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Abstract

Wearing a face mask has been accepted as one of the most effective ways for slowing the spread of COVID-19. Yet information regarding the degree to which masks affect acoustics and perception associated with voice performers is scarce. This study examines these effects with common face masks, namely a neck gaiter, disposable surgical mask, and N95 mask, as well as a novel material that could be used as a mask (acoustic foam). A recorded excerpt from the “Star-Spangled Banner” was played through a miniature speaker placed inside the mouth of a masked manikin. Experienced listeners were asked to rate perceptual qualities of these singing stimuli by blindly comparing them with the same recording captured without a mask. Acoustic analysis showed that face masks affected the sound by enhancing or suppressing different frequency bands compared to no mask. Acoustic energy around the singer's formant was reduced when using surgical and N95 masks, which matches observations that these masks are more detrimental to the perceptions of singing voice compared with neck gaiter or acoustic foam. It suggests that singers can benefit from masks designed for minimal impact on auditory perception of the singing voice while maintaining reasonable efficacy of filtering efficiency.
TaggedH1How Face Masks Affect Acoustic and Auditory Perceptual
Characteristics of the Singing VoiceTaggedEnd
TaggedP*Liran Oren,
Michael Rollins,
Ephraim Gutmark, and *Rebecca Howell, *yzCincinnati, OhioTaggedEnd
TaggedPSummary: Wearing a face mask has been accepted as one of the most effective ways for slowing the spread of
COVID-19. Yet information regarding the degree to which masks affect acoustics and perception associated with
voice performers is scarce. This study examines these effects with common face masks, namely a neck gaiter, dis-
posable surgical mask, and N95 mask, as well as a novel material that could be used as a mask (acoustic foam).
A recorded excerpt from the Star-Spangled Bannerwas played through a miniature speaker placed inside the
mouth of a masked manikin. Experienced listeners were asked to rate perceptual qualities of these singing stimuli
by blindly comparing them with the same recording captured without a mask. Acoustic analysis showed that face
masks affected the sound by enhancing or suppressing different frequency bands compared to no mask. Acoustic
energy around the singers formant was reduced when using surgical and N95 masks, which matches observations
that these masks are more detrimental to the perceptions of singing voice compared with neck gaiter or acoustic
foam. It suggests that singers can benet from masks designed for minimal impact on auditory perception of the
singing voice while maintaining reasonable efcacy of ltering efciency.TaggedEnd
TaggedPKey Words: Singing voiceFace maskAcousticsPerceptual characteristics.TaggedEnd
TAGGEDH1INTRODUCTIONTAGGEDEND
TaggedPBroadway theatre in New York City is a billion-dollar
industry that employs thousands and contributes billions
more to the local economy in tourism.
1
On March 17, 2020
the Skagit County, Washington choir informed public
health ofcials of ill members, leading to 53 of 122 testing
positive for SARS-CoV-2 virus. Since this report, the act of
singing has been identied as a contributor of transmission
(emission of aerosols by loudness of vocalization) or super-
emitters (those that release more aerosols compared to
others).
2
TaggedEnd
TaggedPThe mode of transmission for SARS-CoV-2 virus is expo-
sure to infected respiratory droplets or aerosolized par-
ticles.
3
Both types of particles can be expelled by infected
individuals through coughing, sneezing, speech, singing, or
breathing.
4
Droplets are particles that, once emitted by a
person, will follow a trajectory that is affected predomi-
nantly by gravity and depends on their size and ejection
force. Aerosolized particles are generally <5mm and can
remain suspended in the air for longer periods after being
expelled.
4,5
The transmission of SARS-CoV-2 occurs when
healthy individuals come into contact with or inhale par-
ticles that carry these pathogens.
6
TaggedEnd
TaggedPUntil herd immunity can be achieved (likely by vaccina-
tion), public health efforts to combat COVID-19 have
focused on prevention strategies. The Center for Disease
Control has focused on reducing transmission via droplet
and aerosolized particles by encouraging social distancing,
avoiding crowds, hand washing, and mask wearing. Wear-
ing a facial covering has become a common practice to miti-
gate transmission.TaggedEnd
TaggedPAll face masks, whether home-made or well-tted (eg,
medical grade), can effectively block the larger droplet size
particles. However, the ltration efciency, dened as the
percentage of aerosolized particles stopped by the mask
from spreading away from the source, varies with the lter
material. For example, the lter efciency of woven or non-
woven polypropylene, such as a disposable surgical mask or
N95 mask, is about 50% and 95%, respectively, compared
with about 10% efciency for fabric material such cotton.
7
9
Despite these differences, it is well documented that using
any type of face covering is critical to reducing the number
of hospitalizations and deaths related to COVID-19.
1012
TaggedEnd
TaggedPThe factors affecting the ltration efciency of masks are
well documented, but their impact on speech and especially
singing has not been sufciently quantied. Studies have
shown that masks can reduce both intelligibility and loud-
ness of speech
1315
and that speakers wearing a facial cover-
ing tend to make their normal speech louder.
