Why shouting won’t help you talk to a person with hearing loss

I’ve written a few posts [1, 2] about my mom’s use of a reading machine to compensate for macular degeneration, and I made a video that shows the optimal strategy for using the machine. We’re past the point where she can get any benefit from the gadget, though. She needs such extreme magnification that it’s just not worth it any more.

So she’s more dependent than ever on her hearing. Sadly her hearing loss is nearly as profound as her vision loss, and hearing aids can’t compensate as well as we wish. She’s still getting good mileage out of audiobooks, and also podcasts which she listens to on MP3 players that I load up and send her. The clear and well-modulated voice of a single speaker, delivered through headphones that block out other sound, works well for her. But in real-world situations there are often several voices, not clear or well-modulated, coming from different parts of the room and competing with other ambient noise. She depends on hearing aids but as good as they’ve gotten, they can’t yet isolate and clarify those kinds of voices.

One of the best ways to communicate with my mom is to speak to her on the phone. That puts the voice directly in her ear while the phone blocks other sounds. And here’s a pro tip I got from the audiologist I visited today. If she removes the opposite hearing aid, she’ll cut down on ambient noise in the non-conversational ear.

In person, the same principle applies. Put the voice right into her ear. If I lean in and speak directly into her ear, I can speak in a normal voice and she can understand me pretty well. It’s been hard to get others to understand and apply that principle, though. People tend to shout from across the room or even from a few feet away. Those sounds don’t come through as clearly as sounds delivered much more softly directly into the ear. And shouting just amps up the stress in the room, which nobody needs.

Lately, though, the voice-in-the-ear strategy — whether on the phone or in person — had been failing us. We had thought maybe the hearing aids needed be cleaned, but that wasn’t the problem. She’s been accidentally turning down the volume! There’s a button on each hearing aid that you tap to cycle through the volume settings. I don’t think mom understood that, and I know she can’t sense if she touches the button while reseating the device with her finger. To compound the problem, the button’s action defaults to volume reduction. If it went the other way she might have been more likely to notice an accidental change. But really, given that she’s also losing dexterity, the volume control is just a useless affordance for her.

Today’s visit to the audiologist nailed the problem. When he hooked the hearing aids up to his computer and read their logs(!), we could see they’d often been running at reduced volume. On her last visit he’d set them to boot up at a level we’ll call 3 on a scale of 1 to 5. That’s the level he’d determined was best for her. He’d already had an inkling of what could go wrong, because on that visit he’d disabled the button on the left hearing aid. Now both are disabled, and the setting will stick to 3 unless we need to raise it permanently.

Solving that problem will help matters, but hearing aids can only do so much. The audiologist’s digital toolkit includes a simulator that enabled us to hear a pre-recorded sample voice the way my mom hears it. That was rather shocking. The unaltered voice was loud and clear. Then he activated mom’s profile, and the voice faded so low I thought it was gone completely. I had to put my ear right next to the computer’s speaker to hear it at all, and then it was only a low murmur. When there aren’t many hair cells doing their job in the inner ear, it takes a lot of energy to activate the few that still work, and it’s hard apply that energy with finesse.

I’m sure we’ll find ways to compensate more effectively. That won’t happen soon enough for my mom, though. I wonder if the audiologist’s simulator might play a useful role in the meantime. When we speak to a person with major hearing loss we don’t get any feedback about how we’re being heard. It’s easy to imagine a device that would record a range of speech samples, from shouting at a microphone from across the room to shouting at it from a few feet away to speaking softly directly into it. Then the gadget would play those sounds back two ways: first unaltered, then filtered through the listener’s hearing-loss profile. Maybe that would help people realize that shouting doesn’t help, but proper positioning does.