How to Communicate Better, and More Compassionately, With People With Hearing Loss

By Mary Florentine, Ph.D., Julia B. Florentine, and Michael J. Epstein, Ph.D. 

A trio of experts with both professional and personal connections to hearing loss share advice for better communication. 

They are a distinguished professor emeritus and expert in psychoacoustics (how humans perceive sounds); her daughter  who coaches communication skills and researches the link between language, language, and mental health; and an auditory scientist  who has investigated hearing better in background noise. 

Here they tell us what individuals with hearing loss say works and why these tips are effective.

“Look at me, and take your hands away from your mouth. Please don’t exaggerate your pronunciation.”

Many people have learned to use visual information from the mouth and facial expressions along with the sounds they receive to understand speech. The words “bother” and “father” sound very similar to people with hearing loss, but they look different when they are being said. The lips come together for “bother” to make a puff of air to start the word; the air coming through the mouth is continuous at the start of “father.”

Using these cues to understand speech is called “speechreading.” It used to be called “lip reading,” but we now know that we use more than information from the lips. Facial expressions also help.

Although there are excellent speechreading courses, some people learn to speechread on their own without formal training. Whether a person has had formal training speechreading or not, be sure that they can see your face.

Although many words can be speechread, others cannot. If you go to the mirror and say “mom, bomb,” in a natural manner and speed, they look the same on your lips. Speechreading can be helpful, but do not expect that someone can understand all speech 100 percent of the time using speechreading alone.

Many people exaggerate their pronunciation because they think it will make them easier to understand, but it can actually make it worse. Exaggerated pronunciation changes speechreading cues and may bring unwanted attention from others who can see you. Speak naturally. 

If you are eating while talking, make sure that you swallow the food in your mouth before you start to talk. Holding food in your mouth while talking will also change the speechreading cues. 

Don’t talk in the dark; good lighting is important. Don’t talk from the other room unless the listener can see through walls! And get their attention first, such as by asking “Can you hear me?” before speaking.

“If I do not hear you the first time, please repeat with different words.”

Some words are more difficult to hear than others. When a person with hearing loss misses a word, they often ask the speaker to repeat what they said. Most people will repeat the word that the person did not hear the first time.

If the listener does not hear the word again, some people continue to say the same word. Each time the word gets a little louder. This situation is extremely annoying to both the speaker and the listener.

If a person does not hear a word, it may be because the sound of that word might be especially difficult for them to process, and they do not have enough context to help them piece together the meaning. Saying the same thing with different words is a better strategy; it gives them another way to understand the message. If the word is an object and you both can see it, point or gesture. Writing or texting the word can be useful.

Even if you are having difficulty getting them to understand what you are saying, never give up and say, “Never mind.” You may think that what you have to say may not be that important, and you may be right. But the person with hearing loss wants to know what you said and is likely to feel left out. If you are having difficulty getting someone to understand, or you need to finish the conversation, it is better to say, “I’ll tell you later.” But if you say this, remember to tell them later or they will not believe you the next time.

The “I’ll tell you later” response can work well when the conditions for communication are bad or when you need time to think of a way to rephrase (and not just repeat) what you said.  

“Let’s try to limit or avoid background noise. I do not hear well in noisy environments.” 

It is difficult for people without hearing loss to understand the impact of background noise on a person with hearing loss. This is because they hear differently. People without hearing loss efficiently filter out unwanted noise, except when in the most extreme noise environments. People with hearing loss experience varying amounts of difficulty doing the same thing.

Every time we listen, unless we are in a sound-isolating chamber, we hear the sounds we want to hear mixed with sounds we do not want to hear. 

We usually get used to it and can tune out low-level background noises, such as the hum of a refrigerator or ventilation system fans. We can also tune out most other background noises, except when it gets very loud and/or really bothers us, like when a buzzing insect flies by.

People with hearing loss have difficulty separating out unwanted sounds. Most very low-level sounds are usually not a problem because they are not heard. Moderate and loud sounds that mix with speech can be a big problem. 

Noisy restaurants are always a problem, although there are ways to minimize the problem. You could go at a less crowded time, or ask for a quiet table away from the kitchen and the bar. If that doesn’t work, vote with your feet and go to another restaurant with better acoustics. You can look for reviews of quiet restaurants and even rate them yourself.

At home, you have more control over background noise. You can simply turn off the television or radio. If the person with hearing loss is watching television and you need to speak to them, ask them to put the television on pause or mute. If noise is coming from the hall, you can shut the door.

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Many other background sounds can occur at home. Don’t talk while washing dishes in the kitchen sink, using a food processor, or any other appliance that makes noise. Outside the home, you have less control over noise. It is usually best not to try to talk while walking outside on a noisy street and when you cannot face your conversational partner. Seek ways to limit background noise or wait until you are in a better environment to communicate.

We hope these strategies help facilitate better communication and engaging conversations for you and your loved ones.

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This is excerpted from “How to Talk to People With Hearing Loss,” available at and also previously appeared in the Summer 2019 issue of Hearing Health magazine. Mary Florentine, Ph.D. (far left) is a Matthews Distinguished Professor Emeritus at Northeastern University in Boston. Julia B. Florentine is the director, coach, and trainer at Glisten Training, which she founded, based in theU.K. Michael J. Epstein, Ph.D., is an auditory scientist, writer, filmmaker, and musician.

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How to Plan for the Cost of Hearing Care


Out of the estimated 48 million Americans living with some degree of hearing loss, only one in five wears hearing aids. The main reason? Cost. And these aren’t the only costs associated with hearing loss. Over the course of a lifetime, healthcare fees can add up to tens of thousands of dollars—or more. Here are tips to help you budget and plan for these expenses.

Find a health insurance plan tailored to your needs.
Hearing aid devices usually range from $1,000 to $4,000 each and may require replacement roughly every five years. Many insurance companies do not provide full or even partial hearing aid coverage. Currently, only 22 states require insurance companies to provide hearing aid coverage for children, and only five states have provisions that include coverage for adults. Government healthcare programs such as Medicare offer little to no coverage, with the breadth of coverage varying from state to state for Medicaid. 

If your current health plan does not cover hearing aids, an accredited insurance broker or agent can help you identify a plan that will work best for your situation and location. Make sure your agent represents several major insurers to ensure they are not incentivized toward selling you a specific plan.

Plan and budget to cover your healthcare costs.
Plan for three types of expenses: fixed monthly premiums to your insurance company; routine out-of-pocket expenses (e.g., hearing devices); and unexpected costs (e.g., emergency room visits). In addition, make sure you understand all the costs included with your health plan, including deductibles, copays, co-insurance, and the out-of-pocket maximum. Once you’ve identified all these expenses:

Add up the cost of your fixed premiums and routine out-of-pocket expenses. Divide the total by 12 and aim to save that amount each month. 

Open a separate medical emergency fund. You’ll want to start saving enough to cover your deductible and eventually, your plan’s annual out-of-pocket maximum. Consider opening a high-yield savings account, as they often have no fees and no minimum balance and offer higher returns than a typical savings account. 

Ask your employer whether you’re eligible for a Health Savings Account (HSA) or Flexible Spending Account (FSA), both of which allow you to make tax-free contributions to save for medical costs. You may be able to use HSA or FSA funds to pay for hearing aid devices and hearing aid batteries. One key difference is that HSA funds automatically roll over from year to year, while FSA accounts have a use-it-or-lose-it provision. 

If you’re raising a child with hearing loss, consider developing an estate plan to help ensure they are financially secure.
A financial planner or estate planning attorney can help you navigate this complex topic and develop a plan tailored to your financial situation as well as to your child’s needs. A trust, for example, can ensure your child’s inheritance is carefully managed according to your wishes. If your child is eligible for Medicaid or Supplemental Security Income (SSI), a special needs trust will ensure that he/she will remain eligible for federal benefits. 

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The costs associated with hearing loss can be overwhelming, but you don’t have to navigate them alone. A trusted financial professional can help you plan for these expenses or ensure your loved one’s costs are taken care of after you’re gone. 

Matthew Phillips is a wealth adviser at Trilogy Financial, a privately held financial planning firm with advisers across the country. Based in Corona, California, Phillips partnered with RISE Interpreting and California Baptist University to deliver American Sign Language–certified translation, workshops, and other services to better serve his clients. For more, see This article originally appeared in the Spring 2019 issue of Hearing Health magazine. For references, see

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Which Restaurants Are Way Too Loud (or Not)? Get Real Data and Share It!

By Kathi Mestayer


Recently, I found myself in a restaurant that was so noisy, the waitress leaned over and told us, “I can’t hear in here, either!” So, it’s not just me. In fact, a 2015 survey by Zagat that found that noise in restaurants was listed as the top complaint by diners.

