En español | As critical as they are to our collective health, face masks can make conversation a little harder — or at least less comfortable — for everyone. But those with hearing loss face greater communication challenges when facial expressions disappear under two layers of cotton and lipreading becomes impossible. Masks also reduce the volume and clarity of human speech, especially when there's ambient or background noise.
Eryn Staats, audiology manager in the department of otolaryngology at the Ohio State University's Wexner Medical Center in Columbus, says that masks reduce the volume by 4 to 12 decibels, depending on the material with which they're made. “We're all living through such difficult times in terms of isolation and quarantining, so this can add another layer of frustration to an already difficult situation.”
The potential fallout is significant, especially because “about 70 percent of people over 70 have some hearing loss, whether or not they own it,” says Jan Blustein, M.D., a professor of health policy and medicine at New York University's Robert F. Wagner Graduate School of Public Service, who notes that many were struggling to communicate at the grocery store or in social situations before masks were introduced.
Experts also worry that communication challenges with doctors and other health care practitioners could compromise the quality of health care those with hearing loss receive. Increasingly, clinicians are advocating for the use of clear masks or face shields to allow such patients to be able to see people's mouths — since “lipreading helps with clarity,” Staats says.
"Clear window masks — or face shields — can be useful when people are struggling with hearing or understanding in social or work situations or at doctor's appointments,” Staats says. That said, face shields have not yet been approved by the Centers for Disease Control and Prevention as a substitute for face masks, although some experts say shields may provide decent coronavirus protection.
Having whiteboards or tablets available in a medical setting also can help in a pinch. Virtual visits (as in telemedicine) can be a boon because people with hearing loss can see the speaker's mouth for lipreading and opt for captions with videoconferencing calls, says Michael McKee, M.D., an associate professor of medicine at the University of Michigan in Ann Arbor, who was born with hearing loss.
In or outside of medical settings, those deaf and hard of hearing are helped by others wearing clear masks, McKee says. “It's not the people with hearing loss who especially need to wear masks — it's everybody else,” Blustein notes.
Other ways to surmount sound barriers
Depending on the level of hearing loss, a variety of other tactics can help with communication in the face-mask era. For those with mild hearing loss, it helps to try to eliminate background sounds from, say, a dishwasher or a fan, which can mask the sound signal from someone's voice, Blustein says. Similarly, it's important to turn down the volume on a TV or radio or to close a door in order to shut out noise from an adjacent room.
If you're trying to communicate with someone with mild to moderate hearing loss, it helps to get that person's attention first (perhaps by waving to him or her) and to look directly at him or her while speaking, so that sound is directed toward the person. From there, don't talk quickly — but also don't exaggerate your speech — and make a conscious effort to enunciate clearly and distinctly, Blustein advises. Rather than repeating the same information or speaking more loudly if what you're saying is not understood, rephrase the information and add supporting details so that the person can get a greater sense of context for what you're saying and potentially fill in the gaps he or she missed.
Technology can also make a difference. A handheld amplification device, called a pocket talker, allows people with hearing loss to amplify sound while wearing headphones or earbuds; it's basically an external microphone that you can turn up as you need to. “In a pinch, it's better than nothing, but it will amplify background noise, too,” Staats says. If you wear a hearing aid, custom programs can be added (by your audiologist) to most hearing aids to turn up the volume while people are wearing face masks.
Another option: You can download a speech-detection app (such as Otter.ai, Google Live Transcribe or Interact-Streamer) for your smartphone or tablet that transcribes what's being said into text in real time. If someone who's wearing a mask is talking to you, you'd hold a phone with the app close to his or her mouth (or have the person do so to follow social distancing guidelines), then read what the person is saying on your smartphone screen. “The live transcription apps are capturing live speech and transcribing it on the phone so you can read it while someone is talking to you. It's like closed-captioning on the TV,” Staats explains.
Or you can opt for a sound-amplifying app to turn up the volume on speech around you. But be forewarned: “It will amplify everything around you, including noise. So these are meant for use in one-on-one communication environments,” Staats says.
While there may be trial and error involved, it's important to find strategies and tools that work for you and your loved ones with hearing loss. “Be your own advocate if you're struggling,” Staats says, “and be prepared to ask for help.” Doing so could mean the difference between feeling isolated and engaged in what's happening around you.