Dr. Ross on Hearing Loss
Coping with a Hearing Loss
by Mark Ross, Ph.D.
The first and indispensable step in coping with a hearing loss is to acknowledge --openly-- that it exists. This statement is not as simplistic as it might appear. Our society is full of people who deny to themselves the fact that they are hearing impaired, while still others, who are aware of their hearing problems, do their best to disguise its presence to the world at large. In both of these cases, developing efficient coping strategies will be difficult or impossible. Without self-acceptance, a successful adjustment to a hearing loss is impossible. By successful adjustment, I do not mean the elimination of the communication problems associated with the hearing loss, but rather their reduction insofar as it is humanly and technically possible.
Before we too easily dismiss people who cannot come to terms with their hearing losses as being neurotically and self-defeatingly vain, we should understand the nature of most of their hearing losses. In the usual case, the hearing loss is gradually progressive, and it takes a number of years before the effects become apparent. What the hearing-impaired person is aware of is not the hearing loss itself, but the fact that people seem to be talking less clearly than they once did, or that the world is apparently much noisier than it used to be (which is true, but the noise disturbs normal-hearing people less than it does someone with a hearing loss). So there is a tendency, in the beginning, to project one's difficulty on the external circumstances--that is, to blame others for one's hearing problems. ("If you'll just take the mud out of your mouth, maybe I'll be able to understand you!" or "Why are you always whispering to me?") There is a point, however, when it is apparent that other people in the same situation are able to get along just fine, and when the extent of the listening problems become so great, it becomes very difficult to deny the reality of a hearing loss, at least to oneself.
Actually, most adults with progressive hearing losses display not so much a "hearing" problem as they do an "understanding" one. The nature of the most common hearing losses are such that it is the higher pitch sounds which are the most impaired, while the lower pitch tones may be affected much less or not at all. Unfortunately, it is higher pitch sounds which are most important for the understanding of speech. (Many important consonants, for example, are comprised mainly of the higher pitch sounds.) When spoken to, the person with this kind of hearing loss can hear that speech is taking place on the basis of the better low-tone hearing acuity, but cannot understand what is being spoken because of the greater impairment in the higher-tone hearing acuity. It is not easy for hearing-impaired people to accept the responsibility for the communication breakdowns, the fact that the problem resides in their ears and not in other peoples' mouths, but it must be done. The association of hearing loss with increasing age and infirmity and the psychological blow that this may entail to one's self-esteem are examples of the hurdles that must be confronted and overcome. The way we use our language also plays a role. A "hearing loss" is equated with "deafness," and "deafness" associated with being "dumb"; and, after a lifetime, who wants to accept this as a label describing themselves?
This is not necessarily a conscious process, and the reluctance to acknowledge a hearing loss will undoubtedly be based on other factors as well, but whatever the reason or reasons, and whatever psychological and semantic associations are involved, it is not possible to cope with the hearing loss until the person first acknowledges that it exists. However difficult this may be, the alternative of openly confronting the hearing loss has much less negative implications than continuing efforts to deny or disguise its presence. People in contact with a hearing-impaired person are aware that a problem exists. They can note the misunderstood words, the unusual or irrelevant responses to a spoken comment, the repetition in a conversation of what has already been covered, the lack of responsiveness in some situations and the avoidance of other situations, and the frequent recourse to dominating the conversation (if one talks all the time, it is not necessary to listen). They can see, in other words, the effects of the hearing loss. If they are not aware of the primary cause of these effects, then they will attribute the behavioral excesses or abnormalities to other causes, such as senility, aloofness, ignorance, or mental illness. The preferred choice seems obvious.
Maybe they know that the hearing-impaired person indeed has a hearing loss; and, then again, maybe they do not. It is not up to them to discover this fact. It is, rather, up to the hearing-impaired person to make them aware of it, in any situation in which this acknowledgment will improve their participation in and comprehension of the communication interactions. If the hearing-impaired person clearly accepts the reality of his or her own condition, other people will also.
This leads to the concept of assertiveness. In this context, assertiveness is the attempt by hearing-impaired people to modify the communication situation as realistically and as efficiently as they can in order to improve their ability to participate in it. These situations can be anything from a personal or group conversation, to being a member of the audience in a lecture, theatrical performance, or as a congregant in a house of worship. Assertiveness means taking a personal responsibility to enhance one's comprehension in these situations, and not just blaming others for communication breakdowns and problems.
The first step the hearing-impaired person should take is to ensure that he or she has the proper hearing aids and that they are properly adjusted to one's hearing loss. This requires consultation with an audiologist. The hearing-impaired person should not hesitate to ask questions regarding the relative effectiveness of different aids and adjustments. Hearing-impaired people should view themselves not simply as passive recipients of someone else's efforts, but as active participants in the rehabilitation process. Audiologists generally welcome this expression of interest on the part of their clients. After consultation with the audiologist, one may find that the problems in many communication situations can be reduced or eliminated with the proper kind of assistive device, such as special telephone amplifiers, TV attachments, large-space listening systems (FM or infra-red special listening devices), and a host of other signal and warning devices. This can be termed the "hardware" solution, in which problems are alleviated by means of the developments in technology.
The "software" solution, the manipulation of conversational situations or oneself, is more difficult to implement but every bit as necessary. This is based on the fact that no device can replace normal hearing; problems will always remain, and it is up to the hearing-impaired person to take the next step in order to reduce their impact. It is not easy to change the habits of a lifetime and begin to assert one's own communication rights in an open and public manner, but it is vital that it be done. Most hearing-impaired people are quite aware of the consequences of their not making an assertive effort to improve their communicative reality. The resulting anger, frustration, and isolation are all too well known to people with hearing losses. Taking what control one can of one's problems is a healthier and more mature response than just doing nothing. It is not necessary to make a big deal of it. Just the comment that "I don't hear very well" or "You know I have a hearing loss" or any similar statement lets a person know why a specific request is being made. Actually, most people will be pleased to know what they can do to improve the communication situation. If they are interested in talking to you, they are interested in being understood by you.
Let us review some typical situations in which assertive behavior can enhance verbal comprehension. People with a hearing loss have an inordinate amount of difficulty understanding speech in a noisy situation. The proper kind of assertive behavior in this situation is to ask that the competing sounds be reduced, if at all possible. In a social situation, it is not necessary to have the TV blaring a few feet away. The car radio does not have to be on when one is talking to another person in the car. The host can wait to turn the dishwasher on until after the guests have left. The serious conversation at a table can be deferred until after everyone has shuffled all the chairs in the dining room and gotten seated. The sound system in a restaurant need not be turned up so high. And so on. If the hearing-impaired person makes no comment about these difficult listening situations, nothing will be done. A request, politely expressed, with the reasons included, can work wonders. Even unsuccessful requests will help sensitize people for similar future requests.
Assertive behavior also means arranging or controlling (again, politely) the seating arrangements in a social or public situation. Hearing-impaired people should seat themselves as far from unavoidable noise sources as possible. If necessary, they should politely ask someone to change seats. At public performances, they can ask the box office about seats up front or directly in line and close to the loudspeaker. In other types of public performances, they should arrive early and select the most appropriate seats, which would ordinarily be up front. In a social situation, they should not sit parallel to other people, such as on a couch, but sit facing the majority of people in the room. In these and other situations, changing seats to determine whether another location is better is perfectly appropriate.
One of the biggest problems faced by hearing-impaired people in a small social gathering (not a party) is the amount of cross talk which takes place. It is extremely difficult for people with impaired hearing to participate in a group discussion when more than one person talks at a time. Assertiveness in this situation means that the group be informed of this fact and for the participants to try to refrain from too many side-conversations. They will find this difficult, and it will be necessary to remind them of this fact from time to time, but it must be done if the hearing-impaired person is to fully participate in the conversation. As a bonus, group cohesion is enhanced when all the members can participate in the complete conversation, either as a speaker or as a listener.
Another very difficult listening situation for hearing-impaired people is attempting to understand the other speakers in a noisy party or restaurant. Even the best hearing aids are not too helpful under very noisy conditions. At the present state of the art, the best solution is to use some kind of external microphone which is then placed closer to the person speaking. Such microphones can be directly connected to the hearing aid via a wire cord or employed with an FM transmitter (both of these are commercially available) in conjunction with a special FM receiver worn by the subject. By placing a microphone closer to the mouths of the people talking, much of the noise is reduced while the loudness and clarity of the speech signal are enhanced. The use of such microphones does constitute a public admission of the presence of a hearing loss. The choices a hearing-impaired person has in these kinds of noisy listening situations are to avoid them, attend but understand very little of what is going on, or use an external microphone. Hearing-impaired people who can accept the unpleasant fact of their own hearing losses should have no reluctance to employ assistive listening devices and to request that their conversational partners talk into them. This illustrates the point made earlier: that coping with a hearing loss necessarily entails acknowledging its presence.
Hearing-impaired people are being properly assertive when it is necessary to ask their conversational partners to change their speech patterns to a certain extent. Perhaps they are talking too rapidly or facing away during an utterance or talking with a cigarette or pipe in their mouths. Cashiers, receptionists, clerks at information booths and other locations, frequently talk softly while facing down. Many people accompany their speech with gestures which cover the lips or lean their face on their hands when talking. Again, a simple request framed in terms of a specific suggestion, such as informing clerks about the hearing problem and asking that they talk a little louder and face the speaker, will help ensure comprehension and prevent confusion.
It is not sufficient to say "What?" when something is not understood. This does not indicate to the speaker the source of the communication breakdown. Did the hearing-impaired person not understand. Did he or she miss someone's name or a particular location? Lacking specific information, the speaker does not know what should be repeated, and if other people are involved in the conversation and the What?" happens too many times, a feeling of general annoyance is soon generated. The better strategy is to frame the "What?" as a specific request, such as "What was that name again?" or "Did you say that happened in Podunk or Poland?" or "I missed the last sentence. Would you repeat it?" Such a strategy is flattering to the speaker - someone is actually listening - and can expedite the conversation.
Assertiveness does not mean aggressiveness. When a hearing-impaired person engages in aggressive behavior, he or she is not coping with the hearing loss, but trying to force others to do so. In aggressive behavior, one blames the other person as the source of the difficulty and demands, not requests, that changes be made. An aggressive hearing-impaired person seeks to center all communicative situations around him or herself, thereby alienating family and friends and probably reducing, not expanding, future communicative opportunities.
In short, coping with a hearing loss means taking control of one's own communicative situation to the realistic extent possible without being obnoxious about it. At work, home, or in social situations, the responsibilities the hearing-impaired person must take include informing others of his or her condition, analyzing the potential sources of communication breakdowns, and making known the possible solutions to the problems. Some problems are difficult or impossible to solve by oneself, such as attempting to have listening devices installed in public places. In these cases, joining and becoming active in a self-help group can help bring about the desired external solution (the listening devices) and will also help foster the inner resolve to cope with the hearing loss and thus lead to a full life in spite of the hearing impairment.
The preparation of this paper was supported in part by Grant #H133E80019 from the National Institute on Disability and Rehabilitation Research.