Opaque face masks harm communication by preventing speech-reading (lip-reading) and attenuating high-frequency sound. Although transparent masks and shields (visors) with clear plastic inserts allo...

The objective was to measure the effect of various face masks on speech recognition threshold and the word recognition score in the presence of varyin…

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To overcome the effect of face masks for hearing aid users Wearing a face mask during conversation has become commonplace to deter the spread of the COVID-19. Face masks, however, attenuate the high frequencies of the speech of the person wearing the mask. This presents a challenging problem for the hearing-impaired community for whom the […]

Face masks muffle speech and make communication more difficult, especially for people with hearing loss. This study examines the acoustic attenuation caused by different face masks, including medical, cloth, and transparent masks, using a head-shaped loudspeaker and a live human talker. The results suggest that all masks attenuate frequencies above 1 kHz, that attenuation is greatest in front of the talker, and that there is substantial variation between mask types, especially cloth masks with different materials and weaves. Transparent masks have poor acoustic performance compared to both medical and cloth masks. Most masks have little effect on lapel microphones, suggesting that existing sound reinforcement and assistive listening systems

The use of face masks in public settings has been widely recommended by public health officials during the current COVID-19 pandemic. The masks help mitigate the risk of cross-infection via respira...

The purpose of this article is to help audiologists and others navigate the considerations for transparent face coverings. Specific commercial products are indicated in this article; however, they do not represent endorsement by the authors. Because of COVID-19 and broad mandates to wear face coverings, there are numerous local, state, and national conversations regarding communication access for individuals who are deaf and hard-of-hearing (DHH) in school, hospital, and public settings. Although there was an initial shortage and concerns about meeting global demands, we have witnessed, in a short period, rapid production of various types of masks and shields intended for use by either the public or health workers, including masks with clear (transparent) windows.  The major problem is that typical masks (cloth or medical) present an obvious visual barrier to those who depend on nonverbal communication cues on the face (e.g., mouth, lips, teeth, tongue, and cheeks) (Gardino et al 2008; Atcherson et al, 2017; Atcherson and Finley, 2019; Elby et al., 2020; Baltimore and Atcherson, 2020). Indeed, both linguistic and nonverbal information are important for understanding social communication and interaction (Rieffe and Terwogt, 2000; Most and Aviner, 2009). In a timely publication concerning medical masks, Goldin et al (2020) reported acoustic degradations where medical masks act as lowpass filters and high frequencies between 2000-7000 Hz are attenuated by about 3-4 dB for simple surgical masks and up to 9-12 dB for N95 masks. They cautioned that these reductions would prove challenging for DHH individuals when listening to speech in background noise and in reverberant (echo-like) settings—especially with advancing age and greater likelihood of hearing loss.  Gardino et al. (2008) recorded passages by a male speaker wearing a mask and presented those with and without pre-recorded dental office noise to listeners with normal hearing and moderate hearing loss in an audio only format. When the passages were presented in quiet, the simple surgical mask did not influence speech understanding. Not surprising, however, the dental office noise did have a detrimental effect on speech understanding. These authors considered the possibility that listeners with greater degrees of hearing loss might have more difficulty with masks as the reliance on visual cues increased. Atcherson and colleagues (2017; 2019) conducted the first comparison of the standard surgical mask with a prototype transparent mask (prototype FaceView mask) and found that the transparent mask improved speech understanding in noise by making the lips and mouth visually accessible. In their studies, listeners in both the moderate and severe-to-profound hearing loss groups benefited, with the greatest magnitude of benefit observed for the severe-to-profound group. None of these studies, however, have considered the impact of transparent masks and their use with or without face shields.  In terms of the availability of transparent medical masks, the demand has far exceeded the supply. There are likely to be further supply challenges for these items as many schools and universities anticipate reopening. One commercially available transparent medical mask that has been around for nearly two years is The Communicator by Safe ‘N’ Clear, which is a Food and Drug Administration (FDA) Registered ASTM Level 1 surgical mask.  Safe ‘N’ Clear has experienced a surge in orders, and they carry a backlog. They hope to meet the demand as quickly as they can. The only caveat about The Communicator is that it is not an N95-style mask that would be safe enough to use with COVID-19 patients. Not too long after COVID-19 arrived, two other transparent options became available. They include the Humanity Shield by Rapid Response PPE (i.e., personal protection equipment) and The Clear Mask, neither of which are FDA registered.  The Humanity Shield includes a full-face shield with draping fabric to cover the sides of the face and below the chin and can be used with a mask underneath. The Clear Mask is a face shield that covers the nose and mouth, but not the eyes. The manufacturers of these two newer offerings are also taking orders as well and may be delayed in production as demand surges. Therefore, those awaiting viable transparent mask options are looking for acceptable alternatives and safe PPE combinations, such as cloth coverings (with and without transparent options) and face shields. TABLE 1 lists some of the transparent masks and face shields relevant to this topic. The reader will note that there are a variety of transparent cloth masks sold by various vendors, including patterns to try to make your own. TABLE 1. Transparent Mask and Shield-Like Coverings to Date MANUFACTURER DESCRIPTION Safe ‘N Clear Transparent Surgical-Style Mask (FDA Registered), available but backordered Rapid Response PPE Face Shield with Drop Cloth ClearMask Face Shield for Mouth and Nose FaceView Transparent Respirator-Style Mask, not commercially available LEAF Mask Transparent Mask (FDA Registered), not commercially available HelloMask Transparent Surgical-Style Mask, not commercially available Various Cloth Masks Commercial and Do-It-Yourself Transparent Cloth Masks by Catharine McNally and Dr. Tina Childress Preliminary Data on Masks and Masks Plus Shields The avalanche of interest in transparent face coverings has us wondering about the possible effect of transparent masks and/or face shields on speech acoustics. Recently, we collected preliminary data on some masks available to us (e.g., standard surgical mask, KN95 mask, N95 mask (vented), prototype FaceView transparent mask, Safe ‘N’ Clear’s transparent surgical mask, and handmade transparent cloth mask). We presented white noise through a fabricated loudspeaker manikin head, and we recorded the output from 6 feet in a double-walled sound booth.  TABLE 2. Maximum Sound Pressure Level Reduction (in dB) for Masks Only and Masks Plus Shield Compared to the No-Mask Condition DEVICE MASK ONLY MASK + SHIELD Surgical Mask 5.0 dB 20.0 dB KN95 Mask 8.7 dB 29.2 dB N95 Mask 10.9 dB 28.7 dB FaceView Mask (transparent window) 12.0 dB 24.9 dB Safe ‘N’ Clear Mask (transparent window) 13.3 dB 24.7 dB Transparent Cloth Mask 21.2 dB 29.2 dB   TABLE 2 shows the maximum SPL reduction (in dB) of the different mask types as well as each mask type in conjunction with a standard face shield when compared to the no-mask condition. With minor exceptions, our preliminary data closely mirror the results by Goldin et al. (2020), and the presence of the face shield had the most dramatic effect. On average, the presence of the face shield produced total reduction by as much as 29 dB! Also surprising is that each of the three transparent masks attenuated more than their non-transparent counterparts, and they also produced a resonant peak somewhere between 5000 and 7000 Hz. FIGURE 1. Standard surgical mask with (orange line) and without (blue line) a face shield. White line is the reference ‘no-mask’ condition. From upper to lower y-axis, decibels (dB) are arbitrarily reported from high intensity (-20 dB) to low intensity (-80 dB).  This resonant peak is believed to coincide with vibrational distortions produced by the film. As examples, FIGURES 1 THROUGH 3 illustrates visually how some of the masks with and without a face shield perform. In these figures, the y-axis is reported arbitrarily in SPL from high intensity (-20 dB) to low intensity (-80 dB). The white line, representing the no-mask condition, has the highest SPLs. The blue line, representing the masks only condition, has the next highest SPLs. Finally, the orange line, representing, the mask plus shield condition, has the lowest SPLs. These levels can now be compared to the data reported by Goldin et al (2020). Conclusion Although transparent masks were shown to reduce SPL and conceivably further degrade speech more than their non-transparent counterparts, they play an important role in preserving nonverbal communication cues on the face. FIGURE 2. Safe ‘N’ Clear transparent mask with (orange line) and without (blue line) a face shield. White line is the reference ‘no-mask’ condition. From upper to lower y-axis, decibels (dB) are arbitrarily reported from high intensity (-20 dB) to low intensity (-80 dB).   Without a doubt, transparent masks used with or without shields help maintain access to the mouth, which can help to aid some listeners with lipreading and other nonverbal cues, such as emotion (McIntosh and Howell, 2020; Atcherson, 2020; Most and Aviner, 2009). However, it is also possible that the degradation of speech acoustics outweighs the supplementation to speech understanding provided by any transparent windows.  Additionally, new knowledge about further sound pressure reductions by transparent masks, with or without shields, raises several considerations: Do we use more vocal effort with different types of mask materials? Are we exaggerating our speech through certain types of mask materials? Does speaking with a mask cause our masks to shift, requiring repeated adjustments? Subsequently, do we enunciate less to reduce mask shifting? FIGURE 3. Transparent cloth mask with (orange line) and without (blue line) a face shield. White line is the reference ‘no-mask’ condition. From upper to lower y-axis, decibels (dB) are arbitrarily reported from high intensity (-20 dB) to low intensity (-80 dB).   Do we speak less loudly when we wear shields (sound reflection back towards our ears)? What is the effect on listening with increased distance between two people talking while wearing masks and/or face shields?   Are all people good at reading nonverbal cues? Does communication with non-transparent masks increase cognitive effort and fatigue? Do hearing aids and implantable devices compensate or adjust to mask-related decibel changes? Is there any value in considering supplemental acoustic ac...

We research, test, and share information about mask materials and designs intended for use as stop-gap solutions to address the COVID-19 crisis.

Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

Face shields may be an alternative to masks for those returning to work or heading out on errands as Canada gradually opens its economy and public places amid the ongoing threat of COVID-19.

People are wearing masks to help slow the spread of coronavirus (COVID-19). Some toddlers and young children may feel uneasy about masks. Here's how to reassure your child.

With caregivers' faces covered, infants and young children will miss out on all the visual cues they'd normally get during stages of rapid developmental growth.

Experts are hopeful.

Editor's Note The authors of this article, published in 2015, have written a response to their work in light of the COVID-19 pandemic. We urge our readers to consider the response when reading the article. Objective The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks. Setting 14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam. Participants 1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards. Intervention Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks. Main outcome measure Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection. Results The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%. Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated. Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12610000887077.

Health care workers are exposed to potentially infectious airborne particles while providing routine care to coughing patients. However, much is not understood about the behavior of these aerosols and the risks they pose. We used a coughing patient simulator and a breathing worker simulator to inves …

Doctors are suggesting a "simple and affordable face shield, if universally adopted," might be a great complement for testing, tracing & hand washing.

This Viewpoint discusses the prospect that face shields might be more effective than face masks at reducing community SARS-CoV-2 transmission and calls for rapid adoption of face shield-wearing by the public as an infection control strategy.

Tested 30 materials for homemade masks.