16
Similar
information regarding the degree to which face masks affect
acoustics and perception associated with professional voice
users such as singers is scarce. With live entertainment
largely on hold, wearing face masks will likely be recom-
mended once these activities resume in efforts to minimize
risks of transmitting COVID-19, especially considering it is
known that loud speech increases emission of aerosolized
particles.
17,18
Because vocal performers rely on the percep-
tual qualities of their voice
19
(eg, loudness, clarity, and
ring), there is a need to improve the understanding regard-
ing the acoustic effects of masks and auditory perception of
the singing voice.TaggedEnd
TaggedPAs a rst step, this study examines the effects of common
face masks, namely a neck gaiter, disposable surgical mask,
TaggedEndAccepted for publication February 22, 2021.
TaggedEndTaggedEndThe authors have no nancial or personal interests that could inappropriately inu-
ence (bias) the work in this manuscript.
TaggedEndFrom the *Department of Otolaryngology-Head and Neck Surgery, University of
Cincinnati, Cincinnati, Ohio; TaggedEndyDepartment of Biomedical Engineering, University of
Cincinnati, Cincinnati, Ohio; and the TaggedEndzDepartment of Aerospace Engineering and
Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio.
TaggedEndAddress correspondence and reprint requests to Liran Oren, Department of Otolar-
yngology-Head and Neck Surgery, University of Cincinnati, 231 Albert Sabin Way
Room 6113, MSB PO Box 670528, Cincinnati, OH 45267. E-mail: liran.oren@uc.edu
TaggedEndJournal of Voice, Vol. 37, No. 4, pp. 515521
TaggedEnd0892-1997
TaggedEnd© 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
TaggedEndhttps://doi.org/10.1016/j.jvoice.2021.02.028
and N95 mask, as well as a novel material that can be used
as a mask (acoustic foam), on acoustics measures and per-
ceptual characteristics of listening to a masked singing
voice. A recorded singing voice was used as the acoustic
source in order to isolate the direct acoustic effects caused
by the mask from the inuences of using a mask on the act
of singing. This study therefore does not evaluate the sing-
ers perspective, only the listeners.TaggedEnd
TAGGEDH1METHODSTAGGEDEND
TaggedH2Setup and recording of singing voice stimuliTaggedEnd
TaggedPThe audio sample used for the study consisted of the phrase
O'er the land of the freeextracted from a recording of a
soprano singing The Star-Spangled Bannera cappella. It
was played from a miniature speaker (Intsun, Tomtop Elec-
tronic) that was placed inside the mouth of an airway simu-
lator manikin (AirSim Combo Bronchi X, TruCorp). The
manikins external features such as head circumference,
nose and ears matched an average human adult. The minia-
ture speaker was aligned with the manikins lips and was
connected to a laptop by an audio cable that was threaded
through the airway (Figure 1a). This setup intended to
mimic a reproducible singing voice emanating from a singer
and also allowed for comparable evaluation of several types
of masks.TaggedEnd
TaggedPRecordings of the audio sample were captured with the
manikins face covered with one of three commonly used
face masks (Figures 1b-d). These include a neck gaiter (sin-
gle-layer cotton fabric material), a disposable surgical mask,
and an N95 mask. Reference data were obtained by record-
ing a sample without the mask. In addition to the three
standard masks and the reference, the manikinsfacewas
covered with acoustic foam of a single- or double-layer (7.5
and 15 mm, respectively) thickness (Figure 1e). Overall, the
audio recordings were made for six mask congurations.TaggedEnd
TaggedH2Audio recordingsTaggedEnd
TaggedPThe manikin was placed near the center of an anechoic
chamber (7.6 by 7.2 m). A 1/2-inch microphone (Type 2671,
Br
uel & Kjær) was positioned 30 cm directly in front of the
mouth. In testing directivity effects of this setup, there was a
<3 dB change when the microphone was offset by 30° from
the sagittal plane. All audio recordings were captured at
51.2 kHz using a National Instruments data acquisition sys-
tem (NI 9234).TaggedEnd
TaggedPSinging audio samples were captured for 6.6 seconds with
each mask. Recordings with each mask type also included a
chirp signal with a tone that increased logarithmically over
the frequency range from 20 to 20 kHz over 1.5 seconds.
The chirp sound was repeated three times (total of 4.5 sec-
onds) in each recording.TaggedEnd
TaggedH2Acoustical data analysisTaggedEnd
TaggedPThe acoustic analysis was based on the spectrum for the
audio data captured with the chirp signal. The analysis also
included extracting 0.5 seconds of the sustained /æ/ and /i/
vowel segments in each singing sample and computing the
acoustic energy of the singers formant
20
by integrating the
TaggedEnd TaggedFigure
FIGURE 1. Setup used for audio recordings. Miniature speaker is placed inside the manikins mouth and the same audio sample is played
with ve types of masks. (a) Baseline recording with no face mask, (b) neck gaiter, (c) disposable surgical mask, (d) N95 mask, (e) acoustic
foam. Single- (shown) and double-layers of acoustic foam were tested.TaggedEnd
TaggedEnd TaggedFigure
FIGURE 2. Spectra of /æ/ vowel segment extracted from the
recorded samples of baseline (no mask) and N95 mask. Acoustic
energy in the singers formant energy is computed by integrating
the area under the curve between 2 and 3.5 kHz (shown for the no-
mask case as the shaded area).TaggedEnd
TaggedEnd516 Journal of Voice, Vol. 37, No. 4, 2023
spectral energy in the frequency band of 23.5 kHz
(Figure 2).TaggedEnd
TaggedH2Perceptual evaluationsTaggedEnd
TaggedPA panel of four listeners (R1-R4) rated the recorded singing
samples for each of the six mask congurations. All four
have personal backgrounds in vocal performance and
speech-language pathology training (range of 07 years
clinical experience). Each listener completed the evaluation
alone seated in a quiet ofce in front of a laptop that pre-
sented the audio samples through its internal loudspeakers.TaggedEnd
TaggedPPerceptual ratings were done using a paired-stimulus pre-
sentation method. That is, each listener rated a series of
trials, each trial containing a pair of singing stimuli. The
presentation of audio recordings and capture of the percep-
tual response were done using the Alvin program.
