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.