COVID-19, masks and communication in the operating theatre: the importance of face value

Influence of surgical and N95 face masks on speech perception and listening effort in noise

Daily-life conversation relies on speech perception in quiet and noise. Because of the COVID-19 pandemic, face masks have become mandatory in many situations. Acoustic attenuation of sound pressure by the mask tissue reduces speech perception ability, especially in noisy situations. Masks also can impede the process of speech comprehension by concealing the movements of the mouth, interfering with lip reading. In this prospective observational, cross-sectional study including 17 participants with normal hearing, we measured the influence of acoustic attenuation caused by medical face masks (mouth and nose protection) according to EN 14683 and of N95 masks according to EN 1149 (EN 14683) on the speech recognition threshold and listening effort in various types of background noise. Averaged over all noise signals, a surgical mask significantly reduced the speech perception threshold in noise was by 1.6 dB (95% confidence interval [CI], 1.0, 2.1) and an N95 mask reduced it significantly by 2.7 dB (95% CI, 2.2, 3.2). Use of a surgical mask did not significantly increase the 50% listening effort signal-to-noise ratio (increase of 0.58 dB; 95% CI, 0.4, 1.5), but use of an N95 mask did so significantly, by 2.2 dB (95% CI, 1.2, 3.1). In acoustic measures, mask tissue reduced amplitudes by up to 8 dB at frequencies above 1 kHz, whereas no reduction was observed below 1 kHz. We conclude that face masks reduce speech perception and increase listening effort in different noise signals. Together with additional interference because of impeded lip reading, the compound effect of face masks could have a relevant impact on daily life communication even in those with normal hearing.