21
Listen-
ers could control the pace of presentation and their response
time for each trial. Although they were allowed to repeat
each pair as often as needed, they had to make their selec-
tion before advancing to the next pair. The samples in each
pair were separated by 0.4 second pause.TaggedEnd
TaggedPThe paired-stimulus had listeners compare a baseline
recording (no mask) with another recording in a blinded
fashion. Rating the singing stimulus of each mask was
repeated 8 times, with the baseline recording presented
4 times as the rst of the pair and 4 times as the second
sample. The paired samples also included comparison of the
baseline with itself; this conguration was done to aid in
assessing rater reliability and only repeated 4 times. In sum-
mary, each listener rated a total of 44 singing samples (ve
masks for 8 times + no mask for 4 times). The order of pre-
sentation was randomized and the experiment lasted 10
15 minutes for each listener.TaggedEnd
TaggedPThe perceptual evaluations included comparison of the
ringand overall singing qualityfor each pair. The com-
puter displayed a slider scale,with the slider button posi-
tioned at the midpoint (Figure 3). The ends of the slider
scale were labeled as Sample 1 and Sample 2, respectively.
The following instructions were read to listeners before the
experiment: You will be presented with a series of paired
audio segments sung by a woman wearing a face mask. For
each presentation, the segments should have differing sing-
ing qualities. Your task is to (1) indicate whether Sample 1
TaggedEnd TaggedFigure
FIGURE 3. Screen capture of the Alvin program used for perceptual ratings. Baseline recording was always included as one of the pair.
Rating was done by having the listener moving the slider toward the side with better Ringand Overall Singing Quality.TaggedEnd
TaggedEndLiran Oren, et al How Face Masks Affect Acoustic and Auditory Perceptual Characteristics of the Si TaggedEnd517
or Sample 2 has the better Ring and (2) by how much.
Use the mouse to move the slider from the middle of the
scale toward the presentation that has the better Ring. Indi-
cate the degree of Ring difference by how close you move
the marker to the speech sample; the closer to either end,
the larger the difference in Ring. You will then perform
a similar judgment of the Overall Singing Quality on the
second slider.TaggedEnd
TaggedPThe Alvin program recorded the listeners rating for each
pair as an integer that ranged from 500 to +500, where
minusscores indicate better ringor overall singing
qualityof Sample 1 while plusscores related to Sample
2. For data analysis, the scores absolute value was used as
it was always referenced to the no maskbaseline. A rating
of zero would indicate that there was no difference between
the two samples. Hence, lower ratings indicated that the
singing recording with a mask was perceived to be more like
the singing without a mask (i.e., lower score means less
impact of the mask).TaggedEnd
TaggedPSample pairs where listeners judged the baseline sample
(no mask) to have worse ring or worse overall singing qual-
ity than the singing sample with a mask were removed from
the data set (27 of the total 176 samples, 15%). The statisti-
cal mean (and its 95% condence interval) of the ratings of
the singing samples with each mask of the 4 listeners was
then computed. Rater reliability was assessed using the
intraclass correlation coefcient, ICC(2,k).
22
TaggedEnd
TAGGEDH1RESULTSTAGGEDEND
TaggedPAcoustic analysis showed that the face masks affected the
sound by enhancing or suppressing different frequency
bands compared to no mask. For example, the difference
between N95 mask and the baseline spectra are shown in
Figure 4a. The difference between each mask and baseline
was assessed by subtracting the spectrum of the chirp signal
for baseline from the spectrum of each mask (Figure 4b).
Because the chirp signal includes all audible frequencies
(within the 20 Hz to 20 kHz range), the differences between
the spectra showed which frequencies were amplied and
which were suppressed for each mask. Compared with base-
line ndings, the neck gaiter had a small effect on the spec-
trum with some amplication (<2.5 dB) of frequencies
below 4 kHz and minimal differences for frequencies
>4 kHz. Amplication of frequencies below 2 kHz was
observed for all masks. The greatest amplication (~5 dB)
was observed with the disposable surgical mask and with
two layers of acoustic foam. The surgical mask also showed
signicant amplication also between 4.5 and 7.0 kHz.TaggedEnd
TaggedPThe face masks caused suppression in other frequency
bands. Most notably, the N95 mask suppressed frequencies
between 2 and 5 kHz and above 6 kHz. The surgical mask
showed some suppression between 3-5 kHz. The neck gaiter
yielded minimal change in the spectrum. Similar spectral
trends for each mask were also found using the long time
averaging spectrum of the singing audio samples.TaggedEnd
TaggedPPerceptual testing shows a direct relationship between the
type of mask and the perception of the singing samples
(Figure 5). Overall, the perception of ringseemed to be
more affected when using a mask than the perception of
overall singing quality. Three out of four listeners showed
excellent intra-rater reliability (0.98 for R2, 0.93 for R3,
and 0.91 for R4). Intrarater reliability for R1 was 0.71,
which is moderate, perhaps because of lack of experience in
performing perceptual ratings. The reliability between lis-
teners was moderate at 0.67, which was similar to the
TaggedEnd TaggedFigure
(a) (b)
FIGURE 4. Face masks amplify and supressed different frequencies. (a) Spectra of the audio sample using chirp singal; only the baseline
and N95 cases are shown. (b) Difference of each masks spectra relative to baseline (no mask) using a chirp signal.TaggedEnd
TaggedEnd518 Journal of Voice, Vol. 37, No. 4, 2023
current literature using perceptual ratings of the singing
voice.
23-25
TaggedEnd
TaggedPThe statistical mean (with its 95% condence interval) for
the listeners ratings of each mask is shown in Figure 6 (left
ordinate). The gure also shows the corresponding acoustic
energy calculated for the 23.5 kHz frequency band (the
singers formant) with each mask (right ordinate). Overall,
there was minimal difference between no mask and a neck
gaiter while a disposable surgical mask or an N95 mask was
more detrimental to ring and overall singing quality percep-
tions. The N95 mask had the greatest impact on reducing
the ring quality. Single layer of acoustic foam had minimum
impact on perception compared to both surgical and N95
masks.TaggedEnd
TAGGEDH1DISCUSSIONTAGGEDEND
TaggedPThis study provides useful information regarding the impact
of different face masks on the acoustics and perceptual
measures of the singing voice for the listener. This will be of
particular interest to voice professionals such as singers,
actors, and vocal coaches. A mask creates a barrier to sound
propagation, acting as an acoustic lter where material and
thickness determine its response characteristics. Changes in
TaggedEnd TaggedFigure
(a) (b)
FIGURE 5. Perceptual ratings of singing samples by mask type. Lower scores indicate less perceptual difference relative to baseline (no
mask). R1R4 correspond to each listener (a) Ring. (b) Overall singing quality.TaggedEnd
TaggedEnd TaggedFigure
(a) (b)
FIGURE 6. Comparing perceptual and acoustic characterisitcs of all mask congurations. The statiscal mean (with 95% condance inter-
val) based on all listenersratings for each mask is shown on the left ordinate for the perception of (a) Ringand (b) Overall singing qual-
ity.The acoustic energy within the 23.5 kHz frequency band (the singers formant) during sustained /æ/ and /i/ vowel segments in each
singing sample is shown on the right ordinate of each plot.TaggedEnd
TaggedEndLiran Oren, et al How Face Masks Affect Acoustic and Auditory Perceptual Characteristics of the Si TaggedEnd519
these factors can amplify or attenuate certain frequency
bands, thus altering the formants and affecting the percep-
tion of radiated sound.TaggedEnd
TaggedPThe purpose of the face mask is to maintain a reasonable
efcacy in ltering aerosolized particles. An ideal singing
mask should be designed to avoid frequency suppression
around the signers formant and be made from material(s)
with the highest lter efciency.TaggedEnd
TaggedPA neck gaiter has minimal effect compared to no face
mask. However, a single-layer cotton material common to
neck gaiter design offers minimal ltering efciency, speci-
cally for aerosolized particles. While the N95 mask is highly
effective in ltering air particles, this study suggests it is far
more disruptive to the auditory perceptual characteristics of
the singing voice, possibly because it suppresses the singers
formant.TaggedEnd
TaggedPThe magnitude of acoustic energy in the singers formant
frequency band could be an indicator of the perceptual data
trends. There was minimal difference in acoustic energy
between the no-mask baseline, neck gaiter, and acoustic
foams. The bigger differences for the surgical and N95
masks matched the drop in their perceptual ratings.
Changes to the acoustic energy in the singers formant are
expected by looking at the chirp signal spectra. The differ-
ence from baseline (Figure 4b) shows both surgical and N95
masks suppressed some of the frequencies within the singers
formant, with the latter to a larger extent. This comparison
shows that the amplication of frequencies below 2 kHz,
which occurred with all masks, did not affect the perception.
Although the highest amplication occurred for the double
layer foam, the perceptual difference relative to the baseline
was not as pronounced as for the N95 mask.TaggedEnd
TaggedPAcoustic foam, which is not a material currently used for
face covering, showed little effect on the perception of sing-
ing voice. Its single- and double-layer ltration efciency is
about 30% and 50%, respectively.
26
These values are similar
to disposable surgical masks but far lower than N95. Using
acoustic foam as face covering material would require fur-
ther characterization such as its breathing resistance
27
(ie,
difculty of breathing through the material). An ideal sing-
ing mask should be designed to avoid frequency suppression
around the signers formant and be made from material(s)
with the highest lter efciency.TaggedEnd
TaggedH2LimitationsTaggedEnd
TaggedPThere are several limitations to our study. First, we only
considered a limited number of masks and only certain
types. For example, neck gaiter with multiple layers, thicker
N95 material, and surgical mask with medical grade can
absorb the sound differently and therefore will have differ-
ent perception and/or acoustic characteristics. Second, the
sample recording was a soprano voice of a native-English
female singer. A singers formant is known to depend on the
singing range (alto/tenor/baritone/bass).
28
Third, the acous-
tic propagation from the computers internal speakers can
limit listenersability to notice perceptual differences. This
could also explain why nearly 15% of the ratings were mis-
judged(as if wearing these specic masks is better com-
pared with no mask) and needed to be removed from the
analysis. It is reasonable to expect different perceptual
results if the listeners were using high-quality headphones.
Lastly, the study did not consider perception from the singer
using a mask; this would require a different analysis on the
aerodynamics and compensatory breathing patterns of a
singer wearing a mask. However, it is possible that profes-
sional singers could adapt their singing to the mask, allow-
ing their voice to be perceived as the same quality by a
listener, regardless of the mask type used. This requires fur-
ther evaluation.TaggedEnd
TaggedH1ACKNOWLEDGMENTSTaggedEnd
TaggedPThe authors would like to thank Sergey Grinshpun, PhD for
measuring the lter efciency of the acoustic foam material.TaggedEnd
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... Studies showed that masks obstruct visual cues, which contribute to speech intelligibility. [8,25,33,34] Wearing masks makes communication harder because masks muffle the sound, which makes it difficult to understand speech and takes away the ability to read lips, which may be the reason for poorer speech intelligibility, speech naturalness, and speech comprehensibility rating with medical mask compared to the ratings without medical mask. [35] Similarly, facial PPE and respiratory PPE covering the mouth and nose have been reported to diminish speech intelligibility and impair the wearer's verbal communication ability by attenuating sound transmission and reducing intelligibility because of muffled speech and impingement on the nasal alae. ...
... Few other studies have demonstrated that when talker is wearing the face mask, it causes difficulty to understand the speech. [8,39] Another study also found that speech intelligibility is one of the factors that contribute to speech naturalness. [21] The presence of medical mask could degrade the speech signal, decrease speech recognition performance, and affect overall speech comprehensibility. ...
Article
Introduction The COVID-19 situation has led to an increase use of medical mask for protection. Facial and respiratory PPE covering the mouth and nose have been reported to diminish Speech Intelligibility. Altering the volume, rate and volume and rate together may contribute to influencing the speech intelligibility and speech naturalness rating. Therefore, identifying the appropriate method to speak with medical mask can help train people to communicate with mask. This study aimed to (1) analyse effects of wearing masks on speech intelligibility, naturalness and comprehensibility, and (2) document an altered style of speaking to improve speech intelligibility, naturalness and comprehensibility while wearing masks. Method Cross-over study design was used. Spoken utterances from 14 naïve speakers were recorded with and without medical mask, and speech in typical style, increased volume (loudness), reduced rate, and mixed method (combination of increased loudness and reduced rate) with medical mask was recorded from 12 professional speakers. Two expert listeners rated the naïve speakers, and two naïve listeners rated professional speakers using standard rating scales of speech intelligibility and naturalness. Percentage of correct identification of utterance was calculated as a measure of comprehensibility. Wilcoxon signed rank test and Friedman test were used to report significant differences among conditions and parameters analysed. Results Speech intelligibility, naturalness and comprehensibility was poorer while speaking with medical mask than without them. Speaking in mixed method (combination of increased loudness and reduced rate), while using medical masks was the most appropriate style of speech in order to be intelligible, natural and comprehensible, followed by increased loudness style, typical style and reduced rate style. Conclusion People should be alerted that wearing mask leads to reduction in speech intelligibility, comprehensibility and naturalness. These can be improved by modifying the style of speaking.
... Face masks, regardless of the type, act as a barrier to sound propagation, and their material and thickness determine the listener's perception characteristics 11,23 . The types most used by teachers in this study were the surgical mask and the FFP2/N95, both considered adequate against the spread of the virus. ...
Article
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Purpose: to analyze possible interferences of face masks on teachers’ sensation of vocal effort, voice use, self-reported vocal quality, and vocal signs and symptoms. Methods: an observational cross-sectional study with 212 teachers (175 women; 37 men; mean age of 47 years), working at different education levels. They were contacted from the database of a previous study and completed an online questionnaire upon returning to in-person classes during the COVID-19 pandemic. Association analyses between aspects of mask use and other variables were performed using Fisher's exact test, Kruskal-Wallis H test, and Student's t test, with a 5% significance level. Results: 85% of participants wore masks in class, mainly surgical and FFP2/N95 ones. They reported increased vocal effort, difficulty in being understood, general fatigue, and the need to speak louder; 54% removed the mask to facilitate communication. Those who did not wear a mask had worse vocal quality and more hoarseness. The mask type was not relevant; reporting negative interference from the mask was associated with vocal signs and symptoms. Conclusion: the mask interfered with these teachers’ communication, further hindering occupational voice use where the occurrence of dysphonia is already high. Keywords: Voice; COVID-19; Faculty; N95 Respirators; Containment of Biohazards
... A máscara de proteção facial, independentemente do tipo, funciona como uma barreira à propagação do som, sendo que o material e a espessura de cada uma determinam as características de percepção do ouvinte 11,23 . Os tipos mais utilizados pelos professores do presente estudo foram a máscara cirúrgica e a PFF2/N95, sendo ambas consideradas adequadas ao se considerar a propagação do vírus. ...
Article
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Purpose: to analyze possible interferences of face masks on teachers’ sensation of vocal effort, voice use, self-reported vocal quality, and vocal signs and symptoms. Methods: an observational cross-sectional study with 212 teachers (175 women; 37 men; mean age of 47 years), working at different education levels. They were contacted from the database of a previous study and completed an online questionnaire upon returning to in-person classes during the COVID-19 pandemic. Association analyses between aspects of mask use and other variables were performed using Fisher's exact test, Kruskal-Wallis H test, and Student's t test, with a 5% significance level. Results: 85% of participants wore masks in class, mainly surgical and FFP2/N95 ones. They reported increased vocal effort, difficulty in being understood, general fatigue, and the need to speak louder; 54% removed the mask to facilitate communication. Those who did not wear a mask had worse vocal quality and more hoarseness. The mask type was not relevant; reporting negative interference from the mask was associated with vocal signs and symptoms. Conclusion: the mask interfered with these teachers’ communication, further hindering occupational voice use where the occurrence of dysphonia is already high. Keywords: Voice; COVID-19; Faculty; N95 Respirators; Containment of Biohazards
... 1 The masks significantly influence speech communication, such as speech intelligibility (SI), listening effort, singing voice, and online talking display in healthy people. [2][3][4][5][6][7][8] If mask-wearing influences the assessment of voice, it may affect clinical diagnosis in patients with voice disorders. Furthermore, the effect of mask-wearing on phonatory capability and daily communication exchanges in patients with voice disorders still has been unclear. ...
Article
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Objective Medical masks have been shown to significantly influence speech communication in healthy people. The effect of mask‐wearing on phonatory capability and daily communication exchanges in patients with voice disorders remains unclear. To evaluate the effect of the medical mask on acoustic parameters in patients with a voice disorder, we measured the voice frequency, quality, and intensity. Methods Thirty‐three healthy and 44 voice disorder patients were involved in this study, including 27 patients with vocal‐fold lesions and 17 with primary functional dysphonia. Perceptual evaluation and acoustic parameters, including F0 (fundamental frequency), jitter, shimmer, and maximum vocal intensity, were analyzed without and with medical masks. Results With medical mask‐wearing, the maximum vocal intensity significantly decreased in all patients with voice disorders (p < 0.05), especially in patients with lesions of vocal folds (p < 0.05) and functional dysphonia (p < 0.05). The perceptual evaluation roughness scales also increased in patients with lesions of vocal folds (p < 0.05) and functional dysphonia (p < 0.05) with mask‐wearing. There were no significant effects of mask‐wearing on acoustic parameters for healthy participants. Conclusions The intensity was influenced when wearing medical masks in patients with disordered voices. The voice perceptual roughness scales also significantly increased compared to those without medical masks.
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One of the most established pillar systems includes the following 5 pillars/facets as a minimal standard for voice assessment: a visual analysis of the vocal folds and the larynx, an auditory-perceptual judgment, an aerodynamic analysis, an acoustic analysis, and a self-assessment (Dejonckere et al. 2001; Boominathan et al. 2014; Lechien et al. 2023). Such a multidimensional voice protocol should be quantifiable for all individual measurement parameters, enabling a more effective assessment, for example, before and after treatment. Sections 2.1 to 2.5 list and describe various measurement parameters under this successfully evaluated five-pillar system, considering the current state of research, evidence, and technology. They are handled as a minimal standard to evaluate voice problems and voice disorders for the individual patient, as well as to determine the extent to which dysphonia (degree of dysphonia severity) is present due to the deviant measurement parameters.
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Summary: Objectives. Face masks have become important after the pandemic, but the change in voice when wearing a face mask is still unclear. The study investigated the effect of face masks on the acoustic and perceptual characteristics of voice quality associated with young and older Chinese adults. Methods. Voice samples of the sustained vowel /a/ and continuous speech produced by 44 older and 61 young adults with and without an ASTM level-3 surgical face mask were recorded and analyzed. Perceptual and acoustic parameters including mean fundamental frequency (F0) and intensity, perturbation measures (jitter and shimmer), harmonic-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), and long-term average spectrum (LTAS) measures were obtained and compared. Results. When comparing masked to unmasked voices, for both male and female speakers, F0 and intensity showed no significant changes, except for F0 of continuous speech, which increased significantly. Meanwhile, perturbation measures such as jitter and shimmer were reduced, while HNR and CPPs increased. In addition, LTAS measures included low-frequency mean spectral energy (MSE), high-frequency MSE, and spectral tilt (ST), which were different. For perceptual measures, the overall grade of dysphonia, and roughness were reduced, except for the breathiness among older male speakers, while the other vocal qualities were not changed. Between young and older speakers, significant differences in shimmer, CPPs, and perceived breathiness among male speakers, and low-frequency MSE among female speakers were found. Conclusion. Wearing a surgical mask appeared to change the perceived voice quality. This is supported by the change in perturbation and LTAS measures, and HNR and CPPs values. In addition, some differences between young and older adults were observed. Oral Communication effectiveness may be affected when wearing surgical masks due to changes in voice quality. Additionally, clinic
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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.
