7 Practical Communication Strategies for People with Hearing Loss
Hearing aids can't do it all. Here are seven easy-to-use evidence-based tips that can make conversations easier, reduce frustration, and help people stay connected.Lawrence Cardano, AuD, CDP
One of my patients described a habit that had gradually become automatic: “When I missed something, I would smile and nod. Eventually, I realized I was not really part of the conversation. I was just trying not to look lost.”
He had begun avoiding dinner parties, speaking less at his book club, and letting phone calls go to voicemail. His hearing loss posed difficulties, but so did the strategies he was using to manage it.
He thought pretending, guessing, and withdrawing would protect him from embarrassment. What it actually did was make him less connected to the people and activities he valued and deny his communication partners the chance to help him understand them. He also began to suspect that it was sapping his confidence and making him look less mentally sharp than he was.
After more than 30 years as a Doctor of Audiology, and now working as a life coach for adults with hearing loss, I have seen this pattern many times. Hearing technology can improve access to speech, but successful communication also depends on what happens before, during, and after a conversation.
The encouraging news is that communication strategies are learnable skills that can be implemented into your everyday habits. Randomized trials of Active Communication Education programs have found that structured training can increase the use of communication strategies, improve acceptance of hearing loss, and yield gains in quality of life and social relationships.1,2,3
The Most Important Shift: From Hiding the Problem to Guiding the Conversation
Shifting your mindset from focusing on just trying to hear better to focusing on communicating better allows you to access many helpful tools and strategies you might otherwise overlook. Many people try to minimize their hearing loss by saying nothing and working harder. That approach often fails because the person you are communicating with has no idea that anything needs to change.
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A more effective approach is calm, specific self-advocacy. The goal is not to announce your complete hearing history; it is to give the other person one useful instruction.
Research on hearing loss stigma helps explain why this can be difficult. In a 2025 international survey of 331 adults with hearing loss, about one-quarter reported that they did not disclose their hearing loss to anyone or in any situation.4 Concerns about being viewed as old, incapable, or burdensome can make silence feel safer.
Silence, however, leaves your communication partner guessing. A brief statement such as, “I have some hearing loss, and it helps if I can see your face,” gives the conversation a better chance to succeed.
Seven Practical Strategies
Decades of research and experience in hearing care clinics have shed light on how to improve communication for people with hearing loss. Here are seven evidence-based ways to improve your listening and communication.
1) Disclose early, before communication breaks down
Tell people what they need to know at the beginning of an important interaction. This is especially useful at medical appointments, meetings, restaurants, and family gatherings.
“I want to be sure I understand. I hear best when I can you speaking.”
“I may need an occasional rephrase, especially with the background noise.”
Early disclosure reduces the need to explain yourself after frustration has already built.
2) Replace “What?” with a specific request for repairing communication
A vague request often produces the same sentence again, only louder. A targeted request tells the speaker what information you missed and what action would help.
“I heard that the appointment is Tuesday. What time did you say?”
“Could you say that another way?”
“Please repeat the last few words.”
“Could you give me the key point first?”
Research has shown that adults can learn to use a wider range of repair strategies through communication training.5 The objective is not repetition for its own sake; it’s restoring shared meaning as efficiently as possible.
3) Prepare for predictable listening challenges
Some of the most effective communication work happens before the conversation begins. Anticipatory strategies have long been recognized in hearing rehabilitation as a way to prepare for upcoming interactions.6
Before a medical appointment, write down your questions, request written instructions, and consider bringing a trusted person. Before a restaurant meal, review the menu online, choose a quieter time, and request a table away from speakers and the kitchen. Before a meeting, ask for the agenda and sit where you can see the key participants.
A few minutes of preparation can prevent an hour of unnecessary strain.
4) Protect your visual access
Facial expression, lip movements, gestures, and eye contact all provide information that supports understanding. In a study of naturally occurring audiology appointments, 76% of the observed communication breakdowns occurred when mutual gaze was absent, often because the clinician was speaking while looking away or multitasking.7
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Ask people to face you, improve the lighting, and avoid beginning an important message while walking away or speaking from another room. In a group, choose a position that lets you see as many faces as possible.
This is not about perfect lipreading. It is about giving your brain more of the available message.
5) Confirm the information that matters most
Understanding the general topic is not enough when the details involve medication, money, dates, directions, or commitments.
“Let me make sure I understood. You want me there on Thursday at 2 PM.”
“So the dosage changes tonight, correct?”
Follow important conversations with written confirmation when possible. Text messages, appointment summaries, captions, notes, and email can provide a reliable backup when accuracy matters.
6) Make communication a shared responsibility
Hearing loss affects both people in a conversation. Family members and friends often want to help, but may rely on unhelpful habits such as shouting, overenunciating, or repeating the same words.
Explain what works better:
- Get my attention before speaking.
- Face me and keep your hands away from your mouth.
- Speak clearly at a natural pace.
- Rephrase when repetition is not working.
- Reduce competing sound when possible.
Partner-involved audiological rehabilitation has been studied as a way to address the communication and psychosocial effects experienced by both the person with hearing loss and a spouse or significant other.8
The practical lesson is straightforward: better communication is a team effort.
7) Match the technology to the situation
Hearing aids may be the foundation, but they are not the only tools available. Remote microphones can bring a distant speaker’s voice closer. Bluetooth streaming can improve phone and television access. Captioned telephones, real-time captioning apps, and venue-based hearing systems like telecoils and Auracast can provide additional information when sound alone is not enough.
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The best tool depends on the situation. Ask your hearing care professional to help identify the environments that remain difficult and the technology most likely to address each one.
Turning Strategies Into Habits
Knowing a strategy and using it under pressure are different skills. Many people understand what would help but hesitate in the moment, especially if they have spent years hiding their hearing difficulty or trying not to inconvenience anyone.
Start with one recurring situation. Choose one sentence you will use and one environmental change you will request. Practice the sentence until it feels natural.
“I want to hear this. Could we move away from the music?”
“I caught most of that. Please rephrase the last part.”
“It helps me stay involved when one person speaks at a time.”
For some people, professional guidance can make this process easier. A professional experienced in hearing rehabilitation and communication can help identify patterns, involve communication partners, select appropriate technology, rehearse self-advocacy language, and turn general advice into a realistic plan. A 2025 randomized trial found that an individualized, clinician-supported communication program increased strategy use and improved acceptance of hearing loss, with benefits maintained at six months.1
Communication strategies are not evidence that you have failed to hear well enough. They are tools for protecting understanding, confidence, energy, relationships, and your quality of life.
My patient did not regain perfect hearing. He did something more immediately useful: he stopped pretending, began telling people what helped, and prepared for situations that mattered. He returned to his book club discussions and became more comfortable joining social events.
The goal is not to catch every word. The goal is to remain a confident, active participant in your own life.
References
- Werther L, Sundewall Thorén E, Brännström J, Andersson G, Öberg M. Efficacy of the web-based Swedish Individualized Active Communication Education (I-ACE) program in first-time hearing aid users: Randomized controlled trial. J Med Internet Res. 2025;27:e71975. doi:10.2196/71975
- Marcotti A., Rivera S., Silva-Letelier C, Galaz-Mella J, Fuentes-López E. Effectiveness of the Active Communication Education program in improving the general quality of life of older adults who use hearing aids: A randomized clinical trial. BMC Geriatrics. 2024; 24:828. doi:10.1186/s12877-024-05424-0
- Hickson L, Worrall L, Scarinci N. A randomized controlled trial evaluating the Active Communication Education program for older people with hearing impairment. Ear Hear. 2007; 28(2):212-230. doi:10.1097/AUD.0b013e31803126c8
- Meyer C, Nickbakht M, Ekberg K, Timmer B, Scarinci N, Waite M, Hickson L. The decision to tell or not to tell is associated with experiences of stigma and hearing aid use among adults with hearing loss. Intl J Audiol. 2005;64(Suppl. 1):S48-S57. doi:10.1080/14992027.2024.2446480
- Tye-Murray N. Repair strategy usage by hearing-impaired adults and changes following communication therapy. J Sp Hear Res. 1991;34(4):921-928. doi:10.1044/jshr.3404.921
- Tye-Murray N. Preparing for communication interactions: The value of anticipatory strategies for adults with hearing impairment. J Sp Hear Res. 1992; 35(2):430-435. doi:10.1044/jshr.3502.430
- Ekberg K, Hickson L, Grenness C. Conversation breakdowns in the audiology clinic: The importance of mutual gaze. Intl J Lang Comm Disord. 2017;52(3):346-355. doi:10.1111/1460-6984.12277
- Preminger JE, Meeks S. Evaluation of an audiological rehabilitation program for spouses of people with hearing loss. J Am Acad Audiol. 2010;21(5):315-328. doi:10.3766/jaaa.21.5.4
About the Author
Lawrence Cardano, AuD, CPD© is a Doctor of Audiology and Certified Dementia Practitioner with more than 30 years of experience helping adults with hearing loss improve their communication and quality of life. He is the founder of Meaningful Pursuits, a personal coaching practice dedicated to helping adults with hearing loss live with greater purpose, connection, and vitality. Correspondence can be sent to Dr. Cardano at LawrenceCardano365@gmail.com.
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Lawrence Cardano, AuD, CDP