For Better Care for Older Adults, Think Hearing Loss.

Two scholarly papers published this month discussed the impact of hearing loss on patient communication in older adults. Both found that unrecognized hearing loss may have a serious negative impact on health care in the elderly.

In the first, published in the British Medical Journal (BMJ) on January 18, researchers Jan Blustein, a professor of health policy and medicine at NYU, Barbara E. Weinstein professor of audiology at the CUNY Graduate Center, and Joshua Chodosh, a geriatrician at NYU, found that the rate of hearing loss is underestimated in medical settings, and analyzed the effect of undetected hearing loss on doctor-patient communication.

pexels-photo-272864

In the second, published in the Journal of the American Medical Directors Association (JAMDA)  on January 30, the same authors as well as Ellen M. McCreedy, at the Center for Gerontology and Health at Brown University, discussed why hearing loss may be especially disabling in nursing home settings, and provided an estimate of the prevalence of hearing loss in those settings.

Hearing loss in older adults is measured in various ways. One is a catchall number that includes everyone over a certain age:  two-thirds of those over 70 have hearing loss, four-fifths of those over 80 have hearing loss. Sometimes it’s measured by decades: half of those 70-79 have hearing loss; 80 percent of those over 80 do. These figures include everything from mild to profound loss.

Whatever way you count it, however, the elderly experience hearing loss in large numbers. So when the researchers found that federal data indicated that 68 percent of long-term nursing home residents over the age of 70 had “adequate” hearing, it seemed worth investigating.  Was hearing loss just not being recognized in nursing homes? And if so, was it affecting care?

The Federal Data was compiled from the Minimum Data Set (MDS) that all nursing homes are required to report to the federal government. In 2016, nursing homes reported that 68 percent of their residents had “no difficulty in normal conversation, social interaction, or listening to TV.”

That number seemed “implausibly low” to Dr. Blustein and her colleagues. The National Health and Nutrition Survey (NHANES), which is the authoritative source about the rate of hearing loss among adults who live outside of institutional settings, found that only 44% of those 80 and older said that they had “excellent or good” hearing. As the JAMDA paper notes, these two figures are at “striking odds” with each other.

It stands to reason that the rate of hearing loss in nursing home residents should be about the same as that of adults living outside of institutional settings, which would mean that many people in nursing homes and other health care settings are having trouble hearing. They may not be having trouble hearing all the time, but crucial hearing situations are often the noisiest.

Many of those who say they hear adequately probably have mild to moderate age-related hearing loss. Their speech comprehension may be fine in quiet conversation. But nursing homes are far from quiet – studies show that social settings are often very noisy, with televisions blaring, dishes clattering in cafeterias, and residents crying out. Moreover, “high stakes” medical-care situations – emergency rooms, intensive care units, ambulances — tend to be the noisiest. These are also stressful situations, and stress also impacts comprehension.

Hearing aids are one solution, but hearing aid use remains low even in this population. Even if they do have hearing aids, people may leave them at home or in a safe place, to prevent loss or damage.

In both articles, the authors propose easy low-tech solutions for making sure hearing loss doesn’t get in the way of good patient care.

The first is for clinicians to be aware that their elderly patients may have hearing loss, even if they don’t know it. They should also check for impacted cerumen, or ear wax, which can affect hearing.

Every facility should have on hand personal amplifiers that can be shared with patients. The PocketTalker is perhaps the best known. The researchers also mention the Mino and the Sonido Listener. These devices cost about $150.

Health care workers also need to be mindful of communication strategies: they should make sure they have the listener’s attention, face the listener, speak clearly but not too slowly, rephrase rather than repeat words the listener has not understood.

Dr. Blustein (who has hearing loss herself and who serves on the Board of Trustees of the Hearing Loss Association of America, as do I) believes that hearing loss profoundly affects communication with patients. “Those of us with hearing loss often smile and nod so that the world thinks that we understand. It’s much more convenient. It’s easier. A patient may nod and smile, but not really understand what she is being told,” she said in an interview with the BMJ. Busy clinicians, too, may just want to move on, get their work done. So both the patient and the clinician may be contributing to the detriment of good patient care.

Unrecognized hearing loss can also sometimes be misdiagnosed as a cognitive impairment. “I think… my intuition… is that this is one of the great issues,” Dr. Blustein told the BMJ. “It’s sort of low-hanging fruit in clinical medicine, the assumption that someone has cognitive impairment when they don’t respond appropriately.”