Article
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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The COVID-19 pandemic triggered a surge in demand for facemasks to protect against disease transmission. In response to shortages, many public health authorities have recommended homemade masks as acceptable alternatives to surgical masks and N95 respirators. Although mask wearing is intended, in part, to protect others from exhaled, virus-containing particles, few studies have examined particle emission by mask-wearers into the surrounding air. Here, we measured outward emissions of micron-scale aerosol particles by healthy humans performing various expiratory activities while wearing different types of medical-grade or homemade masks. Both surgical masks and unvented KN95 respirators, even without fit-testing, reduce the outward particle emission rates by 90% and 74% on average during speaking and coughing, respectively, compared to wearing no mask, corroborating their effectiveness at reducing outward emission. These masks similarly decreased the outward particle emission of a coughing superemitter, who for unclear reasons emitted up to two orders of magnitude more expiratory particles via coughing than average. In contrast, shedding of non-expiratory micron-scale particulates from friable cellulosic fibers in homemade cotton-fabric masks confounded explicit determination of their efficacy at reducing expiratory particle emission. Audio analysis of the speech and coughing intensity confirmed that people speak more loudly, but do not cough more loudly, when wearing a mask. Further work is needed to establish the efficacy of cloth masks at blocking expiratory particles for speech and coughing at varied intensity and to assess whether virus-contaminated fabrics can generate aerosolized fomites, but the results strongly corroborate the efficacy of medical-grade masks and highlight the importance of regular washing of homemade masks.
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The masks have always been mentioned as an effective tool against environmental threats. They are considered as protective equipment to preserve the respiratory system against the non-desirable air droplets and aerosols such as the viral or pollution particles. The aerosols can be pollution existence in the air, or the infectious airborne viruses initiated from the sneezing, coughing of the infected people. The filtration efficiency of the different masks against these aerosols are not the same, as the particles have different sizes, shapes, and properties. Therefore, the challenge is to fabricate the filtration masks with higher efficiency to decrease the penetration percentage at the nastiest conditions. To achieve this concept, knowledge about the mechanisms of the penetration of the aerosols through the masks at different effective environmental conditions is necessary. In this paper, the literature about the different kinds of face masks and respiratory masks, common cases of their application, and the advantages and disadvantages of them in this regard have been reviewed. Moreover, the related mechanisms of the penetration of the aerosols through the masks are discussed. The environmental conditions affecting the penetration as well as the quality of the fabrication are studied. Finally, special attention was given to the numerical simulation related to the different existing mechanisms.
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Objective: We examined the ability of fabrics which might be used to create home-made face masks to filter out ultrafine (0.02-0.1 µm) particles at the velocity of adult human coughing. Methods: Twenty commonly available fabrics and materials were evaluated for their ability to reduce air concentrations of ultrafine particles at coughing face velocities. Further assessment was made on the filtration ability of selected fabrics while damp and of fabric combinations which might be used to construct home-made masks. Results: Single fabric layers blocked a range of ultrafine particles. When fabrics were layered, a higher percentage of ultrafine particles were filtered. The average filtration efficiency of single layer fabrics and of layered combination was found to be 35% and 45%, respectively. Non-woven fusible interfacing, when combined with other fabrics, could add up to 11% additional filtration efficiency. However, fabric and fabric combinations were more difficult to breathe through than N95 masks. Conclusions: The current coronavirus pandemic has left many communities without access to N95 face masks. Our findings suggest that face masks made from layered common fabric can help filter ultrafine particles and provide some protection for the wearer when commercial face masks are unavailable.
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Face mask use by the general public for limiting the spread of the COVID-19 pandemic is controversial, though increasingly recommended, and the potential of this intervention is not well understood. We develop a compartmental model for assessing the community-wide impact of mask use by the general, asymptomatic public, a portion of which may be asymptomatically infectious. Model simulations, using data relevant to COVID-19 dynamics in the US states of New York and Washington, suggest that broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19 and decrease peak hospitalizations and deaths. Moreover, mask use decreases the effective transmission rate in nearly linear proportion to the product of mask effectiveness (as a fraction of potentially infectious contacts blocked) and coverage rate (as a fraction of the general population), while the impact on epidemiologic outcomes (death, hospitalizations) is highly nonlinear, indicating masks could synergize with other non-pharmaceutical measures. Notably, masks are found to be useful with respect to both preventing illness in healthy persons and preventing asymptomatic transmission. Hypothetical mask adoption scenarios, for Washington and New York state, suggest that immediate near universal (80%) adoption of moderately (50%) effective masks could prevent on the order of 17–45% of projected deaths over two months in New York, while decreasing the peak daily death rate by 34–58%, absent other changes in epidemic dynamics. Even very weak masks (20% effective) can still be useful if the underlying transmission rate is relatively low or decreasing: In Washington, where baseline transmission is much less intense, 80% adoption of such masks could reduce mortality by 24–65% (and peak deaths 15–69%), compared to 2–9% mortality reduction in New York (peak death reduction 9–18%). Our results suggest use of face masks by the general public is potentially of high value in curtailing community transmission and the burden of the pandemic. The community-wide benefits are likely to be greatest when face masks are used in conjunction with other non-pharmaceutical practices (such as social-distancing), and when adoption is nearly universal (nation-wide) and compliance is high.
