COVID-19: No Impact on Hearing Loss

Throughout this pandemic, we’ve seen countless headlines about how COVID-19 impacts individuals differently. From asymptomatic patients, to those who may suffer from long-term effects like the permanent loss of the sense of smell. Early on, one of those speculations had been about whether the COVID-19 virus has any effect on hearing loss, and it was largely debated. Good news: Studies show that COVID-19 has no permanent impact on hearing loss.

Researchers in Israel decided to investigate this question back during the first wave of the pandemic, when the number of patients infected with the virus was relatively small. They were trying to determine if hearing loss while infected with COVID-19 was caused by actual damage to the auditory system, or if it was more like the temporary symptoms of a common cold, with fluid clogging the middle ear. 

In this small study, investigators tested 8 asymptomatic individuals who tested positive for COVID-19 and 8 healthy volunteers who served as a control group. All participants reported no prior hearing loss. The study provided for the first time quantitative measures for hearing quality following exposure to the virus. “Our study explored whether COVID-19 can cause permanent neural or sensory damage to the hearing system. We found no evidence for such damage,” said co-author Dr Amiel Dror of the Galilee Medical Center and the Azrieli Faculty of Medicine at Bar-Ilan University. 

At this stage, according to Dror, their study showed COVID-19 has no impact on hearing loss. This was determined by measuring electrical data from the brainstem to test the route of the soundwaves through the ear until these electric waves were finally received in the brain. They also examined the activity of the inner ear hair cells. Based on their findings, they concluded there was no difference between COVID-19-positive subjects and the control group.

Co-author Dr Eyal Sela of the Galilee Medical Center and the Azrieli Faculty of Medicine at Bar-Ilan University concludes, “This study proposes that the COVID virus does not cause extensive neurological damage but is rather spotty, mostly affecting the sense of smell. Moreover, the hearing impairment among some patients is mostly transient and secondary to fluid buildup in the middle ear, as for the common cold, and therefore likely passes once the acute disease is over.”

It’s important to remember that science and research is ongoing, ever-changing, and always being updated. The researchers are currently conducting a much more comprehensive study with hundreds of patients, including persons who had been severely ill and even ventilated. Let’s hope their results continue to show no permanent hearing loss due to COVID-19—we’ll keep you posted as soon as we hear more!

For now, know that all of us here at Longmont Hearing and Tinnitus Center are here to provide you with the hearing support you need. Whether you need to be fitted with new hearing aids, an earwax cleaning, or have questions, reach out! Give us a call to make an appointment or to ask us any questions. We look forward to hearing from you!

The Link Between Hearing Impairment and Diabetes

As you may know, many health conditions—like hearing impairment—are linked to each other in some way, and knowledge of these connections is vital in helping diagnose, treat, and manage certain conditions, like diabetes. Until recently, hearing loss had not been linked to diabetes in any way. But that has finally changed. The American Diabetes Association (ADA) has recognized hearing loss as being more common in people with diabetes. With this recognition, the ADA has now added audiology to its table on referrals for initial diabetes care management in its recent updated Standards of Medical Care in Diabetes-2021 published in the January 2021 edition of Diabetes Care, the organization’s magazine.

For audiologists everywhere, this is big news. In fact, the inclusion of the link between hearing impairment and diabetes is a significant victory not only for hearing healthcare as a whole, but specifically for the executive director of The Audiology Project, Kathy Dowd AuD. The Audiology Project promotes audiology-based medical management for chronic diseases, and in recent years, they focused much of their effort on educating stakeholders in diabetes about the links between the disease and hearing loss.

The ADA document addresses the link between hearing impairment and diabetes twice in their document, below is an excerpt:

Hearing impairment, both in high-frequency and low- to midfrequency ranges, is more common in people with diabetes than in those without, with stronger associations found in studies of younger people. Proposed pathophysiologic mechanisms include the combined contributions of hyperglycemia and oxidative stress to cochlear microangiopathy and auditory neuropathy. In a National Health and Nutrition Examination Survey (NHANES) analysis, hearing impairment was about twice as prevalent in people with diabetes compared with those without, after adjusting for age and other risk factors for hearing impairment. Low HDL cholesterol, coronary heart disease, peripheral neuropathy, and general poor health have been reported as risk factors for hearing impairment for people with diabetes, but an association of hearing loss with blood glucose levels has not been consistently observed. In the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort, time-weighted mean A1C was associated with increased risk of hearing impairment when tested after long-term (.20 years) follow-up. Impairment in smell, but not taste, has also been reported in individuals with diabetes.

