The tips that Audiologist Nina Perisic shares in this video will make communicating through masks easier for everyone!
You will learn:
- Why masks make listening so difficult
- How masks impact speech signals
- How you can take control of your listening environment
- How to adjust your hearing aids for masked communication
- How to keep hearing aids from flying off your ears
This talk was originally presented as part of the Healthy Hearing Online Expo.
Read the video transcript:
So good afternoon, everyone. Thank you for joining me. My name is Nina. I’m one of the audiologists here at Broadmead Hearing Clinic and today I’m going to be talking about some tips and tricks for communicating while wearing a mask. And I know that this has definitely been a huge challenge for many of us during the pandemic. So I’m hoping that after today’s session, you’ll walk away with some new tools under your belt that can help keep those conversations flowing a little bit easier. Okay. So let’s get started. So let’s just go over what we’ll be talking about today. So we’ll go over why it’s harder to hear with a mask, what we can do about it and, lastly, how do we keep those hearing aids from coming off when we take off our masks? And I know that this last one is of particular concern and we have patients ask us this almost every day.
Why do masks make listening so difficult?
And for anybody who has the most popular behind-the-ear style hearing aids, every time that mask comes off, those hearing aids tend to want to go flying off the ear. So I’m going to try to address that towards the end of the presentation and, hopefully, give you some ideas on how to prevent that from happening. So let’s talk about why masks make communication so difficult in the first place. So, firstly, they lower the volume of the speakers voice and they garble that voice slightly. If a person is speaking at their normal volume, it can be almost impossible to hear them clearly, as well lip cues and facial expressions are no longer visible. And this one is particularly important, because we rely heavily on facial expressions and cues to help us deliver our intended messages, and even if we’re not consciously aware that we’re doing so.
We rely on emotions and facial cues
For example, the letters S and F look very different on my face, but as soon as my lips are covered, it can be much harder to tell what the difference between those sounds is, especially for anyone who has a hearing loss. Background noise will interfere with hearing even more. And we know that background noise is already bothersome for anyone who has a hearing loss and who is trying to participate in a conversation. So that already challenging situation now becomes even more challenging and more effort has to be given to that conversation. And with the masks already lowering the volume of speech, garbling it, and the lack of facial cues, conversations can become really difficult in background noise. Additionally, anyone who is speaking with a mask and has an existing communication problem, like a voice problem or aphasia, this will add to that complexity. And, finally, due to social distancing, we can no longer just walk closer or lean in to hear someone better.
So we’re going to talk a little bit about how a lack of access to emotions and facial cues makes communication more difficult. And to do this, I’m going to use some examples from this article, which is entitled Effect of Face Masks on Interpersonal Communication during the COVID Pandemic. So, first of all, I’m just going to ask you what emotion do you think this person is showing? And I’m going to put up a poll right here. (silence) Okay. I’ll give you all some time to think about this and answer. (silence) Excellent. I see so many results coming in. I’ll give it a couple more seconds. (silence) Okay. I will count down. So five, four, three, two, one, ending polling. Good. Okay. So as you can all see, it’s actually about 30% think he’s showing happiness, 33% think it’s sadness and 35% think it’s frustration. So it’s actually very, very close. So we’ll go over what he’s actually trying to express.
So for everyone who gets happiness, congratulations, that’s the actual emotion. But for anyone who found this really difficult, the reason it’s so challenging is because the eyebrows and the eyes are the upper part of that face are not the most important part of his expression, but rather we look at the mouth, the cheeks and the teeth. And we know that emotions are so important during an interaction, because it lets the person who is speaking know whether their message is being received in a positive way, or, at least. In the way that it was intended. And in this article, the authors talk about a study done by Kestenbaum and they found that, of course, for happiness, the mouth is the most important part of the face that lets us recognize a smile or a happy expression. And we find that with facial masks covering up expressions, especially during medical appointments, it will reduce the ability of the medical professional to determine what their patient is feeling and their emotions, and it can affect their response to the situation.
