These are quite unprecedented times and authorities across the world are scrambling to manage the COVID-19 virus and its spread. The considerations for people with hearing loss are not dissimilar for other people, although, people with hearing loss and hearing aids may face some issues that others don't. If your hearing aid fails or appears to fail, what do you do? How can you get service without turning up to a clinic? I thought it was important that we covered everything we knew about the virus, talked some facts and discussed some particular issues for people with hearing aids.
It Was Never a Hoax
Firstly, this was never a hoax and secondly, it is not just serious flu. This is a novel virus, one that has never been faced by humankind before. There is absolutely nothing made up about the COVID-19 virus nor its possible effects. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US, said the mortality rate of COVID-19 is 10 times more than flu (1.). He went on to say that if we didn't do serious mitigation now, we would be weeks behind. According to WHO figures from around the world, 10 times is actually a conservative estimate.
Mortality rate across the world at the time of writing this article originally was between 3 and 4% depending on geography (2.). That is in fact 30 to 40 times worse than flu mortality rate. That rate is still in flux, it is also in question because we truly don't know exactly how many cases there is of the virus globally. Some people have the virus and are asymptomatic (no symptoms), those people never get tested, therefore, are not in the statistics.
Some people have only very mild symptoms, and in the early stages of the virus, many of them were not tested and therefore do not appear in the statistics. So a true definitive mortality rate is difficult to assess. My own opinion is that arguments over the mortality rate are just smoke and mirrors. It doesn't matter how high or low the true mortality rate is, it will be of no succour to the people who lose family and friends. The one thing that is clear, is that this is a serious health threat that will have serious repercussions for certain risk groups.
While panic is a bad thing, simply dismissing this as some sort of partisan political hubbub for political point-scoring is both ridiculous and dangerous. This is a major health threat that we as a society must take measures to overcome. Reliable, definitive treatment, a cure or a vaccine, are many months away, our responsible action is needed to slow down the spread of this virus while medical professionals can work towards making everyone safe.
More Deadly for Risk Groups
The mortality rate of the virus is different from group to group and demographic to demographic. Unfortunately, the older you are, the higher the death rate. Pre-existing conditions also play a part, people with pre-existing conditions such as Diabetes, Hypertension, Respiratory Conditions, are more likely to die. Unfortunately, many people with hearing loss and who wear hearing aids fall within these categories. That means, they need to take measures to protect themselves from this virus.
Protecting Yourself
The advice from the WHO (3.) is simple, but as with most simple things can be a little difficult to put into practice, let's take a look at it:
- Wash hands frequently for 20 seconds or more with soap
- If hand washing facilities aren't readily available, use a high alcohol content hand sanitiser
- Use your elbow to cover your mouth when coughing or sneezing
- Practice social distancing, three feet between you and other people
- Stay at home if you begin to feel unwell, even with mild symptoms such as headache and slight runny nose, until you recover. Why? Avoiding contact with others and visits to medical facilities will allow these facilities to operate more effectively and help protect you and others from possible COVID-19 and other viruses.
- If you develop fever, cough and difficulty breathing, seek medical advice promptly as this may be due to a respiratory infection or other serious condition. Call in advance and tell your provider of any recent travel or contact with travellers. Why? Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also help to prevent the possible spread of COVID-19 and other viruses.
The first piece of advice is to wash your hands more regularly in particular if you have been in contact with surfaces that you aren't sure are clean. The rule is to wash them with good soap under warm water for 20 seconds or more. Ensure that you wash between your fingers, around your thumbs, the back of your hands and your fingernails and back of the fingers. In this way, you can be sure to wash everywhere and remove anything on your hands.
If you are out and about, that isn't quite as easy as it sounds. The advice extends that if hand washing is not readily available, using a high alcohol content hand sanitiser is acceptable. The process is the same, ensure that you cover the entire area of your hands by rubbing the sanitiser everywhere. Then let the sanitiser dry itself. Hand sanitiser is particularly handy when out and about after you have touched door handles etc.
If you feel like coughing or sneezing, do so into your elbow. This reduces the impact of aerosolised particles and ensures that you don't have them on your hands to pass them on to everything you touch. If everyone does this, we will reduce the chance of infection being passed on through aerosolised droplets or infected hands.
As someone in a risk group, social distancing is an important safety measure. Try to always keep a three feet distance between you and other people around you when you are out and about. If possible, keep trips out to a minimum and only take necessary journeys. Follow the advice of your local health bodies carefully. In many parts of the world right now, people are more or less confined to their homes unless they have a reason to be out.
Depending on the prevalence in your area and your personal risk depending on pre-existing conditions, it may be a good idea to self-isolate. This may seem like an over-reaction, but for some people, in particular those with chronic respiratory conditions, it might be a good idea. That is a decision best made by you, balancing all of the information that you have in your local area.
Wearing a Mask
There have been mixed messages in relation to the wearing of masks by the general public. While originally the advice was not to bother, I think as more information has become available, that has begun to change. Originally, it was thought that viral particles where only shed when someone coughed or sneezed. There is a growing weight of evidence that this virus may be aerosolised. That means that people with the virus may be shedding viral particles when they breathe.
That means that wearing a face mask when out and about may, in fact, be a decent protective measure. If you are going to wear a face mask, try to get an N95 grade face mask. The type that is commonly sold as dust masks in many hardware, or motor equipment stores. These types of mask offer the best protection.
However, they will only offer protection when worn properly. When you are out and about with your mask on, never take it off, never lower it to under your neck to speak to someone. When you are finished wearing your mask for the day, remove it carefully and spray a hydrogen peroxide solution on the outside of the mask. This will kill off any viral particles while not damaging the structure of the mask.
Gloves & Masks Don't Mean To Forget Everything Else
I have witnessed some people appear to think that wearing a mask and gloves gives them invincibility, it doesn't. This is what many health care professionals are worried about, that people wearing gloves and masks will forget that washing their hands, washing surfaces and social distancing are still core tenets of protecting yourself. Gloves won't stop you picking up contamination on your glove and then cross-contaminating another surface. So just because you are wearing gloves, doesn't mean that you shouldn't wash your hands or use hand sanitizer.
Hearing Aid Specific Considerations
With all of that in mind, there are specific considerations pertaining to hearing aids I wanted to discuss. Firstly, if you have a problem with your hearing aid and if you have decided to isolate yourself, what can you do? Firstly, I want to state categorically that most hearing care professionals are taking their responsibilities at this time very seriously, they are enacting even more stringent infection controls than before with this virus in mind.
Individually, they are also taking steps to limit the exposure of their patients to both the virus and other people. That means buffer times between patients and disinfectant wipe downs of all surfaces between patients.
If Your Aid Stops Working
First things first, check the wax guard if it has one. Most of the time the main culprit for sudden hearing aid failures is the wax guard. It is full of wax and the sound isn't getting through. If you have Receiver in Canal device with a generic silicone tip, take the tip off and check it for wax blockage first. While you have it off just clean through it to knock any detritus out of it. After you have done that, check the wax guard and see if it is blocked.
If it is, change it for a new one. Nine times out of ten there will be an instant difference in the sound. If not, change the battery, sometimes, even if you have put a new battery in, it could be faulty, so changing it for a new one is a good step. The last thing to do should be to check the microphone ports on the body of the aid. Take a close look at them and make sure no crud has got into them. If they look dirty, give them a brush to clear them. So that's:
Troubleshooting Receiver In Canal Hearing Aids
- Take silicone tip off and clean any rubbish out of it
- Check wax guard at end of receiver and change if necessary
- Change the battery, even if you have just put a new one in
- Brush the microphone ports to clear them out
- If all else fails, you will have to make a trip to your professional.
If you have a custom in the ear hearing aid, just check the wax guard at the business end. Again, if it looks like it has a lot of crud in there, change it for a new one. Occasionally with a custom hearing aid, the problem might not be the wax guard, it could be a microphone blockage. Make sure you brush the microphone covers on the faceplate to knock out any detritus out of them.
Troubleshooting In The Ear Hearing Aids
- Check wax guard at end of receiver and change if necessary
- Change the battery, even if you have just put a new one in
- Brush the microphone ports to clear them out
- If all else fails, you will have to make a trip to your professional.
BTE hearing aids don't have wax guards, so you need to check the tubing to see if it has been blocked by wax. If there is any blockage, take the tube off the aid and shove a pipe cleaner through it to knock the blockage out. It is also worthwhile checking the microphones on the body of the aid and the batteries just as you would with the other types of aid.
Troubleshooting Behind The Ear Hearing Aids
- Check the tubing for any blockage
- If the tubing is blocked, take it off the hearing aid and use a pipe cleaner to push the blockage out
- Brush the microphone ports to clear them out
- Change the battery even if you have just put in a new one
- If all else fails, you will have to make a trip to your professional
If everything has failed, call your hearing professional and discuss with them a time that you may come in and your concerns about social exposure. They should easily be able to arrange something to allay your fears and allow you to get your aid sorted out.
Discuss Remote Care
Remote telecare has been a growing feature in the hearing aid world for the last couple of years. Most modern hearing aids purchased in the last two years should have access to remote telecare. Discuss this feature with your professional and see if it can be activated. If it can, it will allow you to have fine-tuning and troubleshooting undertaken remotely. It will not be the answer to every problem, however, it will mean that you don't have to attend as many appointments face to face. We have by now completed a series of remote care articles on what is available from the hearing aid manufacturers which you can see on our Blog section.
As I said, these are quite unprecedented times, we shouldn't panic, however, we should follow the guidelines and advice of true medical professionals carefully. Your cousin's mate Gerry who once dated a paramedic is not a medical professional, neither are many of the talking heads we see on the TV. There are several fantastic sources of valid advice out there, with the WHO being one of the best. You can read what they have to say at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Please keep yourself safe.
- 1. 10 Times Worse Than Flu, The Hill, https://thehill.com/changing-america/well-being/prevention-cures/487086-coronavirus-10-times-more-lethal-than-seasonal.
- 2. Real estimates of mortality following COVID-19 infection, The Lancet, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30195-X/fulltext
- 3. Novel Coronavirus 2019 Advice For The Public, WHO, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
