Behind the Face Mask 

Image by Gabriele Lässer from Pixabay

The Spanish government has started to relax lockdown restrictions aimed at curbing the spread of coronavirus. In Madrid, we spent two months inside our homes, under strict measures, only being allowed outside for a few distinct purposes such as to go to the supermarket. On Saturday 2nd May, we were finally able to go for a walk and to exercise outdoors. 

With many people currently wearing face masks in public places to help reduce COVID-19 transmissions, I have realised that this poses a challenge for people with hearing loss.

I have single-sided deafness (SSD), the result of a sudden hearing loss in 2016. I have a profound hearing loss in my left ear and functional hearing in my right ear. Although I am thankful for my remaining hearing, having only one working ear comes with unique challenges. 

Sound localisation is a skill enabled by having two working ears; the mind registers which ear has heard the sound first, to determine where the sound is coming from. With only one hearing ear, the audio always enters my right ear. This means that all sound seems to be coming from my right side. 

The other main difficulty that comes with SSD, is the inability to hear speech clearly amongst background noise. With one working ear, there is difficulty in filtering out unimportant sounds when trying to understand speech in noisy environments, such as cafes or restaurants.

Now, there is the added challenge of the face mask.

Muffled Sounds and Lipreading

In attempting to communicate with people wearing face masks, namely the local greengrocer, it has only recently occurred to me how much I rely on lipreading. 

When speech is unclear, I often guess the general theme or significance, using the tone of voice as a guide. I instinctively look towards the speaker’s mouth and watch the shapes and movement of their lips to give me clues about the content. The muffled sound that comes through a face mask, is never clear. Now, with the majority of people wearing face masks, lips and faces are no longer visible to read and I am completely unaided. I am guessing without a hint.

Concealed Expressions 

In addition to concentrating on the sound of speech in conversation, I also focus on the reactions of the speaker. For example, if someone is telling a story and smiling, I know that a smile is an appropriate response, regardless of how much of the dialogue I am able to hear. Expressions are not visible through face masks. 

Customers of a local shop were being permitted to enter one-at-a-time, every time someone exited. Whilst at the front of the queue, the sound of a loud cough startled me and my automatic reaction was to quickly turn around. I made eye contact with a woman who was standing behind me in the queue. Without the ability to identify the location of a sound source, I didn’t know if the woman behind me had been the one who had coughed. I hadn’t turned around in judgement. Loud sounds startle me. As our eyes met, I smiled a friendly smile but it suddenly struck me that this had gone unseen, concealed by my face mask. I quickly turned around. I didn’t want to make the woman feel uncomfortable. 

Whatever our hearing capacity, we rely so much on expressions to understand how others are feeling. 

Developing Communication Strategies

Whilst paying for my shopping, the greengrocer uttered something from behind his face mask. I didn’t hear him clearly. I looked at him and was about to ask him to repeat himself. He quickly acknowledged my pause and spoke again in a clearer voice. 

Unfortunately, I didn’t hear the second time either. Again, he acknowledged my pause and this time endeavoured to help me understand by using hand gestures. He pointed to the top of the card reader. Ah! Do I want a receipt? 

I wonder if everyone is finding it difficult to communicate through face masks. Perhaps people are becoming accustomed to speaking more clearly. Maybe we are unwittingly developing strategies to break down barriers and make communication clearer and more accessible.  Perhaps the impact of face masks on communication will ultimately be a positive one. 

16 comments

  1. Hi Carly. I haven’t had to do much mask wearing because my husband has done most of our shopping and such but I can imagine how you feel. I do think that despite you mouth being covered people can see a smile in your eyes.

    Liked by 1 person

      1. We are well, thank you.
        I recently wrote a post about being diagnosed with Parkinson’s disease. https://donteatitsoap.com/2020/04/10/when-life-threw-me-curve-ball/#comments
        I mention this to you because during the process of being diagnosed I asked the neurologist if my hearing loss might be related to the other symptoms I was having. He did say that demyelination (tears in the myelin sheath) can cause hearing loss. For me since the diagnoses was PD we did not go on to explore the hearing loss any farther. The cause is still unknown and likely not related to the PD. But I was wondering if you have seen a neurologist and if this possibility has been considered.
        Take care My Friend.

        Liked by 1 person

        1. Hello Ruth,
          Thank you for sharing your post – it is beautifully written and shows a lot of strength and positivity. I hope you are doing well.

          I find it interesting how hearing loss can be connected to so many different illnesses and can be the result of so many different issues. I am actually waiting to see a neurologist (due to my balance issues and suspected vestibular migraine). Unfortunately my appointment has been postponed, due to COVID, but I am hoping they can give me some more information regarding my symptoms. Let’s see!

          Take care
          Carly

          Liked by 1 person

  2. Wow, Does this ever hit home, Carly! It is nearly impossible for me. Word discrimination is the bulk of my hearing difficulty to start with. Although I am not “deaf” by definition, when people are speaking I feel like it. Now, with the masks it’s like pouring salt in a wound.

    If masks are a requirement going forward (an they probably should be) I’m going to be less and less social, something I swore I wouldn’t let happen.

    On the plus side, our Governor has kept our beaches open for exercising (walking, running, swimming, fishing) but no gathering of crowds of lunging around. Thankfully, we get to take the pups over every day for a good long walk.

    Good luck with your “coming out” over there. As if we needed to be tested anymore, right?

