There are an estimated demographic figure of 36 million deaf and hard of hearing in the United States. Of this large number, only a few million are considered ?deaf? and the remainder are ?hard of hearing.? Further confusing statistics is the fact that some ?deaf? people may actually be ?hard of hearing,? and some ?hard of hearing? people may actually be ?deaf.?

In previous years, the labels ?deaf? and ?hard of hearing? were employed as subcategories of the term ?hearing-impaired.? During that time, it was used as a generic term that was applicable to anybody with any degree of hearing loss. However, some deaf people objected to the description of their hearing status as ?impaired? because they felt that the term also implied that the person was ?impaired.? Such degrading terms can actually cause depression and anxiety among deaf people and, thus, this generic label has been dropped.

The deaf and hard of hearing community is very diverse, differing greatly on the cause and degree of hearing loss, age at the onset, educational background, communication methods, and how they feel about their hearing loss. How a person ?labels? themselves in terms of their hearing loss is personal and may reflect identification with their relationship with the deaf community or merely how their hearing loss affects their ability to communicate. They can either be deaf, Deaf (with a capital ?D?), or hard of hearing.

Interestingly, the lowercase ?deaf? is used when referring to the audiological condition of not hearing, while the uppercase ?Deaf? is used to refer to a particular group of people who share a common language such as the ASL (American Sign Language) and culture. The members of this group have inherited their sign language, used it as a primary means of communication among themselves, and hold a set of beliefs and their connection to the larger society. They are distinguished from those who find themselves losing their hearing because of illness, trauma, or age. Although these people share the condition of not hearing, they do not have access to the knowledge, beliefs, and practices that make up the culture of Deaf people.

Generally, the term ?deaf? refers to those who are unable to hear well enough to rely on their hearing and use it as a means of processing information. On the other hand, the term ?hard of hearing? refers to those who have some hearing, are able to use it for communication purposes, and who feel reasonably comfortable doing so. A hard of hearing person, in audiological terms, may have a mild to moderate hearing loss.

To understand hearing loss, it is important to understand how normal hearing takes place. There are two different pathways by which sound waves produce the sensation of hearing: air conduction and bone conduction.

In air conduction, sound waves move through the air in the external auditory canal (the ?ear canal? between the outside air and the eardrum). The sound waves hit the tympanic membrane (eardrum) and cause the tympanic membrane to move. Hearing by bone conduction occurs when a sound wave or other source of vibration causes the bones of the skull to vibrate. These vibrations are transmitted to the fluid surrounding the cochlea and hearing results.

Fortunately, there are many treatments that are available for hearing loss. People with conductive hearing loss can have the middle ear reconstructed by an ear, nose, and throat specialist. Hearing aids are effective and well-tolerated for people with conductive hearing loss. People who are profoundly deaf may benefit from a cochlear implant.

For people with hearing loss, it is a matter of deciding whether to treat it as an audiological perspective or as a cultural lifestyle. It's all about choices, comfort level, mode of communication, and acceptance of hearing loss. Whatever the decision, there are support groups and organizations that represent all deaf and hard of hearing Americans, and advocacy work that can benefit everyone, regardless of the type of hearing loss and background.