Public health experts recommend wearing face masks in public to minimize the risk of COVID-19 infection. But, according to audiologists, face coverings can impair communication, especially for people who have hearing loss and rely on lip reading.
Even among people without hearing problems, effective conversation doesn’t just depend on the ability to hear words, says Alison M. Grimes, AuD, director of audiology and newborn hearing at UCLA Health. Looking at faces and facial expression facilitates communication.
“Virtually everyone who has a hearing impairment uses lip reading without even being conscious of it,” she says. “Even people without hearing impairment use lip reading.”Seeing a speaker’s lips, facial expression and body language allows listeners to pick up extra cues, such as the speaker’s emotion and demeanor.
“Are they OK, angry, concerned, scared? Are they friendly? Are they hostile?” Dr. Grimes says. “We discern all those things without even being conscious of it. We make inferences about the people we’re talking to.”
For people with hearing impairment, discerning conversation when a speaker is masked can be challenging. Early in the start of the COVID-19 pandemic, Dr. Grimes says, she and her colleagues realized that treatment of audiology patients in the office, where everyone wears masks, would require significant changes in communication strategies.
She says some of her patients with hearing impairment have mentioned the challenges they’re facing in the outside world, among colleagues and friends and others who are wearing masks.
But communication may be hitting snags in all corners of American society due to masks, she says. She recommends everyone – with or without hearing problems – practice good communication strategies. That means getting the listener’s attention first by making eye contact and facing the individual (not shouting from across the room or from behind the listener). It also means speaking slowly and beginning a conversation with a tip on the subject of the conversation.
“Among couples or close friends, we have a tendency to holler from another room. That’s often not a good communication strategy,” Dr. Grimes says. “Get someone’s attention first. Say their name first. Let the other person know you’re going to say something. Initiate the topic. Say ‘I want to talk about what we’re going to have for dinner’ instead of ‘Do you want lasagna or mac and cheese?’ Those are basic rules of good communication.”
For people with some hearing loss, these strategies are often a necessity as well as an important courtesy, she says.
And don’t assume that people who use sign language or lip reading to communicate are the only ones who struggle with hearing loss. About 15% of U.S. adults older than 18 report some trouble hearing, according to the National Institute on Deafness and Other Communication Disorders. Only about two-thirds of people who need hearing aids use them, Dr. Grimes says. Moreover, older adults and people who don’t speak English as a first language may have an especially difficult time communicating in the face-mask era.
“We know there is a tremendous number of people who have hearing loss who don’t wear hearing aids,” she says. “One can’t make an assumption about the person’s ability to hear well.”
Despite the challenges, don’t remove your mask in order to permit lip reading or improve communication, she says. Protection from COVID-19 infection should be the first priority.
However, people who converse regularly with a hearing-impaired individual can consider purchasing transparent face masks. They can be purchased from online retailers, although some products may be on back-order. The masks are typically made from a clear, impervious plastic that won’t fog or become saturated.
Face-shields are a good alternative, permitting full view of a person’s facial expression and lip movement.
Finally, if you find it difficult to make out conversation when the speaker is wearing a mask, consider getting a hearing consultation – particularly if you’re 50 or older. You could benefit from hearing aids or strategies to improve communication.
“Everybody when they hit their 50th birthday should make an appointment and see an audiologist,” Dr. Grimes says. “Get your hearing tested every two to five years. Virtually everyone eventually develops some hearing loss.”