When Hearing Loss Looks Like Something Else: What Healthcare Providers May Be Missing

/ Adaptability for Life LLC /

Recognizing unaddressed hearing loss in the clinical encounter.

Hearing loss doesn't always announce itself with, "I'm having trouble hearing." Yet significant numbers of your patients may be struggling to understand.

In a busy healthcare setting, it may show up in much quieter ways: a patient who asks for something to be repeated, talks before a question is finished, watches your face closely, relies on a family member, or seems to miss the point of a conversation.

These behaviors can have many explanations. But they can also be signs that the patient is working harder than we realize to hear and understand what is being said. And in today's fast-paced clinical environment, that matters.

Because when a patient doesn't fully hear the conversation, they may not fully experience the conversation either. They can miss information, lose their place, hesitate to participate, or leave feeling that they weren't really heard or understood. Over time, that can affect the relationship with the healthcare provider—and even whether the patient feels it is worth coming back.

A Common and Under-Documented Condition

Hearing loss is one of the most prevalent chronic conditions in older adults and one of the least likely to appear in a problem list. A 2023 analysis of Medicare beneficiaries in the National Health and Aging Trends Study found that 65 percent of adults aged 71 and older had measurable hearing loss, rising to 96 percent by age 90. Among those with hearing loss, fewer than one in three used hearing aids. The interval between onset and treatment is long. The figure most often cited in the literature is approximately nine years.

What Might Make You Wonder About Hearing?

No single behavior indicates hearing loss. Look instead for patterns.

A patient may:

  • Complain about mumbling or rate of speech.

  • Ask you to face them, or move hand away from mouth.

  • Watch your face closely while you speakGive responses that don't quite fit the question.

  • Talk a lot or over others or begin responding before the question is finished

  • Rely on a spouse, child, or caregiver to repeat parts the conversation

  • Seem frustrated or short tempered during conversations.

  • Seem to not follow instructions completely.

Presentations That Are Commonly Misattributed

1. Apparent nonadherence. The patient agreed to the plan because the fragments they caught sounded reasonable. They are not resisting the plan. They are working from an incomplete version of it.

2. Apparent cognitive impairment. Effortful listening consumes working memory. A patient allocating substantial cognitive resources to decoding speech has less available for encoding and recall, and may present as slow, tangential, or forgetful.

3. Apparent disengagement or rudeness. A patient who does not respond to their name in a waiting room has not heard it. Names are short, competing voices are many, and waiting rooms are acoustically poor.

4. Apparent irritability with staff. Repeated communication failure across settings is fatiguing and often humiliating. Frustration presenting at your front desk may have accumulated well before the patient arrived.

5. Reliance on an accompanying family member. Deferring to a companion is an effective workaround that costs the patient privacy, autonomy, and accurate history-taking. It is worth noticing rather than accepting.

6. Attrition. Patients rarely disengage by citing hearing. They describe the practice as unpleasant, or simply do not rebook.

Hearing Sound Is Not the Same as Understanding Speech

A patient may be able to hear your voice and still miss much of what you are saying.

This becomes especially apparent when there is background noise, when several people are speaking, or when the conversation moves quickly. Many people compensate without consciously realizing it. They use context, facial expressions, familiar phrases, and what they expect to hear to fill in the gaps.

Often, it works. Until it doesn't.

In a healthcare encounter, a missed word can matter. A medication name, a dosage, a follow-up instruction, or a qualification such as "unless" or "only if" can change the meaning of an entire conversation.

A Simple Way to Check During the Visit

You don't necessarily need a formal hearing test to recognize that hearing may be affecting the encounter. You can start with the conversation already happening. Choose something meaningful from the visit—a piece of information from the chart, a medication instruction, or a brief explanation you've just given.

Then ask the patient to tell you more about it.

Rather than asking:

"Did you hear me?"

try:

"Tell me what you understood from that."

This gives you much more information. If the response is on topic and reflects the important information, communication is probably working reasonably well at that moment. If the response is consistently off topic, misses key information, or seems to reflect a different version of what you said, pause.

Instead of asking simply, "Do you have hearing loss?", ask:

"Are there situations you avoid because it's difficult to understand what people are saying?"

Restaurants. Family gatherings. Meetings. Social events. Places with several people talking at once.

