Why is it hard for cochlear implant recipients to hear on the telephone?

Acoustically, the telephone signal has a more limited frequency band than a typical speech signal, the phone instrument distorts voices, and there can be an echo and/or other noises that make comprehension difficult for anyone but most especially for people with hearing loss. These challenges combined with the inability to use speech reading when talking on the phone are significant barriers to fluent telephone conversations. The lack of eye contact that prevents you from receiving visual cues for speech reading also pertains to the person you are speaking to as he or she cannot see your facial expressions or other nonverbal cues either—cues that typically help someone to know that you did not grasp completely what was just said.

Hence it is important to tell the person you are talking to when you don’t understand. The other person may not be aware of your lack of understanding unless you tell them.

Telephone Tips When Starting Out:

1. Choose your partners carefully. This is good advice for life in general and is highly recommended when you begin talking on the phone with your CI. Begin with people who will be mindful and tolerant as a conversationalist as they will likely need to make adaptations for you. You probably know which friends or family members have relatively clear speech. You should ask for their help and guide them with some basic principles.
2. At first, you should be the initiator of phone calls. Call your partner(s) from a quiet room.
3. Use your preferred method of connecting from your processor to the telephone. There are several connection methods available including Bluetooth, telecoil, or another ALD (Assisted Listening Devices) that can help you. Ask your audiologist and make sure that you have been updated with every device that can work with your CI. I also recommend that you review our previous blog post by Erin Schafer on Assistive Listening Devices for Cochlear Implants.
4. If you don't use an ALD to connect to the telephone, take care to find the best position to hold the telephone receiver before you make a phone call. This position may be different from where you held the phone with your hearing aid.
5. Ask your practice partners to take your phone calls when they are also in quiet spaces. Ask them not to converse with you when they are driving a car, sitting in a restaurant, or using a speakerphone. Ask them to wait until they are in an ideal acoustical environment to talk.
6. Do not feel embarrassed to inform your partners that you did not understand what they just said! Remember that if you do not inform them at the moment when you missed something they said, there is an increased chance of further misunderstandings. Let them know in advance that they should expect that you will not understand every word.
7. Ask your partners for clarifications such as “I did not understand.” “Please say it again.” “Could you speak slower?" Guide them to use basic clarification strategies such as slowing down their speaking rate and conveying the message using other simple words rather than repeating precisely what they said before. When you miss a name of a place or a person and you are not sure you have understood the word in full, your partner could spell the word ("N" as in Nancy, etc.) or briefly describe the person or the place ("My sister Ann whom we visited last Sunday" or any other significant clue).
8. If the conversation includes instructions, information regarding meetings and so on, check back by repeating what was said and then writing it down.
9. One last tip is relevant if your speech is not perfectly clear (i.e., you have imperfect speech intelligibility). Speechreading is an important source of information for many people—not just those with hearing loss. People who have normal hearing may use speechreading in some situations without knowing they are doing it. These situations include understanding speech in noisy environments, especially when the listener is in conversation that is not their native language or they are listening to someone with lower speech intelligibility. If your speech intelligibility is lower than typical speech, a communication partner may need clarification on the telephone as well.
10. Remember, both of you will need to be patient and use the clarification strategies described above.
11. You might also try the telephone practice tools from the CI companies, all of which are available for free in the rehab areas of the company websites. These may help you develop the confidence to converse with a real person!

What is the right time to start telephone practice?

I suggest starting telephone practice only after you are able to understand short, simple sentences without speechreading. Some people can do this immediately after device activation, some are able after a few months, and others are ready only after a year of CI use. Not everyone implanted at a later age will be able to understand speech on the phone. Talking on the phone can be a challenging mode of communication for a CI recipient as it requires the person to have robust speech perception skills, to have pursued specific training and practice, and to have high auditory processing abilities (which may be based upon previous hearing experience).

Good luck and have fun!

Naama Tsach