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Dr. Jared Young Au.D., FAAA, CCC-A

Hearing Each Other Is a Two-Way Street (From ASHA Dec 18, 2012)

Hearing Each Other Is a Two-Way Street
Simple Strategies Can Help People Live Well With Hearing Loss
by Nicole Marrone, Mary Rose Durkin & Frances P. Harris

Below are the top six most commonly recalled communication strategies. These strategies may be most effective because they are easily implemented and can show immediate positive effects on communication and decrease communication breakdowns.
1. Get attention first.
2. Walk before you talk.
3. Speak slowly.
4. Give the topic.
5. Rephrase.
6. Use keywords.

Louise is frustrated. At her assisted living facility, menu options are presented aloud in the large, noisy dining hall. It is so noisy, one caregiver always calls out, “Are you hearing me?!” Louise—experiencing age-related hearing loss—routinely misunderstands and sometimes misses that she is being spoken to. Then, suddenly, it seems like the caregiver is yelling at her.

But the caregiver assumes Louise is experiencing cognitive decline, and makes meal choices for her. As a result, Louise finds herself served food she dislikes. During a group audiologic rehabilitation session at her care center, facilitated by audiology doctoral students from the University of Arizona (UA), Louise explains, “Sometimes I don’t eat. I just want to get some food that I like. I want to say, ‘Are you hearing me?'”

Louise’s story illustrates that communication is a two-way street, where both partners share responsibility for communication breakdowns. Louise is eager to learn strategies for better living with her hearing loss. So she and her caregivers are taking steps toward more effective communication by learning to use simple communication strategies through a Living WELL With Hearing Loss group program.

The groups are for people with hearing loss and their frequent communication partners, including caregivers, family, community workers, and health care professionals. Louise and her caregivers participated in a group held at her care center, facilitated by students in the university’s AuD program.

Living Well With Hearing Loss
The Living WELL With Hearing Loss groups are part of a UA program that grew from the efforts of private donors James and Dyan Pignatelli and the Unisource Energy Corporation. In 2009, they collaborated with the UA Department of Speech, Language, and Hearing Sciences to develop a community-oriented program of direct intervention, research, and training for the next generation of health care professionals. The program seeks to improve the lives of people with hearing loss and their families (Marrone & Harris, 2012). Group classes are at the heart of the approach, based on their effectiveness in spurring positive adaptations to acquired hearing loss (Hawkins, 2005).

Group training in the use of communication strategies is one aspect of a multidimensional approach to rehabilitative audiology with adults (e.g., Hickson, Worrall, & Scarinci, 2007; Hogan, 2001; Stephens & Kramer, 2010; Tye-Murray, 2009). Communication partners are included not only to provide support, but also to raise awareness of how hearing loss affects their lives and what each person can do to make communication more effective (Preminger, 2003). In some groups, the focus is specifically on the needs of caregivers or partners.

To date, more than 400 adults have participated in Living WELL With Hearing Loss groups on-campus and more than 140 people have participated in the group programs at assisted and skilled-nursing facilities and community centers.

Six Key Strategies
After the first group session—which focuses on education and communication strategies—Living WELL With Hearing Loss participants are asked what they most clearly recall from the session. They are encouraged to begin incorporating these strategies in their daily communication immediately.

Below are the top six most commonly recalled communication strategies. These strategies may be most effective because they are easily implemented and can show immediate positive effects on communication and decrease communication breakdowns.

1. Get attention first. Improve speech understanding by getting a person’s attention first. For example, tapping Louise on the shoulder would let her prepare to receive the incoming message and allow her to direct her attention appropriately. This strategy is useful when speaking to anyone, but especially for someone with hearing loss because it provides additional cues to the listener about when and where the signal will occur (Best et al., 2009).

2. Walk before you talk. It is beneficial to be in the same room and facing the listener. This strategy not only decreases the distanec between the speaker and the listener, but also allows the listener to take advantage of visual cues. Integrating auditory and visual cues has been shown to improve speech understanding for listeners with hearing loss (Grant, Walden, & Seitz, 1998). Decreasing the distance between the speaker and the listener increases the intensity of the signal, thus improving the signal-to-noise ratio. More favorable listening conditions may lead to increased speech understanding (Boothroyd, 2004; Jordan & Sergeant, 2000). For example, walking to the same side of the table and facing Louise would be more effective than speaking from above and behind her.

