Hearing Loss News

25 Apr
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Sudden Hearing Loss

Sudden sensorineural hearing loss (SSHL), commonly known as sudden hearing loss, should be considered a medical emergency. As professionals, we train our patients to see their family doctor at the onset of a sudden hearing loss, and if the doctor can’t immediately see the patient, to go to their nearest emergency room.

Why is treatment so important?

Sudden Hearing Loss

Sudden hearing loss should be considered a medical emergency.

Only about 50 percent of those with sudden hearing loss will recover some of their hearing if not treated. About 80 – 85 percent of those who are treated properly will recover most or some of their hearing loss. Some erroneously think it is due to a cold, a sinus infection or allergies, so they put off or ignore treatment. Know that delaying proper treatment always decreases the effectiveness and recovery.

What causes sudden hearing loss?

There is not one real reason for SSHL. Sudden hearing loss is not a virus or a disease that can be caught. Less than 20 percent of those with SSHL are diagnosed with an identifiable cause. Some listed causes of SSHL are trauma to the head, poor blood circulation, drugs that may affect the sensory cells, diseases or disorders like multiple sclerosis or tumors along the eighth nerve connecting the ear to the brain

How do you treat sudden hearing loss?

Probably the most common practice of treating SSHL is prescribing steroids (corticosteroids). They decrease inflammation or swelling, which helps the body fight the illness. In the past, steroids were prescribed using pills, but recently, steroids are injected into the middle ear past the eardrum. This practice allows the steroids to reach the inner ear at a faster rate.

If you are taking drugs that are toxic to the ear, you may be advised to stop or switch to another drug. Sometimes your immune system may be the cause of sudden hearing loss. If this happens, you may be prescribed medications to suppress your immune system.

Conclusion

In the hearing industry, we often see patients suffering from sudden sensorineural hearing loss. We always recommend you immediately see your doctor or go to the nearest emergency room for treatment. The sooner you get treatment, the better chance of saving your hearing.
 

9 Apr
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Saving Hearing Lives on the Bolivia and Peru Hearing Aid Mission

My Experience by: DeAnne Pacheco, TeleHear Clinical Director

mission

I had the honor of serving in a Starkey Hearing Foundation mission with the most amazingly dedicated, hard-working people. We completed four mission days in three cities: Santa Cruz, Bolivia; Cusco, Peru and Trujillo, Peru, where we fit nearly 2000 children and adults with hearing aids. I was first struck by the grand scale of the operation but more amazed of how well-executed every step was performed. I was part of Phase 2 where we, as volunteers, go into the mission location with Tani Austin, Starkey’s Chief Philanthropy Officer, and her team to fit our patients with their hearing aids and custom molds. Patients are also provided with batteries, counseled on how to properly use and care for their devices and what to expect in Phase 3.

This has been so much more than a service opportunity — it was a gift to me that I will treasure forever and one that has impacted my life in the most meaningful way. My heart has never been so full of love and joy. I left Bolivia and Peru with a sense of true accomplishment, satisfaction and happiness. I’m addicted and can’t wait to serve again!
 

mission

We started with a huddle every morning before our long days led by our tireless leader, Tani. I feel privileged to work beside her and learn from such a strong and dedicated woman. I honor what she kept reminding us: we will look our patient in the eyes and show them the respect, care and love they deserve as human beings. She emphasized that this global mission is NOT about “us” and that we are the least important people there. Our patients are the most important people and the reason why we are there. Words were never so true. We are here to give and to serve, the highest calling.
 

missionI’ll never forget the smiles on the children’s faces when they heard their own voice, the tears of a mother when her own child heard her voice and the young lady who now has a better future ahead of her because she can hear. That young lady can now participate in and contribute to her community. It’s a brilliant circle of love. The more we give, the more is given in return. God bless the elderly women and men who came to see us dressed in their Sunday best. They came sporting their shined shoes, distinctive hats and the brightest smiles. They were proud to be there and showed us the most gratitude and grace I’ve received. They thanked us over and over as though we were giving them the greatest gift, but little did they know that they gave me back something far greater. My heart was never bursting with so much love, honor and gratitude for being able to be used as a vehicle to spread hope, love and the gift of hearing.

Visit Starkey Hearing Foundation for more information on the hearing aid missions. Follow #hearingaidmissions on social media for more photos and videos.

22 Jan
Written by in Hearing Loss News | 25 Views | Comments Closed

Hearing Loss Studies: Life is Worth Hearing

Hearing loss is one of the most common health issues in the world. In the United States, 12 percent of the population, or 38 million people, have a significant hearing loss. Yet, only one out of every five people who could benefit from hearing aids actually wears them. Reduced hearing acuity can not only be frustrating for yourself but also for those around you. Difficulties with your hearing can have an effect not only on your relationships but also on your mental and physical health, your income and your personal safety.

hearing loss studies

Recent hearing loss studies show a connection between hearing loss and dementia, depression, risk of falls and loss of earning potential.

There have been several hearing loss studies that connect hearing impairment to mental degeneration. They show an increase in anxiety and depression, accelerated brain tissue loss and dementia. People with a hearing loss are 2-5 times more likely to experience cognitive decline than someone with normal hearing. A study performed by Johns Hopkins Medicine tested volunteers with hearing loss over a six-year period and found their cognitive abilities declined 30-40 percent faster than peers with normal hearing. The researcher, Dr. Frank Lin, states that “if you want to address hearing loss well, do it sooner rather than later, before brain structural changes take place”.

Another study performed by Johns Hopkins Medicine displays the link between hearing loss and your physical health. In this study, researchers found that people with even a mild hearing loss are three times more likely to have a history of falling. One of the possible explanations for this link is that people who cannot hear well might not have keen awareness of their overall environment, making tripping and falling much more likely.

This lack of awareness can also be frightening when you are not hearing as well as you should. The inability to hear the sirens, vehicles and alarms in your everyday life can be very important. By treating your hearing loss with hearing aids, you will be able to enhance your consciousness of your surroundings.

Income and hearing loss have also been linked. A study performed by the Better Hearing Institute states that people with an untreated hearing loss can see an income hit of up to $30,000 annually. It also states subjects were nearly twice as likely to be unemployed as peers who wore hearing aids.

Helen Keller once said “Blindness separates people from things; deafness separates people from people”. Untreated hearing loss can lead to social isolation and depression. The decreased hearing acuity can often cause people to withdraw from family, friends and social activities that once brought them enjoyment. Treating your hearing loss with hearing aids enables you to hear your friends and loved ones and ensure you don’t miss out on the people and activities that make you happy.

Hearing loss is not just an ear issue — it’s a quality of life and health issue. These hearing loss studies prove it is important to take a proactive and empowered approach to health during every stage of your life. Let it begin with your hearing health.
 

Sources for Hearing Loss Studies:
Johns Hopkins Medicine. Hearing Loss Linked to Accelerated Brain Tissue Loss. Retrieved from: https://www.hopkinsmedicine.org/news/media/releases/hearing_loss_linked_to_accelerated_brain_tissue_loss_
World Health Organization. Millions of people in the world have hearing loss that can be treated or prevented. Retrieved from: http://www.who.int/pbd/deafness/news/Millionslivewithhearingloss.pdf
Johns Hopkins Medicine. Hearing Loss and Dementia Linked in Study. Retrieved from: https://www.hopkinsmedicine.org/news/media/releases/hearing_loss_and_dementia_linked_in_study
American Academy of Audiology. Untreated Hearing Loss Linked to Depression, Social Isolation in Seniors. Retrieved from: https://www.audiology.org/publications-resources/document-library/untreated-hearing-loss-linked-depression-social-isolation
Johns Hopkins Medicine. Hearing Loss Linked to Three-Fold Risk of Falling. Retrieved from: https://www.hopkinsmedicine.org/news/media/releases/hearing_loss_linked_to_three_fold_risk_of_falling
Lin, F.R., Yaffe, K., Xia, J. Xue, Q. Harris, T.B…. Hearing Loss and Cognitive Decline in Older Adults. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869227/
Better Hearing Institute. The Impact of Untreated Hearing Loss on Household Income. Retrieved from: http://www.betterhearing.org/sites/default/files/hearingpedia-resources/M7_Hearing_aids_and_income_2006.pdf

4 Dec
Written by in Hearing Loss News | 30 Views | Comments Closed

Verification and Validation: Are You Hearing As Well As You Should Be?

“Are you hearing as well as you should be?” seems like a simple question. Believe it or not, that is actually one of the hardest questions for my patients to answer. Typically, patients respond with, “I don’t know” or “How can I tell?” That is the main reason why verification and validation are some of the most important steps in the hearing aid fitting process.

verification and validation

Verification is one of the most important steps in a successful hearing aid fitting. All American Hearing’s proprietary Verified Best Hearing™ platform can help you see, in writing, whether or not your hearing aids are performing the way they should.

Verification, in the context of a hearing aid fitting, is an objective measure of the performance of the hearing aid. This can be done with several different tests. Real ear measurements involve placing a probe microphone in the ear and measuring what is coming out of the hearing aid at the level of the eardrum. The clinician measures the hearing aid output for a set of stimuli and compares it to the prescription that she has programmed into the hearing aid. In addition to this method, an actual aided hearing test can be performed with the patient wearing the hearing aids to compare to pre-hearing aid test results. This is called aided Soundfield testing, or functional gain testing. It is also very useful to have aided word understanding testing performed, comparing to the target score from the original hearing exam. It is eye-opening to compare the aided word understanding test results to an unaided trial in a real “apples-to-apples” comparison. Utilizing the Verified Best Hearing™ worksheet, I can show the patient a picture of the hearing improvement with the devices. Using these methods, we can objectively measure if the hearing aids are doing their expected job.

Validation is more subjective. It is important to get specific information from the perspective of the patient. A variety of patient surveys, such as the Abbreviated Profile of Hearing Aid Benefit (APHAB) or the Client-Oriented Scale of Improvement (COSI) have been developed to target different aspects of hearing lifestyles. Asking a patient about his most important hearing objective, and then measuring from his perspective how closely that goal was met is an integral part of the hearing aid fitting experience.

Verification and validation definitely should be done the first time any new hearing aid is fit. However, I often utilize different combinations of these types of tests throughout the year with my patients. The patient and I know that we have started with the best possible settings in the hearing aids because of the extensive testing regimen, but things can change over time. Patients’ hearing levels can change over time. The hearing aids can malfunction. The patients can simply acclimate to the hearing aids, especially if they are a new user, and they may need changes to the programming as time goes on. Even the hearing lifestyle can change over time. It is not simply enough to ask if everything is ok and send a patient on his/her way. It is important to continually verify and validate my patients’ performance with their hearing aids, so that I can help them to answer that question: “Am I hearing as well as I should be?”

20 Nov
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Hearing and Memory Loss

Did you know that your hearing, or lack thereof, can affect your memory?

People with poor hearing often mistakenly feel that their hearing loss only affects their ability to hear other people. They do not realize that hearing loss has a far greater impact. Over the last ten years there have been numerous studies linking hearing loss to decreased cognitive function and memory loss, when measured over time. One recent study at Johns Hopkins University found that over a ten-year time span, people with hearing loss showed signs of dementia three years sooner, on average, than those people of the same age but without hearing loss. Just think what three years can buy a person in terms of independence! (Archives of Neurology. 2011; 68[2]:214).

A recent study at Johns Hopkins University indicates a correlation between untreated hearing loss and memory loss.

A recent study at Johns Hopkins University indicates a correlation between untreated hearing loss and memory loss.


Other significant findings of this study link hearing loss to cognitive decline using Magnetic Resonance Imaging (MRI) scans. Researchers found that untreated hearing impairment is associated with brain atrophy, specifically in the temporal lobe of the brain, which is responsible for hearing and processing of auditory information (spoken language). What this means is that people with hearing loss must work harder to hear, and over time that increased hearing effort affects our brain in more ways than we realize. When living with untreated hearing loss, the brain is not receiving enough sound to be adequately stimulated. This causes the brain to shrink, which can result in dementia. (Neuroimage.2014; 90:84-92)

Unfortunately, the costs of dementia are far greater than the costs of treating your hearing loss. If you find yourself or your loved one saying, “I hear what I want to hear” or “my hearing loss isn’t bad enough yet,” this information is very significant and worth serious consideration. Wearing hearing aids to treat your hearing loss will certainly play a role in preserving your cognitive health.

6 Nov
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Earwax and Hearing Loss

One of the most common causes of hearing loss is earwax, or cerumen, blocking sound from reaching the eardrum. This occurs when the wax is pushed back toward the eardrum or if the ears produce more wax than is needed.

earwax

Earwax is a combination of skin cells and oily secretions in the ear canal. It serves to shield, clean, and lubricate the ear. However, if too much wax is pushed back toward the eardrum, hearing loss may occur.

