Captioning technology allows people to more fully communicate with the world, once they agree to start using it.
By Melanie Hamilton-Basich
Hearing aids can greatly improve a person’s ability to interact with the world around them, but they can only do so much. For many patients, especially those with severe hearing loss or difficulty with speech recognition, captioning technology serves as a vital complementary tool that greatly increases understanding, restoring confidence in communication. By providing a visual representation of spoken words, these technologies can empower patients in situations where amplification alone falls short.
While some patients may initially resist adopting another piece of technology, hearing care professionals (HCPs) who understand the nuances of different captioning options and how to frame them for patients can achieve remarkable results. “I think hearing aids are important and I think they are great tools that are so much better than they used to be, but I know they’re not perfect,” says Janelle Parker, a sensory disability consultant and educator who helps clients through her company Tamco Learning Creations. “So I want to encourage people to look at captioning as an additional tool for the job.” From more traditional captioned telephones to mobile apps, the right captioning tool can significantly improve a person’s quality of life.
Reconnecting Patients with Their Worlds
The impact of integrating captioning technology into a patient’s life can be profound, extending far beyond simple comprehension. For many, it represents a reconnection with family, a restoration of professional confidence, and a newfound sense of independence.
Parker recalls a family where the wife’s progressing hearing loss had made phone calls with her sisters who lived out of state increasingly frustrating. After introducing a captioned telephone, the dynamic changed completely. Weeks later, her husband called Parker. “He said ‘I have a bone to pick with you… My phone bill went up,’” Parker recounts. “And then he laughed. Apparently his wife has been able to reconnect with all of these sisters again, and he was just thrilled as could be that she could have that connection.”
For those with the most severe hearing loss, captioning can be less of a supplement and more of a necessity. Kira Savin, AuD, president of California Hearing Center, shares the story of a patient she calls “Judy,” who has a corner audiogram and is a cochlear implant candidate but is resistant to the surgery. For Judy, who is highly social, captioning is essential. “She uses caption technology for phone calls, and she uses caption technology even when she’s out in a more crowded situation, because that’s really her only way to fully understand speech,” Savin says.
The utility of captioning is not limited to phone calls. Mobile apps with speech-to-text functionality can be invaluable for in-person communication. Parker worked with a late-deafened woman in her 80s who primarily relied on a TTY and email, and struggled with writing notes back and forth in public. Parker demonstrated a speech-to-text app on her phone during a chance meeting in a parking lot. “She just stood there with her mouth open,” Parker says. The client immediately had her use it to communicate with a librarian and soon after acquired her own smartphone. “It made a big difference in her independence.”
This independence is also crucial in the professional sphere. Savin has some patients who are older, still-practicing lawyers. In a post-COVID world of online meetings, they use captioning technology during depositions and trials conducted over Zoom. “When every word counts, especially in these depositions or these trial cases, when they’re working by hearing what the person is saying, but then having that captioning technology right in front of them, they’re not missing things,” Savin says. “They’re not asking for repetition… so they’re just so much more accurate at their job.”
Navigating Patient Resistance and Stigma
Despite the clear benefits, some patients are hesitant to adopt captioning. The most common source of this resistance, according to Savin, is a fundamental misunderstanding of the limits of amplification. “If I’m spending all of this money and energy on hearing aids, shouldn’t it fill in all the gaps for me?” she says, summarizing the patient perspective. “That’s been the biggest challenge is like convincing people to adopt additional technology because their hope is that the initial technology will do everything for them.”
The first step in overcoming this hurdle is patient education. It’s essential to have a frank conversation about the nature of their hearing loss and the realities of what hearing aids can and cannot do. “The auditory system is complicated,” Savin explains. “When you have hearing loss, there’s damage and things don’t present well… So while hearing aids will help for most things, these captioning tools will help fill in the gaps.”
Framing captioning as just another tool in a toolbox can be a powerful approach. Parker often uses analogies that resonate with her patients’ experiences. For some, she compares a hearing aid to a trusty old screwdriver and captioning to a power drill. “When my arthritis digs in, let’s go get a drill. We’re done,” she says. For others, she might ask, “You can mix those cookies by hand, but aren’t you going to go get a mixer and get it done?” This reframes the technology not as a crutch, but as a way to make a task more efficient and less strenuous.
