Measures to Mitigate the Discriminatory Impact of COVID-19 on Individuals with Hearing Loss

by Gopalkrishna G. Verma and Joy D. Desouza


The COVID-19 pandemic has been a severe blow to 466 million individuals with hearing loss disability. Governments worldwide have suggested wearing face coverings/masks in enclosed places in an attempt to control the transmission of coronavirus. Unfortunately, this measure has an unintended discriminatory impact on these individuals as they rely on their ability to read lip movements and facial expressions during communication. Face masks and face shields have made it a difficult task. We aim to provide practical solutions that will mitigate this unintended discrimination and will promote effective communication with these individuals without compromising safety and infection control measures for SARS-CoV-2 infection. These measures can be easily implemented in various clinical healthcare settings (general practice, community, primary and tertiary hospitals) worldwide.

Impact of Face Coverings/Masks/Face Shields and Social Distancing Measures:

Face coverings/masks cover half the face, making it impossible to read lip movements or facial expressions. Masks muffle sound and reduce clarity of spoken speech. Social distancing makes it even more difficult to understand lip movements or facial expressions or appreciate muffled sounds. Face visors are transparent, but surrounding light reflects from plastic visors, which makes it difficult to interpret lip movements and facial expressions. Personal Protective Equipment (PPE) interferes with and makes it more uncomfortable to wear hearing devices, such as hearing aids and cochlear implants. 

Impact on Mental Health:

COVID-19 preventative measures are affecting the mental dignity of these individuals. They are compelled to reveal their disability, which is not seen. PPE leaves them feeling ostracized by compromising their independence and making them dependent on others. This leads to low self-esteem, low self-confidence, increased anxiety, stress, and further isolation. Many just prefer to walk away from the situation disheartened and feeling sorry for themselves.

Practical Solutions to Mitigate the Discriminatory Effects of Face Coverings/Masks and Social Distancing in Various Clinical Healthcare Settings:

  1. Create awareness of hearing loss disability: Posters within clinical area will act as reminders to staff members. Frequent displays of messages on intranet website, “creating awareness of hearing loss difficulty” will help technology-savvy staff/employees. Employees should be encouraged to attend disability awareness course towards their annual appraisal process. Every healthcare employee should be aware of hearing disabilities in a patients, as it is invisible.
  2. Offer a badge that displays hearing loss disability to patients with this disability on registration at reception. This will make staff members aware of their disability during interactions with them.
  3. Human factors Do’s and Don’ts: Do have patience, speak slowly, reduce background noise, and make it a quiet place. Rephrase remarks and don’t just repeat the words if it is not understood. Be prepared to write down as needed. Don’t shout or speak very softly. Don’t overemphasize, or exaggerate your words. Be careful with the tone of your speech and don’t appear to patronize.
  4. Use hearing loss friendly PPE: Clear masks and transparent perspex screens allow clear views of lip movements, facial movements, and expressions. Clear masks start to fog due to warmth of exhaled breath during speech, which interferes with visibility of lip movements. Clear masks/full-face shields/visors with anti-fog coating will prevent fogging, and antireflective coating will prevent reflection of surrounding light. This will help with clear interpretation of lip movements and facial features.
  5. Hearing or induction loops: This is the most effective, easy to use and trouble-free assistive technology, which is widely available. Hearing aids do not work effectively in group settings as they do not cancel background noise or group chatter. This makes it difficult to clearly understand words spoken by an individual. On the other hand, hearing loops send pure clear sounds from sound systems directly to hearing aids, filtering out any distortions or background noise. With Bluetooth wireless technology-compatible hearing aids, there is no need to connect wired loops to the hearing aids.
  6. Digital technology such as translation apps are a great way to convert speech to text instantly during a consultation. If a sign language interpreter is required, then remote a video digital conference sign interpreter service is very helpful. This will prevent face-to-face presence of sign language interpreter and thus help in following COVID-19 measures and preventing transmission of the coronavirus.
  7. Allocate extra time for clinical consultation: This will prevent delays in the clinics to other patient appointments and promote a relaxed approach during a consultation.
  8. Encourage patients with hearing loss to reveal their disability. This will encourage others to act with empathy and patience, and prevent an embarrassing or confusing situation.
  9. Check the degree of understanding by simply asking the patient to repeat the advice offered and clarify any doubts.
  10. Provide written advice: Patients can take this away with them so that they can reflect on it at their convenience so that they do not miss any critical parts of the advice.

Conclusions:

Unintended discriminatory effects of COVID-19 preventative measures have left many individuals with hearing loss feeling even more isolated than they are already. Every health care professional should be vigilant about the communication needs of individuals with hearing loss while following preventative measures for COVID-19. Implementation of these measures will help empathize and mitigate any discriminatory feelings in these individuals in our common fight to defeat coronavirus.


Gopalkrishna G. Verma, MBBS, MS Orth, MRCS, European Board of Orthopaedics and Traumatology (EBOT), is a trauma and orthopedic surgeon with special interest in hip and knee joint arthroplasty at Manchester Royal Infirmary University Hospital NHS Foundation Trust in Manchester, UK.

Joy D. Desouza is an advanced practice nurse at Liverpool Heart and Chest Hospital in Liverpool, UK. She holds degrees in general nursing and midwifery, clinical studies in cardiothoracic nursing, and advanced nurse practitioner critical care. She is currently undertaking a masters degree program in Advance Practice Nursing.

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