When is a person functionally deaf?

An estimated 1.3 Million South Africans may experience significant functional hearing loss

A Perspective of the Fanie Dreams Movement

Important note: This article presents the perspective of the Fanie Dreams Movement. The term “functional deafness” is used as a functional concept and is not proposed as a replacement for formal audiological diagnosis. Population calculations based on WHO data are illustrative and should not be interpreted as an established South African prevalence figure for functional deafness.

INTRODUCTION

What does it mean to be deaf?

Is a person deaf only when they have profound or complete hearing loss?

Or can a person who retains some hearing nevertheless experience functional deafness when their ability to access spoken communication is significantly restricted?

The Fanie Dreams Movement believes this question deserves greater attention.

This article presents the perspective of the Fanie Dreams Movement on functional deafness. It does not propose functional deafness as a replacement for an audiological diagnosis, nor does it suggest that everyone with a particular hearing threshold should automatically be regarded as deaf.

Instead, the concept draws attention to an important distinction: Having residual hearing is not necessarily the same as having reliable functional access to communication.

For the Fanie Dreams Movement, the issue is therefore not simply how much a person can hear. It is also:

• What can the person understand?

• In which environments can they understand it?

• How much effort is required?

• What communication strategies do they use?

• And what support do they need to participate effectively?

THE SCALE OF HEARING LOSS

The World Health Organization's World Report on Hearing estimates that more than 1.5 billion people globally experience some degree of hearing loss, representing approximately one in five people. The report provides a breakdown according to the severity of hearing loss. [1] South Africa's population is approximately 63 million people. Statistics South Africa's 2026 mid-year population estimate is approximately 63.52 million. For the purposes of this article, this is rounded off to approximately 63 million. [2] If the WHO's global distribution of hearing-loss severity is applied illustratively to a population of approximately 63 million, the potential numbers become significant.

Degree of hearing loss — WHO global prevalence — Illustrative number in SA

• Mild — 14.9% — ±9.39 million

• Moderate — 3.4% — ±2.14 million

• Moderately severe — 1.3% — ±819,000

• Severe — 0.4% — ±252,000

• Profound — 0.2% — ±126,000

• Complete — 0.2% — ±126,000

The moderately severe, severe, profound and complete categories together represent approximately 2.1%. Applied to 63 million people, this numbers approximately 1.32 million people, or rounded off to approximately 1.3 MILLION PEOPLE

But this is not a prevalence figure for functional deafness. This distinction is fundamental. The 1.3 million figure is not being presented as the number of functionally deaf people in South Africa. It is an illustrative calculation based on applying the WHO's global distribution of hearing-loss severity to the South African population. South African-specific research would be required to establish the actual prevalence of functional deafness.

The statistic is therefore not the basis of the Fanie Dreams Movement's argument. It simply illustrates the potential scale of the population living with more significant levels of hearing loss. The real question is what happens within that population.

FROM AUDIOLOGICAL HEARING LOSS TO FUNCTIONAL DEAFNESS

A diagnostic hearing evaluation provides essential information about a person's hearing sensitivity. The degree of hearing loss may range from mild and moderate through moderately severe, severe and profound. However, an audiogram does not necessarily tell us how effectively a person can communicate in every real-world environment.

The Fanie Dreams Movement therefore proposes that functional deafness should be considered through a broader lens. A person may experience functional deafness in a particular communication context when their hearing impairment results in such substantial difficulty accessing spoken communication that they cannot reliably participate without significant reliance on additional communication strategies, technology or reasonable accommodation.

This is a functional concept, rather than a new audiological diagnosis.

HEARING A VOICE IS NOT NECESSARILY UNDERSTANDING SPEECH

One of the most important distinctions is between audibility and speech understanding. A person may hear that somebody is speaking without being able to understand what is being said. They may hear the voice. They may hear the volume. They may hear some of the words. But they may not reliably understand the message.

This becomes particularly significant when:

• there is background noise;

• several people are speaking;

• the room has poor acoustics;

• the speaker is far away;

• the speaker's face cannot be seen;

• the speaker is unfamiliar;

• the conversation moves quickly; or

• communication takes place by telephone or through an inaccessible online platform.

A person who functions relatively well in a quiet room may therefore experience substantial communication barriers in a workplace meeting, classroom, healthcare consultation, restaurant or social gathering.

Consequently, the question: “Can you hear?” is often insufficient. The more meaningful question is: “Can you reliably understand and participate in the communication?”

WHEN DOES HEARING LOSS BECOME FUNCTIONALLY DEAF?

