Addressing Hearing Loss Among
First published in Friends Journal, October 2003. Won Award of
Excellence from Associated
Church Press for being "The Most Personally Useful Article".
Reprinted with permission. To subscribe: www.friendsjournal.org
About 15 percent of people in the United States have at least mild
hearing loss in their better ear; hearing loss is part of life’s
reality for half of those over 65. The National Institutes of Health
Hearing statistics rely on self-report: 10 percent report having
hearing loss, one third over 65; however, a small-scale study
(Cruickshanks, et al, "Prevalence of Hearing Loss in Old Adults
in Beaver Dam, Wisconsin”) indicates that the number of
Americans with hearing loss is half again as much. British statistics,
which also rely on audio tests, produce similar estimates: 14.7 percent
of British have hearing loss of at least 30 dB in their better ear.
Very few of these people are deaf: only about 0.2% of the population
has a hearing loss so severe that oral communication is essentially
impossible. Perhaps one-fourth of these people are fluent in sign
Hearing loss hurts more than the individuals, families, and friends
involved; it hurts our community if we fail to address the practical
and emotional needs of members.
Before we can answer the needs of the hard of hearing, perform a needs
assessment, and allow space for the introduction of feelings.
The Meeting community usually does not realize how many people are
having difficulty hearing, which is one reason a needs assessment is
necessary. In addition to seeking answers from a sizeable percentage of
your Meeting, you may also want to interview people who no longer
attend. Keep in mind that all discussions go better with some laughter.
Solutions depend upon how many of the hard of hearing the Meeting wants
to reach. One should ask, how many people do we want to hear ministry
Here are some suggested queries:
- How well do I hear messages in Meeting for Worship? (not at all,
some, every message)
- When I give a message in Meeting, am I able to let it come
through me so it can be heard and understood by others? What makes this
easier or more difficult for me?
- Do I make my needs known—lovingly asking others to speak louder,
slower, more clearly, at a lower frequency, etc?
- Has anyone ever asked me to speak louder, slower, or more
clearly? Do I accept such suggestions lovingly?
- Where else is hearing difficult (Meeting for Business, interest
- Have I used a hand-held microphone? How do I feel about the
Be clear that this is a step in building a loving, caring community,
and be sure to address the emotions that arise. The love of God and the
community is apparent when Friends take time to listen.
Discuss the results of the needs assessment worshipfully in Business
Meeting or in a called meeting. Among the feelings that might come up
are isolation, the body’s betrayal, the challenge of speaking louder to
a spouse losing hearing even while one’s own voice is weakening, the
relative lack of respect and attention accorded those with quiet voices.
Our Meetings are in transition. Some Friends will want to avoid
discussing hand-held microphones and PA systems because they see little
chance that the Meeting would reach unity to use either. But unity is a
process, and results are not foreordained. Reaching unity on hearing
systems and other hearing issues will be a long process for most
Meetings; avoiding discussions of the technically best solutions will
only delay the process.
A nice thing about wheel chair ramps is that they always work; one
failure is unacceptable, and no question exists about what is good
enough. Fixing hearing loss is harder: The law in my home state,
California, requires solutions that “work” for the majority of people
with hearing loss but it does not call for a before-and-after
assessment, nor is “work” defined. California law is clear that
religious bodies are not exempt. For many Meetings, the question is how
many people do you want to help, and how well? Many systems increase
the number of words heard but have little effect on the number of
messages understood because they don’t work well enough.
Solutions depend upon needs and flexibility of the Meeting. For
example, one small Meeting with one particularly hard of hearing member
always has someone write or type the messages for her. This article
will address the technical solutions for larger Meetings with several
people who have difficulty hearing.
Meetings should not neglect the emotional components, especially
because no sound system will work without the cooperation of Meeting
members. For instance, a microphone doesn’t work if people don’t speak
clearly into it.
- Train the Meeting in good speaking etiquette.
- Get rid of as much echo as possible; carpets, curtains,
tapestries, and acoustic tiles all help.
- Most systems work better with hearing aids with T-coils: a loop
inside a hearing aid that picks up a magnetic signal rather than the
sound. They work with neckloops and with the room loop, both described
below. Encourage all members purchasing a hearing aid to get a T-coil.
All systems require some form of microphone. Many Meetings prefer
hanging microphones or PZMs (pressure zone microphones) on the wall. A
smaller Meeting might prefer a conference microphone on the floor or
table around which everyone sits. An alternative is to speak into
hand-held or other microphones.
Hanging microphones and PZMs are unlikely to be effective in a
medium-sized or large group, except for those with mild hearing loss.
None of the Meetings in Pacific Yearly Meeting with hanging microphones
finds that they work well, though Berkeley Meeting’s mildly
hard-of-hearing benefit from an array of six hanging microphones.
Meetings with a small number of people with mild or moderate hearing
loss may prefer hanging microphones or PZM, because they are not
One complaint about hanging microphones is that they are at least as
effective at picking up coughs as voice. All assistive listening
systems – the FM, IR (infrared), and/or a loop – are used primarily to
bypass the room’s acoustic problems, and secondarily to amplify the
sound. Hard-of-hearing people require a much greater signal to noise
ratio for understanding than do hearing people. This is why an
assistive system may not be effective with hanging microphones or PZM.
Every person I’ve ever asked who works in sound says hand-held
microphones work best. One Friend who initially opposed speaking
directly into a microphone in Business Meeting found that she
appreciated the lack of shouting. On the other hand, some say that the
use of a hand-held microphone in Meeting for Worship would be
distracting, and some cannot hold a microphone while giving powerful
Microphones can be hardwired or wireless, but wireless microphones
require batteries, so Meetings may prefer to limit their use to
hand-held or lapel models. Wireless microphones broadcast at various
frequencies, usually a different frequency for each microphone
The number of microphones will determine whether a mixer is necessary.
If you use more microphones than your amplifier can accommodate
directly, the microphones must be routed through a mixer, then to the
amplifier. An alternative is to have several hand-held microphones, all
of the same frequency. A problem with this approach is that the group
must be trained to turn off microphones that are not being used.
The mixer can be manually controlled. This makes sense for larger
gatherings like yearly meetings, but not for smaller meetings. More
often it looks for the loudest signal, but can confuse speech and cough.
Address, FM, IR, and Loop – Transmitting the Sound
The output of the system can be a PA (speaker), loop, IR, FM, or
several of these (for example, PA plus a loop plus FM or IR). The
advantages and disadvantages of each are discussed below, and
summarized in a table at the end.
A PA may make the most sense when large numbers of people cannot hear
and understand; it may make sense even for a small group. In Berkeley
Meeting, one-third reported that they missed all or substantially all
of the messages during worship; presumably others have difficulty
understanding. The question arises as to whether an assistive listening
system for the hard-of-hearing is the logical starting place, or
whether an audio speaker for all participants is needed first. Using
PZM or hanging microphones with a PA means that everyone will hear the
extra noises they pick up, as well as the lower sound quality.
FM and IR systems work equally well for most hard of hearing. Both
require the user to wear a matching receiver and a listening
accessory (headphone, earphone, earbud, silhouette. neckloop,
stetoclip, direct audio input) suited to one’s own hearing loss
situation. (People with hearing aids without T-coils will have to take
their hearing aids out or use headsets with a large earpiece.) Infrared
is better if the room is near electrical interference or FM noise
sources (movie theaters close by), or if privacy is important. If you
will use more than one system in the building at a time, IR is simpler,
but a small group can be trained to use multi-channel FM without too
much difficulty. FM is a little easier to move around, because you can
position it anywhere in the room equally well. IR is harder to
position, and so a little less portable.
Most larger Meetings will want a room loop. A piece of wire leaves the
amplifier, loops all or part of the room either on the floor, above the
ceiling, or along the wall, and returns to the amplifier. Anyone with a
T-coil can set the T-switch and sit inside the loop. Induction
receivers work for those without T-coils, or the loop can be used with
an FM or IR system with its own headset. (Audio experts emphasize the
better sound quality of FM and IR systems, and your Meeting may want
one. However, the hard-of-hearing are less bothered by the slightly
worse sound quality of loops, preferring the ease of changing the
hearing aid setting over using a headset or other listening accessory.)
Loops will not work everywhere: check the space you are interested in
looping by having two or three people with T-coils visit the area at
different times of day to check for inductive noise (hum, static, or
other noise heard only when the hearing aid is set to the T-switch).
Multiple loops close to each other will have spillover from one to
A basic portable audio amplifier for a small Meeting with one
microphone input (remote or hardwired) may cost as little as $400. A
basic FM or IR assistive listening system with four receivers and
accessories is about $1000. A basic induction loop system for a 12-ft x
12-ft area with four receivers (and listening accessories) is about
$800, or less if you do the labor. Medium or large Meetings will
probably spend much more.
More explanations, and links to further explanations, are available at http://www.quaker.org/fep/hearing.html
Teach people how to use the microphones. Hand-held microphones should
be lower than the lips and pointed at the lips or vertical. Besides the
acoustic value of holding microphones below the lips, most
hard-of-hearing people (and many others) use lip-reading clues. Those
with particularly soft or loud voices will need to pay attention to
microphone distance. Hanging microphones require an ability to project
the voice. Discuss whether they are working.
Is the PA too soft? Too loud? Is there resentment about catering to the
hard-of-hearing? Do you feel that Meeting is sacrificing too much for a
few individuals? Do you feel that the changes make Meeting a more
caring and inclusive community?
Discuss cooperation in the Meeting. Do you feel that others in the
Meeting respond cooperatively when a Friend makes a need known? How
should uncooperative behavior be addressed, and by whom?
Hopefully by the fall of 2003, California Self Help for Hard of Hearing
People will be distributing Facing the Challenge: A Survivor’s Manual
for Hard of Hearing People, a short and easy-to-read manual that
explains just about everything. Contact me at Karen_Street at sbcglobal dot
net to get copies for your Meeting. I recommend two manuals per
member because many in the average Meeting are hard of hearing or have
hard of hearing friends and family members.
Please send the results of your Needs Assessment to the same address to
help us know the needs of Friends Meetings.
||Reaches a larger number of
people, good when many are not hearing ministry
||Amplification may irritate some.
Requires hand-held microphones and
training in their use unless someone adjusts volume for each speaker
||Easy to use with any hearing aid
||Does not work when there is
significant inductive noise
|More portable; transmitter can
be in another room
The only private system (won’t transmit through walls); multiple
systems are simpler to use
|Does not work if there is FM
interference from nearby FM transmitters
or electrical interference from within building or nearby towers
Can be a little more difficult to set up; emitter panel must be in room
Hanging or PZM
Hand-held, lapel, etc
Much more effective for hard-of-hearing people. Preferred option for PA
or loops especially, ideal for those with moderate or greater hearing
Both pick up extraneous noise as well as the room’s acoustical
problems, such as echoes.
|Many do not want to hold or are
unable to hold microphones while giving ministry.
(may be included in amplifier)
No personal attention required
Preferred method in large meetings, such as YM, compensates for the
difference in people’s voices, ignores coughs
Karen is a long-time member of
Berkeley Meeting in Pacific YM. She was an electronics engineer for
several years (different field), and then taught high school for a
decade until losing much of her hearing in 1995. Karen is the hard of
hearing representative to the Equipment Program Advisory Committee of
the California Public Utilities Commission's Deaf and Disabled
Telecommunications Program, the state program that provides telephones
and relay service to people with disabilities. She also works with Self
Help for Hard of Hearing People California as well as her local
chapter, and was a participant in the SHHH hearing assistive technology
©Karen Street 2003