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- - - - Lane, J. et al. Impacts of impaired face perception on social interactions and quality of life in age-related macular degeneration: A qualitative study and new community resources. PLoS ONE 13, e0209218 (2018).
        https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209218
        facial recognition is important for social interaction and quality of life
        “accurate face expression recognition is also important for normal social interactions" ...
        “People use others’ facial expressions to judge how they are feeling (e.g., happy, angry), the intended meaning of their words (e.g., if they are serious or making a joke), whether they are engaged by the conversation or bored, and, ultimately, to decide how to respond"
        Poor face perception in AMD (age-related macular degeneration) is an important domain contributing to impaired social interactions and quality of life.
      - Nastevski, A.L., Yu, B., Liu, S., Kamigaki-Baron, M., De Boer, G. and Gick, B., How do masks affect the way we speak?. —
        https://cla-acl.ca/pdfs/resumes-2021-abstracts/Nastevskietal.pdf
        study tests how masks effect speech and the use of facial expressions."audiovisual speech-related behaviour" as masks obscure visible speech articulators, there could be a possible increase using eyebrows and other visible articulators.—
        the visual findings show we do not compensate e for the lack of lowerface visual cues by adopting more upper face )eyebrow), head or hand movements.
      - Kastendieck, T., Zillmer, S. and Hess, U., 2021. (Un) mask yourself! Effects of face masks on facial mimicry and emotion perception during the COVID-19 pandemic. Cognition and Emotion, pp.1-11.
        https://www.tandfonline.com/doi/abs/10.1080/02699931.2021.1950639
        Face masks have been said to impact face-to-face interaction negatively. Yet, there is limited evidence on the degree to which partial face occlusion is detrimental to empathic processes such as emotion perception and facial mimicry.
        Thus, these findings suggest that whether face masks impede emotion communication depends on the emotion expressed and the emotion-communication aspect of interest. With unprecedented changes in nonverbal communication brought about by the COVID-19 pandemic, this research marks a first contribution to our understanding of facial mimicry as an important social regulator during these times.
      - Mheidly, N., Fares, M.Y., Zalzale, H. and Fares, J., 2020. Effect of face masks on interpersonal communication during the COVID-19 pandemic. Frontiers in Public Health, 8, p.898.
        https://www.frontiersin.org/articles/10.3389/fpubh.2020.582191/full
        explore the role of facial expressions in communication and highlight how the face mask can hinder interpersonal connection.
        Nonverbal communication, such as facial gestures and expressions, constitutes 55% of our overall communication
      - Davis, J.M., McKone, E., Dennett, H., O'Connor, K.B., O'Kearney, R. and Palermo, R., 2011. Individual differences in the ability to recognise facial identity are associated with social anxiety. PloS one, 6(12), p.e28800.
        https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0028800
        are you more likely to experience social anxiety when you have difficulty recognising facial identity? yes
        “our primary new finding is that, even within the normal range of face recognition abilities, there is also a small but significant relationship between face recognition ability and social anxiety, such that poorer face recognition skills are associated with higher social anxiety."
      - Freud, E., Stajduhar, A., Rosenbaum, R.S., Avidan, G. and Ganel, T., 2020. The COVID-19 pandemic masks the way people perceive faces. Scientific reports, 10(1), pp.1-8.
        https://www.nature.com/articles/s41598-020-78986-9
        how face masks prevent facial recognition and perception - big random words, unpleasant to read and very confusing
        “Face masks are an important tool in the effort to minimize COVID-19 virus transmission and, as a result, are increasingly prominent in everyday social interactions"
      - Marschark, M., LePoutre, D. and Bement, L., 1998. Mouth movement and signed communication. Hearing by eye II: The psychology of speechreading and auditory-visual speech, pp.243-264.
        https://books.google.com/books?hl=en&lr=&id=9ZzWAQAAQBAJ&oi=fnd&pg=PA245&dq=mouth+shapes+sign+language&ots=J-4PF5RGXg&sig=Ngve4ZV1QPigRurzAAyF-1u_EEYa
        no access, looked a bit shit tho
      - Marler, H. and Ditton, A., 2021. “I'm smiling back at you”: exploring the impact of mask wearing on communication in healthcare. International journal of language & communication disorders, 56(1), pp.205-214.
        Issues of wearing face masks on communication
        essential in protecting the health of staff and patients, there are numerous logistical, physiological, psychological, social and economic complications associated with the wearing of masks. The ability of healthcare staff to successfully communicate with patients and with colleagues is jeopardized,
      - Prusti, S.M. and Dash, M., 2022. Effect of the mask on communication: a perspective of the scenario of covid-19. Asian Journal of Research in Social Sciences and Humanities, 12(1), pp.188-201.
        https://indianjournals.com/ijor.aspx?target=ijor:ajrssh&volume=12&issue=1&article=034
        loss of facial expression, face masks require veral expression instead of facial
      - Tsantani, M., Podgajecka, V., Gray, K.L. and Cook, R., 2022. How does the presence of a surgical face mask impair the perceived intensity of facial emotions?. PloS one, 17(1), p.e0262344.
        https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262344
        the perceived intensity of intended emotions (i.e., the emotion that the actor intended to convey) was reduced by the presence of a mask for all expressions except for anger.
        this showcases the ambiguity that arises when interpreting the facial expressions of masked faces.
      - PV, M.M.A., Joe, G.C. and Jalaludeen, A., 2021. Facial Expression behind the Mask. NVEO-NATURAL VOLATILES & ESSENTIAL OILS Journal| NVEO, pp.9847-9850.
        https://www.nveo.org/index.php/journal/article/view/2760
        The messages otherwise conveyed through facial expression need to be spoken. Spoken communication no longer gets the support of facial expression.
        majority of the people feel that wearing mask is a barrier to face-to-face communication
        The barrier of face-to-face communication while wearing facial masks include difficulty in expressing and understanding ideas mainly because it is less audible, and not able to see lip movements and not able to recognize facial expressions.
        The channel that communicates the most specific emotional states is the face. Today, the mask has become a permanent fitment to the face, hindering our capability to express and recognise each other's facial expression
      - Henke, L., Guseva, M., Wagemans, K., Pischedda, D., Haynes, J.D., Jahn, G. and Anders, S., 2022. Surgical face masks do not impair the decoding of facial expressions of negative affect more severely in older than in younger adults. Cognitive Research: Principles and Implications, 7(1), pp.1-15.
        https://cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-022-00403-8
        face masks do impact emotion perception and slef confidence in decoding others emotions, this negative effects does not not impact the older generation more than younger, both are impacted
        
