By Dr. Charles Laszlo
I am a hard of hearing person who wears hearing aids. People think this solves all my communication problems – after all, that’s what the hearing aid advertisements say, don’t they? But I have many communication needs that require more than hearing aids can provide.
There are many faces to the hard of hearing person.
I am a hard of hearing student who wears hearing aids. At home, my mom makes sure my needs are met, but at university next year, I’ll be living alone. I’m worried about sleeping in and being late for classes. But I’m also worried about hearing the professors and whether they and other students will communicate with me the way I need. I depend on captioning for everything.
I’m an adult office worker and I wear hearing aids on the job. Being safe and connected when I travel on business is always a challenge, as is communicating well in our noisy office, and during meetings and conferences.
I am a senior and I am hard of hearing. Living alone, I’m worried about being safe in my home, because my hearing aids don’t pick up everything. I cannot hear the doorbell, the telephone, or the fire alarm and when someone tries to explain all the options, I get confused. Social outings are noisy and challenging, including the seniors centre, when I go to the doctor’s and at my place of worship. My main entertainment is now TV, but I find it hard to read captioning.
No matter which of my faces you see, I have needs that hearing aids alone do not provide for.
The conventional wisdom is that if I am provided with the means of hearing sounds better, my problem is solved. But hearing sounds is not the same as understanding speech! As a hard of hearing person, I need more than just to hear. I need and want to communicate! That means the ability to understand and interpret sounds properly, to understand speech and be able to extract information, and to react appropriately to what is said and to what is happening around me.
Hearing aids are wonderful devices but they have limitations. Perhaps it’s more accurate to say that the hearing aid (a technical device) and I (the person wearing it, a physiological entity) together have limitations. The intact auditory system together with the brain has the incredible ability to understand even severely distorted speech and to extract meaningful information when masked by noise and interference. But I have lost this ability to varying degrees, even when the sound is loud enough. Hearing aids are designed both to amplify sound and to compensate for this loss of ability. They amplify well, but can only compensate for ‘discrimination loss’ to a limited extent.
This is where assistive devices come into the picture.
Here’s a summary of my major activities and the assistive devices that I may require in those circumstances:
|
DAILY EVENT
|
ASSISTIVE DEVICES |
| Wake up | Alarm clock with vibrator and flashing light. |
| Phone calls at home and at work, land lines | Hearing aid-compatible phoneTextingBuilt in amplificationRinger connected to visual or vibrator indicatorComputerized speech recognition
|
| Driving to work, to the doctor, to school | Emergency siren recognizer |
| One-to-one discussion with a friend, a co-worker, the doctor, in the bank | Personal communication device (FM or infrared) |
| Meeting with a group of people present at work, at the seniors centre, in school | Portable FM or infrared device placed in the middle of the table, loopReal-time captioningOne-to-one personal communicator |
| Noisy restaurant | Personal communication device with directional microphone. |
| Conference in a large hall holding 300 people | Large-area infrared, FM or loop system. |
| Cell phone call | Phone with vibrating option.TextingHearing aid-compatibleHigh output |
| Travelling in car with passenger | Personal one-to-one communication device with directional microphone. |
| Family dinner | Portable infrared or FM device placed in the middle of the table. |
| Watching TV | CaptioningInfrared, FM or loop device connected to TV. |
| Door bell rings | Vibrator worn on body and flashing lights. |
| Child care | Baby monitoring device with vibrating annunciator |
| House and fire-alarm | Flashing lights and/or vibrating annunciator |
Many of the technologies don’t stand alone in isolation but form a system of communication for me. I need this system to remain active, productive, emotionally balanced, and not isolated.
Some of these technologies aim to deliver ‘clear speech’ without distortion and noise so I can use my remaining speech-understanding ability to the fullest. Other devices alert me to warning and other environmental sounds, while others connect me to electronic communication devices. Each of these devices provides an essential component of my daily communication needs, allowing me to function in the family, society, in the workplace, and in the school.
While a great deal of information on assistive technologies is available on the internet, this is not enough. First, I have a problem selecting proper equipment – I need technical expertise or expert guidance. No equipment is suitable for every situation and I often don’t have the experience or the technical knowledge to judge or even understand what the specifications say.
My second problem is that I have to make the various devices work with my hearing aids. This is a great challenge, as different ‘interfacing’ approaches have different limitations and may or may not fit my circumstances. It would have been a tremendous benefit if my hearing aid fitting had included provisions such as a T-switch to use with assistive devices.
The third problem is that different brands of devices work differently and lack of standards prevents me from combining different brands to fit my needs. You can buy a hi-fi from one company and speakers from another, but I am often tied to a specific line of assistive devices.
These problems show that I need a comprehensive approach to hearing aids and assistive devices so that I can derive maximum benefit. I often look for help rather desperately. Sometimes I get it from peer contacts, volunteer consumer organizations and through service organization, but often I don’t have anywhere to turn.
Yet, there is one professional who has the expertise to advise and to guide me in my quest for communication accessibility – the audiologist.
The profession of audiology is highly respected and I trust your advice. You provide support with custom hearing aids that are digital and/or programmable and check my functionality with assistive devices and I am grateful. Yet I feel that far too often you don’t seem to be involved with my struggle to communicate and to function effectively.
Yes, you fit my hearing aids and you do a marvelous job, but beyond that we have no contact! You are in the best position to guide me in my quest to communicate, to achieve security and to participate in everyday life. You have the training, the technical knowledge, and you are the professional who fits my hearing aids.
What I need and what I want is for you to look beyond your conventional role and become my communication specialist!
