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:
|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. firstname.lastname@example.org
This article is an abridged version of Dr. Laszlo’s article that originally appeared in the Canadian Hearing Report, Vol.7 No.6, 2012.