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Previously, we demonstrated a strong correlation between the amplitude of human speech and the emission rate of micron-scale expiratory aerosol particles, which are believed to play a role in respiratory disease transmission. To further those findings, here we systematically investigate the effect of different ‘phones’ (the basic sound units of speech) on the emission of particles from the human respiratory tract during speech. We measured the respiratory particle emission rates of 56 healthy human volunteers voicing specific phones, both in isolation and in the context of a standard spoken text. We found that certain phones are associated with significantly higher particle production; for example, the vowel /i/ (“need,” “sea”) produces more particles than /ɑ/ (“saw,” “hot”) or /u/ (“blue,” “mood”), while disyllabic words including voiced plosive consonants (e.g., /d/, /b/, /g/) yield more particles than words with voiceless fricatives (e.g., /s/, /h/, /f/). These trends for discrete phones and words were corroborated by the time-resolved particle emission rates as volunteers read aloud from a standard text passage that incorporates a broad range of the phones present in spoken English. Our measurements showed that particle emission rates were positively correlated with the vowel content of a phrase; conversely, particle emission decreased during phrases with a high fraction of voiceless fricatives. Our particle emission data is broadly consistent with prior measurements of the egressive airflow rate associated with the vocalization of various phones that differ in voicing and articulation. These results suggest that airborne transmission of respiratory pathogens via speech aerosol particles could be modulated by specific phonetic characteristics of the language spoken by a given human population, along with other, more frequently considered epidemiological variables.
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We evaluated the effectiveness of 11 face coverings for material filtration efficiency, inward protection efficiency on a manikin, and outward protection efficiency on a manikin. At the most penetrating particle size, the vacuum bag, microfiber cloth, and single-layer surgical-type mask had material filtration efficiencies >50%, while the other materials had much lower filtration efficiencies. However, these efficiencies increased rapidly with particle size, and many materials had efficiencies >50% at 2 μm and >75% at 5 μm. The vacuum bag performed best, with efficiencies of 54–96% for all three metrics, depending on particle size. The thin acrylic and face shield performed worst. Inward protection efficiency and outward protection efficiency, defined for close-range, face-to-face interactions, were similar for many masks; the two efficiencies diverged for stiffer materials and those worn more loosely (e.g., bandana) or more tightly (e.g., wrapped around the head) compared to an earloop mask. Discrepancies between material filtration efficiency and inward/outward protection efficiency indicated that the fit of the mask was important. We calculated that the particle size most likely to deposit in the respiratory tract when wearing a mask is ∼2 μm. Based on these findings, we recommend a three-layer mask consisting of outer layers of a flexible, tightly woven fabric and an inner layer consisting of a material designed to filter out particles. This combination should produce an overall efficiency of >70% at the most penetrating particle size and >90% for particles 1 μm and larger if the mask fits well. Copyright © 2021 American Association for Aerosol Research
Article
Although the benefit of population-level public facial masking to protect others during the COVID-19 pandemic has received a great deal of attention, we discuss for one of the first times the hypothesis that universal masking reduces the “inoculum” or dose of the virus for the mask-wearer, leading to more mild and asymptomatic infection manifestations. Masks, depending on type, filter out the majority of viral particles, but not all. We first discuss the near-century-old literature around the viral inoculum and severity of disease (conceptualized as the LD50 or lethal dose of the virus). We include examples of rising rates of asymptomatic infection with population-level masking, including in closed settings (e.g., cruise ships) with and without universal masking. Asymptomatic infections may be harmful for spread but could actually be beneficial if they lead to higher rates of exposure. Exposing society to SARS-CoV-2 without the unacceptable consequences of severe illness with public masking could lead to greater community-level immunity and slower spread as we await a vaccine. This theory of viral inoculum and mild or asymptomatic disease with SARS-CoV-2 in light of population-level masking has received little attention so this is one of the first perspectives to discuss the evidence supporting this theory.
Article
Background Conflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database. Results A total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR = 0.35 and 95% CI = 0.24–0.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR = 0.20, 95% CI = 0.11–0.37) and 47% (OR = 0.53, 95% CI = 0.36–0.79). The protective effect of wearing masks in Asia (OR = 0.31) appeared to be higher than that of Western countries (OR = 0.45). Masks had a protective effect against influenza viruses (OR = 0.55), SARS (OR = 0.26), and SARS-CoV-2 (OR = 0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials and observational studies. Conclusions This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.
Article
On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir's member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (2-5). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.