FUNCTION OF THE NORMAL EAR
The ear is divided into three parts:

• External ear
• Middle ear
• Inner ear

Each part performs an important function in the process of hearing.

The external ear consists of an auricle and ear canal. These structures gather sound and direct it toward the eardrum. The middle ear chamber lies between the external an inner ear. This chamber is connected to the back of the throat by the eustachian tube, which serves as a pressure equalizing valve.

The middle ear consists of the eardrum and three small ear bones (ossicles): malleus (hammer), incus (anvil) and stapes (stirrup). These structures transmit sound vibrations to the inner ear. In so doing, they act as a transformer, converting sound vibrations in the external ear canal into fluid waves in the inner ear.

The inner ear chamber contains the microscopic hearing nerve endings bathed in fluid. Fluid waves stimulate the delicate nerve endings which in turn transmit sound energy to the brain, where it is interpreted.

A person with a conductive hearing loss may notice that his ears may seem to be full or plugged. He usually speaks softly, with a well modulated voice, because he hears his own voice quite loudly. In general, he hears better in noise than in quiet. Crunchy foods, such as celery, sound very loud and he may have to stop chewing to be able to hear what is being said. With this type of impairment one hears quite well over the telephone.

Fortunately, the patient with a conductive hearing impairment will never go deaf. He will always be able to hear, with reconstructive ear surgery or by use of a properly fitted hearing aid.

SENSORINEURAL IMPAIRMENT
A sensori-neural hearing impairment may result from disturbance of inner ear circulation, increased inner fluid pressure or from disturbances of nerve transmission. The most common cause of sensori-neural impairment is an aging change in the nerve endings (hair cells in the cochlea). This type of impairment is not able to be corrected by surgery, but rarely leads to deafness.

The person with a sensori-neural impairment may state that he can hear people talking, but he cannot understand what they are saying. An increase in the loudness of speech may only add to his confusion. Speech is audible, but not often understandable. He usually hears better in quiet places and he may have difficulty understanding what is being said over the telephone. He will probably hear low tones better than high tones and, therefore, may find a man's voice more understandable than a woman's higher pitched voice. Often the patient with this type of hearing impairment may not hear a door bell or the telephone ringing in another room.

HEARING IMPAIRMENT IN ONE EAR
A hearing impairment that is confined to one ear prevents a person from distinguishing the direction of sound. He will also have difficulty hearing from the involved side and may find it difficult to understand words in a noisy background or where the acoustics are poor.

When this impairment is secondary to a middle ear problem (i.e. conductive), surgery will usually be possible to restore the hearing, giving a better auditory balance. When the impairment is sensori-neural (i.e. hair cell loss), it is often possible to restore some of this hearing balance through the use of a hearing aid.

REHABILITATIVE MEASURES
A complete audiologic/otologic examination by a competent ear specialist is necessary to determine what type of hearing impairment is present, its probable cause and its treatment.

The treatment of choice may be remedial, preventive, medical, surgical or a combination of these. Each person with impaired hearing should have the benefit of adequate auditory rehabilitation.

A well rounded program of rehabilitation for persons with a hearing loss may include speech reading, auditory training, speech strategy techniques, instruction in the use of a hearing aid and guidance in social adjustment. All aspects of the program do not necessarily apply to each individual with impairment, but each individual may be helped through some of these methods.

HINTS FOR FRIENDS AND RELATIVES OF THE HARD OF HEARING
The individual with a hearing impairment must stop, look and listen in order to understand speech.

There are a number of factors that can significantly influence the communicating ability of the hearing handicapped. An understanding of some of these factors will prepare you to communicate more effectively with such persons.

Persons with a mild hearing loss may have trouble hearing only certain sounds such as f, s, and t, h, or hearing in certain situations. Hearing problems may also occur when the sound source is far away or when there is a lot of background noise. Persons with moderate or severe hearing losses have trouble in many situations, and persons with profound hearing loss hear little or nothing around them.

Speech Reading (lip reading). It is not uncommon for the person with impaired hearing to say, "I can't hear a thing without my glasses." This expression is a sure indication that he relies heavily on speech reading (lip reading). Many use speech reading without being aware that they have developed the skill. Over the years, the listener unconsciously compensates for his auditory impairment by obtaining visual clues of speech from the lips and facial expressions of the speaker.

