When hiding lips, masks reveal hearing loss

Masks have been one of the pillars of public health guidance in preventing the spread of the coronavirus. But they’ve also provided an unwelcome revelation to some – that they’ve been relying on lip reading to compensate for unrecognized hearing loss. 

“Everyone does some lip reading, even people with normal hearing,” said Meredith Duffy, Au.D., an MUSC Health audiologist.

For example, in a noisy, crowded setting like a restaurant, our brains use lip reading to “fill in the blanks” and determine whether a friend has said she’s “sad” (lips separated and teeth visible when making the “s” sound) or “mad” (lips closed together when making the “m” sound) about a situation.

But Duffy has seen a definite uptick in people coming in because they’ve realized that, with so many people wearing masks, they can’t hear as well as they thought they could.

Hearing loss is common as people age, particularly as they get into their 60s. Typical age-related hearing loss, called presbycusis, affects the high frequency hearing range that provides clarity of speech.

Duffy said that studies have shown that masks muffle higher frequencies – by 3 to 4 decibels for medical masks and up to 12 decibels for N-95 masks.

“This is significant when someone has a hearing loss and their speech intelligibility is already affected,” she said.

Lindy Brennan started wearing a hearing aid several years ago due to a congenital issue, so she was aware of her hearing loss before the pandemic. But hearing aids aren’t a perfect replacement for natural hearing, and the masks definitely made life more difficult, she said.

“Very frustrating,” she said. “I wasn’t aware of how much I read lips, even with the hearing aid, until the masks." 

“It's just wearing to try to hear what people say and have to ask them to repeat, so it’s not been fun,” she said.

 

Hannah Burrick, Au.D., noted that two hearing aid companies have responded to the problem by adding a “mask mode” to the menu of settings that hearing aid users can toggle between. The mask mode increases high-frequency volume to compensate for how the masks muffle those sounds.

While simple aging can cause some hearing loss, excessive noise is also a factor. In fact, the Centers for Disease Control and Prevention reports that 40 million Americans between the ages of 20 and 69 have some noise-related hearing loss – and 24% of people in that age range who report they have “excellent hearing” actually have measurable hearing damage.

Brennan was seeing Duffy for a new hearing aid. After wearing the aids for several years, she describes them as lifesavers. Other patients, though, don’t necessarily embrace hearing aids right away, Duffy said. The average patient waits seven years before seeking help for hearing loss, and even if they come in suspecting hearing loss, they might not be ready to accept that they need the aids. Surveys of people with hearing loss, though, indicate that people with hearing aids report much higher satisfaction with their ability to hear in a variety of situations than people without hearing aids report.

Duffy said that people who suspect they have hearing loss will first come in for a comprehensive hearing test, usually after a referral from their doctor. If they are a candidate for hearing aids, they can schedule a complimentary hearing aid consultation where they are counseled on all available options. If the patient decides on hearing aids, they’ll be ordered and at the fitting appointment they’ll be programmed to each ear individually and per pitch. The patient will then have 60 days to try out the hearing aids, she said.

But with or without hearing aids, there are things we can all do to make ourselves more intelligible through masks, she said: Speak up. Speak more slowly. Face the person you’re speaking to. And have patience.