After businesses started reopening in Dane County, Jack Spear wanted to get a haircut. He went to the same salon he’s been visiting for years, and like all hair professionals these days, his stylist wore a mask during the service. Her voice was muffled, and along with the background music playing in the salon, Spear was not able to hear what she was saying.
Spear is hard of hearing (HoH), and if those were his only auditory challenges, he still would be able to hold a conversation. He has expert lip reading skills. But the mask prevented him from seeing her mouth to watch her form words. In the end, he just told her that he wanted “the usual” and continued through the appointment without being able to communicate.
"I do not like this loss of independence, but to some degree perceive it as one of the consequences of COVID-19,” he said.
“Masks cover critical cues that those who are HoH rely on to distinguish speech and expressions of the speaker,” said Veronica Heide, a Madison audiologist with over 25 years in practice. “Today we refer to the holistic process of seeing facial expressions and lip reading to communicate as speech reading.”
Only 30% of sounds in English are visible on the lips, so for people who are HoH, the capacity to see the speaker’s face is important in distinguishing between words like “beer” and “cheer.” The speaker’s face also communicates mood and intent. Is the person mad? Happy? It all makes a difference in interpreting speech.
In a study about medical masks degrading speech reception published in the April issue of the journal Hearing Review, researchers found each type of medical mask essentially functioned as an acoustic filter for speech. “The speech quality degradation, in combination with room noise/reverberation and the absence of visual cues, renders speech close to unintelligible for many patients with hearing loss.”
Studies have shown that when two people in close proximity both wear masks, the rate of transmission of COVID-19 drops significantly, and the Centers for Disease Control and Prevention has recommended that everyone cover their face whenever social distancing is not possible. As Dane County reopens and people come in closer contact again, wearing masks will be common, if not required. But while protecting ourselves from COVID-19, what is being lost in our ability to communicate with each other?
Spear, who is the chair of the Madison chapter of the Hearing Loss Association of America, said that effects of masked communication will vary widely, mostly because being HoH is not a static condition. All of us move on continuums of personal identity related to hearing.
“Sometimes I function like a hearing person and sometimes like a deaf individual,” said Spear. “Even hearing people at times are unable to hear well, and HoH people vary greatly depending on circumstance. The basic reasons are rooted in environment (light, noise, distance, visibility, etc.) and intrapersonal, meaning that some people are more patient than others. Some people are uncomfortable and some are not, some are witless and react according to stereotypes, and some are hearing but ‘get it.'”
Heide recommends anyone having a hard time understanding masked speech ask the person to text or email critical information. In an office setting, ask the person to type what they are saying in a font size that is easy for you to read while you are at a safe distance.
“There are apps that transcribe voice to text such as Otter, Ava, and Evernote, but it means getting your phone close to the person who is talking and then taking it back to read what they are saying. Which may be OK if it’s a close family member, but not OK if it’s a stranger. Writing information down on a notepad, notecard, or dry erase board is a low tech but effective solution.”
Many of the people experiencing complications from COVID-19 are older, where age-related hearing loss is not uncommon. If patients are hospitalized, they may be away from family members, suffering from multiple chronic conditions, and without hearing assistance. This population is increasingly vulnerable to communication problems in hospitals, emergency departments, and intensive care units — settings where communication can be a matter of life and death.
Dr. Anne McIntosh is the founder and CEO of Safe ‘n’ Clear which produces the Communicator, a surgical mask with a clear window. Many of these medical settings are the ones buying these masks, like health care clinics, hospitals, and doctors, as well as public-facing companies like airlines and retail stores.
“The question is not if but when will you run into a visual communicator,” McIntosh said. “If we can see that smile, we can better understand what the other person is trying to communicate. Reducing medical errors that are attributable to communication breakdown can improve patient outcomes. We see so many benefits to switching to transparent face masks. Masks have not really changed much since their inception; the clear window allows clearer communication while still providing protection.”
“It is vital that both the recipient of services and the provider of services be aware of what the specific needs of the individual are at that time,” said Spear. “Too often providers make snap judgments based on stereotypes such as ‘I will just speak louder’ or ‘it’s just a hearing loss, nothing more’ or ‘all deaf people require an interpreter and it is out of my hands.’”
He continued, “It is vital that the person with a hearing loss be aware of what their legal rights are with respect to appropriate access to services. Some may need sign language, others may need to use an assistive device such as speech to text, and others may need a very quiet location along with patience and clear speech.”
Videoconferencing has become both vital to business and a key social outlet for many people maintaining distance from others. However, the same technology that fosters communication can become frustrating for some people who are hard of hearing.
“I have had several tearful calls from patients who were so excited to be included on the family Zoom only to find that they could not understand what was being said. Poor internet connection, person not talking into the microphone or camera, children talking while moving around the room, speaking too fast, music on in the background, not using clear speech,” said audiologist Heide.
“Hearing loss disrupts communication and isolates people from friends and family even without the COVID-19 pandemic,” said Heide. “Accessibility is a legal obligation under the Americans with Disabilities Act. People who are hard of hearing need to educate and advocate for their rights to access the tools that they are entitled to have to effectively communicate.”
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