This sort of knowledge is crucial in helping all of us in the health care industry to provide the best in care. If you believe you are suffering from hearing impairment, whether you are diabetic or not, we can help! Reach out to us to ask any questions, book and appointment, or to schedule a time for hearing aid maintenance. As always, our goal is to help you in any way we can.

New Technology Could Measure Tinnitus in Patients

It is estimated that 32% of the U.S. population suffers from tinnitus— the perception of a sound that has no external source. Most patients report they hear a ringing, humming, buzzing, or cricket-like sound that can be constant, intermittent, heard in one ear, both ears, or in the head. Needless to say, it’s uncomfortable, widespread, and difficult to care for because tinnitus is a symptom, not a disease. This means most attempts to address the issue do not cure the actual disease, but rather, alleviates the symptom. However, there may be hope on the horizon.

According to a new study published in November 2020, a technology called functional near-infrared spectroscopy (fNIRS) can be used to objectively measure tinnitus, or ringing in the ears. This is a huge achievement, as to this day there has been no clinically used, objective way to determine the presence or severity of the condition.

How it works

Researchers turned to fNIRS, a non-invasive and non-radioactive imaging method which measures changes in blood oxygen levels within brain tissue.

– By using fNIRS, the study team was able to track different areas of the brain’s cortex known to be linked to the condition.
– Researchers collected data from 25 patients with chronic tinnitus, and 21 people were used as controls (who do not have tinnitus) that matched the 25 patients in terms of age and level of hearing loss.
– Patients were asked to rate the severity of their tinnitus using the Tinnitus Handicap Inventory.

The fNIRS revealed some very interesting findings! Results showed a statistically significant difference in the connectivity between the areas of the brain in people with and without tinnitus. In addition, it was found that the brain’s response to both visual and auditory stimuli was lower among those with tinnitus. Researchers applied machine learning to the data they collected, and the program they used was able to differentiate between patients with mild tinnitus from those with moderate to severe tinnitus with an 87.32% level of accuracy. For a condition that until recently wasn’t even accepted by all audiologists, this is a huge accomplishment!

What this means

We’re so thrilled about these findings, and cannot wait until this technology becomes widespread. But we have to emphasize that that day has yet to come. For now, these are the early stages, and this technology is not available at doctor’s offices. This is but the first step of many, and it is a crucial one! Once this technology is further tested, improved, and approved, we can then hope to see them distributed to hearing care centers, like Longmont Hearing and Tinnitus Center.

Until then, all of us at Longmont Hearing and Tinnitus Center are dedicated to giving you the treatment you need. We are skilled at the screening and treatment of tinnitus, and are here to help. If you or a loved one is suffering from tinnitus, don’t wait, let us help! Make an appointment with us, and let’s see what we can do to provide you with relief.

Toys May lead to Hearing Loss in Children

Wow! It’s almost impossible to believe the holidays are upon, and yet, here we are, it’s December! Many of us celebrate the holidays with gift-giving, and this year shopping may be a little different. With COVID-19 still keeping us primarily at home, many will have to stick to online shopping to get gifts for their loved ones.

Hearing Loss in Children

Though it’s difficult to believe, there are certain toys out there that are too loud, and they run the risk of damaging your child’s hearing. That’s why the Arizona Commission for the Deaf and the Hard of Hearing (ACDHH) recently tested and released a list of 2020’s hottest toys to avoid. These are toys that reach a sound level of 85 decibels (dB) or higher. According to the American Speech-Language-Hearing Association, 85 dB is the maximum volume a child should be exposed to for no more than eight hours a day. Sounds louder than 100 dB can lead to hearing loss in children in less than 15 minutes. With online shopping on the rise, it’ll be harder and harder for parents to test toys out before their purchase, but the ACDHH is here to help. Read on for a list of toys they recommend as well as those to avoid.

Did you know?

Noise is the number one cause of hearing loss in children. Nearly 15 percent of children between the ages of 6-19 have some degree of hearing loss. Loud noises can increase fatigue, decrease a child’s ability to pay attention, and reduce short term memory. It’s not a great combination. That’s why the ACDHH spent time this year examining this season’s most popular toys, chosen at random, to provide parents with guidance this holiday season. Each dB measurement was taken as if the child placed their ear next to the speaker. If your shopping list includes toys for the children in your life, you may want to consider turning down the volume on these toys:

