1 – Defining Hearing Loss

The term “hearing loss” covers a range of difficulty hearing sound that varies from slight to complete loss of ability to hear. There is a major distinction between those who have less than normal hearing and depend on the use of sign language for communication, and those who do not use sign language, but instead rely on spoken or written language for communication. Within both of these categories people vary from having profound or complete inability to hear sounds to those who have some usable residual hearing.

“People who have hearing loss” is a term replacing “person who is hard of hearing or people.” “Hard of hearing” is an older, out-of-date term used previously to describe people who have some degree of hearing loss and attempt to communicate by relying on their remaining or residual hearing ability. A preferable term is “hearing loss” which eliminates some of the negative connotations of “hard of hearing,” e.g., the implication that the person is old and/or has some degree of confusion or infirmity. The term “hearing loss” is vague in that it does not specify the degree of loss the individual has, but it serves to distinguish between those who depend on sign language (deaf) from those who do not use or depend on sign language.

It is important to keep in mind that not everyone with less than normal hearing lost it somewhere along the way. Some, relatively few, people were born with little or no hearing and, therefore, never had it to lose. Some of these people belong in the deaf sub-category.

Hearing Loss Terms

Terms that have been used to define the variety of types of hearing loss are as follows:

Hearing Impaired

Often this term causes confusion because it does not provide information about the level of hearing loss or the subgroup to which the person with hearing loss belongs. For example, some people assume that “hearing impaired” refers to a person who is completely deaf. The term “impairment” also has pejorative implications, suggesting a major deficiency or abnormality in-overall functioning, which is often not the case. For these reasons the term should not be used.


These are people who have, by definition, a severe to intense hearing loss and whose age of onset of deafness is after the development of speech and language, usually after age three. Most late-deafened individuals lose their hearing in adulthood and gain little or no benefit from hearing aids. They rely on visual representation of their native language, e.g., English, German, or Spanish. They may learn and use some system of sign language, but they usually try to function primarily in the “hearing world.”If the onset of late-deafness is sudden and the degree of loss is severe to profound, the person and her or his communication partners will likely be in a crisis situation needing immediate psychosocial intervention, information and support.

Most people, who have hearing loss or are late-deafened have already established a language base, education, career, relationships and adequate self-esteem. The task for them is maintaining career, relationships, etc. Those who experience loss of hearing earlier in life have the difficult task of establishing language, education, training, career, relationships and adequate self-esteem.

Oral Deaf

People who are oral deaf have little or no residual hearing and rely on visual representation of spoken language such as written language provided on a computer or handwritten on paper or chalkboard. People who are oral deaf also rely on speech/lip reading for understanding what is being said.

Manual Deaf

People who are manual deaf also have little or no residual hearing but rely on some system of sign language, such as American sign Language (ASL) for communication. ASL is a separate language that has a grammatical structure which is different from English. People who are deaf also rely on speech reading, and reading written language for communication.

Cochlear Implant Patients

Cochlear implant patients are people who were no longer able to use their remaining hearing for communication and for receiving other environmental auditory information and had a part of their auditory anatomy altered.  Cochlear implanting is a procedure in which an electronic unit is inserted into the cochlea to deaden the cochlea, but provides for electronic reception of auditory information. The implant users then learn to interpret the meaning of the new sounds they hear.


Literal interpretation of the terms “deaf,” “hard of hearing” and “late-deafened” imply respectively, no hearing ability, some hearing ability, and no hearing ability. However, in reality some people who call themselves “deaf” have better hearing than many people who call themselves “hard of hearing.” In the final analysis, the placement of an individual in one of these subgroups is more dependent on the group with which he or she identifies and his or her communication preferences, than it is based on the severity of his or her hearing loss.

Progressive vs. Sudden Hearing Loss

Most people who have hearing loss experience its progression to increasing levels of loss over time; some gradually become late-deafened. Others lose their hearing very rapidly, sometimes overnight due to ototoxic medications, infections, surgery or trauma. Those who lose their hearing rapidly and completely usually experience a time of crisis, while those with progressive loss over a longer period of time usually don’t have a particular time of major upheaval. It is good to remember that in the time of crisis, family members, employers and coworkers are also greatly affected.

A major problem for people with sudden, profound hearing loss is managing the severe emotional upheaval along with learning new methods of communication.On the other hand, a major problem for those who lose their hearing progressively over time is that they often develop many bad communication habits that may be difficult to change.

Note of Caution

Sometimes, professionals view people with less than profound hearing loss as simply being less deaf, and, therefore, not experiencing as many communication or other hearing loss-related problems. The reality is that all levels of hearing loss, from slight to intense, produce problems in understanding what people say and difficulty hearing important environmental sounds. The term “mild hearing loss” should not be taken to indicate that it is not a big deal; it is a big deal for those who have it.