“ You Never Listen to Me ” and Other Hearing Loss-Related Stories Samuel Trychin, Ph.D.

1. “You Never Listen to Me” and Other Hearing Loss-Related Stories Samuel Trychin, Ph.D. Janet Trychin, Au.D.

2. Thanks for inviting us to Beautiful Fresno

3. Part 1 The importance of putting hearing loss in a larger context.

4. Two basic things we need to do in order to survive 1. Avoid or escapefromharmfulor dangerous things or events—those that threaten physical and psychological health and integrity, 2. Approach beneficial or renewing things or events—those that promote physical and psychological health and integrity.

5. Survival requires several abilities 1. Ability to detect those harmful and beneficial things and events. 2. Ability to learn ways to avoid or approach those harmful and beneficial things and events. 3. Ability to consolidate that learning in memory for dealing with future similar things and events.

6. Adding hearing loss to the equation Hearing loss, our most basic and important sense, affects two levels of human functioning: 1. External, physical and social , and 2. Internal, physiological, emotional, and cognitive.

7. Hearing loss is a systems issue affecting… The external social system—hearing loss affects what we are able to detect that has important influence on our sense of acceptance or belonging: Examples: The person speaking is angry and voice level is: Loud Soft (pick one) The person speaking delivers a loving message and the voice level is: LoudSoft (pick one)

8. Hearing loss is a systems issue affecting… The external environmental system—hearing loss also affects a person’s ability to detect important environmental sounds: Katrina, car horns, alarms clock, sirens, telephone ringing, kettle whistling, microwave timer, etc. Question: What is the influence on one’s sense of competence and control or influence over events?

9. Hearing loss is a systems issue affecting… The internal, physiological systems, such as, the nervous, hormonal, cardiovascular, respiratory, immune, and digestive systems. Two internal system issues to consider are: a. Negative emotional arousal, and b. Unrealistic, dysfunctional attitudes and expectations

10. Hearing loss is a systems issue affecting… The interactions between the external and internal systems, as occurs when: Difficulty understanding discussion at a business meeting (external) produces… Anxiety (internal) which lessens the ability to focus attention and use judgment (micro) which causes… Increased inability to understand what others are saying (external) which increases anxiety further and also… Prevents effective problem-solving (internal) and then Communication problem persists/worsens(external).

11. In order to break these cycles people need to learn to do two things 1. Manage communication situations in order to prevent or reduce those communication difficulties that are due to hearing loss. Failure to do so can result in feeling: Less acceptable to others, Less competent in work and everyday functioning, Less influence or control over social and other events.

12. People also need to learn to… 2.Manage themselves because even when they learn and regularly practice tactics and strategies for preventing or reducing communication breakdowns, they will not always be successful because: a. Other people refuse to cooperate, and/or b. It is not possible to modify the environment

13. Learning to manage communication situations involves Recognizing situations that produce problems and those that don’t, Knowing the causes of communication breakdowns: Knowingwhat to do to prevent/reduce communication problems. Practicing until new behaviors becomes habitual. Anticipating difficulties in upcoming events.

14. One Problem Most people who have hearing loss don’t recognize it, or admit to having it, or take steps to deal with it. For example, of the estimated 34.25 million people who have hearing loss in the United States: Less than 1 in 10 with mild hearing loss use amplification, and Less than 4 in 10 with moderate to severe hearing loss use amplification. Kochkin,S. MarkeTrak VIII: Hearing Review. 2009:16 (11): 12-31.

15. A Second Problem Many of those who know they have hearing loss attempt to hide it from others. Problems… 1. Behaviors signal that something is wrong. 2. Others make assumptions that are not in that individual’s best interest. 3. Additional anxiety from fear of being found out.

