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.

Lipreading

Most deafened people using hearing aids or cochlear implants will still need to lipread. You may need help and a lot of practice to acquire this skill but even then the abilities of different individuals may vary considerably.

Lipreading is using the visual clues supplied by the movements of the lips and tongue against the teeth to understand speech. It relies a 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. m, b and p, so the difference between bath and path would not be clear to the lipreader 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 lipread. It doesn’t always work though - “she was married last year” and “she was buried last year” convey entirely different messages but to the lipreader they look much the same! So in the last resort, always keep a pen and paper handy, it can be very useful should you get into trouble.

All people, whether hearing or deaf read other visual clues in communication, notably those from “body language”. Smiles and nods are often used intentionally to convey a meaning while other signs, for example frowning and fidgeting, are often unintentional but can usually give an equally obvious meaning. Many people with hearing loss can become very skilled in gathering these non-verbal clues. You will be introduced to reading these clues in lipreading classes along with other skills such as fingerspelling and communication tactics.

Lipreading classes, available in many but not all areas of the country are generally few in number and may involve travelling some distance. In some cases they may be provided by local charities at no cost to those attending. When provided at Further Education Colleges however, they will be subject to normal Adult Education fees and you will have to pay unless you are on one of a specified range of benefits.

To find a lipreading class contact your local Adult Social Care (sensory disability team) or NHS audiology (hearing services). The Association of Teachers of Lipreading to Adults (ATLA) website (see Factsheet 1, Section b) also provides a link to a listing of all lipreading courses by region currently being run.

Qualified lipreading teachers may also 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 lipreading classes and qualified tutors. As well as learning and practising lipreading you will have the chance to meet other people with hearing loss and discover more about the wide range of strategies that are essential for adequate communication.

Strategies

You won’t be able to pick up a conversation from lipreading, body language or any remaining hearing that you have when the person you are talking to is, for example, mumbling, laughing, eating or looking away while talking. They need to be fairly close to you and somewhere reasonably quiet, with a good light on their face and no distractions. They need to be looking at you, speaking clearly and preferably a little more slowly than normal. But hearing loss is a hidden disability and if you are fussing around trying to arrange all that without letting the other person know what you are trying to do, it can begin to seem a bit odd and you may get flustered and anxious which will simply make matters worse.

When you are first deafened, it isn’t easy to tell others that you are “deaf” or that you are trying to lipread but you do need to let them know somehow, or they will simply carry on regardless. Once they do know, most people will try to help but may be rather unsure how to do so. It would take a long time to tell them everything and would get very boring, so be brief at first and you can feed other bits in later, if you need to.

Like how it can help if they get your attention before starting to speak and making sure that you know the subject early in conversation. They will also understand and feel far more comfortable when you frequently keep asking them to repeat or to rephrase bits that you simply cannot work out no matter how hard you try, as you no doubt often will!

So don’t get edgy and anxious trying to catch every word because you won’t. Relax and you will often find that you can pick up more of what is said. You’ll start to find ways to deal with the gaps or sometimes fill them in retrospectively but do ask for help if you need it.

A Hearing Aid?

With the introduction of digital technology, many more people 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). There are some that fit in the ear and therefore cannot be seen but these are not normally suitable for severe/profound hearing loss.

All that a hearing aid will do is amplify the sound that is already there. However, the audiologist can now adjust the amounts of amplification at different sound frequency bands, which will help to meet the personal needs of each individual. There is also a volume control on the aid which can be adjusted by the wearer but background noise, general chatter and traffic are amplified too, which can be annoying. Electronic feedback causes the aid to whistle, and the wind causes it to roar, although many aids now have a program switch to help get the best results in different circumstances.

A very important part of the hearing aid is the earmould. 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 that 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 understanding by a combination of lipreading and 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 see Factsheet 7.

The Hearing Aid/Cochlear Implant T (telecoil) switch

BTE aids and cochlear implants will normally include a T switch, which can be easily operated without removing the aid and will connect the aid with the sound output from an induction loop. The wearer will then hear the incoming sound from the induction loop microphone alone, cutting out most of the background noise and interference. Many hearing aid users find this helpful in banks, ticket offices and similar noisy places so look for the T symbol at these places to see if a loop system is in use (or simply try using the T switch to find out that way).

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 lipreading.

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.

Cued Speech?

Cued Speech is a method of improving understanding in lipreading. Different hand shapes are made in different positions close to the face to clarify the invisible or ambiguous lip patterns. Although it takes longer to learn than finger spelling, the fact that it is English based makes it easier to understand the 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 , Section b ).

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. 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.

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.

Finger spelling?

Finger spelling, which is normally taught in lipreading 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 lipread it can provide a vital clue. Deafened people, their families, friends and colleagues would benefit from learning finger spelling.

If you would like interactive practice using fingerspelling, go to the RNID website page or the British Sign page.

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