entertainment

Breaking Stereotypes: Hearing Loss in the Media

By Alexander Chern, M.D.

Last summer’s blockbuster film “A Star Is Born” brought hearing loss into mainstream media. What has the entertainment industry done since? 

Friend: This is my friend Ally.

Ally: Oh, my God! Hi.

Jackson: Hi. Hey. 

Ally: I thought that might be you.

Jackson: What’d you say?

Ally: I thought that might be you.

Jackson: That’s me.

Ally: So why are you in here hon?

Jackson: Sorry?

Ally: What brings you here?

Jackson: Oh I was playing right around here tonight. I’m a musician.

This exchange stood out to me while watching “A Star Is Born,” the blockbuster film from the summer of 2018 about a hard-drinking, seasoned rock star, Jackson (played by Bradley Cooper), who discovers and falls in love with a struggling artist, Ally (Lady Gaga). 

This scenario is familiar to most people (with or without hearing loss)—sometimes we miss a few words here and there when having a conversation in a noisy environment, such as a loud concert or a cocktail party. But something felt strange about this scene; this type of situation rarely happens in a movie, let alone twice in one scene, because movies are scripted. 

In most movies, any imperfections of daily life are often erased from movie dialogue so that everyone seems perfect—and this includes the ability to hear. As a resident physician in otolaryngology–head and neck surgery (also known as ear, nose, and throat surgery, or ENT) and as a person with hearing loss, I suspected there was something more to this than meets the eye. Several scenes later, my hunch was proven correct when we learn that Jackson suffers from hearing loss and tinnitus. 

Bradley Cooper and Lady Gaga in “A Star is Born.” Credit:    Peter Lowe   , Flickr.

Bradley Cooper and Lady Gaga in “A Star is Born.” Credit: Peter Lowe, Flickr.

When Jackson visits a hearing specialist (a cameo by William Slattery III, M.D., an otolaryngologist from the House Ear Clinic in Los Angeles, and Cooper’s actual ear doctor), they discuss Jackson’s hearing loss and the importance of using in-ear monitors to protect his hearing while performing. In the next scene, Jackson adamantly refuses to use hearing protection when performing at loud rock concerts, and he later explains that his struggles with hearing and tinnitus began when he was younger. His hearing worsened throughout his career as a musician, suggesting he likely has noise-induced hearing loss from exposure to loud sounds, a common occupational hazard in the music industry. 

Hearing loss is both underrepresented and misrepresented in the media, which frustrates many of us who actually have hearing loss. When hearing loss is represented in the media, it is often in connection with aging—individuals who are hard of hearing have typically been depicted as elderly, isolated, and disabled individuals who are dependent on others. Other media representations of hearing loss focus on Deaf culture; television shows like “Switched at Birth” and “The Society” and movies like “A Quiet Place” and “Wonderstruck” represent individuals with deafness, but are not necessarily relatable for all individuals across a wide spectrum of hearing loss. 

In contrast, Cooper’s character in “A Star Is Born” is a famous, still-young music celebrity who does not meet the typical stereotype of someone with a hearing loss. As the movie progresses, we watch Jackson struggle with his hearing loss and its impact on his self-image as he continually refuses to have his hearing treated or protected while exposed to loud music onstage. 

Though Jackson’s struggles with his hearing are not the main focus of the movie, this subplot also reminds the public that this condition not only affects the elderly—young people can have hearing loss, too. One in five young adults ages 20 to 29 reportedly has trouble hearing. And fewer than 16 percent of individuals ages 20 to 69 who could benefit from wearing hearing aids have actually used them. 

I can relate to Jackson’s struggle to reconcile his image with his hearing loss. Even though I am currently an ENT physician-in-training, pursuing a career that helps treat people with hearing loss, I spent almost 10 years of my life while in college and medical school refusing to wear my hearing aids when I certainly could have benefited from them. As a young person with a hearing loss (I am 29), I made life harder for myself for no good reason other than what I felt was society’s perception of people with hearing loss.  

The media is the fastest and most cost-effective way to raise awareness and eliminate stereotypes, promote inclusion of individuals with hearing loss, and reduce the perceived stigma that is still ingrained in our society. Doing so will also help us fight the hidden epidemic of hearing loss, which is both highly prevalent and severely undertreated. 

