Face Masks Hinder Communication for Patients and Clinicians With Hearing Loss

By Carolyn Crist

July 20, 2020

(Reuters Health) - Wearing a face mask in public to prevent the spread of COVID-19 has created communication challenges for everyone, but people with hearing loss are facing particular difficulty in reading others' facial expressions and lip movements, according to a group of doctors.

Companies are beginning to create clear masks that show the mouth, but other innovations are needed as well - and urgently, they write in an editorial in The BMJ.

"Communication is essential. It's essential to being human, to being connected with others and to getting good medical care," said co-author Dr. Jan Blustein of New York University in New York City.

About two-thirds of people over age 70 have some form of hearing loss, she said, which has created significant challenges for older adults during the pandemic. Those in the deaf community who use sign language have also faced issues with communication.

"We all know people with hearing loss," Dr. Blustein told Reuters Health by email. "Yet it is often treated as a peripheral concern, or a natural consequence of aging."

Dr. Blustein and colleagues Dr. Joshua Chodosh and Barbara Weinstein of the NYU Grossman School of Medicine write about communication challenges in medical settings in particular. Even before masks were required due to the pandemic, people with hearing loss struggled to communicate in healthcare settings, and poor communication often led to worse health outcomes. Emergency departments and hospital wards are especially loud and can obstruct spoken communication. Now, masks create new barriers by blocking lip movements and muffling high speech frequencies.

"While we need to control infection, we also need to avoid disconnecting a vulnerable segment of the population," Dr. Blustein said. "There are ways to open lines of communication. We need to make the effort."

First, the authors write, awareness is key. People should be mindful that others could have problems understanding speech through a mask, especially older adults who may have hearing loss. Basic steps include facing someone, getting their attention before talking, slowing speech slightly, raising voice volume slightly and checking for understanding. A non-response or inappropriate response could mean a sign of hearing difficulty.

Next to that, low-tech aids could help, such as white boards or notebooks where people can write down their thoughts. Smartphone and tablet apps with speech-to-text transcription may be useful as well. In health care facilities, patients may also use a personal amplifier to better hear someone's speech through headphone or earbuds.

Clear face masks or masks with clear windows have been approved and are now being marketed, although the supplies are low. People with hearing loss, including those in the deaf community, are creating their own clear masks, which are typically used in locations with a low risk of transmitting COVID-19, the authors note. In hospitals, doctors and patients still need N95 masks or respirators that offer better protection.

In some cases, video consultation can make the difference. A doctor can speak remotely from another room and use a clear mask or no mask at all to talk with patients. Video could also use speech-to-text transcriptions.

"Although video doesn't sound like a great solution because the patient is removed from the physician, it removes the barriers of masking and other aspects such as noise," said Dr. Nicholas Reed of Johns Hopkins University in Baltimore, who wasn't involved in the editorial.

"We've known about these communication difficulties for a long time, and it's time to start thinking about a long-term plan that will help those with hearing loss in a sustainable manner," he told Reuters Health by phone.

A separate paper on the same topic, published in JAMA Otolaryngology-Head and Neck Surgery, suggests some of the same measures and also notes the possibility of using interpreters and smartphone captioning apps.

SOURCE: https://bit.ly/3jhsnra The BMJ, online July 9, 2020; and https://bit.ly/2OCk3o6 JAMA Otolaryngology-Head and Neck Surgery, online July 16, 2020.