Addressing Hearing Loss Among Friends

First published in Friends Journal, October 2003. Won Award of Excellence from Associated Church Press for being "The Most Personally Useful Article".

Reprinted with permission. To subscribe: www.friendsjournal.org

About 15 percent of people in the United States have at least mild hearing loss in their better ear; hearing loss is part of life’s reality for half of those over 65. The National Institutes of Health Hearing statistics rely on self-report: 10 percent report having hearing loss, one third over 65; however, a small-scale study (Cruickshanks, et al, "Prevalence of Hearing Loss in Old Adults in Beaver Dam, Wisconsin”) indicates that the number of Americans with hearing loss is half again as much. British statistics, which also rely on audio tests, produce similar estimates: 14.7 percent of British have hearing loss of at least 30 dB in their better ear. Very few of these people are deaf: only about 0.2% of the population has a hearing loss so severe that oral communication is essentially impossible. Perhaps one-fourth of these people are fluent in sign language.

Hearing loss hurts more than the individuals, families, and friends involved; it hurts our community if we fail to address the practical and emotional needs of members.

Needs Assessment

Before we can answer the needs of the hard of hearing, perform a needs assessment, and allow space for the introduction of feelings.

The Meeting community usually does not realize how many people are having difficulty hearing, which is one reason a needs assessment is necessary. In addition to seeking answers from a sizeable percentage of your Meeting, you may also want to interview people who no longer attend. Keep in mind that all discussions go better with some laughter.

Solutions depend upon how many of the hard of hearing the Meeting wants to reach. One should ask, how many people do we want to hear ministry or messages?

Here are some suggested queries:

How well do I hear messages in Meeting for Worship? (not at all, some, every message)
When I give a message in Meeting, am I able to let it come through me so it can be heard and understood by others? What makes this easier or more difficult for me?
Do I make my needs known—lovingly asking others to speak louder, slower, more clearly, at a lower frequency, etc?
Has anyone ever asked me to speak louder, slower, or more clearly? Do I accept such suggestions lovingly?
Where else is hearing difficult (Meeting for Business, interest groups)?
Have I used a hand-held microphone? How do I feel about the experience?

Be clear that this is a step in building a loving, caring community, and be sure to address the emotions that arise. The love of God and the community is apparent when Friends take time to listen.

Discuss the results of the needs assessment worshipfully in Business Meeting or in a called meeting. Among the feelings that might come up are isolation, the body’s betrayal, the challenge of speaking louder to a spouse losing hearing even while one’s own voice is weakening, the relative lack of respect and attention accorded those with quiet voices.

Finding Solutions

Our Meetings are in transition. Some Friends will want to avoid discussing hand-held microphones and PA systems because they see little chance that the Meeting would reach unity to use either. But unity is a process, and results are not foreordained. Reaching unity on hearing systems and other hearing issues will be a long process for most Meetings; avoiding discussions of the technically best solutions will only delay the process.

A nice thing about wheel chair ramps is that they always work; one failure is unacceptable, and no question exists about what is good enough. Fixing hearing loss is harder: The law in my home state, California, requires solutions that “work” for the majority of people with hearing loss but it does not call for a before-and-after assessment, nor is “work” defined. California law is clear that religious bodies are not exempt. For many Meetings, the question is how many people do you want to help, and how well? Many systems increase the number of words heard but have little effect on the number of messages understood because they don’t work well enough.

Solutions depend upon needs and flexibility of the Meeting. For example, one small Meeting with one particularly hard of hearing member always has someone write or type the messages for her. This article will address the technical solutions for larger Meetings with several people who have difficulty hearing.

Meetings should not neglect the emotional components, especially because no sound system will work without the cooperation of Meeting members. For instance, a microphone doesn’t work if people don’t speak clearly into it.