Credit: Disney Studios

Credit: Disney Studios

Not so long ago, people persisted in using terms such as “deaf and dumb,” “deaf-mute,” and “hearing impaired” to refer to these individuals. Such terms reflect the unconscious biases people have against such individuals who struggle with hearing, which, in part, prevents them from seeking treatment. I believe those who work in entertainment—writers, producers, and directors—should take the artistic responsibility to portray individuals with hearing loss in an accurate, authentic, and diverse way. 

In addition, the frequency of individuals with hearing loss portrayed in the mainstream media needs to more accurately reflect its real-life prevalence. According to the National Institute on Deafness and Other Communication Disorders, about 20 percent or 48 million Americans report some degree of hearing loss. Normalizing hearing loss and fighting stereotypes will also require the entertainment industry to show us more characters with hearing loss wearing modern, digital hearing technology. We also need more character development, storylines, and subplots about hearing loss, not to mention actors, directors, and writers affected by this condition who are best able to tell such stories. Diverse media representation will be crucial in raising awareness and educating the public about hearing loss. 

I recently saw “Toy Story 4,” the latest installment of Pixar’s iconic “Toy Story” series that began decades ago, in 1994. I was thrilled to see the creators of the movie took a big step toward inclusivity when they featured a young child wearing a cochlear implant with a bright green processor. (It’s in an early scene when Bonnie goes to kindergarten for the first time and meets her classmates.) 

I remember, as I am sure many of us do, what it felt like to be made fun of for wearing hearing aids as a child—it was embarrassing. For many, this perceived stigma is often a barrier to obtaining treatment for their hearing loss. Wearing hearing aids makes us feel different, and not in a positive way. Glasses, a medical device seen as part of everyday life for many people, used to be stereotyped as being worn by nerdy kids without any friends. However, glasses are now considered fashionable and stylish—many individuals wear glasses even if they do not have vision loss. 

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There is no reason why having hearing loss treated with hearing aids or cochlear implants should be perceived any differently than having vision loss treated with glasses, especially nowadays when wearing name-brand headphones or earbuds or other accessories on the ear is commonplace. Though there is still a long way to go in raising awareness, breaking stereotypes, and making hearing loss hardly anything different in the media, that little boy in “Toy Story 4” rocking his bright green processor marks an important first step. 

Alexander Chern is a second-year ENT resident physician at NewYork Presbyterian Hospital, Columbia/Cornell.

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Net Gains

By David Pierce

In 1979, captioning was in its infancy on broadcast television. Services were provided by Caption Center (which had been doing it since 1972) and National Captioning Institute, which was launched in 1979 to serve as competition to Caption Center. Only a few television series were being voluntarily captioned, as Federal Communications Commission captioning regulations did not yet exist. 

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Also that same year, Silent Network was launched in Hollywood to provide broadcast television programming for viewers who were deaf and hard of hearing using sign language, open captions, and full sound on broadcast and cable. The word “SILENT” is an acronym: “SIgn Language ENTertainment.”

It was a pioneering time for accessible television, and the general public was being exposed to captioned and sign language programming on a national basis. Silent Network was founded by Hollywood veteran Sheldon I. Altfeld and Kathleen Gold. Gold’s daughter, Julianne, was born deaf, and became a Broadway actress appearing in the original Tony Award–winning production of “Children of a Lesser God.” The founders identified the need for actors and producers who were deaf and hard of hearing to have a place to work, and the network was formed to fulfill that goal. 

The network’s first program, “Sign of Our Times,” aired on NBC in 1979 during a prime-time slot and was hosted by comedian Norm Crosby. The response was overwhelming, and the network expanded its offerings to broadcast, cable, and satellite. By 1995, it was a full network airing 24 hours a day, 7 days a week. Around the same time, when broadband internet was relatively new and serving low-resolution streaming video, it was one of the first 24/7 networks to stream its live satellite signal to the internet simultaneously.

Silent Network cofounders Sheldon I. Altfeld and Kathleen Gold with comedian Norm Crosby during the production of "Sign of Our Times" in 1979.

Silent Network cofounders Sheldon I. Altfeld and Kathleen Gold with comedian Norm Crosby during the production of "Sign of Our Times" in 1979.

Over the years, as it earned several Emmy Awards and other accolades, Silent Network weathered ongoing changes in the media landscape but eventually ran into financial difficulties. It entered into economic hibernation in 2000 when the network went off the air via satellite. However, with the advent of over-the-top (OTT) television, which allows content creators to stream their products directly to consumers, the network relaunched in 2017. 

Along with Silent Network and its sign language programming, a new network called Access Network was launched in 2018, providing open captioned and language-free programming for the general public and deaf, hard of hearing, and people learning English as a second language. The language-free content can be viewed by anyone around the world, with strong visuals relaying the story instead of spoken word. In 2019, as part of its 40th anniversary celebration, Silent Network launched a second OTT network for Roku players and TVs, free to Roku subscribers. 

In the network’s long history, it has experienced different owners, resulting in several changes to the network’s name. In recent years, the network reverted back to its original name of Silent Network by the current owners—my wife Robin Byers-Pierce, and me. 

As the network’s longest-standing alumnus and profoundly deaf, I was involved with several aspects of the network over a 32-year period as it underwent various incarnations. I currently run the post-production and master control operations of the network at our two locations in Texas. Robin, also a longtime alumnus who is hard of hearing, handles editing, captioning, and interpreting work for the network.

Herb Larson (left) and Lou Fant (center) with actor Lou Ferrigno on the set of Silent Network's long-running series “Off-Hand.”

Herb Larson (left) and Lou Fant (center) with actor Lou Ferrigno on the set of Silent Network's long-running series “Off-Hand.”

With the network’s large archive of 15,000 programs, videotape preservation and restoration work is a regular practice in order to preserve the content for the benefit of future generations. Most broadcast videotape has a shelf life of between 20 to 35 years (dependent upon proper storage conditions), so it is a ticking time bomb for the older programming. Our film and video preservation company, Davideo Productions, performs the restoration work.

The network’s content is varied to target different age groups and constituencies. On a new service called Access Community, which is part of Access Network, professional content providers can contribute their own unique programming in sign language. Viewers who are hard of hearing, especially senior citizens who lost their hearing later in life, seem to gravitate toward the open captioned programming on Access Network, especially classic films and television shows. People for whom English or sign language is not a native language can enjoy the language-free programming that has no dialogue. 

New content is added to both Silent Network and Access Network on a weekly basis. Robin and I are proud to carry on the network’s legacy of accessibility and inclusion. 

For nearly 35 years, David H. Pierce has worked in all aspects of television programming and production and has a long list of production credits. A writer and advisory board member for this magazine in the 1980s, Pierce is a managing partner of Silent Network. A certified sign language interpreter since 1976, Robin Byers-Pierce owns Specialty Interpreters and is a partner at Silent Network. For more, see thesilentnetwork.tv, accessnetwork.tv, davideo.tv, and channelstore.roku.com/details/285737/access-network.

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Close-Minded Captioning

By Amber Gordon

Sound can provide remarkable connections to the world around us. As a Longwood University communication sciences and disorders student, I’ve come to better understand how people with hearing loss experience sound, and that improvements to accessibility are urgently needed.

I have typical hearing, but know from Longwood professor Mani Aguilar, Au.D., that insufficient access to auditory information can have negative emotional and social consequences in many areas of life, including entertainment. Watching a TV show with a friend with typical hearing and not understanding why they are laughing is bound to make one feel left out.

While hearing aids and cochlear implants are extraordinarily beneficial to communication, many people with hearing loss rely on captioning to fully access audiovisual media. Because of its necessity, the Americans with Disabilities Act (ADA) requires closed captioning for video transcripts by state and local government entities and “places of public accommodation” (including universities, libraries, and hotels). Sections 504 and 508 of the Rehabilitation Act require the electronic communications of U.S. federal offices and federally-funded organizations to be accessible and captioned. 

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For TV programs, the Federal Communications Commission (FCC) requires TV captions to be “accurate, synchronous, complete, and properly placed.” The 21st Century Communications and Video Accessibility Act calls for “video programming that is closed captioned on TV to be closed captioned when distributed on the Internet.”

But there are no existing laws to address captioning in the majority of online video. This was brought to light when the National Association of the Deaf sued Netflix for the lack of closed captioning on videos on their site. The district judge ruled in favor of closed captioning on streaming services; however, because this was not a Supreme Court ruling, the case did not establish a national model for ADA’s standards for online services and businesses. 