3. Speak slowly. Slow your rate of speech when speaking to someone with hearing loss to improve comprehension and recall. A recent study showed that at a typical conversational rate of speech, listeners with hearing loss recall significantly fewer elements of the message than those with normal hearing. However, when listeners with hearing loss are allowed to adjust the rate of speech, these differences are eliminated (Piquado et al., 2012). Louise might consider asking others to speak more slowly and clearly.

4. Give the topic. When listeners know the topic of conversation before the talker begins speaking, speech understanding is enhanced. Listeners are able to fill in the gaps when they miss auditory input. Listeners with hearing loss may use knowledge of the topic or context to reduce the number of possible alternatives, thus increasing accurate perception of speech (Grant et al., 1998). For example, when the caregiver takes a dinner order, conversation topics naturally may shift. Letting Louise know that the next topic is a menu choice could help.

5. Rephrase. When a listener misunderstands, a speaker’s typical response is to repeat the message. Although this is the most common repair strategy, it is the least effective after one repetition. The preferred strategy is to then rephrase the message by changing the word order or selecting different vocabulary (Tye-Murray, 1991).

6. Use keywords. Miscommunication may occur due to poor understanding rather than not hearing. Responding with a keyword instead of a nonspecific

“What?” or “Huh?” gives speakers additional information about how to rephrase their responses. For example, “What did you say about dinner?” rather than, “What?” might reduce emotional reactions and increase communication. The speaker knows the listener is engaged in the conversation, and how to repair the breakdown (Tye-Murray et al., 1990).

Why Work in Groups?
Preventing and repairing communication breakdowns is a shared responsibility, yet neither partner may understand how to make necessary changes (Trychin, 2006). This is one reason group programs are effective, allowing participants to learn from each other, and realizing that each person is capable of successful adaptations (English, 2008; Erdman, 2009; Hawkins, 2005). Communication habits and attitudes develop over a lifetime, well before the onset of age-related hearing loss. So it may take time for people to recognize and acknowledge hearing loss and develop new communication habits in response. Participants’ feedback confirms that common communication strategies can make a difference.

There is growing evidence of the benefits of building confident communication behaviors among older adults with hearing loss (Smith & West, 2006) and perhaps, most important, of the cognitive and health benefits of maintaining social engagement as we age (Cacioppo et al., 2011). Providing caregivers and other communication partners with the knowledge and skills needed to decrease communication-related frustration will likely reduce their stress and improve their quality of life (Preminger, 2003; Preminger & Meeks, 2010; Scarinci, Hickson, & Worrall, 2011; Scarinci, Worrall, & Hickson, 2008).

These strategies are simple, and with practice new communication habits may replace those that are no longer effective. Some of the most exciting moments in groups occur when partners recognize that strategies to improve communication are already within reach. They learn from one another that their problems and frustrations are common experiences, and that it is possible to make positive changes, motivating them to continue to adopt the new strategies.

Nicole Marrone, PhD, CCC-A, is an assistant professor in the Department of Speech, Language, and Hearing Sciences at The University of Arizona. Marrone’s research area is hearing loss and rehabilitative audiology across the lifespan, with specific interests in speech communication in noise and factors that influence treatment outcomes. She is an affiliate of Special Interest Groups 6, Hearing and Hearing Disorders: Research and Diagnostics, and 7, Aural Rehabilitation and Its Instrumentation. Contact her at

Mary Rose Durkin, BS, is a third-year AuD student at the University of Arizona and a research assistant for the Living WELL With Hearing Loss Program. Her research is focused on quality of life outcomes from the Living Well With Hearing Loss programs. Contact her at

Frances P. Harris, PhD, CCC-A/SLP, is the James S. and Dyan Pignatelli/Unisource Clinical Chair in Audiologic Rehabilitation for Adults at the University of Arizona. Her interests include exploring multifaceted solutions for maximizing communication while minimizing the effects of hearing loss. She is an affiliate of SIG 7. Contact her at

cite as: Marrone, N. , Durkin, M. R. & Harris, F. P. (2012, December 18). Hearing Each Other Is a Two-Way Street : Simple Strategies Can Help People Live Well With Hearing Loss. The ASHA Leader.

Published by Jared Young, Au.D.

As a Doctor of Audiology, my primary objective is to deliver unparalleled hearing health care and support to my valued patients. By using cutting-edge technology and a patient-centered approach, I strive to empower each person to overcome communication challenges and rediscover the joys of active and connected living.

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