Research I Can Hear and See You When You Wear a Surgical Mask! Samuel R. Atcherson, Ph.D

I Can Hear and See You When You Wear a Surgical Mask! By Samuel R. Atcherson, Ph.D.

The surgical face mask is commonly worn in hospitals and other healthcare settings. Its purpose is to provide a protective barrier between the healthcare worker and the patient against airborne liquid droplets during talking, coughing, or sneezing, as well as offering some protection against bodily fluid splashes. While these surgical masks appear to be just paper, they are made with fabric that is breathable and blocks small particles often invisible to the naked eye.

But what happens when the patient has a hearing loss in the healthcare setting? Or, what if it’s the other way around and the patient has to wear a mask, while the healthcare worker has a hearing loss? In these situations, the surgical mask now imposes a visual barrier to speechreading (lipreading). It blocks access to the lips, mouth, and teeth.

It is this communication issue that has motivated the Association of Medical Professionals With Hearing Losses (AMPHL) to solicit solutions. My involvement in this issue began when I first joined the AMPHL 8oard of :_h[Yjehi in 2001 j^hek]^
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and I learned a great deal from the early groundwork of Stacy Cordwell Carroll, RN, Ph.D., a nurse practitioner with a hearing loss. She had written about being able to speechread the words of a patient who could not use her voice to if[Wa. Around this time, I came across an old clipping from a June 1938 Modern Mechanix magazine featuring a nurse wearing a clear mask alongside the headline, “Surgical Mask Made From Transparent Material.” You might think that after all this time, a transparent mask would be commonplace, but that’s not the case.

I began my first research study in the mid-2000s with my colleagues Lisa Lucks Mendel, Ph.D., and Julia Gardino, Au.D. In that study, we explored whether the conventional paper mask distorted the sounds of speech and how well listeners with and without typical hearing could understand recorded sentences against a background of recorded dental office noise. This paper was published in 2008 in the Journal of the American Academy of Audiology.

Visual Cues The 2011 AMPHL conference in Portland, Oregon, was when I first met Jeanne Hahne, RN, MSN, who presented on her vision and invention of a transparent mask. Jeanne wanted to make the healthcare environment friendlier for children who would be able to see the smiles of those wearing the mask. She also realized that such a mask would remove communication barriers for individuals with hearing loss and for individuals who work in noisy settings. Years later, I asked Jeanne if I could study the acoustics and speech understanding of her invention, and that resulted in another publication with :h$
Lucks Mendeb and some audiology students and research associates. In that study, we added a third group of listeners who had severe-to-profound hearing loss, and because of the transparent mask, we were able to compare the groups with no mask, with a conventional mask, and with a transparent mask in both audio-only and audio-visual conditions. This paper was published in 2017, also in the Journal of the American Academy of Audiology. In 2017 , Jeanne and I received a technology grant from the National Institutes of Health. We proposed that there was a need to improve communication, minimize communication-related medical errors, and increase patient satisfaction, and that this could be done through the use of a transparent surgical mask. Jeanne worked with a manufacturer to further refine the invention, now called FaceView Mask. I have since completed two additional research studies. The first study was to repeat the 2017 study, but with the FaceView Mask specifically, and the second study was to give some health professionals and student trainees the opportunity to provide their feedback while using the FaceView Mask in real world or simulated clinical settings. Results are underway and will hopefully be published in the near future. (FaceView is the mask that we used in our research, but it is not the only transparent mask available.)

Studying the Effects Combined, our studies have revealed a number of interesting findings. First, the conventional paper and transparent masks do affect the sound quality slightly, but not enough to affect speech understanding. Typical hearing listeners generally performed quite well whether there was no mask, the conventional mask, or the transparent mask even when noise was also present.

24 hearing health hhf.org photo credit: ben krain, university of arkansas little rock communications

For listeners with moderate and severe-to-profound hearing loss, access to the lips, mouth, and face with the transparent mask improved speech understanding compared with the conventional mask.

The greatest improvement, on average, was seen among patients who have severe-to-profound hearing loss, as the clarity of sounds typically diminishes with the severity of hearing loss.

Also, I was reminded during these studies that not all individuals (with or without hearing loss) can speechread at the same level! Granted, the individuals participating in my study had to repeat standardized sentences with noise presented in the background, as well as in a sound booth. However, in healthcare settings where communication is crucial, I believe that the transparent mask removes a critically important communication barrier. While it seems obvious that a transparent mask can help some individuals with hearing loss through speechreading, there are benefits for other communities. I know that some Deaf individuals who communicate primarily through sign language may use speechreading cues as a supplement to spoken language. Interpreters for individuals with hearing loss see value in the transparent mask whether or not they use sign language, or when their clients have different proficiencies in sign language. And in noisy environments, listeners with typical hearing rely on facial cues and speechreading to supplement what they hear, even if they aren’t aware they are doing it.

What about people who come from different parts of the country or the world and speak differently? What about trying to understand someone who speaks softly, or at a pitch that is hard to understand? Or individuals with speech impairments? A transparent mask can supplement communication here as well.

Hearing loss or not, visual access to all parts of the face is also likely to help improve recognition of how the person wearing the mask is feeling. For all patients, regardless of age, seeing anyone with a smile can put them more at ease in an already scary and stressful environment.

Better Communication As I reflect on the work my colleagues and I have been doing over the past decade, I am excited about the transparent mask. I am also excited because I myself have a hearing loss, and I worry about being put in a compromising position where I might not be able to speechread.

I have already experienced dental hygienists, dentists, nurses, and surgeons wearing conventional masks and

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mask.

I have struggled to understand them, especially when there is noise in the background. I know I have trouble with the way some people speak because of their accents. I can also imagine how frightening conventional masks can be for children and individuals with cognitive impairments in healthcare settings. As W
h[ikbj, I am also looking at amplified stethoscopes and how well they do or do not pick up sounds from the heart or lungs, and how amplified stethoscopes can be successfully used with hearing aids or cochlear implants worn by healthcare professionals or medical students.

The goal is to provide strategies for using these various tools effectively. I believe in a future world where we can eliminate as many communication barriers as best we can.

Samuel R. Atcherson, Ph.D., is a professor in the department of audiology and speech pathology and the department of otolaryngology–head & neck surgery at the University of Arkansas for Medical Sciences. A past contributor to Hearing Health magazine, he is an audiologist and researcher with a lifelong hearing loss. For references, see hhf.org/winter2020-references.

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