A Day in the Life of Someone Living with Hearing Loss

Written by an anonymous patient

“Your disability is not readily apparent but yet you have a hearing loss. At medical appointments they call your name, but you don’t hear it so they think you left. When you finally get in, the medical staff turns their back on you and tries to take your medical history and type it into a computer, but your hearing aids only work well when the sound is directed towards you. This happens even though you filled out the paperwork with the information that you have a hearing loss. You inform the medical staff, but they are so used to doing this, you have to keep reminding them. 

You do not have closed captions on your televisions in the waiting rooms. I sometimes sit waiting for a long time and just like anyone that is hearing, I also would appreciate the distraction.

At parties, you can’t carry on a conversation, so you usually skip it or leave early. Your friends want to meet for lunch, but the restaurant is so noisy that you can’t carry on a conversation. You usually have to ask them to switch places because they are sitting on the side that is the worst. You can’t hear the specials, so you order off the menu.

Having a conversation in a car is difficult, and forget trying to listen to music if anyone else is in the car. They won’t enjoy the loud volume. In a hotel, your neighbors bang on the door because your TV volume is too loud, so you just read.

Going to the movie, a play or a musical are not that enjoyable. It is better to wait until the movie is on cable and turn on the close captions, which always seem to be positioned right over the actor’s face, so they annoy your family and friends.

You try a yoga class, but can’t hear the instructor because she is talking softly and once you bend down, your hearing aids don’t pick up her voice.

Business meetings are a challenge. You used to contribute more, but now you just try to get through them and hope no one asks any questions about whatever it was they were discussing that you could not hear.

Sometimes you leave water running because you don’t hear that it is on. You occasionally try to start your car twice because you didn’t know it was running.

Fortunately, hearing aids have improved greatly since I first put them on around 15 years ago. I can manage one-on-one conversations in a quiet environment without much issue. If someone has an accent, it is too much for my brain to handle. It is already working so hard just to turn the limited sounds I hear into meaningful words, there is no additional brain power to deal with an accent. Fast talkers can be challenging too.

Fortunately, we use computers and email much more in the business environment and in our everyday lives. We also use texting and social media more now than in the past. These changes are seen as negative by many, but they are a boon to people with hearing loss.

I am lucky. I have no other physical disabilities. I have a job that is dependent mostly on technical knowledge with heavy computer use, means to buy the latest hearing aids, a husband with a deep voice that I can hear easily, and a dog that doesn’t need me to carry on a conversation.”

Communicating with People with Hearing Loss

Successful communication requires the efforts of all people involved in a conversation. Even when the person with hearing loss utilizes hearing aids and active listening strategies, it is crucial that others involved in the communication process consistently use good communication strategies, including the following:

Practice face-to-face positioning:
Face the person with hearing loss directly, on the same level and in good light whenever possible. Position yourself so that the light is shining on the speaker’s face, not in the eyes of the listener.

Show room awareness:
Do not talk from another room. Not being able to see each other when talking is a common reason people have difficulty understanding what is said.

Use clear speech:
Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating mouth movements. Shouting distorts the sound of speech and may make speech reading more difficult.

Use name cueing:
Say the person’s name before beginning a conversation. This gives the listener a chance to focus attention and reduces the chance of missing words at the beginning of the conversation.

Simplify your speech pacing:
Avoid talking too rapidly or using sentences that are too complex. Slow down a little, pause between sentences or phrases, and wait to make sure you have been understood before going on.

Ensure your mouth is uncovered:
Keep your hands away from your face while talking. If you are eating, chewing, smoking, etc. while talking, your speech will be more difficult to understand. Beards and mustaches can also interfere with the ability of people with hearing loss to speech read.

Better side awareness:
If the listener with hearing loss hears better in one ear than the other, try to make a point of remembering which ear is better so that you will know where to position yourself.

Sound distortion awareness:
Be aware of possible distortion of sounds for the person with hearing loss. They may hear your voice, but still may have difficulty understanding some words.

Reduce background noise:
Most people with hearing loss have greater difficulty understanding speech when there is background noise. Try to minimize extraneous noise when talking.

Understand sensitivity to loud sounds:
Some people with hearing loss are very sensitive to loud sounds. This reduced tolerance for loud sounds is not uncommon. Avoid situations where there will be loud sounds when possible.

Use rephrasing strategies:
If the person with hearing loss has difficulty understanding a particular phrase or word, try to find a different way of saying the same thing, rather than repeating the original words over and over.

Provide Topic clarity:
Acquaint the listener with the general topic of the conversation. Avoid sudden changes of topic. If the subject is changed, tell the person with hearing loss what you are talking about now. In a group setting, repeat questions or key facts before continuing with the discussion.

Confirm details:
If you are giving specific information – such as time, place or phone numbers – to someone who has hearing loss, have them repeat the specifics back to you. Many numbers and words sound alike.

Give written support:
Whenever possible, provide pertinent information in writing, such as directions, schedules, work assignments, etc.

