Face masks, hearing loss and hearing aids

Face masks and other personal protective equipment (PPE) help protect us from the coronavirus and other infections, but they add communication challenges for everyone, especially people who are hard of hearing. That's because:

• Face masks lower the volume of a person's speech and slightly garble it.
• Face shields, social distancing and plastic barriers further muffle or reduce sound.
• Face mask ear loops may tug on your hearing aids and cause other problems.
• You can't rely on lip reading clues and other facial movements that help you understand speech and emotion.
• You can accidentally pull out a hearing aid when removing a mask. (If this happens to you, here's what to do if you lose a hearing aid.)

How face masks affect communication, speech and hearing

Face masks reduce volume and clarity of speech

Depending on the type of face mask, they may reduce the clarity of speech and lower it from anywhere to 5 to 15 decibels (dB). In other words, speech is not just quieter, it's more muffled. 

Which type of mask muffles speech the least?

The trick is selecting a mask that doesn't dampen your voice too much, protects you from the coronavirus AND if you have hearing loss, works well with your hearing aids or implants. That's a lot for one mask to provide. Research from the University of Illinois at Urbana-Champaign shows that, sound-wise, single-use surgical masks (the blue ones) and KN95 respirators both dampened sound only a little (about 5 dB) and can filter out small particles. Cloth masks provide less protection from viral particles but perform best "acoustically," the researchers noted.

Interestingly, face masks with clear plastic windows—the very kind often recommended for communicating with people who are lip readers—reduced the volumed of the speaker's voice the most. "Talkers who use clear masks—or any masks—should consider using a sound reinforcement or assistive listening system to improve audibility and reduce vocal fatigue," the researchers stated. "Communicating during a pandemic is already stressful enough; we should not have to worry about being heard."

Social distancing and protective barriers make it harder to hear

Communication is also made more challenging by the standard social distancing recommendation to stay fix feet apart. We're also more likely to encounter barriers in public settings that protect workers from respiratory droplets and aerosols, such as large plastic dividers when you check-in at a doctor's office. These may protect us from infection, but they further reduce the volume and clarity of the speaker in front of you.

"These necessary precautions can be exhausting—especially for individuals with hearing loss who may depend on lip-reading to communicate," said Dr. Debra L. Tucci, Director of the federal Institute on Deafness and Other Communication Disorders (NIDCD), in a blog post about the challenges posed by face masks.

A now-universal experience

The upshot? The worldwide impact of COVID-19 means these changes and their resulting challenges are universal experiences. By now nearly all of us—even those of us with normal hearing—have had to ask a person with a mask to repeat themselves or to speak up. 

Hearing loss and face masks

If you have hearing loss, asking someone to speak up may not help. Louder speech bordering on shouting can actually hurt your ears, due to a phenomenon known as hearing loss recruitment. Instead, you should adjust your hearing aids and learn other best practices for communicating. 

By now nearly all of us have had to ask a person with a face mask to repeat themselves or to speak up. 

'Face mask mode' on your hearing aids

If you wear hearing aids, you may be able to adjust them to account for the affect of face masks on speech.

Several manufacturers issued updated settings known as "face mask mode" that you can control via your device's smartphone app. These brands include Signia and Starkey. Oticon, a major manufacturer, also released this guide for providers.

If you're not sure how to adjust your hearing aids yourself, don't worry. You can ask your hearing care provider to adjust them to account for how speech volume and clarity is affected by people wearing face masks.

Tips for wearing hearing aids with a face mask

If you wear behind-the-ear hearing aids, you may encounter problems trying to wear a standard face mask with elastic ear loops. The loops may tug at the wire or tube that goes from the body of the hearing aid down to your ear. You also may inadvertently pull your hearing aids out and lose them when removing your mask. What's a hearing aid wearer to do? 

• Fabric ties may work better as they are adjustable and don't tug as much as elastic ear loops
• Mask holders or extenders can relieve your ears from the double (or triple!) duty of holding up your face mask, hearing aids, and eyeglasses
• Some masks clasp at the neck instead of the ears (similar to gaiters but shorter) 
• Always remove your mask carefully so you don't accidentally yank your hearing aids out

Because there are so many types of hearing aids and face masks, we recommend you reach out to your hearing care provider who may have solutions they've come up with from talking to other patients.

Mask extenders and hearing aids

Mask extenders are a great way to get a snug fit without dislodging your hearing aids and/or eyeglasses. Options include:

• Using a fabric or bendable plastic mask extender with buttons or other notches to attach the mask straps 
• Using simple tools like plastic s-hooks for straps
• Use a cord-and-clip system, such as Ear Gear or Earstay to secure hearing aids 
• A ponytail or bun can also be used as a loop anchor

More: Hearing aids and eyeglasses: Tips for a comfortable combo

How to communicate when wearing a mask

Face masks lower the volume of a person's voice, and they muffle speech clarity. Follow these tips, especially when talking to someone with hearing loss, to improve communication:

• Reduce the room's noise and get the person's attention
• Ask if the person can hear you 
• Speak slowly and clearly 
• Do not shout
• Make sure hearing aid wearers are using them
• Consider using a portable hearing aid amplifier, especially if you're in a medical setting where communication is very important
• If you're not understood, try to rephrase what you said with different words 
• Take turns while speaking 
• Do not talk while walking or looking away

"Speakers often naturally try to compensate by projecting, but a more effective approach is to speak more clearly, with greater enunciation," explains Nicole Marrone, PhD, associate professor in Speech, Language, and Hearing Sciences at the University of Arizona.

When out in public, such as at a shopping trip, these tips can't always be followed. But, for example, if you and your spouse are both wearing masks, make sure your spouse is aware they must speak more slowly and clearly to you. And speak up for yourself when talking to strangers, letting them know you can't hear well and need them to speak more clearly and slowly. 

If you're the one trying to speak to someone with hearing loss, "use some creativity to get your meaning conveyed, instead of repeating the same misunderstood phrases over and over again," recommends Dr. Mandy Mroz, AuD, president of Healthy Hearing. "Don't underestimate the power of body language, eye contact and slowing down speech to be more clear."