Toys to Avoid listed in highest dB order:
  1. Leap Frog Scrub and Play Smart Sink: 103 dB
  2. Vtech Turn & Learn Driver: 101 dB
  3. Fisher Price Sing & Learn Music Player: 98 dB
  4. Leap Frog 100 Animals Books: 98 dB
  5. Nickelodeon Baby Shark Musical PlayPad: 98 dB
  6. Jada Police Hero Patrol Lights & Sound 95 dB
  7. Leap Frog Fridge Phonics: 94 dB
  8. Vtech Helping Heroes Fire Station: 93 dB
  9. Adventure Force Mighty Dragon: 92 dB
  10. Leap Frog 100 Words Book: 92 dB
  11. Vtech Peppa Pig Learn & Discover Book: 91 dB
  12. Vtech Brilliant Baby Laptop: 90 dB
  13. Vtech Magic Star Learning Table: 89 dB
  14. Fisher Price Leave a Message Smart Phone: 89 dB

The ACDHH also created a list of toys they encourage parents to purchase (the list is not all-inclusive).

List of Safe Toys under 85dB listed by age:
  1. Leap Frog Learn & Groove Caterpillar Drums: 80 dB
  2. Leap Frog Pick Up & Count Vacuum: 78 dB
  3. Vtech Care for Me Learning Carrie: 75 dB
  4. Vtech Drop & Go Dump Truck: 75 dB
  5. Vtech Bright Lights Soccer Ball: 70 dB
  6. B. Toy Critter Clinic: No sound
  7. Melissa & Doug Ice Cream Counter: No sound
  8. Melissa & Doug Dust Sweep Mop: No sound

When buying toys for your children, it’s important to think about how the child will use the toy. More often than not, children may choose to hold the toy close, versus at arm’s length, which can be risky. Another consideration is what other sounds may be present at the time of play. Perhaps there’s a television on, other children they’re playing with who are yelling, or other loud toys they may not be interacting with. All of these sounds can add up, and ultimately lead to hearing loss in children.

If you’d like to conduct your own decibel test, there are a few applications you can download on your smartphone to test sound levels of toys you’re considering purchasing or already bought:

A few suggested dB testing apps from a report:
  • Apps for both Android and iOS
    • Decibel X
    • SPL Meter
    • Too Noisy Pro
  • Apps for iOS only
    • NIOSH Sound Level Meter
    • SPLnFFT Noise Meter
  • Apps for Android only
    • Sound Meter Pro
    • Sound Meter and Noise Detector

Simple test methods to ensure toys won’t hurt young ears: 

  • Use ‘try-me’ buttons on the toys when available
  • Hold the toy as close to your ear as your child would and ask yourself if the toy is too loud
  • Hold the toy eight inches away from your ear (approximately the length of your child’s arm), and if you must speak at a higher volume above the sound effects, it’s too loud

How to keep the volume down on loud toys:

  • If the toy has volume control, ensure it’s always set to the lowest level
  • Put waterproof tape or super glue over speaker to mute it
  • Put tape over volume control to prevent your child from increasing the volume to unsafe volume level

As always, our priority is your well-being. If you think your child may be suffering from hearing loss, or perhaps you, be sure to make an appointment with us. We’re practicing all social distancing safety measures, and are here to help with all your auditory needs. Give us a call to set up an appointment, or to ask any questions. We’re here for you!

Surgical Masks and Hearing Loss: COVID-19

Wow! It’s December already, and though we’re past 8 months into the COVID-19 pandemic, we’re still learning something new each day. We wanted to share new data that shows how surgical masks degrade speech quality, affecting those with hearing loss the most. Recent studies show mask use can render speech close to unintelligible for many patients with hearing loss.

What’s Up, masks?

The COVID-19 virus has definitely had an impact on clinician-patient communication, especially fo those with hearing loss. In fact, the trajectory of hearing loss and the infection fatality by age distribution tell a very important story, one we may not have thought of. Many of the people who have fallen victim to the virus and have been hospitalized are older adults, which coincidentally means many of them suffer from hearing loss. These patients tend to be unaccompanied by family members, are frail, have a variety of chronic conditions, and are likely there without any hearing assistance. 

Therefore, their struggle to understand speech is further exacerbated by the use of masks, which of course are a necessity to help minimize the spread of the virus. Surgical mask use presents two challenges for patients with hearing loss when it comes to speech comprehension:

1: The patient can’t facilitate comprehension by lip-reading
2: The healthcare provider’s voice is muffled and distorted

The data we’re referencing comes from a study that focused on how masks distort sound.

How Does a Surgical Mask Impact the Speech Signal?