Many streaming services do include closed captions within their video services with no stipulations for quality. As noted in HuffPost, the Netflix series Queer Eye had inaccurate captions that censored profanity and changed words being used in multiple instances. A Reddit user states that shows on Netflix and Amazon Prime, in general, do not signify who is talking when they are off-screen, creating confusion as to which character is saying what.  

Meanwhile, platforms like YouTube and Facebook remain unregulated. Enabling auto-captioning on videos is merely an option for video creators, and, in many cases, this auto-generated captioning is not accurate. For precise captions, video creators must make manual edits, which can be time-consuming or expensive. 

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Consider also that tone and verbal inflection can change the entire meaning of a sentence. Spoken words are just part of the piece the puzzle for those who rely on captions. According to The Atlantic, machine translation “can’t register sarcasm, context, or word emphasis. It can’t capture the cacophonous sounds of multiple voices speaking at once, essential for understanding the voice of an angry crowd of protestors or a cheering crowd. It just types what it registers.” 

We already have requirements for government programming and news alert systems. We have accessibility laws for television and even for some online content. But as entertainment becomes increasingly digital, these regulations must be transferable.

Otherwise, information remains lost in translation because captioning laws are only applicable to some circumstances. Isn’t access for everyone, regardless of hearing ability, enough reason to advocate for expanded captioning? Why must those with hearing loss be kept back by where we’ve drawn the line on accessibility?

If you are a hearing individual, I encourage you to place yourself in the shoes of someone with hearing loss. Mute your TV for a day. Mute the sound on your device playing YouTube or Facebook and enable closed captioning. How long does it take until you get annoyed? Frustrated? I’m willing to bet not very long. 

It is undeniable that closed captions have contributed greatly to the advancement of accessibility for people with hearing loss, but much work remains. We have to recognize the urgency of reliable captioning in online media.

What can we do? If you’re in a restaurant and notice that there are TVs playing without captions, politely request them. If you run a business where there are waiting rooms and lounges with televisions, please turn on captions. If you watch YouTube and notice that one of your favorite creators does not caption their videos, leave comments or write emails to encourage them. Hold streaming services like Netflix and Amazon Prime accountable by letting them know when captions are inaccurate or poorly transcribed. Lastly, if you’re watching television or your favorite show and you notice poor closed captioning, file a complaint to the Federal Communications Commission under the “Access for People with Disabilities” section of their Consumer Complaint Center. 

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Slowly but surely, if we continue to think of others who are unlike ourselves, strive for empathy and advocate for equal accessibility for all, a change can and will be made. 

Amber Gordon is an aspiring speech-language pathologist who lives in Virginia.

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Hyped Up Now, Hurting Later

By Yishane Lee and Lauren McGrath

In an interview, longtime healthcare professional Bob Kambic warns about the health risks of the over-amplification that is becoming increasingly common at recreational events.

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What got you interested in the topic of the dangers of loud entertainment?
I am 75 and a grandfather. Recently I was in Detroit for an event in which my grandchildren participated. The finale of the event was held in Ford Stadium, a football venue. The electronically amplified sound was deafening even wearing my noise-canceling headphones.

The 30,000 or so people in the stadium were subject to what in other places would be called torture. I wondered, is there a way to tell the organizers they are harming our young citizens, the future of our country?

As a retired healthcare professional, I have a half century of experience in the healthcare field and more than 50 publications in peer-reviewed journals. This got me thinking about noise levels in entertainment venues. Raising awareness of this public health problem needs to be done.

Why is the music so loud?
Consider a musician playing an electric guitar in front of a crowd. She will hear her music from an amplifier. But she then finds that she likes it loud and turns the small knob up. After weeks or months that level is not satisfactory and she makes another turn up.

Over time, as the louder sounds gradually diminish hearing, it becomes necessary to turn the knob up more and more. For music professionals, this is called increasing the gain, which is one way to increase the volume of sound from the speakers. The other way to increase volume is to turn up the signal coming out of the speakers themselves.

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When musicians play to big crowds they now have amplifiers and systems that produce thousands of watts of power and can project over 100 decibels (dB). This technology is also used for recorded music. It “entertains” but it also may harm the listeners’ ears. Musicians and their producers know that “loudness does not equal quality”—but that caution can get lost in the need to entertain.

