Helping Clients Own Their Hearing Loss and Choose Action

Author: Judith A. Curtin, Au.D.

How many times have you heard this conversation?
Spouse 1: "You can’t hear!"
Spouse 2: "I can hear! You mumble."

No doubt you’ve heard that in your own practice countless times.

As an audiologist, you know what is happening. An audiogram tells you that Spouse 2 has a bilateral normal to severe sloping sensory neural hearing loss (SNHL). Spouse 1 tells both of you that Spouse 2 is missing parts of conversations, is becoming withdrawn and that both of them feel frustrated.

Odds are that you have shared that information with him or her. You might also have educated him or her that the only people who mumble all the time are teens, people with neurological impairments or who are very tired. And you well know that Spouse 1 has made his or her point repeatedly. “You hear what you want to hear.”

But Spouse 2 is adamant: “I can hear.”

How do you help your client, Spouse 2, recognize that a hearing loss is behind the struggle, so that together you can begin an open-minded conversation about solutions?

The process to setting up a shift in mindset is:
  • Listen and validate.
  • Create a path to allow Spouse 2 to come to his or her own conclusion—that a hearing loss is the culprit in the situation and that hearing aids aren’t a fate worse than death, but a tool that will bring empowerment and joy back to their lives.
The key behind the process is to recognize that no one wants to be told what to do and, therefore, to help the client discover what’s happening. This process begins by fixing everyone’s language. Here are some tip for getting the conversation headed in a more productive direction:
Listen and validate
Acknowledge that these clients can hear. Validate that, in fact, they hear all the time. They can detect vowel sounds and most environmental sounds just like an 18-year old. There is just no “clarity”. Let them know that you are hearing them when they say they understand: When they smell coffee brewing and they hear, “Wanna u of offee,” they are completely accurate when they reply, “Yes, make it a large.” Recognize, furthermore, from their perspective it does sound like people around them mumble a lot of the time.

Instead of thinking that clients are denying the truth, and arguing your point of view, realize that they have a different perception of their situation that could be expanded.
The Path to Self-Discovery
To help clients recognize and identify that their struggle is a hearing loss, take them through the following exercises:

  1. Compensation through speechreading

    Say to clients: “I just stubbed my toe.”

    Mouth without voice: “Oh, Sh..t.”

    Ask: “Did you understand that?’

    Most likely they will answer yes. Explain that their ears hear vowels and a few consonants, although some may sound unclear or mumbled. Some sounds they can’t hear are easy to see on the lips—sh, f, p and th. Let them know that in some of their communication, they are speechreading/lipreading instead of hearing all the signals. Although clients may have insisted that they are not even able to lipread, let them know that they can and are, as the exercise demonstrated. That’s why speech is clear when people face them and not clear when they walk away.
  2. Compensation through context

    Extend your hand and say to clients these vowel sounds: “Ow-ah-ou?”

    Ask: “Did you understand that?”

    Again, they will say yes. That is an opening to explain that much of what they believe they are hearing only is actually understanding through context. Educate them that speechreading and communicating in context aren’t always possible. Explain that when speakers turn their heads or leave a room, listeners lose visual signals. If speakers turn their heads and change the topic, listeners are really in the dark.
  3. Filling in the gaps

    Say to clients: “I don’t feel very well.” While waving your hand in front of your face, say with normal intonation, “I’m going to go upstairs to… o da e.” Ask: “What did I say?”
    Most clients will say, “I’m going upstairs to go to bed.” Let them know that you said, “I’m going upstairs to…” and that you then mumbled gibberish. Explain that our brains are filling in words all the time. Thank goodness for context sometimes…

    Caution clients, however, that our brains don’t always fill in the gaps correctly. Let them know that when asked to repeat whether you said “sick,” “sex,” or “six,” people may prefer not to say what they heard. Then their brain has to try and figure out what was really said, they hope. This takes up working memory or “inside brain chatter”, new information cannot get into your brain because it’s busy sorting out, “was it sick or sex”. Reinforce “no wonder you think you have memory issues! Your brain is on ‘overload’ all the time.”
  4. Identifying ease and struggle.

    Explain that you are going to talk to clients starting at a soft conversational level. Ask clients to note how they relax or become tense while you talk them, and what it feels like when they need to work or pay close attention in order to understand.

    Then speak to them at PB MAX through an audiometer about sports or a current event. Go down to 40dBHL and switch to an unpredictable topic for 30 seconds. Then take it back up to their MCL, change the topic again, and remind them to focus on how relaxed or tense they feel. Finally, go back down to 40dBSL.

    Ask: “How would you describe the changes in tension and energy as you were listening?” At normal/soft conversational levels your brain has to work hard. That is why you are so tired and/or irritated after being with more than one person.

    Most likely, clients will describe a shift in energy and tension, including discomfort when conversation is at normal conversational level and reduced when conversation is within their hearing range.

    Explain that when they feel all day, every day, the level of tension they felt when the conversation was quiet, their bodies are experiencing undue stress. According to the Mayo Clinic, prolonged stress affects individuals in different, but unhealthy ways: contributing to muscle pain, fatigue, loss of sleep, upset stomach, change in sex drive and mood including irritability, sadness and lack of motivation, and more.

    The relaxation that your ears hear at MCL is exactly what hearing aids will do for you. “They will make you more relaxed, less tired and more confident at the end of the day.” Emphasize relaxed, energized and confident.
As clients feel heard and validated, and experience the opportunity to discover—on their terms—what is occurring when they listen, they expand their understanding of the listening situation. Instead of projecting their challenges as family and friends mumbling, or identifying them as memory loss or other problems, they discover that their ears are mishearing, a situation easily corrected. That realization provides the opening for a discussion about hearing aids and a return to joy, more energy, relaxation and easier conversations. They will either decide to move into action, or go home and “prove me wrong”. In three months, they will have proved me right, through self-discovery and re-identifying how their hearing is impacting their life.    
Dr. Curtin is the owner of ABC Hearing in West Chester , PA and can be reached at

This article was edited with help from Carol Mtezger.