Stigma can also be a significant barrier. Some patients worry about privacy, asking if a third party is listening to their calls. Parker addresses this by comparing a captioning assistant to a secretary taking notes in a meeting, emphasizing their professional obligation to confidentiality. Others are concerned about what people will think. “People often will say to me, ‘I don’t want to wear hearing aids or I don’t want to use all this special stuff because I don’t want everybody to know,’” Parker says. She counters this by pointing to her own glasses or to a neighbor’s walker, arguing that visible tools that improve function are normal and accepted.
Savin notes that the fear of being perceived as less competent is a powerful driver of stigma, especially in professional settings. “People, no matter what, always when you don’t hear well and you keep asking for repetition, people make assumptions about your intelligence, no matter how intelligent you are, unfortunately,” she says. Highlighting how captioning can help a patient avoid asking for repetition can be a compelling argument for professionals like the lawyer she works with.
Tips for Introducing Captioning
For HCPs looking to help patients feel more comfortable with the idea of using captioning, a thoughtful and patient-centric approach is key. It begins with understanding that adoption is a process, not a single event.
“Sometimes it’s just a matter of slow introduction and thinking about which device to look at,” Parker advises. A patient who is intimidated by technology might do better starting with a simple captioned landline phone that looks familiar, whereas a more tech-savvy individual might be comfortable jumping directly to a mobile app.
Using TV captions can be an excellent, no-cost entry point. “I often ask people about watching TV,” Parker says. “Well, do you watch the words on the TV at home? … just practice with it. It won’t cost you any money.” This allows patients to get used to reading and listening simultaneously in a low-pressure environment. It also provides a natural opportunity to manage expectations, explaining why captions for a pre-recorded movie are more accurate than for a live news broadcast.
When introducing phone-based captioning, Parker recommends a gradual approach. “We start out with a familiar person that we know the patient is going to talk to all the time,” she suggests. From there, patients can work their way up to calling businesses and eventually tackling automated systems or unfamiliar callers.
It’s also helpful for HCPs to know what resources are available. An audiology clinic doesn’t have to be the expert on every device. “Many states have equipment distribution programs through the Telecommunications Equipment Distribution Program Association (TEDPA),” Parker notes. “As an instrument provider, I don’t have to worry about having that consultant in my lobby and that device in my lobby. I can refer them to those programs and those programs can show them the whole gamut.” Other resources like I Can Connect, which serves the deaf-blind community, as well as vocational rehabilitation and the VA can also assist patients.
Ultimately, the goal is to empower the patient. Framing the adoption of captioning as a no-risk trial can be effective. “My approach is, let’s try. If you’re not going to use it, it didn’t change anything, right?” Savin says she tells her patients. “If you feel like it’s a detriment or somehow not helpful, you can always stop.”
From Landlines to Wearables: The Future of Captioning
The technology behind captioning is continually evolving, offering more options and greater convenience for users. While landline-based captioned telephones are still “super helpful” for patients without mobile phones, apps are often a more effective solution for those who are comfortable with them. “The apps I think work better,” Savin says. “They’re just processing that information faster.”
The portability of apps is a major advantage. As Parker notes, “I’m going to have it in my pocket all the time so I can use the apps for talking on the phone. I can use the apps for communicating in person.” This versatility is increasingly important as communication moves online. The widespread adoption of video conferencing during the COVID-19 pandemic was a “game changer,” says Parker, making real-time captions in meetings a standard and expected feature.
The future of captioning is moving toward even greater integration into daily life. Savin is particularly excited about the potential of wearable technology. “I think wearable technology and wearable captioning is certainly where we’re moving forward to,” she says. “Even at a restaurant where it’s really loud and noisy, imagine if I could just put glasses on and then hear people talking and whatever I don’t hear, it’s just being captured in the glasses.”
This vision of seamlessly integrated, real-time captioning highlights the ultimate goal: to make communication easier and more accessible in every environment. “If we can have captions not just on the phone, not just on Zoom, but out in the real world in our everyday life, I think it will make communication for people so much easier overall,” Savin concludes. For hearing care professionals, staying informed about these advancements and offering them as part of a holistic communication plan is more important than ever.
Featured image: ID 25013668 © Andreblais | Dreamstime.com
