Chapter 7
Hearing Loss
and Listening
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Hearing Loss and Listening
Listening is necessary for everyday life, and learning to become an effective listener is a
useful skill that carries a person further in every relationship. The HURIER model includes
hearing as the “H” in the acronym, which together with understanding, remembering,
interpreting, evaluating, and responding creates the most effective listener. However, just as one
should consider how to best become a talented listener, one should consider the challenges that
can arise in listening. This chapter covers the difficulties that a person with hearing loss faces
while listening and communicating with others. Numerous issues cause conductive and
sensorineural hearing loss in children and adults, thus changing the three levels of listening and
adjusting the explanations in the HURIER model of listening in order to be effective listeners
while communicating to or as someone with hearing loss.
The Human Ear Explained
Both conductive and sensorineural hearing loss take place in the human ear, although
some forms of sensorineural hearing loss affect the nerves and brain,
which will be covered in depth later. Hearing is a complex process so
the human ear has been split into three major sections: the outer ear,
middle ear, and inner ear. As shown in the diagram on page two, the
outer ear consists of the concave pieces of cartilage and tissue on both
Outer ear: includes the
pinna and the ear canal
Pinna: visible part of the
outer ear, directs sound
waves into the ear canal
Ear canal: tube-like
tunnel that leads to the
middle ear
sides of the face also called the pinnas, and the ear canal, which leads
into the skull to the middle ear (“Ear Anatomy,” 2010). The pinna uses its concave shape to herd
sound waves into the ear canal. This is why cupping a hand around the ear can increase the
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hearing ability because more sound waves are “caught” and directed through the ear canal. The
ear canal is a tube-like tunnel that leads to the middle ear, as shown below.
Figure 1: Diagram of the Human Ear ("How Hearing Works," 2010)
The middle ear encompasses the eardrum, malleus, incus, and stapes (“Ear Anatomy,”
2010). The eardrum is a thin membrane that is stretched across the
Middle ear: includes the
eardrum, hammer, anvil,
and stirrup
Ossicles: the hammer,
anvil, and stirrup - the
three tiny bones that move
in the middle ear
ear canal as canvas is stretched across a drum base (“Ear Anatomy,”
2010). The malleus, incus, and stapes are more commonly called the
hammer, anvil, and stirrup, respectfully. All three are tiny bones in
the middle ear, and together they are called the ossicles. Sound
waves are changed to vibrations by running into the eardrum causing it to vibrate, and in turn
vibrating the ossicles.
This leads to the necessity of the inner ear, which includes the cochlea and the
semicircular nerves (“Ear Anatomy,” 2010). The vibrations
caused by the sound waves travel through the stapes (or stirrup)
and through the wall of the snail-shaped cochlea. These
Inner ear: includes the cochlea
and the semicircular nerves
Cochlea: snail-shaped tube
filled with liquid and cilia
Cilia: the hair-like cells that
cover the inside of the cochlea
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vibrations cause the liquid in the cochlea to move, in turn moving the miniscule hair cells called
cilia in the cochlea back and forth (“Ear Anatomy,” 2010). The cilia are very important to the
hearing process as well as hearing loss, which will be covered in the section “Types of Hearing
Loss and their Causes” (“How Hearing Works,” 2010).
A few parts of the human ear that are shown in Figure 1 are not a part of the direct
hearing process, but are affected by hearing loss. This includes
Semicircular nerves: liquidfilled tubes connected to the
cochlea and responsible for the
body’s ability to balance
Eustachean tube: a tube that
allows a person to pop their
ears and equalize the pressure
between the middle ear and the
outside air
the semicircular nerves in the inner ear, the Eustachian tube, and
the nerves connecting the inner ear to the brain. The
semicircular nerves also contain liquid, are connected to the
cochlea, and are the key to the human body’s ability to balance
(“Ear Anatomy,” 2010). The eustachean tube connects the
middle ear to the nasal cavity and allows a person to alleviate the pressure difference between the
middle ear and the outside air (“Ear Anatomy,” 2010). This equalization of pressure is the
sensation that occurs when a person pops his ears. The nerves between the cochlea and the brain
are responsible for transferring the electronic impulses from the cilia to the brain so that a person
can make sense of the sounds (“Auditory Nerve,” n.d.).
Types of Hearing Loss and Their Causes
As previously mentioned, the two main types of hearing loss are conductive and
sensorineural hearing loss. Conductive hearing loss is
“caused by anything that interferes with the transmission of
sound from the outer ear to the inner ear” (“Conductive and
Sensorineural hearing loss,” 2011). On the other hand,
Conductive hearing loss:
caused by anything that
interferes with the transmission
of sound from the outer ear to
the inner ear
Sensorineural hearing loss:
caused by damage to the
pathway from the inner ear to
the auditory nerve and the brain
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sensorineural hearing loss is caused by damage to the pathway from the inner ear to the
auditory nerve and the brain (“Conductive and Sensorineural hearing loss,” 2011).
Although there are many causes behind conductive hearing loss, this chapter focuses on
the three most common causes: middle ear infection, fluid in the middle ear, and wax blockage
of the outer ear (HAK, “Conductive Hearing Loss,” 2011, ASLHA, “Conductive Hearing Loss,”
2011). A middle ear infection, also referred to as otisis media, is the most common type of ear
infection (“Ear Infection,” n.d.). As such, seventy-five percent of children have experienced this
painful infection at least once before the age of three (“Ear Infection,” n.d., “Conductive and
Sensorineural hearing loss,” 2011). This type of infection is caused by a viral or bacterial
infection, such as a sore throat virus, that travels through the eustachean tube to the middle ear
and infects the middle ear (“Ear Infection,” n.d.). This infection causes temporary hearing loss
because of swelling, inflammation, and discomfort (“Ear Infection,” n.d.). Fluid in the middle ear
causes hearing loss because the middle ear needs to be dry so that the ossicles can freely vibrate
and transfer the sound waves to the cochlea properly. The ear naturally creates wax to keep itself
clean, but too much wax build-up in the ear canal can cause hearing loss (HAK, “Conductive
Hearing Loss,” 2011). Many people clean the wax from their ears with Q-tips, but this can force
the wax back into the ear canal, causing a blockage in the ear that needs to be removed by a
doctor (HAK, “Conductive Hearing Loss,” 2011). Fortunately, “many cases of conductive
hearing loss are treatable” (HAK, “Conductive Hearing Loss,” 2011) and will not result in
permanent damage, unlike sensorineural hearing loss.
Unfortunately, sensorineural hearing loss is nearly always permanent and is most
commonly caused by age and acoustic trama (HAK, “Sensorineural Hearing Loss,” 2011,
ASLHA, “Sensorineural Hearing Loss,” 2011). Age-related hearing loss occurs naturally with
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age and the constant exposure to sound, causing the cilia in the cochlea to wear down and fall out
(“Conductive and Sensorineural hearing loss,” 2011). Acoustic trama, “injury caused by a loud
noise,” (“Conductive and Sensorineural hearing loss,” 2011) also causes the cilia to wear down
suddenly, resulting in permanent hearing loss.
Results on Levels of Hearing
The three levels of hearing: primary, secondary, and tertiary, are greatly affected by
hearing loss. The primary level of listening is what someone voluntarily
listens to, but those with hearing loss can either choose very little to focus
on or cannot choose what to focus on at all (Brownell, 2010). Those with
Primary level:
what someone
listens to
voluntarily
moderate hearing loss have a difficult time selecting what to listen to at this level, while those
with severe hearing loss do not have this level of hearing.
The secondary level of hearing involves both voluntary and
Secondary level: both
voluntary and
involuntary hearing
involuntary hearing. You can be focusing on one thing, but involuntary
hearing can also draw your attention to background noises (Brownell,
2010). With moderate to severe hearing loss, the background sounds are much harder to hear and
take concentration to focus on, so it is unlikely that the people suffering from hearing loss will
hear on the secondary level much different from the primary level.
The tertiary level of hearing is nearly always involuntary. Things such as sirens and
alarms are so loud that they are meant to be at the tertiary level of hearing. When someone has
hearing loss, this level can slip into more of a voluntary hearing level,
which could result in dangerous systems with no method of alert.
Turning up the volume could work as a temporary solution, but
Tertiary level:
only involuntary
hearing
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eventually with severe hearing loss, all sounds will become voluntary to hear.
Communicating to Someone with Hearing Loss
As in many life situations, a listener may not be aware that he is communicating with
someone who has hearing loss or some other communication barrier. The person with hearing
loss may not be comfortable explaining his predicament, so an effective listener will be aware of
his nonverbals and interpret them correctly. Nonverbals can include facial expressions, eye
behavior, body movements, posture, gestures, touch, appearance, vocal cues, and even silence
(Brownell, 2010). Brownell states that nonverbal “meanings must be assigned with great care
since... nonverbal behavior depends on such variables as role relationships, the personalities of
those involved..., and each individual’s past experiences and expectations” (2010).
Effective listeners will be aware of nonverbals that show the person is struggling to
follow the conversation through his facial expressions or behavior. He (the person with hearing
loss) may have a confused expression while visibly turning his ears toward the person speaking
and focusing his attention on the speaker’s lips. The person may be showing these signs
unconsciously, which could result in more frustration on his part because he cannot understand
why it is so hard to participate in a conversation.
As a result, the effective listener should adjust and add to the HURIER model to better
communicate with a person with hearing loss. Hearing: continue to be aware of nonverbal
communication to make sure that the person with hearing loss is able to hear the entire
conversation. Understanding: the effective listener should ask the victim of hearing loss if they
can understand everyone, and if he cannot, the listener should ask the speaker to pronounce more
or reiterate a thought (perhaps louder) for the benefit of the group. Remembering: remind the
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person with hearing loss of any key points so that, if he could not hear or was not listening
properly, he can remember the key ideas. Interpreting and evaluating: keep in mind while
listening to the person with hearing loss that his responses may not be exactly what was meant if
he did not hear the conversation or question accurately. Be careful not to attach too much
meaning or evaluate nonverbals as though the reactions are always genuine because, again, they
are based off of many factors that cannot all be taken into account. Responding: the effective
listener will speak loudly and slowly when responding to someone with hearing loss so that they
can easily understand the whole conversation.
Communicating as Someone with Hearing Loss
Anyone with hearing loss should strive to keep communication open between themselves
and the speaker so that the person with hearing loss does not feel isolated and misunderstood. By
being honest forthcoming about the hearing loss situation, the speaker is more apt to adjust his
communication because of this information. Everyone may not observe the difficulties that a
person with hearing loss experiences, especially when he tries to hide or deny the hearing loss.
The average listener may be oblivious of the issues without being told of the situation, and it
shows effective listening and communication skills when the person with hearing loss realizes
that the other person does not know he cannot hear the speaker.
By the person with hearing loss adjusting the HURIER model, the average listener will
be able to better communicate with him. Hearing: when the person with hearing loss cannot hear
the conversation, it is vital that he speaks up by asking the person to repeat, speak louder, and
remind the person that he cannot hear very well. It is also necessary to not joke while explaining
the hearing loss if the person truly wants the communication to change. If the person with
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hearing loss jokes by laughing while saying, “Remember, I’m deaf!” it may not be as effective as
a serious plea for better communication. When he is joking, his words, tone of voice, and
inflection is tells everyone listening that he is not frustrated with the situation and they will
probably forget to speak louder and slower. Understanding: ask for clarification if you cannot
understand, just as all effective listeners should. A person with hearing loss may have to do this
more often if they miss part of the explanation. Remembering: if the person has sensorineural
hearing loss due to age, the person may have age-related memory difficulties as well. Writing
things down in one place is a very effective way to remember lists, questions, and items. Also,
by asking someone to write down the list, a person with hearing loss is certain to understand and
remember every item, provided he does not lose the list! The person with hearing loss should
also help the speaker remember to speak loudly, slowly, and enunciate to benefit his listening.
Interpreting and evaluating: remember that if something does not make sense, the effective
listener will ask the speaker to repeat or clarify instead of evaluating the wrong communication
and a person with hearing loss will need to ask for repeats more often. The person with hearing
loss should keep in mind that by asking for clarification he is not unintelligent or annoying, but
participating in the conversation and avoiding isolation. Responding: someone with hearing loss
should reinforce good communication with a “Thank you” or a private word of recognition so
that the speaker knows he was communicating effectively. In addition, the person with hearing
loss should take extra effort to make sure that he is actively listening when he can hear so that he
is responding with the correct verbal and nonverbal communication.
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Summary
The human ear is very complex and consists of three sections: outer, middle, and inner,
and each part can contribute to hearing loss. The two types of hearing loss, conductive and
sensorineural, both affect one’s ability to hear on the primary, secondary, and tertiary levels. The
major difference between conductive and sensorineural hearing loss is the permanence.
Conductive hearing loss is usually temporary and can be fixed in most cases, while sensorineural
hearing loss is permanent due to the loss of cilia. Hearing loss is a difficult burden to bear, but it
can be much less cumbersome with efficient communication and effective listening. By adjusting
and specifying the HURIER model of listening for both the person with hearing loss and the
speaker or listener, the person with hearing loss should benefit from hearing the interactions and
participating in the conversations with greater ease.
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Study Aid – Helpful Notes Outline
Make a copy of this outline and write down notes as you read through the chapter. Fill in
the definitions, answer the questions, and use note cards to study the definitions provided in the
chapter.
I.
II.
III.
IV.
Hearing Loss and Listening Introduction
a. Jot down any unfamiliar words or phrases found in the chapter. If any are left
unexplained at the end of the chapter, look up the answer to fully understand the
meaning. __________________________________________________________
__________________________________________________________________
The Human Ear Explained
a. Three main parts of the ear and what they include: _________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Types of Hearing Loss and Their Causes
a. Conductive Hearing Loss
i. Caused by (definition):_________________________________________
____________________________________________________________
ii. Definition of causes:
1. Middle Ear Infection: ____________________________________
2. Fluid in the Middle Ear: __________________________________
3. Wax Blockage of Outer Ear: ______________________________
b. Sensorineural Hearing Loss
i. Caused by (definition): ________________________________________
____________________________________________________________
ii. Definition of causes:
1. Age-related hearing loss:
2. Acoustic trauma (loud noise):
3. Head trama:
Results on Levels of Hearing
a. Primary Level
i. Definition: __________________________________________________
ii. How does hearing loss affect this level? ___________________________
____________________________________________________________
____________________________________________________________
b. Secondary Level
i. Definition: __________________________________________________
ii. How does hearing loss affect this level? ___________________________
____________________________________________________________
____________________________________________________________
c. Tertiary Level
i. Definition: __________________________________________________
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V.
VI.
VII.
VIII.
ii. How does hearing loss affect this level? ___________________________
____________________________________________________________
____________________________________________________________
Communicating to Someone with Hearing Loss
a. Be aware of nonverbals such as: _______________________________________
b. Additions to the HURIER model:
i. Hearing: ____________________________________________________
____________________________________________________________
ii. Understanding: _______________________________________________
____________________________________________________________
iii. Remembering: _______________________________________________
____________________________________________________________
iv. Interpreting: _________________________________________________
____________________________________________________________
v. Evaluating: __________________________________________________
____________________________________________________________
vi. Responding: _________________________________________________
____________________________________________________________
Communication as Someone with Hearing Loss
a. Strive to keep communication open by: __________________________________
__________________________________________________________________
b. Additions to the HURIER model:
i. Hearing: ____________________________________________________
____________________________________________________________
ii. Understanding: _______________________________________________
____________________________________________________________
iii. Remembering: _______________________________________________
____________________________________________________________
iv. Interpreting: _________________________________________________
____________________________________________________________
v. Evaluating: __________________________________________________
____________________________________________________________
vi. Responding: _________________________________________________
____________________________________________________________
Summary – Look at your notes of unfamiliar phrases or terms. If something was left
unexplained, take the initiative to look it up and write the definition here:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Hearing Loss and Listening Terms – Use note cards and utilize the bolded definitions
on the edges of the pages to write the term on one side of the card and the definition
on the other side.
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Bibliography
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December 10, 2011 from http://www.asha.org/public/hearing/conductive-hearing-loss/.
American-Speech-Language-Hearing Association. (2011). Sensorineural Hearing Loss.
Retrieved December 10, 2011 from http://www.asha.org/public/hearing/SensorineuralHearing-Loss/.
Brownell, J. (2010). Listening: attitudes, principles, and skills. Boston: Allyn and Bacon.
EMedTV. (2011). Ear Infection.Retrieved December 9, 2011 from http://ear.emedtv.com/earinfection/earinfection.html.
Enchanted Learning. (2010). Ear Anatomy. Retrieved December 7, 2011 from
http://www.enchantedlearning.com/subjects/anatomy/ear/.
HearingAidKnow. (2011). Conductive hearing loss. Retrieved December 10, 2011 from
http://www.hearingaidknow.com/2008/02/02/conductive-hearing-loss/.
HearingAidKnow. (2011). Conductive and sensorineural hearing loss. Retrieved December 10,
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HearingAidKnow. (2011). Sensorineural hearing loss. Retrieved December 10, 2011 from
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North Caroline Self Help for Hard of Hearing People Inc. Auditory Nerve. (n.d.). Retrieved
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Simple Hearing Solutions. (2010). How hearing works. Retrieved December 9, 2011 from
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