By 2022, live music industry revenue is projected to be worth $31 billion worldwide, according to PricewaterhouseCoopers. Like other industries, the money is the driver. To me this means the live music industry will continue to use larger and louder electronic amplification.

The electronically amplified sound is now also ubiquitous at rallies and sporting events, both professional and collegiate—or even younger—to hype up the crowd.

What can we do to protect our hearing, and especially the hearing of children?
Earplugs. I was happy to see an article in a music industry publication saying that the purchase of custom musician’s earplugs is one of the best investments a music industry worker can make. They didn’t recommend earphones, mixers, digital equipment, or music instruments—just earplugs. Frequent concert-goers should also invest in custom musician’s earplugs.

For children, this is a tough question because kids don’t want to be told what to listen to and how loud the sound should be. But there are a variety of products for hearing protection. The first are simple foam earplugs, widely available at hardware stores, pharmacies, and online. The disadvantage is that they must be pushed into the ear canal and may not fit all size ears. (See “8 Pairs of Earplugs in 4 Noisy Settings,” next page.)

The next step up is over-the-ear earmuffs that cover the ear entirely. They are long-lasting and work well but they are also big and bulky.

Finally there are noise-canceling headphones made by audio or electronic equipment manufacturers. I use battery-powered noise-canceling headphones on airplanes and trains, and was wearing them at the event at the Ford Stadium. You may want to explore the varying prices and technology. Many can also play personal music through wireless and/or wired connections.

Besides using hearing protection, what else can you do?
Take action against unnecessary noise. Groups of parents can petition their schools and sports teams to reduce amplification at indoor and outdoor events. Decibel meters are inexpensive or free as smartphone apps and can be used to show managers and administrators the sound level at events, and when the volume reaches dangerous levels at over 85 dB.

The music and electronic sound industry is in control of this problem because of the amount of money in the industry, but also because well-known musicians such as Huey Lewis and Eric Clapton, who are open about their hearing loss, are helping to raise awareness. Media coverage and local action can bring attention to bear, and over time the industry may become aware of amplification as a health problem for everyone, including the audience, not just for those in the industry.

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Bob (Robert T.) Kambic, MSH, is a retired health professional who worked at the U.S. Department of Health and Human Services and the Johns Hopkins University (JHU) Bloomberg School of Public Health. He is a current visiting scientist with the JHU Medical School Division of Health Sciences Informatics and plays and sings American traditional music using acoustic instruments.

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Facing the Music

By Joe Mussomeli

Every family has holiday traditions—ours is to visit New York City. For the past five years, my mom, dad, and brother, Alex, have committed a single hour drive to experience the magic of the greatest city in the world during Christmas time. When we arrive each December, Alex and I are in awe of the magical sight of neon Christmas lights covering Radio City and the giant tree in Rockefeller Center. Despite our fascination with the city’s holiday decor, nothing we see outside compares to the highlight of our annual tradition, attending a musical performance on Broadway.

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Our first musical, Annie, was an incredible experience for our family, but it was difficult for Alex. Born with a hearing loss, Alex uses a hearing aid and cochlear implant. Though his devices have greatly helped him over the years, there are some situations where their benefits are limited. While watching  Annie, Alex had trouble understanding some of the lines that the actors were saying, missing every few words spoken. As a result, he couldn’t grasp the full context of the story or make sense of the audience’s reactions. Whenever the audience laughed, Alex would laugh along with them. He laughed knowing that he had missed a word, had lost a sentence, and didn’t catch the joke.

Alex followed this copycat formula for the next few Broadway plays we attended. When we saw The Lion King, he was amazed by the costumes and the bright lights, but he couldn’t hear Timon and Pumbaa singing “Hakuna Matata.” The beautiful music in Aladdin delighted Alex, but he didn’t pick up on Jafar calling Aladdin a “diamond in the rough.” After we saw Aladdin, I asked Alex if he enjoyed the musical. He told me that he did, but felt as if viewing the show was like trying to complete a project without all the tools. For Alex, the musical was a puzzle and he had lost a few pieces while assembling the final product.