Earwax is also the most common cause of hearing aid malfunctions. A tiny amount of wax can plug the receiver, or speaker, of a hearing aid, preventing sound from coming out. An equally small amount can plug the microphone covers, preventing sound from getting in.

As a hearing aid provider, I spend a lot of time removing wax both from hearing aids and ear canals. It is standard practice in our follow-up care.

So, why do we have earwax? It does have a purpose. It shields our ears from outside invaders and lubricates our ears, just as tears lubricate our eyes. It is also part of a self-cleaning mechanism. As we move our jaw, earwax slowly moves from the eardrum to the ear opening, where it will fall out.

Earwax is a combination of skin cells and secretions from the ceruminous glands in the outer ear canal. It comes in two types – wet and dry. People of Asian descent tend to have dry wax, while people from other regions tend to have wet.

We have all heard the old saying, “don’t put anything smaller than your elbow in your ear.” This is sound advice. Not only can you damage your ear canal or eardrum, but you will most likely push the earwax further in. If excess wax is a problem, it is best to seek professional help, or try one of the over-the-counter wax removal kits sold in the pharmacy section. The latter is only for someone with healthy eardrums, free of tubes or perforations.

3 Nov
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Ask An Audiologist: What Is Tinnitus?

Tinnitus is described as any abnormal ear noise and can arise in the outer ear, the middle ear, the inner ear or the brain.  It is not a disorder in and of itself, but rather a symptom and may be perceived as ringing, buzzing or humming. Some people describe it as a “clicking” or “pulsing” sound.
 

tinnitus

Tinnitus is a “head noise” that has no apparent external source. Some experience it as a buzzing, whistling or ringing sound.

Usually it is a symptom of sensorineural hearing loss, and often the person experiencing it can tune it out, sleep normally and proceed with daily activities.  For a person with tinnitus, quiet is the enemy, and one is more likely to notice it while trying to sleep or first thing in the morning. In cases where the tinnitus is clicking or pulsing, it can arise from TMJ (temporomandibular joint disorder), multiple sclerosis, blood flow through the carotid artery, as well as vascular tumors.
 
Tinnitus is listed as a side effect of over 200 medications.  Decreasing salt and caffeine intake can help.  There are many over-the-counter medications sold for the relief of this head noise, but none have been approved by the FDA and some even have adverse side effects.
 
For those with bilateral tinnitus related to sensorineural hearing loss, most will notice relief or “masking” from the use of hearing instruments.  For severe cases, most hearing instruments have a masking element which can be turned on and used in tinnitus retraining therapy.
 
In patients who experience tinnitus unrelated to sensorineural hearing loss, a medical referral should be made for diagnosis and management of its effects on daily life, including depression and insomnia.

2 Nov
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Aural Rehabilitation Exercises

You have taken, or are planning to take, a wise first step, the investment in hearing instruments. Hearing aids help you to hear sounds which are interpreted by your brain. This brain stimulation is an important part of hearing health. The following aural rehabilitation exercises will allow you to increase brain stimulation and improve your speech discrimination.
 

Exercises for Better Listening

aural rehabilitation

Reading aloud to your grandchild for 10 minutes a day, an important strategy in aural rehabilitation, can significantly improve your speech understanding.


1. Read out loud 10 minutes a day

One of the easiest and most effective ways to increase your speech understanding is to read out loud 10 minutes each day. Why? Because reading out loud allows you to simultaneously say, hear and see the words you are reading. This process imprints sounds on the brain faster than simply hearing the same words.

Your audience and source of material can vary, so have fun! Read to yourself, your pet, grandchild or others. Follow a daily reading plan, or choose a magazine article, newspaper, book of poetry or pleasure reading. The important thing is to commit to making this a part of every day.

The effectiveness of reading out loud 10 minutes a day is exemplified by one of my patients.  An 87-year-old woman was discouraged by not being able to hear her beloved soap operas on television. Speech discrimination tests showed she was understanding only 68 percent of what she heard. She agreed to read out loud to herself every day for six weeks. When she returned just three weeks later, her speech discrimination score had improved 17 percent. She was delighted at the results, being able to correctly understand 85 percent of the words she heard. Her daughter confirmed her mother was faithfully reading out loud ten minutes each day and wasn’t going to stop!

2. Practice in a noisy environment

After six weeks of reading out loud, you may want to add an additional challenge. Turn your radio or television on at a low volume. Continue to read out loud, focusing on what you say, hear and see. This will simulate conversations in more challenging environments. Continue to practice with this soft background noise for four weeks.

3. Converse in an active listening position, being focused and proactive

At this point you have practiced diligently for 10 weeks. You may have noticed an improvement in your ability to understand speech both in quiet and slightly noisy environments. Now you are ready to practice focused conversations with friends and family. For this aural rehabilitation exercise, you must be in the same room as your conversation partner. Sit facing each other approximately five feet apart. Become aware of sounds that could become a distraction and try to tune those sounds out. Focus on the conversation. If you are having trouble understanding the other person, be proactive. Honestly share what you need from them. For example, let them know it would be helpful for you if they spoke just a bit slower or let you know when they are changing subjects. The important points of this experience are to be in a good listening position, focus on the conversation and be proactive.

I hope you will make these aural rehabilitation exercises a permanent part of your hearing health routine. My passion is to help you hear your best and enjoy conversation with everyone you interact with each day.
 

19 Jun
Written by in Hearing Loss News | 45 Views | Comments Closed

Santa Brings 7-Year Old the Gift of Hearing

This past holiday season, children filled out their Christmas lists to send to Santa. Hoverboards and video games topped the lists of many. However, for one special 7-year old in Deerfield Beach, Florida, all she wanted was the gift of better hearing.

Every year, the All American Hearing network of hearing healthcare providers holds a special holiday contest. We give the gift of hearing to someone in need of hearing help. We ask that the loved ones, friends and family members of the person who is in need, to write Santa a letter and explain why the gift of hearing should be given to the person in need. Each year we receive submissions from across the United States. This year we received hundreds of requests from the loved ones of those in need.

As you can probably imagine, it is not easy narrowing down hundreds of submissions to just one. In an effort to help all with their hearing loss, we offer a buy one get one free deal to everyone who had a submission. This is a savings of over $2,000!

Each submission is read by a panel at All American Hearing. We read every single letter that comes into our mailbox. These letters are touching and moving. This year, one submission stood out.

Kaitlyn Newland was born with a hearing loss. She has needed hearing aids since birth to hear and speak. Her hearing loss has affected her everyday life. According to a submission from her school, Trinity Christian School, “Kaitlyn is struggling in class and at home with ordinary tasks, and would greatly benefit from positive interactions and experiences in her young life.” Several other letters indicated that Kaitlyn’s hearing loss has effected her learning that she has fell so far behind in school that she faced the possibility of being held back.

Kaitlyn has a twin sister. We know how close twins are in life. Kaitlyn had been separated from certain parts of her life due to her hearing loss, we did not want her to be separated from her twin sister in school as well.

Letters from Santa

Submissions received for Kaitlyn Newland

We received four submissions from her school, aunt, grandmother and family friend urging us to choose Kaitlyn for the gift of better hearing. With her whole life ahead of her and the opportunity to live it to it’s fullest present, we choose Kaitlyn Newland as the recipient of a brand new pair of Audibel A4 hearing aids.

This is the part of the story where one would think everything was going according to plan. We have a 7-year old little girl who struggles with hearing loss that lives just minutes away from our office in Deerfield Beach, FL. Shortly after contacting her family and letting them know the good news, we were informed that Kaitlyn and her family were moving north to Greenville, SC. What was once a 10 minute drive to our office now turned into a three hour trip and over 200 miles to our closest office in Rome, GA.

Not to be deterred, we worked with Kaitlyn’s mother, Christina, and the local office in Rome, GA (Audibel) to work with their schedule to get Kaitlyn the help she so desperately needed. Finally, after weeks of conversation and planning, we were able to visit with Kaitlyn in our Rome, GA office in March of 2017, three months after it was announced she was the winner. In an email from Katilyn’s mom Christina, she wrote “When we went to the hearing center in Rome, GA she was having a pretty bad day since we had to drive at 4:30 am to make the appointment but please know that she is over the moon about getting a new set of hearing aids.”