Many take formal training from tutors who are especially prepared in this area. Whatever the means of acquiring the skill, it is helpful to all hearing handicapped to be able to view the face of the speaker. The speaker who absentmindedly covers his mouth, chews gum, or does not face the patient with a hearing loss during a conversation deprives the handicapped listener of valuable visual information that could enhance this understanding. Poor speech habits not only limit the lip reading skill of the listener, but also introduce distorted speech sounds. On the other hand, overly precise lip movements are to be avoided because exaggerated mouthings also result in speech distortion. Lip readers have learned to interpret normal speech movement.

Attention. Relatives of the hard of hearing have been heard to say, "Oh, he hears what he wants to hear." Sometimes a person is able to hear and understand without apparent difficulty. However, his "good hearing" is often the result of an ideal listening situation in which he was communicating at a short distance, with an articulate speaker, in the absence of noise. Attempts to communicate in noise or with poor articulation or from another room in the house will often end in failure. The hearing handicapped expend an enormous amount of energy in an effort to determine the important clues of speech. Their attention to the task of hearing requires concentration.

Modulated Voice. A very loud voice that is further amplified by a hearing aid becomes distressing and sometimes painful to the hearing aid user. If a person seems to hear but not understand, shouting will not benefit the listener. It is also wise to remember not to drop the loudness of your voice at the end of a sentence.

Speaking Clearly. One must speak with care while at the same time not exaggerating the words. Overdoing one's enunciation also leads to distorted speech. Remember that the listener will not understand all the sounds even when they are properly articulated. Faulty enunciation will further reduce his understanding.

Rate. Rapid speech is very difficult for the hard of hearing to understand. Spoken words last only a fraction of a moment. The brain must quickly identify each group of sounds in a word and assign a meaning. If groups of sounds (words) are run together or any single word is distorted or omitted by fast speaking, then the listener's understanding is affected. Because spoken language is so brief, the listener only has a short time to identify each word. Frequently, the hard of hearing give the wrong answer to a question, not because they don't know the answer, but because they have misinterpreted the question.

Speech Clues. Poor speech discrimination (inability to understand words) is the major handicapping aspect of a hearing impairment. Because the meaning of many words is lost or misinterpreted by the hearing impaired patient, the speaker can help by offering as many clues as possible to establish the meaning of conversation. By using several different words to express the same thought, the hard-of-hearing listener is provided with additional clues as to the context of the speech. For example, instead of saying, "Would you like to see the paper?" you might say, "The Gazette; would you like to read the newspaper?" You will notice that the loss of some of the more important words is less critical when there are others to indicate the same idea. However, the misinterpretation of the single work, "paper" in the first sentence results in a complete breakdown of communicating that particular idea.

Hearing impairment is a complex handicap. The task of adjusting to one's handicap can be eased by remembering a few simple rules.

• Get the hard of hearing person's attention
• Enunciated clearly
• Speak loudly enough
• Don't speak rapidly
• Above all, be patient

All of us, whether we have hearing impairment or not, employ the sense of sight as well as the sense of hearing in ordinary conversation. We find it easier to comprehend if we can watch the speaker's facial expression, lip movements and gestures. A study of the fundamentals of speech reading will make conversation less of an effort and therefore more pleasant for both the speaker and the listener.

It is important that the person who has a hearing loss inform his family, close friends, and associates with his problem so that they may avoid needlessly increasing the difficulty of speech reading. He speech reader must, so to speak, "stop, look and listen", in order to understand what he hears. It is helpful to point this out to family and associates so that they will get the patient's attention before speaking.

The patient with the hearing impairment must recognize characteristics of the English language. Many sounds and many words look the same on the lips. Look into your mirror and say the following pairs of groups of sounds and works: f, v, p, b, m; beet, meet, meat, shoe, chew; few, view. Each pair or group of letters and words looks the same on the lips.

The speech reader must determine from the context of the sentence which word is being used, just as the normal hearing person must depend upon the context to tell which of two or more words that sound the same are being used.

