Communication with hard-of-hearing patients, particularly those who are older, is a longstanding challenge for all physicians. Otolaryngologists, especially those specializing in otology, are even more likely to see patients for whom hearing loss is the primary medical complaint or a secondary issue that deserves major consideration.
Explore This IssueOctober 2020
During the COVID-19 pandemic, however, hard-of-hearing patients have faced additional challenges, including worsened communication and difficulties accessing healthcare. Through awareness and planning, otolaryngologists can help their patients better navigate these issues to get the help they need.
Whether resulting from increased cognitive load, social isolation, or other degenerative factors, researchers have found independent associations of hearing loss with dementia, poor health outcomes, and overall mortality. Unfortunately, the COVID-19 pandemic may exacerbate these existing problems. Neurotologist and otologist Howard W. Francis, MD, MBA, the Richard Hall Chaney Sr. Distinguished Professor of Otolaryngology at Duke University in Durham, N.C., noted that patients with hearing loss tend to report poorer communication with their physician and worse perceptions of their overall healthcare quality (J Am Geriatr Soc. 2014;62:2207-2209).
“We’re using social isolation to combat the novel coronavirus, which is good; however, social isolation for a hard-of-hearing patient is horrible,” said Jed Grisel, MD, an otolaryngologist practicing in Wichita Falls, Texas. “The public policy that’s being used to address COVID-19 could actually be exacerbating some of the effects of hearing loss.”
In addition, hard-of-hearing patients who are older face an increased risk of suffering severe complications from COVID-19 due to pre-existing health conditions, said Dr. Grisel. “Unfortunately, the group of patients with hearing loss who are at greater risk of social isolation and dementia are the exact same group of patients who are at greater risk of complications from the coronavirus.”
The Mask Situation
Communication with hard-of-hearing patients is a challenge under normal circumstances, but the widespread use of face masks to decrease COVID-19 spread has only exacerbated this challenge.
Face masks disrupt the visual input that many hard-of-hearing individuals depend on. These visual clues are especially important for people with more profound hearing loss, who may rely heavily on lip reading. Additionally, masks muffle voices and decrease the quality of sound received. With more brain resources working to process degraded speech, hard-of-hearing patients may be less able to engage in other cognitive operations, leading to mental fatigue and avoidance behaviors (Ear Hear. 2018;39:204-214).
“What’s most interesting to me is how significantly transmission of higher frequency sounds—1,000 hertz and higher—is negatively affected by masks, therefore obscuring consonant sounds,” said Dr. Francis, remarking on a study that examined the reduced transmission of speech through face coverings (arXiv ePrint archive. August 11, 2020. Available here). “Masks affect the worst possible frequency range for effective communication. Unfortunately, that’s where most of the hearing loss already is, particularly for older patients.”