Common Difficulties Faced by Hearing-Impaired People and Tips for Communication with Them

Difficulties at medical institutions

Illustrations by MAMIE (a nonprofit organization)

Types and characteristics of hearing loss

There are often misconceptions about the ways hearing-impaired people communicate and hear.

Common misconceptions include that hearing-impaired people live in a completely silent world, that sign language allows you to communicate with all hearing-impaired people, and that hearing aids enable all hearing-impaired people to hear. Generalizing all types of hearing loss may prevent you from interacting appropriately with hearing-impaired people. There are many different types of hearing loss, whose characteristics vary according to the following factors:

① Where in the ear the problem is (the location of the problem)

② When hearing loss occurred (the time of the onset)

③ How hard it is to hear (the degree of hearing loss)

1. Conductive, sensorineural, and mixed hearing loss

Sound enters the outer ear from the auricle and passes through the external auditory canal to reach the tympanic membrane, from which it enters the middle ear. If there is a problem somewhere along this pathway, it can cause hearing loss of a type that is curable with treatment.

A large volume of earwax in the external auditory canal, a tear in the tympanic membrane, or fluid in the middle ear due to otitis media prevents the smooth flow of sound waves, thereby causing difficulties in hearing. This type of hearing loss is called “conductive hearing loss.” It causes the patients to hear human voices and other sounds at lower volume than before they suffer it, just as when the volume on the TV is turned down. When you are wearing earplugs or plugging your ears with your fingers, you are experiencing how patients suffering conductive hearing loss are hearing.

After reaching the middle ear, sound enters the inner ear, the deepest part of the ear. If there is a problem somewhere between the cochlea in the inner ear, where auditory stimuli are generated, and the auditory nerve, it can cause hearing loss of a type that is hard to cure. This type of hearing loss is called “sensorineural hearing loss.” Unlike patients suffering the abovementioned conductive hearing loss, patients suffering sensorineural hearing loss hear sounds not only at low volume but also distortedly and unclearly. As a result, they often cannot comprehend what people are saying despite hearing the voices as sounds. Hardness of hearing among elder people is a kind of sensorineural hearing loss but it is sometimes combined with conductive hearing loss. The type of hearing loss that combines both conductive and sensorineural hearing loss is called “mixed hearing loss.”

2. Congenital hearing loss, acquired hearing loss, hearing loss in children, and hearing loss in the elderly

If a baby is born with hearing loss, it is called “congenital hearing loss,” while hearing loss whose onset is during childhood after birth is called “hearing loss in children.” These two types of hearing loss cause the patients difficulty in learning to hear and speak and are also called “prelingual hearing loss.” Acquired hearing loss that occurs after language acquisition causes the patients difficulty in hearing only, with little difficulty in speaking.

Hearing people begin to experience a decline in their hearing ability in their 30s, and as they age, their hearing function gradually decreases. After the age of 65, the proportion of people with “hearing loss in the elderly” drastically increases. However, elderly people tend to be hesitant to accept the fact that they are suffering hearing loss, believing that they can hear normally. Meanwhile, hearing loss is less visible to others than a decline in physical strength or eyesight, causing the problem that the difficulties the patients are facing are hard for others to understand. In the case of elderly people with decreased cognitive function, it can be difficult to determine whether the slowness or loss of their reaction to the words of others comes from hearing loss or decreased cognitive function.

3. Mild, moderate, moderately severe, and severe hearing loss, and profound hearing loss (deafness)

Mild hearing loss (25–39 decibels): Difficulty in hearing soft voices

Moderate hearing loss (40–69 decibels): Difficulty in hearing normal conversations

Moderately severe hearing loss (70–89 decibels): Inability to hear normal conversations

Severe hearing loss (90 decibels or higher): Inability to hear even words spoken close to the ear

The degrees of hearing loss (average hearing levels) are measured in decibels (dB), with 0 decibels being normal hearing. Hearing loss to a degree that prevents the patients from hearing beeps at the highest volume in hearing tests is called “profound hearing loss” or sometimes “deafness.” In Japan, the term “rosha” (lit. “deaf people”) is used especially for hearing-impaired people who have selected to use sign language as the main communication tool rather than relying on hearing, even if they have remaining hearing ability.

Individual differences

There are various communication means available to hearing-impaired people, who differ in terms of what means they use and how much those means help them. For example:

・Can or cannot hear using hearing aids

・Can or cannot use lipreading

・Can or cannot use sign language

Additionally, below are common misconceptions:

・Those with lipreading ability may be able to communicate by phone

・Those who can pronounce clearly may be able to hear

・Those who can hear the phone ring may be able to comprehend the speech of others

・Those who can read lips during a chat may be able to talk with others about work.

There are large differences between individuals in the type and degree of their impairment, the environment in which they have grown up, etc. However, common to all hearing-impaired people is that visual information is a very important source of information for them.

More about the ears

Recognizing the different voices of multiple people at the same time

Many of you may be able to understand what others are saying even in a noisy setting, such as a drinking party. This mysterious ability can be explained by the “cocktail party effect,” the phenomenon of the ears exercising their special ability in sound processing to select and receive the necessary information only.

However, human voices recorded on a voice recorder are all mixed and hard to comprehend. The same is the case with sounds heard through hearing aids; hearing-impaired people using hearing aids are often unable to comprehend the simultaneous speech of multiple people.

Furthermore, hearing-impaired people need to constantly stare at speakers’ mouths to infer what they are saying. When multiple people are speaking at the same time, it is hard for hearing-impaired people to know whom they should look at, causing them difficulties in communication.

[Source] Why can people talk with each other even in a noisy place?
Japanese Psychological Association: https://psych.or.jp/interest/ff-10/ (in Japanese only)

Difficulties in communication

While hearing loss in children creates for them an impediment to language acquisition, hearing loss in adults who have already acquired language creates for them an impediment to information acquisition. Hearing loss, whether in adults or children, can impair communication with others.

The first problem that hearing-impaired people face is the difficulty in obtaining audio information from the surrounding environment. It is likely that they do not understand what others are saying or that they are not informed of what all others know. In such a case, they may request others to repeat what they said or ask them what is happening. However, they may again face the difficulty in comprehending what others are saying and ask others to repeat it. Then, even if they think they now understand what others have said, they may have misheard it and come up with an irrelevant response. Such a process of miscommunication will likely make others feel tired.

The biggest frustration of hearing-impaired people is not being unable to hear itself but being thought by others to be troublesome due to miscommunication and consequently being excluded from human communication.

Various means of communication

Hearing-impaired people vary in the degree of impairment and the type of hearing, resulting in differences in the communication means they prefer.

Means	Description and features
	Lipreading makes it easier for hearing-impaired people to comprehend words uttered slowly from widely opened mouths in simple conversations. However, this means cannot solve the difficulty in differentiating homonyms.
	Hearing aids rely on the remaining hearing ability of the user. Even with this means, being some distance from a speaker or a noisy setting will cause the speaker’s voice to mix with the noise and be hard to hear. The effect of hearing aids depends on not only individual differences in hearing ability but also the environment in which they are used.
	When multiple people speak simultaneously, speech-to-text devices and apps (such as UD Talk) are less likely to be able to recognize their speech. When there are multiple speakers, they should speak to the microphone one after another.
	Written communication is often used together with lipreading, but it is sometimes requested that written communication be used when there are technical terms or when work instructions are given in order to avoid mistakes.
	Some numbers are pronounced with a similar mouth motion. Gestures are effective in daily conversation, which often includes numbers and mistake-prone words.
	A hearing loop system sends audio signals to a magnetic induction amplifier, which transmits those signals as electrical signals to a loop antenna (multicore cable). A dedicated microphone delivers the speaker’s voice sounds directly to hearing aids regardless of the distance between the speaker and the hearing aid user.

* What is information assurance?

Information assurance denotes creating an environment where hearing-impaired people can have secure access to necessary information. One way to provide an assurance of information from the ears is to use hearing assistance systems, such as a magnetic induction loop and an FM hearing aid system, to make hearing easier. The methods of providing an assurance of information from the eyes include text presentation, whereby audio information is converted into text and displayed on a computer or tablet screen, as well as the use of a condensed transcription writer or sign language interpreter.

Tips for understandable speech

Where to speak: The best position of the speaker is that directly opposite the hearing-impaired person in a bright place.

Hearing-impaired people mostly look at the lips of speakers when communicating with others. If you speak near a window, the backlighting may make you difficult to see. If you have to talk with a hearing-impaired person in a dark place, you may enter text into your smartphone or computer and show it.

Lip movement:

・Move your lips clearly so that the vowels you are pronouncing can be visually distinguished from each other

・Tongue movement and the way of uttering plosives and voiced sounds are also important

These are extremely important information sources for hearing-impaired people who use lipreading techniques, inferring what speakers are saying from the movement of their lips. Therefore, if you speak close to their ear, they will be unable to understand what you are saying.

If your lips are overly close to them, it may be difficult for them to read your lips.

If you are wearing a mask, remove it or use written communication during conversation with hearing-impaired people.

Note that hearing-impaired people differ from each other in terms of whether or not the volume of the voice is important.

Speed: Speaking at moderately slow speed is the best.

Some hearing-impaired people face difficulties understanding overly slow speech. When you talk to hearing-impaired people, adjust the speed of your speech according to their reaction.

Clear intonation and pauses:

× Uttering words without pauses in such a manner as “Niwaniwaniwatoriganiwaimashita”*

○ Uttering words with appropriate pauses in such a manner as “Niwa-niwa_niwatori-ga_niwa_imashita”

* A Japanese tongue twister that literally means: “In the garden (niwa-niwa), two chickens (niwatori-ga niwa) existed (imashita).”

Tips for conveying information clearly

Compensate words with gestures:

Example: Say “two o’clock” while raising two fingers.

　　Say “Rainbow” while moving your arms above your head in a large arc.
(In Japanese, “two o’clock” and “rainbow” are both pronounced “niji.”)

Convey your topics:

Once hearing-impaired people know the topic, they can infer the content of your speech to some extent by thinking of related words based on your lip movement.

Every time your topics change, convey this fact.

Supplement speech with text: Use written communication, air writing,* text entries on a computer or smartphone, etc.

Words that are not commonly used, foreign words, and technical terms are difficult to infer from lip movement, so write such words for easy communication.

There is a technique called “condensed transcription” of using simple symbols, such as , which means “hearing-impaired people,” to save the time and labor necessary for writing.

* Air writing: Writing words in large size in the air with your finger

Supplement speech with relevant illustrations, photographs, and materials:

In such cases, hearing-impaired people have to look at both the speaker’s lips and the material, so align the direction of the material with the direction of your face and point to the part you are talking about.

Self-introduction book for the general public

Hearing data collection

Facilities that are difficult for hearing-impaired people to use

Source: Gihei Takahashi et al.: A Study Regarding Environmental Improvement in Facilities for Hearing-Impaired People,
Journal of Architecture and Planning (Transactions of AIJ), No. 567, pp. 29–35, 2003

Number of people with hearing problems in Japan

Source: Estimated from JapanTrak 2015 and 2018

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