The study used a GRAS head and torso simulator to play white noise through an artificial mouth, with a mask on, and the output acoustic signal was measured by a microphone 2 meters away. There were 4 different masks used for this study:

The study found that all surgical masks types essentially worked as a low-pass filter. This means the masks ended up reducing high frequencies spoken by the wearer, with the decibel (dB) level of attenuation ranging from 3-4 dB for a simple mask, to close to 12 dB for the N95 masks. Basically, mask use led to speech quality degradation, especially when in combination with room noise/reverberation and the absence of visual cues, and it renders speech close to unintelligible for many.

Addressing the Issue

Because of this, the use of effective communication strategies becomes more important than ever. Here are a few ways that patients with hearing loss and their physicians can bridge the gap to ensure communication is functioning at its best:

  • Speak Slowly
  • Be sure to obtain each other’s attention
  • Reduce any noise when possible
  • Rephrase when not understood
  • Do not shout, over-emphasize, or exaggerate your words

We know surgical masks have an effect on patients with hearing loss when attempting to comprehend speech, and that’s a real challenge. As always, we’re here to help. If you feel you’re experiencing hearing loss, need help with your hearing aids, or have any questions, give us a call and set up and appointment. Here at Longmont Hearing and Tinnitus Center, we’re dedicated to helping our patients every step of the way.

Tinnitus: Exacerbated by COVID-19

New findings indicate that tinnitus is exacerbated by COVID-19. As if the COVID-19 virus hasn’t done enough damage, it now appears to exacerbating the effects of Tinnitus, according to the Angela Ruskin University (ARU) website. As a reminder, Tinnitus is is the perception of a sound that has no external source. Common sounds include ringing, humming, buzzing, or cricket-like. It can be constant or intermittent and is heard in one ear, both ears, or in the head. It’s uncomfortable, a nuisance, and has no cure (yet).

A study led by the ARU, with support from the British Tinnitus Association and the American Tinnitus Association, studied 3,103 people with tinnitus from 48 different countries, with the majority coming from the UK and the US. Research found that 40% of those displaying COVID-19 symptoms simultaneously experience a worsening of their tinnitus. It is important to note, though the study was centered on people with pre-existing tinnitus, it was found that a small number of participants reported their tinnitus was triggered by developing COVID-19 symptoms, which suggests that tinnitus could be a “long COVID-19” symptom, in certain cases.

The study also found that a large number of people believe their tinnitus is worsening due to social distancing measures, as they have led to significant changes in work and lifestyle routines. 46% of respondents in the UK and 29% of respondents in the US say that lifestyle changes have impacted their tinnitus. It was found that internal stressors, like fear of catching COVID-19, financial worries, loneliness, and trouble sleeping has made tinnitus more of a problem for 32% of respondents. External factors like increased video calls, noisier home environments, home-schooling, and increased coffee and alcohol consumption were also cited by respondents as a potential reason for the worsening of their tinnitus.

Worse yet, the COVID-19 pandemic has made it increasingly difficult for people to access healthcare support for tinnitus, which can further increase emotional distress leading to a worsening of tinnitus symptoms. It’s a vicious cycle. It’s clear, tinnitus is exacerbated by COVID-19.

Lead author Dr Eldre Beukes, a Research Fellow at ARU and Lamar University in Texas, said: “The findings of this study highlight the complexities associated with experiencing tinnitus and how both internal factors, such as increased anxiety and feelings of loneliness, and external factors, such as changes to daily routines, can have a significant effect on the condition.

“Some of the changes brought about by COVID-19 appear to have had a negative impact on the lives of people with tinnitus and participants in this study reported that COVID-19 symptoms are worsening or, in some cases, even initiating tinnitus and hearing loss. This is something that needs to be closely examined by both clinical and support services.”

David Stockdale, Chief Executive of the British Tinnitus Association and a co-author of the study, said:“With the second wave of COVID-19 and the resulting national lockdown likely to increase feelings of stress and isolation, it’s vital that we don’t see the same mistakes as before when it comes to community health provision for people with tinnitus.

“Poor treatment of tinnitus in the early stages often leads to much worse cases and severe tinnitus can have a huge impact on mental health. With this in mind, as the COVID-19 second wave takes hold, the healthcare system needs to ensure that anyone who develops tinnitus or experiences a worsening of their condition can access the professional healthcare support they need as quickly as possible.”

Original Paper: Beukes EW, Baguley DM, Jacquemin L, et al. Changes in tinnitus experiences during the COVID-19 pandemic. Frontiers in Public Health. 2020;8. DOI=10.3389/fpubh.2020.592878.

Source: ARU, Frontiers in Public Health

Hearing Health and Cognitive Screenings

All of us at Longmont Hearing and Tinnitus Center are dedicated to improving your hearing health. Did you know? There is a connection between hearing health and cognitive function? That is why we have started incorporating Cognivue Cognitive Screenings as part of our offering. Though it may seem unrelated, there is increasing evidence that age-related hearing loss is linked to a more rapid progression of cognitive decline and incidental dementia.[1]

Hearing Loss: Impact

Studies have shown that long-term hearing deprivation of auditory inputs can impact cognitive performance by decreasing the quality of communication, which leads to social isolation and depression, and can facilitate dementia.[2] In fact, limited cognitive skills from aging may reduce the cognitive resources available for understanding speech, especially when background noise is present. [3]

There are 3 fundamental processes that people need in order to hear well and understand speech.

  1. The ear serves as a connection between the acoustic environment and the brain. It detects, codes, and sends the signal along.
  2. The central auditory system then modifies and analyzes the signal.
  3. Finally, the brain (this is the cognitive process) enhances perception, understands the content received, and stores the information.

Studies have shown that efferent top-down and afferent bottom-up processing is critical to speech perception [4], making the link between audibility and cognition that much more vital. This process works in both directions, both from top-down to bottom-up. Here’s how:

Top-Down Processing—Cognition:

  • The brain emphasizes certain aspects of the incoming signal, allowing for improvements in perception
  • The brain works to compensate for poorly understood bottom-up sensory cues
  • Cognitive Factors help with: attention, listening effort, memory, multi-sensory integration, and prediction in helping code/understand sounds

Bottom-Up Processing—Audibility:

  • The ear engages in additional processing to refine the signal, and extracts important elements that are used for higher level processing
  • Sounds are initially coded by the ear, before it’s sent through the auditory system
  • Neural signal passed up through auditory system

How do we Conduct Cognitive Screenings?

We use the Cognivue® Thrive device. With the Cognivue® Thrive Device, we’re able to provide a 5-minute self-administered test to evaluate cognitive function. It’s a computer-based screening that involves watching a screen and moving a joystick. It’s super easy to take and is not dependent on hearing. The screening tests the following:

  • Memory
  • Visuospatial
  • Executive Function
  • Reaction Time
  • Processing Speed

About Cognivue® Thrive:

  • Based on FDA-cleared technology used by neurologists and other physicians to test for cognitive function
  • 5-minute self-administered computerized screening
  • Proven superior test-retest reliability
  • Evaluates three cognitive domains: memory, visuospatial, and executive function
  • Measures two speed performance parameters: reaction time and speed processing

Once you’ve completed the test, you then receive a report on your cognitive function:

  • Provides brain health score for each domain and performance parameter: Memory, Visuospatial, Executive Function, Reaction Time, and Processing speed
  • Informs on patient’s ability with examples of impact on daily activity

We’re very excited about the improvements in hearing health that we can achieve with the use of this device. If you’re curious about whether you have hearing loss, or if your hearing loss has impacted cognitive function, reach out to us! We’ll set you up with a test, along with tips on how to proceed with whatever results you get.



1. Fortunato S, Forli F, Guglielmi V, et al. A review of new insights on the association between hearing loss and cognitive decline in ageing. Ipoacusia e declino cognitivo: revisione della letteratura. Acta Otorhinolaryngol Ital. 2016;36(3):155-166.
2. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013;173(4):293-299.
3. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis [published correction appears in JAMA Otolaryngol Head Neck Surg. 2018 Feb 1;144(2):176]. JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126.
4. Rönnberg J, Lunner T, Zekveld A, et al. The Ease of Language Understanding (ELU) model: theoretical, empirical, and clinical advances. Front Syst Neurosci. 2013;7:31. Published 2013 Jul 13. doi:10.3389/fnsys.2013.00031

Face Masks and Hearing Loss: NAL Report

The COVID-19 pandemic has affected all areas of our lives, and the need to wear masks has made life extra difficult for those with hearing loss. The National Acoustic Laboratories (NAL) recently released a report on the many ways face masks and shields have been shown to challenge people with hearing loss. See below for the report, and as always, if there is anything we at Longmont Hearing and Tinnitus Center can help you with, reach out. We’re here to help, whether you need new hearing aids, an ear wax cleaning, or help with communication strategies.

The COVID-19 pandemic has increased the use of face masks and face shields among health professionals and the general public. The use of face masks is known to adversely impact on aspects of communication, and this has created unique challenges for the hearing-impaired community who may be put at a greater communication disadvantage than those with normal hearing.1 National Acoustic Laboratories (NAL) is aware of these challenges and is working to provide innovative research and solutions. The following aspects of communication may be impacted by the wearing of face masks/face shields:

Reduced sound levels at high frequencies; amplification at low frequencies.

