Dr. Ross on Hearing Loss
Assertive Listening and Hearing Tactics
by Mark Ross, Ph.D.
Americans have a love affair with noise. You can't eat in a restaurant, drink in a bar, attend a reception, shop in the local supermarket, or even be put on "hold" on the telephone, without being bombarded by loud sounds (usually masquerading as music - as judged by someone else!). Young people think that the normal position for the volume control of their stereos and TV sets is when their sternums begin to vibrate. Loud sounds are considered mood enhancers and equated with life, activity, and "having a good time". And if some sound is presumed to offer a psychological boost, why more of it must really be elevating! In short, we live in a noisy world, one that seems to be getting noisier all the time.
Somehow, most people still manage to engage in what passes for oral communication regardless of the loudness level of the background sounds. (Though I do wonder about the quality of a communication exchange that is being rendered at the top of one's voice). Most people, that is, but not those of us with hearing loss. We find these noisy circumstances distressing and stressful and often can't understand a word someone else is saying. Indeed, the deleterious effects of noise upon speech comprehension is the most frequent complaint made by people with hearing loss. But all this seems to be off the topic; how does the fact that we live in a noisy world fit in a paper that is titled "assertive listening and hearing tactics"? It fits because in many of these difficult communicative situations, people with hearing loss can exercise some control over the listening environment. We can ask that the loudness of offending sounds be reduced or we can maneuver ourselves to a more favorable listening position. This is, broadly, what I mean by the term "assertive listening and hearing tactics".
The concept of assertive listening and hearing tactics has many facets and I'll try to cover a number of them in this paper. All of them derive from several underlying assumptions. The first is that everyone involved in a conversation has an investment in the accuracy of the exchange. Communication is a two way street; it's not only you that wants to understand, the people you talk to also want you to understand. Why else are they talking to you? (Yes, some people are only interested in hearing themselves talk, but they're a minority - really!). The second assumption is the fact that you, as the hearing-impaired person, are the only one who knows whether or not, or how much, you did understood of a conversational exchange. And if you didn't get it all, only you really know what went wrong. Saying "what?" or "huh?" when you didn't understand something does not help your conversational partner understand exactly why and what you missed.
And that leads to the third assumption, one that needs to be emphasized again and again. As a hard of hearing person in a conversational situation, you can't simply be a passive presence. You can't just stand there and assume that people will be sensitive to your hearing difficulties and that they will do the right things. Some will some of the time, but few people will do so all of the time (it doesn't make them "bad", just human). As the person with the hearing loss, we must assume that you will be taking the major responsibility for ensuring your own speech comprehension. If you can't or won't do as much as you can to help yourself, you cannot realistically expect that others will do it for you.
You are listening assertively when you can make specific suggestions - in a polite, but forthright manner - that will improve your comprehension of speech. Not apologetically as if you did something you are ashamed of. Assertive listening does not mean making angry or hostile comments when something interferes with your understanding ("if you'll take your damn hand away from your mouth, maybe I'll be able to understand you better"!). Assertiveness is educational; you are helping others understand why and what they must do to be more effective communicators. Hearing tactics, on the other hand, are the devices and stratagems you may use to enhance your communication ability in any given situation. It's the specific steps that an assertive stance permits you to take (like asking someone to change seats with you in a living room party, or using an external microphone to pick up someone's voice at a noisy reception). It's not always easy to change the habits of a lifetime and assert one's own communication needs in a conversational situation. It doesn't have to be done all at once, and will get easier the more you do it. Some of the suggestions I made below may be a good place to start. Let's talk about different situations and see how assertiveness and hearing tactics can play out and develop in real life.
You enter a restaurant or a bar with one or more dinner (or drinking) companions. The PA system is going full blast. Before you take your seat, you ask the waiter if he/she would please turn the sound down. You make this request nicely: not "shut that damn thing off", but "I have a hearing loss and I don't hear well when there's too much noise". And if the waitperson thinks you're being an old grouch, that's their problem, not yours. The point is that you have to do it, not your spouse or your dinner partners. They may not even be aware how much the background sounds disturb you. This is a reasonable first step to take on the road to a generally more assertiveness listening stance.
