Communication and Mental Health Challenges faced by the Hearing Impaired during the Covid-19 Pandemic
Manashi Sarmah
Chandana Bhuyan
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome virus 2(SARS-CoV-2) that started from the city of Wuhan in China and then quickly spread worldwide has made dramatic changes in people's individual, family, and social lifestyle. These wide-ranged alternations have also affected the healthcare services across the globe.
Around 360 million people across the globe suffer from disabling hearing loss which constitutes 5.3% of the world’s population. In India, 63 million (6.3%) people suffer from significant hearing loss [WHO]. 4 in every 1000 children suffer from severe to profound hearing loss and 100,000 babies are born with hearing deficiencies every year [Garg et al,2009]. Also, hearing loss is the second most common cause of disability and most common cause of sensory deficit in India [NSS,2002].
Untreated hearing loss has been proven to cause poor health outcomes such as deterioration in cognitive functions, reduced quality of life and limitations in mobility (Ciorba et al,2012). Studies suggest such poor health outcomes to further bring negative psychosocial consequences, such as stress, depression and anxiety (Bernabei et al 2011; Gomaa et al,2014). On the other hand, it is a fact that the use of amplification devices like hearing aids and cochlear implants have very significant positive effects on psychosocial lives of hearing-impaired people.
Humans have various communication needs. COVID‐19 has had the most detrimental effect on people with impaired hearing. To contain the further outbreak of the Covid 19 pandemic, some inevitable changes such as wearing the face mask and social and physical distancing were recommended which have gravely affected social interactions for all people. However, these changes have posed as severe challenges for the hearing-impaired community. They have affected not only daily interactions between hearing-impaired and their partners but also the interaction between them and their therapists which is more important. Communication is the basis of the quality of services provided to the patient which, in this way, they can participate in their healthcare management [Goldin et al,2020]. This is well achieved through the effective communication between patient and therapist and is the heart of medical care [Chodosh et al,2020]. Post fitting of amplification devices like Hearing Aids or Cochlear Implantation, auditory habilitation is one of the most important and essential aspect for the development of speech and language. The care and maintenance of Hearing Aids and the speech processors along with continuous Auditory Verbal Therapy sessions are of utmost importance to achieve the essential goals [Shivaprakash et al ,2019]. For the optimal clinical outcome, the habilitation programme post cochlear implantation should be seamless and uninterrupted under the guidance of trained hearing health care professionals. Literature has documented various studies which emphasises the importance of seamless post cochlear implantation habilitation programme for the development of excellent linguistic skills in children [Geers et al,2003; Connor et al,2006]. Any interruption in post implant habilitation is likely to affect the outcomes and have psychological impact on both the children and their parents [Ornell et al 2020]. The wide spread nature of the COVID-19 pandemic has necessitated extra care and alteration in all post implant management services [Dham,2020]. The parents of children with congenital severe to profound sensorineural hearing loss have significant psychological impact when the habilitation services get disrupted [Geers et al,2002].
The COVID-19 pandemic outbreak is expected to be temporary, but its impacts might last for years to come. Very little information is available on the impact of the COVID-19 outbreak on the hearing-impaired population [Naylor,2020]. Wearing a face mask is one of the major challenges for either people with hearing loss or their partners. However, there are very few studies on face masks as a barrier to communication. A recent study showed that people with hearing loss face many problems in speech perception when talking with face masks to health care professionals [West et al 2020] which suggests that the use of face masks has made communication with healthcare professionals harder for many of the hearing-impaired patients [Grote et al]. Hamton et al. investigated the impact of wearing face masks on speech perception in normal hearing individuals who work in hospital set ups and found that speech perception is attenuated by 70 dB when wearing a face mask, compared with a no mask condition. Effective communication affects general health; hence, the communication needs of hearing-impaired individuals should be taken into consideration.
The main obstacle faced by the hearing-impaired community in relation to healthcare access to is primarily related to the linguistic barrier, due to several impediments, such as lack of training of health care professionals, financial difficulties to employ interpreters, and absence of adaptations for hearing impaired patients [De Souza et al]. The consequences of ineffective communication for people with any degree of hearing loss is unpredictable and undocumented till date. Hearing loss usually causes psychological, social, educational, and occupational barriers [Samad et al,2006] and studies have shown that disabilities from hearing loss often target psychological factors [Bakhit et al ,2012]. Literature suggests that hearing loss is associated with loneliness and social isolation [Shukla et al,2020]. In children and in adolescents, communication difficulties due to hearing impairment affect social interactions which are associated with many consequences of major problems in education, psychological disorders such as isolation, depression, disappointment, hopelessness, and in more severe cases aggression, and disruption of language and speech acquisition in younger children. Consequences of ineffective communication in hearing impaired adolescents may happen in other ways because they are changing identities in this age range [Mousavi et al 2018]. It has been seen that communication problems in hearing-impaired children who are integrated into regular and mainstream schools might make it difficult for them to function appropriately in the class, which in turn can lead to feelings of isolation, and lack of belonging [Mousavi et al 2018]. In addition to the above-mentioned difficulties, disruption of proper communication with peers leads the hearing-impaired individual’s failure to acquire age appropriate social and communication skills. All these disruptions lead to severe consequences such as low self-esteem, social rejection, feelings of inferiority, low and limited quality of friendship as well as low self-belief and ultimately a negative impact on their mental health [Mousavi et al 2018]. In addition to direct consequences of hearing impairment, there are also other indirect factors that affect the communication process such as general communication skills, denial, and acceptance of hearing loss, attitude towards hearing loss, and also attitudes and behaviours of peers and colleagues [Rouhbakhsh,2006]. Similarly, for the elderly hearing-impaired community, hearing loss can be associated with disappointment, loneliness and communication difficulties and which can negatively affect their quality of life [Ciorba,2012]. Hence, hearing loss impacts personal, and social life negatively and has multidimensional effects on communication, which in turn can cause many additional problems for people with hearing loss. However, evidence-based studies have shown that even the same degree of hearing loss can have different degrees of impact or disability in different people which means that disability and handicappedness are not precisely predictable from the severity of hearing loss [Chang et al,2009]. Also, they suggested that not all elderly persons with hearing impairment perceive hearing handicap equally and several factors other than auditory factors such as cultural variations also contribute to the self-perceived handicappedness and disability due to the hearing impairment. Despite all these problems, the current state of scenario has mandated social and physical distancing which has also exacerbated the difficulties for people with hearing loss.
In light of all the difficulties faced by the hearing-impaired community during the Covid -19 pandemic, adoption of compensatory strategies which may be useful for hearing-impaired community and training them, which is primarily the responsibility of the audiologists, psychologists and other related healthcare professionals who are directly associated with hearing impaired individuals can help the individuals in identifying and overcoming their problems in critical situations. Also, identifying risks and protective factors for hearing-impaired individuals at the earliest stage will be of critical importance to predict the psychological impact of both the epidemic and the response to the health crisis, and to reduce the overall stress in the hearing-impaired community.