The hard-of-hearing person should be aware that it is impossible to see certain words on the lips and therefore he will continuously need to fill in "gaps" in words and in sentences. Look in the mirror again and say the following sounds: k, g, n, l, and t. It is impossible to see these sounds on the lips because they are formed in the throat and in back of the mouth. Two-thirds of all sounds in the English language are not visible on the lips. Because of the difficulties presented by sounds, the speech reader is encouraged to follow the context or thought of what is being said, rather than to try to lip read each word.

The hard-of-hearing person can also help himself by being keenly aware of the rhythm of conversation. A change in the rhythm is a definite aid to understanding what is being said. Pauses between words and sentences, stress and inflection, all effect what the speech reader sees and should convey different meanings to him.

To master speech reading, one must acquaint himself with the "setting" of a given situation. For instances, if the hard-of-hearing person is invited to a gathering, he should find out as much as possible about the occasion to give himself a background for speech reading. Who will be present? What are the names of some of the persons who are likely to attend? What are the interests of this particular group? What are they most likely to discuss as a group or individually?

The person, who is learning to speech read, learning to use a hearing aid, or both, should have the help of a professional person trained to teach these skills. There are many books on the subject of speech reading. Recognizing spoken words by watching the speaker's lips, face and gestures is a daily challenge for all deaf persons. Speech reading is the least consistently visible of all the communication choices available to deaf people; only about 30 percent of English sounds are visible on the lips and 50 percent are homophonous, that is, they look like something else.

Hearing aids may be worn as ear level instruments or as body type aids. Ear level aids may be placed deep in the ear canal, in the outer ear opening, or may be worn in back of the ear. Body worn hearings aids as a general rule have a greater amplifying potential and are used in severe or profound hearing impairment.

The CROS hearing aid is available for persons with a one-sided hearing loss. This aid picks up sounds which originate on the poor hearing side and routes the sound to the better ear. A CROS hearing aid may be worn behind the ear or in the ear.

In using a hearing aid, remember that hearing loss involves two factors: volume and clarity. A hearing aid amplifies speech to help you hear what people say. It also amplified most of the sounds around you. However, the amplification of other sounds, such as clattering dinnerware or a plane flying overhead may be distracting. For this reason, it often takes several weeks to become accustomed to wearing a hearing aid.

Some hearing aids have a "T" switch which enables them to hear on the telephone. In addition to acting as an amplifier, the "T" switch helps to eliminate background noises.

If you have a hearing loss but you do not want a hearing aid, you might still benefit from an amplifier for your telephone. Several kinds are available. One type comes built into the receiver and is available from phone companies. Another type is portable, can be attached to any telephone, and is small enough to be carried in a purse or a pocket. There are numerous different styles of hearing aids: all in the ear, behind the ear, body aid, canal aid, and deep insert canal aid.

THE USE OF A HEARING AID

Individuals react differently to the use of a hearing aid. One's age, the severity of the hearing impairment, and the acceptance of the need for the aid may strongly influence one's reaction to supplementing his own hearing with amplified sound. The type and degree of hearing impairment may limit the benefit to be gained from a hearing aid. Generally speaking, the hearing impaired patient has a dual problem. He experiences a reduction in the intensity of sound in which every day environmental noises, including speech, are not perceived in their normal loudness. In addition, there is often an accompanied reduction in what is called discrimination. An impairment of one's ability to distinguish among the sounds of speech leads to a reduction of understanding.

If a person has an impairment of a conductive type, he can expect maximum benefits from a hearing aid because discrimination ability is not greatly affected. Most persons with this type of impairment become adjusted to using a hearing aid with very little difficulty.

If the hearing impairment is of the sensorineural or sensory type (loss of hair cells), the difficulty of adjusting satisfactorily to a hearing aid may be greatly increased. Very often, persons who have this type of loss can hear speech sounds if they are loud enough, but cannot always understand what is being said. It is true that the speech must be loud enough to permit the listener to understand to his full capability. But making speech increasingly louder will not necessarily lead to a correspondent improvement in discrimination because the hair cells have become less sensitive to the acoustic differences of speech sounds. A hearing impaired person will often say, "I hear but I cannot always understand what I hear." Because the prime function of an aid is to amplify sounds, many users of these instruments continue to experience difficulty in understanding. Although the hearing aid does not correct the discrimination impairment through amplification, many sounds of speech can be heard and understood with greater ease. A hearing aid offers the user hearing that is short of normal acuity but more satisfactory than the uncompensated impairment. The major problem for a new hearing aid user is to adjust the hearing aid in noise. There have been many innovations in hearing aid fitting that have helped new users to learn to live with noise. Changes in circuitry of the hearing aid have greatly eased the initial learning process for many patients.

STEPS IN LEARNING TO USE A HEARING AID

Whatever the type of hearing impairment, it is important to follow a planned program of "learning to use the hearing aid." The ease or difficulty of hearing will vary depending on the loudness of background noises, the distance of the listener from the source of the sounds, the clarity of speech or of music, and the lighting (which may enhance or may interfere with lipreading). Practice exercises will help to prepare the wearer to use his hearing aid in a variety of different situations. Recommendations for learning to use a hearing aid for maximum benefit are described in the following paragraphs.

1. Use the Aid at First in Your Own Home Environment.
Your hearing aid amplifies noise as well as it amplifies music or speech and you may be disturbed temporarily by background noise. Concentrate on listening for all of the normal household sounds and try to identify each sound that you hear. Once you identify background noises, such as the hum of the refrigerator, the roar of an electric fan, the clinking of dishes, or the slamming of doors, these noises will tend to be less annoying and distracting to you.

2. Wear the Aid Only as Long as You Are Comfortable With It.
Do no attempt to set an endurance record or to wear the aid at first during all of your waking hours. If you are tired and fatigued after using the aid for an hour or two, take it off. Let the way you feel be your guide. You can, over a period of several weeks, gradually lengthen the amount of time that you wear the aid.

3. Accustom Yourself to the Use of the Aid by Listening to Just One Other Person - husband or wife, neighbor or friend.
Talk about familiar topics; use common expressions, names, or a series of numbers for practical purposes. After a few day of practice with one person in a quiet environment try a different listening exercise. Turn on the radio or television and with this auditory distraction try to understand your companion's speech.

4. Do Not Strain to Catch Every Word
The importance of listening carefully and of concentrating on what is being said cannot be overemphasized, but do not worry if you miss an occasional word. Normal hearing persons miss individual words or parts of sentences and unconsciously "fill in" with the thought expressed. (Keep your eyes on the face of the speaker. Speech reading is a very great help as a supplement to the hearing aid.)

5. Do Not Be Discouraged by the Interference of Background Noises.
If your initial experience with the aid is unsatisfactory, remember that you are learning new habits, or rather, relearning old habits in a new setting. Normal hearing persons are aware of background noises too, but have learned to push them out of conscious awareness. As you learn to discriminate between noise and speech and to identify various background sounds, you will also be able to ignore extraneous noises just as persons with normal hearing do.

6. Practice Locating the Source of Sound by Listening Only.
Localization of sound (the determination of the direction from which the sound comes) often presents a special problem to wearers of hearing aids. One exercise that helps to develop directional perception is to relax in a chair, keep your eyes closed, and have someone speak to you from different places in the room. Each time your helper changes his position, attempt to locate him through the sound of his voice alone.

7. Increase Your Tolerance for Loud Sounds.
At first, hearing aid users tend to set the volume control at a level too low for efficient listening. Louder sounds need not cause discomfort. By a very simple procedure you may, over a period of time, increase your tolerance for sound. While you are listening to one speaker or to your radio or television in your home, gradually turn up the volume control of your hearing aid until the sound is very loud. When the loudness is uncomfortable, very slowly turn the volume down to a more comfortable level. After a period of practice you will find that your comfort level has increased considerably.

8. Practice Learning to Discriminate Different Speech Sounds.

Prepare a list of words which differ in one sound only. For example:

Have your helper pronounce these words slowly and distinctly. Watch the lip movements closely while you carefully listen for the differences in similar pairs of words. Then try to discriminate the words by listening alone.

9. Listen to Something Read Aloud.
A good exercise in listening is to have your companion read aloud from a magazine or a newspaper while you follow along with your own copy of the reading material. At irregular intervals your reader should stop and have you repeat the last word read.

