INTRODUCTION
During the Coronavirus disease 2019 (Covid-19) pandemic, healthcare professionals have, where supplies exist, delivered care to their patients across the world wearing mandated Personal Protective Equipment (PPE)1. The authors anecdotally found communication and understanding wearing PPE to be drastically reduced in clinical areas, and impact on communication of PPE in general has previously been raised in popular press2 and scientific literature3,4,5. We sought to assess these difficulties through a simulated clinical environment model.
In the clinical context, workers frequently speak and communicate with a degree of background noise, unlike the gold standard silent audiological testing booth. Pure tone audiometry (PTA) represents the “gold standard” test for hearing ability and is a good measure of hearing impairment. However, the audiogram generated by the PTA is a poor indicator of speech recognition in noise6. PTA measures hearing sensitivity rather than assessing the auditory and hence speech processing ability of the subject, therefore findings do not always correlate with the functional hearing ability of subjects faced with real-world signals and noise, such as speech7. A words-in-noise task adds significant cognitive load versus the same task without noise, and as in clinical settings where there is always a degree of background noise, a Speech in Noise (SiN) testing to be a better real world “stress test” of auditory function8.
Rather than a test of hearing, SiN testing for adults can assist clinicians in undertaking assessments of speech understanding in noise. A screening test that uses sentences rather than single words or phonemes is preferred than monosyllabic word lists presented in quiet conditions as the latter have demonstrated limited reliability and lack validity in relation to real-world simulations9,10,11,12,13. We sought to identify if there were genuine measurable challenges to speech discrimination wearing Covid-19 PPE in the present study by SiN tests.