Face Masks Make It Harder to Hear

Michigan resident Kellyann Navarre, a psychology research assistant with mild hearing loss and auditory processing disorder, was picking up a curbside order when she first discovered the challenges of communicating during the COVID-19 pandemic. As her food was being delivered, Navarre couldn’t understand what the delivery person was saying behind their face mask. Navarre isn’t alone. Communicating in a masked world is more difficult for everyone, especially for the millions of Americans living with hearing loss.

Navarre had “a sudden increase in anxiety” when she couldn’t understand what was being said “behind the mask.” Navarre told Hearing Tracker that she was concerned the delivery person would think they were being ignored and get frustrated. “I was also afraid they would try to take their mask off and talk to me without asking,” Navarre said.

Hard-of-hearing people are left in a complex situation during the coronavirus outbreak. While face masks play a major role in preventing the spread of COVID-19, research suggests that masks can muffle speech and also make it more difficult or impossible for people to lip-read.

Dr. Gabrielle Saunders, a senior research fellow at Manchester Centre for Audiology and Deafness, surveyed people with normal hearing and hearing loss and found that those with hearing loss faced more challenges. "People who either reported hearing difficulties or who wore hearing aids were significantly more impacted by face coverings than were people without hearing difficulties,” Dr. Saunders said. “They had more trouble hearing and understanding what was being said as well as feeling less engaged in the conversation and less connected with the person speaking.”

Which masks are better for hard-of-hearing people?

Dr. Ryan Corey, a postdoctoral fellow at the University of Illinois at Urbana-Champaign tested the acoustics of different masks earlier this year. Dr. Corey found that blue surgical masks had the best acoustics. “They're made of nonwoven fabric, which I think is part of why they don't block the sound quite as much as some of the woven fabrics did,” Dr. Corey said.

The acoustics of cloth masks ranged drastically depending on the fabric that was used to make them and how many layers they had. “Things like t-shirt fabric are pretty light and breathable and they let a lot of sound through as well,” Dr. Corey said. “Whereas something like denim is very densely woven, and the sound doesn't get through.”

However, Dr. Corey noted that the best cloth masks for acoustics may not be the safest for protection against COVID-19. “It seems that the looser fabrics are also less effective against droplets, so there might be a trade-off there,” Dr. Corey said.

For hard-of-hearing people—who rely on lip-reading more than sound—transparent, plastic masks may be a more accessible option. “The plastic blocks a lot of sounds, [with sound] reflected off to the sides,” Dr. Corey said. “A transparent mask might make sense for people who really rely on speech reading, so [would be most useful for] people with more severe hearing loss.”

Challenges that hard-of-hearing people face with masks

While the COVID-19 outbreak has disrupted many parts of people’s lives, the need for clear communication is still there. Dr. Dave Fabry, the Chief Innovation Officer at Starkey Hearing Technologies told Hearing Tracker about how social distancing and masks can reduce the volume of speech.

“We know the typical talker-listener distance, at least in the United States, is at least three feet,” Dr. Fabry said. “When you increase that to six feet, the audibility of speech drops by anywhere from six to up to twelve decibels. That's a significant drop in audibility for all of us just due to the social distancing aspect.” When people wear masks, high pitch speech sounds are reduced by “anywhere from about four decibels to another twelve decibels.”

A recent paper published in the Mayo Clinic Proceedings—co-authored by Dr. Fabry—reviewed the difficulties that hard-of-hearing patients have in a healthcare settings. Dr. Fabry says it’s now critical to ensure that hard-of-hearing patients can understand their healthcare professionals during the COVID-19 outbreak, especially if they are a high-risk individual and alone during an appointment. “They're communicating with someone who's wearing a mask and there might even be background noise present,” Dr. Fabry said “This is a really stressful situation.”

Dr. Nicholas Reed, assistant professor at the Johns Hopkins University Bloomberg School of Public Health, recently echoed this sentiment on the Hearing Tracker podcast. Dr. Reed said "the system should be built so that it accommodates [hearing loss] with built-in processes.” Johns Hopkins is piloting a program that puts personal sound amplifiers on every floor of the hospital, and Dr. Reed is seeing positive early results.

Even out of the hospital, communicating with others who wear masks can be a stressful situation for people who are hard-of-hearing. Joanne Baker, a reflexologist in England, said she has difficulty understanding people behind screens at the supermarket. “It makes me feel distanced and isolated from the conversation,” Baker said. “If it’s a friendly cashier I just pretend to hear them and laugh in all the right places. I do ask people to repeat themselves if I have to, but most of the time I pretend I’ve heard them.”

Strategies to help accommodate the hard-of-hearing people

Dr. Fabry recommends that healthcare professionals try numerous strategies to make sure that hard-of-hearing patients understand them. He suggested minimizing background noise and reframing statements that patients don’t understand them the first time. “We also want to remind healthcare workers, in particular, the importance of encouraging people to get a hearing test and to use hearing aids because hearing aids can help offset a lot of those challenges that are provided by the use of face masks,” Dr. Fabry said.

And while Dr. Saunders found that masks muffle speech, she wonders whether communication will become easier with time. "Of course, the fact that face coverings muffle sound will always be a problem, but I am guessing that some of the social aspects of the problem, those to do with anxiety, discomfort, and embarrassment at using a face covering, will decrease over time,” Dr. Saunders said.

Don’t be afraid to ask for help

If masks make it harder for you to hear, don’t be afraid to ask for help. Ask conversational partners to slow down and speak more clearly. Stand as close as you can, while still maintaining a safe distance. And, if possible, try to relocate away from background noise. If you suspect you may have a hearing loss, consider checking your hearing with an online hearing screener, or better yet, making an appointment with a nearby audiologist.