Last December, my family and I watched our newest musical, Dear Evan Hansen, and it was Alex’s favorite so far. We arrived at the theater happy to know there was  a closed captioning option for guests with hearing loss. Weeks before, my parents had called the captioning company that provides services for Broadway musicals and reserved a closed captioning device for Alex. He was given a small tablet and was told that the actors’ lines would appear on the tablet as they were spoken. Minutes later, the musical began, and Alex was just as invested in the show as the rest of the audience. Now, he could understand everything that was happening on stage! It was an enlightening experience for him. He understood every sentence, took in every word, and laughed at every joke, and not for the sake of laughing along to fit in, but because he got the joke. When we finished the musical I turned to Alex and asked him if he liked it. He replied with three words: “I loved it.” Finally, Alex had completed his puzzle with ease.

Joe Mussomeli is a 10th-grade student who lives in Westport, CT. His younger brother, Alex, has been featured in Hearing Health magazine and is a participant in HHF’s “Faces of Hearing Loss” campaign.

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Making Entertainment Relatable and Accessible for More

By C. Adrean Mejia

Films, plays, and television series have long served as platforms to create awareness of important topics that have otherwise been kept out of the spotlight. Hearing loss is one example of such a topic.

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As an organization that seeks to inform the public about the prevalence, prevention, and treatment of hearing loss, Hearing Health Foundation (HHF) applauds the growing prioritization of this issue in entertainment. We are pleased to know that the number of films featuring characters with hearing loss—played by actors with hearing loss—has risen with the years, generating greater public awareness of the third most common health condition in the United States. Complementing this trend of an increased presence of hearing loss on screen is the introduction of recent legislation to make entertainment more accessible to viewers with hearing loss.

Actors and characters with hearing loss expand society’s understanding of the condition. Hearing loss empowers abilities, emotions, and experiences unlike those of people with typical hearing. Some recent works with characters with hearing loss include the following:

The Silent Child tells the story of a profoundly deaf four-year-old girl who is about to attend a mainstream school with minimal support—until a social worker teaches her American Sign Language (ASL). The film communicates the disappointing statistic that over 78% of deaf children attend mainstream school without accommodations. A final comment that states that the creators “hope this film contributes in the fight for sign language to be recognized in every school across the globe.”

Children of a Lesser God, a play written in 1979, made its Broadway debut last April. The piece focuses on the professional and romantic relationship between a deaf janitor and a typical hearing teacher and shows the contrasting worlds off sound and silence. To Sarah, the janitor, deafness is an identity, not a defect.  

This Close is a TV series by two deaf writers and actors that narrates the true story of their lives. The show provides a close look of the everyday day life of two best friends, emphasizing their challenges and frustrations while highlighting the positive and beautiful things that their hearing loss brings to their existence.

HHF commends these and the artists behind similar works for the awareness their creations have generated. Likewise, the organization is proud to witness the introduction of new laws and procedures to make entertainment more accessible to the hearing loss community.

Credit: Naugatuck Patch

Credit: Naugatuck Patch

The American with Disabilities Act (ADA) first broke barriers by advocating for the requirement that all video program distributors close caption their TV shows. But it wasn’t until recently, with the help of technology, that these rules have expanded. On November 2016, the Final Rule on the ADA Title III was signed, requiring all American movie theaters to provide accessibility for captions. Large cinemas now offer assistive listening, closed captions, and descriptive audio.

Broadway, too, has made tremendous improvements. In 2016, the Theater Development Fund (TDF) and The Broadway League, launched www.theatreaccess.nyc, a website with information about tickets prices, dates and accommodations for theatergoers with disabilities. In addition, TDF now provides accessibility programs with open captioning and/or ASL at select Broadway performances.

Entertainment has made progress in becoming more inclusive for people with hearing loss since the implementation of these programs, but additional work is needed. Though mandating captioning at movie theaters represents great progress, other entertainment settings, including sports arenas and concert halls, must follow suit.

To optimize the listening experience for audience members with hearing loss, more must adopt the use of hearing loops, which transmit sound from a PA system to hearing aids and cochlear implants. In December 2017, the state of Minnesota passed a bill requiring hearing loops in public meeting spaces, taking after similar New York City legislation from earlier in 2017.

HHF looks forward to a day where no one must live with hearing loss. As long as hearing remains out of reach for tens of million Americans, fair accommodations are the most ethical choice.

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