Christina, Katilyn’s mother, drove Kaitlyn the 200+ miles trip to Rome, GA for appointment number one. With both parties determined to find a solution that would greatly benefit Kaitlyn, a set of brand new Audibel A4 hearing aids were selected by the hearing healthcare provider Charles Scoggins. Charles even customized the hearing aids for Kaitlyn to fit her exact ear canal.

Kaitlyn would have to make the 200 mile trip one more time to get her brand new custom hearing aids. Finally, in early April, Kaitlyn returned to our Rome, GA office to receive her hearing aids. The impact the hearing aids had on Kaitlyn’s life was instant. While she had hearing aids in the past, they were not as technologically advanced as the set she received from All American Hearing.

Christina wrote to us in an email after they received the hearing aids:

“The hearing aids have been such a blessing for Kaitlyn.  She loves the hearing aids and loves he fact that she can turn them up or down whenever she needs it. They are amazing, the technology is unbelievable and it has completely changed her mood. She is so much more controlled, calm and social.  She is not embarrassed to tell people she wears hearing aids anymore.  I am overwhelmed with joy, and it brings tears to my eyes to see how different she is now and how this has impacted our lives. I can’t thank you enough for choosing her. Thanks again for caring and for helping Kaitlyn be a normal little girl.  We will be forever grateful.”

It’s stories like Kaitlyn’s that drives our hearing healthcare providers across the nation to help more people hear better. The impact that proper hearing can have on someone’s life is priceless. Kaitlyn will now be able to learn at the level she is capable of in her classes. She can experience life in a way she had not had before. She can converse with her twin sister about all things sisters love to talk about. Her mother, Christina, can smile knowing that Kaitlyn is no loner embarrassed about her hearing loss.

We want to extend a special thank you to Kaitlyn, her mother Christina, those who submitted submission’s on Kaitlyn’s behalf, her entire family who accompanied Kaitlyn to the appointment and our local staff in Rome, GA, Charles and Sharon Scoggins. Together, we all made an impact and a different in one little girls life.

Kaitlyn Newland with Chalres and Sharon Scoggins

Kaitlyn Newland with our hearing healthcare provider Charles Scoggins and office manager Sharon Scoggins in Rome, GA

14 Dec
Written by in Hearing Loss News | 599 Views | Comments Closed

Tips For Communicated With The Hearing Impaired

Does someone you know wear hearing aids but they still sometimes have difficulty understanding what is being said?  Hearing aids cannot fix the damage inside the ear, they simply amplify the damaged haircells.  So sometimes the person still may misinterpret what is being said.  There are things you can do to help the person understand correctly the first time:

  • Understand that hearing aids do not restore normal hearing. We can do amazing things with hearing aids but they cannot repair the damage to the auditory system.
  • Remember that just because a person can hear your voice, does not mean they can understand your words. Hearing loss may cause distortion in the way sounds are perceived. “Toothpaste” may sound like “suitcase” even when speech is loud enough.
  • Speak naturally and with normal expression. People with hearing loss may need things repeated.  But when a person with hearing loss isn’t understanding you, your natural instinct may be to raise your voice.  Shouting or raising your voice can often make things more distorted.  Louder doesn’t mean clearer, it just means loud!
  • Slow down your rate of speech.
  • Quiet places will assist communication. Be aware of noises that may be in the listening environment that can effect speech understanding. Things like air conditioners, fans, TVs, water running, restaurant noise, and other people’s conversations can all significantly effect the ease of communication for someone with hearing loss.
  • Gain someone’s attention before you start a conversation. Address them directly by saying their name before starting a conversation so they have time to focus.
  • Hearing aids will help you hear conversations at a reasonable distance. Decrease the distance between you and the listener. This is the single most effective way to increase understanding. Speech understanding is significantly decreased beyond 15 feet so do not expect your loved one to understand you when you are in the basement and they are on the 3rd floor!  If you can’t see the person’s face, you are probably too far away for effective communication.
  • If a hard of hearing person needs something repeated, instead of repeating it the exact same way, try rephrasing it.  For example:
    “We are joining the Smiths for dinner at 6.”
    “What?”
    “We are going to the Outback with Joan and Bob for dinner tonight.”
  • Finally, look directly at the person! Most people with hearing loss use visual cues to fill in where they may misunderstand.   The lips, face and body gestures all provide valuable cues and can help fill in for sounds they are not getting.
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