    Liked by 1 person

    1. Hi Al,
      How are you?
      Thank you for the comment.
      I think many people with hearing loss are going to struggle communicating while the use of face masks is recommended. There are actually masks that have been made which have a clear window so that the lips can be seen – I wonder if these will start to be used more commonly by ENT specialists?
      It’s good to hear that you are able to exercise on the beaches and it must be nice to go outside to walk the dogs everyday 🙂
      Stay safe and healthy, Al!
      Your blogging friend,
      Carly

      Liked by 1 person

  3. Hi Carly. I wish I shared your optimism that the experience is going to be a positive one. It just gives me a sinking feeling….oh no….here we go…..back to not being able to make sense of anyone any more. I suppose it may be a good idea to have face coverings in some situations (although the evidence seems to be marginal) so we’ll see. You’re ahead of us in the UK on this one.
    I don’t know about Spain (obvs) but here in the UK there has been very little reporting of the difficulties people with hearing loss will face if people start routinely wearing masks. I contacted Action on Hearing Loss, who signposted me to a number of helpful things that are happening in hospitals (eg written flash cards explaining the most common courses of action they might be needing to explain to sick patients with hearing loss) but there wasn’t any mention of a public awareness campaign. I think we need one – what the problem is, what you can do to help (if you hear) etc.
    Anyway…..glad to hear that you are well. Take care of yourself.
    Vera

    Liked by 1 person

    1. Hi Vera,
      How are you? It’s great to hear from you.
      Here in Spain, facemasks must be worn on public transport and, because the city is so densely populated, most people are opting to wear masks whenever they go outside. The health service are giving everyone free masks when we show our social security health cards.
      I hope there will be more awareness brought to communication difficulties (in particular for those with hearing loss) that will come with the use of face masks. I think your idea of a campaign is what is needed, and I hope this will happen soon in the UK. It would be helpful if a list of strategies to help aid communication could be produced and made into a poster to be displayed in public places, and especially in doctors surgeries and hospitals…
      I hope you and your family are safe and healthy.
      Take care, Vera,
      Carly

      Like

  4. Man, Spain is really doing a MUCH better job at this than the US is! I’m SHOCKED by how many people refuse to even acknowledge that there is a problem. They don’t wear masks. They still want to congregate. There are…excuse me, were, “lock downs” but so many people paid no attention to them and the “essential” businesses were crazy! Golf courses, pawn shops, gun shops!…why are these places essential?? it’s different for different states, but really there isn’t enough being done and everything is opening up now. It’s going to be a mess. But the economy is busted. My husband was laid off last week. We’re lucky we’ll be okay for a while, but there are a lot of people who won’t be. But that’s not what your post was about, sorry.
    I can’t understand anyone with a mask on. I’ve always had trouble in hospitals. I do have some masks that were given to me at a Hearing Loss Association of America meeting that are made for hospitals that have a window so you can see the speakers lips, so if I need to go somewhere Stuart wears one of those and translates for me. I seriously hope we don’t have to wear masks forever. They don’t fit with my cochlear implants and my glasses, there are just so many things I can fit behind my ears. I tried one that ties but it slides off my head, I don’t know how doctors use them. I think my ties are too short. There are so many challenges.

    I don’t know if the mask will stop me from getting it, but I think if I have it and I’m asymptomatic it will help stop me from spreading it. Therefore I think it’s my civic duty to wear one when I’m out. If only everyone thought this way we could stop the spread of this, but when the president refuses to wear a mask, this country will probably just be a cesspool of disease soon.

    I’m so happy to see you are safe. We are safe and hot here in the desert. Just got blindsided by Stuart losing his job.

    Liked by 1 person

    1. Hi Wendy,
      It’s lovely to hear from you.

      Spain has had a hard lockdown, though I think we were late to react. Also, business are now starting to open, due to economy issues. That’s shocking that gun shops are deemed essential businesses in the US! I hope you and Stuart have been able to stay indoors as much as possible, and are able to get food supplies safely. I’m sorry to hear about Stuart and hope that he will be able to get a new job soon. I understand this must be very worrying.

      I have read online about the masks with the windows to allow for lipreading. They’re a great idea. It’s a shame that healthcare professionals can’t all have them. It’s not just people with hearing loss who could benefit from them.

      I found this article and thought you might find it helpful. There is a section that has some suggestions for wearing face masks with hearing devices: https://www.theaudiologymethod.com/blog/2020/4/14/navigating-covid-19-with-hearing-loss-resource-guide

      We are wearing masks now, whenever we go outside. Madrid centre is densely populated and it is impossible for people to keep at a 2m distance. The social security health system is giving free face masks to people when they show their health cards in pharmacies – I think this is a great initiative. I hope the US will do something similar.

      Take care, Wendy, and stay safe and healthy.
      Best wishes from Madrid,
      Carly

      Like

      1. Thank you so much for the article! It is very helpful!!
        I wish the US would do something similar too, but they won’t. Remember we don’t have a universal health plan so they aren’t going to “give” anything away. And the hospitals don’t have enough masks, so that really limits things. We’re wearing homemade masks. The US was slow to react and now we are pushing things open too fast, I think. I’m just waiting to see how things change in a month. I really hope I’m wrong and things won’t be worse, so much worse.
        Right now, I’m staying home.

        Stay safe Carly.
        Best from Tucson, AZ

        Liked by 1 person

        1. Hi Wendy,
          I hope you are doing OK.
          I was thinking of you becuae i remeber you saying that Stuart had some masks with the clear windows to show his lips when speaking. I have seen more companies advertising these online and hope you have managed to purchase some. I read a tip about how to stop the clear window from steaming up with condensation. Apparently, if you rub a (dry) bar of soap across the mask window, it helps prevent it from steaming up. i hope this helps!

          Take care.
          Wishes from Madrid,
          Carly

          Liked by 1 person

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