Hearing Loss

Hearing Loss Overview: Adults become deaf in different ways, many of them through the same mechanisms as children. Understand late-deafness requires a short detour through some of this information. Some people develop an infectious disease like spinal meningitis, or are given medications for a severe illness and end up deaf as a side-effect of that medicine, or develop Menieres syndrome. A large number are dismissed with the explanation that their deafness was caused by a VIRUS. (Doctors do not seem to realize how meaningful it is to have a reason for something as important as deafness. Because this virus is never given a name, we call it THE VIRUS to mock doctors). Dr. Kathryn Woodcock.


In this section you will find:

  • Types and Causes: a brief overview of common types and causes of late-deafness
  • Communication: a narrative description of ALDAs Communication Philosophy, WHATEVER WORKS!
  • Crash Course: Basic communication strategies for both the person with hearing loss and hearing people who want to support our communication needs.

Conductive Hearing Loss:
In conductive hearing loss, disorders in either the outer or middle ear prevent sound from passing into the inner ear. Voices and sounds may sound faint, distorted, or both. Conductive hearing losses are most often seen in young children, but they can also be seen in some adults. Most conductive hearing loss can be improved medically or surgically if treated promptly.

Causes of conductive hearing loss include:

  • Infection of the ear canal or middle ear
  • Fluid in the middle ear
  • Perforation or scarring of the eardrum
  • Ear wax (cerumen) build-up
  • Dislocation of the three middle-ear bones, called ossicles
  • Foreign objects in the ear canal
  • Otosclerosis (abnormal growth of bone in the middle ear)
  • Unusual growths in the outer or middle ear

Sensorineural Hearing Loss:

In people who have sensorineural hearing loss, sound is efficiently sent to the inner ear, but some sort of damage to the inner ear interferes with proper hearing. This type of hearing loss occurs when there is either damage to the inner ear structures or the hearing nerve.

Sensorineural hearing loss is the most common type of hearing loss among adults. It usually is not medically or surgically treatable, but can be treated successfully with hearing aids. Those who suffer from sensorineural hearing loss may complain that people seem to mumble, or that they hear - but don't understand - what is being said. Aging is the most common cause of sensorineural hearing loss. As we get older,the sensory cells of the inner ear gradually die.

In addition to advancing age, sensorineural hearing loss can be caused by:

  • Injury
  • Excessive noise exposure
  • Viral infections (such as measles or mumps)
  • Ototoxic drugs (medications that damage hearing)
  • Meningitis
  • Diabetes
  • Stroke
  • High fever
  • Meniere's disease
  • Acoustic Neuroma (tumors)

Source Cited link: http://www.stronghealth.com/services/Audiology/hearing/typeshearingloss.cfm

Meniere's Disease:

Meniere's disease is an abnormality of the inner ear causing a host of symptoms, including vertigo or severe dizziness, tinnitus or a roaring sound in the ears, fluctuating hearing loss, and the sensation of pressure or pain in the affected ear. The disorder usually affects only one ear and is a common cause of hearing loss. Named after French physician Prosper Meniere who first described the syndrome in 1861.

Source Cited link: http://www.nidcd.nih.gov/health/balance/meniere.asp


Neurofibromatosis encompasses a set of distinct genetic disorders that cause tumors to grow along various types of nerves and, in addition, can affect the development of non-nervous tissues such as bones and skin. Neurofibromatosis causes tumors to grow anywhere on or in the body.

Neurofibromatosis 2 (NF2): also known as Bilateral Acoustic NF (BAN) is much rarer, occurring in 1:25,000 births. NF2 is characterized by multiple tumors on the cranial and spinal nerves, and by other lesions of the brain and spinal cord. Tumors affecting both of the auditory nerves are the hallmark. Hearing loss beginning in the teens or early twenties is generally the first symptom.

Source Cited link: http://www.ctf.org/Learn-About-NF/Learn-About-NF.html

Sudden Deafness:

Sudden Sensorineural Hearing Loss (SSHL), or sudden deafness, is a rapid loss of hearing. SSHL can happen to a person all at once or over a period of up to 3 days. It should be considered a medical emergency. A person who experiences SSHL should visit a doctor immediately.

A doctor can determine whether a person has experienced SSHL by conducting a normal hearing test. If a loss of at least 30 decibels in three connected frequencies is discovered, it is diagnosed as SSHL. A decibel is a measure of sound. A decibel level of 30 is half as loud as a normal conversation. A frequency is another way of measuring sound. Frequencies measure sound waves and help to determine what makes one sound different from another sound.

Hearing loss affects only one ear in nine out of ten people who experience SSHL. Many people notice it when they wake up in the morning. Others first notice it when they try to use the deafened ear, such as when they make a phone call. Still others notice a loud, alarming "pop" just before their hearing disappears. People with SSHL often experience dizziness or a ringing in their ears (tinnitus), or both.

Some patients recover completely without medical intervention, often within the first three days. This is called a spontaneous recovery. Others get better slowly over a one or two week period. Although a good to excellent recovery is likely, 15 percent of those with SSHL experience a hearing loss that gets worse over time.

Approximately 4,000 new cases of SSHL occur each year in the United States. It can affect anyone, but for unknown reasons it happens most often to people between the ages of 30 and 60.

Source Cited link: http://www.nidcd.nih.gov/health/hearing/sudden.htm

Cogan's Syndrome:

Cogan's syndrome is a rare, rheumatic disease characterized by inflammation of the ears and eyes. Cogan's syndrome can lead to vision difficulty, hearing loss and dizziness. The condition may also be associated with blood-vessel inflammation (called vasculitis) in other areas of the body that can cause major organ damage or, in a small number of cases, even death. It most commonly occurs in a person's 20s or 30s. The cause is not known. However, one theory is that it is an autoimmune disorder in which the body's immune system mistakenly attacks tissue in the eye and ear.

Source Cited link: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/35151.html 

Hearing Aid Types and Styles:

  • ITE - In the Ear, hearing aid fits directly into the external ear.
  • ITC - In the Canal, it is possible to make hearing aids small to fill just a portion of the external ear
  • CIC - Completely in the Canal, fit deeply into the ear canal (CIC), making them nearly invisible
  • BTE - Behind the Ear, hearing aid is housed in a small curved case that fits behind the ear and is attached to a custom earpiece molded to the shape of your outer ear. Some BTE models do not use a custom earpiece; instead, the rubber tubing is inserted directly into the ear. The case is typically flesh colored, but can be obtained in many colors and/or patterns.
  • Telecoils - electromagnetic signals can be picked up from the handset of the telephone and amplified in a manner similar to the amplifying function of the hearing aid. Also known as T-coils these features allow the user to benefit from assistive listening technology that uses FM frequencies to transmit sound.

For more information visit: http://www.betterhearing.org/hearingpedia/hearing-loss-resources

Resources for Financial Assistance for Hearing Aids:

Advocates for any patient who has been turned down for insurance coverage for a hearing device.

Hear Now:

Hear Now collects hearing aids for recycling purposes. Any make or model, regardless of age, can be donated to the hearing aid recycling program. All donations are tax deductible and a letter of acknowledgement will be sent to all identified donors.

6700 Washington Avenue South
Eden Prairie, MN 55344

Communication Strategies for Late-deafened People:
- Use whatever works to help you understand.
- Experiment with different techniques for both the speaker and the listener
- Do more of what works and less of whatever does not work.
- Turn off the television. If you have some residual hearing, avoid extra noises such as dishwasher or other conversations.
- Try to position yourself so that the window or light is behind you. That allows the face of your companion to be well lit, and you do not have the fatigue of looking toward the light while you watch what they are saying. You will also avoid the distractions of what is happening outside the window.
- Pick the best spot to communicate by avoiding areas that are poorly lit and very busy. 

Others will understand you more easily if you keep speaking.

If you choose to stop speaking, you may lose your ability to speak.

