Of the 22 million hearing impaired persons in the United States, as many as 679,000 are adults who have a severe or profound sensorineural hearing loss in both ears. This is also called "nerve deafness." Most are individuals who once had normal hearing and had developed normal speech and language. Almost all people with this degree of loss require the use of hearing aids to hear speech. With powerful hearing aids, and the use of speechreading (lipreading), they can communicate to some extent, but the process is laborious and incomplete. Some have no hearing in either ear and no longer use hearing aids.
Deafness that occurs in adulthood has a significant effect on individuals who learned spoken language when they had normal hearing. Spoken communication now requires great effort and attention. Many of these deaf individuals are anxious or embarrassed when they misunderstand or do not hear what has been said. As a result, they avoid communication; this leads to social isolation and loneliness. Difficulties in communication often cause problems with job performance and employability, and for those who are retired, reduced ability to live independently. These individuals also can experience fatigue, stress, anxiety, depression and psychological disturbances because of their difficulty with communication.