One of the more satisfying things I do in that situation is to get out the decibel app on my smartphone and take a measurement. Is it really that loud? The answer is usually yes! I’ve gotten decibel readings as high as 95 dBA (“dBA” refers to decibels adjusted for human hearing). So, I gripe politely to the wait staff or manager, and consider adding it to my “never again” restaurant list. Or I visit during off hours, at 3 p.m.

Then I discovered that there are decibel apps that allow you to share your data on how loud (or quiet!) the restaurant is! Here’s SoundPrint, which I have been using for a couple of years with great success (and whose founder wrote in the Spring 2019 issue of Hearing Health about the genesis for the app).

Here is how SoundPrint works:

1. Download the app from the site above.

2. When you want to take a decibel reading, take out your iPhone, open the app, and touch the “Start” button. Record the dBA level for at least 15 seconds.


3. Then, hit “Stop.” 

4. To share the sound level at the restaurant/bar/coffeeshop, hit the “Submit” button. 


5. That will take you to the “Your Location” screen, which will give you its best guess as to where you are. You can also enter the name of the venue into the field near the top. (It will be easier to find the venue if you have the “Locations” setting activated on your iPhone. You can turn it off again immediately, if you’re as paranoid as I am.)


6. Select the venue and hit “Submit.” Your data will be on the SoundPrint site, without your name or any identification, for the rest of us to see. I’ve submitted data on places that are way too loud or nice and quiet. 

I just took a look, using the Search icon at the lower left of the iPhone screen, at Richmond, Virginia, where I live, and got a few hits! The red ones are way too noisy, orange is pretty noisy, yellow is a little noisy, and green is… quiet! The brown ones are venues that don’t have any data yet.


Clicking “View details” got me to the address and phone number, and gives you the option of leaving a comment. Now, that said, if you go there and it’s loud, you can take another measurement and submit it, too. And you can add a comment for others to see.

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If SoundPrint users continue to add to the database, for places all around the country, and especially when places are quiet(ish), it results in such a wonderful shared resource! My favorite memory is of the time I was taking a decibel reading and the waitress was looking over my shoulder, very curious about what I was up to. I showed it to her, and hope she shared it with the manager.

Staff writer Kathi Mestayer serves on advisory boards for the Virginia Department for the Deaf and Hard of Hearing and the Greater Richmond, Virginia, chapter of the Hearing Loss Association of America.

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Amplifying the Home: A Technology Guide

By Neyeah Watson


Living independently may seem challenging, or even daunting, to someone who has recently been diagnosed with a hearing loss. Fortunately, innovations in technology can vastly improve life and safety in the home. Functions like answering visitors at the door, waking up with an alarm clock, and responding to an emergency can be simplified with various tools. 

Below we review devices and applications that can help you or your loved one with hearing loss perform everyday tasks and live safely.

Waking Up
A specialized alarm clock with a round, vibrotactile device attached can be placed under one’s mattress or sheets. Instead of making sounds like beeps or music, the vibrotactile device wakes the sleeper through movement. A vibrating watch worn to sleep can be used instead of, or in addition to, an alarm clock with a shaker device. Like an alarm clock, these watches use vibrations and visual representations to wake sleepers.


Responding to Danger
A multi-part device that includes a bed-shaker can be connected to a smoke detector to notify the resident of danger. One part is a flat, round, vibrotactile device placed under the mattress or other furniture that responds with movement when the smoke detector identifies a fire. The other part of the device mimics the design of an alarm clock. When activated by the smoke detector, strobe lights and/or the word “FIRE” display on the screen. Carbon monoxide devices for residents with hearing loss are designed similarly. If carbon monoxide is detected, the strobe lights and vibrating device are triggered.

Landline Phone Conversations
Captioned telephones help those who struggle to hear on a landline phone. These phones translate spoken conversation into visual text. The telephones look like standard phones with large screens attached. Most of these landlines transcribe what the other person on the other end saying, not the entire conversation. Captioned phones are available for free to individuals with hearing loss with documentation from a professional such as an audiologist or medical doctor. 

Smartphone Use
For those who use their smartphone as a means of communication at home, smartphone applications can make conversations easier by captioning the call in real time. Speech-to-text apps, the majority of which are free, use a computer voice recognition system to provide captions. Other apps transcribe in-person conversations picked up by smartphones’ microphones. 

