According to the World Health Organization, 466 million people globally experience disabling hearing loss.

An even greater number of children and adults experience mild hearing loss which may impact their ability to communicate freely when conditions are not ideal.

But, if you can't fully hear what's being said – facial expressions and lip patterns can often help complete the message.

Now, imagine if you rely on these elements of non-verbal communication in order to understand what someone is trying to tell you. Then, one day, their face is obscured by a mask.

This has become the reality for many people with hearing impairment since COVID-19 face masks became a necessary part of our lives.

Widespread use of face masks is a good thing for everyone as it helps prevent the spread of the virus. For most of us, they are a minor hassle, but face masks come with far greater side effects for those who rely on seeing the whole face in order to communicate well.

UNDERSTANDING THE OBSTACLES

Given our current social distancing restrictions, it's important to recognise and understand that there are many people in our community at particular risk of social isolation.

One of these groups is people who have a hearing impairment, particularly older adults. People can stop joining in group conversations and social activities because of the huge "listening effort" required to piece a conversation together when you can't hear enough of it.

It can become difficult to interact with others if communication becomes too challenging.

Take this example.

"I usually manage really well in my part-time job at KFC, but now that the manager wears a face mask it's hard for me to know what he's asking for, and the customers get annoyed when the food order is wrong". J.F. (16-year-old with cochlear implants).

But what about those who are already withdrawn from society?

Older people may already be at risk of social isolation as well as hearing impairment. It's a significant concern that changed patterns of societal interaction may become entrenched leading to long-term isolation.

But it's not just social interaction, crucial everyday activities are also impacted. One person with hearing loss described her recent experience when her husband was taken to hospital.

"I was required to approach a desk where two nurses were wearing masks. They both had soft voices and accents, and from behind their masks I could not understand them. Neither could I see their mouths to read their lips or read their expressions. I walked away still unsure of where I was going, walking in the general direction that they had pointed to. The situation was possibly frustrating for them, it was certainly difficult for me."

REDUCING COMMUNICATION BARRIERS

Meet Emma. She works as an audiologist at the University of Melbourne in the Department of Audiology and Speech Pathology at the Melbourne School of Health Sciences.

As an audiologist, she is only too aware of the communication barriers faced by those with hearing impairment. Emma also has two cochlear implants (bionic ears) and relies heavily on lipreading and facial cues for communication.

Emma's role as an audiologist is to lead the way, adapt and advocate for those with hearing impairment. Her personal insights into the additional barriers that hearing impairment can raise during these already challenging and tiring times highlight the difficulties faced by many others in the community.

"Using see-through face masks is one way that we can help to reduce communication barriers," she says.

Another strategy that the audiology clinic at the University of Melbourne has adopted is video-conferencing software that allows students to remain involved in appointments without the need for face masks.

For all of us, strategies to use when talking to people with hearing impairment include increased use of hand gestures, and speaking slowly and clearly. If it's necessary, write down what you want to communicate or provide written information sheets.

But the golden rules are always ensure you are facing people you're talking to and be patient.

INCREASING AWARENESS

Experiencing hearing impairment from the age of three has meant Emma is used to piecing together information.

But, in COVID-19, she's living with the impact of reduced facial cues and muffled speech from behind masks.

"This can result in some frustration, miscommunication and listening fatigue," says Emma.

"But, if we can find a silver lining at a time like this, it's a new level of awareness of how hearing difficulties impact communication and social interaction."

Emma has found that the simple act of a health professional or someone in the community asking how they can communicate more effectively with a person with hearing impairment is a positive experience.

"That one simple question can be the difference between attending appointments and participating in the community," says Emma.

As a result, Emma is hopeful and optimistic that this awareness will extend post-COVID-19 to better support members of the community with any degree of hearing difficulty.

Researchers from the Departments of Audiology and Speech Pathology, and Social Work have received seed funding from the Melbourne Disability Institute for a survey to document the impacts of face mask use for people with and without hearing impairment.

The hope is to understand the impacts on communication and social interaction, as well as to give the community the opportunity to report the solutions which work for them in the real world.

If you're interested in contributing to research into face mask use and communication, take the online survey. It's open to all adults, with and without hearing impairment or hearing difficulties.

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