10. Gradually Extend the Number of Persons with Whom You Talk, Still Within Your own Home Environment.
You will find that it is more difficult to carry on a conversation with three or four persons than it is to talk to one. Concentrate mainly on the individual who is talking the most.

11. Gradually Increase the Number of Situations in which you use Your Hearing Aid.
After you have adjusted fairly well in your own home to background noise and to conversation with several people at once, you will be ready to extend the use of your aid to the supermarket, church, theater, and other public places. Turn the volume low to reduce the impact of unfamiliar background noise; do not sit under balconies; move about in different areas of the auditorium or theater until you find a section or a seat where you can hear well. Dining out may present special problems to the hearing aid user, so eat your first meals in public in a quiet restaurant with carpeted floors and draped windows. Avoid noisy cafeterias. Sit away from the kitchen area. As your tolerance for noise increases, you will find it easier to experiment with increasingly noisy environments.

12. Take Part in an Organized Course in Lipreading.
Lipreading will help you in general communication with others; consider it an important supplement to the use of the hearing aid. Although lipreading has many limitations, some words cannot be seen on the lips and some words cannot be distinguished from each other, lipreading combined with a hearing aid is often more satisfactory than is either alone.

13. The Telephone and the Hearing Aid.
If your hearing loss is not especially severe, you will probably be able, with a little practice, to use your hearing aid with the telephone. Place the receiver end of the telephone next to the microphone of the hearing aid. In some hearing aids an induction coil is an integral part of the aid, and the cordless portion of the telephone is placed in contact with the case of the aid. Getting used to the placement of the telephone and getting used to listening in this manner requires practice. It is suggested that you arrange to have a friend telephone you at a certain time each day for several days to help you become accustomed to the telephone procedure with the hearing aid.

The prime objective in wearing a hearing aid is to give you more normal communications in every day life. For maximum benefits, lipreading rehabilitation should accompany the practice training in using the hearing aid.

SPECIAL DEVICES
You may have certain communications that cannot be solved by the use of a hearing aid or by speech reading. These problems may involve the use of the telephone, radio, and television, and the inability to hear the door chime, telephone bell, and alarm clock.

Special instruments have been developed to solve these problems. They are listed in journals such as Shhh and Voice.

TELEPHONE COMMUNICATION

The telephone represents an important avenue of communication and one that offers the hearing handicapped considerable difficulty.

Many hearing aids provide a telephone switch. Moving the switch turns off the aid's microphone and activates what is called an "induction coil." The telephone receiver is placed in contact with the case of the hearing aid to amplify the conversation without picking up distracting noises.

Volume control handset. This telephone handset is equipped with a thumb-operated wheel with which to adjust the loudness of an incoming message.

Telephone amplifier. This unit is a pocket size battery operated amplifier that is useful to the hearing impaired person who uses different telephones. It can be carried in a purse or pocket and simply clips on to most telephone receivers.

Auxiliary receiver. Many severely handicapped people rarely rely solely on speech reading which, of course, cannot be used on the telephone. A procedure using the assistance of a third person is helpful. The "third person' listens to the incoming message through the auxiliary receiver attached to a conventional telephone. He repeats the message so that the hard-of-hearing "listener" can lip read and speak his answer directly into the telephone. In this way, the profoundly handicapped can actively participate in the telephone conversation.

Code-Com telephone set. This telephone instrument converts incoming sounds into light and vibratory signals. By using a prearranged code of dots and dashes, the profoundly deaf can enjoy telephone communication by watching the flashing light --TDD/TTY (Telephone Device for the Deaf) systems.

Teletypewriters. The telephone-teletype system is another method of communication for the profoundly deaf that permits the two-way transmission of typewritten messages over telephone lines. The deaf person who wishes to make a telephone call to someone with similar teletype equipment places the handset in a special cradle and dials the number. A monitor light flashes to signal when the phone at the other end is busy, ringing, or when someone answers. After contact is made, a conversation can be typed back and forth between the two parties, offering a printed record of the messages. A large national telephone-teletype network for the deaf has been made possible, in part, by the generosity of organizations that donate repairable teletype machines to the deaf. A number of these different devices can be seen in the Hearing Journal.