Asked why the effect of hearing loss on good communication has remained unrecognized by many doctors, Dr. Blustein replied: “I think disability, generally, is not something that medicine is attracted to. We tend to be attracted to really dramatic, acute illness. Disability is complicated, it takes time.” And, she added, it occurs primarily in older people. “This is dismissed as ‘normal aging’. It’s ageism.”

People with hearing loss share some of the responsibility. Both patients and providers will benefit from the Guide for Effective Communication in Health Care, created by Jody Prysock and Toni Iacolucci. It includes information specifically for patients and their families (including a form that can be filled out in advance of medical interactions and should be entered into patient charts) and for providers. It can be found on the New York City Chapter’s website under Resources, with a link to the national website.

For people with hearing loss, it’s important to be honest, to disclose our disability. For providers, it’s important to recognize that hearing loss may be a factor. It’s a two-way street.

 

For more information about living with hearing loss, read my book “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You. 

Why Internet is Essential for the Hard of Hearing

No Internet When You’re Hard of Hearing
For those with hearing loss, access to the internet is essential. Getty Images

This past week, we moved to a new apartment and I found myself without high-speed internet — no DSL or Wi-Fi connection at home — for 10 (long) days.

It was an uncomfortable reminder of how vitally important the internet is for people with hearing loss. I did have a smartphone, so I was not completely cut off from communication, but it was very limited. Here’s what no home internet meant for me:

No captioned telephone. I hear on the phone, but not well. Even using the telecoil setting on my hearing aid does not make the speaker’s voice completely clear. Captioned telephones depend on DSL or Wi-Fi for the captioning part of the call, which appears on the screen of your special phone. Two of the major manufacturers of these captioned phones are CapTel and CaptionCall. They are available free of charge to people who can provide proof of their hearing loss, and oftentimes their representative will come to your home to set it up. But you do need a high-speed internet connection.

For captions on cellphones, a company called Innocaption has been developing a system to provide simultaneous voice and captioning. It’s still got some kinks to work out, but when it works, it’s terrific. Unfortunately, at least on my phone (an iPhone 5S) and with my carrier (Verizon), I cannot get voice and captions at the same time unless I have DSL or Wi-Fi. (Innocaption, which has very responsive consumer support, confirmed this in an email: “Unfortunately, Verizon supports voice and data at the same time from iPhone 6, not iPhone 5/5s.”) I need that connection to Wi-Fi.

This is a problem anywhere outdoors, but I live in a big city, and without captions my cellphone is close to useless on the street. This is because electromagnetic interference produces a buzz in telecoil mode that drowns out talk. I guess I need to spring for a new iPhone.

I did have Ava. Ava is a voice recognition system used for in-person conversations. Two or more people sign on to the app on their smartphones. Their voices are simultaneously captioned on each user’s phone, color-coded by speaker. Ava is still in the testing stage, but you can download it here. The version I was using required Wi-Fi, but the newest version, which I downloaded (free) today, no longer requires Wi-Fi. I had a nice conversation with someone in the dog park. I could understand him over the yapping dogs because he was talking into my Ava-equipped phone.

Email was difficult. I’m a voluminous emailer, not only because I’m hard of hearing, but also because of the work I do both professionally and as a volunteer. The volume of mail I receive gets lost on the small screen of a smartphone. For those of us with hearing loss, email tends to be a lifeline for communicating with others. I did email on my smartphone (using satellite technology rather than Wi-Fi). But once I had Wi-Fi again and went back through the emails on my computer, I saw I’d missed quite a few. Also, no matter what size phone screen you have, it’s still pretty small.

Sherry Turkle‘s 2011 book, Alone Together: Why We Expect More from Technology and Less from Each Other, prompted consternation about the “death of conversation” due to an over-dependence on technology.

But for those of us with hearing loss, technology is sometimes the only way we can communicate. In a restaurant we may be looking at our smartphones, but that’s because we’re getting captioning from a program like Ava telling us what the speaker across the table is saying. At the theater we may be looking at a smartphone, but that’s because we’re lucky enough to be at a performance with I-Captions or Globetitles.

Texting and emailing are conversation for people with hearing loss. I was surprised by how handicapped I felt without high-speed internet. I lived two-thirds of my life before the internet came along, so you’d think I’d know how to manage for a week or so. I wasn’t as hard of hearing then, it’s true. But also, once you’ve enjoyed the advantages that Wi-Fi and DSL offer those with hearing loss, it’s really hard to give them up.

This post first appeared on AARP Health on 10/18/2016.
shoutingwonthelp

Living Better jpeg

Katherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

Emergency Preparedness Plans for Those With Hearing Loss

Tips that go beyond the usual for the deaf and hard of hearing.

Emergency Prep for Hearing Impaired

Tips for those with hearing loss on how to be prepared in the case of an emergency. — Getty Images/iStockphoto

Emergencies happen. Just recently, the country has seen floods, tornadoes, wildfires and terrorist attacks, not to mention a host of other catastrophes. It was also the 15th anniversary of 9/11, which ushered in a new era of emergency awareness.

It goes without saying that everyone should be prepared with an emergency plan. But for people with hearing loss, being prepared goes beyond the usual.

 The Centers for Disease Control and Prevention offers information on its website for emergency preparedness plans, and the American Red Cross suggests what you should have in your emergency kit.

For more specific advice for those with hearing loss, the New York City chapter of the Hearing Loss Association of America recently hosted a presentation on emergency planning for the deaf and hard of hearing. Representatives of New York City Emergency Management offered information about basic emergency planning, as well as these useful tips for adults with hearing loss:

  • Use “legacy technologies.” These include old-fashioned pen and paper for communicating with friends, family and emergency workers if you do not have access to your hearing aid or cochlear implant. Another legacy technology is a landline telephone. Even when cellphones, Internet, power and everything else goes, a landline may still work. Check with your provider.
  • Keep extra batteries in your emergency kit. Be sure to include batteries and chargers to keep your hearing aids, cochlear implants and assistive listening systems safe and working. You’ll want to have several packets of backup hearing-aid batteries and a sealed waterproof container in your emergency kit, for your hearing aid or cochlear implant. The bag or container should be big enough for extra batteries, chargers and assistive listening devices. Don’t forget to include your medications, written copies of your medical information, your prescriptions, and your driver’s license and passport.
  • Consider a portable battery charger. Cochlear implants are more of a challenge during an emergency because their rechargeable batteries generally last at most about eight hours. This is where a portable battery charger — or two, if you want to be extra careful — may be useful. The chargers themselves need to be charged, however, so be sparing in how you use them.
  • Don’t forget your car as a power source. Even when all other power is out, your car (depending on the model, and as long as you have gas) will have some power for charging things like a cochlear implant battery pack, your cellphone and so on. These will be charged through the USB port.
  • Flashlights are a must. They are especially important for the hard of hearing. If it’s dark, you may need a flashlight to help in reading lips. Make sure you have them in your emergency kit and in a handy place in your home.
  • Use Facebook’s Safety Check. If cellular phone service is still working, this feature allows Facebook to notify you in the event of a disaster in your area and ask if you’re safe. You click the “I’m safe” button and the message will go to your Facebook network. Facebook can also give you a list of friends who might be affected by the disaster. Facebook is selective in the disasters it covers with Safety Check, and has been criticized for implementing it in some disasters and not others, but it’s still a good way for the deaf and hard of hearing to check on friends and relatives.
  • Get a weather-alert radio. If you live in an area where tornadoes, hurricanes, floods, landslides or other natural disasters are common, you may want a NOAA (National Oceanic and Atmospheric Administration) weather-alert radio. They come in all price ranges, and a variety can be found by Googling “weather alert radio” or checking online at Amazon. If you are deaf or hard of hearing, you can activate a warning light. Some weather alert radios have an LCD screen for alerts.
  • Sign up for emergency alerts issued by your city or community.

  • Finally, for anyone who lives alone, hearing or not, form a support network.  Ask two or three friends, neighbors or coworkers to be in your network so you don’t go through an emergency alone. Your network partners should make a plan to stay in contact during an emergency. They also should know your medical conditions and needs, and where to find emergency and medical supplies.

From AARPHealth on 9/2916.

Katherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

For My Summer Vacation, I Went to Hearing Camp

Who says only kids get to go to summer camp? Last week I went to hearing camp. We didn’t sleep in bunks, but we did have sing-alongs, games and picnic lunches. And we spent a lot of time talking and, more importantly, listening.
 Hearing camp was a four-day program at the University of Connecticut at Storrs, sponsored jointly by the university’s Aural Rehabilitation Laboratory and photo-HRFthe Hearing Rehabilitation Foundation, run by Geoff Plant in Somerville, Mass.

Most people may know UConn because of its championship women’s basketball team, but the school also has a well-known Department of Speech, Language, and Hearing Sciences, of which the lab is a part. Four of the lab’s graduate students, who are earning dual degrees in audiology, led the one-on-one aural rehabilitation exercises — 90 minutes in the morning and afternoon daily. The warm-up for the morning sessions was rollicking sing-alongs, led by Plant. Even for an aging cynic like myself, it was fun. And combined with plenty of coffee, it did get the brain working.

Aural rehabilitation, in the broadest sense, teaches you to listen better. It is often used for people getting cochlear implants and sometimes for those getting hearing aids for the first time. It can take many forms, from computer programs to group sessions to individual sessions with an audiologist or speech-language therapist. The American Speech-Language-Hearing Association (ASHA) has a good description of auditory rehabilitation.

For this camp, four people with severe hearing loss (three of us with cochlear implants, one with two hearing aids) worked with the four audiologists. Each camper and each audiologist had at least two sessions together.

The technique that was used is called KTH speech tracking, a program originally developed by Swedish researchers. The version we used was designed by a team at Gallaudet University, a Washington, D.C., institute of higher learning for deaf and hard-of-hearing students.

Here’s how speech tracking works: In alternating five- and 10-minute sessions, the audiologist reads from a prepared script, stopping at the end of each line whether or not it’s the end of a sentence or even makes sense. The client repeats what has been read. The audiologist’s computer keeps track of how fast the client is responding. This is done with the speaker’s face visible, and with it covered. Not surprisingly, most everyone does better when the speaker’s face is visible. The exercises are designed to enhance the speed and agility of the brain to hear sound and repeat exactly what was read.

Program director Plant wrote the text we listened to — a supernatural suspense story about a boy and his mother from Australia. You might not want to sit down and read it, but it was effective for this kind of training.

If you’re new to hearing aids or a cochlear implant, auditory rehabilitation helps your brain adjust, which ultimately helps you hear better. The result is improved, faster, more accurate word recognition. If auditory rehab isn’t offered in your area, there are lots of ways to create your own version.

The easiest is to have a companion read to you from a book, stopping at the end of a line and having you repeat the words back. You can also listen to a recorded book, pausing it every few minutes to look at the written text to see how much you understood.

There are also several computer programs available online. The best-known of these is the L.A.C.E. program, which uses increasingly difficult exercises, usually with an increase in background noise. Background noise is the one thing, more than any other, that stymies people with hearing loss. There is also a fun computer game called Read My Quipsthat is designed to challenge you to understand speech amid noise.

So how did I do? I don’t know yet. The audiologists will enter the KTH results in a computer, along with the results from a speech-in-noise test (QuickSIN) conducted at the beginning and end of camp to measure my improvement. I am hearing better anyway, because I recently got a new hearing aid, but hearing camp gave me an excellent chance to try it out. I look forward to getting my results.

But I’m not finished yet — and I never will be. As Plant says, auditory rehab is an ongoing process. He likens it to going to the gym to stay fit. If you stop, it doesn’t take long for things to go back to the way they were.

Photo Courtesy of the Hearing Rehabilitation Foundation

This post first appeared on AARP Health on August 25, 2016.Living Better jpegshoutingwonthelp

Katherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

The Hazards of Driving While Deaf

The death last week of 29 year-old-Daniel Harris, who was Deaf,  is a reminder for all of us who are Deaf and Hard of Hearing that we need to be extra cautious when pulled over by a police officer. Here’s a link to the New York Times article, which also includes heart-breaking photos of this very young man.image3-1

The risk is even greater if you’re black, as the Pearl Pearson case in 2014 showed. Pearl Pearson—a grandfather (with both a son and son-in-law in law enforcement), who was Deaf and black—was pulled over by a highway patrolman. When he failed to respond properly, the patrolman handcuffed him and put him in the police car. The incident was videotaped, and he was treated roughly enough to require medical attention

What should you do if you’re pulled over? This can be difficult and even dangerous for someone with hearing loss. Even if you tell the cop you have hearing loss he’s still going to expect you to answer his questions. Remember, you don’t <I>look<I> deaf. “Lady, do you know how fast you were going?” The correct answer is not to reach over to the glove compartment for your registration.

This situation is even more difficult at night, when the headlights from the police car behind you may blind you. What if the officer doesn’t even get out of the car but blares through his loudspeaker “Get out of the car!” Or was that “Don’t get out of the car!” That kind of misunderstanding can get you killed, or at least roughed up. This is even more of a possibility if you also happen to be young, male, or black. Add hearing loss and the situation is even more likely to escalate. (Harris was white.)