Because you cannot hear your own voice to modulate it, ask others to let you know when you speak too loud or too soft. If you are open about it, others will be comfortable helping you.
Keep using your voice if that works for you. 
American Sign Language is a beautiful, full language and may open the doors of communication and interpretation for you.
Have people with whom you are close take classes with you so you will have someone to practice with.
Consider learning to sign. 
If you know it is going to be a crowded situation, look for the calmest area when you arrive.
Be prepared by thinking about what the topics of conversations might be ... keep up on current events, for example.
Review names before going so they are easier to understand.
Anticipate difficult situations and plan to minimize problems. 
For example: Please speak just a little more slowly
"Please raise your voice a little" helps the speaker know exactly what you need.
Model clear speech (naturally slower with words clearly formed) so others know the way you would like them to speak to you.
Tell others how to talk to you best.
Remind them if they forget.
Be sure to thank them when they remember.
Provide feedback to speakers about how well they are communicating. 
It is easier to verify what you think you heard or understood than to ask someone to repeat everything.
For example.. What time do you want to meet Thursday? lets them know what you need.
Learn to verify and clarify what you have understood.
Provide feedback of what you understand or fail to understand. 
You can avoid confusion by having them write down instructions, addresses and phone numbers, etc.
If you are confused and think the topic has changed, ask for a quick note.
Ask someone to be your communication assistant to stand beside you and write names, key words and important details on a paper for you.
Ask for written clues of key words, if needed. 
You risk embarrassment and misunderstandings when you are not honest about your hearing loss.
You also rob yourself of truly being part of the discussion and the group.
Take a break during parties to relieve the stress of constant concentration.
Arrange for frequent breaks if discussions or meetings are long. 
If you keep interrupting, you may frustrate or antagonize the speaker.
If you are unable to understand what is being said, stop them right away (courteously, of course) to explain what you need to understand.
If you ask them to speak slower and they keep forgetting (and they will), tell them you will use a palm-down signal to remind them to stay slow. This allows the natural flow to continue.
Try not to interrupt too often.
Set realistic goals about what you can expect to understand. 

Now for the Other Side:

Tips for Communicating with a Late-deafened Person:

Only about 30% of sounds can be determined by lip reading.
You must do more than just speak if you are to be understood.
Lip reading is a learned skill and is limited when used alone. 

You can avoid frustration and reduce the need to repeat things by touching their arm,
knocking on the table, flashing the lights or waving your hand; then wait for a response.
Be sure they are looking at you before you begin to speak
Get the persons attention before you communicate. 

Do not have objects in your mouth such as gum, cigarettes, or food.
Avoid putting a hand or paper in front of your mouth.
If you wear a mustache, consider trimming it so your lips can be seen easily.
Keep your mouth visible. 

The best distance for communication is 3 to 6 feet.
If you speak at a slow-to-normal rate and pause between sentences, you will give the listener time to catch up. (Their mind must process a lot of clues to make up for what they do not hear.)

Encourage questions and clarifications.

Speak clearly and at a moderate pace. 

These help fill in the blanks and add more information.
Consider learning sign language if your friend or family member starts learning it.
Use facial expression and gestures. 

Tell the listener what you are talking about.
Agree on a gesture or sign that indicates you are starting a new topic.
Give clues when changing the subject. 

If one or two words keep tripping someone up, try using a different word.
Rephrase when you are not understood. 

Shouting makes you look and sound angry.
It actually distorts the sound signal.
It is better to make sure the listener can see you.
If there is some residual hearing, it may help to speak slightly louder than normal,
but not as loud as a shout.
If the hearing is gone, shouting won't bring it back.
Do not shout. 

Keep the competition to a minimum for their attention. If the late-deafened person
has some residual hearing, consider background noise as well as background visuals
(TV, dishwasher, music, etc.).
Ask the host for the quietest table in the restaurant, away from the traffic patterns.
Consider going places during off-hours to avoid the crowds (dinner at 4:30 or 8:30,
for example).
Avoid busy background situations. 

It may take more time to learn how best to talk with someone who has lost their
hearing. You are both learning how to handle this. Experiment a little.
Use humor and smiles.
Ask how you can help or what might work better.
Be patient, positive and relaxed. 

Talk TO the deafened person, not ABOUT him or her to their partner. Remember
that a hearing partner does not need to see your face to understand. 

Type as much or as little as is needed; you determine if it needs to be every word.
Experiment with voice recognition software for the family and closest friends to put
captions on your conversations.
A computer or laptop can be used when a lot of information needs to be exchanged. 

Use it to help with key words, names, numbers and not sentences.
Draw a picture to help communicate.
Always have paper and pencil handy. 

They may need your help to find the right volume.
Realize that a deafened person can not hear his or her own voice. 

Use email more because deafness disappears on email.