16. Some reasons why people hide their hearing loss Pragmatic reasons, e.g., afraid of being fired Cosmetic reasons, e.g., will be less attractive Social reasons, e.g., don’t want to appear different Cultural reasons, e.g., are aware of negative stigma and don’t want to be devalued

17. Stigma—A major factor that interferes withacceptingthe fact of, oradmitting to having, hearing loss • 1. General social/cultural stigmatizing: • Old, weak, deteriorating, incompetent, dependent, burden, stupid, etc. • 2. Communication partner stigmatizing: • Spouse/lover, “Your hearing is fine…” • Parent/child, “It’s not a problem; he/she’s ok.” • Spillover--Concern about reflection on themselves • 3. Self-stigmatizing: • Oneself—buys into the negative stereotype of self

18. A Third Problem Misinformation about hearing loss and about those who have it contributes to failure to take effective action. Misinformation about hearing loss also contributes to relationship difficulties as in, “Why don’t you pay attention?” or “How many times do I have to tell you to slow down when talking?”

19. Myths and Misconceptionsabout Hearing Loss • Hearing aid myth • Lip-reading myth • Sign language is for everyone • Professionals understand hearing loss • People who are hard of hearing understand their own hearing loss and its effects • Communication partners understand hearing loss • Trychin, 1987

20. Part 2 Hearing loss considered as a communication disorder

21. Rationale for including communication partners Hearing loss is primarily a communication disorder for most people who experience it. As a communication disorder hearing loss affects: The person with hearing loss who is listening, and The person/people who is/are speaking to him/her. Good perspective: “It is our hearing loss.”

22. Examples Beryl, Minister’s wife, Grandpa,

23. Hearing loss challenges That subgroup of people who have hearing loss who come to audiologists for help in accommodating their hearing loss do so because: 1. They are experiencing hearing loss-related difficulties in their daily lives, or 2. Someone close to them, e.g., spouse, friend, employer, etc., has urged them to do something about their hearing condition.

24. Hearing Loss As a Communication Disorder • CPs are physiologically affected by their partner’s reactions to hearing loss-related problems via overt /verbal distress signals, mirror neurons, and electromagnetic transmission. • CPs are emotionally,cognitively and behaviorally affectedby the difficulties they encounter in being understood when speaking.

25. Hearing Loss As a Communication Disorder The perspective and experiences of CPs should be taken into consideration during assessment, treatment, and follow-up because: CPs can facilitate or inhibit the tendency of a person who has hearing loss to take effective action to deal with it. CPs may report problems that the person who has the hearing loss is unaware of or is unwilling to discuss.

26. Who are these communication partners? In the past we have used the term significant others. Usually, we think of significant others as a person’s spouse, lover, child, or parent. However, most people communicate with a large variety of people in the course of a day, week, month, or year.

27. YOU

28. Who are these communication partners? The most important communication partner at any given time is that person with whom the individual with hearing loss is conversing at that moment. Example: Physician’s office (both ways)

29. Ease of communication When the communication partners in one’s inner circle, i.e., those with whom the person communicates most frequently (family, friends, coworkers, etc.) and the person with hearing loss use strategies and tactics for preventing or reducing communication problems, interactions proceed rather smoothly, and relationships benefit.

30. Dis-ease of communication However, if there are frequent communication breakdowns, the result is often a weakening of the bonds that hold relationships together. Then, there are emotional, cognitive, and behavioral effects on both the person who has hearing loss and the communication partner(s).

31. Three major problems for person who has hearing loss • 1. Didn’t realize someone was speaking to her (didn’t get her attention before speaking) • 2. Not understanding: • 3. Misunderstanding: • Examples: Riverside, Aspirin, Obama

32. Effects of hearing loss on those who have it and on their communication partners The following specific problems have been reported by many of those people with whom I have worked. It is likely that these problems are also present in the lives of those people who have hearing loss but who have not yet recognized it, admitted to having it, or taken steps to deal with it.

33. Problem situations frequently reported by people who have hearing loss • Hearing alarm signals, at home/in a car • Someone talking to you from another room • Can’t see speaker’s face • Poor illumination • People whispering

34. Problem Situations Reported by HOH • Voice’s on TV or radio • Conversations in a moving car • Family dinners at holidays • Understanding conversations on the phone • Several people talking at once • Medical situations/reports • Outdoors-wind, traffic, etc.

