COVID-19 Brings Extra Challenges for People with Hearing Loss
Janine Verge, AuD, Aud (C) is coordinating the “Issues in Accessibility,” column which will cover topics addressing issues in accessibility for people who are Deaf/deaf and hard of hearing.
People with hearing loss battle isolation and communication difficulties in normal times. COVID-19 has only exacerbated these challenges. While critical for public health, masks take away our superpower — speechreading — because they make visual clues unusable for filling in the gaps in what we hear. This can make social interactions or even a trip to the grocery store full of uncertainty and miscommunications.
The prevalence of virtual communications has a similar impact. While visual clues are available, faulty connections and Zoom fatigue can make following conversations challenging, especially without captioning or other accommodations. While some platforms like Google Meet and Microsoft Team provide free automatic speech recognition (ASR) captioning on all calls, others like Zoom hide their versions behind a paywall. Since Zoom is the most popular platform, the lack of accessibility has left many people with hearing loss unable to fully participate at work, school, and during virtual social interactions.
What Covid-19 Taught Me about Hearing Loss
As a hearing loss advocate — and a person who has lived with hearing loss for more than half my life — I pride myself on knowing a lot about hearing loss. Over the years, I have become skilled at self-identifying, using assistive listening technologies, adjusting the environment for better hearing, and asking others to use communication best practices. But as the pandemic showed me, there is always more to learn.
I rely on lipreading more than I thought
I have always used speechreading cues to help me fill in the blanks of my residual hearing, but I didn't know to what extent until they were gone. Trips to the grocery store, the doctor, or an outdoor restaurant have become increasingly challenging with everyone's faces hidden. Asking people to face me when talking to me, one of my go-to strategies is no longer effective. I never expected to long for the days when only facial hair was the barrier between me and the information carried by someone’s lip movements and facial expressions.
With only my residual hearing available (boosted by my hearing aids, of course), I feel awkward and ill at ease when running errands or trying to socialize. Keeping six feet apart only adds to the discomfort, as this distance is often the outer limit of usefulness for many hearing devices.
Everyone’s hearing loss is different
Masks do more than block speechreading cues; they also muffle sound, especially higher-pitched sounds, critical for speech understanding. A recent study showed that sound dampening effects vary significantly by type of mask. Surgical masks had the least impact, blocking only 5 dB of sound, while clear masks, popular with people with hearing loss because they allow speechreading, block 12–14 dB, depending on the brand.
For people who rely on residual hearing to communicate more than speechreading, clear masks may actually make it harder to communicate. But if you are primarily a speechreader, they are of enormous benefit. The vast differences in how people experience hearing loss make it hard to find one solution that works for us all.
My hearing loss confidence has taken a hit
Hearing loss exhaustion is a common side effect of hearing loss. I describe it as the feeling at the end of the day that you cannot bear to interpret even one more sound. When you have hearing loss, understanding speech takes effort to combine the sounds that we hear, context clues, visual clues, and body language to determine what is being said. It's not easy, mainly because the conversation does not pause while doing all this mental processing. And then, you may need to reply!
The pandemic has only made this phenomenon worse, given the added strain of communicating with masks. The fear of not understanding adds to the exhaustion of each communication encounter — whether online or in person. My hearing loss confidence falters at times, but I am rebuilding it by embracing new technologies, including speech-to-text apps like Google's Live Transcribe (Android only) or Otter.ai.
Hearing loss is invisible
Most people take their hearing for granted, so they assume everyone else can hear too. Grocery check-out workers speak at a normal volume despite being masked and behind plexiglass, as do doctors and nurses, and almost everyone else. This is only natural given their life experience. And because hearing aids are small and hard to see, people may not realize we do not hear well unless we tell them.
Wearing a button or a pin declaring your hearing loss is an easy way to make your hearing loss more visible. Some people have even embroidered “Please speak louder” or “I am deaf” onto their masks. How we choose to let people know about our hearing loss is our choice, but we must do it. Self-identification is the first critical step toward better communication.
Self-advocacy is the key to success
Self-advocacy has always been the key to success with hearing loss, and it continues to be. Once we identify ourselves as a person with hearing loss, we must let others know the specific things they can do to help us understand. The more detailed we are, the higher the chances are for successful communication. Making our requests with a smile, even one hidden behind a mask, is more likely to get results. Everyone is struggling in these challenging times. When we ask for what we need with kindness, there is a much higher likelihood the person will do as we ask.
How Can Audiologists Help?
Audiologists are essential partners in our hearing care in normal times. They are even more critical during the pandemic as we adapt to mounting communication difficulties and remote hearing care challenges. Audiologists can help in the following ways.
Stay engaged with your patients
You may not see your patients in the office as regularly as you would like, but this does not mean you cannot continue to treat them. Embrace telehealth for check-in visits or small programming changes. Use an accessible platform like Google Meet, which provides automatic speech recognition (ASR) captioning. After the video call, follow up with a written summary of the discussion to ensure the information was understood and that your advice will be implemented properly.
For device repairs, utilize curbside service, where someone from your office meets your patient at their car to retrieve their device in a safe and socially distanced manner. For small repairs, they can wait safely in their car until it is complete. For larger issues, set up a second appointment to return the device.
Embrace alternate technologies
Hearing aids and cochlear implants are miracle devices, but incremental assistance is likely needed for effective communication in this time of crisis. This can come by way of assistive listening devices or even apps. For example, Roger pens can be wonderful for bringing sound directly into your devices when socially distanced. Speech-to-text apps can also be a lifesaver in many situations, both in-person and online. Educate your patients about the best videoconferencing platforms and how to enact captions to aid in communication.
Mask programs for hearing aids that boost the high frequencies muffled by masks can also be beneficial. Encourage your patients to experiment with these new settings to see if they help.
Share information and tips
Your patients are eager for good advice during this time of uncertainty. Share communication best practice tips they can use and share with their friends and family. Actions like getting the person's attention first or making sure you face someone when you speak may seem obvious to you, but they may not be to people who are newer to hearing loss and their families. The pandemic may also be unmasking cases of mild to moderate hearing loss for some. If you can be a resource for them now, they are more likely to contact you for assistance in the future.
Share tips for protecting your patients’ hearing devices while wearing a mask. Many people with hearing loss are inadvertently losing aids or cochlear implants when they become tangled in the mask straps. Recommend alternative mask-wearing options like using masks with ties that can be fastened on the top of the head or using a headband to secure devices. Other tricks may work as well.
Encourage self-advocacy skills
Point your patients to hearing loss support groups like Hearing Loss Association of America (HLAA) or Canadian Hard of Hearing Association (CHHA). Here they will find suggestions and tips for coping with the challenges of living with hearing loss and camaraderie and peer support for riding out the tough times. Or refer your patients to your favorite hearing loss blogs (mine is LivingWithHearingLoss.com) or Facebook groups for people with hearing loss. When we learn from one another, we build strength as a community.
Now more than ever, people with hearing loss are leaning on one another, as well as on our audiologists, for insights, suggestions, and tips for working through new and sometimes overwhelming communication challenges. I hope some of these newly discovered tools and workarounds will transition to post-pandemic normality, too, helping to ease communication burdens for people with hearing loss well into the future.