Importance: The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators . Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date .
Objective: To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR] ) in the operating room . Design, Setting, and Participants: This quality improvement study was conducted in June 2020 . Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited . All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital . Exposures: All participants performed the speech intelligibility tasks with and without an in-ear communication device . Main Outcomes and Measures: Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100 %) was obtained for each speech intelligibility test . Listening effort was assessed using the NASA Task Load Index . An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained .
Results: A total of 12 participants were included (mean [SD] age , 31.2 [1.9] years; 8 women [66.7 %] ). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8 %) without the in-ear device vs 94.3% (7.4 %) with the device . While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4 %) without the in-ear device vs 90.8% (8.9 %) with the device . While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8 %) without the in-ear device vs 94.5% (5.5 %) with the device . Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3% ; 95% CI , 23.8% -40.7% ; P <.001) and the PAPR (9.9% ; 95% CI , 1.4% -18.3% ; P = .01). Furthermore, use of the device was associated with decreased listening effort . The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device . While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device . While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device . Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI , 23.5-53.3; P <.001) and the PAPR (18.4; 95% CI , 0.4-36.4; P = .04). Conclusions and Relevance: This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort . Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.