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Face Masks, Hearing Loss and Hearing Aids

Face masks are now required in many public places to help prevent the spread of coronavirus. For people with hearing loss, though, this may be easier said than done. 

That's because face masks add extra challenges for people with hearing impairments:

  • It's harder to understand people when they're speaking to you with a mask on their face, since masks lower the volume of speech and also slightly "garble" it.
  • If you wear hearing aids, the ear loops may tug on your hearing aids and cause other problems.

"I have yet to figure out a way to remove my mask without the hearing aids also coming off," explained Martha Malan, of St. Paul, Minn. She normally wears hearing aids and eyeglasses. Now she also has to contend with elastic ear loops on the backs of her ears. "It's a challenge," she added.

Hearing aid settings can be adjusted for listening to people wearing face masks

If you wear hearing aids, you may want to look into having the settings adjusted to make it easier to hear people wearing a face masks. In mid-2020, some premium brands released "face mask mode" that you can control yourself via your device's smartphone app. For other hearing aids, you can ask your hearing care provider to adjust their settings to account for how speech volume and clarity is affected by people wearing face masks. Many providers are now following these recommendations for mask adjustments when helping patients with hearing loss.  

Tips for wearing a mask with hearing aids

If you wear behind-the-ear hearing aids, you will likely encounter some problems trying to wear a standard face mask with elastic ear loops. The loops may tug at the wire or tube that goes from the body of the hearing aid down to your ear. You also may inadvertently pull your hearing aids out and lose them when removing your mask. What's a hearing aid wearer to do?

Because there are so many types of hearing aids, we recommend you first reach out to your hearing care provider who may have solutions they've come up with when talking to other patients. We've seen lots of creative workarounds floating around out there, such as these suggestions from hearing loss advocates and nurses.

Related: A design fix for face masks and hearing aids.

Mask extenders and hearing aids

Mask extenders are a great way to get a snug fit without dislodging your hearing aids and/or eyeglasses. Options include:

  • Using a fabric or bendable plastic mask extender with buttons or other notches to attach the mask straps 
  • Using simple tools like plastic s-hooks for straps
  • Use a cord-and-clip system, such as Ear Gear or Earstay to secure hearing aids 
  • A ponytail or bun can also be used as a loop anchor

"There have been calls for the public to use transparent face shields, rather than masks, which may offer a solution. But the public has yet to adopt this solution," said Kevin Munro, PhD, professor of audiology at the University of Manchester in the U.K.

A similar sentiment is supported by the CDC, which states in their guidelines on wearing cloth face coverings:

How to speak to people with hearing loss when wearing a mask

In medical settings

People with hearing loss also face challenges when trying to listen to someone who is wearing a mask. In medical settings, where stress is running high and provider-to-patient communication is tantamount, muffled speech can lead to frustrating scenarios on both sides. It's also harder to read facial expressions. 

"Masks pose two obvious problems for patients with hearing loss: the patient cannot gain any cues from lipreading, and the voice of the healthcare provider is attenuated and distorted," note the authors of the study "How do medical masks degrade speech reception?", published in The Hearing Review. (In this context, "attenuated" means a mask lowers the volume of a person's voice.)

Speech could be "close to unintelligible" for many hospitalized people with hearing loss, the study noted.

To help, the authors provided this checklist for talking to patients with hearing loss in medical settings:

  • Reduce the room's noise and get the patient's attention
  • Ask how the patient prefers to communicate
  • Speak slowly and clearly 
  • Do not shout (this can be painful to a person with hearing loss)
  • Make sure hearing aid wearers are using them
  • Consider using a portable hearing aid amplifier
  • Rephrase remarks if not understood
  • Take turns while speaking to the patient
  • Do not talk while walking
  • If obtainable, masks with clear plastic make lipreading easier

"Speakers often naturally try to compensate by projecting, but a more effective approach is to speak more clearly, with greater enunciation," explains Nicole Marrone, PhD, associate professor in Speech, Language, and Hearing Sciences at the University of Arizona.

In public settings

When out in public, such as at a shopping trip, these tips can't always be followed. But, for example, if you and your spouse are both wearing masks, make sure your spouse is aware they must speak more slowly and clearly to you. And speak up for yourself when talking to strangers, letting them know you can't hear well and need them to speak more clearly. 

If you're the one trying to speak to someone with hearing loss, "use some creativity to get your meaning conveyed, instead of repeating the same misunderstood phrases over and over again," recommends Dr. Mandy Mroz, AuD, president of Healthy Hearing. "Don't underestimate the power of body language, eye contact and slowing down speech to be more clear."

More COVID-19 resources for people with hearing loss

(Editor's note: Malan is the mother-in-law of the author of this article.)

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