Background     One in six Americans has impaired hearing, with higher prevalence among the elderly. Hearing loss can pose a barrier to effective communication. This Fast Fact discusses ways to improve communication with patients with hearing loss.

Consequences of hearing loss     Hearing loss can lead to misunderstandings, which in the health care setting can literally have life-or-death implications. Patients or family members can misunderstand treatment options and instructions for medications and appointments. They may have trouble hearing on the telephone (or even that the telephone is ringing). Clinicians may incorrectly assume they have cognitive impairment.

Hearing loss can have emotional impact including social isolation, loss of self-esteem due to communication mistakes, and frustration at the difficulty with communication. People may withdraw and/or become depressed. Persons living with people who have hearing loss also may experience anger and frustration at the effort it takes to communicate.

Since speech comprehension takes added mental effort when hearing loss is present, persons who are delirious, fatigued, in pain or otherwise distracted often have increased trouble understanding what is said. Other factors which affect the ability to understand speech include background noise, poor lighting (which impedes lip reading), soft or rapid speech, and use of unfamiliar words such as medical terminology.

Identifying patients with hearing loss     Congenitally deaf people usually identify themselves as such, and may prefer communication with sign language. In this case, a health care interpreter who is fluent in sign language should be used (see Fast Fact #154).  

Acquired hearing loss is often invisible. Many people with acquired hearing loss do not realize that they have it, or underestimate the degree of its impact on communication. Most people with acquired hearing loss acquire it later in life and are unlikely to know sign language. They may smile and nod without admitting that they did not understand. The person may fail to respond to a request or a question, or may answer incorrectly based on what he or she thought was said. He may say “What?” or ask you to repeat. Hearing aids and cochlear implants, while helpful, do not restore perfect hearing. Many who could use them do not, due to cost, inconvenience, or denial.

Techniques to improve communication with persons with hearing loss

• Reduce background noise and distractions as much as possible.
• Create opportunities for the person to have a trusted, non-hearing impaired support person present during the conversation to assist with understanding and memory of the information.
• Make sure you have the person’s attention before starting a conversation.
• Ensure that the listener can see your face. Sit or stand at eye level and face her or him. Have the listener wear eyeglasses if necessary. Ensure adequate lighting on the face of the speakers.
• Speak distinctly and clearly. Avoid shouting if possible: this can make you sound angry and will distort the shapes of words on your lips.
• Ask the person if she or he can hear you, and if there is anything you need to do to help him or her understand you.Use gestures, spelling and writing as needed to clarify. A dry-erase board and marker or notebook can be kept at the bedside.
• Ask the person to summarize what he or she heard. This will help to identify misunderstandings before one of you departs, and will reinforce teaching.
• Use technology. Persons with hearing aids should be encouraged to wear them during discussions (and to bring spare batteries). Those without hearing aids may benefit from personal amplifiers or assistive listening devices. Text telephone relay services (which transcribe voice-to-text) or secure e-mail may be useful alternate forms of communication.   Particularly in the hospital setting, clinicians should seek assistance from speech language pathologists to help maximize a patient’s ability to communicate.

Additional Resources:

Hearing Loss Association of America (available at: http://www.hearingloss.org) and Better Hearing Institute (available at: http://www.betterhearing.org).

References:

1. Bade PF. Hearing Impairment. In Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. 7th ed. New York: American Geriatrics Society; 2010.
2. Bogardus ST, Yueh B, Shekelle P. Screening and Management of adult hearing loss in primary care: clinical applications. JAMA. 2003; 289(15):1986-90.
3. Lezzoni LI, O’Day BL, Killeen M, et al. Communicating about health care: observations from persons who are deaf or hard of hearing. Ann Intern Med. 2004; 140(5):356-62.

Author Affiliations:  Sanford School of Medicine at the University of South Dakota; Hospice of the Hills, Rapid City, SD.

Version History: Originally published May 2011; Copy-re-edited August 2015.