Hearing loss and phone calls: why the type matters

The Washington Post ran a piece on October 1 about the different kinds of hearing loss and what helps with each. It made us think about the situation many people find hardest of all: the phone call. This is our take, focused on calls.

Hearing loss comes in different kinds

Hearing loss isn’t one thing. It’s usually described by where the problem is, and that shapes what can be done about it (CHSA):

• Conductive hearing loss means sound is blocked on its way to the inner ear, somewhere in the outer or middle ear. Fluid from colds or allergies, ear infections and earwax are common causes, and it can often be treated with medicine or surgery.
• Sensorineural hearing loss comes from damage to the inner ear or to the nerve pathways that carry sound to the brain. It’s the most common kind of permanent hearing loss. Medicine and surgery usually can’t reverse it, but hearing aids or other assistive listening technology may be recommended.
• Mixed hearing loss is a combination of the two.
• Unilateral hearing loss is hearing loss in one ear, with typical hearing in the other.

Hearing loss also varies in degree, from a mild loss where you miss certain high-pitched sounds to a total loss of hearing (NIA).

The kind most people meet first, in themselves or a parent, is age-related hearing loss (presbycusis). It comes on gradually and usually affects both ears, so you may not realize you’ve lost some of your hearing. It’s common: according to the NIDCD, about one in three people in the U.S. between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing.

One kind needs attention right away. Sudden sensorineural hearing loss is an unexplained, rapid loss of hearing, all at once or over a few days, and it often affects only one ear. The NIDCD says to treat it as a medical emergency and see a doctor immediately (NIDCD).

Why phone calls are harder than talking in person

The Hearing Loss Association of America says trouble with phone conversations is “often the first sign of a problem,” and that calls can still be hard to understand with hearing aids or a cochlear implant (HLAA). There are good reasons for that.

• No faces. In person you see lips, expressions and gestures. On a call, all of that is gone. Researchers writing in the Journal of the Acoustical Society of America, citing an earlier study, name the loss of visual cues as one of three main reasons phone calls are hard, along with the limited frequency range of the line and its reduced audibility (Liu et al., 2009).
• A narrow sound. The traditional public telephone network passes only sound between 300 and 3,400 Hz. That makes it harder for listeners, with or without hearing loss, to pick out high-frequency consonants like “s”, or to tell “s” from “f” (Hu and Loizou, 2010). If high-pitched sounds are already the ones you miss, that’s a double hit.
• Noise at both ends. Trouble understanding speech over background noise is one of the signs of hearing loss the NIA lists. On a call you get your own room’s noise and the caller’s too: a car, a kitchen, a busy office.
• No replay. People read out phone numbers, dates and addresses once, at talking speed. Ask them to repeat it and they often say it the same way, just as fast.

Which kind of hearing loss you have changes which of these gets in the way most. That’s a question for an audiologist. But some things help on almost any call.

What helps on calls

Get the sound right.

• Turn the call volume up, and if your hearing differs between your ears, try the phone on each side.
• If you wear hearing aids, ask about streaming. Most smartphones can send calls straight to Bluetooth hearing aids; some need the hearing aid maker’s app (HLAA).
• Many hearing aids and cochlear implants have a telecoil, which was originally designed to make sound clearer over the telephone (NIDCD). Phones labelled “hearing aid compatible” (HAC) let hearing aid users connect through it (HLAA).
• For a landline, amplified phones make the other person’s voice and the ringer louder (HLAA).

Choose the room. Take calls somewhere quiet. Close the door, turn off the TV, and use headphones if they help.

Change how the call goes.

• Say it up front: “I’m hard of hearing. Please speak clearly, and text me the address afterwards.” Most people are happy to help.
• Ask for anything that has to be exact, such as a phone number, an appointment time or a confirmation code, in writing by text or email.
• Read numbers back to check them.

Add text to the call.

• Live captions. Smartphones have built-in live transcription, and there are captioning apps for phone calls too (HLAA).
• Captioned telephone service. You talk and listen as usual while reading captions of what the other person says (FCC). The internet-based version, IP CTS, works with an existing phone and a computer or other web-enabled device.
• Relay. In the U.S., Telecommunications Relay Service lets people with hearing or speech disabilities place and receive calls through a communications assistant. Dial 711 to reach TTY-based relay from any phone; the FCC calls it “fast, functional and free.” 711 doesn’t work for captioned telephone service (CTS or IP CTS); those calls go through the captioning provider.

Where Redtie fits, and where it doesn’t

Redtie is a phone line in an app, on Mac, Windows, Android or the web (iPhone and iPad are in App Store review), designed first for people who are deaf or hard of hearing. On a call it gives you:

• Two-way real-time transcription. Both sides of the call appear as text while you talk, labelled by speaker. Read the address as it’s said instead of asking for it again.
• An AI assistant that takes the message in writing. When you’d rather not take a call live, the assistant answers, asks who’s calling and what they need, and reads the callback number back to check it. You can follow along as captions, take the call over at any point, and get a written summary by email or text.
• A transcript afterwards. Every call’s transcript is saved, so you can go back and check what was said.

What it isn’t:

• It isn’t a medical device or a hearing aid, and it doesn’t replace a hearing evaluation.
• It isn’t an FCC-certified captioned telephone service. If you mainly need captions on personal calls, look at captioned telephone services first.
• It may not support 911 or other emergency calls. Keep your regular phone, and any relay service you use, for emergencies.
• The captions come from speech recognition, which can mis-hear names, numbers and noisy lines. That’s why the assistant reads callback numbers back, and why the transcript is there to check.

Start with a hearing test

If phone calls have started to feel harder, take it seriously. Your doctor may be able to diagnose and treat the problem, or refer you to an audiologist, a health professional who can identify and measure hearing loss (NIA). Knowing which kind of hearing loss you have tells you which of the tips above will help most. And if your hearing drops suddenly, don’t wait: see a doctor right away.

This isn't medical advice. It's general information. Talk to a doctor or an audiologist about your own hearing.