The Fanie Dreams Movement does not propose a single audiometric threshold that automatically determines functional deafness. Rather, consideration should be given to:

• Degree of hearing loss

• Speech perception

• Speech understanding in noise

• Benefit from amplification

• Communication environment

• Communication demands

• Communication strategies

• Need for reasonable accommodation

A person with moderately severe, severe, severe-to-profound or profound hearing loss may therefore be within a population where functional deafness becomes particularly relevant. However, the person's actual functioning must still be considered. Two people with similar audiograms may have very different communication abilities and needs.

RESIDUAL HEARING DOES NOT EQUAL FUNCTIONAL COMMUNICATION

 

This is one of the central principles of the Fanie Dreams Movement. A person may have residual hearing without having reliable functional hearing for communication.

They may hear a door closing, a vehicle, music, an alarm, or a person's voice. But detecting environmental sounds does not necessarily mean that the person can understand spoken language reliably.

Similarly, the ability to speak does not necessarily demonstrate effective hearing. A person can speak fluently while experiencing significant hearing loss. They may have developed spoken language before their hearing deteriorated. They may have learned to communicate orally despite hearing loss. They may use hearing aids or cochlear implants. They may be highly skilled at speechreading. None of these circumstances necessarily means that the person has unrestricted access to spoken communication.

FUNCTIONAL DEAFNESS IS NOT SYNONYMOUS WITH SIGN-LANGUAGE USE

This is particularly important in South Africa. The Fanie Dreams Movement fully recognises the importance of South African Sign Language (SASL) as a language and recognises the cultural and linguistic identity of the Deaf community. However, functional deafness should not be defined by whether a person uses sign language.

People with significant hearing loss are a highly diverse population. Some use SASL.  

Many others communicate primarily through spoken and aural methods. Some use hearing aids. Some use cochlear implants. Some rely heavily on speechreading. Some use captions or speech-to-text. Some use written communication. Some use assistive listening technology. Many use a combination of these approaches.

The Fanie Dreams Movement therefore believes that the communication method a person uses does not determine whether their hearing loss has a functionally deaf impact.

AURAL AND SPOKEN-LANGUAGE COMMUNICATION

A significant hearing loss does not necessarily change a person's preferred language. A person may continue to communicate primarily through the spoken language they have always used. They may rely on residual hearing, amplification, speech-reading and other strategies to understand others. For this reason, people who may experience functional deafness should not automatically be assumed to be sign-language users.

The broader population includes people who communicate primarily through: spoken language, aural communication, speech-reading, hearing technology, captioning, written communication, or a combinations of these.

This is particularly relevant in a multilingual and multicultural country such as South Africa.

WHO IS MISSING FROM DEAF AWARENESS?

One of the concerns raised by the Fanie Dreams Movement is that people with significant hearing loss who communicate primarily through spoken and aural methods may receive limited recognition or representation in some Deaf awareness campaigns.

This is not a criticism of the Deaf community or of South African Sign Language.  

The Deaf community has its own important linguistic, cultural and lived experience, and SASL deserves recognition and respect.

The concern is different. Are we representing the full diversity of people affected by significant hearing loss? Much of the public understanding of deafness understandably focuses on Deaf culture, sign language and the experiences of people who identify as Deaf. These voices are important. But they do not necessarily represent everyone living with significant hearing loss.

There are also people who:

• speak rather than sign;

• use hearing aids or cochlear implants;

• rely on speechreading;

• use captions or speech-to-text;

• communicate in their first spoken language;

• use a combination of communication methods;

• may never have learned sign language; and

• may not identify culturally as Deaf.

Some of these people may nevertheless experience substantial functional communication barriers. Yet they may not recognise themselves in conventional Deaf awareness messaging.

AWARENESS SHOULD INCLUDE THE WHOLE SPECTRUM

The Fanie Dreams Movement believes that Deaf awareness should not unintentionally create another form of exclusion. Recognising SASL and Deaf culture is essential. But recognising them should not mean overlooking people whose experience of significant hearing loss is different. Awareness should make room for both. For the person who communicates through SASL. And for the person who communicates through speech. For the person who identifies strongly with Deaf culture. And for the person whose hearing loss is an invisible disability within their existing linguistic and cultural identity. For the person who uses sign language. And for the person who uses hearing technology, speechreading, captions or other communication strategies.

There is no single way to experience significant hearing loss.

The Fanie Dreams Movement believes that true awareness must make the invisible visible—including people whose hearing loss may be hidden behind speech, technology and years of learned coping strategies.

SOUTH AFRICA'S DIVERSE COMMUNICATION LANDSCAPE

South Africa makes this distinction particularly important. People with hearing loss may speak isiZulu, isiXhosa, Afrikaans, English, Sesotho, Setswana, Sepedi, Xitsonga, siSwati, Tshivenda, isiNdebele, or a number of other languages.

They may come from different cultural, social, educational and geographic backgrounds. Their communication preferences and needs may therefore be very different. A person with significant hearing loss does not stop belonging to their linguistic or cultural community because they have lost hearing. They may continue to communicate predominantly through their spoken language while using additional strategies to access what other people are saying.

