The holiday season is coming round again and there will be many gatherings of families and friends. Those who come together will include youngsters, adults in their middle years, and the elderly. Many among them will have difficulty hearing, including children.

According to *Healthy People 2000: National Health Promotion and Disease Prevention Objectives* impaired hearing becomes increasingly common after age 50, affecting 23% of people aged 65 thru 74; 33% of those in ages 75 thru 84, and 48% of those who are 85 and older. These figures are considered to be underestimates.

*Healthy People 2000* emphasizes that: "...patient and family communication training and environmental structuring can help to enhance the... quality of life for the hearing-impaired...." Greater awareness of the adverse effects on a person because of hearing impairment, and using easy tips such as the following, will facilitate communication between the hard-of-hearing and *normal-hearing* persons.

The original list, posted about a year or so ago here and elsewhere, was based on suggestions by a teacher on talking to the hard-of-hearing. The list was subsequently expanded to include suggestions from experts in audiology, geriatrics, and the hearing-impaired. Please consider circulating or offering a copy of this list to persons who are hoh and to their families and friends, to health care providers, senior centers, school teachers and the local PTA, managers of older adults' residential and convalescent communities, children and older adult day care centers, Park & Recreation facility staff, etc., and to others who communicate orally with the hearing-impaired. Also consider employee and customer newsletters and bulletin boards in department stores, public libraries, factories, offices and other places where the hoh do business or gather:

Tips

• Whenever possible, face the hard-of-hearing person directly, and on the same level.
  
• Your speech will be more easily understood when you are not eating, chewing, smoking, etc.
  
• Reduce background noises when carrying on conversations -- turn off the radio or TV.
  
• Keep your hands away from your face while talking.
  
• If it's difficult for a person to understand, find another way of saying the same thing, rather than repeating the original words. Move to a quieter location.
  
• Recognize that hard of hearing people hear and understand less well when they are tired or ill.
  
• Do not talk to a hoh person from another room. Be sure to get the attention of the person to whom you will speak before you start talking.
  
• Speak in a normal fashion without shouting or showing impatience. See that the light is not shining into the eyes of the hard-of-hearing person.
  
• A woman's voice is often harder to hear than a man's, because of its pitch. A woman might try to lower the pitch of her voice when talking to the hoh to see if that helps.
  
• Speak slowly and clearly.
  
• If the hoh person wears a hearing aid, make sure that it has batteries installed, the batteries work, the hearing aid is turned "on" and that the hearing aid is clean and free from ear wax.
  
• If you know (or if it becomes evident) from which side the person hears best, talk to that side.
  
• It is better to speak directly face-to-face in situations where relatively diffuse lighting is adequate and lights the speaker's face. This allows the hoh listener to observe the speaker's facial expressions, as well as lip movements.
  
• Persons with hearing impairment can also benefit from seating themselves at a table where they can best see all parties (e.g. from the *end* of a rectangular table).
  
• Announce beforehand when you are going to change the subject of conversation. Doing so might avoid an unfortunate "faux pas" by a hoh listener.
  
• Sometimes hoh persons have "good" or "better" sides -- right or left -- ask them if they do. If they indicate a preference, direct your remarks to the "good" side or face-to-face, as they wish.
  
• Check to see that a light is not shining in the eyes of the hoh person. Change position so that you are not standing in front of a light source such as a window, which puts your face in shadow or silhouette and makes it hard for the hoh person to *speech read*.
  
• Avoid abrupt changes of subject or interjecting small talk into your conversation, as hoh listeners often use context to understand what you are saying.
  
• If the hoh person wears an aid, trying raising the pitch of your voice just slightly. If the hoh listener is not wearing an aid, try lowering the pitch of your voice.
  
• If all else fails, rephrase your remarks or have someone whose voice is familiar to the hoh person repeat your words.
  
• Don't talk too fast.
  
• Pronounce words clearly. If the hearing-impaired person has difficulty with letters and numbers say: "M as in Mary", "2 as in twins", "B as in Boy", and say each number separately, like "five six" instead of "fifty-six," etc. The reason for doing so is that m, n and 2, 3, 56, 66 and b, c, d, e, t and v sound alike.
  
• If you are around a corner, or turn away, you become much harder to understand.
  
• Keep a note pad handy, and write your words out and show them to the hoh person if you have to -- just don't walk away leaving the hearing-impaired listener puzzling over what you said and thinking you don't care. Example: feedback from my previous posting:
  
  "My niece lost her hearing at the age of 10. They never determined why it happened. The toughest thing for me was to tell her that I didn't understand what she was saying, so I stopped. Then one day my brother asked me if I was upset with my niece. Of course I said "no". Then he told me that it hurt her when I didn't ask her to repeat herself until I understood. We began to talk again and when we had difficulty with each other, I reached for pencil and pad. It became a game! We would spend more time working to understand because to write it down meant we hadn't yet succeeded to complete the bridge. Today, we still have to ask each other to repeat, but never have to reach for a pencil. She is the mother of two older teenagers, is employed at a university library and is an avid cyclist. She is far from being "dumb".