Effect of Face Mask on Voice Production During COVID-19 Pandemic: A Systematic Review

Abstract

Summary: Objective . The Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic and wearing face mask is recommended across the globe to break the transmission chain of infection. The masks available in the market are of different types and materials and tend to alter the voice characteristics of the speaker. This can therefore impair optimal communication and the present study is a systematic review exploring the effect of various masks on voice production parameters. Study Design . