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Face masks are a challenge for people with hearing difficulties

The use of face masks by the public is a controversial topic and not supported by the World Health Organization. Evidence suggests that while face coverings and surgical masks can prevent large particles spreading from an infected person wearing a mask to someone else, they don’t trap tiny particles such as coronavirus.

A mask may also increase a person’s risk of contracting COVID-19 by encouraging them to touch their face as they fit and adjust it. Exhaled air can irritate the eyes, which might also tempt the wearer to wipe them.

On the other hand, wearing a mask may stop people with coronavirus spreading it to others (although the evidence for this is currently weak). As governments search for a surefooted transition to whatever the new norm will be, there is a danger that a policy of encouraging the public to wear face masks may precede the evidence.

Unintended consequences

It’s important to consider some of the unintended consequences. Wearing a face mask may impair the ability for some people to communicate with ease because it prevents lip reading and it can reduce the level of speech transmitted from the mouth.

At the very least, removing visual cues can make communication more taxing because of the mental exertion required to listen, especially when there is background noise. As a result, even if a person can follow what is said, they have fewer mental resources left to think about and recall what they heard.

Research has shown there are beneficial effects of wearing surgical masks made from a transparent material that allows the mouth to be seen, but these aren’t widely available. And there have been calls for the public to use transparent face shields, rather than masks, which may offer a solution. But the public has yet to adopt this solution.

The increased effort needed to listen and communicate is exacerbated in people who have a hearing loss. According to the WHO, there are 1.33 billion people globally with hearing loss.

Hearing loss leads to communication difficulties between family members, colleagues and friends. It is associated with negative factors such as poor social interactions, isolation, depression and anxiety, increased risk of dementia and reduced quality of life. In fact, there are probably many people with hearing loss who were able to manage but would struggle with the widespread use of masks.

Mask misery

An unintended consequence of wearing a face mask might be that social distancing is replaced with social isolation and poor mental wellbeing in older adults with hearing loss. A huge section of society could be subjected to mask misery.

It is also not clear whether wearing a face mask provides a false reassurance about risk reduction (encouraging people to relax behaviours that are known to interrupt transmission, such as keeping at least two metres apart), or if it acts as a reminder to steer clear of people.

Coronavirus tends to take a more severe form in older people, many of whom are likely to suffer from hearing loss. This means that those admitted to a hospital are especially vulnerable.

The N95 and FFP3 respirator masks for frontline health and care workers can filter 95% of tiny particles, but they are much more likely to distort and reduce the level of speech. This makes communication particularly difficult at a time of heightened anxiety and when the content of conversations is novel and unpredictable. Imagine the apprehension of being greeted by someone in full PPE wearing a fitted mask and muffled speech competing with the hiss of oxygen from a breathing mask or nasal cannula.

Communication in hospitals can be particularly difficult at this time. Stephanie Lecocq/EPA

Practical advice for the hard of hearing

So what can you do to improve communication if you have a hearing loss and are confronted by someone wearing a face mask?

  1. Ask them to reduce the background noise as much as possible or move to a quieter location.

  2. Ask them to talk slowly and not shout.

  3. If you have a hearing aid, make sure to wear it.

  4. Some hospitals provide portable hearing amplifiers to help with communication if you have lost your hearing aid or it has stopped working.

  5. If you don’t have a hearing aid but need one, you can always download a hearing aid app to your mobile phone that can provide amplification to improve speech understanding. Or you can find an app that translates speech into text in real-time.

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