Greeting Visitors
Door signalers notify residents of the arrival of visitors and can take different forms. Devices with screens—to show who is at the door or to indicate that someone is present—can be placed around the home. Other versions are connected to the doorbell; when the bell is detected, signal lights in front of the door will flash.

Acknowledging Natural Disasters
Weather alert machines come in the form of receivers that are connected to weather stations. When an emergency occurs, the receiver will turn on and issue a response, usually in the form of vibrations or an extremely loud alarm. Then the warning light will appear with a short message such as “TORNADO” on the display. External devices, such as strobe lights, sirens, and vibrating devices, will also be activated.

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Hazardous Noise Can Affect More Than Your Hearing

By Strom & Associates

Each year, hazardous noise causes about 22 million workers in America to suffer a hearing loss on the job, and that hearing loss can affect everything from the quality of life to income potential and the ability to work. Understanding the far-reaching implications of permanent, irreversible hearing loss is critical for workers to protect their health and mental well-being.

Risk of Hearing Loss in the Workplace

Noise is one of the most misunderstood workplace hazards. The risk of hearing loss due to workplace exposure is significant. If the noise in a workplace is higher than 85 decibels average over eight hours, permanent hearing loss can occur. Even the noise from a carpenter’s shop or a farming operation can reach this threshold daily.


Hearing Loss Affects Mental Health

People who have untreated hearing loss report a number of mental health issues. They may feel angry or irritable, and often they feel lonely because they are not able to interact with other people easily. This can cause them to avoid social situations. Untreated hearing loss can cause stress, fatigue, and undue tension. Some people with this condition also suffer from depression.

Hearing Loss Affects Income Potential

Hearing loss suffered on the job can also impact a worker’s overall income potential. When a worker cannot hear, he or she may not be able to do a job to the fullest. Reduced job performance can make it difficult to get promotions or raises. It can also lower the individual’s earning power because certain jobs require a full use of hearing to perform safely.

Additional Effects of Hearing Loss

In addition to income potential and mental health concerns, hearing loss can impact an individual’s overall quality of life. This is difficult to measure, but the National Institute of Occupational Safety and Health estimates hearing loss takes away 2.5 healthy years from workers exposed to work noises. Also, hearing loss can impair an individual’s memory and ability to learn new tasks.

The effects of hearing loss reach far beyond the ears. When workers are aware of the long-term and far-reaching impacts of hearing loss, the importance of using protective equipment may become more evident even if the sounds do not seem overly loud in the workplace.

This article was republished with permission from Strom & Associates, a Chicago-based personal injury law firm. For more, see

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Have Loop, Will Travel

By Stephen O. Frazier

I'm 80 years old with a hearing loss. What I've learned through my travels is that I need more than just my hearing aids.

In New York City not long ago, I expected to have a problem when I approached the fare booth to buy a subway pass. I knew the roar of trains constantly passing through makes it difficult for someone with typical hearing to communicate, let alone someone like me with a severe hearing loss.

National Association of the Deaf via

National Association of the Deaf via

But when I noticed a sign for hearing loops, a blue symbol with an ear and a “T,” I turned off my hearing aids’ mics and turned on their telecoils. To my surprise and delight, I heard quite clearly the attendant’s voice, just as a train was passing through underneath.   

Telecoils, or T-coils, are tiny coils of wire in my hearing aids that receive sound from the electromagnetic signal from a hearing loop. A hearing loop, in turn, is a wire that surrounds a defined area and is connected to a sound source such as a public address system. It emits a signal that carries the sound from its electronic source to the T-coils in my hearing aids, which are already optimized for my hearing ability. It’s as simple as flipping a switch to gain access to sound in any looped setting.

Beyond New York City, hearing loops are available around the country in auditoriums, train stations, airports, places of worship, theaters, and more. For a full and growing list, see and

The technology also works with devices called neck loops—personal loops that replace the headsets used in assistive listening situations (such as a museum audio guide, in-flight entertainment, or a live theater production) and send sound to the telecoils of hearing aids.

Travelers with hearing loss should look for the international hearing loop symbol, which is usually blue in the U.S. but may be maroon or green or some other color abroad. If you aren’t sure whether your hearing aid has T-coils, talk to your hearing healthcare provider. Keep in mind the smallest-size hearing aids sometimes do not come with telecoils.