SPEAKING DOES NOT EXCLUDE FUNCTIONAL DEAFNESS

A particularly damaging assumption is: “But the person can speak, so they cannot be deaf.” This is not a reliable conclusion.

Speech production and hearing perception are different functions. A person can speak clearly and still have significant difficulty understanding other people's speech. They may have spent years developing strategies to compensate for their hearing loss. They may position themselves carefully. They may watch the speaker's face. They may ask people to repeat themselves. They may use hearing technology. They may avoid noisy environments. They may depend on written information.

These behaviours can sometimes conceal the extent of the underlying communication barrier. What may look like successful communication from the outside can require considerable concentration, effort and adaptation from the person with hearing loss.

THE HIDDEN COMMUNICATION BURDEN

Functional impact is often invisible. A person may appear to participate normally in a meeting, but perhaps they understood only part of what was said. Perhaps they inferred the rest from context. Perhaps they watched other people's reactions. Perhaps they were too embarrassed to ask for repetition. Perhaps they went home exhausted from the concentration required to follow the conversation.

The outcome may appear successful. The process may have been extremely demanding. This is why the Fanie Dreams Movement believes that functional impact must be considered alongside the diagnostic result.

HEARING TECHNOLOGY DOES NOT AUTOMATICALLY REMOVE THE FUNCTIONAL DISABILITY

Hearing aids and cochlear implants can provide enormous benefits, but the presence of hearing technology should not automatically be interpreted as evidence that communication barriers have been eliminated. The appropriate question is: “What level of functional communication access does the person achieve with their available technology?” And: “Does that level of access remain adequate in the environments in which the person is expected to function?”

A person may communicate effectively one-to-one in a quiet room while struggling substantially in group meetings, classrooms, noisy workplaces,

healthcare settings, public-service environments, restaurants, telephone conversations, or online meetings.

FROM DIAGNOSIS TO FUNCTIONAL IMPACT

The Fanie Dreams Movement believes that there is a fundamental difference between asking: “What is the diagnosis?” and asking: “What is the functional impact?”

The diagnosis establishes the impairment. The functional assessment helps explain what that impairment means in everyday life. This distinction is particularly important when considering reasonable accommodation. A person should not have to prove that they are completely unable to hear before their communication needs are taken seriously.

REASONABLE ACCOMMODATION SHOULD FOLLOW FUNCTIONAL NEED

Communication accommodation should not be determined solely by the person's diagnostic label. Nor should it be determined simply by whether they use SASL. The relevant question should be: “What does this individual require to access information and participate effectively?” Depending on the person and environment, this might include:

• captioning;

• speech-to-text technology;

• written information;

• appropriate seating;

• good lighting;

• clear visual access to the speaker;

• assistive listening systems;

• accessible online meeting practices;

• repetition or clarification;

• written instructions;

• sign-language interpretation; or

• a combination of communication supports.

The objective is not preferential treatment. It is to remove communication barriers that prevent equal participation.

THE 1.3 MILLION FIGURE: WHY MENTION IT?

The Fanie Dreams Movement believes that the estimated 1.3 million people should be understood in the correct context. It is not a claim that 1.3 million South Africans are functionally deaf. It is an illustrative population estimate based on WHO global hearing-loss severity percentages. Its purpose is to demonstrate that the population potentially affected by significant hearing loss is large enough that functional communication cannot simply be treated as a marginal issue.

The real challenge is to determine how many people within this population experience communication restrictions that amount to functional deafness in particular environments. This is a question that deserves further South African research.

A MORE INCLUSIVE UNDERSTANDING OF DEAFNESS

The Fanie Dreams Movement believes that South Africa needs a more nuanced understanding of hearing-related disability. This means recognising the Deaf community and the importance of SASL.

It also means recognising people who:

• do not use SASL;

• communicate through speech;

• use hearing technology;

• use speech-reading;

• rely on captions;

• use written communication;

• use multiple communication methods;

• speak different languages; and

• come from different cultural backgrounds.

These people should not become invisible simply because their communication method does not fit a traditional understanding of deafness.

THE FANIE DREAMS POSITION

The Fanie Dreams Movement's position can therefore be summarised simply:

1. Deafness should not be understood only through the audiogram.

2. Functional deafness should not be defined by sign-language use.

3. The ability to speak does not exclude functional deafness.

4. Wearing hearing technology does not automatically eliminate communication disability.

5. Residual hearing does not necessarily provide functional access to spoken communication.

6. Aural and spoken-language users should not be overlooked when discussing deafness and hearing-related disability.

7. Communication needs should be assessed individually.

8. And perhaps most importantly, the question should not only be “How much can this person hear?” but “How effectively can this person access, understand and participate in communication?”

