By Paul Tuveson

The telephone is still far from perfect relative to hearing aid use. Captioned Telephone Service is a free complementary solution that too few dispensing professionals are offering to their patients.

When Alexander Graham Bell invented the telephone, the process had started out more as a challenge—wondering if sound could be transferred over a wire. Later, as he progressed with his experiments, he started to explore the idea of speech transferring over a wire. 

When Bell succeeded, people couldn’t see a need for the telephone. Even President Harding wondered, “What are you going to do with a telephone? Who needs it?” Eventually, Bell was invited to demonstrate the telephone for Queen Victoria. The Queen liked the idea so much that she wanted a telephone for all of her residences. Because everyone wanted to have something that the Queen had, the rest is history.

Hearing on the Phone

Home telephone lines, for the most part, are analog lines much like the old hearing aids offered before the digital age. One of the main differences between an analog hearing aid and a digital hearing aid is the ability to reach out across the entire speech spectrum. Older analog hearing aids would peak out around 2800 Hz. Guess what? Today’s telephone lines are not much different!   

To make home phone lines digital right now across the United States is cost prohibitive. As a result, we are stuck with analog technology, which makes it difficult, especially for someone with any degree of hearing loss, to hear on the phone. The frequency range provided by analog phone service is extremely condensed, eliminating many of the high and low frequency tones. Hence, many consonants and other important sounds are lost on the phone.

In some cases, the telephone signal can be substantially weaker than that of face-to-face communications. Also, when using the telephone, there are no visual cues to help with understanding. Watching the speaker’s face has been shown to enhance speech understanding dramatically. On the phone, critical visual cues—such as eye contact, shifts in gaze, or facial expression to signal the end of a statement or new conversational turn—are not available. The speaker’s face also helps interpret emotion or whether they are asking a question or making a statement. In fact, seeing the total face during conversation has been shown to improve the accuracy of consonant recognition.

Cognitive issues associated with aging also have an impact on an individual’s ability to keep up over the phone, concentrate, remember, or follow through. As people advance in years, they have a general cognitive and speech reception disadvantage relative to younger listeners.1

Uneasiness using the phone due to scam calls, telemarketers, and other unknown calls also has impacted many seniors’ ability to use the phone. They can feel stressed about answering the phone. When anticipating a difficult call, it becomes a distraction, further exacerbating communication issues.

Practical Solutions for the Telephone

While hearing aids are beneficial, even essential, in a variety of listening situations, there are still some inherent difficulties when it comes to using the telephone with hearing aids. MarkeTrak VIII2 (2008) showed that 73% of users were satisfied with their phones, and 17% were dissatisfied. Telephone use can be seen as a major obstacle to increased hearing aid market penetration; MarkeTrak VII showed that 25% of hearing aid nonusers viewed telephone use as a reason impacting their decision not to purchase hearing aids, and 82% of hearing aid users said that hearing aids that worked better on the phone were either “desirable” or “very desirable.”3

We regularly hear about individuals taking their hearing instrument out when using the phone. There are new telephone technologies available today that do not discount or diminish the need for hearing aids in any way—tools that can be used in conjunction with hearing aids to improve the audio experience as well as reintroduce visual cues into telephone conversations.

Captioned Telephone Service (CTS, Figure 1) is one such complementary solution. Similar to captioned television, captioned telephones use voice recognition technology to display written captions of what a caller says on a large, easy-to-read, display screen that is built into the phone.

When a captioned telephone user receives a phone call, they hear the caller’s voice over their standard home telephone line. The captioning telephone sends the caller’s voice to a captioning service via an Internet connection. A communication assistant quickly converts the caller’s words to text using voice-recognition technology. Captions are then sent back to the captioning telephone’s display screen to be read by the hearing impaired individual. 

HR captioncall_phone_opt
Captioned Telephone Service phone from CaptionCall.

All this is done quickly, with a slight delay between what is being said and what appears on the screen. The speed and accuracy of captions has a lot to do with the quality of the captioning service provider. Also, as Internet speed gets faster, the ability to have quick accurate captioning consistently improves. 

A captioned phone also may offer other beneficial features for enhanced communication, such as amplification and customizable audio settings. Users may enjoy special features such as storing contacts, speed dialing, and saving captions from a call. Additionally, some captioned telephone manufacturers offer in-home delivery assistance and hands-on training at no cost to you or your patients, ensuring a pleasant experience for everyone. 

For Those Qualified, There Is No Cost For Captioning

As a provision of the Americans with Disabilities Act of 1990, the Federal Communications Commission (FCC) established a fund that gives individuals with hearing loss access to CTS at no cost. The FCC compensates CTS providers for administering the captioning service.

Captioning telephones have come a long way in the last 2 years.  Many individuals who had given up on using the telephone due to hearing loss are now using the telephone again with confidence. As a hearing care professional, captioning telephones are a “must have” on your list of solutions to recommend to your patients.

CTS is a win-win proposition for everyone.


1. Beck DL, Edward B, Humes LE, Lemke U, Lunner T, Lin FR, Pichora-Fuller MK. Expert roundtable: Issues in cognition, audition, and amplification. Hearing Review. 2012;19(10):16-26.

2. Kochkin S. MarkeTrak VIII: Consumer satisfaction with hearing aids is slowly increasing. Hear Jour. 2010;63(1):19-32.

3. Kochkin S. The importance of captioned telephone service in meeting the communication needs of people with hearing loss. Hearing Review. 2013;20(3):28-35.

CORRESPONDENCE to HR or Paul Tuveson at: [email protected]

September 2013 HRP Citation: Tuveson P. The Phone and Hearing Aids: Why Every Dispenser Needs to Offer Patients a Captioned Telephone Service. Hearing Review Products. 2013;Fall (September):16-17.