Here are some of my other travel tips, as a lifelong travel enthusiast:

  • If you have a Pocket Talker or some other personal sound amplifier, take it along with a neck loop to hear over cabin noise in flight.  

  • Download a speech-to-text app like Live Caption or InnoCaption to your cell phone to let you read what's said to you by others.

  • Download a captioned phone app such as the one from Hamilton CapTel so you will have captioned phone access during your trip, for both placing and receiving calls.

  • Pack extra hearing aid batteries and, if you have one, an extra hearing aid for the trip.  

  • If your hearing aids are rechargeable, be sure to take the charger and put it in your carry-on in case your checked luggage doesn't arrive with you.

  • Take a pen and notepad with you to communicate with ticket/gate agents in case you can't hear them over the noise in the airport.

  • Download the SoundPrint app for its Quiet List that identifies restaurants and bars in several U.S. cities, including popular destination New York City, that are less noisy than others and more conducive to conversation.

  • Print your ticket and boarding pass at home, or send it to your phone.

  • If available, take a seat near the information counter at the gate and alert the attendant to your hearing loss. Request that you be notified of any emergency or other announcements. Often the agent will add you to the group allowed to preboard.

  • As you board the aircraft, alert the flight attendant(s) to your hearing loss so they will know to pay attention to your communication needs, and read the safety instructions in the pocket in front of you—you will probably have difficulty understanding the oral version offered by the flight crew.

  • Once you reach your destination, if staying in a hotel, alert the desk clerk to your hearing difficulty so staff can be instructed to personally inform you of any emergency, e.g., fire alarms. If you feel you need it, ask for an Americans with Disabilities Act (ADA) deaf/hard-of-hearing kit from the hotel; they are required to have them available.  These kits include such items as a door knock sensor, telephone handset amplifier, telephone ringer signaler, visual/audio smoke detector, and a special alarm clock. Not all hotels are in compliance with the ADA so check ahead on the availability of a kit.

  • And most of all, relax and enjoy your travels!

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Stephen O. Frazier is a hearing loss support specialist, the former Hearing Loss Association of America (HLAA) chapter coordinator for New Mexico, and director of Loop New Mexico. He serves on the national HLAA Hearing Loop Steering Committee and on the New Mexico Speech-Language Pathology, Audiology, and Hearing Aid Dispensing Practices Board. To learn more about loops, see

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8 Tips for the New Hearing Aid User

By Brad Grondahl

I am a second-generation hearing aid specialist, now retired. My father had a hearing loss, caused from noise exposure on the artillery range while serving in the U.S. Army. Initially he wore a body, or pocket-type, hearing aid with an external cord and receiver. Eventually he came to sell hearing aids himself, driving to visit prospective clients in their homes.

After my father passed away, my mother helped push for the eventual passing of licensing laws for hearing aid dispensers in the state. After college, I took over the business, earning licenses and certifications for dispensing hearing aids and also taking audiology coursework.

I share this advice I’ve gleaned after decades of dispensing the instruments:


1) Entering the world of improved hearing with amplification is not at all like being fit with new glasses for visual correction. With glasses, you put them on and instantly everything is clear. This is not generally true of hearing devices, which have to be personalized and programmed to your individual hearing ability—a process that can take several visits to your provider.

2) Since hearing loss usually comes on gradually and you compensate and become accustomed to softer sounds, it can be a shock when you first use hearing devices—especially if your hearing loss has been untreated for years. (A 2018 Ear and Hearing study by Hearing Health Foundation board member Judy Dubno, Ph.D., and team found the average time between hearing aid candidacy and adoption is 8.9 years.) Many things may not sound as you feel they should, including your voice. But with time and effort, you can train your brain to recognize the new sounds as normal.

3) There is no such thing as a “one and done” approach with hearing aids. Ongoing care and maintenance will be required, including inspecting your instruments daily when you put them on.

4) Sometimes a simple dead battery is the culprit if an aid doesn't seem to function. Always try at least two batteries to be sure it is not just a dead battery.

5) Earwax can be another challenge. If earwax is blocking the sound outlet—the part of the aid that enters your ear canal—the devices may seem weak or have no amplification. Replace the wax filter or clean the outlet or earmold using a special cleaning tool.

6) Earwax in the ear canal itself will affect sound. But do not use cotton swabs, hairpins, or any other “home remedy” to clean your ear—ask your hearing provider for help. (The news is full of earwax-cleaning mishaps, such as, recently, a British man’s brain infection that ended up resulting from swabs!)