35. Problem Situations Reported by HOH • Person who’s speech is not clear • Misinterpretation of mistakes • Unaware that the person is talking to me • Movies, plays, lectures, classes • Stopped for traffic violations • Dancing and talking

36. Extent of effects of hearing loss It should be apparent that hearing loss can affect virtually everything a person does from the time he/she arises until going to sleep—and even thereafter. Communication partners are also affected when their attempt to communicate orally with the person who has hearing loss fails or they ar uncertain that the message has been correctly received.

37. Problem Situations frequently reported by communication partners • Having to repeat often • Having to interpret frequently • When we become frustrated or irritated • When she/he doesn’t pay attention • Not talking as much as before • When he/she is not understanding someone else • Difficulty remembering what to do • Not knowing whether she/he understands • Trychin & Albright, 1993

38. Problem Situations for Communication Partners • The variability in his/her ability to understand • Hard to get her/him to understand me • TV or radio is much too loud • Becoming too dependent on me • Being isolated from friends and family • Not doing things we enjoyed previously • Having to repeat in pressure situations • Not traveling or going new places

39. Problems for students/trainees In each kind of situation that the person who has hearing loss encounters there are a variety of problems and concerns that arise and need to be anticipated and planned for ahead of time. Schools and other training programs, for example, have many ways of producing difficulties for students and trainees who have hearing loss.

40. Problem Situations for Students/Trainees Who Are HOH • Teacher does not understand the effects of hearing loss in classroom settings • Teacher talks while facing the blackboard • Other students ask questions from behind • Teacher talks while walking around room • Teacher uses microphone as a pointer

41. Problem Situations for Students/Trainees Who Are HOH • Use of uncaptioned TV, videos, or films • Recorded as absent, didn’t hear name • Examine time announced from rear of room • Air conditioning drones on during lecture • Teacher has heavy foreign accent • Teacher not open for suggestions

42. Problem Situations for Student/Trainees Who Are HOH • Teacher lectures while students take notes • Teacher does not provide written outline • Student is unable to follow other student’s comments in work groups • Teacher comments on films, slides, or videos when lights are out • Difficulty understanding PA announcements

43. Major life-tasks • The impact of hearing loss on one’s life can be enormous—especially in earlier development. • For adults: Continuingtheir education or training and Maintaining job/career, relationships, self-respect/confidence. • For children/adolescents: Establishingeducation/training,job/career, relationships, self respect/confidence

44. Preventing/reducing communication problems As stated, the major problem for most people who have hearing loss and for their communication partners is the breakdown in communication. Both the person who has hearing loss and his/her communication partner(s) contribute to difficulties in communication, and both need to cooperate in attempting to prevent or reduce these problems.

45. Preventing/reducing communication problems In order to begin to minimize communication problems both the person speaking and the person listening must know the major causes of communication problems. They also need to understand that hearing loss is only one causal factor and that most of the other causal factors can be prevented or reduced.

46. Factors that influence understanding what is being said • Speaker factors-the person who is talking. • Environmental factors-the place/situation in which the message is being delivered. • Listener factors-the person receiving the message

47. Speaker Factors that Influence Understanding • Does not first get the listener’s attention • Does not face the listener while talking • Covers face while talking • Talks too rapidly/too slowly • Talks too softly/too loudly • Does not enunciate clearly • Uses too little/too much facial expression or body language

48. Speaker Factors that Influence Understanding • Has a foreign accent/regional dialect • Has distracting mannerisms • Has an untrimmed beard or mustache • Has a boring delivery or message • Is impatient with the listener • Is irritated with having to repeat

49. Environmental Factors that Influence Understanding • Background noise • Poor lighting • Poor room acoustics • Too far from source of sound • Visual or auditory distractions • Objects interfere with seeing speaker

50. Environmental Factors that Influence Understanding • Poor seating arrangements • Inadequate ventilation • Lack of assistive listening systems • Lack of alerting systems • Lack of visual aids-overheads, CART, etc. • Illegible visual aids