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Altan E, Barmak E, Tatar EÇ, Saylam G, Korkmaz MH. Which Mask, N95 or Surgical Mask, Causes Hoarseness in Healthcare Workers? J Voice 2024:S0892-1997(24)00154-1. [PMID: 38902143 DOI: 10.1016/j.jvoice.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study aimed to determine the impact of different types of masks on the voices of healthcare professionals who had to wear masks for an extended amount of time during the pandemic period and had a healthy voice. METHODS Our research included 41 healthcare workers. The participants were separated into two groups: surgical (n = 21) and N95 mask users (n = 20). Healthcare workers evaluated masks before and after wearing them for at least 8 hours throughout the workday. All subjects had a videolaryngoscopic examination; the Voice Handicap Index-10 (VHI-10), GRBAS, acoustic voice analysis (F0, jitter%, shimmer%, noise/harmonic ratio, relative average perturbation [RAP]), aerodynamic measures (maximum phonation time, MPT), and blood oxygen saturation were evaluated. RESULTS Although both groups' VHI-10 scores increased after using the mask, this rise was not statistically significant in our research. According to the GRBAS classification, voice quality deterioration was identified in 9.6% (mild-moderate) of the group using surgical masks and 15% (mild) of the group wearing N95. Only the jitter and RAP values of individuals wearing both surgical and N95 masks were determined to be statistically significant. There was no significant change in MPT following mask wear in either group. Both the surgical and N95 mask-using groups showed a substantial drop in blood oxygen saturation before and after mask usage. CONCLUSION There was no change in voice quality between healthcare workers wearing surgical and N95 masks. It has been noticed that voice perception and quality are affected by the mask's barrier effect rather than the kind of mask.
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Affiliation(s)
- Esma Altan
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Elife Barmak
- Ankara Yıldırım Beyazıt University Department of Speech and Language Therapy, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
| | - Guleser Saylam
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Lokman Hekim Hospital, Ankara, Turkiye
| | - Mehmet Hakan Korkmaz
- Department of Otorhinolaryngology and Head and Neck Surgery, Ankara Private Practice Dr, Etlik City Hospital, Ankara, Turkey
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Gojayev EK, Büyükatalay ZÇ, Akyüz T, Rehan M, Dursun G. The Effect of Masks and Respirators on Acoustic Voice Analysis During the COVID-19 Pandemic. J Voice 2024; 38:798.e1-798.e6. [PMID: 34961655 PMCID: PMC8627850 DOI: 10.1016/j.jvoice.2021.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/31/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES World Health Organization declared the coronavirus disease (COVID-19) as a global pandemic on March 11, 2020. The aim of this study was to determine the effectiveness and reliability of voice analysis performed with surgical masks and respirators during the pandemic and to discuss its routine applicability. METHODS This prospective study included 204 patients who applied to our clinic between the ages of 18 and 55, whose preoperative SARS-Cov-2 PCR tests were negative. Voice analyses were performed on each patient without a mask, with a surgical mask and with a valved face-filtering piece-3 (FFP3) respirator respectively. The F0, shimmer, jitter, s/z ratio, maximum phonation time and harmonic/noise ratio (HNR) values obtained from the voice analyses were compared with each other. RESULTS No significant difference was found in terms of F0, Jitter, Shimmer, HNR, s/z and maximum phonation time values in the voice analyses performed without a mask and with a surgical mask. With an FFP3, a significant difference was found in only the Shimmer and HNR values compared to the other analysis values. When we look at the data with sex distinction, in the group of female and male patients, when the data of voice analysis obtained in three situations were compared, different results were obtained from the female and male group. CONCLUSION In conclusion, it should be decided by the physician to perform the voice analysis with a surgical mask or with an FFP3, considering the clinically desired parameters.
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Affiliation(s)
- Ebru Karakaya Gojayev
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| | | | - Tuğba Akyüz
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| | - Mustafa Rehan
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| | - Gürsel Dursun
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
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3
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Shekaraiah S, Suresh K. Effect of Face Mask on Voice Production During COVID-19 Pandemic: A Systematic Review. J Voice 2024; 38:446-457. [PMID: 34802856 PMCID: PMC8502684 DOI: 10.1016/j.jvoice.2021.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic and wearing face mask is recommended across the globe to break the transmission chain of infection. The masks available in the market are of different types and materials and tend to alter the voice characteristics of the speaker. This can therefore impair optimal communication and the present study is a systematic review exploring the effect of various masks on voice production parameters. STUDY DESIGN Systematic review. MATERIALS AND METHODS The titles and abstracts screening was carried out for the inclusion of articles using eight electronic databases spanning the period from 1st January 2020 to 30th April 2021. 10 articles (8 published & 2 in pre-print) that met the inclusion criteria were considered for this systematic review and the pooled age range was 18 -69 years. RESULTS Three primary studies from the USA, 2 each from Australia & Italy, one each from Brazil, China, and Germany were found to have investigated the influence of wearing N95, KN95, surgical and fabric masks on voice related measures. The users significantly reported vocal fatigue, discomfort, and also perceived voice problems. Attenuation of speech sound amplitude was highest for the transparent mask followed by cloth mask, N95, KN95, and surgical mask. CONCLUSION The World Health Organization (WHO) has been repeatedly endorsing the need to use a face mask in the current COVID-19 pandemic. However, for an unintruded voice production, the surgical mask is recommended for everyone, including healthcare professionals when they are not in close contact with patients, and not involved in aerosol-generating procedures. For teachers, doing direct teaching (offline classes), 'surgical mask' can reduce the vocal load of teachers, smoothen the teacher-student interaction and thereby facilitate better learning by the students. Additionally, it would be useful to protect oneself from the risk of developing voice problems by following standard vocal healthcare tips.
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Affiliation(s)
- Sheela Shekaraiah
- Department of Speech and Hearing, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, India.
| | - Kiran Suresh
- A. J. Institute of Speech and Hearing (AJISH), Mangalore, Karnataka, India
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4
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Mehta R, Mat Q, Maniaci A, Lelubre C, Duterme J. Influence of a Surgical Mask on Voice Analysis in Dysphonic Patients During the COVID-19 Pandemic. OTO Open 2024; 8:e102. [PMID: 38229973 PMCID: PMC10790191 DOI: 10.1002/oto2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
Objective COVID-19 has radically changed medical practice. The main objective of this study was to assess the impact of surgical mask (SM) on voice quality analyzes in a group of patient with different common benign vocal organic pathologies. Study Design A cross-over study. Setting A group of 20 patients with different organic benign vocal pathologies was recruited from the ENT consultation of the University Hospital of Charleroi in Belgium. Methods On the day of the assessment, each subject underwent an endonasal laryngeal videostroboscopy followed by a voice analysis (VA) with and without a new SM. The following parameters were analyzed: fundamental frequency, maximum frequency, range in amplitude and frequency of the voice, jitter and maximum phonatory time. Results In this research, we showed that VA can be performed with an SM while not changing the measured vocal parameters. These results also suggest that for the same individual a VA performed before the pandemic without SM could be compared to one with a SM to follow the patient's evolution of his or her voice quality. Conclusion The wearing of an SM during VA should always be recommended in case of immunodeficiency, a contagious disease of the patient or during a (new) pandemic.
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Affiliation(s)
- Rupal Mehta
- Department of OtorhinolaryngologyC.H.U. CharleroiCharleroiBelgium
| | - Quentin Mat
- Department of OtorhinolaryngologyC.H.U. CharleroiCharleroiBelgium
- Faculty of Medicine and PharmacyUniversity of Mons (UMons)MonsBelgium
- COVID‐19 Task Force of the Young Otolaryngologists of the International Federations of Oto‐rhino‐laryngological Society (YO‐IFOS)ParisFrance
| | - Antonino Maniaci
- COVID‐19 Task Force of the Young Otolaryngologists of the International Federations of Oto‐rhino‐laryngological Society (YO‐IFOS)ParisFrance
- Faculty of Medicine and SurgeryUniversity of Enna “Kore”EnnaItaly
| | - Christophe Lelubre
- Faculty of Medicine and PharmacyUniversity of Mons (UMons)MonsBelgium
- Department of Internal MedicineC.H.U. CharleroiCharleroiBelgium
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5
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Silva MT, Occhi-Alexandre IGP, Teixeira LC. Association Between Vocal Symptoms, Communication, Work Environment, and Sense of Coherence in Hospital Health Professionals. J Voice 2023:S0892-1997(23)00370-3. [PMID: 38129270 DOI: 10.1016/j.jvoice.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
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.
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Affiliation(s)
- Melyssa Tamietti Silva
- School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | | | - Letícia Caldas Teixeira
- School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Barsties v. Latoszek B, Jansen V, Watts CR, Hetjens S. The Impact of Protective Face Coverings on Acoustic Markers in Voice: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5922. [PMID: 37762863 PMCID: PMC10531748 DOI: 10.3390/jcm12185922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Wearing respiratory protective masks (RPMs) has become common worldwide, especially in healthcare settings, since the onset of the COVID-19 pandemic. Hypotheses have suggested that sound transmission could be limited by RPMs, which possibly affects the characteristics of acoustic energy and speech intelligibility. The objective of this study was to investigate the effect of RPMs on acoustic measurements through a systematic review with meta-analysis. METHODS Five database searches were conducted, ranging from their inception to August 2023, as well as a manual search. Cross-sectional studies were included that provided data on widely used gender-independent clinical acoustic voice quality measures (jitter, shimmer, HNR, CPPS, and AVQI) and habitual sound pressure level (SPL). RESULTS We found nine eligible research studies with a total of 422 participants who were compared both without masks and with different types of masks. All included studies focused on individuals with vocally healthy voices, while two of the studies also included those with voice disorders. The results from the meta-analysis were related to medical/surgical and FFP2/(K)N95 masks. None of the acoustic measurements showed significant differences between the absence and presence of masks (p > 0.05). When indirectly comparing both mask types, statistical significance was identified for parameters of jitter, HNR, CPPS and SPL (p < 0.001). CONCLUSIONS The present meta-analysis indicates that certain types of RPMs have no significant influence on common voice quality parameters and SPL compared to recordings without masks. Nevertheless, it is plausible that significant differences in acoustic parameters might exist between different mask types. Consequently, it is advisable for the clinical practice to always use the same mask type when using RPMs to ensure high comparability and accuracy of measurement results.
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Affiliation(s)
| | - Viktoria Jansen
- Speech-Language Pathology, SRH University of Applied Health Sciences, 40210 Düsseldorf, Germany
| | - Christopher R. Watts
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, TX 76109, USA
| | - Svetlana Hetjens
- Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, 68165 Mannheim, Germany
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Gao Y, Feng Y, Wu D, Lu F, He H, Tian C. Effect of Wearing Different Masks on Acoustic, Aerodynamic, and Formant Parameters. J Voice 2023:S0892-1997(23)00191-1. [PMID: 37541926 DOI: 10.1016/j.jvoice.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This study aimed to investigate the effects of different types of masks on acoustic, aerodynamic, and formant parameters in healthy people. METHODS Our study involved 30 healthy participants, 15 of each gender, aged 20-40 years. The tests were conducted under four conditions: without a mask, after wearing a surgical mask, after wearing a head-mounted N95 mask, and after wearing an ear-mounted N95 mask. Voice recording was done with the mask on. The acoustic parameters include mean fundamental frequency (F0), mean intensity, percentage of jitter (local), percentage of shimmer (local), mean noise to harmonic ratio (NHR), aerodynamic parameter, maximum phonation time (MPT), and formant parameters (/a/, /i/, /u/ three vowels F1, F2). RESULTS The main effect of mask type was significant in MPT, mean F0, mean HNR, /a/F1, /a/F2, /i/F2. However, the effect sizes and power in /a/F2, /i/F2 were low. MPT, mean F0 and mean HNR significantly increased and /a/F1 significantly decreased after wearing the head-mounted n95 mask. The mean F0 and mean HNR increased significantly after wearing the ear-mounted n95 mask. No significant changes were observed in parameters after wearing the surgical mask in this study. When the statistics are performed separately for males and females, the results obtained are similar to those previously obtained for unspecified males and females. CONCLUSION After wearing the surgical mask, this study found insignificant changes in mean F0, jitter (local), shimmer (local), mean NHR, mean intensity, MPT, and the vowels F1 and F2. This may be due to the looser design of the surgical mask and the relatively small attenuation of sound. N95 masks have a greater effect on vocalization than surgical masks and may cause changes in F0 and HNR after wearing an N95 mask. In the present study, no significant changes in jitter and shimmer were observed after wearing the mask. In addition, there was a significant reduction in /a/F1 after wearing the N95 headgear mask may owing to its high restriction of jaw mobility. In future studies, the change in jaw movement amplitude after wearing the mouthpiece can be added to investigate.
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Affiliation(s)
- Yongxiang Gao
- Department of Hearing and Language Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang Province, China
| | - Yan Feng
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Di Wu
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Feiao Lu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hualan He
- Department of Hearing and Language Rehabilitation, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang Province, China
| | - Chenghua Tian
- College of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
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8
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Tunç-Songur E, Gölaç H, Önen Ç, Duyar TR, Yılmaz M, Kemaloğlu YK. How Does Long Term Use of Surgical Face Mask Affect the Voice in Normophonic Subjects? J Voice 2023:S0892-1997(23)00037-1. [PMID: 36907682 DOI: 10.1016/j.jvoice.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To assess the effects of the longterm-use of surgical face mask (SFM) on acoustic and auditory-perceptual voice parameters in normophonic subjects without any known risk factor related to voice disorders. MATERIALS AND METHODS Of 73 normophonic subjects who were previously included in a couple of studies before the COVID-19 outbreak, 25 people (18 female and 7 male) who were free of any known risk factor related to voice disorders during the outbreak were re-evaluated to assess the long-term effect of SFM on voice by using acoustic (mean F0, Jitter-local, Shimmer-local, Cepstral Peak Prominence (CPP), Noise to Harmonic Ratio (NHR), maximum phonation time (MPT)) and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice, CAPE-V) parameters and those data found in SFM period were compared with the previous (preSFM) data. MPT and acoustic data were analyzed by PRAAT software. RESULTS It was seen that the mean F0 value presented a significant increase, while Jitter-local and Intensity values revealed a significant decrease in females after 2 years pass with SFM use (average 22.52 ± 0.18 months).In males, only a significant decrease in Jitter-local was detected. CONCLUSIONS This study is the first longitudinal investigation on the effects of SFM use on acoustic and auditory-perceptual measures of voice. The data in this study, revealed that long-term use of SFM would not appear to be negatively affecting the acoustic parameters of the voice in normophonic subjects (particularly females) without any related risk factors such as tobacco use, reflux, and etc.
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Affiliation(s)
- Elif Tunç-Songur
- Department of Speech and Language Therapy, Selcuk University, Konya, Turkey.
| | - Hakan Gölaç
- Department of Speech and Language Therapy, Gazi University, Ankara, Turkey
| | - Çiğdem Önen
- Department of Speech and Language Therapy, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Tugay Rifat Duyar
- School of Psychology, Queen's University Belfast, Belfast, United Kingdom
| | - Metin Yılmaz
- Department of Otolaryngology, Gazi University, Ankara, Turkey
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Calà F, Manfredi C, Battilocchi L, Frassineti L, Cantarella G. Speaking with mask in the COVID-19 era: Multiclass machine learning classification of acoustic and perceptual parameters. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:1204. [PMID: 36859154 DOI: 10.1121/10.0017244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
The intensive use of personal protective equipment often requires increasing voice intensity, with possible development of voice disorders. This paper exploits machine learning approaches to investigate the impact of different types of masks on sustained vowels /a/, /i/, and /u/ and the sequence /a'jw/ inside a standardized sentence. Both objective acoustical parameters and subjective ratings were used for statistical analysis, multiple comparisons, and in multivariate machine learning classification experiments. Significant differences were found between mask+shield configuration and no-mask and between mask and mask+shield conditions. Power spectral density decreases with statistical significance above 1.5 kHz when wearing masks. Subjective ratings confirmed increasing discomfort from no-mask condition to protective masks and shield. Machine learning techniques proved that masks alter voice production: in a multiclass experiment, random forest (RF) models were able to distinguish amongst seven masks conditions with up to 94% validation accuracy, separating masked from unmasked conditions with up to 100% validation accuracy and detecting the shield presence with up to 86% validation accuracy. Moreover, an RF classifier allowed distinguishing male from female subject in masked conditions with 100% validation accuracy. Combining acoustic and perceptual analysis represents a robust approach to characterize masks configurations and quantify the corresponding level of discomfort.
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Affiliation(s)
- F Calà
- Department of Information Engineering, Università degli Studi di Firenze, Firenze, Italy
| | - C Manfredi
- Department of Information Engineering, Università degli Studi di Firenze, Firenze, Italy
| | - L Battilocchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Frassineti
- Department of Information Engineering, Università degli Studi di Firenze, Firenze, Italy
| | - G Cantarella
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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10
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Abdel-Hady AF, Dessouky HME, Saqr HH, Farag HM. The effect of wearing face masks on voice and intelligibility of speech during the COVID-19 pandemic. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2023. [PMCID: PMC9993366 DOI: 10.1186/s43163-023-00410-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Background The study aims at evaluating the effect of wearing face masks on voice and intelligibility of speech in Egyptian working individuals during the COVID-19 pandemic to identify if there are any adverse effects of wearing face masks in the working environment. Materials and methods A cross-section analytical study was conducted on 153 participants. Personal data and data about the nature of their workplaces were collected. The evaluation included a subjective assessment of voice and intelligibility of speech using a specifically designed questionnaire addressing self-perception of voice fatigue, speech unintelligibility, received auditory feedback and breathing difficulty, and objective voice assessment by Computerized Speech Lab, while objective speech unintelligibility assessment by the Arabic Speech Intelligibility Test. Results The study revealed poor workplace acoustics and increased their self-perception of voice fatigue, speech unintelligibility, auditory feedback, and breathing difficulty while wearing masks. Medical professionals showed increased self-perception of speech unintelligibility and the received auditory feedback. No significant difference was found in absolute jitter with and without a face mask. Increasing shimmer and mean fundamental frequency and decreasing noise to harmonic ratio and maximum phonation time were found. The study revealed decreased speech intelligibility especially with the N95 mask. Conclusion Wearing face masks negatively affects communication in the workplace, with poor room acoustics. It affects both speech intelligibility and voice subjectively and objectively. It caused increased self-perception of voice fatigue and changes in objective voice parameters.
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Affiliation(s)
- Aisha Fawzy Abdel-Hady
- grid.7776.10000 0004 0639 9286Phoniatric Unit, Otolaryngology Department, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Mohamad El Dessouky
- grid.7776.10000 0004 0639 9286Phoniatric Unit, Otolaryngology Department, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hagar Hussein Saqr
- grid.7776.10000 0004 0639 9286Phoniatric Unit, Otolaryngology Department, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Mahmoud Farag
- grid.7776.10000 0004 0639 9286Phoniatric Unit, Otolaryngology Department, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
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11
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Fischer A, Elbeji A, Aguayo G, Fagherazzi G. Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research. Interact J Med Res 2022; 11:e40655. [PMID: 36378504 PMCID: PMC9668331 DOI: 10.2196/40655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic accelerated the use of remote patient monitoring in clinical practice or research for safety and emergency reasons, justifying the need for innovative digital health solutions to monitor key parameters or symptoms related to COVID-19 or Long COVID. The use of voice-based technologies, and in particular vocal biomarkers, is a promising approach, voice being a rich, easy-to-collect medium with numerous potential applications for health care, from diagnosis to monitoring. In this viewpoint, we provide an overview of the potential benefits and limitations of using voice to monitor COVID-19, Long COVID, and related symptoms. We then describe an optimal pipeline to bring a vocal biomarker candidate from research to clinical practice and discuss recommendations to achieve such a clinical implementation successfully.
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Affiliation(s)
- Aurelie Fischer
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Abir Elbeji
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Gloria Aguayo
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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12
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Zhang T, He M, Li B, Zhang C, Hu J. Acoustic Characteristics of Cantonese Speech Through Protective Facial Coverings. J Voice 2022:S0892-1997(22)00269-7. [PMID: 36266224 DOI: 10.1016/j.jvoice.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Protective facial coverings (PFCs) such as surgical masks attenuate speech transmission and affect speech intelligibility, which is reported in languages such as English and German. The present study intended to verify the detrimental impacts on production of tonal languages such as Cantonese, by examining realization of speech correlates in Cantonese under PFCs including facial masks and shields. METHODS We recorded scripted speech in Hong Kong Cantonese produced by three adult speakers who wore various PFCs, including surgical masks, KF94 masks, and face shields (with and without surgical masks). Spectral and temporal parameters were measured, including mean intensity, speaking rate, long-term amplitude spectrum, formant frequencies of vowels, and duration and fundamental frequency (F0) of tone-bearing parts. RESULTS Significant changes were observed in all acoustic correlates of Cantonese speech under PFCs. Sound pressure levels were attenuated more intensely at ranges of higher frequencies in speech through face masks, whereas sound transmission was affected more at ranges of lower frequencies in speech under face shields. Vowel spaces derived from formant frequencies shrank under all PFCs, with the vowel /aa/ demonstrating largest changes in the first two formants. All tone-bearing parts were shortened and showed increments of F0 means in speech through PFCs. The decrease of tone duration was statistically significant in High-level and Low-level tones, while the increment of F0 means was significant in High-level tone only. CONCLUSIONS General filtering effect of PFCs is observed in Cantonese speech data, confirming language-universal patterns in acoustic attenuation by PFCs. The various coverings lower overall intensity levels of speech and degrade speech signal in higher frequency regions. Modification patterns specific to Hong Kong Cantonese are also identified. Vowel space area is reduced and found associated with increased speaking rates. Tones are produced with higher F0s under PFCs, which may be attributed to vocal tension caused by tightened vocal tract during speaking through facial coverings.
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Affiliation(s)
- Ting Zhang
- Department of Linguistics and Translation, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong S.A.R., China
| | - Mosi He
- Department of Linguistics and Translation, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong S.A.R., China
| | - Bin Li
- Department of Linguistics and Translation, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong S.A.R., China.
| | - Cuiling Zhang
- School of Criminal Investigation, Southwest University of Political Science & Law, Chongqing, China; Chongqing Institutes of Higher Education Key Forensic Science Laboratory, Chongqing, China
| | - Jinlian Hu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong S.A.R., China
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13
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Asensio C, Pavón I, de Arcas G. How the COVID-19 Pandemic Muted and Remixed the World's Acoustics for a While. CURRENT POLLUTION REPORTS 2022; 8:328-340. [PMID: 36258901 PMCID: PMC9561339 DOI: 10.1007/s40726-022-00236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE OF REVIEW This review aims to analyze the effects of the pandemic on the world's sound environment. RECENT FINDINGS The confinements associated with the pandemic led to a reduction in sound levels worldwide and a change in the perception of soundscapes in the absence of traffic noise and human-generated noise. SUMMARY In response to the COVID-19 pandemic, many countries and regions around the world adopted a series of interventions in 2020 that have been referred to as "lockdown" or "confinement." These sets of restrictions had a clear and obvious consequence derived from the absence of people in the streets and the reduction of daily activity and commuting, which caused an unprecedented silencing on a large scale. Along with the silence that ensued, the pandemic and the confinements affected acoustics and our relationship with sounds on different scales. In the cities, this phenomenon had a strong reduction in acoustic intensity due to the absence of vehicles on the streets. Perhaps this was more perceptible in our neighborhoods, with notable changes in their soundscapes, first due to the absence of people in the streets and later due to more outdoor activity derived from the fear of the spread of the virus in indoor spaces. The longer periods of time spent in our homes during the lockdowns also highlighted the importance of sound insulation in buildings and the acoustic conditioning of our schools or homes.
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Affiliation(s)
- César Asensio
- Universidad Politécnica de Madrid (Instrumentation and Applied Acoustics Research Group), Madrid, Spain
| | - Ignacio Pavón
- Universidad Politécnica de Madrid (Instrumentation and Applied Acoustics Research Group), Madrid, Spain
| | - Guillermo de Arcas
- Universidad Politécnica de Madrid (Instrumentation and Applied Acoustics Research Group), Madrid, Spain
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14
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Sinagra C, Wiener S. The perception of intonational and emotional speech prosody produced with and without a face mask: an exploratory individual differences study. Cogn Res Princ Implic 2022; 7:89. [PMID: 36194295 PMCID: PMC9530435 DOI: 10.1186/s41235-022-00439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
Face masks affect the transmission of speech and obscure facial cues. Here, we examine how this reduction in acoustic and facial information affects a listener's understanding of speech prosody. English sentence pairs that differed in their intonational (statement/question) and emotional (happy/sad) prosody were created. These pairs were recorded by a masked and unmasked speaker and manipulated to contain audio or not. This resulted in a continuum from typical unmasked speech with audio (easiest) to masked speech without audio (hardest). English listeners (N = 129) were tested on their discrimination of these statement/question and happy/sad pairs. We also collected six individual difference measures previously reported to affect various linguistic processes: Autism Spectrum Quotient, musical background, phonological short-term memory (digit span, 2-back), and congruence task (flanker, Simon) behavior. The results indicated that masked statement/question and happy/sad prosodies were harder to discriminate than unmasked prosodies. Masks can therefore make it more difficult to understand a speaker's intended intonation or emotion. Importantly, listeners differed considerably in their ability to understand prosody. When wearing a mask, speakers should try to speak clearer and louder, if possible, and make intentions and emotions explicit to the listener.
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Affiliation(s)
- Chloe Sinagra
- grid.147455.60000 0001 2097 0344Language Acquisition, Processing, and Pedagogy Lab, Department of Modern Languages, Carnegie Mellon University, Pittsburgh, PA USA
| | - Seth Wiener
- grid.147455.60000 0001 2097 0344Language Acquisition, Processing, and Pedagogy Lab, Department of Modern Languages, Carnegie Mellon University, Pittsburgh, PA USA
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15
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Cavallaro G, Murri A, Nelson E, Gorrasi R, Quaranta N. The Impact of the COVID-19 Lockdown on Quality of Life in Adult Cochlear Implant Users: A Survey Study. Audiol Res 2022; 12:518-526. [PMID: 36285909 PMCID: PMC9598621 DOI: 10.3390/audiolres12050052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The COVID-19 pandemic rapidly spread through Europe in the first months of 2020. On the 9th of March 2020, the Italian government ordered a national lock-down. The study’s objectives were: to investigate the effect of lockdown on CI users; and to detect the difference in the perception of discomfort existing between unilateral cochlear implant (UCI) users and bilateral cochlear implant (BCI) users, due to the lockdown experience. Methods: A 17-item, web-based, anonymous online survey was administered to 57 CI users, exploring hearing performance, emotions, practical issues, behavior, and tinnitus. Participation in the study was voluntary. Results: all CI users obtained an abnormal score in all questionnaire themes. For the emotion theme and the practical issue theme, the age range 61–90 showed a significant difference between UCI and BCI users in favor of BCI users (emotion theme: UCI mean = 3.9, BCI mean = 2.3, p = 0.0138; practical issues: UCI mean = 4, BCI mean = 3, p = 0.0031). Conclusions: CI users experienced the lockdown negatively as regards behavior, emotions, hearing performance, and in practical issues. CI subjects with UCI in old age suffered more from the experience of lockdown than subjects with BCI in the same age, with regards to emotions and practical issues.
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16
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Mehta R, Mat Q, Lelubre C, Lechien JR, Duterme JP. Influence of a surgical mask on voice analysis in healthy subjects in the COVID-19 pandemic: A cross-over study. Clin Otolaryngol 2022; 47:692-695. [PMID: 35836337 PMCID: PMC9349984 DOI: 10.1111/coa.13964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Rupal Mehta
- Departement of Otorhinolaryngology, C.H.U. Charleroi, Charleroi, Belgium
| | - Quentin Mat
- Departement of Otorhinolaryngology, C.H.U. Charleroi, Charleroi, Belgium.,Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium.,COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Society (YO-IFOS), Paris, France
| | - Christophe Lelubre
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium.,Department of Internal Medicine, C.H.U. Charleroi, Charleroi, Belgium
| | - Jerome René Lechien
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium.,COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Society (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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17
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Lee SJ, Kang MS, Park YM, Lim JY. Reliability of Acoustic Measures in Dysphonic Patients With Glottic Insufficiency and Healthy Population: A COVID-19 Perspective. J Voice 2022:S0892-1997(22)00168-0. [PMID: 35835646 PMCID: PMC9273473 DOI: 10.1016/j.jvoice.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has affected the voice assessment protocols for dysphonic patients. In this study, we compared the changes in acoustic measures of the healthy population as well as dysphonic patients due to glottic insufficiency between the pandemic period requiring face masks and the prepandemic period when the masks were not essential. The clinical reliability of the acoustic measures with and without face masks was explored. METHODS A total of 120 patients (age = 42.3 ± 11.9 yrs) with glottic insufficiencies such as UVFP and sulcus vocalis and 40 healthy population (age = 40.5 ± 11.2 yrs) cohorts were enrolled during the pandemic period. Age- and gender-matched 120 patients and 40 healthy population cohorts who underwent voice assessment without face masks before the pandemic were enrolled as prepandemic controls. Acoustic measures and overall severity estimates of vowel and speech samples were compared, which included cepstral peak prominence (CPP), L/H spectral ratio (SR), their standard deviations, F0, jitter percent (Jitt), shimmer percent (Shim), noise-to-harmonic ratio (NHR), Cepstral Spectral Index of Dysphonia (CSID), and Acoustic Psychometric Severity Index of Dysphonia. RESULTS Both patients and healthy cohorts showed higher SRv and SRs but lower CSIDv during the pandemic compared to the prepandemic period. F0 of the healthy male controls during the pandemic was higher than during the prepandemic periods, while the CSIDs was lower for the pandemic period. The pandemic patient cohort showed lower σSRs compared to the prepandemic patient cohort. When the acoustic measures of patients were compared to the healthy population cohort, the patient cohort showed lower CPP and σCPPs, while higher σCPPv, Jitt, Shim, and NHR during both pandemic and prepandemic period. Overall, the area under the curve of the acoustic measures and overall severity estimates was similar between the mask and non-mask groups, although the AUC of the SR measures was poor. CONCLUSIONS Wearing face masks during the pandemic did not compromise the overall reliability of the acoustic analysis in patients with glottic insufficiency, suggesting the current protocol of acoustic analysis can be carried out reliably while wearing a mask to ensure safety in the pandemic era.
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Affiliation(s)
- Seung Jin Lee
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Republic of Korea
| | - Min Seok Kang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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18
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Reliability of the Acoustic Voice Quality Index AVQI and the Acoustic Breathiness Index (ABI) when wearing CoViD-19 protective masks. Eur Arch Otorhinolaryngol 2022; 279:4617-4621. [PMID: 35522325 PMCID: PMC9073513 DOI: 10.1007/s00405-022-07417-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Investigating whether the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) are valid and comparable to previous unmasked measurements if the speaker wears a surgical mask or a FFP-2 mask to reduce the risk of transmitting air-borne viruses such as SARS-CoV-2. METHODS A convenience sample of 31 subjectively healthy participants was subjected to AVQI and ABI voice examination four times: Twice wearing no mask, once with a surgical mask and once with a FFP-2 mask as used regularly in our hospital. The order of the four mask conditions was randomized. The difference in the results between the two recordings without a mask was then compared to the differences between the recordings with each mask and one recording without a mask. RESULTS Sixty-two percent of the AVQI readings without a mask represented perfectly healthy voices, the largest AVQI without a mask value was 4.0. The mean absolute difference in AVQI was 0.45 between the measurements without masks, 0.48 between no mask and surgical mask and 0.51 between no mask and FFP-2 mask. The results were neither clinically nor statistically significant. For the ABI the resulting absolute differences (in the same order) were 0.48, 0.69 and 0.56, again neither clinically nor statistically different. CONCLUSION Based on a convenience sample of healthy or only mildly impaired voices wearing CoViD-19 protective masks does not substantially impair the results of either AVQI or ABI results.
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19
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Knowles T, Badh G. The impact of face masks on spectral acoustics of speech: Effect of clear and loud speech styles. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:3359. [PMID: 35649889 PMCID: PMC9202821 DOI: 10.1121/10.0011400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 05/03/2023]
Abstract
This study quantified the effects of face masks on spectral speech acoustics in healthy talkers using habitual, loud, and clear speaking styles. Harvard sentence lists were read aloud by 17 healthy talkers in each of the 3 speech styles without wearing a mask, when wearing a surgical mask, and when wearing a KN95 mask. Outcome measures included speech intensity, spectral moments, and spectral tilt and energy in mid-range frequencies which were measured at the utterance level. Masks were associated with alterations in spectral density characteristics consistent with a low-pass filtering effect, although the effect sizes varied. Larger effects were observed for center of gravity and spectral variability (in habitual speech) and spectral tilt (across all speech styles). KN95 masks demonstrated a greater effect on speech acoustics than surgical masks. The overall pattern of the changes in speech acoustics was consistent across all three speech styles. Loud speech, followed by clear speech, was effective in remediating the filtering effects of the masks compared to habitual speech.
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Affiliation(s)
- Thea Knowles
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, New York 14215, USA
| | - Gursharan Badh
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, New York 14215, USA
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20
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Georgiou GP. Acoustic markers of vowels produced with different types of face masks. APPLIED ACOUSTICS. ACOUSTIQUE APPLIQUE. ANGEWANDTE AKUSTIK 2022; 191:108691. [PMID: 35250034 PMCID: PMC8889311 DOI: 10.1016/j.apacoust.2022.108691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 05/28/2023]
Abstract
The wide spread of SARS-CoV-2 led to the extensive use of face masks in public places. Although masks offer significant protection from infectious droplets, they also impact verbal communication by altering speech signal. The present study examines how two types of face masks affect the speech properties of vowels. Twenty speakers were recorded producing their native vowels in a /pVs/ context, maintaining a normal speaking rate. Speakers were asked to produce the vowels in three conditions: (a) with a surgical mask, (b) with a cotton mask, and (c) without a mask. The speakers' output was analyzed through Praat speech acoustics software. We fitted three linear mixed-effects models to investigate the mask-wearing effects on the first formant (F1), second formant (F2), and duration of vowels. The results demonstrated that F1 and duration of vowels remained intact in the masked conditions compared to the unmasked condition, while F2 was altered for three out of five vowels (/e a u/) in the surgical mask and two out of five vowels (/e a/) in the cotton mask. So, both types of masks altered to some extent speech signal and they mostly affected the same vowel qualities. It is concluded that some acoustic properties are more sensitive than other to speech signal modification when speech is filtered through masks, while various sounds are affected in a different way. The findings may have significant implications for second/foreign language instructors who teach pronunciation and for speech therapists who teach sounds to individuals with language disorders.
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Affiliation(s)
- Georgios P Georgiou
- Department of Languages and Literature, University of Nicosia, Nicosia, Cyprus
- Department of Foreign Languages, RUDN University, Moscow, Russia
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21
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Oosthuizen I, Saunders GH, Manchaiah V, Swanepoel DW. Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review. Front Public Health 2022; 10:815259. [PMID: 35419343 PMCID: PMC8995421 DOI: 10.3389/fpubh.2022.815259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications. Method A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist. Results Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues. Conclusion Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.
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Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
| | - Gabrielle H. Saunders
- Manchester Centre for Audiology and Deafness (ManCAD), University of Manchester, Manchester, United Kingdom
| | - Vinaya Manchaiah
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
- Ear Science Institute Australia, Subiaco, WA, Australia
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22
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Aliabadi M, Aghamiri ZS, Farhadian M, Shafiee Motlagh M, Hamidi Nahrani M. The Influence of Face Masks on Verbal Communication in Persian in the Presence of Background Noise in Healthcare Staff. ACOUSTICS AUSTRALIA 2022; 50:127-137. [PMID: 35095185 PMCID: PMC8789375 DOI: 10.1007/s40857-021-00260-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
Wearing face masks has resulted in verbal communication being more challenging during the COVID-19 pandemic. This study aimed to investigate the effect of face masks on the speech comprehensibility of Persian nurses in healthcare settings. Twenty female nurses from the governmental hospitals randomly participated in an experiment on seven typical commercial face masks at two background noise levels. Nurses' speech intelligibility from a human talker when wearing each face mask was determined based on the speech discrimination score. The vocal effort of nurses wearing each face mask was determined based on the Borg CR10 scale. Based on the linear mixed model, the speech intelligibility of nurses from a human speaker wearing surgical masks, N95 masks, and a shield with face masks were approximately 10%, 20%, and 40-50% lower, respectively, than no-mask conditions (p < 0.01). The background noise decreased the speech intelligibility of nurses by approximately 22% (p < 0.01). The use of a face shield further decreased speech intelligibility up to 30% compared to using a face mask alone (p < 0.01). The vocal efforts of nurses when wearing surgical masks were not significant compared with the baseline vocal efforts (p > 0.05); however, vocal efforts of nurses when wearing N95 and N99 respirators were at an unacceptable level. The face masks had no considerable effect on the speech spectrum below 2.5 kHz; however, they reduced high frequencies by different values. Wearing face masks has a considerable impact on the verbal communication of nurses in Persian. The level of background noise in the healthcare setting can aggravate the effect sizes of face masks on speech comprehensibility.
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Affiliation(s)
- Mohsen Aliabadi
- Center of Excellence for Occupational Health, School of Public Health and Occupational Health and Safety Research Center, Hamadan University of Medical Sciences, P.O. Box 4171-65175, Hamadan, Iran
| | - Zahra Sadat Aghamiri
- Center of Excellence for Occupational Health, School of Public Health and Occupational Health and Safety Research Center, Hamadan University of Medical Sciences, P.O. Box 4171-65175, Hamadan, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Shafiee Motlagh
- Center of Excellence for Occupational Health, School of Public Health and Occupational Health and Safety Research Center, Hamadan University of Medical Sciences, P.O. Box 4171-65175, Hamadan, Iran
| | - Morteza Hamidi Nahrani
- Department of Audiology, School of Rehabilitation, Hamadan University of Medical Sciences, Hamadan, Iran
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23
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Derrick D, Kabaliuk N, Longworth L, Pishyar-Dehkordi P, Jermy M. Speech air flow with and without face masks. Sci Rep 2022; 12:837. [PMID: 35039580 PMCID: PMC8763952 DOI: 10.1038/s41598-021-04745-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/28/2021] [Indexed: 01/02/2023] Open
Abstract
Face masks slow exhaled air flow and sequester exhaled particles. There are many types of face masks on the market today, each having widely varying fits, filtering, and air redirection characteristics. While particle filtration and flow resistance from masks has been well studied, their effects on speech air flow has not. We built a schlieren system and recorded speech air flow with 14 different face masks, comparing it to mask-less speech. All of the face masks reduced air flow from speech, but some allowed air flow features to reach further than 40 cm from a speaker's lips and nose within a few seconds, and all the face masks allowed some air to escape above the nose. Evidence from available literature shows that distancing and ventilation in higher-risk indoor environment provide more benefit than wearing a face mask. Our own research shows all the masks we tested provide some additional benefit of restricting air flow from a speaker. However, well-fitted mask specifically designed for the purpose of preventing the spread of disease reduce air flow the most. Future research will study the effects of face masks on speech communication in order to facilitate cost/benefit analysis of mask usage in various environments.
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Affiliation(s)
- Donald Derrick
- New Zealand Institute of Language, Brain, and Behaviour, University of Canterbury, Christchurch, 8041, New Zealand.
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
| | - Luke Longworth
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
| | | | - Mark Jermy
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
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24
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Does the wearing of masks change voice and speech parameters? Eur Arch Otorhinolaryngol 2021; 279:1701-1708. [PMID: 34550454 PMCID: PMC8456395 DOI: 10.1007/s00405-021-07086-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/10/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The authors aim to review available reports on the potential effects of masks on voice and speech parameters. METHODS A literature search was conducted using MEDLINE and Google Scholar databases through July 2021. Several targeted populations, mask scenarios and methodologies were approached. The assessed voice parameters were divided into self-reported, acoustic and aerodynamic. RESULTS It was observed that the wearing of a face mask has been shown to induce several changes in voice parameters: (1) self-reported-significantly increased vocal effort and fatigue, increased vocal tract discomfort and increased values of voice handicap index (VHI) were observed; (2) acoustics-increased voice intensity, altered formants frequency (F2 and F3) with no changes in fundamental frequency, increased harmonics-to-noise ratio (HNR) and increased mean spectral values in high-frequency levels (1000-8000 Hz), especially with KN95 mask; (3) aerodynamics-maximum phonatory time was assessed in only two reports, and showed no alterations. CONCLUSION Despite the different populations, mask-type scenarios and methodologies described by each study, the results of this review outline the significant changes in voice characteristics with the use of face masks. Wearing a mask shows to increase the perception of vocal effort and an alteration of the vocal tract length and speech articulatory movements, leading to spectral sound changes, impaired communication and perception. Studies analyzing the effect of masks on voice aerodynamics are lacking. Further research is required to study the long-term effects of face masks on the potential development of voice pathology.
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