General Suggestions

Train the Meeting in good speaking etiquette.
Get rid of as much echo as possible; carpets, curtains, tapestries, and acoustic tiles all help.
Most systems work better with hearing aids with T-coils: a loop inside a hearing aid that picks up a magnetic signal rather than the sound. They work with neckloops and with the room loop, both described below. Encourage all members purchasing a hearing aid to get a T-coil.

Microphones

All systems require some form of microphone. Many Meetings prefer hanging microphones or PZMs (pressure zone microphones) on the wall. A smaller Meeting might prefer a conference microphone on the floor or table around which everyone sits. An alternative is to speak into hand-held or other microphones.

Hanging microphones and PZMs are unlikely to be effective in a medium-sized or large group, except for those with mild hearing loss. None of the Meetings in Pacific Yearly Meeting with hanging microphones finds that they work well, though Berkeley Meeting’s mildly hard-of-hearing benefit from an array of six hanging microphones. Meetings with a small number of people with mild or moderate hearing loss may prefer hanging microphones or PZM, because they are not intrusive.

One complaint about hanging microphones is that they are at least as effective at picking up coughs as voice. All assistive listening systems – the FM, IR (infrared), and/or a loop – are used primarily to bypass the room’s acoustic problems, and secondarily to amplify the sound. Hard-of-hearing people require a much greater signal to noise ratio for understanding than do hearing people. This is why an assistive system may not be effective with hanging microphones or PZM. Every person I’ve ever asked who works in sound says hand-held microphones work best. One Friend who initially opposed speaking directly into a microphone in Business Meeting found that she appreciated the lack of shouting. On the other hand, some say that the use of a hand-held microphone in Meeting for Worship would be distracting, and some cannot hold a microphone while giving powerful ministry.

Microphones can be hardwired or wireless, but wireless microphones require batteries, so Meetings may prefer to limit their use to hand-held or lapel models. Wireless microphones broadcast at various frequencies, usually a different frequency for each microphone

The number of microphones will determine whether a mixer is necessary. If you use more microphones than your amplifier can accommodate directly, the microphones must be routed through a mixer, then to the amplifier. An alternative is to have several hand-held microphones, all of the same frequency. A problem with this approach is that the group must be trained to turn off microphones that are not being used.

The mixer can be manually controlled. This makes sense for larger gatherings like yearly meetings, but not for smaller meetings. More often it looks for the loudest signal, but can confuse speech and cough.

Public Address, FM, IR, and Loop – Transmitting the Sound

The output of the system can be a PA (speaker), loop, IR, FM, or several of these (for example, PA plus a loop plus FM or IR). The advantages and disadvantages of each are discussed below, and summarized in a table at the end.

A PA may make the most sense when large numbers of people cannot hear and understand; it may make sense even for a small group. In Berkeley Meeting, one-third reported that they missed all or substantially all of the messages during worship; presumably others have difficulty understanding. The question arises as to whether an assistive listening system for the hard-of-hearing is the logical starting place, or whether an audio speaker for all participants is needed first. Using PZM or hanging microphones with a PA means that everyone will hear the extra noises they pick up, as well as the lower sound quality.

FM and IR systems work equally well for most hard of hearing. Both require the user to wear a matching receiver and a listening accessory (headphone, earphone, earbud, silhouette. neckloop, stetoclip, direct audio input) suited to one’s own hearing loss situation. (People with hearing aids without T-coils will have to take their hearing aids out or use headsets with a large earpiece.) Infrared is better if the room is near electrical interference or FM noise sources (movie theaters close by), or if privacy is important. If you will use more than one system in the building at a time, IR is simpler, but a small group can be trained to use multi-channel FM without too much difficulty. FM is a little easier to move around, because you can position it anywhere in the room equally well. IR is harder to position, and so a little less portable.