And as well, the patient will have increased anxiety while their medical professional is wearing a face mask, because they can’t feel that they’re being understood. Or if what they’re saying is actually being interpreted. Going onto this slide here, and it’s the summary slide from this article actually. So one of the things that they show here is that not all emotions will be affected by face mask use completely, but some important ones will. So as an example, anger, we can usually tell much more easily, because the furrowed brow is so pronounced and it’s much easier to tell that, whereas something like disgust, which is down here in the E section, it involves the nose wrinkling and the raising of that upper lip and both of these things are covered by face masks.
How do masks impact speech signals?
So we’ll talk about how face masks actually impact speech signals. So each mask is actually reducing the high frequencies in this picture here. And this is a study based out of Israel and they were comparing N95 masks, simple masks and no masks to the speech signal. So the green line, which is right here, actually shows no face mask use. We can already see where this purple line is that any simple mask use is decreasing the high frequencies, especially, by three to four decibels. And when somebody puts on an N95 mask, it’s going to reduce that signal even further up to about 12 decibels, which is quite significant. So you can see both types of N95 down here in the corner.
So masks are significantly reducing the quality of the speech signal. And this effect gets compounded or gets worse when the listener cannot see the speaker’s face and lips, which we just discussed, is in the presence of background noise or has hearing loss. So now that we’ve talked about some causes of what’s going on with face masks and our ability to hear, what can we do about it? So we’ll talk about taking control of your listening environment, changing some settings on your hearing aids and, as well, using other tools to aid in communication.
Take control of your listening environment
So for taking control of your listening environment, what you want to make sure is that, first of all, you’re facing your communication partner and that you have their attention before you speak. We really tend to look away or bend down while we’re speaking to each other, and that can make our voices softer and make things more difficult to hear.
Secondly, for the speaker, we want you to speak a tad louder and slower than you normally would. And I want to emphasize here that when I say speak louder and slower, I don’t mean yell. Please do not yell at your communication partner or slow down your speech so much that it becomes distorted. What you want to do is just make sure that you’re speaking a little bit louder and really enunciating your words. And if a sentence isn’t being understood, do not repeat yourself numerous times. A good rule of thumb is that if you said something twice and you can see that the person hasn’t registered what you said or looking at you blankly, you just know that they’re maybe even nodding, but you know that they haven’t actually understood what you’ve said, say that phrase or word that they’re missing in a different way. And also try to shorten the sentences just while wearing face masks, especially, to make that message a little bit simpler.
You can also move to a quieter place to have a conversation. And I know that we’ve been spending a lot of time outdoors lately, not so much indoors, and this makes that not so easy, because there’s traffic, there’s wind, there’s all kinds of environmental sounds. But if you can, find a spot in a quiet park or a bench at least away from any main roads, and that can really help everybody be heard a bit easier. Using hand gestures and body language to your advantage. And as you’ve probably noticed, maybe you can’t see my hands during this, but I have been using my hands through this entire presentation to get my point across. And if you’re a patient of mine, you’ve probably seen me do this regularly. But don’t be afraid to do it. Most of what we say to each other is actually translated through body language and not so much the words that we say.
And finally, don’t be afraid to ask your conversation, partner if there’s anything you can do to make things easier for them. We all learn and receive information in different ways and I don’t think there’s anything wrong in asking the person that you’re talking to to try to make things a little bit more comfortable for both of you. We can now talk about how we can change some settings on your hearing aids. So as we’ve said, masks reduce some speech frequencies more than others. And the strongest reduction is actually at 4,000 hertz and 4,000 Hertz includes all of these speech sounds. So the F, the S, the “tha” sound, and those are particularly hard for anybody with a hearing loss to catch. So to get around that, two manufacturers have actually created something called a mask mode, and I’m going to what that is.
Mask mode on hearing aids
So let’s talk about turning on mask mode. So for Starkey, there’s both something called an edge mode and mask mode that they have made available. So for edge mode, which is only for the Livio Edge AI hearing aids, you’ll turn it on by double tapping the hearing aid. If it’s behind, you’ll tap here. If you have an in the ear style, you can tap here. And edge mobile will scan the environment that you’re currently in and try to make adjustments to the sound accordingly. For mask mode. It’s only available for their Livio AI hearing aids and it’s available through the Thrive app. And since it’s a little bit hard to find in that app, I’m just going to go over how you can locate it. So when you open up the app at the bottom of the screen in the lower right-hand corner, there’s something called a hamburger menu. And if you click on that, it will lead to this new page. And the second from the top is device settings. And you’ll want to click on that.
