Re: Face masks can be devastating for people with hearing loss: a simple solution to be considered
Dear Editor,
As Chodosh et. al. stated, hearing loss is a relevant and disabling condition associated with poorer ratings of patient-physician communication (1) and worse health outcomes (2). This is even more pertinent in the context of the COVID-19 pandemic and the increasing use of facemasks.
Furthermore, Chodosh et. al. advocated that ‘adopting simple strategies can help maximise communication whilst innovation ramps up’, suggesting the use of personal amplifiers ‘(costing £50-160)’ and speech to text applications. Although both excellent alternatives, commonplace access to personal amplifiers cannot be guaranteed and speech to text apps may be particularly difficult in aging populations, especially when considering a demographic whose eyesight is likely to be affected alongside their hearing (3). Both methods are also likely to cause difficulty in the acute setting, requiring time to set up and explain.
In view of Chodosh et.al’s search for a ‘simple strategy’, we would like to highlight a straightforward and effective method to help maximise communication; the reverse stethoscope technique. This entails putting the stethoscope earpiece into the patient’s ears and the healthcare professional speaking into the diaphragm. This is a resource that all health professionals have readily available in every healthcare setting, be it the ward or the accident and emergency department. This technique has been reported before in the BMJ (4) and we have used this technique in more than 60 patients (age range 50-99yrs) with hearing loss with great success. The greatest benefit of this technique is the removal of background, ambient noise. We are in the process of assessing whether the benefit is maintained with the addition of facemasks.
Admittedly, infection control could pose a challenge for this method due to the lack of social distancing and the reusing of stethoscopes. However, with appropriate PPE and either the use of alcohol wipes to sterilise the stethoscope in between patients or to have a one patient, one stethoscope policy, this risk would be mitigated. We believe that, in the emergency setting the reverse stethoscope technique is an effective, simple, easily accessible yet underused technique that many clinicians could utilise to improve communication in some patients with hearing impairment.
References
1. Mick P, Foley D, Lin F. Hearing Loss is Associated with Poorer Ratings of Patient-Physician Communication and Healthcare Quality. Journal of the American Geriatrics Society. 2014;62(11):2207-2209.
2. Chodosh J, Weinstein B, Blustein J. Face masks can be devastating for people with hearing loss. BMJ. 2020;:m2683.
3. Besser J, Stropahl M, Urry E, Launer S. Comorbidities of hearing loss and the implications of multimorbidity for audiological care. Hearing Research. 2018;369:3-14.
4. Vadodaria B. BMJ 1998; 316:1382.
Competing interests:
No competing interests
01 September 2020
Irwin T Foo
Consultant Anaeshetist
Hodson, Alexander; Clancy, Noah - University of Edinburgh School of Medicine
Department of Anaesthesia, Western General Hospital, Edinburgh
Rapid Response:
Re: Face masks can be devastating for people with hearing loss: a simple solution to be considered
Dear Editor,
As Chodosh et. al. stated, hearing loss is a relevant and disabling condition associated with poorer ratings of patient-physician communication (1) and worse health outcomes (2). This is even more pertinent in the context of the COVID-19 pandemic and the increasing use of facemasks.
Furthermore, Chodosh et. al. advocated that ‘adopting simple strategies can help maximise communication whilst innovation ramps up’, suggesting the use of personal amplifiers ‘(costing £50-160)’ and speech to text applications. Although both excellent alternatives, commonplace access to personal amplifiers cannot be guaranteed and speech to text apps may be particularly difficult in aging populations, especially when considering a demographic whose eyesight is likely to be affected alongside their hearing (3). Both methods are also likely to cause difficulty in the acute setting, requiring time to set up and explain.
In view of Chodosh et.al’s search for a ‘simple strategy’, we would like to highlight a straightforward and effective method to help maximise communication; the reverse stethoscope technique. This entails putting the stethoscope earpiece into the patient’s ears and the healthcare professional speaking into the diaphragm. This is a resource that all health professionals have readily available in every healthcare setting, be it the ward or the accident and emergency department. This technique has been reported before in the BMJ (4) and we have used this technique in more than 60 patients (age range 50-99yrs) with hearing loss with great success. The greatest benefit of this technique is the removal of background, ambient noise. We are in the process of assessing whether the benefit is maintained with the addition of facemasks.
Admittedly, infection control could pose a challenge for this method due to the lack of social distancing and the reusing of stethoscopes. However, with appropriate PPE and either the use of alcohol wipes to sterilise the stethoscope in between patients or to have a one patient, one stethoscope policy, this risk would be mitigated. We believe that, in the emergency setting the reverse stethoscope technique is an effective, simple, easily accessible yet underused technique that many clinicians could utilise to improve communication in some patients with hearing impairment.
References
1. Mick P, Foley D, Lin F. Hearing Loss is Associated with Poorer Ratings of Patient-Physician Communication and Healthcare Quality. Journal of the American Geriatrics Society. 2014;62(11):2207-2209.
2. Chodosh J, Weinstein B, Blustein J. Face masks can be devastating for people with hearing loss. BMJ. 2020;:m2683.
3. Besser J, Stropahl M, Urry E, Launer S. Comorbidities of hearing loss and the implications of multimorbidity for audiological care. Hearing Research. 2018;369:3-14.
4. Vadodaria B. BMJ 1998; 316:1382.
Competing interests: No competing interests