Only once, in the years I've done this, have I been refused (after several requests by different people in my party, the owner came to our table and indignantly asserted that "the music is part of our ambiance and we're not going to turn it down". We left and haven't been back since). As a bonus, you'll find that either most of the other patrons are not consciously aware that the background music level has been diminished, or that they positively prefer the relative quiet. In a survey appearing in the January l998 issue of Bon Appetit magazine, it was found that 44% of the people patronizing a restaurant found that noise was the least favorable aspect of the dining experience. We are not alone.
The next step (a hearing tactic) is to look for the quietist table, away from the crowd. Ask the waitperson. He/she usually knows the best (quietist location). If the tables are close together, select a seat furthest away from the other diners. (You really can't shut them up, as much as you may like to). This table will usually be some distance from the kitchen or the piano player. If you're with more than one person, try to insinuate yourself into the middle seats, with the one you can hear best (your spouse, for example) furthest from you. (There'll be plenty of opportunities to talk to this person later).
When the waitperson seats you at the table and starts reciting the specials, either have her or him stand next to you while going through the recitation, or ask to see a written version of the specials. There is almost always one available. Again, you inform this person that you have difficulty hearing and this will help you. You're doing more than helping yourself, but also helping other people with hearing loss who will come after. Not only that, you may actually know what "special" you've selected to eat that night!
If you eat out moderately frequently, you're going to be developing a list of restaurants that not only serve good food (the point of this excursion, of course), but where you can also engage in some good conversation. Restaurants do differ in the amount of noise they generate, in having some "quiet" corners available, and in having predictable slow periods (less people, less noise). Patronize the restaurants that do provide a "noise free" location, and let them know why they have your repeat business.
Restaurants are difficult listening situations, which is why I began with them. While some background sounds (e.g. music from the PA system) can be reduced, and some relatively favorable seating arrangements made, you cannot control the chatter of the people around you, the clatter of the dishes, or the cross conversations at the table (in a larger dinner party). Some of the devices I describe in another article on this web page will help ("When a hearing aid is not enough"), such as an FM radio hearing aid, but it is unlikely that any device or any seating arrangement will completely preclude listening problems. While my personal FM system provides important help in these types of listening situations, significant problems still remain. I prefer to think of my glass moving from 1/4 full to 1/2 full. Not bad, even if not perfect. Whether the resulting listening problems outweigh the benefits you perceive, is an equation only you can make. But you can't do it if you don't try.
There are several general rules that will apply in any noisy situation:
The first is to do what you can to reduce the level of the noise. Not just in restaurants, but in someone's else car (ask to have the radio shut off) or at a party in someone's else's home (ask the host/hostess to shut to stereo off - no one is listening anyway). If your spouse wants to make a comment while the TV set is on, and you don't understand, take control of the remote and "mute" - temporarily.
The second is to get as close as you can to the person who is speaking. I'm not suggesting you sit in the person's lap or violate their personal space, but you be surprised how much better you can hear if you can arrange yourself just a few feet closer to a speaker. In noisy parties, where it is impossible to reduce the level of the noise and where getting closer doesn't help, find the quietist location and try to carry on some of your conversations there.
The third is to be sure that you seat yourself in a position where you see the person talking. You may not realize it, but as long as you can see the other person's lips you can speechread to some extent.. You will understand more with the help you get from visual cues.
Conversational tactics cut across all situations and all people. Most hard of hearing individuals have much less difficulty understanding when talking to one person in a quiet place. This is part of the reason why a partial hearing loss is often so mystifying. Sometimes the hearing impaired person seems to understand everything, and sometimes nothing. This leads to the frequent comment that "he/she can hear when she wants to" (which never fails to infuriate me). A major hearing tactic goal is to help people with hearing loss identify the conditions that affect their ability to understand speech. Once identified, then they're in a position to make specific requests to improve the situation. We've already discussed some tactics to use in noisy situations; in this section, the focus is going to be on modifying the speech of the person talking.
You're talking to someone and you don't understand what was said. What do you do? Do you say "what" or "huh?" If you do, the person is likely to repeat the utterance exactly in precisely the same way. But you may still not understand the second time around, if the sentence is being spoken in exactly the same way. Any more "whats", and the talker may start getting annoyed while you start feeling frustrated and angry. What you have to do is consider exactly why and what you didn't understand. And then let the talker know. This is an example of assertiveness in action - all based on the same principal: you inform your conversational partner what she or she has to do in order for you to understand. Simple, but very effective. Here are a few examples.
The person is talking to you with his mouth covered, with a pencil in his mouth, or lecturing while facing a blackboard. You need to see the person's lips and you need to let this person know this. Asking someone to take his hand away from his mouth, to remove a pencil, or to face you while talking are each reasonable requests.
The person is talking too softly or too rapidly. Ask her to say it again, please, but a "a bit slower", or a "bit louder". Rapid and soft speech are probably two of the most frequent reasons why it is difficult to understand some people's speech.
You got part of the message but not all of it. Ask the person to either rephrase, or to repeat just the part you didn't get (e.g., "where did you say that man came from?").
Your spouse is talking to you from a different room, or while walking away from you with his/her back turned. Solutions are self-evident (e.g. to get your attention and/or to move into the room before speaking). Diagnosing the problem is much easier than rectifying it. This kind of situation often develops into a family battleground, but it need not be. Instead of anger, a simple request, with a reasonable explanation of why, does help.
Most of these examples are mainly applicable to occasional conversational partners. For the people with whom you interact regularly, there are some global suggestions that can be made that will definitely improve your ability to understand. This is a concept that is known as "clear speech". No, it's not that "people don't talk as clearly as they used to"; rather it is that however people spoke, in any era, their speech can be made much intelligible for hearing-impaired people with a few simple steps. Would you believe that for well over ten years such prestigious research institutions as the Massachusetts Institute of Technology have investigated this concept! It's not a trivial matter. What they found was that with a little training, people could talk in a certain way that would improve the speech comprehension of hard of hearing people by about 20%.
These investigators found that they could achieve these results with only 10 to 15 minutes of training. Basically, people are being asked to talk "naturally" slower and louder, but not to focus on the loudness or speed per se. What should be focused on is the talker's careful production of every sound, word, and sentence in a precise manner. No slurring across sentences, no dropping of syllables, no joke "punch line" dropped to a whisper! The talker should be sure to provide clear pauses between phrases and sentences. Clear speech is not speech spoken in an artificial monotone or exaggerated fashion. Actually what it comes to is what many grandparents tell their grandchildren to do when speaking to them: "For goodness sake, slow down and enunciate more clearly!" (For this we needed MIT?).
What does your audiologist have to do with "assertive listening and hearing tactics". As much as you require of them. None of the comments made in the previous pages should be unfamiliar to practicing audiologists; not only that but they should be your source for further information and for any additional services you may require (e.g. various aural rehabilitation practices). That is where assertiveness comes in: as the person with a hearing loss, you often have to take the initiative in acquiring this information from the audiologists. They may not know you have specific concerns or require more assistance unless you inform them.
When, after you have been fitted with hearing aids, audiologists say "call me if you have any problems", they mean it. As you read through the material they provide you, or as you talk to other people with hearing loss (perhaps by joining the national consumer group, Self-Help for Hard of Hearing People, Inc.), questions and issues will arise that never occurred to you previously. These may deal with advances in hearing aid or telecommunication technology, how such laws as the Americans with Disability Act apply to you, or specific suggestions for particular hearing needs (e.g. amplified stethoscopes for doctors and nurses, direct audio input from a computer into hearing aids, ear protection for a hard of hearing worker in a noisy work place, or suggestions for an impending, and difficult listening situation).
Think of audiologists as your employees (or maybe your partners). While they may be the expert on hearing, you pay for their services and they work for you. I have never met an audiologist that wasn't capable of doing more, or providing more information, when a situation required it. Don't be reluctant to ask for their help in any situation that relates to your hearing; assertiveness is the squeaky wheel leading to improved functional communication.
This article was supported, in part, by Grant #RH133E30015 from the US Department of Education, NIDRR.