Published August 14, 2026

Phone calls remain a common route to appointments, public services, and everyday support. Yet they can present real barriers for people with hearing loss. NIDCD estimates that about 30 million people in the United States aged 12 and older have hearing loss in both ears based on standard hearing tests, so telephone access cannot be treated as an edge case.

National evidence identifies broad telephone barriers. Testing the phone system itself reveals what its callers need.

Federal prevalence data describes the population, while local accessibility testing reveals the barriers in a particular phone system. Each form of evidence answers a different question.

What the CDC prevalence estimate measures

Federal hearing-loss estimates draw in part on the National Health and Nutrition Examination Survey (NHANES), which assesses the health and nutritional status of U.S. adults and children. NHANES collects data from a nationally representative sample of the civilian noninstitutionalized population.

These surveys involve detailed, objective audiometric testing, providing precise measures of hearing thresholds rather than relying solely on self-reported symptoms. For instance, NIDCD data indicates that roughly 1 in 8 people aged 12 years and older in the United States, or about 30 million, have hearing loss in both ears, based on standard hearing tests. This translates to tens of millions experiencing difficulties with sound perception.

The CDC's hearing-loss data breaks the estimates down by age, sex, and other demographic factors. Prevalence is higher among older adults, but the data also includes younger people.

How federal surveillance measures hearing loss

NHANES uses a complex, multistage probability sample of the U.S. civilian noninstitutionalized population. Trained health professionals conduct physical examinations that include standardized audiometry. Measuring hearing thresholds this way avoids relying only on self-reported hearing status or medical diagnoses.

The sampling frame excludes institutionalized populations, including nursing-home residents, so the result should not be applied to those groups. The estimate also depends on the threshold used to define hearing loss. Researchers commonly use an average pure-tone hearing threshold of 25 dB HL or greater in the better ear across specified speech frequencies.

Those choices define the population and condition measured by the estimate.

Implications for telephone access

The CDC evidence establishes that hearing loss is common; it does not measure performance on a particular phone system. Telephone conversations can still be difficult because of background noise, uneven audio quality, and the absence of visual cues such as lipreading or facial expressions. Similar-sounding words can be especially hard to distinguish when the connection is poor.

For service providers, a standard voice number may not be usable by every caller. Alternative contact methods and support for relay services can help people schedule appointments or request information when an ordinary voice call does not work.

Communication barriers for people with hearing loss

Individuals with hearing loss employ a variety of personal strategies and external aids to navigate daily communication, particularly in challenging environments like telephone interactions. Many rely on personal assistive listening devices, such as hearing aids or cochlear implants, which amplify and clarify sounds. However, even with these advanced devices, telephone conversations can remain challenging due to inherent limitations like background noise, variable audio quality, or the complete absence of important visual cues.

Telecommunication Relay Services (TRS) enable people with hearing or speech disabilities to communicate by telephone. The Federal Communications Commission regulates these services. Trained communication assistants relay conversations by converting text and speech or by interpreting sign language.

These services provide another way to complete a call when speech alone is not accessible.

Assistive technology and relay services

Captioned telephone services display captions during a conversation so a user can read while listening. Video Relay Service (VRS) connects a person who uses sign language with an interpreter by video; the interpreter relays the conversation to the hearing party.

Service providers should check that their phone systems accept relay calls and that staff know how to handle them. Publishing the available contact options also helps callers choose a workable channel before an urgent request arises.

Service TypeDescriptionPrimary User Benefit
Text-to-Speech (TTY/TDD)Allows individuals who are deaf, hard of hearing, or have speech disabilities to type their conversation. A communications assistant (CA) relays the typed text as speech to the hearing party and types the hearing party's spoken words back to the TTY user.Enables text-based phone conversations for those who prefer or require typing, ensuring access to standard phone lines.
Speech-to-Speech (STS)A communications assistant (CA) revoices words for individuals with speech disabilities who can hear but may have difficulty being understood on the phone. The CA ensures the hearing party understands the STS user's speech.Facilitates clear spoken communication for individuals with speech impediments, making their voice understandable to others.
Video Relay Service (VRS)Connects individuals who are deaf or hard of hearing and use sign language with a certified sign language interpreter via a video connection. The interpreter then relays the conversation in real-time between the sign language user and a hearing party.Provides real-time, visual communication through sign language, preserving the natural flow and nuances of conversation for sign language users.
Captioned Telephone ServiceAllows individuals who are hard of hearing to read captions of what the other person is saying while also listening to the conversation. Captions are displayed on a special captioned telephone or a computer screen.Combines auditory and visual input, enabling users to follow conversations more easily by reading captions if they miss spoken words.

Effective communication requirements

The ADA's guidance on effective communication explains the duties that apply to covered entities and the role of auxiliary aids and services. The appropriate aid depends on the communication and the person's usual method of communication. A provider should apply the rules that govern its organization and seek qualified advice for a specific compliance question.

Compliance does not show whether a caller can complete the interaction. A useful review follows the call from connection through the requested outcome, checking both compatibility with accessibility tools and staff handling of relay calls.

Providers can publish their alternative communication options and explain how to request an accommodation. The FCC regulates Telecommunications Relay Services (TRS) and describes the available service types.

Practical next steps for service providers

A service provider can begin by reviewing its phone process from the caller's perspective. The review should test system compatibility with relay services, identify points where a caller may lose access, and check whether staff can complete a relay-assisted call.

Staff training can explain how relay calls work and when to move a conversation to another accessible channel. A practical assessment should test whether staff recognize a relay call, avoid hanging up on the communication assistant, and confirm the caller's requested next step.

Websites and automated messages should identify the available alternatives, which may include email, text chat, or a TTY number. Feedback from callers with hearing loss can reveal where the documented process still fails in practice.

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