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The Challenges of Communicating With a Mask While Hearing-Impaired

For the almost 48 million Americans who suffer from mild to severe hearing loss, communicating with others wearing masks presents new challenges.

Many people with mild to severe hearing loss rely on visual cues and lipreading to compensate for their inability to hear clearly or at all. But the coronavirus pandemic has brought on a new challenge for the hearing-impaired: communicating with others wearing masks.

To help us determine the best communication methods for hearing-impaired people during the COVID-19 era, we spoke with Dr. Alexandra Costlow and Dr. Irina Linkov Middleton, audiologists at Thomas Jefferson University Hospital’s Balance and Hearing Center.

What are some of the unique challenges people with hearing impairments have endured because of the pandemic?

Dr. Costlow: For people with hearing loss, wearing a mask creates a double disadvantage. While already suffering from a hearing impairment, they are now unable to depend on visual cues. And of course, standing farther away from one another reduces the intensity of sound reaching the listener, restricting any additional information they have access to. But leaning in to hear better, breaking the social distance barrier, puts patients at a higher risk of contracting COVID-19.

Masks are also not conducive to those wearing hearing aids, most of which hook behind the ear. Many have tried different mask styles or purchased mask extenders. But we know patients aren’t skimping on any safety precautions because they come in whenever their hearing aids get lost.

How is communication affected, both for people with hearing impairments and others, when they can’t see someone’s mouth?

Dr. Middleton: With so many people currently wearing masks, we are becoming aware of just how much people with hearing loss rely on visual cues in daily conversation. We’ve all had to shift the way we communicate by slowing down our rate of speech, using hand gestures or utilizing alternative means of communication, such as talk-to-text features on our phones.

What strategies and technologies might help until we return to “normal”?

Dr. Costlow: Prior to engaging in a conversation, both people should minimize any background noise, stand face-to-face and avoid conversing between rooms. The speaker should emphasize using body language. It’s helpful to point at an object, motion toward a certain direction or even gesture to indicate they’re about to speak. It is also important for the listener to be honest about their struggles. Replacing “What?” with “Could you please repeat that?” could make for an easier conversation.

When the verbal language isn’t working, writing a script, printing graphics or using apps with a talk-to-text feature can streamline communication in a public setting. Additionally, for those with hearing aids, manufacturers have created a “Mask Mode” to help block out any extraneous noise. To enable this feature, patients can make an appointment with their audiologist to program this setting into their hearing aids.

Who else may be impacted by mask-wearing?

Dr. Costlow: Children with delayed language development or delayed articulation, people with auditory processing disorders and people that have difficulty interpreting social cues are all affected by mask-wearing. As we begin to venture back into the world, we must be patient and considerate of others because leaving the home poses a real challenge for some individuals. People are not only learning how to manage a “new normal,” but also a new form of communication—which is increasingly difficult for those with a hearing impairment.

How can we fight the stigma around hearing loss during COVID-19?

Dr. Middleton: When people think about hearing loss, they’re fearful of what it means, what they will lose or how they will be perceived. But we like to focus on what they have to gain, like communicating with family and improving their quality of life. If you’re noticing changes in your hearing, especially now with limited access to visual cues, it never hurts to have your hearing evaluated to establish a baseline. Really, knowledge is power. The most important thing we can do as providers is give patients all the information they need to decide what to do on their own terms.

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COVID-19, From the Experts