Facemasks risk social isolation for hard of hearing, warns professor

The use of facemasks to limit the spread of COVID-19 could replace social distancing with social isolation for people with hearing difficulties, a University of Manchester professor has warned.

Professor Kevin Munro says though masks may prevent the wearer from infecting others, they may prevent lip/speech reading and impair speech transmission.

The audiologist makes 5 suggestions to improve communication if wearing a face mask is unavoidable, which are:

  1. Reduce background noise as much as possible.
  2. Talk slowly, and don’t shout.
  3. Wear your hearing aid.
  4. Consider using portable hearing amplifiers if available.
  5. Hearing aid apps can provide amplification or translate speech into text in real time.

Around 1 in 6 adults in the UK have hearing loss, the leading cause of years lived with disability in the UK.

It is associated with poor social interactions, isolation, depression and anxiety, increased risk of dementia and reduced quality of life.

The use of face masks by the general public is a controversial topic and not currently supported by the World Health Organisation or the UK government.

Current evidence suggests that while face coverings and surgical masks (the variety typically worn by dentists) might prevent large particles spreading from an infected person wearing a mask to someone else, it doesn’t trap tiny particles like coronavirus.

Furthermore, there are concerns that even if fitted correctly, a mask may increase your risk by encouraging you to touch your face more often with hands that may be contaminated.

However, wearing a mask may provide a favour to others by preventing the wearer from infecting them, and there is growing interest by the UK public to use face masks.

Professor Munro said: “At the very least, removing visual cues can make communication more difficult because of the 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.

And elderly people in hospital who are frail, frightened and distressed with a likely a hearing loss - may have to cope with the background hiss of oxygen to contend with when communicating with others who have their mouths covered.

“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.”

Professor Kevin Munro
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
Professor Kevin Munro

He added: “Because the consequences of coronavirus is more common in older people, who are likely to have a hearing loss, this means that those admitted to hospital are especially vulnerable.

“The N95 and FFP3 respirator masks for frontline health and care professionals can filter 95% of tiny particles but they are much more likely to distort and reduce the level of speech.

“This makes communication particularly problematic at a time of heightened anxiety and when the content of conversations are 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.

“Research studies have shown the beneficial effects of surgical masks with a transparent material that allows the mouth to be visualised; however, these are not widely available.”

“An alternative to face masks might be for the public to use transparent face shields, which allow facial expressions and the mouth to be visualised, but these have yet to be evaluated in a clinical trial.

“As governments search for a sure-footed 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 and result in facemask misery for many.”

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