In your pocket you have an amazing transcriber and translator—your smartphone. You have access to a tremendous and powerful database that allows for live speech recognition as well as foreign language translation. —Daniel J. Lee, MD
Explore This IssueOctober 2020
Seilesh C. Babu, MD, a neurotologist in Farmington Hills, Mich., has noticed that mask use often changes patients’ perceptions of their own hearing loss. Many of his patients who didn’t think they had much of a problem suddenly recognize that their hearing isn’t as good as they thought it was and that they were previously lip reading without realizing it.
Some otolaryngologists use clear masks to help facilitate communication, with the obvious advantage of providing additional visual clues to patients who rely on lip reading. Transparent masks can be difficult to obtain due to high demand, however, and do have drawbacks. The arXiv study referenced above found that sound transmission was more heavily impaired when traveling through plastic than through cloth.
Daniel J. Lee, MD, associate professor of otolaryngology–head and neck surgery at Harvard Medical School and director of pediatric otology and neurotology at Massachusetts Eye and Ear Infirmary in Boston, said that transparent masks are prone to fogging up from condensation, obviating the advantage of having a transparent screen in the first place.
Safety is another concern for transparent masks. Such masks are more open on the sides and are therefore not very protective against airborne aerosols. Mask side closure can better seal off the aerodigestive tract, but this worsens condensation issues. No transparent mask is approved for COVID-19 inpatient services, and none currently available are N95 rated (JAMA Otolaryngol Head Neck Surg. 2020;10.1001/jamaoto.2020.1705).
Dr. Francis and his colleagues are currently working on their own study to characterize the added impact of face masks on hard-of-hearing patients age 60 or older. The project will include 40 patients who received care from a provider wearing a clear mask and another 40 who received care from a provider wearing a nonclear mask. Dr. Francis hopes to analyze data next spring to identify potential risk factors and evaluate patients’ ease of communication, listening effort, and mental fatigue.
Healthcare Access Issues
The COVID-19 pandemic also poses problems of medical access for some hard-of-hearing patients. Diego A. Preciado, MD, PhD, vice chief of pediatric otolaryngology at Children’s National Hospital in Washington, D.C., explained that underinsured or publicly insured hard-of-hearing patients tend to be delayed in all aspects of their hearing care. “It’s always been an issue for these patients, but it’s magnified now,” he said. “A global recession may make that worse.”
Dr. Grisel noted that the average price for a single hearing aid can be as much as $4,500, a cost that isn’t covered by Medicare. Even when insurance partly helps with this cost, recurring expenses like batteries and, ultimately, replacement can add up.
“If people are scared about finances, hearing healthcare is one thing they’ll eliminate or put off,” said Dr. Grisel. “Everyone’s nervous and there’s a lot of insecurity about what’s going on with the economy, which influences purchasing decisions of all kinds.”
The pandemic has limited healthcare access in other ways. Dr. Preciado noted that COVID-19 has negatively impacted access to medical providers, at least in some tertiary centers. Due to physical distancing measures, some institutions have placed restrictions on the number of patients who can be in ambulatory clinics, with fewer slots available for in-person visits.