Dataphone data set. Dataphone service can link telephone facilities to teletypewriters, facsimile and telewriting devices, and other equipment used by persons with physical impairments.

Graphic Communicator. The telephone can also be used to transmit and receive written messages. Messages and diagrams written on the paper surface of the unit are reproduced simultaneously at any phone location that is equipped with a similar apparatus. Either written or oral material can be seen over the same telephone so that the hearing members of the family can use the same handset.

Switchboard amplifier. The telephone operator who has a hearing impairment will encounter difficulty. However, the requirements of her job may be satisfied through the use of a small transistorized amplifier which has a volume control. The operator simply adjusts the loudness of the incoming calls to suit her needs.

SIGNAL DETECTION

Signal bells. Some hard-of-hearing persons have difficulty hearing the door chime or the telephone bell. The problem of hearing a particular signal may be solved by either amplifying the signal or by substituting it with another sound that can be easily heard. For example, one may find help by substituting a lower pitched buzzer for the door bell. Similarly, the local telephone company supplies eight signal bells with different pitch characteristics ranging for 800 to 4000 Hz. You may request to listen to the different telephone bells in order to select the one you hear most easily. Generally, an "800 Hz bell" is the most rewarding.

Tone ringer. The telephone ringer concentrates the acoustic signal within a range (580-1500 Hz) easily heard by many of the hard-of-hearing patients.

Buzzer. This telephone signal substitutes a buzzer-like sound for the usual ringer. It is preferred by many hearing impaired persons who have adequate hearing acuity for low frequencies.

Extra strength signals. In addition to bells of different pitch, are alarms of extra-loudness, such as gongs, bells, and horns to signal the ringing of the telephone.

Auxiliary control device (Signalman). This unit signals the ringing telephone by activating a flashing lamp. Substituting a visual clue for the auditory signal is particularly helpful to the severely hearing impaired.

Electronic switch. The inability to hear a sound originating in another part of one's home poses another problem for the hearing impaired. One can solve his reception of a specific sound such as a door chime or the cry of a baby by installing this special switch. The switch converts sound into either visual or vibratory impulses. Lamps or vibrators are wired from the sound sensing apparatus to various rooms throughout the house.

Automatic waking devices. This device consists of an electric clock into which is build or plugged into a bedside lamp, buzzer, or vibrator, depending on the preference of the user. The buzzer can be placed under the pillow while the vibrator is attached to the bed frame. At a preset time, the clock activates the alarm signal. It is the light and the vibrations that awaken the sleeper.

Electronic stethoscope. This instrument consists of a standard stethoscope to which a modified hearing aid amplifier is attached. The user adjusts the volume control and frequency response to his requirements. In this way, the hard-of-hearing physician and nurse can hear faint body signals that otherwise would go undetected.

RADIO AND TELEVISION LISTENING

Amplified earphone. This device permits the whole family to enjoy radio and television. Remote headsets allow the hearing impaired patient to adjust volume while situated at his chair.

Loudspeaker. This unit is also connected to the television and the speaker placed conveniently next to the hearing impaired listener's chair. Your radio and television repairman can provide and install a suitable amplifier and when coupled to a loudspeaker or headset will provide adequate amplification.

Desk Model Amplifier. Some persons prefer to use a small transistorized auditory trainer that is equipped with earphones. This type of amplifier offers greater fidelity than the average hearing aid. These devices permit other household members to listen in comfort while the sound is amplified for the hearing impaired listener.

Induction coil apparatus. Frequently, the hearing impaired person complains that he is distracted from radio and television listening by household sounds amplified by the hearing aid. If the aid is equipped with a telephone switch, he can use an inexpensive induction coil that is connected to the loudspeaker of the television. This coil creates a magnetic field from which the hearing aid picks up and amplifies the radio and television signals. The television sound is placed on a plate containing the special coil. A small induction coil plate is also available that can be used with an ear-level aid.

Induction Loop System. This is a variation of the coil apparatus in which a magnetic field is produced by a wire loop running from the television set around the baseboard of the viewing room. A switching device permits the user to receive the sound through his hearing aid from either or both the television loudspeaker and the induction loop system. In this way, hearing impaired and normal hearing viewers can enjoy a television program together.

