Dr. Ross on Hearing Loss
Getting Through: Talking to a Person with Hearing Loss
by Mark Ross, Ph.D.
In recent years, there has been an explosion of technological developments designed to improve the communication ability of hard of hearing people. Because these developments are so impressive and so attuned to our technological culture, it is easy to overlook the many simple techniques that basically serve the same purpose, i.e. improve functional communication skills. Sometimes it is the littlest things that can make the biggest difference. This paper will focus on the "little things", the many non-technical steps that both talkers and listeners can take to "get through" to the other person.
The suggestions given below are based on a simple premise: conversation is an interactional exercise with both parties having an investment in the outcome. Not only do listeners want to "hear", but talkers want to be "understood" (why else are they talking?). Often, however, talkers are not aware that the hard of hearing person may have missed most or much of a message. In these instances, it is up to the listener inform the speaker what he or she can do to "repair" the conversational breakdowns (this was covered in detail in the article "Assertive Listening".). Rather than wait for these breakdowns to occur, however, there is much that talkers and listeners can do to preclude these breakdowns from occurring in the first place.
One of perennial complaints of many older people with a progressive hearing loss is that "people don't talk as clearly as they did when I was young!" We tend to dismiss such complaints as the querulous complaining of an old crank. Actually, as I get older myself, I often think these complaints have a good basis in fact! Upon reflection, however, and as much as I hate to admit it, it's clear that the main obstacle for comprehension resides in an impaired ear and not in the incoherent mumbling of modern-day speakers.
Still, having said that, it is true that many people are a bit sloppy in their speech. Even so, the message gets through to people with normal hearing. It gets through because normally hearing people can tolerate a great deal of distortions and omissions in a speech signal before comprehension is affected. Not so people with hearing loss. Because of their hearing loss, they are already unable to perceive many speech sounds; add the omissions and distortions produced by sloppy speech and their comprehension of the conversation can be severely affected (this also one of the reasons that people with hearing loss have such difficulty understanding people with an accent or in noisy situations).
In "clear-speech, a speaker consciously attempts to provide the clearest possible sample of the spoken utterance. The goal is to compensate for the acoustic speech information filtered out or affected by the hearing loss. He or she does this by (1) articulating all phonemes precisely and accurately, (2) slowing one's speech rate just a bit, (3) pausing slightly between phrases and thoughts, and (4) modestly increasing vocal volume. There has been some creative research projects, at such locations as the Massachusetts Institute of Technology on the concept of clear speech, that clearly demonstrates its effectiveness for hard of hearing people. Actually, if one thinks about it, this is what grandparents have been telling their grandchildren for eons ("don't talk so fast and pronounce your sounds better").
While I recognize that it is not easy for someone to change one's usual speech patterns, a little effort (and sensitivity) can go a long way. In one of the MIT studies, they found that in some situations "clear speech" produced about as much improvement in a listener's comprehension as did hearing aids! So for talkers who really want be to understood by the hard of hearing person they're talking to, they should take the extra effort to practice clear speech. The difference will be immediately apparent; just ask the hard of hearing person.
It is always a good idea for a talker to ensure that the hearing-impaired listener can see his or her face during a conversation. People with hearing loss may not even realize it, but they are speechreading to some extent as long as they can see the other person's lips move (see the article on Speechreading). To help this along, make sure the light falls on your face (assuming that you are the talker with normal hearing) and not on the face of the hearing-impaired person to whom you're speaking. Talkers should make sure that they don't inadvertently cover their lips (like leaning on their elbows at the table with their hands up in the air), or that they don't find it necessary to have foreign objects in their mouths while talking (pencils, eyeglass frames, hamburgers, etc.).
Conversations are sure to take place in noisy places, which is about the only kind of place there is nowadays. People with hearing loss don't do very well when there is a lot of background sounds. Background sounds that may barely register in a normal hearing person's consciousness may be loud enough to severely impact upon the speech understanding of someone with a hearing loss. Being aware of, and sensitive to, the effects of noise is the first crucial step for improving the communicative situation. For example, either a talker or the listener can request that the radio in a car be turned off or that the background music during a social gathering be turned down. Conversations can be moved to quieter sections of a house during a family reunion or party (like out of the kitchen and into the living room or hallway). In any type of situation, the closer the speaker and listener can be, the easier it will be to hear. So if there is a special guest at the table, the person with a hearing loss should be seated close to him or her. A little "anticipatory" planning can sometime go a long way.
Get the Person's Attention
People can't speechread if they don't know someone is talking. In a group conversation, in particular, many hearing-impaired people miss the first few words of the conversation before they know someone is talking and then can identify the speaker. Unlike people with perfectly normal hearing, a hearing loss may affect their ability to quickly localize the source of a sound, which interferes with their ability to immediately focus their attention on the person talking. If they can't do this, then clearly they are not going to be able to use speechreading clues. When, for example, the hearing-impaired person is engaged in another activity, he or she may not even realize that someone is talking until well into the next sentence. So, it is a good idea to get the person's attention before starting to talk. People do understand more when they are prepared to listen.
This is probably the most destructive practice of all for most people with hearing loss. Consider a dinner or meeting with six people around the table. In this situation, it is common to observe perhaps three separate conversations going on at one time (or, if a hearing-impaired person is present, only two and a half since it is unlikely that this person can understand very much). It is simply impossible, for example, for the hard of hearing person to talk to the person across the table, while the people to the right and life of him are having a separate conversation. The rule here, frequently broken but nevertheless which has to be attempted, is to structure the event so that only one person talks at a time. It is a good idea for the hearing-impaired person to make this request before the group convenes (for dinner or a meeting). A gentle reminder, if breakdowns appear to be occurring too often, is not unreasonable. When they do occur, the person with a hearing loss has essentially been excluded from the group. When cross-talk is controlled, the group may find that, having fully shared each other's conversations, they had a group, mutual experience, rather than three or four separate experiences. If cross-talk cannot be controlled, in a recurring situation with the same group, then I would suggest that the person with the hearing loss reconsider their participation. Even a conference microphone can help very little when more than one person talks at a time.
Keeping up With Events
This applies to the person with a hearing loss and may appear to be an odd entry in an essay entitled "getting through", but it is not really. A very famous British Psycholinguist once said that speech perception is 10% "earwork" and 90% "brainwork". What he meant was that understanding speech entails much more than acoustic signals rattling the eardrum and firing off neural responses. Understanding speech requires first, that the person be completely familiar with all the vagaries of the language. This is not an issue for adults with progressive hearing loss, though it may be for people with congenital hearing losses. And second, and most relevant at this point, is being as knowledgeable as possible on the many topics of conversation that may arise during the day. The more one knows about what is going on, the more comprehensive one's fund of general information and world knowledge, the easier it is to fill the acoustic and linguistic fragments that occur in a normal conversation. That is, by knowing more, by having more information stored in the brain, conversational competence would be increased because predictions would be more accurate.
For the overwhelming majority of people in our society, audition is the preferred method of communication. That is, we talk and we listen to one another. When we can't do this, when the ability to engage in relatively effortless conversations is impaired, our ability to fully engage in the social and cultural activities of our society is diminished. A hearing loss will have this kind of impact. It affects our ability to communicate well and easily. We can, however, reduce this impact, first through the intelligent use of technology and second through practicing the non-technical suggestions discussed in this essay.
This paper has been supported in part by Grant #H133E980010 from the US Department of Education, NIDRR.