People could be playing the pre-upgrade version of the game, which is still available as a beta option (afaik). It has much better performance.
I've seen some guides on settings for getting the upgraded version to run better as well, apparently stuff like grass detail makes a huge difference in how well the game runs.
I remember reading before how getting your hearing repaired through surgery (when possible) can get you ostracized from deaf communities. Some consider their deafness to be part of their identity, and regaining your hearing can be treated as sacrificing your identity/heritage.