Elephant Shoes or I Love You…The Good and Bad of Lipreading.


Lipreading, or speechreading is the process in which we try to understand speech by observing the movements of the face, lips, and tongue of a talker.   Note that I say we “try” to understand speech.  It is not possible to fully understand speech from visual cues alone.  Here’s why:

All speech sounds can by classified by three parameters (see chart below):  Place, manner, and voicing.  Place of articulation refers to where the sound is made.  For example, the sounds /p/, /b/, and /m/ are all referred to as bilabials since they are produced using both lips.  The sounds /f/ and /v/ are referred to as labiodentals since the lower lip is placed between the teeth.  There are a whole bunch of sounds that are produced at the alveolar ridge, which is the little shelf jest behind your two front teeth.  With these sounds, the tongue is placed on this ridge.   The remaining sounds are produced further back in the mouth and are pretty much invisible to the eye.  These include sounds such as /sh/, /ch/, /g/,  /k/, and /h/.

Bilabial Labiodental Interdental Alveolar Palatal Velar Glottal
Stops Voiced /b/ bet /d/ dent /g/ goat
Voicedless /p/ pet /t/ tent /k/ coat
Fricatives Voiced /v/ vet /th/ these /z/ zed /zh/ garage
Voicedless /f/ fed /th/ think /s/ sent /sh/ sheep /h/ hot
Affricates Voiced /j/ jeep
Voicedless /ch/ cheap
Nasals Voiced /m/ met /n/ net /ng/ bang
Liquids Voiced /l/ let /r/ reap
Glides Voiced /w/ wet /y/ yell

The other two parameters are manner and voicing.  Manner refers to the type of sound produced.  For example, fricatives sound like air rushing or hissing.  Stops or plosives sound like a burst of sound.  It is very hard to see the manner of a consonant.

Voicing refers to the use of our vocal folds when we make a sound.  Try this little experiment.  Place your hand on your throat and make the /f/ sound and then the /v/ sound.  Don’t say these letters, make the sound.  You will feel your vocal folds vibrating for the /v/ sound, but not the /f/ sound.  This is of course invisible to the eye; we cannot see vocal folds vibrating.

Now lets look again at the sounds /p/, /b/, and /m/.  All three of these sounds will look pretty much the same via lipreading.  However they certainly sound different and more importantly, they change the meaning of the word.  If I say “pat”, “bat”, and “mat”, one cannot see the difference between these words.

So the reason that communicating exclusively via lipreading is difficult is due to two main reasons.  First, many sounds are produced at the back of the mouth and are completely invisible.  Examples include /h/, /g/, /k/, /ng/.  Second, many sounds look exactly the same because they are produced at the same place in the mouth.  The  consonants /p/, /b/, /m/ are a good example of that.

But lipreading can still be useful as a supplement to hearing.  Numerous research studies over the years have confirmed this.  Most studies show that while the scores of most people on lipreading tasks is typically quite low, it makes a great supplement to the auditory channel such that auditory-visual speech perception (lipreading + hearing) is much greater that auditory only.  In fact, I recall reading a study examining auditory only, visual only, and auditory visual speech perception in older adults.  Even though these adults scored 0% on visual only speech perception, their auditory-visual speech perception score was still greater than auditory only.

While I consider myself a pretty good lipreader, I have made some amusing errors over the years.  Here are some examples of embarrassing mistakes I have made. First sentence is what was actually said, and the second is what I thought was said.  It may also reveal the workings of my twisted mind.

What Was Actually Said:  My teacher is so cool, she plays the guitar.

What I Thought:  My teacher is so cool, she pees in a jar.

 

What Was Actually Said:  I am going to design you a tattoo.

What I Thought:  I am dying to touch you.

 

What Was Actually Said:  There is some nice grass over there for your dog.

What I Thought:  There is some nice ass over there…

So here is my advice when it comes to lipreading:

  1. Use it as a supplement to your hearing.
  2. Hearing is still the most important sense we have for communication via speech.
  3. If your are finding that you need to lipread a lot in quiet, you should consider getting assessed for a cochlear implant.  Lipreading all day long is highly inaccurate and very tiring.
  4. If you find yourself lipreading a lot when in noise, consider getting a wireless microphone system such as an FM system to help improve the signal to noise ratio.  Or get out of the noise.
  5. Training to improve lipreading skills is debatable.  Instead, focus on creating favorable conditions for llipreading.  Tune in next time to a discussion on how to enhance the conditions for successful lipreading.
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10 New Years Resolutions for People with Hearing Loss


Here we go again…its that time of year where we make all sorts of cliche New Years resolutions.  We all make the typical “lose weight” “exercise more” types.  Those are permanently affixed to every year’s list of resolutions for me.