        the effect of face masks did not differ between age groups. Further analyses showed that masks also reduced the participants’ overall confidence in their emotion judgements, but not their performance awareness
      - Carbon, C.C., 2020. Wearing face masks strongly confuses counterparts in reading emotions. Frontiers in psychology, 11, p.566886.
        https://www.frontiersin.org/articles/10.3389/fpsyg.2020.566886/full
        Lower accuracy and lower confidence in one’s own assessment of the displayed emotions indicate that emotional reading was strongly irritated by the presence of a mask.
        Facial expressions are not our one and only source of information; we can also take recourse to body posture and body language to infer the emotional states of our counterpart.
        Direct verbal communication even helps to understand the very fine-tuned state of a mind. We have options, and it is essential to make use of them not only when being the receiver of socially relevant information but also when being the sender. And, we should use and optimize those options which we can best play and which suit us best; this not only applies for times and situations where we cover parts of our face due to health or cultural reasons but extends to cases where the ability to express emotions is affected
    - - Lau, W.K. and Chalupny, J., 2021. How expertise can alter effects of face masks: investigating a sample of congenitally deaf participants?. --
        unoccluded face regions like the eyes and eye region remain informative in communication, which might be especially helpful for expert face readers such as the deaf population. --
        are deaf people better at understanding emotions and facial expressions with the use of face masks? --
        These results mostly mimicked data from the hearing, despite the deaf having greater expertise reading faces. Therefore, expert face readers also succumbed to the effects of face masks as the perceived intensity of facial expressions becomes reduced.
      - Siple, P., 1978. Visual constraints for sign language communication. Sign Language Studies, (19), pp.95-110.
        https://www.jstor.org/stable/26203269
        need to see to sign
      - Amadeo, M.B., Escelsior, A., Amore, M., Serafini, G., Pereira da Silva, B. and Gori, M., 2022. Face masks affect perception of happy faces in deaf people. Scientific Reports, 12(1), pp.1-10.
        https://link.springer.com/content/pdf/10.1038/s41598-022-16138-x.pdf
        deaf signers preferentially focus on the mouth region of
        the face24,25, here we studied whether face masks specifcally afect their ability to recognize facial emotional expressions.
        limit the ability of both hearing and deaf people to infer emotions from facial expressions. Moreover, the negative impact of face masks is signifcantly more pronounced when deaf people have to
        recognize the low-intensity expression of happiness.
        Tese results support the important role of holistic processing in recognizing emotions and suggest that deaf people do not compensate with alternative visual strategies when the mouth region is covered.
  - - - Lee, B.J. and Hart, E.T., 2022. Facemask occlusion's impact on L2 listening comprehension. Speech Communication, 139, pp.45-50.
        communication with face masks is difficult specifically for L2 speakers/listeners
      - Smiljanic, R., Keerstock, S., Meemann, K. and Ransom, S.M., 2021. Face masks and speaking style affect audio-visual word recognition and memory of native and non-native speech. The Journal of the Acoustical Society of America, 149(6), pp.4013-4023.
        second language issues with face masks
      - Smiljanic, R., Keerstock, S., Meemann, K. and Ransom, S.M., 2021. Face masks and speaking style affect audio-visual word recognition and memory of native and non-native speech. The Journal of the Acoustical Society of America, 149(6), pp.4013-4023.
        https://asa.scitation.org/doi/full/10.1121/10.0005191
        The present study examines how signal degradation and loss of visual information due to masks affects intelligibility and memory for native and non-native speech.
        word recognition and recall of speech produced with a mask can be as accurate as without a mask in optimal listening conditions. Masks affected non-native speech processing at easier noise levels than native speech.
        Clear speech with a mask significantly improved accuracy in all listening conditions. Speaking clearly, reducing noise, and using surgical masks as well as good signal amplification can help compensate for the loss of intelligibility due to background noise, lack of visual cues, physical distancing, or non-native speech.
        masks did not negatively impact word recognition and memory for either speaker when presented to listeners in quiet. In optimal listening conditions, without any background noise, speech produced with a mask was as intelligible as speech produced without a mask.
        This is in contrast to the Truong et al. (2021) study, which found worse cued recall for conversational sentences presented in quiet when a talker wore a mask.
    - - Alqudah, S., Zaitoun, M., Alqudah, O., Alqudah, S. and Alqudah, Z., 2021. Challenges facing users of hearing aids during the COVID-19 pandemic. International Journal of Audiology, pp.1-7.
        this study reported the main obstacles described by hearing aid users during the COVID-19 outbreak to aid in the development of management options
        In the current study, participants reported that the discontinuation of the hearing and speech services offered by the Ministry of Health was one of the main challenges experienced during the COVID-19 ... Tele-audiology, a branch of telemedicine, can be used to deliver audiological care at a distance as a substitute for the temporarily suspended in-person services... was challenging for patients with hearing loss,
        The current decline in the socioeconomic status and sustained isolation will eventually lead to stress and emotional exhaustion, which are risk factors for hearing disorders.
        a surge in internalising behavioural disorders such as anxiety and depression.
      - Chodosh, J., Weinstein, B.E. and Blustein, J., 2020. Face masks can be devastating for people with hearing loss. bmj, 370.
        https://www.bmj.com/content/370/bmj.m2683.full
        Masking is challenging for everyone, but it is especially difficult for people with hearing loss. Here we focus on how masks undermine speech communication for patients with hearing loss in medical care settings. Masks also create enormous challenges for members of the Deaf community who use sign language
        Even before masks became ubiquitous, people with hearing loss struggled to communicate in healthcare settings,(Mick P, Foley DM, Lin FR. Hearing loss is associated with poorer ratings of patient-physician communication and healthcare quality. // Cudmore V, Henn P, O’Tuathaigh CMP, Smith S. Age-related hearing loss and communication breakdown in the clinical setting. // Shukla A, Nieman CL, Price C, Harper M, Lin FR, Reed NS. Impact of hearing loss on patient-provider communication among hospitalized patients: A systematic review).
        Those challenges remain, but masks bring new barriers: in addition to blocking lip movements and facial expressions (which are so important when hearing is marginal), masks muffle the high frequency portions of sound that are essential to speech.(Goldin A, Weinstein BE, Shiman N. How do medical masks degrade speech reception? Hearing Review. May 2020.)
        How can we preserve communication with patients with hearing loss in this new masked world?
        
        The first step is awareness, Second, basic steps can often improve communication. Face the patient, get their attention before speaking, speak reasonably slowly, raise the volume of our voices slightly, and always check for understanding
        
        Patients and healthcare workers who are members of the Deaf community and use sign language face the greatest obstacles with masking, since facial expressions and lip movements are fundamental components of sign language.
      - Park, J., 2020. Unraveling the invisible but harmful impact of COVID-19 on deaf older adults and older adults with hearing loss. Journal of Gerontological Social Work, 63(6-7), pp.598-601.
        https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1799282
        Masks create difficulty for DOA because they can hide visual cues such as facial expressions, which are necessary components of ASL communication. Face masks also compromise communication with OAHL by preventing lip reading and decreasing volume and accuracy (Perencevich et al., 2020; Tagupa, 2020)
      - Williams, I.J., 2020. Covid-19: lack of guidance on PPE for hearing impaired doctors. bmj, 370.
        https://www.bmj.com/content/370/bmj.m2831
        Masks, with their ear loops, are not ideal for hearing aid wearers.
        more a blog post, but enquiring on the benefit of visors and if they should replace masks in the long term for healthcare workers as they are ore accessible
        Not just the communication needs of hearing impaired doctors are being forgotten, but also specific policy regarding the use of PPE with assisted hearing devices. Nowhere in any guideline have I found information on how to wear or use PPE with hearing aids
      - Maru, D., Stancel-Lewis, J., Easton, G. and Leverton, W.E., 2021. Communicating with people with hearing loss: COVID-19 and beyond. BJGP open, 5(1).
        https://bjgpopen.org/content/5/1/BJGPO.2020.0174.abstract
        its difficult for those with hearing loss to access health services,
        no study / investigation, very little was said here
      - Branda, E., 2020. Improving communication with face masks. Signia. —
        https://www.signia-library.com/wp-content/uploads/sites/137/2020/06/Signia_white-paper_improving-communication-with-face-masks.pdf —
        hearing aid manufacturer, not a study, more of a statement on their hearing aids and that they will continue to work.—
        "wearing masks can become a communication challenging two ways. First, masks cover the mouth, restricting any visual speech cues the wearer might receive. Secondly, masks can impact the acoustic properties of the speech signal itself."
      - Garg, S., Deshmukh, C.P., Singh, M.M., Borle, A. and Wilson, B.S., 2021. Challenges of the Deaf and Hearing Impaired in the Masked World of COVID-19. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 46(1), p.11.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117910/
        lit review of deaf barriers during covid
        the difficulties of deaf people to adjust as per their needs have now increased due to the overwhelming COVID-19 pandemic.
        They face a dual struggle to accommodate themselves in the world designed around hearing, compounded by COVID-19, leading to lack of inclusiveness
        lack of information
        
        deaf are deprived of accurate and reliable information on COVID-19 due to lack of availability of sign language specialists during lockdown and inability to comprehend lip reading due to masks in direct communication.
        
        face masks
        
        this preventive measure, the deaf and hearing-impaired people feel excluded from the world. Deaf people who rely on sign language still need facial expressions for full understanding of what is being communicated,
        
        Anyone with hearing impairment will have difficulty with muffled speech due to facemask.[De Hahn, P., 2020. Face Masks are Excluding the Deaf and Hard of Hearing Community. Quartz. Last accessed on 2020 Jul 03 Available from, pp.com-1839479.]
        
        covering of face by mask can cut down on the ability to connect, especially with the hearing-impaired or deaf community.[Trecca, E.M., Gelardi, M. and Cassano, M., 2020. COVID-19 and hearing difficulties. American journal of otolaryngology, 41(4), p.102496.]
      - Grote, H., Izagaren, F. and Jackson, E., 2021. The experience of D/deaf healthcare professionals during the coronavirus pandemic. Occupational Medicine (Oxford, England).
        https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8135376/
        
        To determine the impact that a lack of transparent masks and reasonable adjustments had on communication, confidence at work and well-being among D/deaf HCPs during the coronavirus pandemic.
        D/deaf HCPs felt left behind, isolated and frustrated by a lack of transparent masks and reasonable adjustments to meet their communication needs.
      - Grieco-Calub, T.M., 2021. COVID-19, Face Masks, and Social Interaction: How a Global Pandemic Is Shining a Light on the Importance of Face-to-Face Communication. Perspectives of the ASHA Special Interest Groups, 6(5), pp.1097-1105.
        https://pubs.asha.org/doi/full/10.1044/2021_PERSP-21-00037
        strategy that listeners employ to preserve recognition when the acoustics of speech are degraded is to usevisual speech cues of the talker producing the speech during face-to-face communication. A listener’s ability to benefit from visual speech (i.e., lipreading or speechreading) to facilitate speech recognition in children and adults when auditory speech is degraded is well established (Erber, 1969;Grant & Seitz, 2000; Kuhl & Meltzoff, 1982; Lalonde &Holt, 2015; MacLeod & Summerfield, 1987; Ross et al.,2011; Sumby & Pollack, 1954)
        hospital-grade masks act as low-pass filters, effectively reducing the intensity of the higher speech frequencies (> 2 kHz) that are important for speech recognition.
        Sumby and Pollack (1954), studies have repeatedly shown that individuals across the life span benefit from both hearing and seeing a talker (i.e., audiovisualspeech perception), particularly in situations when the auditory components of speech are less accessible (Erber, 1969; Grant& Seitz, 2000; Kuhl & Meltzoff, 1982; Lalonde & Holt, 2015;MacLeod & Summerfield, 1987; Ross et al., 2011).
        The widespread use of face masks, therefore, has the potential to not only disrupt access to the speech signal but also disrupt established communication strategies implemented by individuals who already have poor access to the speech signal
        people with mild hearing loss and who are able to navigate their daily lives by using communication strategies, either overtly or covertly, to compensate for their hearing loss.
        access to a talker’s mouth (i.e., access to visual speech) through a transparent mask improves listeners’ speech recognition (Lalonde et al., 2021; Thibodeau et al.,2021). It is important to note, however, that the materials used to make transparent masks and face shields have variable acoustic filtering properties and variable transparency due to reflections or fogging (Corey et al., 2020; L. Hunter, personal communication, June 3, 2021). Thus, the benefits observed with transparent equipment—and thus access to visual speech—may be limited if the material itself causes too much degradation to the speech signal
        
        both children and adults have slowerrecognition of speech when the speech has been degraded bybackground noise or spectral filtering compared to when it isunaltered (Grieco-Calub et al., 2009; McMurray et al., 2017;Newman & Chatterjee, 2013)
        
        degradedspeech impact word recognition and linguistic processing,it may also disrupt acoustic cues related to speech prosody,such as intonation, pitch, and stress, all of which are criti-cal for emotion recognition and processing (Everhardtet al., 2020; Tinnemore et al., 2018)
      - Trecca, E.M., Gelardi, M. and Cassano, M., 2020. COVID-19 and hearing difficulties. American journal of otolaryngology, 41(4), p.102496.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166300/
        Face masks represent an ally in the fight against COVID-19, but a challenge for patients with hearing loss for two main reasons; they reduce acoustic transmission and prevent lip reading [8]. Additionally, PPE makes more uncomfortable for the patients wearing hearing devices, such as hearing aids and cochlear implants.
      - Homans, N.C. and Vroegop, J.L., 2022. The impact of face masks on the communication of adults with hearing loss during COVID-19 in a clinical setting. International Journal of Audiology, 61(5), pp.365-370.
        https://www.tandfonline.com/doi/full/10.1080/14992027.2021.1952490
        the effect of surgical masks and face shields on speech intelligibility of adults with moderate to severe hearing loss.
        With these surgical masks, speech sounds are atte-nuated and people cannot see the facial expressions and lipmovements.
        As wearing masks can even be a challenge for normal hearingpeople, these masks are expected to have a much larger impacton the communication for people with hearing loss (Mendel,Gardino, and Atcherson2008; Chodosh, Weinstein, and Blustein2020; McKee, Moran, and Zazove2020; Naylor, Burke, andHolman2020; Park2020; Saunders, Jackson, and Visram2020;Trecca, Gelardi, and Cassano2020; West, Franck, and Welling2020; Homans and Vroegop2021; Littlejohn et al.2021; Nguyenet al.2021)
        the main problem with the masks was the impossibility of lip reading (for 33 peo-ple) and noise reduction was the main problem for 26 people (Trecca, Gelardi, and Cassano (2020)
        Atcherson et al. (2017) investigated the effect of conventionaland transparent masks on speech perception in noise for personswith and without hearing loss. For normal hearing subjects, nodifferences between the masks was found, but subjects with hear-ing loss showed improved speech perception in noise when vis-ual input was provided through the use of a transparent surgicalmask compared with a conventional mask
        transparent masksand face shields showed to have the worst acoustic performance,as they caused an increase in sound level below 1 kHz and alarge attenuation of sound above 1 kHz (Corey, Jones, and Singer2020)
        ace shields maydistort the sound to a larger extend, but lip reading remains pos-sible. However, surgical masks attenuate sound to a lesser extent,but the mouth is totally covered.
        for speech perception in quiet, surgical face masks, and face shields to a lesser extent, have a negative effect for patients with moderate to severe hearing loss.
      - Poon, B.T. and Jenstad, L.M., 2022. Communication with face masks during the COVID-19 pandemic for adults with hearing loss. Cognitive Research: Principles and Implications, 7(1), pp.1-18.
        https://cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-022-00376-8#Sec11
        Strategies to enhance communication with face masks that participants put forward in the present study were consistent with recommendations from others (Chodosh et al., 2020; Deardorff et al., 2021; Schlögl & Jones, 2020)... such as speaking slower, slightly increasing speech volume, and incorporating written or typed text.
        As expected, face masks interfere with communication, social connection, and even tasks of daily living (e.g., buying groceries). Findings from our study indicate that the vast majority of people who are D/deaf or hard of hearing reported difficulties understanding others with face masks during the COVID-19 pandemic; and, notably, those with more severe self-reported hearing loss were also more likely to report greater difficulties in communication
      - Gutierrez-Sigut, E., Lamarche, V.M., Rowley, K., Lago, E.F., Pardo-Guijarro, M.J., Saenz, I., Frigola, B., Frigola, S., Aliaga, D. and Goldberg, L., 2022. How do face masks impact communication amongst deaf/HoH people?. Cognitive Research: Principles and Implications, 7(1), p.81.
        https://link.springer.com/article/10.1186/s41235-022-00431-4
        investigated whether onset and level of deafness, knowledge of sign language, speechreading fluency, and country of residence predicted communication difficulties, wellbeing, and degree to which transparent face coverings were considered useful.
        both early- and late-onset deaf people reported missing more information and feeling more disconnected from society than HoH people. Finally, signers valued transparent face shields more positively than non-signers. The latter suggests that, while seeing the lips is positive to everyone, signers appreciate seeing the whole facial expression
  - - - Giuliani, N., 2020. For Speech Sounds, 6 Feet With a Mask Is Like 12 Feet Without. Leader Live.
        https://leader.pubs.asha.org/do/10.1044/leader.AEA.25112020.26/full
        more of a magazine article
        Face masks filter out high-frequency speech information, resulting in a now all-too-familiar muffled sound quality. They also obscure visual cues that people use to fill in information their ears may have missed.
        social distancing decreases the intensity of the sounds reaching the listener
        four different facial coverings: a procedure mask, a procedure mask with face shield, a cloth mask, and an N95 respirator. All masks acted as a lowpass filter, meaning that the intensity of high-frequency sounds was reduced, but not low-frequency sounds
        Suggestions for audiologists
        
        Wear a procedure mask for less attenuation of speech sounds and, if possible, use a transparent mask. Doing so will still attenuate your speech, but your patients will receive visual cues to help supplement what their ears miss.
        
        Wear goggles with a face mask instead of a face shield during routine procedures, as a face shield further reduces speech intensity.
        
        Add a manual hearing aid program. Consider adding one with an additional 3–6 dB of gain for frequencies including and beyond 1500 Hz.
        
        Revisit adding a telecoil program for patients to better communicate with workers in places such as fast-food drive-thrus that may be equipped with an induction loop.
        
        Recommend that patients with newer hearing aid technology use smartphone apps to adjust high-frequency output and volume.Use hearing assistive technologies, such as remote microphones, to compensate for sound lost due to social distancing.
        
        Schedule appointments to allow sufficient space in waiting areas and time to clean exam rooms.
        
        Explore remote programming options, which allow you to make adjustments without the patient physically coming to the office.
        
        Provide additional written instructions on improving communication while wearing a mask and social distancing to patients, family, and caregivers.
      - Lipps, E., Caldwell-Kurtzman, J., Motlagh Zadeh, L., Blankenship, C.M., Moore, D.R. and Hunter, L.L., 2021. Impact of Face Masks on Audiovisual Word Recognition in Young Children with Hearing Loss During the Covid-19 Pandemic. Journal of Early Hearing Detection and Intervention, 6(2), p.8. --
        https://digitalcommons.usu.edu/jehdi/vol6/iss2/8/
        children enrolled in an oral school setting, we found that both the standard surgical and transparent apron mask presented a significant barrier to audiovisual communication in young children who are DHH.
        Standard surgical and custom apron shield masks significantly hampered word recognition, even in quiet conditions. The commercially available ClearMask did not significantly affect scores in quiet for young deaf and hard-of-hearing children, but scores were highly variable.
        All three types of mask had a resonant peak at about 500 Hz compared to the no mask condition. This increased level at low frequencies could make speech sounds muffled and less intelligible.
        Consistent with this finding, studies in adults have consistently found negative effects on speech communication with surgical masks in quiet (Bandaru et al., 2020) and for words and sentences in noise (Atcherson et al., 2017; Bottalico et al., 2020; Hampton et al., 2020; Toscano & Toscano, 2021; Wittum et al., 2013)
        Studies in adults have found a benefit of transparent masks, especially in noisy backgrounds, even in adults with normal hearing (Atcherson et al., 2017; Thibodeau et al., 2021). A
      - Bandaru, S.V., Augustine, A.M., Lepcha, A., Sebastian, S., Gowri, M., Philip, A. and Mammen, M.D., 2020. The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario. The Journal of Laryngology & Otology, 134(10), pp.895-898. --
        https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/effects-of-n95-mask-and-face-shield-on-speech-perception-among-healthcare-workers-in-the-coronavirus-disease-2019-pandemic-scenario/83DE0D454255C304D15F2B6AFAF0C965
        Does face masks effect speech perception? yes
        The occlusion effect of the face mask tends to produce a positive feedback effect of speech loudness, which may in fact cause one to speak with a softer tone than normal.
        The use of extra signage in the healthcare setting, adequate lighting, sign language for common instructions, and patient information hand-outs on disease conditions or hand-outs giving instructions may help overcome this communication barrier..
      - Lin, Y., Cheng, L., Wang, Q. and Xu, W., 2021. Effects of Medical Masks on Voice Assessment During the COVID-19 Pandemic. Journal of Voice.
        https://www.jvoice.org/article/S0892-1997(21)00163-6/fulltext
        o assess vocal quality while wearing a masks
        Face Masks make speech less intelligible and may explain the speakers increase in loudness and to now speak with a stronger voice.
        we assumed that it was because their speech became less intelligible when wearing medical masks,3 driving theyto increase their pitch and loudness to make their voices sound clearer."
      - Nguyen, D.D., McCabe, P., Thomas, D., Purcell, A., Doble, M., Novakovic, D., Chacon, A. and Madill, C., 2021. Acoustic voice characteristics with and without wearing a facemask. Scientific reports, 11(1), pp.1-11.
        https://www.nature.com/articles/s41598-021-85130-8
        good rundown of benefits of surgical and kn95 masks, briefly comparing and explain pros and cons
        compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask
        attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95.
      - Giovanelli, E., Valzolgher, C., Gessa, E., Todeschini, M. and Pavani, F., 2021. Unmasking the difficulty of listening to talkers with masks: lessons from the COVID-19 pandemic.
        i-Perception, 12(2), p.2041669521998393. https://journals.sagepub.com/doi/full/10.1177/2041669521998393
        measure the impact of different visual conditions on speech comprehension in typical hearing participants. Results showed that hiding the talkers behind a black screen or concealing their lips via a face mask led to lower performance and lower listening confidence scores as well as increased listening effort. These differences between listening conditions suggest that the actual audio-visual benefit coming from vision relies on lip reading and demonstrate the impact of face masks on speech comprehension.
        This result is in line with previous work concerning the effect of face masks on confidence in reading emotions (Carbon, 2020), which found lower confidence and accuracy scores in recognizing expressions displayed by faces wearing surgical masks. This result supports the idea that hiding the lower part of a face undermines the efficacy of a conversation not only linguistically but also from a nonverbal point of view.
      - Yi, H., Pingsterhaus, A. and Song, W., 2021. The adverse effect of wearing a face mask during the COVID-19 pandemic and benefits of wearing transparent face masks and using clear speech on speech intelligibility. --
        https://psyarxiv.com/z9c4k/
        effects of wearing transparent face masks and using clear speech to support better verbal communication was evaluated here.
        evaluated listener word identification scores in the following four conditions: (
        1) type of masking(i.e., no mask, transparent mask, and disposable paper mask),
        (2) presentation mode (i.e., auditory only and audiovisual),
        (3) speaker speaking style (i.e., conversational speech and clear speech),and
        (4) with two types of background noise (i.e., speech shaped noise and four-talker babble at negative 5 signal to noise ratio levels).
        Our findings revealed the use of face masks (i.e., disposable papermasks and transparent masks) decreasesspeech intelligibility compared to no mask in the presence of background noise.
        no mask condition ranked the highest for speech intelligibility in both AO and AV presentations. Disposable paper masks ranked secondfor speech intelligibility in the AO presentation and third for the AV presentation. The combinationof increased attenuation ofacoustic signals (Corey et al., 2020; Goldin et al., 2020) and lack of visual information could have contributed to the decrease of speech intelligibility in the AO presentations for transparent masks. On the contrary, transparent masks ranked secondfor speech intelligibility in AV presentation and third for AO presentation. T
        Ourresult is consistent with Atcherson et al. (2017) who examined the effects of transparent masks on speech intelligibility in individuals with and without hearing loss. Both listenerswith and without hearing loss benefitted from visual input from a transparent mask
        Disposable paper masks cover the mouth and lip gestures that are criticalaspects of nonverbal communication.
        
        Magee et al (2020) :question:
        measured speech intelligibility in an ideal listening environment, lacking background noise a
        Magee and colleagues found that different types of face masks affected acoustic signals differently, with higher frequencies of acoustic signals being attenuated across three types of masks
        Keerstock et al. (2020) evaluated how protective masks, background noise, and non-native accents affect speech intelligibility and overall communication. They found speech produced in conversational speaking styles with a paper mask was as intelligible as speech produced without a mask. More specifically, conversational speech produced while wearing a paper mask did not negatively affect speech intelligibility in quiet listening conditions for either native or non-native speakers and occasionally even in the presence of noise for the native speaker.
        It has been well established that clear speech enhances speech intelligibility by increasing acoustic-articulatory outcomes (Cook et al., 2014; Smiljanic & Bradlow, 2014; Smiljanic & Gilbert, 2017ab;
        Clear speech has been shown to improve speech intelligibility in the various populations: second language learners (Bradlow & Bent, 2002), learning-impaired children (Bradlow et al., 2003), individuals with hearing loss (Ferguson, 2012; Ferguson & Quene, 2014), children with cochlear implants (CIs) (Smiljanic & Sladen, 2013), and adult with CIs (Rodman et al., 2020)
        Clear speech benefits on speech intelligibility have been well documented and evaluated by a variety of procedures prior to the COVID-19 pandemic (Bradlow & Bent, 2002; Bradlow et al., 2003; Ferguson, 2012; Ferguson & Quene, 2014; Rodman et al., 2020; Smiljanic & Gilbert, 2017; Smiljanic & Sladen, 2013; and Van Engen et al., 2014)
        clear speech resulted in higher speech intelligibility than conversational speech in all types of mask conditions in both background noises and presentation modes
        These findings are mostly in agreement with Keerstock et al. (2020). They found that the use of clear speech improved intelligibility produced with no mask and disposable paper masks in the presence of two maskers.
      - Aliabadi, M., Aghamiri, Z.S., Farhadian, M., Shafiee Motlagh, M. and Hamidi Nahrani, M., 2022. The Influence of Face Masks on Verbal Communication in Persian in the Presence of Background Noise in Healthcare Staff. Acoustics Australia, 50(1), pp.127-137.
        https://link.springer.com/article/10.1007/s40857-021-00260-3
        The vocal efforts of nurses when wearing surgical masks were not significant compared with the baseline vocal efforts (p > 0.05); however, vocal efforts of nurses when wearing N95 and N99 respirators were at an unacceptable level. The face masks had no considerable effect on the speech spectrum below 2.5 kHz; however, they reduced high frequencies by different values.
    - - Corey, R.M., Jones, U. and Singer, A.C., 2021. Comparison of the Acoustic Effects of Face Masks on Speech. The Hearing Journal, 74(1), pp.36-38.
        https://journals.lww.com/thehearingjournal/Fulltext/2021/01000/Comparison_of_the_Acoustic_Effects_of_Face_Masks.11.aspx?context=LatestArticles
        Test different masks to discover if the different material has different effects on acoustics and listening ability of speech.
        difficult to understand speech, especially for listeners with hearing loss. Face masks muffle high-frequency sounds that are critical for speech understanding and block visual cues that are especially important for people with hearing loss.
        performed acoustic measurements to compare the effects of different masks on speech signals
        disposable surgical masks and N95 respirators. Medical masks were found to have little impact on speech intelligibility in audio-only listening experiments.2,3 Surgical masks have especially mild acoustic effects. Clear plastic [transparent masks] can attenuate sound more strongly than the materials used in opaque masks.
        masks had little effect on sound below 1 kHz, modest attenuation between 1 and 4 kHz, and strong attenuation above 4 kHz... he polypropylene surgical mask and KN95 respirator had excellent acoustic performance, while the N95 respirator caused slightly more high-frequency attenuation. These results are consistent with previous studies on medical masks.4,5,8... The performance of cloth masks varies depending on the fabric and the number of layersWhile the number of layers does affect sound transmission, the weave of the fabric appears to be the most important factor for acoustic performance... Clear window masks and shields allow listeners to see lip movements and facial expressions. Unfortunately, they perform poorly acoustically, attenuating high frequencies by as much as 13 dB.
      - Lipps, E., Caldwell-Kurtzman, J., Motlagh Zadeh, L., Blankenship, C.M., Moore, D.R. and Hunter, L.L., 2021. Impact of Face Masks on Audiovisual Word Recognition in Young Children with Hearing Loss During the Covid-19 Pandemic. Journal of Early Hearing Detection and Intervention, 6(2), p.8.
        To investigate effects of surgical and transparent face masks on audiovisual speech recognition of words for deaf and hard of hearing children
        
        Standard surgical and custom apron shield masks significantly hampered word recognition, even in quiet conditions. The commercially available ClearMask did not significantly affect scores in quiet for young deaf and hard of hearing children, but scores were highly variable.
      - Yi, H., Pingsterhaus, A. and Song, W., 2021. Effects of wearing face masks while using different speaking styles in noise on speech intelligibility during the COVID-19 pandemic. Frontiers in psychology, 12.
        https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8292133/
        Good article about the effects of masks-a variety of masks- can effect listening, and what conditions are best for FM usage.
        The use of a face mask compromises communication, especially in the presence of competing noise.
        Results indicate that the combination of face mask type and the presence of background noise negatively impacts speech intelligibility in normal listeners.... The inclusion of visual information offered by the transparent mask significantly helped these listeners understand the target sentences.
        Individuals with disabilities, hearing loss, and second language learners were excluded from the study.
      - Corey, R.M., Jones, U. and Singer, A.C., 2020. Acoustic effects of medical, cloth, and transparent face masks on speech signals. The Journal of the Acoustical Society of America, 148(4), pp.2371-2375.
        https://asa.scitation.org/doi/abs/10.1121/10.0002279
        how different masks effect the speech sound levels. The frequencies are muffled by the masks //
        examines the acoustic attenuation caused by different face masks, including medical, cloth, and transparent masks, The results suggest that all masks attenuate frequencies above 1 kHz, that attenuation is greatest in front of the talker, and that there is substantial variation between mask types, especially cloth masks with different materials and weaves. Transparent masks have poor acoustic performance compared to both medical and cloth masks.
        Recent acoustic studies have shown that surgical masks and N95 respirators can attenuate higher-frequency sounds by between 3 and 12 dB (Atcherson et al., 2020; Goldin et al., 2020; Wolfe et al., 2020).
        Listening tests using audio-only recordings made with medical masks have not shown significant effects on speech intelligibility (Mendel et al., 2008; Palmiero et al., 2016; Thomas et al., 2011).
        . Konda et al. (2020) found filtration efficiency to be higher for densely woven cotton and hybrid fabrics than for loosely woven cotton. Masks with more layers were more efficient. Aydin et al. (2020) found that single-layer masks made of t-shirt fabric were among the most porous materials studied, but three-layer masks performed as well as medical masks
        listening tests with audiovisual recordings of talkers, transparent masks improved intelligibility for listeners with severe-to-profound hearing loss compared to opaque paper masks (Atcherson et al., 2017)
        Acoustic attenuation of face coverings
        
        Most masks had little effect below 1 kHz but they attenuated higher frequencies by different amounts. The surgical mask (1) and KN95 respirator (2) had peak attenuation of around 4 dB, which is consistent with the results reported by Goldin et al. (2020). N95 respirator (3) attenuated high frequencies by about 6 dB, which is similar to the average attenuation reported by Goldin et al. (2020)
        
        100% cotton masks in jersey (4) and plain (5) weaves had the best acoustic performance and were comparable to the surgical mask.
        
        More breathable fabrics transmit more sound.
        
        transparent masks (10–12) performed poorly acoustically at high frequencies, blocking around 8 dB for the human talker and 10–14 dB for the loudspeaker. Although these masks are often recommended to help listeners with hearing loss because they preserve visual cues, they also harm the high-frequency sound cues that are crucial for speech.
      - Atcherson, S.R., Mendel, L.L., Baltimore, W.J., Patro, C., Lee, S., Pousson, M. and Spann, M.J., 2017. The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss. Journal of the American Academy of Audiology, 28(1), pp.58-67.
        https://www.ingentaconnect.com/contentone/aaa/jaaa/2017/00000028/00000001/art00006
      - Sickbert-Bennett, E.E., Samet, J.M., Clapp, P.W., Chen, H., Berntsen, J., Zeman, K.L., Tong, H., Weber, D.J. and Bennett, W.D., 2020. Filtration efficiency of hospital face mask alternatives available for use during the COVID-19 pandemic. JAMA internal medicine, 180(12), pp.1607-1612.
        https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2769443
      - Bandaru, S.V., Augustine, A.M., Lepcha, A., Sebastian, S., Gowri, M., Philip, A. and Mammen, M.D., 2020. The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario. The Journal of Laryngology & Otology, 134(10), pp.895-898.
      - Thibodeau, L.M., Thibodeau-Nielsen, R.B., Tran, C.M.Q. and de Souza Jacob, R.T., 2021. Communicating during COVID-19: the effect of transparent masks for speech recognition in noise. Ear and Hearing, 42(4), pp.772-781.
      - Liao, M., Liu, H., Wang, X., Hu, X., Huang, Y., Liu, X., Brenan, K., Mecha, J., Nirmalan, M. and Lu, J.R., 2021. A technical review of face mask wearing in preventing respiratory COVID-19 transmission. Current Opinion in Colloid & Interface Science, 52, p.101417.
        details different blends/components of face masks, comparing them,
        too many distingshuins between masks
      - Magee, M., Lewis, C., Noffs, G., Reece, H., Chan, J.C., Zaga, C.J., Paynter, C., Birchall, O., Rojas Azocar, S., Ediriweera, A. and Kenyon, K., 2020. Effects of face masks on acoustic analysis and speech perception: Implications for peri-pandemic protocols. The Journal of the Acoustical Society of America, 148(6), pp.3562-3568.
        https://asa.scitation.org/doi/full/10.1121/10.0002873
        Masks can muffle speech sounds, especially higher frequencies that can aid the differentiation of similar sounds. The acoustic effect of a speaker wearing a face mask is equivalent to the listener having a slight high-frequency hearing loss (Corey et al., 2020).
        
        The type of mask affected the speech signal. We observed significant differences in acoustic power distribution across relevant frequency bands for speech in all three mask conditions compared to no mask.
        The masks, however, did not significantly influence listener-perceived intelligibility or acoustic measures of perturbation (e.g., HNR, CPPS).
        small dataset suggests mask type does not systematically impact intelligibility in controlled environments
        Noise in ecological situations may further decrease speech intelligibility, when complementary visual cues blocked by use of face masks play a role in communication.
      - O’Dowd, K., Nair, K.M., Forouzandeh, P., Mathew, S., Grant, J., Moran, R., Bartlett, J., Bird, J. and Pillai, S.C., 2020. Face masks and respirators in the fight against the COVID-19 pandemic: A review of current materials, advances and future perspectives. Materials, 13(15), p.3363.
        
        Cloth masks are often 2-ply and made from a single fabric type (e.g., cotton). The tightness of the fabric weave and mask fit vary widely. Surgical masks are commonly 3-ply nonwoven fabric with a water-resistant outer layer, filter middle layer, and water-absorbing inner lay. Surgical masks fit loosely on the face with air able to escape from the sides. N95 masks are similar in composition to surgical masks with the main differences being a higher filtration rate and a tight seal around the wearer's face, preventing air escape (O'Dowd et al., 2020
        ).
      - Cohn et al. (2021)
        Speakers produced sentences in three speech styles (casual, clear, positive-emotional)
        wearing a fabric face mask does not uniformly affect speech intelligibility across styles (i.e. casual, clear and emotional).
        speakers make different speech adaptations when they wear a face mask (compared to when they are not masked) and that these adjustments consequently affect intelligibility for listeners. In fact, when speakers are able to produce a clear speech while wearing a face mask, their utterances are more accurately understood by listeners than when they do not wear a mask
        me:
        the style of speech has the most impact when wearing face coverigs, when speaking in clear style then speech is clear, in fact its more clear than when not wearing masks most likely due to the speakers effort of compensation. whereas casual speech is less intelligible, this is suggested to be due to the intent not being for explicit understanding when engaging in this style.
      - Tofanelli, M., Capriotti, V., Gatto, A., Boscolo-Rizzo, P., Rizzo, S. and Tirelli, G., 2022. COVID-19 and deafness: impact of face masks on speech perception. Journal of the American Academy of Audiology, 33(02), pp.098-104.
        https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0041-1736577
        face masks worse for hearing impaired, involves multiple materials
        Face masks have a detrimental effect on speech perception especially for HI patients, potentially worsening their hearing-related quality of life.
        Several systems have been developed to facilitate communication, such as transparent face masks and real time speech-to-text transcription applications; however, while their adoption is quite common among health-care personnel, the same does not apply for daily contexts (Chodosh et al., 2020; West et al., 2020)
        speech intelligibility significantly decreased in HI patients when the speaker was wearing any face mask (KN95/FFP2 or a surgical face mask) when compared with intelligibility evaluated with the speaker wearing no mask at all. Comparing the type of face masks, the KN95/FFP2 mask resulted in greater impairment in word recognition than the surgical mask, both in a quiet and in a noisy environment.
        Lip reading is the most popular cognitive strategy applied to improve communication, together with facial expression recognition (Bannwart Dell’Aringa et al., 2007)
        NH subjects reported a worse speech reception when KN95/FFP2 are used in noise if compared with no masks, while in the HI group KN95/FFP2 resulted in worse perception both in quiet and in noise.
        Surgical and KN95/FFP2 face masks have a negative effect on speech perception for HI patients, both in quiet and in noise. Reduced speech intelligibility is observed also for NH subjects in a noisy environment when the speaker wears a KN95/FFP2 mask compared with reading communicating without masks.
      - Brown, V.A., Van Engen, K.J. and Peelle, J.E., 2021. Face mask type affects audiovisual speech intelligibility and subjective listening effort in young and older adults. Cognitive Research: Principles and Implications, 6(1), p.49.
        https://link.springer.com/article/10.1186/s41235-021-00314-0
        Identifying speech requires that listeners make rapid use of fine-grained acoustic cues—a process that is facilitated by being able to see the talker’s face. Face masks present a challenge to this process because they can both alter acoustic information and conceal the talker’s mouth.
        for the transparent mask and the cloth mask with a filter, accuracy dropped approximately 30% in − 5 dB SNR noise relative to quiet.
        subjective listening effort ratings largely paralleled the intelligibility data—effort increased with noise and differentiated between mask types. Of particular note is that even in quiet, where intelligibility was extremely high for all mask types and only the transparent mask led to reduced intelligibility in both age groups,
      - Bottalico, P., Murgia, S., Puglisi, G.E., Astolfi, A. and Kirk, K.I., 2020. Effect of masks on speech intelligibility in auralized classrooms. The Journal of the Acoustical Society of America, 148(5), pp.2878-2884.
        https://asa.scitation.org/doi/full/10.1121/10.0002450
        The effects of three different types of face masks (fabric, surgical, and N95 masks) on speech intelligibility (SI) presented to college students in auralized classrooms were evaluated.
        The use of fabric masks yielded a significantly greater reduction in SI compared to the other masks - no transpaernt masks tested
        Elimination of visual speech reading cues can decrease SI by as much as 20% for people with moderate bilateral sensorineural hearing loss. (A. H. Bannwart Dell'Aringa, E. Satico Adachi, and A. R. Dell'Aringa, “ Lip reading role in the hearing aid fitting process,” Rev. Bras. Otorrinolaringol. 73(1), 101–105 (2007).
  - - - Solomon, N.P., 2008. Vocal fatigue and its relation to vocal hyperfunction. International Journal of Speech-Language Pathology, 10(4), pp.254-266.
        https://www.tandfonline.com/doi/abs/10.1080/14417040701730990
        overview of vocal fatigue in general throughout literature
        fatigue can be caused by consciously making an increased effort, if a person feels the need to compensate for the muffling/difficulty of communication while wearing a masks, metal vocal faituge may occur.
      - McKenna, V.S., Patel, T.H., Kendall, C.L., Howell, R.J. and Gustin, R.L., 2021. Voice Acoustics and Vocal Effort in Mask-Wearing Healthcare Professionals: A Comparison Pre-and Post-Workday. Journal of Voice.
        evaluated voice acoustics and self-perceptual ratings in healthcare workers required to wear face masks throughout their workday.
        The subjects self-reported a significant increase in vocal effort following the workday.
        Healthcare professionals wearing masks reported greater vocal symptoms post-workday compared to pre-workday
      - Gama, R., Castro, M.E., van Lith-Bijl, J.T. and Desuter, G., 2021. Does the wearing of masks change voice and speech parameters?. European Archives of Oto-Rhino-Laryngology, pp.1-8.
        https://link.springer.com/article/10.1007/s00405-021-07086-9
        How does masks effect use of voice, does it strain the voice?- Yes
        While wearing a mask, people show to increase the perception of vocal effort and fatigue, to increase the sense of vocal tract discomfort and to have difficulties in speech and breathing coordination... These changes may result from the attempt of the speaker wearing a mask to adjust the phonation characteristics to make his voice sound clearer
      - Ribeiro, V.V., Dassie-Leite, A.P., Pereira, E.C., Santos, A.D.N., Martins, P. and de Alencar Irineu, R., 2020. Effect of wearing a face mask on vocal self-perception during a pandemic. Journal of Voice.
        https://www.jvoice.org/article/S0892-1997(20)30356-8/fulltext
        testing if those who wear masks for work and in general feel more/less strain/effort compared to those who wear in general only
        Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feedback, and difficulty in coordinating speech and breathing, irrespective of usage.
      - Karagkouni, O., 2021. The Effects of the Use of Protective Face Mask on the Voice and Its Relation to Self-Perceived Voice Changes. Journal of Voice.
        https://www.jvoice.org/article/S0892-1997(21)00149-1/fulltext
        how face masks affect the perception of your own speech- it affects it. you perception of clarity and coordinating breathing is a challenge- it has a negative effect // when wearing a masks the self perception of voice changes
        “The majority of people stated that they have to speak louder and that they have noticed alterations in the perceptual features of their voice, with hoarseness, and volume being the most frequently affected."
        “face mask increases the vocal effort of the speaker, affects the voice-breathing coordination, limits the overall communication, alters the perceptual features of the voice, increases vocal track discomfort levels and results in psychosocial and socioemotional difficulties."
      - Fiorella, M.L., Cavallaro, G., Di Nicola, V. and Quaranta, N., 2021. Voice Differences When Wearing and Not Wearing a Surgical Mask. Journal of Voice.
        https://www.jvoice.org/article/S0892-1997(21)00070-9/fulltext
        difference in voice when wearing a mask and when not - good article,
        “wearing a mask is likely to induce the unconscious need to increase the vocal effort, resulting over time in a greater risk of developing functional dysphonia. The reduction of intensity can affect also social interaction and speech audibility, especially for individuals with hearing loss."
      - Joshi, A., Procter, T. and Kulesz, P.A., 2021. COVID-19: Acoustic Measures of Voice in Individuals Wearing Different Facemasks. Journal of Voice.
        https://www.jvoice.org/article/S0892-1997(21)00201-0/fulltext
        Masks -no matter the type- had no impact on vocal intensity or frequency
        small sample size tho, only 19 people tested
      - Karagkouni, O., 2021. The effects of the use of protective face mask on the voice and its relation to self-perceived voice changes. Journal of Voice.
      - Gutz, S.E., Rowe, H.P. and Green, J.R., 2021. Speaking with a KN95 Face Mask: ASR Performance and Speaker Compensation. In Interspeech (pp. 4798-4802).
        https://www.researchgate.net/profile/Sarah-Gutz/publication/354221582_Speaking_with_a_KN95_Face_Mask_ASR_Performance_and_Speaker_Compensation/links/616f05433d9af67ad738e605/Speaking-with-a-KN95-Face-Mask-ASR-Performance-and-Speaker-Compensation.pdf
        KN95 mask does not affect commercial ASR performance at the sentence level for young, healthy speakers. Additionally, while we found little evidence of natural compensation for the mask,
        speakers may be naturally adapting to the mask by increasing their vowel space area.However, when speakers intentionally altered their speech by speaking clearly or loudly (though not slowly), ASR performance improved. These findings suggest that ASR users can employ speech strategies to achieve better ASR results when wearing a mask.
        subconscious compensation does not occur when wearing masks, however explicit compensation can assist in ensuring speech is clear and intelligible
        Acoustically, masks have been found to disproportionately impact higher frequencies [7]–[10] and decrease intensity overall [8], [11].
        Goldin et al. (2020) found that frequencies in the 2-7kHz range were attenuated by 3-4 dB for simple medical masks and close to 12dB for N95 masks [10]
        Bottalico et al. (2020) found that fabric masks attenuated signal intensity by 4.2 dB, surgical masks by 2.3 dB, and N95 masks by 2.9 dB [13].
        Radonovich et al. (2010) similarly found that wearing different masks impacted speech intelligibility by 1-17% [18]. Bottalico et al. (2020) report that cloth, surgical, and N95 masks reduced intelligibility of prerecorded speech by 12-16% [13].
        Asadi et al. (2020) found, people may naturally alter how they speak while wearing a mask by speaking more loudly [12]. Such natural compensation could influence speech intelligibility beyond what we would expect from applying an acoustic filter alone to speech.
        Research has shown that strategies such as Clear, Loud, and Slow speech can significantly increase speech clarity and intelligibility [20]–[24].
        
        [1] OSHA 1910.134, “Personal Protective Equipment: Respiratory Protection.” 2011, [Online]. Available: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_t able=STANDARDS&p_id=9780.
        "Prior to the pandemic, the Centers for Disease and Control Prevention (CDC) and Occupational Safety and Health Administration (OSHA) recommended masks in medical settings and construction sites, as face coverings have been shown to filter particles and prevent the spread of infection [1]"
    - - Lee, E., Cormier, K. and Sharma, A., 2022. Face mask use in healthcare settings: effects on communication, cognition, listening effort and strategies for amelioration. Cognitive Research: Principles and Implications, 7(1), pp.1-9.
        https://link.springer.com/article/10.1186/s41235-021-00353-7
        in healthcare settings there is increased cognitive load and listening effort for both patients and providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss.
    - - Molnar-Szakacs, I., Uddin, L.Q. and Heffernan, M.B., 2021. The face behind the mask: The future of interpersonal interaction. Neuron, 109(12), pp.1918-1920.
        https://www.sciencedirect.com/science/article/pii/S0896627321004098
        Worldwide use of face masks during the COVID-19 pandemic has changed interpersonal interactions in myriad ways, likely permanently. there's a social disconnection resulting from facial feature obstruction.
        The “epidemic of facelessness” engendered by widespread face mask use dampens communication and diminishes the social bonds fostered through public discourse.
        
        McKee, M., Moran, C. and Zazove, P., 2020. Overcoming additional barriers to care for deaf and hard of hearing patients during COVID-19. JAMA Otolaryngology–Head & Neck Surgery, 146(9), pp.781-782.
        This increased difficulty in communicating and having meaningful social interactions can lead to social isolation and loneliness (McKee et al., 2020).
        
        Szczesniak, D., Ciulkowicz, M., Maciaszek, J., Misiak, B., Luc, D., Wieczorek, T., Witecka, K.F. and Rymaszewska, J., 2020. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain, behavior, and immunity, 87, p.161.
        For those with social anxiety, wearing a mask helps them feel less judged and less self-conscious when they go into public. Mask wearing “might reinforce [their] sense of personal control and… mitigate helplessness and moderate anxiety” (Szczesniak et al., 2020), providing a sense of emotional comfort.
      - Bonnell, K.H., 2020. Implications of Masks on Interpersonal Communication.
        https://www.researchgate.net/profile/Karen-Bonnell-2/publication/346504073_Implications_of_Masks_on_Interpersonal_Communication/links/5fc872b6a6fdcc697bd7a19d/Implications-of-Masks-on-Interpersonal-Communication.pdf
        attidues to wearing masks, and how you perceive those that wear masks.
        Communication satisfaction wearing masks was positively related to attitudesthat everyone should comply with mask mandates, demonstrating concern for self and others by wearing a mask.
        communicating with masks shortened conversations on average...as conversations decrease in length because of mask
        wearing, overall satisfaction may also decrease
- - - - Kiefer, B., 2020. Masque, Covid et liberté. Revue Medicale Suisse, 16(707), pp.1780-1780.
        masks cover half of the face, which is, as stated by Kiefer (2020): “… by far the most involved part of the body in what makes us unique and communicative people"
      - Matuschek, C., Moll, F., Fangerau, H., Fischer, J.C., Zänker, K., van Griensven, M., Schneider, M., Kindgen-Milles, D., Knoefel, W.T., Lichtenberg, A. and Tamaskovics, B., 2020. Face masks: benefits and risks during the COVID-19 crisis. European journal of medical research, 25(1), pp.1-8.
        Matuschek et al. (2020) argue in favor and against mask wearing. Among the arguments against the use of masks, they reported that "the lack of nonverbal communication when wearing a mask may make people feel insecure, disheartened or even psychologically troubled".
      - Goldin, A., Weinstein, B. and Shiman, N., 2020. Speech blocked by surgical masks becomes a more important issue in the era of COVID-19. Hearing Review, 27(5), pp.8-9.
        Wearing a face mask causes voice attenuation and distortion (Goldin et al., 2020; Giovanelli et al., 2021). Face masks attenuate sound level by 3–4 dB and filter sound frequencies mostly between 2and 7 KHz (Goldin et al., 2020). Since these frequencies are important for speech intelligibility (i.e. Chi et al., 1999) and there is an attenuation of the transmitted sound
      - Knowles, T. and Badh, G., 2022. The impact of face masks on spectral acoustics of speech: Effect of clear and loud speech styles. The Journal of the Acoustical Society of America, 151(5), pp.3359-3368.
        Knowles & Badh (2022) confirmed that masks act as a low-pass filter and demonstrated that attenuation of sound with distance increases. masks hamper speech intelligibility for listeners.
      - Carr, E., 2020. Through a Face Mask. Clinical journal of oncology nursing, 24(4), p.345.
        Ellen Carr (2020), "through face masks, direct eye contact can still establish intent, clarity, connection and compassion"
      - Schlögl, M. and A Jones, C., 2020. Maintaining our humanity through the mask: mindful communication during COVID‐19. Journal of the American Geriatrics Society, 68(5), pp.E12-E13.
        Schlögl & Jones (2020) described a way to improve communication in order to take intentional control of our nonverbal communication in this time of masked faces. This way of communication relies on three steps: i) attend mindfully: create a ritual to focus our attention, become more aware of our characteristic gestures and body language, and practice the habit of underlining everything we say with gesture and pantomime; ii) behave calmly: approach people from the front, drop down to eye level, project a positive, calm attitude, and avoid body language that shows frustration, anger or impatience; iii) communicate clearly: use short, simple sentences and underline your words with gestures.