know-how and resources for support activities together with people with hearing loss. The resources necessary for support activities can then be utilized anytime and anywhere, regardless of where they live. This will serve the function of preventing hearing loss in an aging society where the number of people with hearing loss is expected to increase.
In this chapter, the authors first overviewed perspectives on the definition of hearing loss. The legal, sociocultural, and medical definitions of hearing loss are quite diverse. Therefore, people with hearing loss also have different self-perceptions of how they perceive themselves in terms of their hearing. This self-perception influence not only communication methods and characteristics of interpersonal relationships but also the stresses experienced in daily life. These factors could influence the way in which social factors, which are discussed next, affect them.
Next, the factors related to the mental health of people with hearing loss are reviewed. These factors include not only the personal factors of the person with hearing loss themselves, but also the social factors surrounding the person with hearing loss. Therefore, in order to maintain and promote the mental health of persons with hearing loss, it is necessary to consider these factors and provide multilayered support, including not only psychological support, but also support for improving the environment and support for making use of necessary social resources.
Finally, the actual situation of psychological support for people with hearing loss is reviewed, focusing on efforts in Japan, and future issues are also discussed. To prevent hearing loss as well, it is necessary to hold seminars and workshops for people who are at risk of hearing loss, such as the elderly, and to provide them with opportunities to receive a full range of health education. In addition, to address the interpersonal and communication problems associated with hearing loss, it is necessary to encourage participation in self-help groups and provide cooperative learning opportunities for people with hearing loss.
The studies presented in this chapter were supported by JSPS KAKENHI Grant Numbers, JP19K03347 and JP19K02219. We are sincerely grateful to Dr. Pinel for permission to use the Stigma Consciousness Scale. The content of this chapter is based on a presentation given at Phonak’s online seminar “Well-Hearing is Well-Being—The Necessity of Good Hearing and Its Impact on Mental and Physical Health.”
1.Kaga K, Nakamura M, Shinogami M, Tsuzuku T, Yamada K, Shindo M. Auditory nerve disease of both ears revealed by auditory brainstem responses, electrocochleography and otoacoustic emissions. Scandinavian Audiology. 1996;25(4):233-238
2.Kaga K. Auditory nerve disease or auditory neuropathy—auditory dysfunction detected by combined DPOAE, electrocochleography, and ABR in 1996. Journal of Otolaryngology of Japan. 2011;114(5):520-523
3.Katsuya N. Psychological support for people with hard of hearing, acquired hearing loss and auditory processing disorders. The Japanese Journal of Special Education. 2022;60(3):159-169
4.Ministry of Health, Labour and Welfare [Internet]. 2023. Available from: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/shougaishahukushi/techou.html [Accessed: May 25, 2023]
5.WHO. World Report on Hearing. [Internet]. 2021. Available from: https://www.who.int/publications-detail-redirect/9789240020481 [Accessed: May 25, 2023]
6.Manchaiah VKC, Stephens D. Perspectives on defining ‘hearing loss’ and its consequences. Hearing, Balance and Communication. 2013;11(1):6-16
7.Kobayashi Y, Tamiya N, Moriyama Y, Nishi A. Triple difficulties in Japanese women with hearing loss: Marriage, smoking, and mental health issues. PLoS ONE. 2015;10(2):e0116648
8.Takamiya M, Fujita T. Mental health of persons with hearing loss or Acquired Deafness: Assessment with the 30-item General Health Questionnaire. The Japanese Journal of Special Education. 2005;43(4):279-290
9.Takizawa H. Mental health in America and Japanese hearing impaired populations: A comparative study. Journal of the Society of Humanities. Sapporo Gakuin University. 2000;68:33-44
10.Katsuya N. Stress and mental health among people with hearing loss in Japan: Toward a better understanding of hard of hearing and people with hearing loss. In: Proceedings of the 78th Annual Meeting Japan Psychological Association; 10-12 September 2014; Kyoto: JPA; 2014. p. 446
11.Jayakody DM, Almeida OP, Speelman CP, Bennett RJ, Moyle TC, Yiannos JM, et al. Association between speech and high-frequency hearing loss and depression, anxiety and stress in older adults. Maturitas. 2018;110:86-91
