Challenges In Verbal Communication In People With Congenital Hearing Loss
Author: Roselyn Mathew, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, March 26, 2025
Table of Contents
Introduction
Congenital hearing loss means hearing loss that is present at birth. This causes difficulties in speaking and in understanding speech. If not treated adequately, children with congenital hearing loss often have inadequate speech and language skills which might persist into adulthood.
Types of congenital hearing loss
There are 3 types of congenital hearing loss which are:
Sensorineural hearing loss
This type of hearing loss is caused due to abnormalities or damage in the inner part of the ear and auditory nerve, which is the nerve responsible for connecting sounds from the ear to the brain to perceive it. This is the most common type of hearing loss. It is usually permanent.
Conductive hearing loss
Conductive hearing loss is caused due to abnormalities or damage in the outer and middle part of the ear. There is a dampening of the sound that reaches the inner ear which often results in hearing the sound as clear but of very low volume. It is usually reversible but can also be permanent depending on the cause.
Mixed hearing loss
This type of hearing loss is caused due to abnormalities or damage in the outer and/or middle ear and the inner ear. Here, the sound clarity and well as loudness is affected.
Causes of congenital hearing loss
There are various factors that can cause hearing loss at birth. These are:
Genetic factors
Genetic factors are the most common cause for congenital hearing impairment. It can be syndromic (there are multiple issues present along with hearing loss) or non-syndromic (there is only hearing loss with no other issues). Some examples of syndromic hearing loss are Waardenburg syndrome, Usher syndrome and Alport syndrome. Common examples of non-syndromic hearing loss are Connexin 30 mutation, Otoferlin mutation and Pendrin mutation.
Infections
Infections can be bacterial, viral, fungal or parasitic. The most common infections are Rubella, Cytomegalovirus, Syphilis, Toxoplasmosis (a parasitic infection) and Herpes Simplex Virus.
Gestational diabetes
Maternal high blood pressure during pregnancy
Low birth weight
Lack of oxygen during birth (Hypoxia)
Jaundice during birth
Medications that can damage inner part of the ear (ototoxic medications)
Challenges in Verbal Communication
Communication issues include comprehension and expression.
COMPREHENSION
Comprehension includes understanding of speech and language. People with congenital hearing loss can face different issues in comprehension which are:
Reduced ability to understand speech sounds
Hearing loss can cause issues with clarity of speech. Certain words may not be heard as it is and might cause confusion and misunderstandings. For example, a person might hear the word “mat” as “bat” and if someone says “I bought a mat” they would hear it as “I bought a bat”, which could cause misunderstanding and confusion in conversations.
Limited vocabulary which might cause confusion
A person who is less exposed to different words due to congenital hearing loss, might get confused with new words that they have not heard before.
Issues in understanding complex sentence structures
There might be difficulties in understanding long or complex sentences. There might also be difficulties in understanding and following verbal instructions especially when it is about following specific steps in different scenarios.
Difficulties in understanding abstract concepts when described verbally
Since abstract concepts are explained using more complex languages and as there are more descriptions involved, a person with congenital hearing loss might find it difficult to grasp complex descriptions.
Having greater difficulties in understanding social conversations especially when there are multiple people speaking
People with hearing loss have to focus more on listening than people without hearing loss. Due to this, it is difficult to focus when the speaker rapidly changes as there would be immediate shift in the voice, volume and speaking style of the person which would make it more difficult to focus.
Extreme difficulties in understanding when there is background noise
It is generally difficult to listen to speech where there is a background noise as many of the speech sounds won’t be heard and the noise would additionally cause distraction and discomfort. A person with hearing loss would face the same issues at a much higher degree and people with sensorineural type of hearing loss have lesser tolerance to higher noise levels.
Issues in listening to audio calls or when the speaker’s mouth cannot be seen due to a mask or any covering
People with hearing loss rely a lot on visual cues to understand speech especially the mouth movements of the speaker. If the speaker’s mouth is covered or if they are not visible, it becomes more challenging to perceive speech.
EXPRESSION
Expression includes speech. The different factors that might get affected in speech are:
Reduced expressive vocabulary
People with congenital hearing loss might use limited vocabulary if they are not exposed to a wide range of words.
Articulation errors
Articulation issues happen because the person with congenital hearing loss might have difficulties in enunciating certain sounds as they often misheard or not hear all sounds in a word. Different types of articulation issues that are seen are:
Sound omissions- Certain sounds in a word are omitted. For example, the word “paper” might be pronounced as “papuh”by omitting the “r” sound.
Sound substitutions- Some sounds might get substituted with another sound due to lack of adequate auditory input. For example, a person might say “pag”instead of “bag”.
Distortions- Certain sounds might sound unclear as they are not heard well to be enunciated as it is.
Additions- Extra sounds are added in words which is mostly due to overcompensating because of lack of clarity in auditory feedback. For example, the word “play” might be enunciated as “pluh lay”.
Lack of intonation or inappropriate intonation
Intonation means the rhythm of speech. We change intonation by raising and falling the pitch of our voice. A person with congenital hearing loss might not change their intonation and would mostly speak in a monotone speech. They might also drastically and abruptly change their pitch.
Lack of voicing or faulty voicing
People with congenital hearing loss find it difficult to hear differences in voicing in sounds. For example, they might hear “P” as “B”, “G” as “K”, “Z” as “S” etc. as these are some examples of sounds that differ only in terms of voicing. So, they might either say “Pie” for “Bye” or “Bet” for “Pet”.
Errors in nasality
Certain speech sounds like ‘m’ and ‘n’ are nasal sounds which means air has to pass through the nose while making these sounds. Other sounds like ‘k’, ‘s’, ‘b’ etc. are called oral sounds because air only passes through the mouth while making these sounds. People with congenital hearing loss might not hear the difference between nasal and oral sounds and might enunciate nasal sounds as oral sounds and oral sounds as nasal sounds. This results in hypernasality (higher nasality) or hyponasality (less nasality) of speech.
Changes in stress patterns
Certain sounds in a word have to be stressed while saying the word. For example, the sound “pu” is stressed in the word “computer”. As people with congenital hearing loss find it difficult to hear word stresses, they might put additional stress, de-stress or stress another sound while saying a word.
Errors with fricative and affricate sounds
Fricative sounds are enunciated by keeping a smooth, slower airflow in the mouth, while affricate sounds are produced with a burst of air followed with airflow similar to a fricative sound. It is difficult for a person with hearing loss to clearly hear the difference between fricatives especially if they have similar mouth movements. Because of this, a person with congenital hearing loss might substitute a fricative sound with an affricate sound and vice versa. For example, saying “chirt” instead of “shirt”.
Treatment
Most adults with congenital hearing loss would have already received some form of treatment. They can be open to other treatment options or can include other treatment along with the ongoing treatment if they face difficulties in communication. There are different treatment methods depending on the type and severity of the loss and the communication issues, the person is facing. Some of the most common treatment options are:
Hearing aids
With greater advancements in technology, there are different types of hearing aids available depending on the type and severity of the hearing loss, and the lifestyle and comfort of the person.
Cochlear implants
Cochlear implants are an alternative to hearing aids and are often opted for severe to profound levels of hearing loss.
Assistive listening devices
These devices help in hearing better in certain situations like attending conferences or talking through the phone.
Speech therapy
Speech therapy can help in improving enunciation, intonation, social communication and word stress.
Conclusion
Congenital hearing loss is hearing loss that is present at birth. People with congenital hearing loss face greater communication issues than people who develop hearing loss at a later period of their life. There are different issues that could arise in communication. It is important to understand these challenges and get the proper treatment in order to have good communication skills.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
