Q: I have several patients with hearing loss. Communicating with them can be difficult. Do I just raise my voice, or are there other techniques?

A: If simply raising your voice allows you to communicate with a patient who has a hearing impairment, then thats perfectly fine, says optometrist Alan French, of Eleanor, W.Va.

That satisfies both the spirit and the letter of the Americans with Disabilities Act (ADA), Dr. French says. The ADA stipulates that any form of communication is sufficient if it meets the hearing-impaired patients needs and if the patient is comfortable with it. Such forms of communication also include writing notes and using gestures or sign language.

The ADA also states that a doctor must provide auxiliary aids and services for effective communication. So, if a patient requests a professional sign language interpreter, then its the doctors responsibility to provide and pay for the interpreter, Dr. French says.

But, Dr. French doesnt do this. He doesnt need to. He learned sign language to help interpret at his church. He now attracts deaf and hearing-impaired patients to his practice.

Besides speaking loud and clear, he says, there are other simple ways to improve communication:

Lower your voice. Most hearing loss is in the higher frequencies, Dr. French says. So, women practitioners and staff members, whose voices tend to be higher, may actually have a harder time communicating with patients.

Speak in the good ear. If the patient turns her head or cups her ear, youll know thats the better ear. If the patient has only one ear that works well, then do your testing from that side of the patient, he says.

Give the patient time. When you speak, dont repeat yourself immediately. Patients with hearing loss may need a few moments to absorb and process what you just said before they can answer.

Reduce noise distractions. Keep the ambient office noise to a minimum. If you play music in the background, turn it off.

Its no surprise that optometrists see many patients with both hearing and vision loss. Results from the Blue Mountains Eye Study show that patients with visual impairmentcataract and age-related maculopathy, in particularare also more likely to have hearing loss than other patients.1 For each line of reduction in best-corrected visual acuity, the prevalence of hearing loss increased by 18%.

If a patient has trouble hearing you, ask if hes been tested for hearing loss. If need be, refer the patient to his primary-care doctor or to an audiologist.

Q:If I think a patient might be helped by a hearing test or hearing aids, should I refer the patient? What should I say?

A:I just ask them, Do you have hearing aids, or have you been tested for hearing loss? If there is truly a pathological process to the hearing loss, the patient is usually aware of it, Dr. French says.

If the patient seems unaware of the problem or is in denial, say, Have you noticedor has anyone ever mentionedthat you have trouble hearing? If so, suggest that the patient get a physical by his or her primary-care doctor, and follow up with a referral letter. Sometimes, its just something as simple as a buildup of earwax or some type of infection, Dr. French says.

If the patient just had a physical, refer him or her directly to an audiologist. Remember that audiologists also see a lot of patients with vision problems, so they could be a good source of referrals.

1. Chia EM, Mitchell P, Rochtchina E, et al. Association between vision and hearing impairments and their combined effects on quality of life. Arch Ophthalmol 2006 Oct;124(10): 1465-70.