Medical masks essentially serve as a low-pass filter, attenuating the high frequencies (2000-7000 Hz) spoken by the wearer, with the decibel level of attenuation ranging from 3-4 dB for a simple medical mask and close to 12 dB for the N95 masks.2 Cloth masks have also been found to attenuate higher frequencies by differing amounts (above 1000 Hz) depending on their composition and weave.3  While face shields also attenuate high frequencies, they amplify low frequencies so their overall effect on speech understanding is unclear, and research is ongoing.

Reduced discrimination of speech signal amongst competing noise.

Reduced discrimination may occur in an environment with a high level of noise, such as a hospital. Those with hearing loss may suffer more from mask effects than those with normal hearing because of their increased difficulty understanding speech in noise in most situations.

Loss of visual-speech cues.

Auditory-visual speech, where both auditory and visual-speech cues (ie, lip, tongue, and face movements) are available, enhances speech perception.4-6 Those with hearing impairment rely more heavily on visual-speech information than those with normal hearing.7,8 Visual-speech cues help to counteract hearing difficulty experienced,6 particularly in a noisy environment.4,7 Cloth and medical masks block access to visual-speech cues including facial expressions and lip-movements. The impact of mask wearing on communication is likely to differ among people with hearing impairment depending on individual speechreading ability and reliance on auditory-visual speech. Individuals with early-onset, severe-to-profound hearing impairments have been found to have enhanced speechreading ability9 and may therefore experience a negative impact. Clearly, individuals who are totally reliant on lip-reading to communicate will experience a negative impact.10 Further research is required to explore the impact of masks on speech perception for people with hearing impairment, investigating factors such as the onset of hearing loss, degree of loss, and the use of hearing aids/cochlear implants.

Small impact on speech production.

Mask wearing has been found to have only a small impact on articulation and only minor effects on the airstream.11 Therefore, the ability to use the mouth to articulate appears to be not significantly hindered by the wearing of masks, although further research on this topic could be beneficial.

The combination of the above factors related to mask wearing, including the increased difficulty in understanding speech, room/noise reverberation, and the absence of visual cues can put people with hearing loss at a communication disadvantage in comparison to those with normal hearing.2,10

The various types of facial coverings have differing impacts on communication:

Typical masks (cloth and medical)
Both cloth and medical masks perform better acoustically than transparent masks.3 A major drawback of cloth and medical masks is the visual barrier these masks present to those in the hearing-impaired community who depend on nonverbal communication cues on the face.12-14

Transparent face masks (with windows made of plastic)
In comparison to opaque cloth masks, masks with plastic windows perform worse acoustically, reducing the high frequency sound cues that are crucial for speech more than opaque masks.3 Despite this, some studies have found that transparent masks improve speech understanding in noise by making the lips and mouth visually accessible.1 The issue of fogging of the clear plastic window (due to exhaled breath) is also a problem that manufacturers of these masks are currently attempting to overcome.

Face shields
It should be noted that a clear face shield is not considered to provide the same level of protection from infection as a face mask.15 In line with transparent face masks, face shields offer the benefit of visual input.3 Further research into the acoustic impact of face shields is needed; however NAL preliminary findings do not indicate a negative impact on speech intelligibility.16

The use of lapel microphones has been recommended to overcome some of the difficulties encountered with the use of masks. Masks tend to attenuate high-frequency sound in front of the talker, whereas microphones placed above and below the mask are less affected. To preserve visual cues without destroying high-frequency sound cues, the use of clear window masks in combination with lapel microphones has been recommended.3

For hearing aid wearers, NAL has provided a face mask program that increases gain to compensate for the reduced speech levels of a talker wearing a mask. This program can be accessed at NAL’s website at:

Citation for this article:
Martin L. NAL update: Impact of face masks and face shields on communication. Hearing Review. 2020;27(10):28-29.