This is an unprecedented time, but with preparation and attention to detail, we can continue to safely care for our patients, our profession, and ourselves. Re-opening your audiology practice after the COVID-19 pandemic can be both exciting and stressful for you and your patients. Being able to offer audiological services in a safe manner will be a step in the right direction to achieving our “new normal,” will reinstate some form of revenue for your practice, and most importantly, will bring much-needed service back to your patients who rely on their hearing to stay in touch with their family and friends, now more than ever. Keep up to date with frequent reviews of the Centers for Disease Control and Prevention (CDC) website and keep a close eye on your professional associations. Recommendations and information are updating faster than it can be published (Cavitt, 2020; Kornak, 2020). Review the following steps and fine-tune them for your situation to stay calm and confident as you step back into your practice. Before Opening Your Practice Allow your patients to know what you have prepared to keep them as safe as possible. This knowledge will help them feel more comfortable and keep their appointment. Post this on your website and e-newsletters. Ask your front staff to relay this information when scheduling and confirming appointments. Be prepared with at least one facemask per staff member per day and enough gloves to have a new set for each patient. Consider using facemasks with clear portions to allow your patients who are deaf and hard-of-hearing to use speechreading cues during your appointment. Prepare your staff with your new schedule and routines. Give your staff advance notice for any changes to your schedule, routines, or protocols. Knowledge will allow them to feel safer and open the door to ask questions or offer suggestions. Prepare your waiting area to ensure safe social distancing. Keep chairs at least 6 feet apart. Have only a few chairs available to discourage lingering. Mark 6 feet increments anywhere that a line may form, such as check in and check out. Supply hand sanitizer and/or a sink with soap for patients to wash their hands. Post information on teleaudiology services and related technology so patients can familiarize themselves with it while they wait. Before Appointments Reduce your case load to allow for thorough cleaning between patients. Resist the urge to fill your schedules with the same volume as before the pandemic. You will need extra time to thoroughly clean between each and every patient, and this will be more stressful if you have a waiting room full of patients who must stay 6 feet away from each other (Cavitt, 2020). Consider bringing half of your staff at first, with two booths or work areas prepared in case there is a backup of patients. You can move a patient into your second workspace to get them out of the waiting room while you clean the first area. Your workspaces should be prepared ahead of time by removing as many surfaces as possible. Follow your clinic’s cleaning protocol from before the pandemic, knowing that current hospital-grade cleaning processes and supplies are adequate. Remember that COVID can live on metal surfaces for 8-12 hours and porous surfaces for a few hours, so allowing time for your cleaning protocol between patients is critical (Chandrasekhar, 2020). Pre-screen your patients over the phone the day before their appointment. The screening must include, at minimum (Chandrasekhar, 2020): “Have you lost your sense of taste/smell, even if only temporarily?” “Do you have a fever at or above 100.4˚?” “Have you been exposed to anyone who has or may have COVID-19?” If the answer is yes to any of these questions, the patient should be referred to their primary care provider, and the appointment should be cancelled. Use this time to remind the patient of your policy on bringing others to the appointment. Allow only one family member into the appointment, including the waiting room, and only if the patient is underage or requires a guardian. Ask them to arrive on time, but not early, to reduce the likelihood of groups forming in the waiting area. Remind patients of teleaudiology options to consider now and in the future. On the Day of Appointments Screen patients for COVID symptoms before coming into the office. Ask the same questions as the pre-screen, take temperatures, and provide face masks. Be prepared with a referral plan if anyone does not pass this screening. Do not allow unnecessary people, including clinicians, students, and non-essential family members into the workspace. Only allow one necessary family member into the appointment if the patient is underage or requires a guardian. Do case history, give instructions, etc. with at least 6 feet between the clinician and patient as much as possible. This might mean having conversations with the clinician in the hallway, on the control side of the booth, or talking over headphones. All parties, even young children, should wear masks during this and all portions of the appointment. If a child can do conditioned play audiometry, he or she can wear a mask. It should be noted that with masks, interaction within 3 feet is considered safe by the CDC if both parties are not known COVID positive (CDC, 2020). The clinician should be prepared to have a mask, gloves, and eyewear on at all times. Between each patient, the clinician must discard their gloves, thoroughly wash his/her hands, and replace gloves. The clinician should wear some type of eye covering, even if this is typical glasses. If available, the clinician should wear scrubs that he/she changes into at work and out of before leaving. Gowns are not necessary (Chandrasekhar, 2020). If scrubs are not available, the clinician should bring extra clothes in a bag to change into at work and out of before he/she leaves. After Leaving the Practice Shoes should be removed before the clinician enters his/her house. COVID can live on shoes for several hours (Chandrasekhar, 2020). Operating room booties are not necessary. The clinician should shower immediately once he/she arrives home from work. Continue teleaudiology and distance services. You want to keep in-person contact at a minimum while still serving your patients. Consider curbside drop off and pickup for hearing aid, implant, and accessory cleanings and repairs. Become comfortable with remote hearing aid programming via software that is built into many hearing aids already. Prepare videos and e-references for patients to consult from home to troubleshoot their devices with your guidance over a teleaudiology platform. Share your successes and challenges with your colleagues. There are many creative and business plans evolving through this worldwide pandemic (Kornak, 2020), and we should aim to work together for the good of our patients. Now more than ever, we can be stronger together. Conclusion This is an unprecedented time, but with preparation and attention to detail, we can continue to safely care for our patients, our profession, and ourselves.

This Viewpoint discusses the prospect that face shields might be more effective than face masks at reducing community SARS-CoV-2 transmission and calls for rapid adoption of face shield-wearing by the public as an infection control strategy.

OG Description

Audiologists recommend enhanced communication strategies in the time of coronavirus to help the nearly 60 million Americans living with hearing loss in one or both ears.

ClearMask™ is the first fully transparent face mask optimized for maximum clarity and comfort: making connections more human and providing clearer communication for all.