CONCLUSION

Hearing is not an on/off switch. Communication is not an on/off switch either. A person can hear some sounds and still experience substantial barriers to spoken communication. A person can speak fluently and still have significant hearing-related communication needs. A person can use hearing aids or cochlear implants and still require accommodation. A person can have significant hearing loss and never use sign language. And a person can be functionally deaf in one environment while functioning much more effectively in another.

The World Health Organization's global data demonstrate the enormous scale of hearing loss worldwide. When the WHO severity distribution is applied illustratively to South Africa's approximately 63 million people, approximately 1.3 million people fall within the moderately severe-to-complete range.

That number is not the answer. It is the beginning of a question. The important question is what happens to those people in their everyday lives. Can they understand the conversation? Can they follow the meeting? Can they understand the doctor? Can they participate in education? Can they perform their work without avoidable communication barriers? Can they access public services? Can they receive information at the same time and with the same effectiveness as everyone else?

For the Fanie Dreams Movement, this is what looking beyond the audiogram means. It means seeing the person behind the diagnosis. It means recognising functional impact. It means recognising communication diversity. It means recognising the Deaf community and SASL while also recognising the many people with significant hearing loss who communicate through spoken, aural, visual, written or combined methods. It means making visible those whose hearing loss may be hidden behind speech, technology and years of coping strategies.

And it means understanding that hearing something is not necessarily the same as accessing communication. Speaking is not necessarily the same as hearing. Using hearing technology is not necessarily the same as having full communication access. And not using sign language does not mean that a person cannot experience functional deafness.

THIS IS THE PERSPECTIVE OF THE FANIE DREAMS MOVEMENT.

SOURCE INDEX

 

The following sources provide the background and evidence referred to in this article. Statistics are used primarily to provide context and scale. They are not presented as proof of the prevalence of functional deafness in South Africa.

 

[1] World Health Organization — World Report on Hearing, 2021

The report provides the global estimate that more than 1.5 billion people experience some degree of hearing loss, approximately 20% of the world's population. It also provides the severity distribution used for the illustrative calculation in this article:

Mild — 14.9%

Moderate — 3.4%

Moderately severe — 1.3%

Severe — 0.4%

Profound — 0.2%

Complete — 0.2%

 

The WHO report also identifies approximately 430 million people globally as experiencing moderate or higher levels of hearing loss. 

Source: World Health Organization, World Report on Hearing (2021), including Figure 1.5.

 

[2] Statistics South Africa — Mid-Year Population Estimates 2026

Stats SA estimates South Africa's 2026 mid-year population at approximately 63.52 million. For this article, the figure is rounded to approximately 63 million.

Source: Statistics South Africa, P0302 — Mid-year population estimates, 2026.

 

[3] UK Government — British Sign Language Report 2025–2026

UK Government, British Sign Language fourth report: May 2025 to April 2026.

The report provides information regarding the estimated number of BSL users and the much broader population of people who are Deaf or hard of hearing. The figures are not treated in this article as directly comparable populations or as a basis for calculating a universal percentage of sign-language users among people with hearing loss. They are used to illustrate the important distinction between the broader population experiencing hearing loss and the population using a sign language.

Source: UK Government, British Sign Language fourth report.

 

[4] U.S. Census Bureau — Language Use

 The U.S. Census Bureau explains the limitations of its language questions in identifying American Sign Language users. This illustrates the methodological difficulty of establishing a precise national ratio between people with hearing loss and sign-language users. 

Source: U.S. Census Bureau, Language Use — Frequently Asked Questions.

 

[5] University of the Free State — South African Sign Language

The University of the Free State provides information concerning South African Sign Language and has referred to a population of more than 600,000 SASL users.

Estimates of SASL users vary according to source and methodology. Such figures should therefore be attributed to their source rather than treated as an undisputed national census figure.

Source: University of the Free State, South African Sign Language.

 

A NOTE FROM THE FANIE DREAMS MOVEMENT

The purpose of using statistics is not to define people by numbers. It is to make visible the scale of an issue that is often misunderstood. Behind every statistic is an individual person with a particular hearing profile, language, culture, communication method and lived experience.

The Fanie Dreams Movement does not seek to replace one narrow definition with another. It seeks to broaden the conversation. There is a place for Deaf culture. There is a place for South African Sign Language. There is also a place for the many people with significant hearing loss who communicate through spoken, aural, visual, written or combined methods. True inclusion means that all of these experiences can be seen, heard and understood.

 

BEYOND THE DIAGNOSIS.

BEYOND THE LABEL.

BEYOND THE AUDIOGRAM.

UNDERSTANDING THE PERSON.

This is the perspective of the Fanie Dreams Movement.

For peer support

Fanie Dreams 

www.faniedreams.co.za