ALDA Communication: ALDA was founded to help those who had suffered adult hearing loss cope with their situations and live happier, more satisfying lives. One of its basic and most strongly held beliefs is that hearing loss should not be considered as a "handicap", but rather as a condition. That condition, whatever its cause, most often manifests itself as difficulty in communicating with other deaf persons and with members of the hearing community. For that reason, much of ALDA's effort has been and will continue to be focused on how we can better communicate with others, both deaf and hearing.
Our philosophy regarding communicating can be summed up in just two words: WHATEVER WORKS! We believe that there is no "right" or "wrong" way to achieve effective communication, only that different methods work best for different people. Choosing how to understand and be understood by others depends on many factors. These include but are not limited to the degree of hearing loss of each person involved, whether speech impairment is also involved, opportunities to discover, learn and practice various approaches and what is probably most important, personal preference.
How, then, do ALDA members communicate with each other and with hearing persons? The following are a few of the frequently used and most effective means:


In formal meetings, presentations, workshops and other large group activities there will most often be wide variety of preferences for and skill levels in the various communication methods - signing, speech reading, etc. On such occasions it is necessary to provide assistance that will meet the needs of everyone in attendance and this is best done through Communication Access Real-time Transcription (CART), also called Computer Assisted Real-time Translation. CART is the instant translation of the spoken word into English text using a stenotype machine, notebook computer and real-time software. A hearing person, usually trained in legal court reporting, types what each speaker says and the text appears instantly on a computer monitor or other display. This technology provides a visible, readable translation of the speaker's words for the entire audience: deaf, late-deafened, hard of hearing and hearing.

Speech Reading:

Speech reading, often called "lip reading", may well be the most common and frequently used form of communication for people with hearing loss. This is especially true in dealing with hearing people since the likelihood of a hearing person knowing sign language is very small. Speech reading consists of close observation of the speaker's lip and tongue movements, facial expressions and hand and body "English" and attempting to determine from that combination of clues what the person is saying. Although no speech reader would ever claim one-hundred percent accuracy, many ALDAns are amazingly proficient in communicating this way. Although various training programs are available, most really good speech readers will admit that they became skilled in the art largely through necessity and practice. It is a far from perfect but surprisingly effective communication skill for many late-deafened persons.

Sign Language:

A number of ALDA members are excellent signers: some classify themselves as "so-so" in that department and others sign not at all. Of those who do sign, because their hearing loss occurred post-lingually and after some years of using standard English, a great many use what is known as Signed Exact English (SEE). SEE provides a sign for each word and signing is done in standard grammatical order. In that sense it is the form of signing closest to spoken English. Others are proficient in American Sign Language (ASL). In actual practice, most probably use a version of signing known as Pidgin Signed English (PSE), using ASL signs in English order. Although SEE, ASL and, to a degree, PSE are quite different from each other in structure as well as in actual use, ALDAns always seem to find a way to communicate with each other regardless of the signing system used. An interesting note: probably the most commonly expressed reasons given by hearing impaired people for NOT signing is the lack of available classes and too little opportunity to practice.


Often at formal meetings, workshops and other group activities, sign language interpreters are used to translate a speaker's words into sign language. Interpreters are, in a way, the human equivalent of CART (see above) except that they translate speech into sign language rather than text. Highly trained and superbly skillful in the various versions of sign language, interpreters listen to the spoken word and translate it into a pre-agreed upon version of sign language, usually SEE. In many if not most cases, interpreters also use what is known as oral interpretation in which the interpreter clearly and distinctly mouths what is being spoken for the benefit of speech readers in the audience. Often, especially in large group meetings, both interpreters and CART are used simultaneously, thus increasing communication opportunities for everyone regardless of their preference or skill level.

Note Writing:

It is not uncommon at many ALDA events to see a number of people carrying a pad of paper and a supply of pencils or pens or even a laptop computer - their versions of a "conversation tool kit". Note writing is considered by some to be a communication "method of last resort," but it is very frequently employed by individuals in situations and where no other approach seems workable. It is especially effective in group situations where distracting factors may hinder communication, when interacting with persons with speech difficulties who do not use sign language or where there are other factors making communication difficult. Although it is the slowest mode of communication for deaf people, it is also likely to be one of the most accurate and sometimes the only way to understand and be understood.


There are no doubt other communication methods in use in the deaf community. However, these are the ones most commonly in use among ALDA members and are most often used in various combinations. Each has its own advantages and, in some situations, disadvantages. What works well for one person may work less well or not at all for another. Much depends on past experiences, opportunities to learn and practice a method and simple personal preference. However, our determination to ALWAYS find a method or combination of methods which allow us to effectively communicate with each other and with hearing people demonstrates the true meaning of our motto: