COVID-19 pandemic restrictions and problems faced by patients due to difficult hearing.

-Abstract: Aims: The impact of COVID-19 is considerable in patients with hearing impairment who are faced with difficulties in communication due to masks and social distancing. We aimed to provide a preliminary description about difficulties faced by a group of patients due to hearing impairment. We collected data from 300 consecutive patients from a tertiary care urology clinic at Colombo South Teaching Hospital, Sri Lanka. A self-administered questionnaire was used. Chi-Square test was used for statistical analysis. The mean age of the patients was 55.9 (range:11-85). Eight patients (2.7%) had previous known hearing impairment. Repetition of instructions were required at least once due to hearing impairment in 27.3% (once:14.3%; twice:7.0%; three times:3.3%; >three times:2.7%). However, around 81.7% reported that they had no hearing problems while others reported some difficulty (18.3%: mild-10.3%, n=31; moderate-4.3%,n=13 and severe-3.7%,n=11). Nine patients (3.0%) required lowering of the mask to enable lip reading in order to understand the instructions and all reported moderate/severe hearing impairment (moderate: n=1, severe: n=8). Patient reported hearing impairment was significantly higher in those aged ≥65 years (31% vs. 11%, p<0.001). Around 18% of our cohort experienced some form of hearing difficulty. Thus, awareness among the healthcare providers and general public should be improved. Further studies on the impact of this problem with special focus on possible solutions are necessary.


Introduction
The COVID-19 pandemic has caused many challenges to the country's economy and the livelihood and socio-cultural beliefs of general public worldwide and in Sri Lanka (1)(2)(3). The COVID-19 has posed significant impact to health care systems and health care workers altering work pattern and burden (3,4). The impact is not only due to the illness itself but also due to measures recommended and imposed to contain the pandemic (5,6). Patients and health care personnel find it difficult to communicate with each other due to wearing masks and social distancing (8). The difficulties are more among those with hearing impairment and in health care facilities with lot of background noise due to overcrowding.
In USA, more than 70% of those aged above 65 years have some form of hearing impairment (7).

Approximately 20% of urban population in Sri
Lanka have hearing impairment and of them, 86% COVID-19 pandemic restrictions and problems faced by patients due to difficult hearing.
had not sought any medical treatment (8). In Sri Lanka, a considerable proportion of those seeking treatment for their illnesses are elderly patients and clinics of state hospitals are overcrowded with limited space. Furthermore, some health care facilities allow only the patient to meet the doctor to save space in order to ensure social distancing. Therefore, it is likely the current pandemic causes hardships to those with hearing impairment in Sri Lanka. We aimed to provide a preliminary description about difficulties faced by a group of patients due to hearing impairment. Providing robust statistical analyses or giving objective quantification of the current burden is beyond the scope of the analysis.

Methods
We collected data from 300 consecutive patients from a tertiary care urology clinic at Colombo South Teaching Hospital, Sri Lanka from 1 December 2020 to 31 December 2021. A self-administered questionnaire was used to collect details on basic demography and subjective hearing assessment to determine the extent of the problems encountered by patients due to inadequate hearing of speech secondary to face masks and social distancing.

The study was approved by the Ethics Review
Committee of the institute. Chi-Square test was used for statistical analysis. A p value of less than 0.05 was considered statistically significant.

Results
The mean age of the patients was 55.9 (

Discussion
Our preliminary study showed that around 18% Our study is a small prospective study with methodological limitations such as lack of objective assessment of hearing impairment or use of validated instruments. Despite these methodological limitations, we believe this preliminary study provides a useful overview of the burden due to difficulties faced by hearing impairment for clinical consideration (12).

Conclusion
Data on the prevalence and the burden due to difficulties faced by the hearing-impaired patients is limited, especially in the local setting during the COVID pandemic. The findings of this preliminary study show that this problem may be common and should be given adequate emphasis. Thus, awareness among the healthcare providers and the general public should be improved. Further studies on the impact of this problem with special focus on possible solutions are necessary.