12.Adigun OT. Depression and individuals with hearing loss: A systematic review. Journal of Psychology & Psychotherapy. 2017;7(5):1-6
13.Sung YK, Li L, Blake C, Betz J, Lin FR. Association of hearing loss and loneliness in older adults. Journal of Aging and Health. 2016;28(6):979-994
14.Ferrari S, Monzani D, Gherpelli C, MacKinnon A, Mongelli F, Federici G, et al. Acquired hearing loss, anger, and emotional distress: The mediating role of perceived disability. The Journal of Nervous and Mental Disease. 2019;207(6):459-466
15.Krog NH, Engdahl BO, Tambs K. The association between tinnitus and mental health in a general population sample: Results from the HUNT study. Journal of Psychosomatic Research. 2010;69(3):289-298
16.Kim J-Y, Lee JW, Kim M, Kim MJ, Kim D. Association of idiopathic sudden sensorineural hearing loss with affective disorders. JAMA Otolaryngology–Head & Neck Surgery. 2018;144(7):614-621
17.Soleimani R, Jalali MM, Faghih HA. Comparing the prevalence of attention deficit hyperactivity disorder in hearing-impaired children with normal-hearing peers. Archives de Pédiatrie. 2020;27(8):432-435
18.Diaz DR, Landsberger SA, Povlinski J, Sheward J, Sculley C. Psychiatric disorder prevalence among deaf and hard-of-hearing outpatients. Comprehensive Psychiatry. 2013;54(7):991-995
19.Katsuya N. An attempt to create a program to help people with hearing loss understand their own hearing loss and stress: A stress coping workshop. Journal of Special Education. 2019;56(5):305-314
20.Pinel EC. Stigma consciousness: The psychological legacy of social stereotypes. Journal of Personality and Social Psychology. 1999;76(1):114-128
21.Katsuya N, Sano T, Matsuo A. Stigma awareness among people with hearing loss - Do stigma concerns make people with hearing loss more reluctant to receive reasonable accommodations and social support? In: The 87th Annual Convention of the Japanese Psychological Association; 15-17 September 2023; Hyogo: JPA; 2023. (In press)
22.Dalton DS, Cruickshanks KJ, Klein BE, Klein R, Wiley TL, Nondahl DM. The impact of hearing loss on quality of life in older adults. The Gerontologist. 2003;43(5):661-668
23.Barker AB, Leighton P, Ferguson MA. Coping together with hearing loss: A qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners. International Journal of Audiology. 2017;56(5):297-305
24.Williams KC, Falkum E, Martinsen EW. Fear of negative evaluation, avoidance and mental distress among hearing-impaired employees. Rehabilitation Psychology. 2015;60(1):51
25.Hickson L, Allen J, Beswick R, Fulton M, Wolf D, Worrall L, et al. Relationships between hearing disability, quality of life and wellbeing in older community-based Australians. Australian and New Zealand Journal of Audiology. 2008;30(2):99-111
26.Katsuya N. Lay theories of hearing loss. Bulletin Institute of Research Humanity Science Nihon University. 2011;81:123-130
27.Singh G, Lau ST, Pichora-Fuller MK. Social support predicts hearing aid satisfaction. Ear and Hearing. 2015;36(6):664-676
28.Armero OE. Effects of denied hearing loss on the significant other. The Hearing Journal. 2001;54(5):44-47
29.Katsuya N, Sano T. Practice of “Kikoe Cafe” to connect people with hearing loss and difficulty in listening. In: Proceedings of 59th Annual Meeting of the Japanese Society for Special Education; 18-20 September 2021; Ibaraki: The Japanese Association of Special Education; 2021
30.Sano T, Katsuya N. The usefulness and challenges of “Kikoe Café”: An online self-help group for the hearing impaired and hard-of-hearing. In: Proceedings of 60th Annual Meeting of the Japanese Society for Special Education; 8-21 September 2022; Ibaraki: The Japanese Association of Special Education; 2022
31.Sano T, Katsuya N. Characteristics and roles of the Kikoe Café – The Kikoe Café connects people with hearing loss and difficulty in listening with people with normal hearing. In: The 87th Annual Convention of the Japanese Psychological Association; 15-17 September 2023; Hyogo: JPA; 2023. (In press)
32.Katsuya N, Sano T. Practice of “Kikoe Cafe” to connect people with hearing loss and difficulty in listening (2): Status of the cafe and future challenges. In: 61st Annual Meeting of the Japanese Society for Special Education; 25-27 August 2023; Kanagawa: The Japanese Association of Special Education; 2023. (In press)
33.Fernandes JK, Myers SS. Inclusive deaf studies: Barriers and pathways. Journal of Deaf Studies and Deaf Education. 2010;15(1):17-29
34.Kimura H, Ichida Y. Deaf Culture Declaration – Deaf people as linguistic minorities (Deaf Culture Declaration). Gendai Shiso. 1995;23(3):354-362
Written By
Noriko Katsuya and Tomoko Sano
Submitted: 31 May 2023Reviewed: 01 July 2023Published: 02 August 2023
Open access peer-reviewed chapter