  1. Atcherson SR, Mendel LL, Baltimore WJ. The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss. J Am Acad Audiol. 2017;28(1):58-67.
  2. Goldin A, Weinstein B, Shiman N. How do medical masks degrade speech reception? Hearing Review. 2020;27(5):8-9.
  3. Corey RM, Jones U, Singer AC. Acoustic effects of medical, cloth, and transparent face masks on speech signals. Champaign, IL: UUniversity of Illinois at Urbana-Champaign; August 11, 2020.
  4. Bernstein JGW, Grant KW. Auditory and auditory-visual intelligibility of speech in fluctuating maskers for normal-hearing and hearing-impaired listenersJ Acoust Soc Am. 2009;125(5):3358.
  5. Fraser S, Gagné J-P, Alepins M, Dubois P. Evaluating the effort expended to understand speech in noise using a dual-task paradigm: The effects of providing visual speech cues. J Sp Lang Hear Res. 2010;53(1):18-33.
  6. Frtusova JB, Phillips NA. The auditory-visual speech benefit on working memory in older adults with hearing impairment. Frontiers in Psychol. 2016;7:490.
  7. Tye-Murray N, Sommers MS, Spehar B. Audiovisual integration and lipreading abilities of older adults with normal and impaired hearing. Ear Hear. 2007;28(5):656-668.
  8. Fernandez-Lopez A, Martinez O, Sukno FM. Towards estimating the upper bound of visual-speech recognition: The visual lip-reading feasibility database. 2017 12th IEEE International Conference on Automatic Face & Gesture Recognition (FG 2017).May 2017;208-215. Washington, DC.
  9. Auer ET, Bernstein LE. Enhanced visual speech perception in individuals with early-onset hearing impairment. J Sp Lang Hear Res. 2007;50(5):1157-1165.
  10. Chodosh J, Weinstein BE, Blustein J. Face masks can be devastating for people with hearing lossBrit Med Jour. 2020;370:m2683.
  11. Fecher N, Watt D. Effects of forensically-realistic facial concealment on auditory-visual consonant recognition in quiet and noise conditionsAuditory-Visual Speech Processing (AVSP) 2013. September 2013;81-86. Annecy, France.
  12. Mendel LL, Gardino JA, Atcherson SR. Speech understanding using surgical masks: A problem in health care? J Am Acad Audiol. 2008;19:686-695.
  13. Atcherson SR, Finley ET, McDowell BR, Watson C. More speech degradations and considerations in the search for transparent face coverings during the COVID-19 pandemic. Audiology Today.2020.
  14. Baltimore WJ, Atcherson SR. Helping our clients parse speech through masks during COVID-19. ASHA LeaderLive. Published June 1, 2020.
  15. US Centers for Disease Control and Prevention (CDC). Coronavirus Disease 2019 (COVID-19): Considerations for Wearing Masks.. Published August 7, 2020.
  16. Mejia J, Galloway J, Cooper J, Monaghan J,  Edwards B. On managing the impact of face covers on speech understanding in noise using hearing aids. In press.


Other Resources

Don’t Fall To Isolation This Holiday Season

This year has been a tough one, and as it nears to an end, it doesn’t seem to be getting any easier. Though the holidays are often a joyous time to look forward to, many may feel this year is different. Because of all the challenges this year, many people may not have the same excitement that typically comes along with the winter months. Usually, the holidays are a time to look forward to large family gatherings. It’s an opportunity to visit with friends you haven’t seen in a long time. This year is looking like it will be quieter, which is why it’s more important than ever to find ways to stay connected and to hear better during the holidays.  

Connect Via Zoom/Facetime

Stay in touch with loved ones by scheduling video chats via Zoom or FaceTime. Regular check-ins can help us not feel isolated, and chatting through video can help us hear better. When you are on a video chat be sure to reduce any background noise — turn off the television or radio, you don’t need that for your video call! And be sure to take a minute to ensure you have appropriate lighting, as that will allow others to see your face and read your lips, which is crucial in allowing people to hear better. Pass on the information to those you are talking to make the conversation easier. Are you having a hard time understanding the computer? Let us know, and we can figure out a way to connect your hearing aids up to the computer through the use of a neck loop! Even if you don’t have hearing aids, sometimes the audio can be poor. Consider using headphones!

Photo Albums

Look through old photo albums. If you find a special memory, take a picture with your phone and send a text or an email to a loved one reminding them of that special time. Sharing those fun memories will spread joy all around and help others feel connected. Though this might not do anything to help you hear better, it’ll certainly create connection between you and your loved ones, and that’s what the holidays are all about!

Surprise Someone

Send a letter, a card, or a care package. Taking extra time out of your day to do something thoughtful will spread joy during this difficult year, for yourself and the recipient of your special package. Doing so will help decrease the feeling of isolation, and it can be fun too! Did you know that showcases a few small businesses that put together thoughtful care packages created by you? Just search ‘care package’ or ‘quarantine care package’ on to get all the details!

