The Influence of Face Masks on Verbal Communication in Persian in the Presence of Background Noise in Healthcare Staff

Development and testing of a questionnaire on the expectations and experiences with wearing face masks in inpatient and day hospitals

BACKGROUND

The Covid-19 pandemic made wearing of face masks mandatory in the psychotherapeutic context. Against this background, the present study aimed to compare the expectations of patients undergoing day-hospital or inpatient treatment regarding wearing a mask in psychotherapy before the start of therapy with the final experience after the end of therapy. The study also investigated the extent to which expectations and experiences were influenced by other factors such as socio-demographic characteristics, patients' general attitudes towards wearing a mask, duration of treatment, or mental health diagnoses.

METHODS

Patients' expectations and experiences were recorded using two versions of a self-developed questionnaire: the pre-version, which was administered before the start of therapy and recorded expectations, and the post-version, which was administered after the end of therapy and recorded the final experiences. An exploratory factor analysis was conducted for the questionnaire's pre- and post-version. T-tests for paired samples were calculated to compare the patients' expectations regarding the extracted factors with the final experiences. Bivariate correlations were calculated to explore the association of other potential factors with expectations and experiences.

RESULTS

The exploratory factor analysis revealed a three-factor structure: communication barriers, self-confidence, and infection protection. The communication barriers expected by the patients before the start of the therapy turned out to be significantly higher than ultimately experienced after the therapy. Higher age correlated significantly negatively with expectations and experiences, with less self-confidence expected and experienced in therapy with a mask by older patients. There was a significant positive correlation between the expectations and the duration of treatment. Patients' general attitudes correlated significantly with their expectations and experiences.

CONCLUSION

Based on the results, wearing a mask does not appear to negatively impact the success of psychotherapy from the patient's perspective. However, patient-specific characteristics also appear to play a role in this context.

Association Between Vocal Symptoms, Communication, Work Environment, and Sense of Coherence in Hospital Health Professionals

OBJECTIVE

This study aimed to associate the presence of vocal symptoms with sociodemographic and occupational data, work environment self-perception, oral communication wearing a face mask, and the sense of coherence (SOC).

METHOD

This cross-sectional analytical observational study included 66 health professionals from a Brazilian hospital. They answered an online questionnaire on sociodemographic aspects, self-perception of the physical work environment, and oral communication at work. The Voice Symptom Scale (VoiSS) and Sense of Coherence Scale (SOC-13) were also applied. The significance level was set at 5% for the statistical analysis.

RESULTS

The self-perception of vocal symptoms was 62%. Professionals who considered the noise in their work environment unsatisfactory had more vocal symptoms (P = 0.005), especially in the limitation (P = 0.013) and physical (P = 0.028) domains of the VoiSS. Professionals with higher self-perceived vocal symptoms also reported incoordination between breathing, speech, and articulation (P = 0.041) and self-perceived difficulty being heard with a protective mask (P = 0.033). Professionals with a higher self-perceived score in the limitation domain of the VoiSS also had a higher self-perceived effort to speak with a mask (P = 0.035) and a higher self-perception that other people find it difficult to hear them with a face mask (P = 0.050). There was a weak negative correlation between VoiSS and SOC (P < 0.05) and between its domains (P < 0.05).

CONCLUSION

Self-perception of voice symptoms is high among health professionals in a Brazilian public hospital. The presence of these symptoms is related to the perception of a noisy work environment and communication difficulties due to the use of a face mask. The lower the ability to cope with stressful situations, the larger the presence of voice symptoms among health professionals.

Prevalence of voice handicap among nurses in intensive care units due to occupational noise during pandemic

Background

Healthcare workers have been identified as being at risk of occupational voice disorders. Among them, nurses working in intensive care units (ICUs) are particularly vulnerable due to the risk factors that are associated with their exposure to high levels of noise. Thus, this study aimed to determine the prevalence of voice disorders among ICU nurses.

Methods

A questionnaire was administered to 100 ICU nurses from four hospitals in China. The questionnaire assessed vocal-related symptoms, perceived voice handicap, frequently heard noise sources, and the quality of communications.

Results

Results indicate that the most frequently reported voice symptoms were 'voice tiredness' and 'voiceless'. Nurses working more than 50 h per week experienced voice symptoms more frequently than nurses working for 40-50 h per week. The median value of the perceived voice handicap score (VHI-30) was 23, indicating mild voice handicap, while 24% of the nurses reported severe voice handicap. Longer working hours and working at patient wards were significantly associated with higher VHI-30 scores. The nurses also reported that the quality of verbal communication with patients and colleagues and voice problems worsened during the COVID-19 pandemic.

Conclusion

More than 20% of nurses reported severe voice handicap, however, voice handicap among ICU nurses did not appear universally to all nurses. Further research is necessary to identify the risk factors associated with voice disorders and the mechanism behind such heterogeneity among ICU nurses.

Effect of wearing personal protective equipment on acoustic characteristics and speech perception during COVID-19

With the COVID-19 pandemic, the usage of personal protective equipment (PPE) has become 'the new normal'. Both surgical masks and N95 masks with a face shield are widely used in healthcare settings to reduce virus transmission, but the use of these masks has a negative impact on speech perception. Therefore, transparent masks are recommended to solve this dilemma. However, there is a lack of quantitative studies regarding the effect of PPE on speech perception. This study aims to compare the effect on speech perception of different types of PPE (surgical masks, N95 masks with face shield and transparent masks) in healthcare settings, for listeners with normal hearing in the audiovisual or auditory-only modality. The Bamford-Kowal-Bench (BKB)-like Mandarin speech stimuli were digitally recorded by a G.R.A.S KEMAR manikin without and with masks (surgical masks, N95 masks with face shield and transparent masks). Two variants of video display were created (with or without visual cues) and tagged to the corresponding audio recordings. The speech recording and video were presented to listeners simultaneously in each of four conditions: unattenuated speech with visual cues (no mask); surgical mask attenuated speech without visual cues; N95 mask with face shield attenuated speech without visual cues; and transparent mask attenuated speech with visual cues. The signal-to-noise ratio for 50 % correct scores (SNR₅₀) threshold in noise was measured for each condition in the presence of four-talker babble. Twenty-four subjects completed the experiment. Acoustic spectra obtained from all types of masks were primarily attenuated at high frequencies, beyond 3 kHz, but to different extents. The mean SNR₅₀ thresholds of the two auditory-only conditions (surgical mask and N95 mask with face shield) were higher than those of the audiovisual conditions (no mask and transparent mask). SNR₅₀ thresholds in the surgical-mask conditions were significantly lower than those for the N95 masks with face shield. No significant difference was observed between the two audiovisual conditions. The results confirm that wearing a surgical mask or an N95 mask with face shield has a negative impact on speech perception. However, wearing a transparent mask improved speech perception to a similar level as unmasked condition for young normal-hearing listeners.