Becoming a communication specialist will require you to understand how I function and what my specific communication needs are, and then help me acquire the integrated, comprehensive communication system that suits me. You will also need to monitor my ability to cope and remain functional. This includes technology but also goes beyond technological measures. After all, communication goes beyond ‘hearing’.
The hard of hearing community as a whole challenges the audiology profession to embrace this role with enthusiasm.
Charles A. Laszlo is professor emeritus of electrical and computing engineering at the University of British Columbia. His professional career focused on technologies and systems that allow hard of hearing people to function effectively in their everyday lives. He was the founding president of the Canadian Hard of Hearing Association and served as president of the International Federation of Hard of Hearing People. While retired, he remains active in professional and volunteer activities on behalf of the hard of hearing community. [email protected]
This article is an abridged version of Dr. Laszlo’s article that originally appeared in the Canadian Hearing Report, Vol.7 No.6, 2012.
Hearing aids are wonderful but they only connect us to the hearing world as long as the voice is between 3-6 ft from us. We need assistive listening devices and our hearing health provider should be acquainted with them. Power went out last night and needed to listen to battery packed radio for information. Used my personal assistive listening device with headset to hear radio news. This device had a volume and tone control. Also used when I need to go to hospital and do not want to wear hearing aids as they may get lost or damaged.
Dr. Laszlo is absolutely right about the need for communication specialists and one would think that, with Costco now selling Phonak and audiologists complaining about the lack of service those Costco customers will get in the testing/dispensing/servicing of their hearing aids, that they would see being a Communication Specialist as one way to show how their services are superior.
We’re fortunate here in Albuquerque to have a well stocked, professionaly run assistive devices store where people can try, then buy and, if necessary, return devices. It’s never made sense to me that hearing care offices here and especially elsewhere would not stock and sell at least some of the basic devices like neck loops, personal amplifiers and personal FM sets. They seem to be all excited over devices from their HA makers that interact with the TV etc. but not devices with other brand names and applications. I, like so many others, had to learn about HLAA on my own (no help from the audiologists/dispensers) and thru HLAA learn about assisive devices. That the HA makers don’t also market some of these other devices (even if just under license with Williams Sound or whoever) also has never made sense. That’s extra income to the practice, greater satisfaction from the client – a win/win in my book.
Even just a handout picturing and explaining some basic ALDs along with info on how to order them onlline, handouts on coping skills, brochures for HLAA or ALDA and other very cost effective means of providing information and service beyond what Costco, Sam’s Club, Walmart etc. provide would be a step toward being more of a communication specialist.
When over 50% of audiologists and dispensers in one study didn’t even make certain their clients understood the telecoils that were probably in their hearing aids and of the various ways they can increase the functionality of their hearing aids, you know something is wrong. That over 80% didn’t tell their clients about HLAA, ALDA or other consumer resources sort of puts the much touted “superior service” from most hearing care offices in question. Communication specialists – I don’t think they are nor do they want to be – they just want to sell hearing aids.
The total lack of mention for quality captioning is lamentable! No mention of real time captioning (CART) at all – even for education, conferences, etc. – and yet mention of “computer” speech recognition. No mention of modern needs for quality captioning on the Internet (all videos). He’s not our communication specialist.
Talking about the varieties of concerns, sure, that’s good. Ignoring a major group who uses captioning, even with aids and implants too, that’s not good.
Lauren, captioning is included in this article.
As a mother of a young child with hearing loss this is a great post to share with educators. It definitely helps to dispel the myth that when he puts his hearing aids on all of a sudden he is “hearing” – while they help him tremendously there are all the other parts of the communication process to consider. This post does a great job of addressing all the complexities of communication. Thank you!
Excellent article and one that many don’t realize or understand for the hearing impaired and their needs.
There is one area that I didn’t see mentioned in the article and perhaps I may read this again to see if I missed it. I know that this article is geared towards technical communication, but where in this is that those who are HOH would greatly benefit from Speech Reading, so that when in those noisy situations they can use one more means of communication that will help to enhance their ability to hear and see what is being communicated to them?
I have worn Hearing Aids for close to 14 years now and only in the last year as my hearing has decreased to the point that I am waiting to receive a CI, have I even thought about a way to help me learn to hear better and am excited to start learning and eventually teaching others Speech Reading.
Steve,
Steve,
I’m much interested in retail store for ALDs in Albuquerque. Can you provide specific name or address. I’ve thought for some time a bricks and mortar retail place to try ALDs could be very successful in meeting the needs of HOH folks.
Loved this article. Didn’t realize there was such a thing as an Emergency siren recognizer! I will have to research 🙂
As someone who is eventually going to open my own daycare and has a hearing aid and a cochlear implant, I have used the alerting system with the personal alerting system, and it works great! Thanks to technology today, there’s now video baby monitors, which is great for hearing parents too, as babies like to talk in their sleep sometimes, and may not need to be picked up right away. 🙂
Thanks for the fascinating read!
Brilliant! A thorough needs assessment is the foundation of effective hearing loss treatment, and this piece might be included as a required document in the library of every graduate student training for a career in audiology.
Brilliant piece of work and right on target. Enjoyed the thoughtful comments as well.
It is so, so encouraging to read an article that goes beyond the fact that a hearing-aid is the tool to solve all hearing issues and that amplification is not always the solution to a hard-of-hearing status. After studying auditory processing, I have come to gain valued and enhanced insight to the scope of “communication”. I am a speechreader and although a hearing aid provides a cue to sound is coming my way, I am in need of “the visual component” to augment communication elements and understand the oral approach. Thank you for sharing your words of wisdom.
Melanie Elliott
Halifax