Intended for healthcare professionals

Rapid response to:


Face masks can be devastating for people with hearing loss

BMJ 2020; 370 doi: (Published 09 July 2020) Cite this as: BMJ 2020;370:m2683

Linked Opinion

The communication needs of D/deaf healthcare workers and patients are being forgotten

Linked Opinion

D/deafness and solidarity in the covid-19 pandemic

Rapid Response:

Re: Face masks can be devastating for people with hearing loss

Dear Editor,

We welcome the editorial by Chodosh and colleagues and the other responders, that calls for awareness, mitigation and innovation to ensure clear communication in medical settings where masks are worn (1). Although the article proposes several solutions for communicating with D/deaf patients or clinicians, including older patients with hearing loss, we perceive the relevance of the article for paediatrics.

Perioperative complications are known to be more common in neonates, infants and young children versus adults (2). Previous studies have documented subjective communication difficulties of healthcare staff whilst wearing N95 facemasks (3) and ventilated hoods (4). During the Covid-19 era, objective measures of this impaired communication impact have been demonstrated (5).

Although scientists, clinicians and groups advocating for the D/deaf community have promoted clear masks (6,7) or hoods (8) (rather than FFP3 masks and visors) to ensure clear communication in medical settings, we have concerns for acute settings. Many dedicated clinicians have established techniques to reduce children’s uncertainty and fear of masks and PPE (9). The suitability of these measures is unclear for anaesthesia and aerosol generating surgery. Most clear window mask suggestions in the literature are either home-made or lack sufficient registered safety standards, and although hoods may allow better lipreading, most brands have loud fans/respirator units which cause further communication issues and additionally prevent the use of stethoscopes in critical situations (10). Although Chodosh and colleagues propose microphones and personal amplifiers to provide improved communication, we are not aware of any existing solutions that provide mutli-directional speech interaction in the operating theatre setting when multiple clinicians need to interact making complex acute decisions for paediatric surgery.

Whilst acute covid-19 appears to have been milder in children than adults, much has been written about the longterm effects for children in terms of educational, emotional, nutritional and financial impact (11) and modelling predicts large increases in paediatric mortality due to routine health care disruptions (12). As universal masking and other PPE strategies seem likely to continue throughout the year, we feel that targeted communication solutions for operating theatres are required, or this could present yet another challenge faced by children and health-care professionals involved in their care.

1) Chodosh Joshua, Weinstein Barbara E, Blustein Jan. Face masks can be devastating for people with hearing loss BMJ 2020; 370 :m2683
2) Weiss M, Hansen TG, Engelhardt T,Ensuring safe anaesthesia for neonates, infants and young children: what really matters, Archives of Disease in Childhood 2016;101:650-652.
3) L.K.P. Suen, Y.P. Guo, S.S.K. Ho, C.H. Au-Yeung, S.C. Lam, Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures, J. Hosp. Infect. 104 (3) (2020) 336e343,
4) M.J. Coates, A.S. Jundi, M.R. James, Chemical protective clothing: a study into the ability of staff to perform lifesaving procedures, J. Accid. Emerg. Med. 17 (2) (2000) 115e118,
5) Hampton, T., Crunkhorn, R., Lowe, N., Bhat, J., Hogg, E.Afifi, W., . . . Sharma, S. (2020). The negative impact of wearing personal protective equipment on communication during coronavirus disease 2019. The Journal of Laryngology & Otology, 1-11. doi:10.1017/S0022215120001437
8) Elkington, P., & Morgan, H. (2020). Personal respirators for population level control of the COVID19 pandemic. Journal of Infection. doi:10.1016/j.jinf.2020.04.025
10) Roberts V. To PAPR or not to PAPR?. Can J Respir Ther. 2014;50(3):87-90.
11) Sinha Ian, Bennett Davara, Taylor-Robinson David C. Children are being sidelined by covid-19 BMJ 2020; 369 :m2061
12) Roberton T, Carter ED, Chou VB, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health2020; [Epub ahead of print.]. doi:10.1016/S2214-109X(20)30229-1 pmid:32405459

Competing interests: No competing interests

30 July 2020
Thomas Hampton
Sunil Sharma (ENT Consultant, Alder Hey Children's Hospital, Liverpool, UK )
Alder Hey Children's Hospital
Liverpool, UK