As a person with significant hearing loss, there are some things which we can do that will make our lives more enjoyable.  So here are some suggestions for New Years Resolutions.

  1. Develop and Enjoy a Hobby.  As people with hearing loss, our communication challenges affect us in so many ways.  Its easy to let this dominate our lives.  So this is why I put this one at the top of the list of resolutions, because I feel it critical to develop and nurture our entire person.  For me, I have taken up Archery.  I love how archery calms me.  In addition, It requires much practice and skill, so it challenges me.  And it completely takes my mind off my hearing loss.
  2. Learn to use a new Communication Device.  Have you tried captioning on your TV?  Have you tried an FM system?  Do you use your different programs on your hearing aid?  This year, make it a goal to pick a device and learn to use it well.
  3. Learn a New Communication Technique.  There are all sorts of behavioral ways we can learn to communicate better.  Technology is only part of the story.  Ask yourself questions such as “Do I always make sure I sit with the light behind me so I can see other people’s faces better for lip-reading?”, or “Do I use a specific clarification rather than just saying what or pardon me?”.  Pick just one technique and try to apply this as much as you can.
  4. Take Action. This involves learning to be assertive, but not aggressive.  I need to work on being a bit more assertive.  For example, when I sit in a restaurant, sometimes I do not pick the best seat.  The best seat would be one in which I can see as many faces as possible and where the background noise is behind me.  All I need to do is just say to my dinner party “Do you mind if I sit there?  It would help me communicate better.”
  5. Learn to Accept Things.  Even with all the best technology and communication techniques, there are certain situations that may still be too challenging.  For example, even though I may go out to a bar with friends, I cannot hear all the communication from all the people in my group.  With the use of my FM system, I can, however, have conversations with one person at a time.  Therefore I have learned to accept this limitation.  I wish I could hear all the jokes zipping around me, but I can’t.
  6. Develop Calmness.  Again, another one I need to work on.  I am getting better, but sometimes I do get frustrated by my limitations.  Normally, this drive I have to not let this hearing loss limit me is a good thing.  It has driven me to become an audiologist, and learn to use all sorts of technologies and strategies to communicate better.  But sometimes, we might hit a brick wall.  I can get worked up by this and boil inside and its not healthy.  This year, when I get that feeling, I will try to draw upon the calmness I am learning from Archery. (See how this all ties in together?)
  7. Teach a Loved One Communication Strategies.  Communication is a two way street.  I would say that perhaps unlike other disabilities, hearing loss always affects your love ones.  Talking always involves at least one other person and as such, requires changes from communication partners.  So take some time to teach one “significant other” some techniques.  For example, my niece is likely the fastest talking teenager on planet earth.  It is incredible how many words per minute she can say.  I have worked on getting her to slow down when talking with me. Interestingly, she is now working as a waitress saving money for University next year and she has found that she does her job better when she slows down her speech for her customers.  Win win!!
  8. Plan a Dinner with Good Communication Techniques.  This one is a fun project.  Scout out a restaurant that is low noise and has good lighting.  Pick out a table that also fits these two criteria.  Pick out a seat that allows you to see everyone and where your back is towards the background noise.  Decide the number of people in the dinner party that you comfortably can communicate with.  Think about the communication devices you will be using, such as an FM system.  Think about the request for clarification techniques you will employ. And then make a reservation and enjoy!
  9. Read.  For the majority of us, our sense of vision is just fine.  Our eyes are an unimpaired portal to information.  The more we read, the more we keep in touch with the world around us.  Topics become more familiar, which assists greatly in lip-reading and hearing.
  10. Take Time for Family.  Here’s another one for me.  I get so wrapped up in dealing with my own hearing loss issues, that I sometimes do not see how things are with my family.  Be sensitive to how your hearing loss affects your other family members.  Be thankful for the things they are already doing to help you.  Also, your family members have things happening to them, both good and bad.  Make sure we take time to listen to them, rejoice in their successes, and help them with their challenges.  Its not always just about us.

Hearing during the Holidays.


The Holiday Season is now upon us.  There are work Holiday parties, Christmas parties in the neighborhood, Christmas or Hanukkah family dinners, you name it.  And they all have a couple of things in common:

  • It is noisy
  • Alcohol is usually served
  • The main activity is talking and listening.

These functions are not easy for people with hearing loss.  We function best in quiet settings and smaller groups where there is no competing noise.  Moreover we need to concentrate harder to communicate, so remaining sober and unintoxicated is a must.

You don't want to be like this guy.

Given that you will be going to places in which there is a high noise level, you need equipment and strategies on how to communicate in this environment.

So here is the Stelma Survival Christmas Guide for People with Hearing Loss.

  1. If you have a mild loss of hearing, you must use a hearing aid with a good Directional Microphone.  As I discussed in a previous blog entry, these microphones will pick up the person talking in front of you and reduce the noise behind you.
  2. Due to the high noise level of these functions, people with moderate, moderate-severe, severe, or profound  losses of hearing will definitely require an FM system attached to the hearing device (hearing aid or cochlear implant).
  3. You need to set your FM system microphone to the SuperZoom position for maximum noise reduction.
  4. If it is a cocktail party type of event, you will be standing and talking.  So you will place the FM transmitter in your left hand and your refreshing beverage in your right hand.
  5. When conversing, you will point the transmitter at the person you wish to communicate with.  We call this the Reporter Style of using an FM system.  Also make sure you hold the transmitter correctly.  See this video clip for more details.
  6. Remember to use Specific Requests for Clarification if you misunderstand.  For example instead of “what?”, say “Can you repeat the last part you said?”.  See my earlier blog entry on “What’s Wrong with Saying What
  7. Try to position yourself in areas with lower noise.  So if the music is blasting in the living room, move to the kitchen or dining room where these is less noise.
  8. Try to position yourself in areas with better lighting.  Again, if the living room is dark, stay in the kitchen where there is better lighting.
  9. Keep your alcohol consumption to a minimum.  It takes a lot of concentration for us people with hearing loss to communicate and alcohol gets in the way.  Not to mention drinking and driving is illegal.  I typically drink Gin and Tonics, but I alternate with mineral water and lime.  That way nobody bugs me about not having a drink in my hand.

If anyone else has some strategies that they use for coping with Holiday Parties, I would love to hear from you.

Happy Holidays everyone!

Strategies for Communicating in Restaurants


Dining plays in an important role in many cultures.  I think we can all agree that we do not eat simply to nourish our bodies.  It is the human connection that seems to be the most important part of dining.  We propose marriage, celebrate birthdays and anniversaries, close business deals, and simply connect with friends and family while dining.

Unfortunately, many people with hearing loss cannot enjoy the social benefits of dining due to their reduced ability to communicate in this noisy environment.  Indeed, many simply accept that they will only be there to consume the food and not much else.  Others simply choose to eliminate this social activity from their lives altogether.  This is very sad.

There are solutions, however.  These will depend partly on your degree of hearing loss, and partly on how noisy the restaurant is.  In the chart below I list the possible solutions for the various environments for different hearing loss levels.  Note that I am assuming that you have a hearing aid.  The last line is suggestions for CI users.

Degree of Hearing Loss Cafe(SNR @ 5 – 0) Restaurant (SNR @ 0 to -5) Bar (SNR @-10) 
Mild Hearing Aid with Directional Microphones Hearing Aid with Directional Microphones FM system in Zoom
Moderate Hearing Aid with Directional Microphones Either FM system in Zoom or hearing aid directional mic FM system in Zoom.
Moderate-Severe Either FM system in Zoom or hearing aid directional mic FM System in Zoom FM system in SuperZoom
Severe FM system in Zoom FM system in Zoom or SuperZoom FM system in SuperZoom
Profound FM system in Zoom FM System in SuperZoom FM system in SuperZoom
Cochlear Implant Directional mic on CI or FM system in Zoom Directional mic on CI or FM system in Zoom FM system in SuperZoom

So what are these microphone positions I am referring to?  Well, on the SmartLink and ZoomLink there are three different microphones.  The Omni mic is at the bottom and it picks up sound in all directions.  I never use this position in a noisy restaurant.  The middle microphone is called the Zoom position.  This picks up sound from the front, but not from behind.  The top microphone is referred to as the SuperZoom position.  This is a beam forming microphone that only picks up sound directly in front, but not from the sides or behind.

The SuperZoom and the Zoom microphones are the most effective in noisy environments like a restaurant

The trick to getting the most out of your directional microphone or FM system is getting the correct seat. You want to have the noise that you don’t want to hear BEHIND you.  A lot of people make the mistake of getting a table in the corner and having the person with hearing loss sit in the corner facing the entire restaurant.  This is the WRONG seat.  You want the background noise in your back.  This way your directional microphones, either on the hearing aid or the FM system, cancel out this noise and only pick up the person in front.

So here are the steps I take when going our for dinner.

  1. Try to find restaurants that are already quieter.  Choose restaurants that don’t blast music during dinner.
  2. Ask for a table in a quiet section of the restaurant if possible.
  3. Seat yourself with your back towards the background noise.  The waiter will try to seat you in the corner with your back to the wall.  He means well, but ignore him and seat yourself correctly.
  4. If you are a small group, seat the other people in front of you.  Ideally you should see the people you wish to hear in front of you and that’s it.  This way your microphones are only picking up those you wish to hear.  I then place my FM system on the table about half a meter away from the people I want to hear.
  5. If you are a larger dinner party, this presents a challenge.  You will still seat yourself as I described.  But your microphones will not always be pointing at the person who is talking.  You need to move your microphone towards the person you wish to converse with.

A couple more points to consider.

  1. If I am having dinner with just one other person, I may get his person to wear the transmitter.  But I do so after the waiter finishes blabbing about all the specials and takes my order.  (Some of these waiters seem to love the sound of their own voice because they talk way too much.  Hint to waiters: Less talk and better service = bigger tip from me).
  2. The FM microphones work best when they are as close to the talker as possible.  So place the transmitter on the table no more than half a meter away.
  3. When the waiter brings the food, grab your microphone off the table, then reposition it.
  4. When having Sushi, keep the microphone away from your Soya Sauce.  I have killed a few transmitters from spills.
  5. In large dinner parties, you will still miss out on some conversation because the microphone is only pointing at one or two people at a time.  Yes, this is still a limitation.  But you can either sit at home and sulk, or you can still be partially engaged.

What’s Wrong With Saying “What?”


This post was inspired by a fellow blogger (http://chroniclebionicwoman.wordpress.com/2011/10/25/bionic-woman-on…faking-it/) who wrote about the perils of “faking it”.  It got me thinking of what we folks with hearing loss do when we don’t understand or hear.

Our initial inclination is the say “what?”, “huh?”, or “pardon me?”.  However, many moons ago, when I was in grad school for Audiology, I began to wonder if this was a good strategy to employ.  Or maybe we should try a more effective strategy.

When we fail to understand what has been said, we need to employ a request for clarification (RQCL).  RQCL can be classified into 2 categories; Specific RQCL and Nonspecific RQCL.  The chart below shows examples of the two different types.

Nonspecific RQCL Specific RQCL
What? What was that last part you said?
Huh? Can you please say that again more slowly?
Pardon me? Did you say you were going shopping?
Can you please repeat that? Can you please move your hand away from you mouth and repeat again?
I didn’t hear you, come again? Are you talking about baseball?

As you can see the Specific RQCL either asks the communication partner to repeat or rephrase only a portion of what was said.  Or it requests a change in the manner in which the utterance was spoken.  In either event, we are guiding the communication partner to a successful repair of the communication breakdown.

I had a theory that our communication partners would respond more favorably to Specific RQCL.  So I designed a series of experiments in which people had to rate how they felt about a person with hearing loss after watching a videotape of a conversation between a person with hearing loss and a normal hearing individual.  The conversations were scripted ahead of time to control for the number of communication breakdowns that occurred (Low, Medium, and High) as well as the type of repair strategy used (Nonspecific and Specific).  Subjects then used a semantic differential scale to make the ratings.  Below are just a few of the items from the scale I devised:

Talking to this person would make me feel…

Composed       1      2      3      4      5       6     Irritated

Energetic         1      2      3      4      5       6      Tired

Pleased            1      2      3      4      5       6      Annoyed

Comfortable    1      2      3      4      5       6      Uneasy

Here are the results from the study.  Note that a higher number indicates a more emotionally negative rating while a lower number indicates a more emotionally positive rating.  In other words, we want a lower number.

These results show a couple of things:

  1. When we have a low number of communication breakdowns (less than 25% of the exchanges), people have a more positive reaction to us.  It didn’t seem to matter if we only said “what”.  As long as we don’t do this too often, reactions will still be positive.
  2. When we have a medium or high level of communication breakdowns (greater than 50% of the exchanges), people start to get pissed off.
  3. If we use Specific RQCL, people react more favorably, especially as the number of breakdowns increased.

So what does this mean for us folks with hearing loss?

  1. It is crucial we get the best possible technology to help us hear and understand better so that we can reduce the number of communication breakdowns that occur.  That means having good working hearing aids or cochlear implants with directional microphones and, if needed, an FM system.
  2. Try to use Specific RQCL such as “Can you please repeat the last part”, “can you please slow down” etc.