In-Ear Device May Improve Communication Between Healthcare Workers Wearing PPE

By Linda Carroll

April 21, 2021

(Reuters Health) - An in-ear device may help overcome problems hearing and being heard that healthcare workers experience when wearing PPE, a small study finds.

An experiment involving 12 surgical residents revealed that using the earpiece was significantly associated with improved speech intelligibility with two types of mask, according to the report published in JAMA Network Open.

"Communication quality in the OR is degraded when using reusable PPE, which can negatively impact surgical outcomes," said the study's lead author, Don Luong Nguyen, a doctoral student at McGill University.

"Use of an in-ear communication device can be an effective method to alleviate the speech degradation associated with the use of reusable PPE in the OR," Nguyen said in an email. "The device (used in the study) was originally developed for use in an industrial setting and this publication constitutes proof of concept. Adaptations are still required for real-world use in the OR. Voice activation of the device rather than push to talk, as well as full duplex communication is still in development."

Inability to hear clearly what OR colleagues are saying can have serious consequences, Nguyen and his colleagues write.

"Communication errors are associated with adverse events in the operating room," the researchers note. "From 2004 to 2014, The Joint Commission evaluated more than 4,000 adverse events in health care and found communication breakdown to be the most common factor in complications. Specifically, 70% of these adverse events were associated with communication failures, 75% of which resulted in patient death."

To explore whether an in-ear device might facilitate communication in an OR where everyone is wearing PPE and voices are hard to hear, Nguyen and his colleagues recruited 12 surgery residents for an experiment in which each resident would be a listener and be paired with one of the authors, who would act as a talker. To simulate a listening environment similar to that of an actual surgery, the researchers added ambient noise by turning on the suction machine and a warming blanket.

The listener and talker were positioned one meter apart on either side of the surgical table. The residents were asked to repeat, to the best of their ability, the target words or target sentences spoken by the talker.

Speech recognition testing was performed both with an in-ear device (aided) and without the device (unaided). Each of the talkers wore three different types of PPE - N95 mask, half-face elastomeric respirator, and powered air-purifying respirator (PAPR) - which allowed for a total of six different listening conditions. In the aided condition both the listener and the talker were fitted with the in-ear SonX device (EER Global Technologies Inc), which captured and transmitted voices through a microphone that is partly inside the ear canal rather than outside of the PPE.

When the talkers wore the N95 mask, mean speech intelligibility among listeners was very good and not improved by the device (98.8% intelligibility without the device versus 94.3% with the device). When talkers wore the half-face elastomeric respirator, however, the mean speech intelligibility among listeners was 58.5% without the in-ear device versus 90.8% with the device. When the PAPR was worn by the talkers, the mean speech intelligibility among the listeners was 84.6% without the in-ear device versus 94.5% with the device.

While the new study is reassuring in that communication appears to be relatively unimpaired with N95 masks, there may be times when these types of PPE are not as available, said Catherine Palmer, director of audiology in the department of otolaryngology and the department of communication science and disorders at the University of Pittsburgh and UPMC.

Still, "several studies have been published indicating that N95s and surgical masks reduce sound transmission of the mid- to high- frequencies, which contain the speech sounds essential for clarity of speech," Palmer said in an email.

The study shows that if other types of masks must be used, "communication will be significantly compromised and some type of listening device to improve communication should be used," Palmer said. "Accurate communication in the OR is essential for patient safety and the best health outcomes."

SOURCE: JAMA Network Open, online April 19, 2021.