How I Help People Live Well with Hearing Loss



Author: Samuel Trychin, Ph.D.

Don is sitting in the living room reading from his cell phone when Nicole calls from the kitchen, “What time can you be ready to go tonight?” Don responds, “What did you say? I can’t hear you.” Nicole, frustrated, yells, “Aren’t your hearing aids working?” “You’d better get them checked.”

Joan is focused on her own thoughts at the dinner table when her niece compliments her on the dinner she had cooked. Getting no answer, the niece (somewhat annoyed) says to the others at the table, “Her hearing aids don’t seem to be helping her that much.”

Charlie works in a shop in which there is constant low-level background noise. The boss asks him if he hears better since he began using hearing aids. Charlie says, “Not really; in fact my hearing actually got worse when I wore them here. Now they stay in my dresser drawer at home.”

In working with people who have hearing loss and their communication partners over the past thirty years, these and similar scenarios are frequently reported. There are many instances in which psychological, social, and physical variables interfere with people’s ability to get the maximum benefit from their hearing aids. Having a hearing loss myself, I wear hearing aids and have personally experienced some of the issues.

If a person has lost the skill of paying attention to what is being said, a new hearing aid by itself might not help. If a person is socially inept or offensive, a hearing aid adjustment will probably not resolve relationship difficulties. If a person is chronically fatigued, new hearing aids may not help in focusing attention on what others say. Problems arise when people are not aware of the variety of issues that contribute to difficulty hearing environmental sounds, understanding what others are saying, and/or relationship difficulties. However, it is likely that they will blame their hearing aids as being the source of communication and other problems.

When people become aware of the variety of other causes of communication breakdowns, they are better able to determine the source of a specific problem, find a solution for it, and stop blaming their hearing aids. The following are some examples of other causes of communication difficulties.

Psychological variables include the following: Reduced self-esteem, which lowers risk-taking behavior and prevents the person from asking others to alter their communication behavior. Increased emotional reactivity, such as anger, can be overlooked as a cause of communication or relationship problems. Loss of ability to pay attention, resulting from frequent difficulty in understanding what others are saying, can leave one feeling frustrated, and tuning out.

Social variables include being avoided or left out as a result of communication breakdowns, which contributes to deterioration of communication skills. Self-isolation resulting from a history of embarrassment or shame also results in deterioration of social skills and in loneliness. Relationship problems at home or at work, stemming from communication breakdowns, can cause distracted attention and depression, which further interfere with understanding what others say.

The physical variables include the physiological effects of chronic elevated tension due to relative loss of contact with important environmental information/signals.

The physiological effects of increased emotional arousal prior to, during, and following difficult communication situations produce distracting physical and psychological discomfort. Disturbed sleep, due to worry about relationship or other effects of communication breakdowns, can result in fatigue and reduced ability to attend to what others are saying, adding to further communication difficulties.

Lack of information concerning the psychological, social, and physical effects of hearing loss frequently results in people blaming their hearing aids for the problems they continue to experience while wearing them. The result is frequently returning to the audiologist for a better hearing aid adjustment or different hearing aids, or, worse, putting the hearing aids in the dresser drawer and ignoring any further suggestions for improving their ability to hear/understand. There are reports (personal communications) indicating that when people have a better understanding of these psycho/social/physical effects, they stop blaming their hearing aids for the problems they experience and reduce the return rate often seen in many audiology offices.

Two major factors influence how well people adjust to their hearing loss and get the maximum benefits possible from hearing technology. The first factor is the amount of accurate information they have about their hearing loss, the general psycho/social/physical effects of hearing loss, and what to do to prevent or reduce these effects. Having this information is necessary for learning to identify the specific cause(s) of communication breakdowns and then make or suggest the changes necessary for increasing ability to hear and/or understand.

The second factor influencing a person’s ability to live well with hearing loss is how much practice they have had in:
  1. Identifying the causes of communication breakdowns, and
  2. Suggesting or implementing the environmental and/or communication behavior changes necessary for preventing communication breakdowns.
Habits, especially long-practiced communication habits, are very difficult to change, requiring the learning and practicing of new behaviors in response to familiar cues or signals. For example, many people who have hearing loss have developed the habit of bluffing or pretending to understand when they are aware that they do not understand what is being said. Replacing this habit of bluffing with a more functional behavior such as informing the person talking that they are not being understood and offering a suggestion for improving the situation, e.g., “I’d appreciate it if you will speak a little louder” seems relatively easy to do, but is not. Making such changes requires time and practice, practice, practice. Seeing patients in a group setting provides an optimal way of affecting such habit changes, because the behaviors that produce problems become evident as the people in the group interact. Then suggestions for improvement can be offered on the spot.

In this regard, sometimes problems are created when the person who has hearing problems knows what to do but does not know how to do it in an effective way, i.e., in a way that elicits cooperation from others. For example, I may know that I need to request that you speak louder when talking, but I ask you to do it in a way that turns you off completely, such as, “How many times have I asked you to speak up, stupid?” Additionally, it may not be the specific words used that cause the interpersonal problem, but rather that the facial expression, tone of voice, or body language of the requester is offensive. Again, this type of problem behavior/attitude can be more readily seen and corrected in a group setting than in the privacy of a one-to-one session in your office.

My experience working with people who have hearing loss and their communication partners, indicates that the following information is necessary for learning to live well with hearing loss. This is a brief summary of key issues that are covered in much more detail in my Living with Hearing Loss: Workbook.

