Hearing loss & the family (RE-POST)

Steve Hoffman steve at accessone.com
Sat Mar 2 13:01:54 EST 1996


The following article from the SHHH Journal is posted with
permission.  The SHHH Journal is published bimonthly by SHHH
(Self Help for Hard of Hearing People, Inc.), an international
nonprofit volunteer organization devoted to the welfare and
interests of those who cannot hear well.  For membership and
other information, contact:

       SHHH
       7910 Woodmont Ave, Suite 1200
       Bethesda, MD  20814

       301-657-2248    Voice
       301-657-2249    TTY

       Email:  shhh.nancy at genie.com  (Nancy Macklin)

===========================================


It's Our Hearing Loss:
What Families Need to Know and Do About Hearing Loss 
by Samuel Trychin, Ph.D.
SHHH Journal 5/95


Hearing loss is a physical condition that can affect mood, self
concept, aspirations, behavior, interpersonal relationships, and
health. Still, with all the information now available for the
asking, many hard of hearing people and their family members
believe there is little that can be done to accommodate for their
hearing loss or to compensate for it. 

Here are several important issues and suggested coping strategies
concerning hearing loss for people who are hard of hearing and
their family members.   

First, hearing loss is a communication disorder. For most people
who are hard of hearing, their primary problem is diminished or
distorted auditory information from the environment. Speech
sounds are not heard or are unclear resulting in communication
difficulties when information is presented aurally. Environmental
sounds, such as alarm signals, traffic sounds, telephone and
doorbell rings, or sounds that indicate that someone is
approaching or is nearby, may not be heard. Some individuals who
are hard of hearing may also experience other problems such as
vertigo, headaches, or ringing or other sounds in their ears.
But, for most people who are hard of hearing, it is the loss of
auditory information that is the primary issue. 

Second, because hearing loss is primarily a communication
disorder, it affects both the individual who has it and those
with whom he or she interacts. If the listener is hard of hearing
and does not understand what is being said, the person speaking
will also experience a communication problem. In the same way,
speakers, as well as listeners who are hard of hearing, share
responsibility for preventing or reducing communication problems
related to hearing loss. Individuals who are hard of hearing
cannot prevent or resolve communication problems by themselves;
they often need the cooperation of those with whom they
communicate.

Third, many hard of hearing people either do not recognize that
they have a hearing loss or, if they are aware of its presence,
fail to inform others about it. In either case, nothing is done
by the hard of hearing person or those around him or her to
compensate for the hearing loss, and communication problems
continue unabated.

Fourth, many hard of hearing people do not make the connection
between significant problems in their life and their hearing
loss.  They may not associate depression, anxiety, fatigue, or
interpersonal difficulties they are experiencing with their
hearing loss. Similarly, professionals who are consulted about
these problems also may fail to relate them to the hearing loss,
and needless time and effort may be spent in searching for other
causes. Hard of hearing people and the professionals who provide
services to them need to be educated about the psychosocial risk
factors associated with hearing loss.

Fifth, because there is a strong age factor in hearing loss, the
incidence of hearing loss is increasing as the population becomes
proportionately older. About one out of ten people in the United
States currently has hearing loss. Among people over 60, it is
about one in four; and for people over 70, it is about one out of
two. 

Everyone either has loss of hearing, lives or works with someone
who has it, or has a relative, friend, or acquaintance who has
it. This fact may work to the disadvantage of efforts to educate
people about how to cope with hearing loss. Its very familiarity
may lead people to view hearing loss as merely a natural part of
living that just needs to be accepted. This kind of thinking can
prevent people from making efforts to do the things required to
minimize communication problems.

Even more of a problem in this regard is the general lack of
information about what can be done (see below) to compensate for
hearing loss and prevent or reduce communication problems. Many
people who are hard of hearing have reported that even
professionals such as family physicians have told them, "There's
nothing you can do about your hearing loss. You'll just have to
learn to live with it. If that's your biggest problem, you're
lucky."

Sixth, fortunately, there are a variety of changes involving
communication that people who are hard of hearing and their
family members can make that result in preventing or reducing
communication problems. When these changes are made, most people
with hearing loss find that they can get on with their lives and
that there is life beyond hearing loss. 


We call all these efforts to increase understanding coping
strategies, and the remainder of this paper gives brief
descriptions of some major ones. But, first, it is important to
discuss several commonly held misconceptions about hearing loss.

The Hearing Aid Myth

The hearing aid myth causes considerable trouble for people who
are hard of hearing and for those who interact with them. Many
people believe that hearing aids function like eyeglasses; that
is, as eyeglasses give most wearers something close to 20/20
vision, hearing aids are believed to give most wearers "normal"
hearing.  