7) All styles of instruments have their own set of maintenance issues, too numerous to review. If the problem is not the battery or earwax, contact your provider to help troubleshoot a problem.

8) Hearing loss patterns change over time, gradually, and your brain will again adjust to softer sounds. Retest annually and adjust your hearing aids as needed.

A licensed hearing aid dispenser in North Dakota since 1969, Brad Grondahl, BC-HIS, has served as the president of the North Dakota Hearing Aid Society and as a member of the State Examining Board for Hearing Instrument Dispensers and the State Examining Board for Audiology and Speech Language Pathology, both in North Dakota. For references, see

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Your Concerns About Cochlear Implants, Answered

By René H. Gifford, Ph.D, CCC-A, and David S. Haynes, M.D., FACS

“If you qualify for a cochlear implant (CI) but do not have one, please indicate reasons you have not pursued.”

This question was one of three dozen on hearing conditions posed in Hearing Health Foundation’s 2017 Reader Survey, which was administered through the pages of this magazine, online, and also with Hearing Loss Association of America, through their magazine and online. More than 2,300 people responded to the survey. Those who responded to the CI question above gave the following answers, and they were able to check off as many as applied. In order of popularity, the responses were: 1) not convinced of improvement, 2) surgery complications, 3) waiting for biological cure, 4) concerns about sound quality, 5) cosmetic, and 6) fear of discomfort.

Although “other” with a fill-in option was offered, age did not appear to be a primary concern. In fact, many older adults with severe to profound hearing loss whose hearing aids are no longer are beneficial have found success with CIs, as demonstrated by Barbara Sinclair (page 20), who received an implant 17 years ago at age 72, and our cover story author Bruce Douglas (page 6), who had implantation surgery at age 91.

Part of the survey’s purpose is to better understand the needs of our community of readers and supporters, and so, as cochlear implant surgeons, we wanted to address these concerns.

Source: University of Illinois Hospital

Source: University of Illinois Hospital

Not convinced of improvement

All CI centers, including ours at Vanderbilt University Medical Center, perform extensive presurgical testing to determine if a CI is the right option for a patient, versus the continued use of hearing aids. The testing, based on data and experience, answers this question with an incredible degree of accuracy. Our goal is to reach a level of hearing that dramatically outperforms the best hearing aid outcomes for a given individual. Expectations are much higher than this, however, and it is extremely rare for a patient who is wearing their implant full-time not to experience much better preoperative hearing performance. The benefit has been so pronounced that Vanderbilt and other CI centers are working to expand implantation criteria so that this technology reaches people with milder forms of hearing loss.

Surgical complications

Cochlear implantation has one of the most favorable risk–benefit ratios of any surgical procedure in the U.S., offering significant communicative benefit while incurring little risk. Our center performs nearly 300 implants per year, and we monitor and track all procedures, outcomes, and complications. As with any operation your surgical team will provide a list of potential complications in order to be comprehensive, but the actual incidence of CI surgery complications ranges from under 1 percent to 3 percent. If any do occur, they are considered minor and temporary, such as postoperative taste disturbances and dizziness. At most CI centers, implantation is completed as an outpatient procedure and generally performed in 1 to 1.5 hours. We recently completed cochlear implantation on a 96-year-old patient who went home on the same day of surgery.

Waiting on a biological cure
The field of hearing restoration through hair cell regeneration—some of which is being conducted by HHF scientists, through the Hearing Restoration Project—is still in its earliest phases. While there have been exciting advances in gene therapy, current technology via cochlear implants can provide people with severe to profound hearing loss immediate access to sound, and all the benefits that this brings. In addition, improved success with CIs is linked to implantation that occurs closer to the onset of hearing loss, as auditory pathways in the brain need to be stimulated or they weaken. Otherwise the resulting permanent changes in the brain’s auditory centers may limit the ability of a patient to hear, even with a perfectly intact cochlea.

Concern about sound quality
Despite CIs being a mechanical device, the voice sound quality has the potential to be no less electronic sounding than that from a telephone, computer, or television. Often the abnormal sound is due to the stimulation of an ear that hasn't heard for many years (or an ear that has never heard). If this occurs, it typically dissipates with continued use of the CI and the stimulation of auditory pathways. Signal processing technology also continues to advance at a rapid rate, allowing for personalized programming for the best hearing outcomes, and—especially with any neural changes with age—programming is important to do at regular intervals.

