Auditory System Hearing Testing Impairments Communication Choices

There are many communication choices available for those who are hard of hearing. Factors that may affect choices for improving communication for individuals who are deaf or hard of hearing include:

  • Degree and type of hearing loss
  • Individual differences in ability to use certain options
  • Personal preference

Oral Communication

Oral communication is a choice for many hard-of-hearing individuals, whether they have mild, moderate, or severe hearing loss. Those with more mild hearing loss may participate in “speechreading training,” which helps them to determine the words being spoken by the shape and movement of the lips. The combination of auditory information (though it is reduced) and visual information helps these individuals to communicate using spoken language.

Along with speechreading training, individuals may receive speech and articulation training to help their speech to become clearer, more precise, and easier to understand.

Manual Communication

Individuals with more severe hearing loss, for whom communicating through speech presents more difficulty, may choose to pursue manual communication. Oral communication can be challenging for individuals with severe hearing loss because:

  • Hearing the speech of communication partners may be too difficult with a severe loss, even with amplification (such as a hearing aid)
  • Clear speech productions may be difficult to develop or maintain without sufficient auditory feedback (being able to hear your own speech). This can result in distorted speech productions that can be difficult for listeners to understand.

One of the more popular communication choices for individuals with severe to profound hearing loss is manual communication. “Manual” refers to use of the hands in communicating language. One commonly known method is American Sign Language (or ASL). Sign language varies from country to country, much like spoken language. Sign language has its own grammar, denoted by hand position, movement, and placement in space.

Another form of manual communication (used in conjunction with oral language) is cued speech. Deaf or hard of hearing individuals may use cued speech, a manual system, to aid in their production and comprehension of spoken language. Cued speech uses a combination of hand movements and spoken language to differentiate between sounds that look the same on the lips. For example, the words “Bob” and “Mom” look the same when spoken without sound; however, cued speech cleverly assigns a hand movement to the “B” or “M” in those words when they are spoken in order to differentiate them.

Cochlear Implants - Hearing Impairment Communication Choices

Assistive Devices

Individuals with any degree of hearing loss may choose to use assistive, or amplification, devices. Hearing aids are one of the most common types of these devices. Hearing aids have a tiny microphone and speaker to amplify sound directly into the ear canal. Hearing aids are programmed specifically for each individual’s hearing loss, amplifying only the necessary frequencies. Cochlear implants are another choice for individuals with severe to profound hearing loss, or those who are deaf. A cochlear implant is an electronic device that is implanted into the cochlea, and stimulates the auditory nerve based on environmental input when the cochlea is not functional.


Mayo Clinic staff. (n.d.). Hearing aids: how to choose the right one. Retrieved February 1, 2010, from Mayo Clinic Web site:

National Cued Speech Association. (n.d.). Cued speech: definition. February 2, 2010, from National Cued Speech Association Web site:

National Institute on Deafness and Other Communication Disorder.s (n.d.). American sign language. Retrieved February 2, 2010, from National Institute on Deafness and Other Communication Disorders web site:

National Institute on Deafness and Other Communication Disorders. (n.d.). Cochlear implants. Retrieved February 2, 2010, from National Institute on Deafness and Other Communication Disorders web site: