How will I communicate?

Hearing loss is invisible but it affects one of the most vital of all human faculties - the ability to communicate our thoughts and feelings to others through speech and language. Many people become hard of hearing as they get older. This is a gradual process, and is not as traumatic as being deafened, but it is still important to adopt adequate strategies to communicate with other people and avoid becoming isolated. There are many ways of minimising the difficulties by doing whatever is possible to overcome the communication barriers.

Lip-reading

Almost all deafened people, whether they use aids or not, will need to lip- read. The lip-reading abilities of different people vary and you may need help and practice to acquire this skill.

Lip-reading is using the visual clues supplied by the movements of the lips and tongue against the teeth to understand speech. It relies a great deal on guesswork and it helps to know which frequently used words are easily confused, e.g. eighteen and eighty. In addition, some sounds look exactly alike on the lips, e.g. b and p, so the difference between bath and path would not be clear to the lip-reader until they are put into context - "The man is walking down the path", "The bird is having a bath". For this reason it is important not to use a single word on its own - a sentence is much easier to lip-read. In the last resort there is always a pencil and paper so it is useful to have a small notepad handy should you get into trouble.

Many further education colleges run courses in lip-reading, both during the day and in the evening (see previous section). Unfortunately, the pressure on education budgets mean that you will probably have to pay the same fee as for any other course unless you are on one of a specified range of benefits. Some local authorities subsidise courses, by charging a nominal fee, or even provide them free. Find out from your local college or local authority.

Qualified lip-reading teachers may be able to provide tuition in small groups. Employers may wish to support such activities as part of their obligations under the Disability Discrimination Act (see later section on this legislation).

ATLA will provide information about lip-reading classes and qualified tutors. As well as learning and practising reading someone's lips, you will discover the wide range of strategies that are essential to have adequate communication while having the chance to meet other people.

See also the NADP leaflet A Few Tips for Successful Communication with Deafened People.

A hearing aid?

It is important to find out whether, in spite of apparent profound deafness, you have some useful residual hearing. Hearing aid technology has developed to such an extent that some people, who previously thought that they had no useful hearing, are now able to benefit from modern hearing aids.

Most, but not all, people have found that digital aids are better than the analogue aids they have replaced. Most aids, whether analogue or digital, are worn behind the ear (BTE), although there are some that fit in the ear and therefore cannot be seen. A BTE aid will normally have a T-switch, which can be easily operated without removing the aid. This means that the aid is fitted with a telecoil, which receives sound from induction loops and enables the sound to be heard more clearly by the wearer.

All that a hearing aid will do is amplify the sound that is already there. It can be adjusted by the audiologist to give varying amounts of amplification to different frequencies of sound, and this gives an element of meeting the personal needs of the individual. There is a volume control which can be adjusted by the wearer. Background noise, general chatter and traffic are amplified, too, and this can be annoying. Electronic feedback causes the aid to whistle, and the wind causes it to roar.

A very important part of the hearing aid is the earmould. This is made for each individual from a flexible pattern made by the audiologist. If it fits badly, or gets covered in wax, it affects the operation of the aid, so it should be cleaned periodically. The earmould is connected to the aid by a short piece of plastic tubing. This can be blocked by dust or condensation, rendering the aid inoperative, so it needs to be cleared or replaced. Batteries for NHS hearing aids are supplied, free, from the centre which dispensed the aid.

A cochlear implant (CI)?

A CI enables some profoundly deaf people to regain some useful hearing by by-passing the damaged cochlea and sending electrical signals (normally generated in the cochlea by the hair cells) to the auditory centre via the auditory nerve.

The speech processor of most CIs is worn behind the ear, though a body worn processor can be obtained if preferred. The processor transforms sound waves into electrical signals and is connected to a transmitter, held in place by magnets over an internally implanted receiver. The electrical signals are transmitted by radio through the skin and are passed along a wire to the electrodes of the implant which are threaded into the cochlea itself.

The CI is not a miracle cure for deafness but almost all users regain some useful sound, though it will require practice to interpret correctly what you now hear. Users are able to hear environmental sounds such as the doorbell, traffic and animal noises. Most users, after some practice, find that they can improve their lip-reading by using the auditory clues from the CI. Many are able to conduct a natural conversation with friends and family, particularly in a fairly quiet room. A number of people have been able to make some use of a voice telephone again, especially with close friends and family, and recover some enjoyment of music.

If you think that you are not getting much help from the most powerful hearing aids available, ask the ENT surgeon responsible for your care to refer you to the nearest CI centre.

For further information on cochlear implants, and a list of centres in the UK, see NADP's handbook: An Introduction to Cochlear Implants (£5.00 or free to members). See also Cochlear implants: a collection of experiences of users of all ages published by the National Cochlear Implant Users Association.

Sign language?

Some deafened people find it rewarding to learn to use signs and finger spelling. Their family and friends also need to acquire some knowledge of sign if they want to use it at home and socially.

Most of these deafened people use Signs Supporting English (SSE) rather than British Sign Language (BSL). BSL is the language of the Deaf community and is a language in its own right with its own grammar and syntax. BSL users are largely those who were born profoundly deaf or lost their hearing before acquiring speech and language in their families. Like any foreign language it takes time and practice to learn. SSE is the use of some signs taken from BSL to supplement lip-reading.

Some deafened people experience a kind of identity crisis. They do not feel at ease in the hearing world where communication is stressful and difficult and yet they cannot identify with the Deaf community where sign language is used.

A number of books and videos on BSL are available (see Factsheet 7). Courses leading to qualifications in BSL are quite widely available at Colleges of Further Education and other centres. You might find that most students on these courses are hearing people learning the basics of sign language.

Finger spelling?

Finger spelling, which is normally taught in lip-reading classes, is much less sophisticated than BSL or even SSE, and therefore easier to learn. If someone finger spells the first letter of a word that is difficult to lip-read it can provide a vital clue. Deafened people, their families, friends and colleagues would benefit from learning finger spelling. There is an interactive learning tool on the RNID website and a diagram here.

Cued Speech?

Cued Speech is a method of improving understanding in lip reading. Different hand shapes are made in different positions close to the face to clarify invisible or ambiguous lip patterns. Although it takes some time to learn, the fact that it is English based makes it easier to understand spoken language without strain or ambiguity and this can assist the development of lipreading skills. Details may be obtained from the Cued Speech Association (see Factsheet 1).

Through computer technology?

Scientists have been trying to program computers to recognise human speech for many years, and their efforts are now coming to fruition. Software packages, known either as voice recognition (VR) or speech recognition (SR), can now be bought quite cheaply and run on an ordinary PC at home. Currently most of these only recognise one voice, but can be set up within a few hours to track the voice of a family member or work colleague with considerable accuracy. As home computers become more powerful the speed and accuracy of these packages can only improve. It is also hoped that within a few years they will be able to recognise more than one voice, even against a noisy background. This might save having to use notepads to write words down – the hearing person would simply speak into a microphone using this software and what they say would be turned into text on the computer screen.

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