People who wear hearing aids know that doesn't happen; and many
who have the erroneous expectation that it should, become
disappointed and stop wearing their hearing aids at all. Some
people are confused when they see a person wearing a hearing aid
but still having difficulty understanding what is being said.  

Everyone in the communication loop needs to have a more realistic
expectation about what hearing aids can and cannot reasonably be
expected to do. That expectation is that the benefits of hearing
aids are situation specific -- they work wonderfully well in
fairly close, quiet, listening situations, and much less well in
noisy situations. That is because the microphone on the hearing
aid picks up all the sounds in the immediate environment.  Some
hearing aids can be programmed to reduce the effects of
background noise, but none eliminate it entirely.  

Also, many people who have hearing loss need to be able to
clearly see the speaker's face, even when wearing hearing aids.
If they cannot see the speaker's face or if the speaker's speech
is not clear for whatever reason, communication problems will
still occur, even with the use of a hearing aid.

At this point, it is important to state that everyone who has a
hearing loss and who can benefit from amplification should have
hearing aids -- there is no question about that. If the person
has bilateral hearing loss, he or she should have two hearing
aids.  However, other things in addition to wearing hearing aids
need to be done in order to prevent or reduce communication
problems.

The Lipreading Myth

The lipreading myth also causes problems. It goes like this, "Oh,
you have a hearing problem? Then you must be a good lip reader."
Or, some people with hearing loss believe that they can
understand everything said as long as they can see the face of
the person who is speaking. In actuality, ability to understand
what is being said by lipreading (currently called speechreading)
is quite variable.
Some do it well and others not well at all; even an expert will
not understand all of what is said by lipreading alone. Visual
problems, inability to see the speaker's face, poor lighting, and
distance from the speaker are some factors that limit the
usefulness of speechreading or lipreading.

However, everyone who has a hearing loss should take
speechreading classes. Everyone will benefit to some degree by
such instruction, but people need to have realistic expectations
about the benefits they will derive from speechreading. They must
not view it as the final solution that will prevent or resolve
all communication difficulties.  

Some people think wearing hearing aids or learning speechreading
are the only solutions to communication problems. As a result
they do not adopt other helpful strategies and needlessly miss
out on a lot of what is being said. 


Coping Strategies for People who are Hard of Hearing 
and their Families

Let's consider some of the other strategies that people with
hearing loss can use to prevent or reduce communication problems.

Know as much as possible about the functional effects of your
hearing loss.

Know how to read and interpret your audiogram. Be especially sure
that you know the effects of your hearing loss on being able to
understand normally spoken speech sounds. Get your audiologist to
go over your audiogram with you indicating your hearing loss in
regard to the "speech banana."  That is the area where normally
spoken speech sounds appear on your audiogram and, specifically,
the sounds which you are likely to have difficulty understanding.
Have the audiologist also point out which environmental sounds
(telephone ring, baby cry, dog bark, etc.) you will have
difficulty hearing. Be sure your family members also understand
your audiogram in regard to these sounds. That can go a long way
toward preventing misinterpretation of your failure to hear some
things and toward preventing the resulting hurt feelings and
damaged relationships. Know as much as possible about available
assistive technology.

Assistive technology includes hearing aids, assistive listening
devices (ALDs), such as, FM systems, personal amplifiers,
inductive loop systems, infra red systems, FM hearing aids,
direct audio input devices, telecoils on hearing aids, and the
variety of devices available for assisting in using the
telephone. We see people's lives change right before our eyes
when they use these devices for the first time; it is amazing the
differences assistive listening devices can make in increasing
understanding of what is being said. 

The major advantage of assistive listening devices is that they
put the microphone that picks up the speaker's voice right at his
or her mouth. This results in diminishing the negative effects of
background noise that can be such a problem with hearing aids.
Also, with the use of an ALD, the speaker's voice seems as though
he or she were standing no further away than the listener's
shoulder.

Assistive technology also includes a variety of alerting devices
that inform the person with hearing loss when certain
environmental events are occurring, such as, a doorbell or
telephone ringing, baby crying, knocking at the door, alarm clock
ringing, etc. These devices are programmed to trigger flashing
lights or vibrating devices that inform the user that
environmental sound signals are occurring. There are also
specially trained dogs to inform people with hearing loss about
these kinds of sounds occurring.

Appropriate use of these resources enables people with hearing
loss to understand much of what would otherwise be missed and
also serves the very important function of increasing the users'
awareness of what is going on around them and enhancing their
sense of physical safety -- a basic function of the auditory
system. 

Know the specific causes of communication breakdowns -- this is
extremely important for people with hearing loss and for those
who regularly interact with them.

In our experience, most people who are hard of hearing blame
their hearing loss when they experience difficulty understanding
what someone is saying. In reality, there are a host of other
factors that contribute to communication problems. When people
are able to pinpoint these other causes of communication
breakdowns, they are in a position to resolve the problem and
increase their understanding. We divide these other causes into
three categories -

- speaker factors, environmental factors, and listener factors.

 Speaker factors include the way the person talks, e.g., the
rate, loudness level, and clarity of speech and other
characteristics, such as, facial hair, distracting mannerisms,
foreign accent or regional dialect, facing or not facing the
listener, etc.  

Environmental obstacles to understanding include background
noise, poor lighting, visual or auditory distractions, poor
ventilation, and lack of assistive listening devices.  

 Listener factors include such things as type and severity of
hearing loss, ability to pay attention, motivation to hear,
fatigue, emotional state, and tension level.

We believe that all people with hearing loss will benefit from
being able to: 

* Assess listening environments for barriers to communication and
learn how to minimize their effects.

* Assess speaker's communication behavior and offer specific
suggestions for changes when needed.

* Assess their own behavior and condition to identify what they
need to change about themselves in order to prevent or reduce
communication problems.

People who have hearing loss should be able to competently inform
others about the fact of their hearing loss.  

If others are unaware that the person has a hearing loss, here is
a high risk that misunderstandings will be attributed to
something that is not very flattering. People who are hard of
hearing can be accused of being stupid, weird, aloof, unfriendly,
incompetent, lazy, not interested, etc., when, in fact, they have
simply misunderstood what was said or were unaware that someone
was talking to them. It is important to be able to simply and
directly inform others about one's hearing loss in order for them
to know the reason for the problem should a communication
breakdown occur.

It is also very important that people with hearing loss are able
to inform others about what to do to be understood.

Most people with hearing loss will say things like, "What?"...
"Huh?"... "I'm sorry"... "Would you repeat that?"... "I didn't
get that..." when they fail to understand what is said to them.
These kinds of responses are ineffectual in improving
communication because they do not inform the speaker about what
to do to solve the problem. Instead, we want people with hearing
loss to say things like, "It would help me if you could look at
me when you speak."... "I'd appreciate it if you could slow down
a little."... "Because of my hearing loss, I need you to speak a
little louder."... etc.

It is also important that people indicate that they need a change
in communication behavior in the speaker because of their hearing
loss.

Otherwise, speakers can feel criticized and become defensive when
asked to change their behavior. By putting the onus on oneself as
in, "Because of my hearing loss I need you to...," the speaker
has no reason to feel criticized. Such a statement informs the
speaker about the facts of the situation and provides an
opportunity to be helpful (and many people respond positively to
that). Also, once people know the reason for the request, they
are usually more likely to comply.

People who have hearing loss need to learn to use helpful
reminders when others forget to modify their communication
behavior in order to be better understood.

An unfortunate fact of life is that once people are informed
about what to do to be understood, they will almost immediately
forget to do it. We are all more interested in what we are saying
than in how we are saying it, so we quickly forget about the
latter. Also, we have all been talking the way we do for most of
our lives, so our communication behavior is over learned,
habitual, unconscious, and, therefore, very difficult to change.

For these reasons, people will forget what we have just asked
them to do, and we will have to remind them repeatedly. Such
reminders, if verbal, can be most irritating to both speaker and
listener, so we recommend that people use hand signals to serve
as reminders. For example, raising the palm of a hand upward can
be the signal for raising one's voice. The advantage of hand
signals is that they remind the person, without the necessity of
verbally interrupting. 

Another useful strategy is to model the communication behavior
desired from others.

If it is desirable that speaker's refrain from talking from
another room, people who are hard of hearing should not talk to a
person from another room either. They should also learn to
modulate the rate and volume of their speech so that it is about
what they want from others. Being polite while doing so, e.g.,
making requests rather than demands, goes a long way toward
reducing irritation and eliciting cooperation from others.

People with hearing loss benefit greatly from identifying and
eliminating their nonproductive reactions to communication
difficulties and from replacing them with more constructive
responses.

When communication problems develop, both the speaker and the
listener will respond to them in some way. Some responses serve
to improve the situation and resolve the communication problem.
Other reactions serve to make the situation worse and increase
communication difficulties. Examples of the latter are: becoming
angry, depressed, anxious, or guilty. Other examples of
nonproductive responses are: bluffing, withdrawing from the
situation, or dominating the conversation. Replacing these
responses with pausing to identify the cause of the problem --
for example, removing environmental barriers to communication,
informing the speaker about what to do to be understood, and/or
effectively reminding the speaker when he or she forgets to do
what has been suggested -- are examples of constructive responses
to communication problems. Learning to relax instead of becoming
tense and anxious is also very useful in coping with
communication
problems.

