How to offset the challenges of masks and other PPE with students with hearing loss

Although CID is starting the school year virtually, we recognize that some schools are returning to full or part-time in-person learning. The return to in-person instruction will not be without challenges, especially for students with hearing loss.

As several schools return to in-person learning this fall and work to prioritize the safety of all staff and students, we need to consider factors that may be within our control to help optimize outcomes for all students. The use of masks and other personal protective equipment (PPE), while imperative and necessary for safety, presents challenges for all listeners by reducing the volume of speech sounds and eliminating important visual information for speech reading and nonverbal cues. This challenge is further heightened for those with hearing loss, who rely heavily on these cues to supplement auditory information, even when wearing well-fit devices.  Two key areas impacted are the speech signal and visual cues.

The speech signal: Understanding a speech signal requires auditory access to sound from soft to loud levels across the entire key speech frequency range. Of specific importance is access to the high frequency range, which is home to many of the consonants in the English language that give meaning to the words that we hear. For example, discriminating the difference between the words “cat” and “sat” depends on our ability to both hear the “c/k” and “s” sounds and discriminate the two. Recent research suggests that the use of masks, depending upon the type of mask, attenuates the overall volume of the speech signal by 5-12 dB1, 2. The use of a face shield can also present attenuation of the speech signal, and when used in combination with a cloth mask, provides additional decrement of the signal2.

Visual cues: In addition to attenuating the speech signal, the use of traditional masks eliminates access to important visual cues utilized to understand not only the content of a message, but the crucial non-verbal and suprasegmental cues associated with the message, like talker emotion or facial expressions. We know that typical, occupied classrooms present less than ideal listening conditions due to noise levels and reverberation, making listening an even more complex task for children with hearing loss3. Access to visual information becomes even more crucial as the listening environment gets more challenging. Some research suggests that visual cues increase a listener’s ability to understand a message by anywhere from 20-50% 4,5. Access to visual information is key during this period of early learning when children, especially those with hearing loss, are developing language and social-emotional skills in the setting of unfamiliar academic content, new peers, and unique challenges.

What can be done: While we know masks, face shields, and other forms of PPE are critical for the safe-keeping of our educational staff and children, it is important that we acknowledge the obstacles that this equipment presents and work to provide solutions that offset these challenges. The following are two resources that address the specific challenges described in this letter:

1. Hearing assistive technology

  • Equipment that provides consistent, salient access to the teacher’s voice and helps overcome the detrimental effects of distance, noise, and the use of face coverings
  • Example: DM system, Phonak Roger system
  • Well-studied in the benefit it provides to allstudents and reducing teacher vocal effort

2. Masks with clear panels

  • A mask with a clear panel allows teachers and staff to utilize a face covering while still providing access to visual cues for students

Much of what administrators, teachers, parents, and students are experiencing currently is unprecedented and requires that we all work together to provide quality education and maintain the safety of all parties. The recommendations listed are actionable steps that can be taken to help preserve the integrity of the content being taught despite new challenges as a result of COVID-19.

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1 Goldin, Weinstein, & Shiman. (2020). How do medical masks degrade speech perception? Hearing Review, 27(5), 8-9.

2 Saile, T., & Gregori, J. (2020, May 5). Masks and their acoustic side effects. Retrieved from

3 Sato, H., & Bradley, J. (2008). Evaluation of acoustical conditions for speech communication in working elementary school classrooms. J Acoust Soc Am, 123(4), 2064-2077. doi:10.1121/1.2839283

4 Lalonde, K., & McCreery, R. (2020). Audiovisual enhancement of speech perception in noise by school-age children who are deaf or hard of hearing. Ear and Hearing, 41, 705-719.

5 Dorman, M., Liss, J., Wang, S., Berisha, V., Ludwig, C., & S, N. (2016). Experiments on auditory visual perception of sentences by users of unilateral, bimodal, and bilateral cochlear implants. JSLHR, 59, 1505-1519.



Brittany Wuebbles is a pediatric audiologist at CID. She joined the CID Audiology staff in May 2016 after graduating with her doctoral degree from Washington University School of Medicine in St. Louis. Brittany currently serves children ages birth through 13 at CID. Her clinical interests include cochlear implants, amplification and optimizing performance outcomes

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