![]() ![]() While we know that hearing loss in older age typically affects higher sounds first, 12 using a deeper voice or increasing volume may distort the sound and prove less useful. Knowing the topic in advance and any sound heard can improve the accuracy of these guesses. Without sound, only 30% of English is readable on the lips, 12 the rest being educated guessing. Speaking loudly and slowly is technique often employed by the desperate doctor, with the aim of conveying information via lip reading and volume. This aims to draw attention to the underlying factors leading to healthcare inequalities among the deaf community and to offer some guidance to approaching a consultation with patients with hearing loss. This article aims to highlight the challenges faced by healthcare workers in communicating with patients with hearing loss. Entries are still seen in patient records stating that a full history has not been taken because a patient is deaf 5 and doctors interacting with these patients often feel ill-prepared to maximise the consultation and communicate effectively. Sadly, this example is one we see all too often. Would he have received different care had he been able to communicate verbally? Was it clear to the medical team how much this patient understood and consented to? ![]() Fluctuating delirium and medical instability complicated the communicative effort, which raised a number of questions regarding his medical care: It became evident that these communication mediums were far from perfect. History taking, assessing cognition and surgical consent were challenging, but achieved through deliberated written notes. Communication was through shouting and written information, which his daughter claimed was how he communicated at home. Emergency department documentation had branded him a ‘poor historian’ and a largely collateral history was sought. He was profoundly deaf from birth, with hearing aids in place bilaterally. 8 In the UK, the Deaf community is represented by organisations such as the British Deaf Association (BDA) and the Royal National Institute for Deaf People (RNID), who promote the positive aspects of being Deaf and lobby for changes such as the rights to communicate or be educated in their preferred language.Ī recent trauma on-call shift saw the admission of a 95-year-old male who had fallen and broken his hip. A report by Bonnie Poitras Tucker in 1998 describes the use of American Sign Language (ASL) as a visual language with its own syntax and grammar, quite different from spoken English. Members of the Deaf community define deafness as a cultural identity rather than a disability. 6 There exist socio-economic and health education barriers to hearing aid uptake, and people may choose not to be implanted for psychological and cultural reasons. 4 National Institute for Health and Care Excellence guidance suggests the use of hearing aids for adults and children in whom hearing loss impairs their quality of life, and cochlear implantation in those without benefit after 3 months (unless contra-indicated or inappropriate). 4 70,000 of the UK's deaf population are profoundly deaf prior to acquiring speech, 5 and in developed countries 80% of congenital hearing loss is genetic. Causes of hearing loss can be conductive, relating to abnormalities of the external ear or ossicles, sensorineural, relating to inner ear structures, or mixed. 4 It is important to note that conversational speech occurs at 50–60 dB HL, meaning that a ‘moderate’ hearing loss of up to 55 dB is functionally more significant than classified. ![]() Profound hearing loss is defined as a hearing threshold of 90 dB, at which level people will hear noises at least 50% of the time. ![]()
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