It is important to know the difference between not understanding
and misunderstanding.

A very frequent complaint reported by family members is, "I never
know when he's understood me and when he hasn't, It's frustrating
and very irritating." When people who are hard of hearing know
that they haven't understood what has been said to them, they
need to acknowledge that fact, offer a suggestion for resolving
the communication problem, and show appreciation to the listener
for taking the time and effort to help them understand. A major
problem for both speakers and those who are hard of hearing is
misunderstanding -- thinking we heard it correctly, when, in
fact, we did not. Recently, I heard someone tell me, "I'm going
to the tooth fairies place." In reality she had said, "I'm going
to Tewksberry Place." Another one was, "There's the woman with
the bathing suit." This was rather startling because it was in
late October. What had actually been said was, "There's the woman
with the baby seat." 

These kinds of misunderstandings can occur frequently throughout
the day, and they can be devastating to relationships when
appointment times, places to meet, people's names, etc., are
mistaken. At work, when contract figures, telephone numbers,
client names, etc., are misunderstood, the result may be loss of
money or loss of a job.

It does no good at all to ask the hard of hearing person, "Did
you understand what I just said?" If they thought they did
understand, they will answer, "Yes, of course."  The only
solution to this dilemma is that the person who is hard of
hearing needs to say back the important details, such as,
numbers, names, times, and locations. "You said Friday afternoon
at two o'clock at the Riggs Bank on 18th Street?" Then, if a
detail has been misunderstood, the speaker can correct it on the
spot.

Getting Started

All of these strategies seem obvious once stated. The difficulty
lies in putting them into practice, and they need considerable
practice before they feel natural and easy to do.  Practice
sessions at home with family members is an effective way to
establish these good communication habits. 

With all the information now available for the asking, still,
many hard of hearing people and their family members are not
aware that such help exists, and, consequently, believe there is
little that can be done to accommodate their hearing loss or to
compensate for it. Our experience over the past several years of
working with people with hearing loss -- and helping them respond
to and devise coping strategies -- indicates the opposite is
true. There are always things people and those with whom they
interact can do to prevent or reduce the common problems related
to hearing loss.


Education and support are there for the asking.

In addition, for an idea of some of the many books we have
written and videotapes we have made that go into much more detail
about how to make the changes suggested above, please see the
list at the end of this article.

People who have hearing loss and those with whom they frequently
interact will profit greatly by learning about and using local
and national resources such as Self Help for Hard of Hearing
People, Inc. (SHHH).

Samuel Trychin, Ph.D., is professor of psychology at Gallaudet
University in Washington, D.C. He has developed the Living with
Hearing Loss Program under the joint sponsorship of Gallaudet
University and SHHH. Dr. Trychin's field is the application of
psychological concepts, principles and procedures to problems
experienced by people who are hard of hearing, their families,
friends and co-workers. Dr. Trychin is hard of hearing and an
SHHH member.

Living with Hearing Loss

Staying in Touch by Samuel Trychin, Ph.D., and Janet Albright is
a workbook that provides in-depth information about the effects
of hearing loss and includes exercises designed to improve
communication. 100 pages, $15 plus $3 shipping and handling.
Available from SHHH Publications.

Communication Issues Related to Hearing Loss by Samuel Trychin,
Ph.D., is a book that outlines the essential communication issues
related to hearing loss for people who do not know the many ways
in which hearing loss can impact on people's lives. 65 pages, $12
plus $3 shipping and handling. Available from SHHH Publications.

These and other books and videos from the Living with Hearing
Loss Program are available in the SHHH Publications catalog. Call
or write for a free 1995 catalog.


The Unintentional Hurt
by Helen M. Melson

A friend shared an interesting example of misinterpretation --
one that led to emotional hurt. She had gone to the same doctor
for years and always had excellent communication with him.
However, as her hearing deteriorated, so did the communication.
She noticed at times when she asked the doctor to repeat
something he would frown or slightly shake his head.

My friend kept asking herself, "Do I annoy him? Does my hearing
loss bother him too much? Doesn't he realize that it hurts me to
need to ask him to repeat and repeat?"


Finally, she felt that she must know how much her hearing loss
interfered with their communication.

During her next visit to the doctor she said, "I don't like to
ask you, doctor, but does my hearing loss disturb you?"

At that the doctor laughed and shook his head in dismay. "You
disturb me? NO! I disturb myself when I can't put words into a
form which will help you."

Sometimes one just has to ask in order to help understand and
erase a "hurt."

Helen M. Melson lives in Venice, Florida, and is a member of the
Charlotte Ears Tri-County Chapter.



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