Hearing Ear Dog. A new program for the profoundly hard-of-hearing and totally deaf individual is the use of dogs to hear for their masters. A group in Denver, Colorado, has pioneered the first hearing ear dogs to aid deaf persons. Similar to the Seeing Eye program, these dogs are trained to look out for their masters by using their ears. For example, if the deaf individual's house catches on fire, the hearing ear dog is trained to awaken his master in order that he may save himself. In a similar manner, the hearing dog alerts his master to the doorbell, telephone, etc. The Ear Foundation can help answer your questions about this program.

Vibrotactile devices. This is composed of an electronic case which can be carried in the pocket and the vibrator is worn on the chest or with a wrist harness. Many users find the tactile aid of significant help in speech reading as a safety device for being aware of traffic and other warning sounds and generally as a help in feeling more "contacted".

Closed Captioning. This is a process by which the audio portion of a television program is translated into captions (sub-titles) that appear on the TV screen. Hearing impaired viewers can then read what they cannot hear. Closed captions can be seen when a telecaption adapter is connected to a television set.

Computers. Computers (Personal computers) can offer a significant advantage to the hearing impaired child to reach the same level of scholastic development that is achieved by hearing children

Concerts and Auditoriums. Many public facilities such as churches, theaters, and concert halls have special facilities for hearing impaired attendees. These FM or infrared systems are headsets which allow for control of background noise as well as amplification of the "main event." Contact facilities you are interested in attending to determine whether such assistance is available and if advance reservation is required.

Special Surgical Devices-cochlear Implants. Cochlear implants are surgically implanted devices which enable the deaf or profoundly hearing impaired to hear by electrically stimulating the inner ear or cochlea. Components of the system include a microphone, signal processor, external transmitter, and implanted receiver.

SUMMARY

1. A complete audiologic/otologic examination is necessary to determine what type of hearing impairment is present, its probable cause and recommended treatment.
2. Hearing is a natural and a normal way to understand speech. If your hearing can be improved by medical or by surgical means, or through the use of a hearing aid, this should be done.
3. Whatever the type of treatment carried out, rehabilitation is essential if you are to gain maximum benefits from treatment.
4. Be determined to master speech reading, make a hobby of it. It will help in every conversation.
5. Make every effort to relax. Do not strain either to hear or to see speech. Strain causes tension and makes lip reading much more difficult. A combination of seeing and hearing, under relaxed conditions, enables persons with impaired hearing to hear most speakers quite well.
6. Do not expect to understand every word in a conversation, but follow along with the speaker. As you become familiar with the speech, key words will emerge and you will be able to understand the complete thought.
7. Try to stage-manage the situation to your advantage. Lighting is important. Avoid facing a bright light and avoid having a shadow on the speaker's face. Six feet is an ideal separation from the speaker; from this distance his lip movements, facial expressions and gestures can be readily observed.
8. Maintain an active interest in people and events. Keep abreast of national affairs and events in your community and intimate social circles. You will be able to follow discussions more easily.
9. Remember that conversation is a two-way affair. Do not monopolize the conversation in an attempt to direct and control it. On the other hand, do not let it pass by without participating. Take an active and interested part whenever possible.
10. Be particular about your speech. A hearing impairment of long duration may bring changes in volume as well as in articulation and voice quality. These changes must be prevented when possible and corrected where indicated. A pleasant, well-modulated voice is a great asset.
11. A friendly, sympathetic interest in other people and in their problems can do much to smooth one's own path.
12. The education of the public is your responsibility and ours alike. You cannot help others to understand your problem if you conceal it from them. Do not hide the fact that you wear a hearing aid, or that you depend on speech reading to understand conversation. By letting others know about your problem, you can make communications easier for you. It is only through mutual acceptance and understanding of the problems of persons with impaired hearing that the "outsider" can be expected to adjust to needs of the speech reader. Without this understanding the "outsider" may unintentionally add to the problems of the speech reader.
13. Always keep in mind that the success of your auditory rehabilitation is largely dependent on you, your attitude and your acceptance of the problem.
14. Try to find a quiet place to talk. Cutting down on background noise will make it easier to understand the speaker.
15. Ask people to repeat or rephrase things that are not clear. Pretending to understand when you do not will only cause problems later.