Most of my patients agree that hearing in a group of people is one of the most challenging environments of all. Often the noise level alone is irritating, but the kicker is how challenging it is to understand what nearly everyone is saying, especially young children. So, it’s no wonder The Holidays can be particularly taxing for, or outright avoided by individuals with hearing loss.

So, why are these situations with people you know well so challenging? Especially if everyone present knows who has hearing loss and if they have hearing aids?

Let’s review the main challenges:

1) Clarity: For most people with sensorineural hearing loss (the kind acquired with age, noise exposure, or exposure to certain medications for example), the area of their hearing that is most effected is the high pitches, aka the clarity range of speech. With a typical age-related hearing loss, others sound like they are mumbling. This is especially challenging when listening to children, people with soft voices, and people who speak quickly. The listener often has to use visual and contextual cues to fill in the missing pieces, which can be quite taxing.

2) Background noise: For the listeners described above, background noise often washes out the already unclear message they are trying to hear. At this point an enormous amount of focus and energy is being used to make sense of things. Some individuals are aware of the challenge while others may not notice until later on when they feel more exhausted or irritable than usual. The degree of challenge they face depends on their hearing loss, the level and type of noise, and the speakers they are trying to hear.

3) Sub-optimal hearing aid use and/or settings: First, let me say that even when hearing aids are functioning perfectly for that person and their hearing loss, they do not eliminate background noise and do not make everything sound clear to the user. Hearing aids are delivering amplified sound in to ears that have their own potential distortion – they are hearing aids not cures.

They can be extremely helpful, but the truth is many hearing aids are not set (programmed) as best as they could be. In other words, they may not truly be set to the individuals prescription or set well for the environments they are using them in. This is why who you get hearing aids from is important a large factor in how much they cost – programming them and counseling the user on how to use them best play a huge role in their effectiveness.

Also, hearing aids and ears may be clogged with ear wax and/or the listener may have left them in a drawer for weeks before putting them on for Thanksgiving. How often the user wears their hearing aids and how long they had hearing loss before getting hearing aids can significantly impact the amount of benefit they receive from hearing aids, not matter how expensive they are or how well they are programmed.

Understanding in noise

What can we do then?

1) A few ways to improve clarity of speech for the ENTIRE family to employ: 

– Face who you are talking to and do not turn away while talking. Do not cover your mouth or chew while talking. Prepare food before guests arrive to avoid talking with your back to people. Don’t initiate conversations with people in other rooms (this is an old and difficult habit to break but it can make a huge difference). Why? We use visual cues to fill in the missing pieces caused by hearing loss and background noise and talking through walls reduces the quality and volume of the sound on top of removing visual cues. *Tip: for family that won’t be joining the celebrations in person, try getting a video call set up for them, practice in advance. This will allow them to not only get visual information but also hear in both ears instead of just one on the phone.

– Let people know you didn’t understand them instead of bluffing. Nodding and smiling blankly just makes you look like you don’t know what is going on*. Ask them to face you, speak slower or louder, and to rephrase sentences you are having trouble getting instead of just repeating them. *Keep in mind it is much easier to assume someone has a cognitive problem or is intentionally not paying attention, than to discern that someone can’t hear clearly. If you are bluffing, you are letting others assume these things about you, which can lead to very undesireable relationship consequences.

– Do not yell. Yelling distorts speech and often defeats the goal. If the listener asks you to speak up, try to project from your diaphragm instead of your throat.

– Don’t avoid conversation. Your family may misunderstand or misinterpret why you are avoiding them and isolating yourself can create a cascade of health problems.

– Have ears checked for wax build-up prior to the event.

– These changes in communication patterns and efforts to understand can be a lot of work (for both the speaker and the listener) and it takes practice and a commitment to keep working at it.

*Take a look at this video blog where I show you what some of these communication strategies look and sound like.*

2) Reduce as much noise as possible: 

– Keep the TV and music low and avoid conversations near noisy appliances (e.g. dishwasher).

– Encourage people to speak one at a time instead of having 3 conversations at once. I know this is not easy for most families to accomplish, but I encourage you to give it a good try.

– Speak one-on-one with those near you at the table, instead of those farther away from you.

– Using paper plates and utensils may be helpful in reducing some noise during the meal. They sell nice, thick eco-friendly ones online if you can’t find them in stores nearby.

– Smaller rooms with carpeting, drapery, lower ceilings, and soft furniture can be less reverberant and noisy. Position yourself well.

3) Prepare hearing aids for a big event:

– Make sure hearing aids are working a few days (if not weeks) before the gathering. Clean them as needed or schedule an appointment to get them checked by your audiologist.

– Make sure they have fresh batteries (and bring spares that are not expired). If you have rechargeable hearing aids, bring the charger.

– Wear hearing aids every day for at least 8 hours a day (even when it is quiet) to help your brain get accustomed to listening with them. This improves the ability to use the hearing aids in noisy situations – when you need them the most. If there are problems with how the hearing aids sound, tell your audiologist and see what can be done well in advance of important events.

– Also, using free apps like Ear Machine may be helpful for those who don’t have working hearing aids. All you need is to download the app and a set of working headphones. A smartphone turns in to a personal microphone. The app allows for customized increase in clarity and volume delivered through headphones.

– Don’t have hearing aids but thinking about it for an event? – give yourself a few weeks before the event to get them and review options. Getting hearing aids is as much abot finding the right devices as it is about finding the right hearing professional and setting realistic expectations. Getting hearing aids a few days before a holiday is usually a recipe for disaster – it takes time to get accustomed and make sure they fit you properly.

The most important thing to remember is to include yourself and include others in the conversation.

Isn’t that why we gather in the first place?

Here are some more tips from the Huffington Post.

Let me know if any of these tips helped your Thanksgiving or if you’d like some help before the next holiday.

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