When Patients With Hearing Impairments Encounter Masked Medical Professionals

By BETH HARPAZ
Editor of SUM

Mask-wearing and social distancing are essential to preventing the spread of COVID-19. But these practices also create communication barriers for people with hearing impairments. It's hard to hear someone speaking through a mask 6 feet away. It's impossible to read their lips unless they're wearing a transparent mask (and those can fog up). These challenges can increase isolation and prevent hearing-impaired individuals from getting adequate medical care or services.

Professor Barbara Weinstein, founding director of the Doctoral Program in Audiology at The Graduate Center, is working to raise awareness of these issues. She's written extensively about them over the past few months, including in an article in SpeechPathology.com, a Q&A, an invited blog post, and an op-ed.

She's also got the facts and figures to prove her point. She notes that sales of hearing aids declined at the height of the pandemic, while hearing-aid dispensing activity decreased 83% this spring at the Department of Veterans Affairs. For The Graduate Center's 2020 audiology graduates, the reduction in services made it hard to find jobs compared to past years when "nearly 100% of our graduates found employment even before graduating," she said. Despite this, the incoming class is "comparable in size to past cohorts," and is also diverse.

But there's no doubt that the pandemic has hurt "patient-centered communication," which Weinstein describes as "a foundation of health care."

"COVID-19 is exacerbating the problems attending hearing loss which include social isolation, loneliness, and cognitive decline," she said. On the bright side, it's also "an opportunity to highlight the important role of hearing in communication and the impact and burden posed by untreated hearing loss."

How big is the problem? "More than 38 million Americans over 12 years of age have hearing loss," she said, "with prevalence increasing with age: 27% of persons 60 to 69 years, 55% of persons 70 to 79 and 82% in persons 80 and older." The problem also tends to be "under -treated, under-valued, and under-recognized."

Hospitals and emergency rooms are particularly challenging for hearing-impaired individuals "because of the cacophony of voices and white noise from machines." Older people are most likely to need hospital care for COVID-19, but they are also the ones most likely to have hearing loss. And while loved ones can often assist with communication, at the height of the pandemic, patients were not permitted to have visitors.

The overall impact of all this, even before pandemic times, is substantial. "People with hearing loss report poorer care quality and worse communication with their physicians, have a greater likelihood of hospitalization, and have an increased risk of 30-day hospital readmission," she said. "Hearing loss is also associated with higher total costs of care."

What can be done? Weinstein says individuals with hearing loss should let others know about their impairment and ask that they speak more slowly (but without exaggerated lip movements), raise their voices slightly, and position themselves so their facial expressions can be seen. Speech-to-text apps can be helpful, and doctors should put instructions in writing.

Weinstein says aspiring audiologists can also play a role in raising awareness about "the effects of this invisible disability." Weinstein's own doctoral dissertation was the first study to document links between hearing loss and loneliness, and that led to the development of a way to measure self-reported social and emotional difficulties connected to hearing loss. She encourages students to inquire about their patients' well-being and how hearing loss impacts them. "Our interventions can be life-changing," she said.

Beth Harpaz is the editor of SUM. Follow her on Twitter at @literarydj.