And once you’ve done that, it will give you mass mode at the very bottom. So once you see that you can toggle that little switch until it’s blue, and that will turn on mask mode for those hearing aids for you. Signia, as well, has a mask mode and it’s available in all of their Bluetooth-equipped Xperience hearing aids. So it is located as soon as you open the app and at the very top, so in the upper right hand corner, there is a man wearing a little face mask. As soon as you tap on that, mask mode is activated, and you can tap it again to turn it off. There are some minimum phone operating system requirements, such as Android 6.0 or iOS 11 or higher, so make sure that your operating system can actually help you get this going.
And, of course, not all of us have Signia or Starkey hearing aids, so what happens if you don’t have a mask mode? So another thing you can do is you can adjust the treble in your hearing aids. So you’ll open up the application and Unitron, Phonak, Resound and Widex all have an option to change the volume of the bass, the treble and middle sounds. And you’ll want to change the treble in this case. So in Resound, it’s at the bottom in their sound enhancer menu, and you’ll click on that. And for Phonak, it’s also in the bottom right hand corner in their hamburger menu that will allow access to that. Widex in their Moment app also has it. Again, it’s a little bit hidden, so you’ll have to click in the lower right-hand menu and then go to equalizer and that will give you this little shape here. And for most manufacturers, it’s a similar sort of graph, and you’ll be able to increase or decrease the trouble as much as you need.
And for Unitron, as well, it’s in that lower, bottom, right-hand corner. So if you’re ever confused, just check that place first, you’ll most likely run into the menu that you’re looking for. And if you’re not feeling tech savvy or if you don’t want to connect your hearing aids to your phone, there are other things you can do. So you can increase the volume of your hearing needs temporarily. And sometimes that’s all you really need to do. And to do that, it’ll be about one or two presses of the up volume button on your hearing aid. And the pros of this, of course, is that volume control is available in most hearing aid styles and manufacturers, and it’s pretty easy to change. And the cons of this are that it can make everything louder, not just the sounds that you’re missing. So we aren’t able to do a frequency-specific change like we are in an app, for example. So you have to remember to change the settings back to a lower volume.
And this is a question we also get, “How do I get back to my normal settings?” So you can decrease the volume by pressing the button down on your hearing aids. And if you have a certain behind-the-ear style, usually the left will lower and the right will raise, unless you have a toggle switch, in which case you can use either ear. For in-the-ear hearing aids, they generally have a little button that you can press and change the volume that way. Opening and closing the battery doors, as well, will always set everything back to normal or putting the hearing needs in the charger and taking them out will also reset them. And sometimes the volume button on the hearing aids is actually not enabled. So if you’re trying to change the volume and nothing’s happening, give us a call. We can try to add it in for your specific hearing needs.
And we’ll talk about using some accessories, because sometimes hearing these themselves won’t be enough. So for remote microphones, they are available across all manufacturers and for many different hearing aid models. They’re very easy to use and we can show you how to do that in clinic. And they work well for both tech-savvy people or people who consider themselves to be very tech savvy, and also not so tech savvy users. So what they do is that they reduce the distance between the speaker and the listener and it allows for easier listening to a single speaker in very noisy environments, restaurants, lectures, or outside, as I was saying, with a lot of background noise, and it will take that information and send it straight to your hearing aids. And we compare this, like I said, in the clinic. The cost varies between manufacturer going from about $175 to about $300 per remote microphone.
There’s also something called a speech-to-text application and these are available for iPhone or Android phones, they’re available online to use with tablets or computers, and they’re great because they transcribe speech into text in real time. And there’s so many options. They can be free. They can have monthly fees. Today, I’m going to focus on Otter.ai and the reason being is that there’s a really great article in the Canadian Audiologist that goes through the pros of using this tool actually in clinic. Although I think that given all the things that Otter.ai Allows you to do, I believe it can be used just fine outside of the clinic as well. So their transcriptions have really good accuracy and they automatically insert punctuation and breaks between phrases and different speakers. And once you’ve created an account, you can record 600 minutes of transcriptions per month for free, all of which are stored separately on your account and you can actually access afterwards. I will note however that it will only record 40 minutes per conversation.