The thin internal portion of the CI is designed to sit flush with the skull and is not visible. The visible external components (the battery, sound processor, microphone, and transmitting coil) mostly fit behind the ear, not much larger than a standard behind-the-ear hearing aid. The latest sound processors are self-contained in a single unit about the size of a half dollar coin. These “off-the-ear” processors do not have an over-the-ear component, but rest directly over the magnet that is behind the ear and within the hairline. Eventually we expect that all implanted systems will be compatible with these smaller, off-the-ear processors, and nanotechnology and battery miniaturization will further reduce processor size. (And, the
boom in wearable consumer technology makes visible devices even more mainstream.)

Fear of discomfort
Implantation incisions behind the ear heal quickly, and the drilling of the bone required to place the
implant is a simple mastoidectomy. It is a component of most ear procedures and is not painful. Our center performs over 1,200 mastoidectomies per year across various different ear procedures. Postoperative discomfort is a rare complication and easily managed with over-the-counter medications such as acetaminophen (Tylenol).

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Do You Qualify?
If you have a hearing loss that prevents you from talking on the phone without visual cues (such as needing video calls or caption calling); are unable to understand television programs without closed captioning; and/or are actively avoiding large group gatherings for fear of conversational difficulty, talk to your hearing healthcare professional to see if you may be a CI candidate. CIs are the most successful sensory restoration prostheses to date and have been successfully placed in more than half a million individuals worldwide. The wonders of this technology vastly improve hearing, speech understanding, and overall quality of life.  

René H. Gifford, Ph.D, CCC-A, is a professor in the department of hearing and speech sciences with a joint appointment in the department of otolaryngology at Vanderbilt University, Tennessee. She and HHF medical director David S. Haynes, M.D., FACS, direct the Cochlear Implant Program at the Vanderbilt Bill Wilkerson Center.

This article also appeared in the Fall 2018 issue of Hearing Health. For references, see

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How My Hearing Loss Makes Me Better at My Job

By Sarah Bricker

My hearing loss journey led me to a position as a communications specialist at Starkey Hearing Technologies, the Minnesota-based hearing aids manufacturer. Managing a hearing loss at work has meant that I sometimes have trouble hearing speech in noisy conference rooms, and that I may miss various sound cues during international phone calls. Yet as I navigate these challenges in the office, I can also see that having a hearing loss has actually helped me to become a better employee.

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I am comfortable asking for help. There’s a misconception that asking for help means you’re incapable of doing your job or it will make your boss or colleagues think less of you. But I see asking for assistance as showing an interest in learning and growth and a desire to recognize weaknesses and overcome them.

“Hard work” is my middle name. Having a disability often means I have to work a little harder than those with full abilities. I may have to try harder to hear in staff meetings, when talking to clients on the phone, or when attending a seminar in a large auditorium—but I also focus and do due diligence before and after meetings and calls to make sure I didn’t miss anything. Even with my hearing aids, it’s better to be safe than sorry.

I find creative solutions. Because my hearing loss can sometimes prevent me from doing something the usual way, I am always looking for an innovative approach. I believe this is a life skill that will enable me to take on challenging projects at the office and figure out solutions others may not have considered.

I am more accurate in my work.
I know I may miss parts of conversations and other sound signals, but being aware of this has set me up to be extremely detail-oriented otherwise. I am hyper-aware of all the minutiae and will carefully analyze each element of an assignment before I consider a project finished.

I work well alone and with a team! Having a hearing loss means I’ve learned the skills necessary to be self- sufficient and to succeed on my own. By the same token, my hearing loss has also given me an underlying “Go Team!” attitude from years of asking for help. I know I can rely on my team, whether it’s to fully follow a group discussion or to make sure I get all the notes I need in a conference hall.

I am patient. Hearing loss means I may have to listen to the same phrase three times before understanding it, but that’s okay. I’ve learned that getting it right is more important than getting it right now. That outlook is extremely beneficial when it comes to long-term projects and client relationships, not to mention everyday interactions with colleagues, friends, and family.

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Texas native Sarah Bricker holds a bachelor’s degree in journalism from the University of Missouri and is a communications specialist at Starkey Hearing Technologies in Minnesota. She has a profound progressive sensorineural hearing loss that was diagnosed at age 13. This article originally appeared in the Winter 2017 issue of Hearing Health magazine.

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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.


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.


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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