Receiving an acoustic signal, recognising whether this signal is language and if so, applying cognitive functions to make the aural input comprehensible, is a complex task. This meaningful input is not guaranteed, especially for those clients in Australia whose native language is not English. Additionally, the presence of a hearing impairment impacts on the listening task. With many non-native English speaking clients presenting in our clinics, the relevance of providing meaningful input at all times, therefore, is fundamental to achieving reliable results. Sounds differ between languages and the way the sounds are physically produced also differs. A native German speaker would likely have difficulty comprehending and repeating the sounds thin or that. These are sounds which are not present in the German language. The physical movements required to produce such sounds are unnatural for German speakers. A typical error when hearing the English word ‘that’ for this individual, would be to repeat dat, where the sound /d/ is known and able to be produced.

When a listening task is heard for the first time, adults focus on familiar sounds and words and immediate associations are given to these words. Words such as ear and infection, for example, may be associated with pain and headache. The context of the listening task, however, may assign a totally different meaning to these words. These scripts we assign to words or situations are based on our experiences. We have a procedure, for example, of seeing the doctor when we are ill and not when we are well. Scripts enable us to interpret the language, to infer meanings or intentions without requiring specific details. People from different cultures, however, may have very different scripts and when listening to a task in a foreign language, may infer a different meaning resulting in difficulty understanding the true intent of the message.

What is the significance of this in the audiology clinic? Ensure instructions are unambiguous, introduce topics which are relevant and meaningful and ensure all vocabulary in the listening task is known. If not, it should be pre-taught. When a client presents with poor English language abilities, it is not enough to say listen and repeat, when reliable assessment is the goal. The new hearing device may be set optimally, meeting targets in all areas, but if the client is not familiar with or able to physically produce an English sound in the listening task, how can the result provide us with useful and valid information?

Similarly, the clinician might use a sentence task presented live voice, to provide information about everyday listening abilities with the new device. Rhythm and stress, hesitations and false starts and omitted elliptical forms such as auxiliaries or articles, are elements the clinician needs to consider. In spoken form, rhythm and stress are very important features of the English language and can make comprehension challenging. Our clients with more significant hearing losses often depend on stress and rhythm in language to help understand aural input. Intonation and blending of one word to the next, are other features of spoken language which can distort pronunciation, especially for people with hearing loss.