Most larger Meetings will want a room loop. A piece of wire leaves the amplifier, loops all or part of the room either on the floor, above the ceiling, or along the wall, and returns to the amplifier. Anyone with a T-coil can set the T-switch and sit inside the loop. Induction receivers work for those without T-coils, or the loop can be used with an FM or IR system with its own headset. (Audio experts emphasize the better sound quality of FM and IR systems, and your Meeting may want one. However, the hard-of-hearing are less bothered by the slightly worse sound quality of loops, preferring the ease of changing the hearing aid setting over using a headset or other listening accessory.) Loops will not work everywhere: check the space you are interested in looping by having two or three people with T-coils visit the area at different times of day to check for inductive noise (hum, static, or other noise heard only when the hearing aid is set to the T-switch). Multiple loops close to each other will have spillover from one to another.

Costs

A basic portable audio amplifier for a small Meeting with one microphone input (remote or hardwired) may cost as little as $400. A basic FM or IR assistive listening system with four receivers and accessories is about $1000. A basic induction loop system for a 12-ft x 12-ft area with four receivers (and listening accessories) is about $800, or less if you do the labor. Medium or large Meetings will probably spend much more.

More explanations, and links to further explanations, are available at http://www.quaker.org/fep/hearing.html

Further Suggestions

Teach people how to use the microphones. Hand-held microphones should be lower than the lips and pointed at the lips or vertical. Besides the acoustic value of holding microphones below the lips, most hard-of-hearing people (and many others) use lip-reading clues. Those with particularly soft or loud voices will need to pay attention to microphone distance. Hanging microphones require an ability to project the voice. Discuss whether they are working.

Is the PA too soft? Too loud? Is there resentment about catering to the hard-of-hearing? Do you feel that Meeting is sacrificing too much for a few individuals? Do you feel that the changes make Meeting a more caring and inclusive community?

Discuss cooperation in the Meeting. Do you feel that others in the Meeting respond cooperatively when a Friend makes a need known? How should uncooperative behavior be addressed, and by whom?

Hopefully by the fall of 2003, California Self Help for Hard of Hearing People will be distributing Facing the Challenge: A Survivor’s Manual for Hard of Hearing People, a short and easy-to-read manual that explains just about everything. Contact me at Karen_Street at sbcglobal dot net to get copies for your Meeting. I recommend two manuals per member because many in the average Meeting are hard of hearing or have hard of hearing friends and family members.

Please send the results of your Needs Assessment to the same address to help us know the needs of Friends Meetings.

	Advantages	Disadvantages
Public Address (PA/speaker)	Reaches a larger number of people, good when many are not hearing ministry	Amplification may irritate some. Requires hand-held microphones and training in their use unless someone adjusts volume for each speaker
Loop	Easy to use with any hearing aid with T-coils	Does not work when there is significant inductive noise
FM or IR (infrared)	More portable; transmitter can be in another room The only private system (won’t transmit through walls); multiple systems are simpler to use	Does not work if there is FM interference from nearby FM transmitters or electrical interference from within building or nearby towers Can be a little more difficult to set up; emitter panel must be in room
Microphones Hanging or PZM Hand-held, lapel, etc	More convenient Much more effective for hard-of-hearing people. Preferred option for PA or loops especially, ideal for those with moderate or greater hearing loss Both pick up extraneous noise as well as the room’s acoustical problems, such as echoes.	Many do not want to hold or are unable to hold microphones while giving ministry.
Mixer (may be included in amplifier) Automatic Manually controlled	No personal attention required Preferred method in large meetings, such as YM, compensates for the difference in people’s voices, ignores coughs

Summary of Options

Karen is a long-time member of Berkeley Meeting in Pacific YM. She was an electronics engineer for several years (different field), and then taught high school for a decade until losing much of her hearing in 1995. Karen is the hard of hearing representative to the Equipment Program Advisory Committee of the California Public Utilities Commission's Deaf and Disabled Telecommunications Program, the state program that provides telephones and relay service to people with disabilities. She also works with Self Help for Hard of Hearing People California as well as her local chapter, and was a participant in the SHHH hearing assistive technology training.

©Karen Street 2003