Though I think that’s a good amount of time, but you can always stop the recording and start another one if your conversation is going to be longer. And it’s super simple to do. You can open up and create an account with Otter.ai with their app. You put in your email address or your Apple ID, and you can automatically use their system. The only thing is, is just to make sure that you point the microphone of your phone towards the person who is speaking so that you can best record them. It can sometimes, if the microphone isn’t super close, it can miss some words. And, finally, for programming changes, we can always make a custom-mask program for you and they can be created for any difficult listening situation. So definitely call and make an appointment with one of us. We’d be happy to help.
And just to recap here, so how do you hear better with a mask? One, you take control of your listing environment and you take advantage of your hearing aid settings. So there’s mask modes, there’s adjusting treble with the phone app, or just turning your volume up temporarily. Also using available accessories, like remote microphones or speech-to-text application. And, finally, you can come in and see your audiologist for a custom program. I should note that it might take a combination of everything that I’ve talked about. You might need a few or even all of the above options to get you curing better with a face mask. And I don’t think there’s any shame in trying a couple and you need more help, definitely call us. We’re happy to walk you through anything that you need.
Keep the hearing aids from flying off your ears
And now let’s talk about how we keep those hearing aids from coming off when the mask comes off. And this is something that we get asked about almost on a daily basis, and it’s super frustrating. And it is usually happening to the most popular style of hearing aid, which is the behind-the-ear style. So let’s talk about some things we can do. First, I know we all have a tendency to rip the mask off our face as fast as possible, as soon as we step into our house or into our cars, but for any hearing-aid wearers, we really do need to take an extra second to get those masks off of our ears. So to do that safely, make sure that you can actually pull the mask up and over your ear. So I’m going to use my mask here. What you’ll want to do is to take that top piece and pull it up and over gently and slowly, and then take the mask off.
And also make sure that you’re standing in one place as you do this, because if the hearing aids do come off, you can be conscious of that and you can look around and they can’t have gotten far, because there’s only finite space where they can go in that moment. And, definitely, the other thing to do is as you’re getting ready for appointments or if you’re stepping out of your car, just have a good look in the mirror, make sure that the hearing aids are there and that the mask is sitting right next to them and then you should be fine. As well, there are things called mask strap enhancers, mask retainers or your savers, and these all work by keeping the mask strap away from your ears, so that it can’t tangle up with the hearing aid receiver wires. There’s so many different choices for something like this. Right here, I’ve just posted a picture off of Amazon and they have this example of an ear saver and it allows for the ponytail to come through.
I’ve also seen people use the monkeys from Barrel of Monkeys, and then just put that behind and keep those mask straps away from their ears. And you can, definitely, make some at home. It’s 100% something that you can do. If you you sew two buttons on a strip of fabric, you can have your very own ear saver. I’ve seen people put buttons on a cap as well, and also on their glasses, which was an interesting solution, having buttons right here, but all to say that it will keep those hearing aids safe and those masks straps away from your ears. And a simple hair clip or two can also be used just to clip it up. Finally, there’s something called ear gear. And these are, basically, little boots here and they come with a little cord. And the cord can clip onto your jacket or onto a pocket or onto your shirt. And these little boots is where you put the hearing aids and they come a variety of colors here. And what happens is with the boots going over the hearing aids, they will keep them safe as well for moisture.
But if they do fall off, when the mask is removed, they’ll hang from the cord and they won’t get lost. And if anybody’s interested in this, you can let us know. We can always order one into the clinic for you. And also if the hearing aids do fall out, what do we do? So, firstly, take a breath, look around, don’t panic. They might’ve fallen into a really strange place. We always hear they go under the couch or in a shoe, sometimes in a sock. So just have a look around and don’t worry. I’m sure you will find it. Some hearing aids also have a find my hearing aid feature and you can use your phone app to actually locate the hearing aids using geolocation. And these will show if you’re close or far from the hearing aids. So as you get closer to them, it will actually give you a signal that says, “Yeah, we’re pretty close.” And they will also show the last-known location before the battery died. So even if the battery goes out, don’t worry, you at least know where the last time they were on was.
Perfect. So thank you everybody for listening. I’ve put my email and my phone number up here as well. And if you have any further questions, you can definitely call. And also a big thank you to Aisling, who really helped with this presentation. So I’ll turn it over to Doran, because I’m sure he has questions for me.
