Sunday, July 19, 2020

People with hearing loss are challenged in era of masks

By Bill Doyle

Patricia Rushton has been hearing impaired since she was 3 years old, but she’s having more difficulty hearing now than ever.

It’s a problem caused by the pandemic that you may not have heard about.

Rushton, 80, of Worcester, can hear with the assistance of hearing aids in both ears, but she and many others with hearing loss communicate in part by reading lips and facial expressions. That’s not possible with people wearing face masks to prevent the spread of COVID-19.

“I can still understand them,” she said, “but it would be easier if I could read their lips.”

Rushton refuses to complain, however.

“Masks, of course, are most necessary,” she said, “not just to protect yourself, but also to protect the community. So it’s a small inconvenience for a greater good.”

She has been hearing impaired since she was a child and suffered from mastoiditis, an infection in the bones of the ears that destroyed nerve endings. She has a particularly hard time hearing high-pitched sounds.

When she tells people she’s hearing impaired, most don’t remove their masks, they just speak louder.

“That really doesn’t help,” she said. “It’s more enunciation and diction and speaking slowly.”

Of course, masks mask enunciation and diction.

Despite her hearing impairment, Rushton taught for 39 years, including 35 in the Worcester public schools. She retired as chair of the English department at Doherty High School in 2017.

“You can ask the kids,” she said. “I never sat down. I moved around the room and I moved towards them. I would tell them I was hearing impaired and they were very cooperative.”

Rushton doesn’t rank her hearing difficulties during pandemic anywhere near as severe as those suffering from respiratory diseases and heart issues caused by the virus, but losing hearing because of masks is a problem no one saw coming before the pandemic.

Tom Wade, 71, of Worcester, has worn a hearing aid in his right ear for nearly a decade and had an appointment on Thursday to get new hearing aids for both ears. He said he was never trained to read lips, but the natural tendency to do so helped him understand the gist of what most men said. He still, however, had trouble hearing women whose voices are higher pitched. The pandemic made things worse for him.

“I really can’t hear anyone with a mask,” he said. “I have to continually say, ‘What? What?’ Most people will talk at a higher volume so eventually I can understand it, but people talking in their normal tones I can’t hear anything with their masks.”

Wade said he supports the wearing of face masks and he wouldn’t ask anyone to remove them so he could hear them better. He believes his hearing loss is more frustrating for others who have to repeat themselves than it is to him.

This is a problem that Wade never expected to have. Who figured people to have to wear face masks?

“It’s very true,” he said, “but people are very accommodating and understanding, which is nice. We’re all going through the same crisis. Everyone’s trying to do the right thing or I should say most people are. It’s a problem, but it’s not a problem, because of the consideration I receive from individuals.”

Bruce Chansky, 72, of Worcester, wears hearing aids in both ears. Working in the music business contributed to his hearing loss.

He finds it easier to understand people when he can see their faces, but masks hide much of them.

“It sounds like they’re mumbling,” he said. “The mask muffles their voices.”

Chansky believes people should wear masks in public even if it makes it harder for him to hear them. Staying six feet away from him without a mask would help him hear better than getting closer and wearing a mask.

“That would be the ideal situation,” he said.

Chansky doesn’t like the feel of a mask and he finds it restricting, but he wears one in public buildings.

Difficulty hearing through masks is a problem for many.

“I hear it from pretty much every patient every day,” Dr. Aaron Remenschneider, an ear, throat and nose physician for UMass Memorial Medical Center said, “working in a clinic where patients all have hearing loss, even from mild hearing losses to severe hearing losses.”

Dr. Remenschneider cited a study before the pandemic that found N95 masks reduced clarity of hearing among normal hearing people by 17 to 20 percent.

“That means one in five words they didn’t understand,” he said.

Obviously, it’s even worse for the hearing impaired. So if necessary, Dr. Remenschneider remains 10 feet away in his clinic, lowers his mask and speaks clearly while looking directly at his patients. He recommends his patients inform people wearing masks in public that they need them to speak louder and more clearly to them.

Dr. Gary Blanchard, geriatrics director at St. Vincent Hospital, has begun to see his patients in person again. Most of them are in their 80s and many are hearing impaired. So it’s a daily challenge to communicate with them while he wears a required mask.

“Many visits, it’s really a barrier,” he said.

So he writes his main points on a whiteboard and he speaks into a pocket talker, a microphone that is connected to earphones worn by the patient.

Zoom and FaceTime visits can be challenging with some patients, but they allowed Dr. Blanchard to communicate easier with his hearing impaired patients because the volume could be turned up and he didn’t have to wear a mask so they could read his lips.

Blanchard said his patients have frequently commented about the challenges of hearing people wearing masks. The solution for physicians could be wearing clear, see-through masks that provide protection, but allow people to read their lips.

“I think that’s probably the best way to thread the needle,” Blanchard said.

But there’s a shortage of suitable clear masks for physicians.

Connie Camelo is UMass Memorial Medical Center director of Interpreter Services, whose staff often communicates with persons who read lips. The provider and interpreter wear clear masks at UMass so they can communicate better with such patients, but Camelo said only one clear mask company is approved by the Food and Drug Administration. So UMass doesn’t expect to receive more clear masks until September or October.

“That is a huge problem,” Camelo said. “We are all trying to escalate it to the Mass. Commission for the Deaf (and Hard of Hearing) to see what else can be done for the population that is being affected by the lack of masks.”

Camelo said 55 percent of communication is visual for everyone and miscommunication without clear masks can lead to medical error. If a discharged patient misunderstands a physician and doesn’t follow medical advice, it could result in an avoidable return to the emergency room or admission to the hospital.

“It’s more than just the mask,” Camelo said. “It’s about patient care and patient safety.”

Clear, see-through masks are available online to the general public, but relatively few people wear them.

“I’ve never seen anyone wear those,” said treatment coordinator Jordan Green, who works with new patients at Hearing & Brain Centers of New England in Worcester.

Green said people with hearing loss struggle with the clarity of speech.

“It’s not that they can’t hear people speaking,” she said, “it’s really their inability to process what’s being said. So they’re relying more on visual clues and context clues to pick up the message. So when they have hearing loss that’s being untreated, it’s even more difficult now when people are wearing masks because they can’t rely on those visual clues.”

Green recommends hearing devices that pinpoint the cause of the problem rather than merely amplify sound, so people won’t have to rely as much on visual and context clues, including reading lips.

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People with hearing loss are challenged in era of masks

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