Signs and symptoms of hearing loss
There are many people who know they have hearing loss but do not take action to accommodate it, believing that if they do not wear hearing aids, no one will know they are “hard of hearing.” Many other people wear hearing aids, but resort to bluffing when they become aware that they are failing to understand what someone is saying. These people often do not realize that there are conspicuous signs and symptoms related to hearing loss other than wearing hearing aids that indicate that something is wrong. For example, if I ask a person to do a particular thing and she doesn’t do it, I may think she is lazy, incompetent, inattentive, or uncooperative. If I had known she has a hearing loss, I would probably attribute the problem to her not having heard what I asked. That latter attribution would be better for her and for our relationship than any of the other attributions.

Misconceptions about hearing loss
There are a number of misconceptions related to hearing loss that produce difficulties in relationships, and sometimes, prevent a person from taking action to accommodate the hearing loss. An example of such a misconception is the belief that hearing aids and cochlear implants solve the hearing problem similar to the way that eyeglasses solve vision problems by returning many users to 20/20 vision. By assuming that when the person wears hearing aids he always hears normally, other necessary communication behavior and environmental accommodations are not made and he unnecessarily misses a lot of what is being said. Another misconception that creates problems is the assumption that professionals, e.g., physicians, psychologists, and educators, have been trained to know about hearing loss and its effects, when, in fact, the majority of them have not.
Communication disorder
Hearing loss affects everyone in the communication situation—those who are speaking as well as those who are trying to listen. Many people who have hearing loss are unaware of the negative impact of their condition on others. Sometimes, people will take steps to address their hearing loss when they are aware of the benefit to others, even when unwilling to do so for themselves. Also, frequent communication partners have their own perceptions and information about the effects of the hearing loss on the relative or friend who has it. For example, communication partners are often able to report issues that the person who has hearing loss is either unaware of or is too embarrassed to report. A full understanding of the range of effects of hearing loss requires knowledge of how it impacts communication partners as well as the person who does not hear normally. Including these partners in assessments and other phases of treatment can increase compliance with recommendations and otherwise benefit audiologists.
Problems frequently experienced
It is useful to inform patients about the problems frequently reported by other people, who have less than normal hearing-and by their communication partners. Listing these frequently reported problems serves several purposes. First, it clearly shows that hearing difficulties affect communication partners as well as the patient, and that taking steps to improve one's ability to hear and understand benefits others as well. Second, it indicates the range of situations that can be negatively affected by hearing loss, showing the importance of taking action to increase ability to hear. Third, it clearly indicates that the problems and concerns related to hearing difficulty go with hearing loss and are not necessarily an effect of personal inadequacies.
Causes of communication problems
It is probably impossible to solve a problem if its cause is unknown. In regard to hearing difficulties there are at least 40 identifiable causes of communication breakdowns other than less than normal hearing. The vast majority of these other causes are correctable. I find it useful to place these causes into three categories:
  1. Something about the person who is talking, (the speaker)
  2. Something about the environment in which the message is being delivered, (the environment) and
  3. Something about the person receiving the message. (the listener)
When people who are experiencing difficulty hearing or understanding something being said can identify the cause of the problem, they are able to suggest a change that can resolve the problem, e.g., “Please slow down while you are talking.” “If we move closer together, I’ll understand you better,” or “Please say that again, I was thinking about something else and wasn’t paying enough attention.”
Reactions to communication problems
When communication problems arise, people react to them in some way. Some reactions are effective—they resolve the problem. Other reactions are ineffective—they fail to resolve the problem and often make the situation worse.

Staying calm, pinpointing the cause of the problem, and suggesting or making a necessary change is an example of an effective reaction to a communication difficulty. Becoming emotionally upset, blaming oneself or the other person, and giving up is an example of an ineffective reaction to a communication problem that can serve to make the situation worse by damaging self-esteem or the relationship.

Learning to identify one’s ineffective reactions and the causes of communication breakdowns and then making the changes necessary to resolve communication problems is not easy. It requires practice and support, which is most readily available through an ongoing group program that meets on a regular basis.
Managing communication situations—guidelines
When both patients and their communication partners accept the responsibility to do the things required to prevent or reduce communication hassles, life becomes much more pleasant for both. Based on the issues and concerns discussed previously in this paper, I developed a set of communication guidelines for the person who is speaking to follow and a set of guidelines for the person who is listening to follow. When these guidelines are followed, communication breakdowns are greatly reduced. An example of a guideline for the listener is: Pay attention to the speaker. An example of a guideline for the speaker is: Get the person’s attention before beginning to talk.
Managing communication situations—other effective communication behaviors
There are additional communication-related behaviors that are helpful in increasing understanding and maintaining positive relationships when hearing loss is present. Examples are modeling the communication behavior desired from others, reinforcing other’s helpful communication efforts, reminding them when they forget to do what you need, and being specific when requesting a communication behavior change.
Managing oneself
Some people blame their hearing loss for relationship difficulties they experience, when the cause of those difficulties is their dysfunctional reactions to communication breakdowns. Communication problems, especially when frequent or occurring when the information is important, often produce emotional reactions that are not helpful to either the person speaking or to the person trying to listen. When emotional arousal is high, cognitive processes shut down and judgment and problem-solving ability are greatly decreased. Emotional habits are hard to break and require learning and practicing new behaviors and attitudes to familiar situations. Staying calm, determining the cause of the problem, and providing a solution requires learning and practice. The Living Well with Hearing Loss program includes procedures for helping people learn and practice emotional control that enables them to think more clearly in difficult situations.    
Samual Trychin, Ph.D. is a psychologist in private practice and provides consulting services to Stairways Behavioral Health in Erie, PA. One of his specialties focuses on psycho-social interventions for people who have hearing loss and their communication partners. Dr. Trychin can be reached at samueltrychin@gmail.com.