The Pearl Pearson case got a great deal of attention among the Deaf and HOH community, and a fund-raiser was held to help with medical and legal expenses. The local law enforcement community also paid attention. Pearson had a note on his car visor saying he was Deaf, but unfortunately he didn’t get a chance to show it before he was handcuffed and bundled into the police car. That visor message is something that all of us with hearing loss should have. You can download a copy and print it out from Google images.

Neil Baumann offers a visor card you can order for $4.95 that is laminated. His 2005 column on visor cards relates some alarming instances of people with hearing loss being pulled over and having their hearing loss misunderstood. Get yourself a visor card.

Then what? If you’re pulled over, the first thing you should do is unclip the visor message and place it on your steering wheel. Tell the officer that you are Deaf or hard of hearing and point to the visor message. Watch the officer closely as he gives you instructions. If you don’t understand the officer’s words, repeat “I am deaf (or hard of hearing). I did not understand what you just said because I couldn’t hear you. Would you please write down what you just said?’

Make sure the visor message is on the visor, not somewhere in your purse or the glove compartment where you’re going to have to shuffle around looking for it. The ACLU and the actress Marlee Matlin teamed up to produce a video on how to handle a traffic stop if you are deaf or hard of hearing. It has useful advice for both those with hearing loss (and those who hear perfectly). Matlin uses ASL in the video, but it is also captioned and there is a voice-over for the hearing.

As the Harris case shows, law enforcement didn’t learn much from the Pearl Pearson incident. Those of us with hearing loss need to be very very cautious when you’re pulled over. The visor card is a good place to start.

\Living Better jpegshoutingwonthelp

Katherine Bouton is the author of “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids,” and a memoir, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You”. Both available on Amazon.com.

*This essay is adapted from “Living Better With Hearing Loss: A Guide to Health, Happiness, Love, Sex, Work, Friends … and Hearing Aids.”

Can’t Hear These Iconic Sounds of Spring?

It may be time to get your hearing checked.

 

images

Birdsong. Where ever you live in the United States, the great spring bird migration happens at this time of the year. Warblers, tanagers, grosbeaks, orioles, thrushes, vireos fly through on their way from winter homes in the tropics, singing as they wing their way north.eastern-bluebird-c-dorrie-holmes-320 One of my favorites is the eastern bluebird, a very early arrival in my part of Western Massachusetts, claiming its backyard house in February. I realized only this spring (an early one in the east) that bluebirds sing. Here’s a YouTube video. Hope you can hear it!

I was unable to find specific decibel levels for bird songs, which vary according to species of course, but I did come upon a study that found that urban sparrows sing at a higher pitch than they used to, to compete with traffic noise.

Pattering rain. Louder than snowfall but nothing like the deluge of a summer downpour. A moderate rainfall measures about 50 decibels.

Leaves rustling in the breeze are just 20 decibels, close to the softest sound most humans can hear.

Spring peepers. I always thought these were newly hatched frogs, but a “spring peeper” is a member of the tree frog family. The high-pitched sound is a chorus of males, looking for mates. Click here for a picture of the peeper’s balloon-like throat, which makes the sound

Insects. I can’t find any information about the decibel level of a bee buzzing – but it’s good to be able to hear it, especially if it’s near your ear. A buzzing mosquito, on the other hand, comes in at 37 dB, and should be audible.

Squirrels, according to expert Robert Lishak, have a regular language, from “kuk” (a sharp bark of alarm, usually repeated three times) to “quah” (the predator is still in sight but not quite as threatening) to the “quah moan.” Dr. Lishak describes the quah moan as sounding like a “chirp followed by a meow.” “Muk Muk” is a soft buzzing or huffing noise, possibly a male mating call. These vary in decibel level with the softest, the muk-muk, around 20 decibels. You’ll need sharp hearing to hear that one.

Picnics. The crinkle as you open that bag of chips only increases your appetite, and the satisfying crunch as you bite into one makes you want to keep on eating. Healthier foods also have inviting sounds. Thinks of the crunch of a bite of celery, the snap of a carrot. The pop/hiss of a soda can is another familiar picnic sound.

America’s Pastime. How loud is the sound of that bat hitting the baseball? The crack of the bat actually varies in pitch and intensity, depending not only on how hard the ball is thrown and where exactly it meets the bat, but on the kind of hit it produces.

Fun reading: Moonshot: The Analytic Value of the Crack of the Bat, by Robert Arthur. This 2014 analysis of baseball bat sounds found that a line drive in general produced the highest frequency sound, amplified by sound systems in a stadium or on TV or radio. This is followed by the sound of a home run (second loudest), a ground-ball hit, and a ground-ball out.

