Contributed by Jane Hager, telecommunications device evaluator, MD AT Program
This is a fictional story with real implications for those of us with hearing loss.
Mary Smith is 54 years old. She is 1 in 8 people in America who has hearing loss. She leads a successful career in sales for a large corporation, is married, has kids, loves to cook, and is an athlete. She was just diagnosed with COVID19. Her symptoms escalated and she was admitted to a local hospital for treatment. Mary uses 2 powerful behind-the-ear hearing aids and was considering a cochlear implant but hoped to wait a few more years since she was making good use of her residual hearing.
During Mary’s hospitalization, her wife, Sue was only allowed in for brief interactions. Sue and the rest of the hospital workers wore full protective gear including a mask that completely covered the lips. Without being able to see lips and full facial expressions, and with the diminished clarity and projection of voice caused by the face mask, Mary struggled to comprehend what was being said. Sue and Mary asked the hospital if they had access to clear protective masks so that Mary could read lips. Unfortunately, because clear masks are new on the market and with the onset of COVID 19, the hospital’s order for them had not yet been fulfilled. In addition, Mary was leaving her aids out to comfortably rest as she battled for her life with COVID19.
It’s amazing that technology is becoming a critical personal healthcare tool but in these COVID 19 times it’s REALLY true, especially for those of us with hearing loss. Mary was up-to-date on assistive technology apps and found them to be life-savers for communication during her hospital stay. She was a member of Hearing Loss Association of America and before her condition worsened, had downloaded a personal information sheet from their site to bring to the hospital. It explained her hearing loss and communication needs. She brought a whiteboard and markers as a quick easy method of communication. On her android cell phone, she had Live Transcribe, a free app through Google Play for androids using automated speech recognition to caption what’s being said, real-time. Sue made sure Mary’s cell phone was connected to the internet but Live Transcribe will also run from cell service. Mary also made sure she had her charger, extra hearing aid batteries, and her assistive hearing devices that work with her hearing aids to reduce background noise and increase speech comprehension.
Mary’s doctor had an accent. Mary tried using Live Transcribe but it could not accurately transcribe her speech to text. Mary asked her doctor to text what she was saying so Mary could read it on her phone and respond back by voice. This worked.
As Mary began to recover, there were conversations she needed to be part of preparing for her discharge. Sue asked the staff involved to download the Ava & Me app to their phones. This allowed a group conversation transcribing voice to text, with each person identified on Mary’s phone in real-time. Because the speech is seen on the user’s phone as well, each person could check and make sure what they said was accurately transcribed. This was very important because of the muffling of masks and accents of people on the healthcare team.
This is a fictional story with real implications for those of us with hearing loss.
Consider proactive steps to take. Read these resources. Practice and plan.
https://www.hearingloss.org/communication-access-recommendations-hospitals-covid-19/#tools
Barriers, challenges and some solutions for people who are deaf/Deaf/hard of hearing during the COVID19 crisis:
Hearing Loss Exhaustion
- The brain of a person with hearing loss is working very hard to continue processing incoming information while at the same time filling in gaps of missing sounds. Stress and anxiety drain our brain’s energy causing even greater reduced comprehension. Add to that lack of rest, illness and worry and you have the perfect storm of hearing loss exhaustion.
Some Solutions:
Rest, alert, relax
- If possible, communicate when the individual is rested and feels alert. A clear mask is ideal to support lipreading. Encourage the individual to relax, joining them in a few mindful or if possible, deep breaths before beginning a conversation. It’s helpful if the conversation starts with simple light talk so that the person with hearing loss’s brain can adjust to the sound of the speaker’s voice. There are some DIY alternatives to commercially made clear masks that made suffice recovering at home.
Clear-Speech
- The speaker will want to practice rules of clear speech and a technique called chunking. To do this, be sure to annunciate clearly but without over annunciating. You may speak up but DO NOT SHOUT. This is embarrassing, annoying and distorts words. Clear speech is speaking a few words, pausing briefly, then continuing. The pause is not long and should be very natural. This allows the brain time to fill in the missing sounds while keeping up with incoming information.
Framing
- Give a framework to your discussion by naming the topic i.e. “I want to talk to you about your test results.” This prepares the brain of the person with hearing loss for likely vocabulary and topics this conversation might cover.
Anticipate setting
- Reduce, as much as possible, the distance between you and the person with hearing loss
- Eliminate or reduce any background noise (TV, radio, fans, heat/ac)
- Make sure the room is well-lit. Be aware that you, the speaker, are not back-lit by windows or other light that will cast your face in shadow impairing lipreading
- If possible, have your discussion in a smaller room with better acoustics (carpet, sound absorbing walls, cushioned furniture)
- Keep your face clear – don’t put your hands in front of your lips or speak with anything in your mouth
- Make eye contact
Communication repair strategies
- If you are not understood, repeat once or say it in a different way, i.e. “the lab shows a…” “the test results indicate…”
- The person with hearing loss may use strategies such as repeating what they heard and asking for what they missed. Respect this and just repeat what they missed.
- The person with hearing loss may ask for clarification by saying “Was that b as in boy or d as in David?”
- When spelling out by comparison like “B” as in boy, go slowly.
- Clarify communication by writing notes or using apps such as Live Transcribe on androids or Otterai or Notes on iphones/ipads
- Otterai or other transcription services are extremely useful however be very careful of the accuracy. It could also be disastrous if incorrect.
- Google Recorder is another very useful tool for the healthcare provider and the patient. It’s currently only available on Pixel 3 or 4 phones but can record, transcribe and save the conversation for later viewing, organizing and searching. It does not need cell service or wi-fi to work.
- Transcription apps could be utilized, checked for correctness and emailed to the patient as follow-up.
- In meetings, use the Ava & Me or hire a CART transcription service.
- Paper and pen, whiteboard and dry markers are all good back-up tools.
- Does the hospital have a looped conference room? This may also be a great option for hoh people.
- A hospital may consider an assistive listening device such as Maxi Pro or Pocket Talker. These have disposable ear covers and could be disinfected in UV cabinets.
- Hospitals should also have phones with extra loud amplification, a Caption phone and an ipad for videophone services available as an accommodation for people who are deaf/Deaf/hoh.
For additional information contact:
Maryland Technology Assistance Program at
MD Department of Disabilities
410-554-9230; 1-800-832-4827
