Kimberly Erskine wears headphones to hear better on her cellphone. David Goldstein relies on the speaker phone. And Martin Lock doesn't even bother with voice calls most of the time, instead resorting to text messages.
They are among the legions of hearing-impaired people who struggle with these everyday devices that are essential for modern communication.
Cellphone transmissions are not perfect, so anyone can miss a word here or there. A person with normal hearing can generally fill in any gaps from the context, with a minimum of mental effort.
But for a person with even a mild hearing loss, shortfalls in sound quality can make a big difference in comprehension, said Catherine Palmer, director of audiology at the University of Pittsburgh Medical Center.
"If I have a hearing loss, in a sense the signal is already compromised for me," she said.
Contrary to what a normal-hearing person might expect, the answer is not simply turning up the volume. Here is why cellphones can be tough for those with hearing loss, and what to do about it:
When a hearing-aid wearer makes a cellphone call, the loudspeaker on one sophisticated digital device (the phone) must be placed up against the microphone of another such device (the hearing aid). This may not work well.
Users may experience buzzing or interference. Or they may have trouble aligning the two devices correctly, as the microphones of some hearing aids face forward, not sideways, toward where the phone is typically held.
The answer may be to activate a feature called a telecoil, a small coil of wire built into most hearing aids. The technology converts electromagnetic energy from the phone into an audio signal that is carried straight into the wearer's ear. The user no longer needs to hear the sound waves emanating from the phone's speaker, as the hearing aid is picking up the wireless signal from the telecoil, instead.
In August, the Federal Communications Commission required that, within two years, 66 percent of manufacturers' handset models must be compatible with telecoils. In five years, the mandate goes up to 85 percent, to the delight of advocates.
"The FCC has done an amazing job on this issue," said Janice S. Lintz, a New York-based hearing technology consultant.
As a bonus, the telecoil setting also enables hearing-aid wearers to pick up a wireless audio signal transmitted by special "loops" that have been installed in a growing number of auditoriums, churches, and other public venues.
But before buying a hearing aid, ask whether it has a telecoil setting and learn how to turn it on, usually by means of a small switch or button. Also make sure to hold the phone in the right position, typically a tad higher on the ear than for a normal phone call.
A truncated signal
Cellphones, like land-line phones, transmit only a portion of the audible spectrum of sound. The frequency range generally spans from 300 hertz to 3,400 hertz, up near the highest notes on a piano.
But human speech contains frequencies well above that. Much of the sound energy in fricatives — consonants such as s and sh — lies above that range, and is not transmitted in a typical phone call, said Brian B. Monson, a neuroscientist at Harvard Medical School.
The abbreviated signal poses no problem for people with normal hearing, who are able to fill in the gaps subconsciously. But for the hard of hearing, words such as favor and savor sound an awful lot alike, said Linda Kozma-Spytek, a senior research audiologist at Gallaudet University.
Comprehension is even harder without context, such as when someone is spelling out a proper name, letter by letter. Military-style spelling may help: C as in Charlie, D as in Delta...
Another solution may lie in newer phones that can transmit a wider range of frequencies, called wideband audio or high-definition audio by various providers.
Phones that transmit frequencies up to 7,000 hertz can improve speech understanding for people with hearing loss, Kozma-Spytek and colleagues found in a 2016 study.
In order for it to work, people on both ends of the call must have a phone equipped with this feature. Several cellphone providers offer versions of high-definition audio, though the service may not work when the two callers use different carriers.
But Lock, the man who uses his cellphone primarily for texting, cautioned that adding higher frequencies to the sound will not help everyone. Often those are the very frequencies that hearing-impaired people have difficulty hearing.
Erskine, 26, who has cochlear implants in both ears, also is a big fan of texting. But sometimes she needs to make a traditional audio call, and her headphones, with big, cushioned pads that fit over each ear, help block ambient noise.
Also, they allow the adjunct writing teacher at Rowan University to receive the sound in both ears.
"It definitely helps to make it clearer," she said.
Dropped words and static can be a problem for anyone on a mobile phone, impaired hearing or not.
It may seem obvious, but some users forget that the answer may be as easy as moving to a different location, perhaps near a window, audiologists say. Or the next time your town is deciding whether to approve a new cellphone tower, remember that more sites can improve service.
In a pinch, switch to a land line, or ask the person on the other end to do so, said Pittsburgh's Palmer, a past board member for the American Academy of Audiology.
Goldstein, 68, a retired real estate executive from Lower Gwynedd, often steps outside to turn on his speaker phone.
"If I'm in a restaurant, I have to get out of the noise of the restaurant to begin with," he said.
One tactic that probably will not help is asking the other person to speak louder. This can lead to exaggerated speech that is harder to understand. What's more, the sounds that people have a harder time hearing, such as s, sh, and f, are "voiceless" and will not sound any clearer from someone speaking loudly, Kozma-Spytek said.
Lock, 54, a scientist in a University of Pennsylvania gene-therapy lab, once found himself in a jam when he had to call the company that had towed his car.
Unable to understand the person on the other end, he finally asked a friend to make the call for him.
"It's hard for a normal-hearing person to understand," he said. "They just assume so many things, that if you turn the volume up, you'll understand."
Video chat. Apps such as Skype and FaceTime, which allow callers to see each others' faces, can greatly improve speech comprehension. The hearing-impaired can read the other person's lips and also extract a wealth of information from facial expressions and gestures, even if they have not been formally trained to do so. But transmitting video eats up a lot of data, so a WiFi connection is useful.
Streaming. Many newer hearing aids can receive a wireless signal from a cellphone, using services such as Bluetooth. Much as with the telecoil feature, this allows the sound to be piped right into the user's ear, instead of having to pick it up from the phone's speaker.
Some streaming services require the user to wear a small electronic relay device around the neck. A few hearing aids have the necessary circuitry built in.
Caption services are another option. Lock uses a new smartphone app called InnoCaption, which provides a real-time transcription of the conversation.
Move it. Another tip from the seems-obvious department. Plenty of hearing-impaired people do not hold their cellphones in the right position.
That is partly because many of today's cellphones — smartphones, in particular — are in the shape of a smooth, featureless rectangle, without a clearly defined resting spot for the ear. The key is to experiment with proper placement.
"There's a little bit of searching you have to do," Kozma-Spytek said. "I've found that people don't necessarily take the time to figure out what that right position is."
Above all, do not give up. Try before you buy. If you find yourself removing your hearing aid to listen on a cellphone, that is a bad sign, not the least because it is a common way that people lose the expensive devices, Pittsburgh's Palmer said.
Cellphones are here to stay, and those who do not make the effort are missing out on both a vital means of social interaction and an important tool for basic safety, she said.
"You never, ever want to buy a hearing aid that doesn't let you use a phone," she said. "The phone is essential."