According to a similar article in The New York Times, a ball hit in the sweet spot has a sharp crack, a ball hit on either side will thunk. The crack may alert an experienced outfielder to the trajectory of the ball before he can visualize it.

Share your favorite spring sound in the comments box, below.

First published on AARP Conditions and Treatments, 3/19/16

Boomers, Hearing Loss and the Workplace

Americans are working longer than ever, whether by choice or necessity. It’s created a problem the workplace has tried to ignore: hearing loss among the millions of boomers still on the jobolder_1645590c

It’s 2016, which means that the first of the baby boomers turn 70 this year. 2.5 million of them. Having survived to 70, their life expectancy is now 85. That’s just the start. Ten thousand baby boomers will turn sixty-five every single day between 2011 and 2029, according the Pew Research Center, with similarly long life expectancies.

Many of them plan to continue working and many others will be involved in volunteer work. As of today, more than half of boomers are still on the job – that’s about 45 million baby boomers, ranging in age from 51 to 70. The total figure for boomers, according to the Census Bureau is 76 million.

By 2022, the Bureau of Labor Statistics predicts, nearly one-third of those 65 to 74 will be in the work force.One half of those 65 and over have hearing loss. Two-thirds of those 75 and over have hearing loss.

How is the workplace going to cope with this? So far, by ignoring it.

Very few workplaces offer accommodations for those with hearing loss. For instance, company wide meetings might be held in rooms equipped with hearing loops or with both an ASL interpreter and CART captions. Few businesses provide those accommodations. Audiologist Juliette Sterkens, who is HLAA’s Hearing Loop Advocate, thinks the omission is not deliberate on the part of employers: in an email she wrote that she was “convinced that most are unaware that their employees’ struggle.” Echoing a familiar comment about the invisibility of hearing loss, she added, “they may realize something is not right but they cannot put their finger on it.

For now, it falls on you – the hearing-diminished boomer – to hold your own.

Here are some tips.

*Get hearing aids. Unfortunately, corporate America drops the ball on this one too. Most company insurance plans do not pay for hearing aids, nor does Medicare.

*If you can’t afford hearing aids, try a PSAP. If you’re not sure what a PSAP is, start with this New York Times article: “Just Don’t Call Them Hearing Aids.” At one-tenth the average price of a hearing aid, they are very effective for those with mild to moderate hearing loss. Only 20% of those who could benefit from hearing aids use them. That number holds firm well into old age. Hearing aids work. So do PSAP’s. For most employees, either of these devices can correct hearing to nearly normal.

*If you are still having trouble despite hearing aids, tell your supervisor and your colleagues. And then tell them again and again. Hearing loss is invisible, and they’ll quickly forget they need to look at you when they talk, refrain from yelling on the phone, not expect you to hear them from across the room.

*Make sure your hearing aids have telecoils. By law all landline telephones must be hearing-aid compatible, which means that the inner workings won’t cause your hearing aid to buzz. If you flip to telecoil mode when making or receiving a call the reception will be far clearer. And if you happen to work in one of those rare places where meeting rooms are looped, you’ll be able to hear as clearly from the back row as you would from the front.

*If necessary, ask for accommodations. The easiest and most effective of these is a captioned telephone. A captioned phone won’t work for a trader on the floor of the stock exchange – the captions are too slow – but it will help a majority of those with hearing loss to follow a business conversation.

*If you work at an information counter or a cash register, or anyplace where you regularly interact with people, ask for a portable hearing loop. These are usually thought of as accommodations for customers with hearing loss, but they are equally effective for an employee with a loss.

*Use personal assistive-listening devices. If you need to regularly hear one or more speakers – at a daily meeting for instance, look into FM systems or Phonak’s Roger system. The FM systems work best for one on one conversations, but the Roger can be used with several microphones around a table, allowing you to hear all the speakers.

*If you feel you are being discriminated against because of your hearing loss, keep a record of incidents. These can turn out to be invaluable in retaining your job, or in getting a decent settlement if you are told you’re no longer needed.

*Check out HLAA’s Employment Toolkit, which offers a wealth of information.

No company will tell you they’re firing you because you can’t hear, but there are plenty of pretexts – the job is being eliminated, you’re “not a team player,” etc. – and you may be able to expose them for just that if you have kept a written record.

No one wants to get into a lawsuit, and the big guys usually win. So optimize your workplace experience, and keep your job.