Fatigue and illness awareness:
Recognize that everyone, especially the hard-of-hearing, has a harder time hearing and understanding when ill or tired.

Check for understanding:
Pay attention to the listener. A puzzled look may indicate misunderstanding. Tactfully ask the person with hearing loss if they understood you, or ask leading questions so you know your message got across.

Take turns speaking:
Take turns speaking and avoid interrupting other speakers.

Tips for Working With Patients Who Are Deaf or Hard of Hearing in a Medical Setting

Before the Appointment

Patients with hearing loss, with or without hearing aids, may communicate in a variety of ways with health care personnel.

Some patients speak and speech-read or lip-read, some use sign language or communicate by writing notes, and some require that you provide a sign language interpreter for them.

Patients have the right to have an ASL interpreter that is provided for and paid by the doctor’s office or clinic in order to provide effective communication.

This can be done either through an in-person ASL interpreter or through a video remote interpreter. If you choose the video option, then make sure that your Wi-Fi works really well.

In no case should you request that a patient come in with their own interpreter, nor should a patient be dictating who they will bring as an interpreter to their appointment.

The scheduling of an interpreter for a patient’s visit is the responsibility of the physician’s office or clinic.

Reception and Waiting Areas

Waiting areas in health care settings can be very noisy. Patients with severe or profound hearing loss will not hear shouted instructions or staff calling out their name.

Those with moderate hearing loss can also have difficulty. The following general provisions may be helpful:

• In the waiting room, in addition to calling out the patient’s name when it is their turn to be seen, use a number system or a sign, or consider a vibrating pager system.
  
• Write the most important information on clearly displayed signs.
  
• Put up a sign in your waiting room asking patients to inform you if they have a hearing loss. Do not rely on being able to see a hearing aid or cochlear implants — not all patients with hearing loss wear these.
  
• Offer hearing amplification systems if you have one to help with communication for patients with hearing loss.
  
• If a patient with a hearing loss calls in advance to make an appointment (or if someone else calls on their behalf), ask how the patient prefers to communicate and whether a sign language interpreter is needed.
  
• If you know a patient has a hearing loss, make sure the consultation takes place in a suitable setting (see next section).
  
• Keep a note on the patient’s file with details of any communication requirements.
  
  
• Follow Americans with Disabilities Act regulations by keeping all public waiting room televisions on closed captions at all times so patients who are hard of hearing or Deaf can enjoy the programs as well.
  
  

During an Appointment

1. The Consultation Room

• Give the patient privacy: they should be able to ask you to raise your voice without fear that others will hear about their medical history.
  
• Minimize distractions. This is even more important if your patient is a child.
  
• Reduce background noise.
  
• Ensure the room is well lit, so that the patient can see your face or any written information they may be given.
  
• Ask the patient to wear their hearing aids (if they have them and find them helpful) and sit closer to them than you would to another patient.
  
• Offer the patient a pocket talker if you feel it would help with communication.
  
• When adult patients are accompanied, always ask them before you start if they would prefer to be alone with health personnel in the consultation room. Do not wait until the questions become uncomfortable for the patient.
  

2. Remember that your face is an essential communication tool

• Face the patient, not their interpreter or family member.
  
• Remove any masks or face shields if possible, or wear a clear mask that allows the patient to see your lips so that they can speech read if necessary.
  
• Do not have anything between your lips (cigarette, pen, etc.) or in your mouth (chewing gum, sweets, etc.) as this can distort lip movement when you are speaking.
  
• Avoid placing your hand or an object in front of your mouth when talking.
  
• Have the light on your face rather than on the person you are talking to. This makes it easier for them to read facial expressions and to lip-read.
  
• Support your speech with facial expression where you can, e.g., look happy if you are giving good news and sad if you are giving bad news.
  
• When communicating by signing in ASL (American Sign Language), hold your hands up at chest level to enable both your face and hands to be clearly seen.
  
• Understand and use the local culture of gestures, expressions and accepted physical contact (or absence of it).
  

3. Ensure that you speak effectively

• Speak normally, not too fast or too slowly. Certain sounds such as a PockeTalker can be distorted or lost if speech is rushed or slowed down too much.
  
• Use short, simple sentences.
  
• Do not exaggerate your speech or lip movements.
  
• Ask questions if you are not sure you understand what the patient is saying.
  
• Patients tend to agree with their health care workers, sometimes without understanding what has been said to them. After every important point or message, ask the patient if they understand what was said, and if necessary, ask them to repeat the message or instructions back to you (especially important if the patient is unaccompanied).
  

4. Use other means of communication, e.g. writing and signing

• If the patient can sign, use an ASL interpreter either in person or through a video remote interpreter.
  
• Write down important information, such as instructions for taking medicines, to give to the patient. Have this information available in alternative formats (such as large print) for people with impaired vision or give the information to the person assisting them.
• Use pictures and drawings to help the patient to understand you.