Patients may not think of themselves as having hearing loss. But they may readily recognize that they have stopped going places where conversation has become difficult. That distinction is clinically useful. The problem may not be an inability to hear sound.

It may be an increasing inability to understand speech in the situations that matter to the patient.

Don't assume the patient wasn't paying attention.

Change the communication conditions first.

Move closer rather than increasing volume; raising volume only makes vowels louder, not consonants and reads as anger or impatience.

Ask if they have a better ear. Lower your voice and talk a little bit slower. Not exaggerating. Face the patient. Make sure they can see you, Increase lighting. Reduce background noise if possible. Then try again. Numbers like 50 & 60 are particularly hard, so could be a test. If the patient's understanding improves, you've learned something important.

The Part We May Miss: Connection

The consequences of hearing loss aren't limited to missed words. Conversation is how we establish trust. Patients want to feel that their concerns were heard. They want to understand what is happening and feel that they have participated in decisions about their care.

When hearing becomes difficult, that sense of connection can gradually erode. A patient may smile and nod because it is easier than asking for another repetition. They may let a spouse answer because it keeps the visit moving. They may stop asking questions because they aren't sure they heard the answer. They may leave an appointment with less understanding than either the patient or provider realizes.

Screening can be brief.

For an objective measure, the Hearing Number app from the Johns Hopkins Bloomberg School of Public Health is free, available for iOS and Android in English and Spanish, takes about five minutes with headphones in a quiet space, collects no personal data, and returns a decibel threshold for each ear that can be tracked over time. It is a wellness metric rather than a diagnostic audiogram, but it is sufficient to open a referral conversation.

Continuing the Mission of Access and Understanding

Adaptability for Life’s cultural competence - ethics continuing education courses provide engaging and practical skills in supporting their clients with vision/hearing loss.

Approvals - Accreditations:

OHA - Oregon Health Authority - Cultural Competence CE
CEP #18180 CA Board of Registered Nursing, Continuing Education Provider
NASW-OR Nat. Assoc. of Social Workers - Oregon Cultural Competence CE
CRCC - Commission on Rehabilitation Counselors Certification - Ethics CE

Who these courses are helpful for:

Nurses, Psychologist, LCSW, LFMT, PT, OT, SLP, ND, NP, PA, MD, DDS, LPC, Chiropractor, License Professional Counselor, Marriage and Family Therapist, Dentist, Dental Technologist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Lactation Consultant, Long Term Care Administrator, Massage Therapist, Medical Imager, Midwife, Naturopathic Doctor, Occupational Therapist, Optometrist, Pharmacist, Polysomnographic Technologist/Respiratory Therapist, Social Workers, Caregivers and Families.

  • For those seeking to enhance their skills in communicating with those who have vision or hearing loss, consider enrolling.

2-Hour Cultural Competence CE: Effective Communication with Clients Who Are Hard of Hearing
4-Hour Cultural Competence and Ethics CE: Understanding the Diversity of Legal Blindness, Impacts & Solutions
6-Hour Cultural Competence and Ethics CE: Providing Culturally Competent Healthcare for Those Aging with Dual Sensory Impairments

Each course blends over 25 years of experience in rehabilitation counseling and disability services with lived insight and real-world examples. You’ll walk away with tools that help prevent social isolation, improve connection and communication, and foster hope—even in the face of progressive sensory loss.

What You’ll Gain

  • Strategies to prevent social isolation and despair

  • Tools to support clients experiencing progressive loss

  • Skills to improve communication and connection

  • Easy, low- or no-cost accessibility techniques

  • Real-world examples you can apply immediately

About the Instructor

Deb Marinos, MS, CRC, LPC, is a Certified Rehabilitation Counselor, Oregon Licensed Professional Counselor, and CMBM Mind-Body Skills Group Facilitator. She brings decades of teaching experience with health care professionals and other working with individuals navigating sensory loss and disability. Her courses are designed to be interactive, helpful, and will give you more comfort in your work.

Take the Next Step

If you’re ready to strengthen your skills, deepen your empathy, and make your practice more inclusive—join Deb and Olaf on this journey.

👉 Explore the Cultural Competence & Ethics accredited continuing education courses and sign up today at Adaptability for Life

Adaptability for Life LLC
21887 SW Sherwood Blvd. STE C
Sherwood, OR 97140
deb@adaptabilityforlife.com