In Person

If you are meeting with loved ones in person, remember to use your good communication strategies, they are key in helping you hear better. Some pointers:

  • Always remember to look at the person you are speaking to.
  • Try to reduce background noise. Many gatherings have music playing in the background, but for those that have hearing loss, it can make communicating very difficult.  
  • If you do have trouble understanding something, give the speaker clues as to what you did and didn’t hear. You can say something like, “I think you said something about eating dessert, is that correct?” The speaker can also help the listener by rephrasing the sentence if the listener is not hearing well. They can change a sentence from “I really like all of your decorations” to “Those lights that you hung in the living room look very nice.” Speakers should also remember to slow down their speech if necessary. 

Having a hard time understanding someone with a mask on? There’s technology that can help with that! The Ava app is an application on your smartphone that will take spoken language and translate it into text so that you can read what is being said. It’s a great way to ensure you can communicate effectively! Download it today so you have it any time you need it.

Contact Us!

And of course, maintenance is crucial for ensuring you can hear better. Be sure to get your hearing aids cleaned and checked regularly! Many people also like to try new technology around the holidays to make sure that they can hear optimally. Staying connected to others is important and hearing is a big part of that. If you’re looking to try out something new, we can help!

Here at Longmont Hearing and Tinnitus Center, we encourage all our patients to keep up with their communication strategies. If there is anything we can help you with, give us a call and set up an appointment to get you what you need, be it a hearing aid cleaning, ear-wax cleaning, or to be fitted for new hearing aids.

Hearing the Call – Success!

All of us at Longmont Hearing & Tinnitus Center are thrilled with how well our event went on Saturday! Partnering up with Hearing the Call Colorado was a success, and we can’t wait for our next event in Arvada this coming December. 

Hearing loss can be quite isolating for individuals, and as Dr. Rudden explains, the coronavirus pandemic has made access to hearing care more critical than ever: “Especially in this time, where we are wearing masks and there is less socializing, people are isolated, and when they don’t hear well, they feel even more isolated. This event is opening the door for people whose insurance may not cover hearing loss needs, or for patients who may not have the financial resources to pay for both hearing aids. We wanted to fill that gap.”

How did the event become a reality?
Dr. Rudden has been a member of Hearing the Call for the past year, and she wanted to make sure that those in her own community were also getting the help they deserve. That’s why she reached out to other industry leaders about a Colorado branch, and soon found people in other audiology practices across the state that were interested in helping. Representatives from the six different audiology practices that make up Hearing the Call Colorado participated in running the clinic Saturday, including audiologists from Animas Valley Audiology in Durango, Columbine Hearing Care in Littleton, Flatirons Audiology in Lafayette, McArthur Audiology in Burlington and New Leaf Hearing Clinic in Arvada. We even had a group from Entheos Audiology Cooperative in Fort Wayne volunteer on Saturday! It was a true representation of the community coming together for the greater good. 

What does Hearing the Call Provide?
At Saturday’s event, we were able to help 14 individuals with hearing loss have their hearing tested, and if necessary, fitted for hearing aids at little to low cost (cost was determined based on income). But the benefits don’t end there! All the patients we helped on Saturday will continue to receive a year of complementary aftercare. And after that year-long period, they will only be charged $15 per office visit—a lifetime of affordable hearing care.  

Another beautiful aspect of Hearing the Call Colorado is their fostering of good will. As part of its mission, Hearing the Call Colorado asks that those who receive care give back to their communities, like asking patients to do some community service on an honor system. With the pandemic in mind and the risks associated, Dr. Rudden hopes instead to have inspired Saturday’s patients to do small acts of kindness, whether picking up trash in their neighborhood or reading a book to their grandchild.

How did Longmont Hearing & Tinnitus Center find these patients?
Dr. Rudden was connected to patients through nonprofit agencies, including the OUR Center, a nonprofit that helps provide basic needs to people; Out Boulder, an LGBTQ advocacy nonprofit, and Intercambio, a nonprofit resource center for immigrants. If you want to know about the next Hearing the Call event, be sure to follow Longmont Hearing and Tinnitus Center on Facebook.

What is the best part of the day?
“Seeing the joy on someone’s face when they realize what they’ve been missing — it’s really magical. We call it a ‘hearing smile.’ It can be emotional for people, sometimes they cry, sometimes they get wide-eyed. Imagine being able to hear for the first time.” — Dr. Rudden. At the end of the day, this is what the event is all about—restoring hearing to those who need it most. Events like Hearing the Call Colorado and volunteers like Dr. Rudden and her colleagues make that dream a reality.

Hearing loss is serious and should not be ignored. If you or a loved one are experiencing hearing loss, don’t delay. Reach out to us for an appointment and we’ll do everything we can to ensure you get the treatment you need.