Oct 2020 Australian Financial Review

A silent crisis has emerged during the pandemic, with more adults forced to confront their hearing loss as cues such as lip reading and facial expressions have been blocked by the use of masks, especially in Victoria. Experts believe this effect of the COVID-19 crisis will not be reflected in more implant surgeries or audiologist appointments for some time. This is because adult-onset hearing loss tends to affect people aged 60 and above, and this group is less inclined to book in-person appointments due to the risk of catching the virus. But the hearing loss community believes a jump in treatments is likely once the pandemic is controlled.

 Sinead WilliamsCSIRO scientist Sinead Williams was granted an exemption to the elective surgery ban earlier this year so that she could receive a cochlear implant

CSIRO scientist Sinead Williams has suffered from profound hearing loss since birth, but until this year got by with just wearing a hearing aid in her left ear. Dr Williams, who has played a critical role in progressing the world's understanding of the virus causing COVID-19, said she almost had to give up her job during the pandemic because in January she abruptly lost her hearing completely, triggered by an illness. "My world was turned upside down and I get emotional thinking about it ... I had never been so anxious in my life. I'm excellent at lip reading, but I knew having this skill wasn't enough to deal with everyday life."

After a few weeks of steroid treatment, she got next-to-no hearing back and surgeon Stephen O'Leary suggested she think about a cochlear implant. Without an implant, Dr Williams was facing the possibility of not returning to work, not being able to hear her three young children (the youngest of whom has Down syndrome and requires help with his speech), and experiencing isolation like she never had before.

But before she could get the surgery, COVID-19 was declared a pandemic and elective surgeries were banned. "The pandemic has been a nightmare for all deaf people because we rely so much on facial expressions and lip reading. Now with the [Victorian] government saying we have to use masks or face shields, people can't communicate," she said. "I'm still in the process of learning how to listen, so I'm still reliant on lip reading. I may get the first couple of sentences that they're saying, but in my workplace it's critical that I can hear every word that's being said."

Professor O'Leary was forced to campaign on her behalf and Dr Williams was granted an exemption to the ban in order to have the surgery.

In Dr Williams' CSIRO lab in Geelong where they work with diseases such as polio, as well as SARS-CoV-2, she must go through air-locked doors and deposit all clothing and devices before entering the lab. Before her sudden, total, hearing loss, she would have a hearing aid just for the lab and similarly, she now has a Nucleus Sound Processor (which Cochlear donated) for use in the lab only.

While Dr Williams was lucky, many others have had their surgeries delayed. In future pandemics she said, implant surgeries should not be considered elective, for children or adults. "Now we're relying on screens and phones, you need to be able to hear. You can't just rely on lip reading," she says.

Bart Cavalletto, director of services at the Royal Institute for Deaf and Blind Children, said up to 70 per cent of cochlear implants in Australia were in the adult market. Mr Cavalletto said the aftermath of COVID-19 would not be felt for some time, but there could be a spike in inquiries. "We have seen some pockets such as Newcastle, where surgeons have said they're really busy in this space," he said. "While we have been offering email and teleconference appointments for the existing client base, we've had a bunch of people who have said it's too difficult to access these services. For people with hearing loss, it's one of those things that's gradual and creeps up on you. You make adjustments and accommodations to make sure you can still function and you get to a point where those adjustments no longer work. We need to get to them before that."

The dangers of adults not having their hearing loss treated were real and significant, Mr Cavalletto said. "What we know about hearing loss is that prolonged hearing loss can really impact people's lives and the links to things like dementia is really clear in the literature. Not being able to lip read makes people want to withdraw more because it's really difficult for them to engage."

Mr Cavalletto has been working with Hearing Australia to encourage people into its centres to get assessed. He has also been lobbying the government for a reimbursement model for cochlear implant teleaudiology, but said progress was delayed due to COVID-19.

Terry McGee, an obstetrician at Westmead Hospital, started going deaf in her mid-30s and has been forced to change her career trajectory multiple times due to her hearing loss. In 2000, she lost her ability to hear people over the phone, forcing her to leave private practice, and two years ago she stopped working in the birthing unit because she felt her hearing had become so bad she might mishear a patient or colleague in an emergency.

Dr McGee's role is now mostly administrative, but she said it was fortunate she took the plunge to get two cochlear implants last year because when COVID-19 struck, patient histories suddenly started being taken over the phone to reduce face-to-face time in hospitals. "I was hanging on by my fingernails and it got to the point where I didn't have anything to lose," she said. "You become very socially isolated and anyone with a hearing impairment will tell you that. It was already difficult without COVID-19. When you have a hearing problem you prioritise seeing people face-to-face and for most of this year we've had to largely avoid that. We won't see an increase in [hearing loss] appointments yet, but I think this will prompt people to do something.”

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