How our audiologists are responding to COVID-19

Manchester is a thriving centre of research into hearing and balance. We take a look at how our audiology experts are responding to the COVID-19 pandemic.

Audiologists identify and assess hearing and balance function and their associated disorders, and provide appropriate therapeutic rehabilitation and management for children and adults in a range of settings.

Our lecturers explain how audiologists in the NHS and at The University of Manchester are responding to COVID-19 and adapting audiology practice for the future.

Supporting infants with hearing loss and their families

Our audiology team are working with professional societies to understand and mitigate the impact of COVID-19 on the newborn hearing screening service.

One to two babies in every 1,000 are born with a permanent hearing loss. Due to the potential impact on their development, all babies in the UK are screened for hearing loss as soon as possible after birth, usually on the maternity ward in hospital or soon after discharge in a clinic.

The vulnerability of newborn babies to disease means that they currently interact with as few healthcare professionals as possible to reduce their risk of contracting COVID-19, which has an impact on audiologists' ability to provide a screening service. 

Our experts are also planning to work with families of infants with hearing loss to understand the impacts on them and how to support them.

"The time dependency of the newborn hearing screening diagnostic means that the suspension or reduction of some services could have significant impacts on some babies with permanent hearing losses," explains Dr Siobhan Brennan.

"Furthermore, older children waiting for hearing assessment and management are affected as the capacity of audiology services is stretched after movement restrictions are lifted.

"At Manchester, we are investigating tools and questionnaires that can be used by departments to prioritise and mitigate the risks of delayed appointments for paediatric audiological needs."

Investigating the impact of COVID-19 on the music industry

We are also looking at the impact that COVID-19 has had on the music industry, particularly on the hearing health of those working in the sector.

Festivals and gigs are cancelled for the foreseeable future, leading to financial hardship for those in the industry. Dr Sam Couth, who is undertaking research in this area, explains that the lockdown has had a significant financial, mental and physical impact on workers in the music sector, especially as many are self-employed or on temporary contracts.

"From an audiology point of view, the lockdown also affords some interesting research questions in terms of how levels of noise exposure may have suddenly dropped for many music sector workers, and whether this will allow a period of recovery for their ears, and what will happen to hearing health as restrictions are lifted in the coming months."

In the meantime, social distancing restrictions are encouraging new ways of professional practice for workers such as musicians, teachers and producers, Dr Couth adds. This has meant experimentation with new and existing technologies such as Zoom, Skype and Jamkazam.

Supporting vulnerable older patients

Many of the older patients who audiologists work with are likely to be in the vulnerable category, and are therefore self-isolating. It is important that these patients continue to receive support while being protected from COVID-19. We are working to develop guidance for practising audiology remotely, while also looking at the effect of face masks on communication for those with hearing-related issues.

Dr Gaby Saunders, a clinical lecturer at Manchester, explains: "Some aspects of current audiology practice are not compatible with social distancing. For example, looking into someone's ear with an otoscope requires the audiologist to have their face in close proximity to their patient, and doing a standard hearing test requires special equipment and a sound-proof booth."

Despite this, there are many aspects of audiology that can be done remotely just as successfully as face-to-face appointments, she says.

"For example, most of the major hearing aid manufacturers now have hearing aids that can be programmed remotely via an app, video appointments allow audiologists to demonstrate how hearing aids work and to give hearing aid counselling in a one-on-one face-to-face manner, and there are lots of apps that patients can use independently to practice listening skills."

Our experts have developed guidance for audiology remote practice in conjunction with the British Academy of Audiology, Dr Saunders explains.

"The team will update the information on an ongoing basis, so its content remains up to date," she says. "In parallel, in the lab, there are researchers developing online material for reliable hearing testing and tinnitus rehabilitation, and others examining the effect of using face coverings on hearing and communication."

The main challenge is in delivering certain aspects of audiology services using these new approaches where possible, although it is likely that some of these temporary measures will become more permanent if they offer more convenience and cost savings for practitioners and patients – while still offering the same amount of clinical benefit.

"There is concern that older people with hearing loss are at particular risk of loneliness and cognitive decline during lockdown that might be exacerbated by untreated hearing loss," Dr Saunders says.

"We believe that by providing audiological care remotely, we can support hearing needs, which in turn will improve the quality of life and decrease the risk of loneliness among older people with hearing loss."

Face masks and communication

The use of face masks by the public is a topic of debate with no current conclusive evidence that it does reduce the spread of COVID-19. Despite this, more and more people are wearing face masks. 

Kevin Munro, Professor of Audiology at Manchester, has discussed the unintended consequences of this practice for people with hearing difficulties in an article for the Conversation, as well as in a podcast, and has set out advice on how to improve communication around these issues.

"Wearing a face mask may impair the ability for some people to communicate with ease, because it prevents lip reading and it can reduce the level of speech transmitted from the mouth," he explains.

"An unintended consequence of wearing a face mask might be that social distancing is replaced with social isolation and poor mental wellbeing in older adults with hearing loss."

He advises those with hearing loss who need to communicate with a person in a face mask to ask them to reduce background noise if they can and to talk slowly without shouting. People with hearing loss should try to wear their hearing aid, if they have one. 

"Some hospitals provide portable hearing amplifiers to help with communication if you have lost your hearing aid or it has stopped working," he adds.

"If you don't have a hearing aid but need one, you can always download a hearing aid app to your mobile phone that can provide amplification to improve speech understanding. Or, you can find an app that translates speech into text in real-time."