A man and a woman are sitting across from each other.  The man is facing the camera and he is smiling and the woman can only be seen by the back of her head.  They are sitting at a large and multi-colored checkerboard.  The man has his hands on two red checkers.

Many people assume that if a person is deaf-blind they will not be using speech to communicate. The reality is very different. Many people who are deaf-blind use speech as their primary mode of communication. In general, people who lose their hearing later on in life or have residual hearing prefer to hold on to their primary language as long as possible.

There are a variety of devices, systems and techniques available that allow people with a hearing loss to continue to access speech. Some people with a severe to profound hearing loss may use a hearing device along with sign language to ensure comprehension.

Any specialized hearing device should be prescribed by an audiologist. An audiologist, through their education, is knowledgeable about diseases of the ear that may not be helped by hearing aids, therefore, it is incumbent upon the audiologist to direct that person to seek medical attention.

Methods and Accommodations for Accessing Speech

Hearing Aids

A man is standing looking at books on a bookshelf.  He has a blue hearing aid in his right ear.  He is holding a book in one hand and is using his other hand to look through the books on the shelf.A hearing aid is a small device that is worn either inside the ear or behind the ear. A hearing aid makes sounds louder so that a person can access speech and/or environmental information. An audiologist can help identify and prescribe the most appropriate system depending on the person’s type and level of hearing loss and their individual needs.

There are various options when choosing a hearing aid including adding a t-coil (described in detail below) that works in conjunction with other assistive listening devices. Hearing aids come in a variety of styles, sizes and brands to meet the needs of a variety of consumers.

A hearing aid.  The tube and ear insert are made of clear plastic and the part that rests behind a person’s ear is beige plastic.It is important to consider the accessibility aspect of hearing aids. Some hearing aids are more difficult to manipulate, clean and change batteries than others. This should be a consideration when choosing a particular style for a person who has low vision or is blind.

Also note that some individuals who are deaf-blind wear hearing aids solely for environmental information and not for communication purposes.

Cochlear Implants

A cochlear implant is shown on the right side of a woman’s head and a hearing aid is over her ear.A cochlear implant is a small electronic device that is surgically implanted under the skin behind the ear. There is also a receiver unit that is worn on the body. The implant works by bypassing the mechanisms of the ear and directly stimulating the auditory nerve with signals.

The sounds and experience of hearing when using a cochlear implant is different from using a hearing aid. It is recommended (and sometimes required) that a person implanted with a cochlear implant participate in therapy with a trained audiologist to get the maximum benefit from the implant. While some people can achieve the benefit of communicating orally/aurally, others who are deaf-blind use a cochlear implant for environmental information only.



Assistive Listening Device ALD

A computer drawing of a blue square with white curved lines that resemble an ear and a thick straight line diagonally across the square. The image is the sign to depict a hearing loop.Assistive listening devices (ALDs) help to amplify the sounds that are most important to hear, especially when there is a lot of background noise. Some ALDs are designed for large areas such as a theater or stadium while other ALDs are designed for 1:1 or small group settings where a microphone can be passed along.

ALD’s work without hearing aids or cochlear implants. Many hearing aids and implants now have a telecoil (t-coil) installed that works as a wireless receiver to receive the sounds from the ALD system. This system makes it possible to amplify sound, coming from a particular source, directly to the person wearing the hearing aid, cochlear implant or personal amplifier.

Many public and private venues have ALD systems in place including libraries, museums, theaters, houses of worship and government offices such as courthouses.

Kinds of ALD systems include:

  • Hearing loop (or induction loop) systems. Hearing loop systems use electromagnetic energy to transmit sound within a specific range (the loop). A receiver must be wearing a hearing loop receiver or have a t-coil in their device and be within the loop range to pick up the audio. Hearing loop systems can be connected to televisions, public announcement systems or other audio output devices.
  • FM systems use radio signals to transmit amplified sounds. The person who is deaf-blind wears a receiver with headphones tuned to a specific channel. The person speaking talks into a small microphone connected to a transmitter. FM systems can also connect to t-coils in hearing aids and cochlear implants using a neck loop

    FM systems are particularly helpful in smaller areas such as classrooms or meeting rooms where there is one speaker talking at a time. It is also important to note that because FM systems use radio signals to transmit sounds, the sound can travel through walls. Therefore, in a building with several FM system users it is important to make sure receivers are using different channels. 

3 images: Image #1: a small rectangular device with a built in microphone and wires coming from the top. 2 buttons with the labels + and - are on the device. Next to this is a small clip on speaker, Image #2: Two women are seated across from each other at a desk.  One woman is holding an FM system transmitter and the other is wearing an FM system receiver. Two women are seated across from each other at a desk.  One woman is holding an FM system transmitter and the other is wearing an FM system receiver. Image #2: Two women are seated across from each other at a desk.  One woman is holding an FM system transmitter and the other is wearing an FM system receiver. Image #3: a pens shaped speaker a receiver with a loop to be placed around neck placed on a table

  • Infrared systems use infrared light to transmit sound. The infrared system works similarly to the FM system requiring the user to wear a receiver or a neck loop to connect to the t-coil in the hearing aid or implant. A significant difference between the infrared system and FM system is that the infrared system can’t pass through walls. This is useful in situations where confidential information is being shared such as doctors' offices, legal offices or courtrooms and also in environments like multiplex theaters where you want to ensure that the signals are not crossing between theaters. It is important to note that infrared systems can’t be used in environments with too many light sources or that are exposed to strong sunlight as the signals will be compromised
  • Personal amplifiers are portable devices that increase the loudness of sound while reducing background noise. The user wears a receiver, typically a headset or earbuds, and places the transmitter in or near the sound source. Personal amplifiers are particularly useful when the larger systems are not available and for personal use in the home watching television or driving in a car.

Sign Supported Speech

Two women facing each other. One woman is speaking and has her hands placed on the other woman’s hands to receive sign language.  She has a white cane under her arm.  The other woman is signing yes and smiling.Sign supported speech is a technique used by some individuals who are deaf-blind. This method uses spoken language and sign language, following English word order, simultaneously. Individuals use a combination of residual hearing and vision and/or tactile methods to access communication.


Another method of accessing speech is speech reading. In this method individuals rely on the movement of the lips as well as facial expressions and gestures to comprehend what is being said.

Studies suggest that only 30% to 35% of English sounds can be seen on the lips. Therefore, a speech reader must depend heavily on cues from the environment, from the context of the communication and knowledge of what is likely to be said.

If the person you are working with uses speech reading as a primary method of communication it is suggested that you attempt to speak clearly at a moderate pace. The person who is deaf-blind should be able to visually access the speaker’s face and have adequate lighting available so that the speaker's lips and face can be clearly seen. Many professionals recommend that if a consumer is relying on speech reading that there be an additional source of information available to them (for example, a print version of what is being conveyed) to ensure the accuracy of important information.


A woman is sitting with her back to the camera facing a table with an open laptop comput-er.  She is holding a small black electronic device in her lap and her fingers are resting on the keys.  She is wearing large headphones over her ears.Another method to access speech is a voice to text interpreter. Using a service such as CART (Communication Access Real Time translation), text can be relayed in print, large print or braille, in “real-time.”

The National Court Reporters Association (NCRA) describes CART services as “the instant translation of the spoken word into English text using a stenotype machine, notebook computer and real-time software.”

Additional benefits to CART include receiving a full transcript of all communication and the ability to use onsite or remote CART services.