Questions & Answers
Doran: Nina, naturally, that was great. Thank you for that. Very timely and who knew you think of all of the unintended consequences of a pandemic, you wouldn’t have called that lost hearing aids would be one of them. And believe me, we see this literally every day. People are losing their hearing aids because of the behind-the-ear on masks for sure. And from what I’ve heard, they do actually go flying. They’re hooked on that elastic and they fly. It’s not like they just drop right next to you. So it is a problem for sure. Nina couple of questions. First one is about plexiglass. Another barrier there. Can you speak to communication strategies with a plexiglass in between?
Nina Perisic: So I know that absolutely. This has been another huge barrier for people. And I think that if we just ask the person behind the plexiglass, just to speak a little bit slower and a little bit louder and also using any of the tools, so the remote microphones or turning up your hearing aids and asking for them to reword the sentence, maybe in a different way, I think is really, really helpful.
Doran: Yeah, for sure. And I want to stress, too, that you talked about some mask mode, but custom programming is something that we’d love to do to people’s hearing aids. And it’s a really great feature, these new, advanced hearing aids that we can program to do almost anything. There’s car mode, there’s mask mode. So even if it’s not on your app, give us a call, we can set that up for you. One question, does Oticon have a mask mode or mask program?
Nina Perisic: So they do not, unfortunately. So one thing they do have on their app, though, is the ability to change volume. So that is something that you can use their app for.
Doran: Again, I’ll say it one more time. We can do that for you. That’s what we do.
Nina Perisic: We can.
Doran: Bring your hearing aids in. We don’t want you struggling through apps if you can’t figure it out. Give us a call. We can customize your hearing aids quite easily.
Nina Perisic: Absolutely. We can definitely make custom programs for anybody with Oticon hearing needs. That’s no problem.
Doran: And I’m loving some of the strategies as well. The monkeys from a Barrel Full of Monkeys is being used. That’s awesome. And who knew that that would be a clinic recommendation? And also Doug is saying that he’s fashioned himself a baseball cap and the mask attaches here. And then in behind your neck. It’s a problem. And people are, like you said, “I’m out of the store. I’m ripping this thing off my face, because I want it off of there,” and, yeah, it goes flying. It’s a big problem.
Nina Perisic: Definitely.
Doran: Okay. Brian’s just asking about the find-your-hearing aid modes. “Does the hearing aid need to send a message to the other hearing aid if you have a pair?” Work in the smartphone, just find that hearing aid if they’re far away. How does that actually work?
Nina Perisic: The app should be able to find the hearing aids. So I’m happy to go over everybody’s apps, because everybody has a little bit of a different one. So if anybody wants that, you can always call in and I’m happy to walk you through that. But the app itself should be able to find a hearing aid, no matter if it’s separated from its brother, I guess, it should still be able to find the other one.
Doran: And I guess what I’m thinking is patients is your best asset here, because talk about the cards being stacked against you. You have a hearing loss that’s taking out those high-frequency noises, then we’re putting a mask on a person, which reduces those high-frequency noises. And then putting a piece of plexiglass in between those two people. And that mask also masks the lip reading that we’ve all done throughout our whole lives, so it’s just plain old difficult. There’s no way around that or a silver bullet there.
Nina Perisic: Yes, exactly.
Doran: So talk more a little bit about the Otter.ai. How would a person download that and then get that to installed onto their phone?
Nina Perisic: So I do have also, for anyone who’s interested, step-by-step instructions for how to do that, but if you have an Apple phone or if you have an Android phone, if you go into the play store for an Android phone or the Apple store for an iPhone, you can just type in Otter.ai and download the application and then just follow the steps. It’s very straightforward, but if you run into any problems, let me know.
Doran: That’s great. And that voice-to-speech has just come leaps and bounds, even in the past year or so you can see it along the bottom of our screen here. And that simply wasn’t possible even six or eight months ago, I don’t believe. So it’s really something to consider a tool that you may not have used in the past. Okay. Nina, thanks so much for the presentation. Very informative and timely, of course.
Nina Perisic: Thank you to everybody and thank you, Doran.
If you have questions about this presentation, or want to speak with an Audiologist about custom programming for masks for your hearing aids, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.