What’s in a Name? Terms for Hearing Loss

Various terminology is used to describe people with disabilities.  Interestingly, the terms we must use has become a sensitive issue.  Some terms are understandably negative.  For example, the terms idiot, moron, and imbecile used to be accepted terms to describe persons with varying degrees of intellectual disabilities. They are very hurtful terms and of course are not used anymore.  The etymology of the term handicap is believed to be related to begging for money, although this has been disputed by others.  Nonetheless, we must avoid this term as it now has negative connotations.  Strange that Joe in Family Guy uses this term to describe himself, but then again, Family Guy is not a place to learn political correctness.

Similarly, we use many terms or names to describe hearing loss.  Some of the commonly used ones include:

  • Hearing loss
  • Deaf-mute
  • Deaf and dumb
  • Hard of Hearing
  • Deaf
  • deaf
  • Hearing impaired
  • Deafened

Hearing loss is a nice generic umbrella term.  It encompasses conductive, sensorineural, or mixed losses.  I failed to find any reference on the internet to this term being negative or derogatory.

“Deaf-mute” and “Deaf and Dumb” both describe the notion that people with significant hearing loss from birth both cannot hear and cannot speak.  These terms should never be used as they are both inaccurate and of course derogatory.  Most kids born with hearing loss, when provided with appropriate auditory-verbal therapy, support and equipment do learn to speak extremely well and go on to achieve high levels of education.  Some families choose sign language for their children, and also can achieve great things.

“Deaf” and “deaf” are actually considered to be somewhat different terms.  Deaf, when used with a capital “D” (also know as “Big D Deaf”), typically describes members of the Deaf Community who use sign language as their method of communication.  The Deaf Community have their own cultural identity, social groups, drama productions etc.  When used with a lower case “d”, the term deaf or deafness is a general term to describe all degrees of hearing loss.  Typically, the image the term “deaf” conjures up is a person who uses sign language, and therefore, the term deaf, whether capitalized or not, version more commonly used to describe people who sign and cannot hear.

Deafened is also a term you see out there, and is one of the terms I use to describe my condition.  Typically it describes someone who has lost the majority of their hearing post-lingually (after the acquisition of spoken language).  However, deafened people may have had their hearing assisted via high powered hearing aids or cochlear implants.  There are organizations such as the Association of Late Deafened Adults in the US. So this term is well accepted.

Hearing impaired or hearing impairment seems innocent enough.  It can be used to describe a condition in which ability to detect certain or all pitches is either partially or completely impaired/

Interestingly, the terms “Hearing impaired” or “Hearing impairment” seem to be the ones that draw the most criticism and controversy today.  I was looking at the National Association of the Deaf website for their perspective on this term.  Here’s the first sentence “Deaf and hard of hearing people have the right to choose what they wish to be called, either as a group or on an individual basis”.  I completely agree with this statement.  Nobody should force a term on any group.  But here is the second statement “Overwhelmingly, deaf and hard of hearing people prefer to be called “deaf” or “hard of hearing.”  Really?  I completely understand and respect the wishes of the Deaf Community to NOT be called hearing impaired.  But I cannot recall anyone asking people with hearing loss who do not sign if they all wanted to be called Hard of Hearing.  When did this happen?

Hard of Hearing officially refers to those persons with hearing loss which is permits the use of the auditory channel for a certain amount of speech/language.  Hard of hearing people typically use hearing aids, cochlear implants, and FM systems.

I do not like the term Hard of Hearing.  In fact, I vehemently detest it. The problem I have with the term “Hard of Hearing” is two-fold. First is the image it conjures up.  And secondly, the proponents of this term to obtain failed to achieve consensus amongst people with hearing loss that this is the correct term that shall be used.

When I think of the term Hard of Hearing, I imagine a old person from the 1930’s with a listening tube stuck in the ear muttering “What’s that sonny?  I am Hard of Hearin’ and ya gotta shout!”.  I find the term archaic, unintelligent, and unflattering.

Hard of Hearing Person

I have asked many people who are not Big D Deaf (that is, the so called “Hard of Hearing”) about their feelings of these words.  Many do not object to either Hearing Impaired or Hard of Hearing.  It is becoming abundantly clear to me that it was the Deaf Community who did not like the term Hearing Impaired.  Again, that is fine.  I completely respect this.  But what I object to is that the term Hard of Hearing was forced upon everyone else.  We could have gone with Deaf and Hearing Impaired rather than Deaf and Hard of Hearing.  Don’t get me wrong, I am not necessarily seeking to resurrect the term “hearing impaired”.  If that term is dead, so be it.  But I will do everything I can to also kill off the term Hard of Hearing, I hate it that much.

I am very glad that in the US, the group “Self Help for Hard of Hearing” (SHHH) changed their name to the Hearing Loss Association of America (HLAA).  This new name has no negative connotations, and is generic enough to encompass all people with hearing loss.  It is a very welcoming term.  I have joined the HLAA, but not our own Canadian Hard of Hearing Association (CHHA), entirely due to the name.

In the end, the most important thing that all of us people with hearing loss desire is to be seen as people first.  Yes I have a hearing loss and use a cochlear implant, hearing aid, and FM system.  But I also am a father and husband.  I have a graduate degree in Audiology.  I love music, and play bass in a band.  I love to kayak, fish, and hunt.  I am all these things, and I do not wish to be defined solely by one attribute.  So perhaps the term People with Hearing Loss may be the best term of all, as it emphasizes the person first.

Best and Worst Musical Instruments for People with Hearing Loss

As a hearing impaired audiologist, and amateur musician, I often get asked by parents to help select a musical instrument for their child with hearing loss.  Although I have not seen a specific research study analyzing this exact question, we can, based on what we know about hearing loss, make an educated recommendation.

Lets first take a look at some fundamental components of music.  These include Pitch, Timbre, Harmonics, Loudness, and Rhythm.

Pitch is the frequency of the sound, measured in Hz.  For example, middle C is 256 Hz.  When we hear a melody we hear changes in pitch. In Western music, the smallest unit of pitch change is the semi-tone and there are 12 semitones in one Western octave.

Unfortunately, people with hearing loss have reduced ability to recognize pitch due to the damage in the hair cells of the cochlea.  In other words, some people with hearing loss cannot tell the difference between two pitches that are close together.  They need larger and larger differences between two pitches before they can tell that they are different.

Harmonics are a series of tones that are multiples of the fundamental frequency.  So if I pluck a middle C on a guitar or a piano, you will not only hear the fundamental frequency of 256 Hz, but also mathematical multiples of the middle C such as 512 Hz.  Again, this is a pitch based perception task and is hard for people with hearing loss.

Timbre is the unique combination the pitch, harmonics, the attack and release times of the note, that gives each musical instrument its unique colour and character.  Timbre is what tells us a guitar is a guitar or a violin is a violin.  This can also be hard for people with hearing loss.

Intensity of sound is measured in decibels.  We perceive intensity as “loudness”.  Of course when we have a hearing loss, soft sounds are inaudible, but hearing aids and cochlear implants do a pretty good job of allowing us to hear the soft sounds again.

Finally rhythm is the arrangement of sounds in time.  It is the beat or pulse of the music, and fortunately, people with hearing loss can still perceive rhythm quite well.

So based on what we know about hearing loss and about the components of music, it is clear that we will have greater difficulty with instruments that require good pitch perception abilities.  Below are two suggested list of instruments.  The first is a list of good instruments to select for people with hearing loss.  The second is a list of instruments that may be too challenging for the hearing impaired ear.  These lists are based on theory and some practical personal experiences, but are only recommendations.  If you, or your hearing impaired child, have your heart set on playing a particular instrument, by all means give it a try.

  1. Piano.  Piano is a good instrument for people with hearing loss for many reasons.  First, it is professionally tuned, so you do not need to tune it up every time you play.  If it is out of tune, then then the other instruments playing with the piano, must be tuned to the piano, and not the other way around.  Moreover, it is kind of like typing.  You see a symbol on the music staff, and you have to hit the corresponding key of the keyboard.  The hard part about piano is the same for all people, whether they have a hearing loss to not, which is learning to read multiple note music.
  2. Acoustic or Classical Guitar.  Guitar has frets on it, which precisely cuts the string at the correct point to give the correct note.  Daily tuning is required, but the easy solution here is to buy an electronic tuner.  I also think acoustic guitar is easier on the impaired ear than electric guitar.
  3. Fretted Electric Bass Guitar.  The fretted electric bass also has frets that precisely cut the string at the correct point.  Interestedly, this is why Leo Fender, the inventor of  the first electric bass, called it the  “Precision” or “P-Bass”.  It was the first bass with frets.  With bass, one only plays one note at a time, making this easier on the ears to perceive.  Also, it is also a rhythm based instrument which should be easier for people with hearing loss.  (Although some people just have no rhythm period).
  4. Electric Guitar.  I ranked electric guitar lower than acoustic guitar because when used with a lot of distortion, it is hard to hear the notes through all those harmonics.  If you plan to play electric guitar, stick with genres like indy or popular music, and stay away from heavy metal, or hard-core.  However, a plus of electric guitar is that you can get an amp with a headphone jack and plug your FM system into that for practicing.
  5. Digital Drums.  One of the problems with drums is that they can get really loud and overload the microphones of the hearing aids and cochlear implants.  So this is what is nice about a digital drum kit.  You get a volume control that allows you to set the volume at a perfect level, not too loud or too soft.  Moreover, all the digital drum kits I have seen have headphone jacks to plug your FM system in.
  6. Flute.  General the woodwind instruments can be good choices because there are lots of keys that allow you to make the correct note more precisely.
  7. Clarinet. Same as flute
  8. Saxophone.  Same

Challenging Instruments to Play with Hearing Loss.

  1. Violin.  Violin does not have any frets on it.  It requires one to listen carefully to make sure you are pressing on the correct part of the fingerboard.   However, I have heard of people with hearing loss still successfully playing this instrument.  It all depends on your hearing capabilities.
  2. Viola.  Again, same as a violin
  3. Cello.  Same issue as violin.
  4. Upright or Fretless Bass.  Same as violin
  5. Trombone.  Trombone shares some of the same characteristics of a fretless string instrument.  One must move the slide to the correct point to produce the proper pitch and therefore requires good pitch perception.  Not easy on the ears.
  6. Acoustic Drums.  The reason I put acoustic drums on the “Challenging” list is that this is a very loud instrument.  Very loud sounds can over-saturate the microphone or the analog/digital converter in a hearing aid or cochlear implant.  This will make things sound really distorted.  Interestingly, when I play in my band, I actually try to move as far away from the drums as possible.  I still keep the beat using the device I made.  See this previous posting.
  7. Trumpet. Trumpet uses a combination of three buttons or valves to partially produce its pitch.  The other influence is the shape of the lips.  Therefore, it does require a bit of hearing pitch perception to make the correct note.  I successfully played trumpet when I was in high school, but I only had a moderate loss of hearing at that time.
  8. French Horn.  Similar issues to a trumpet.  However, I found that the shape of the lips affected the pitch more in a French Horn than trumpet.  Not sure why, but the French Horn players in our high school band had a harder time keeping pitch than the trumpet section.

So there you have it.  If you are currently playing an instrument and you have a hearing loss, please share your experiences!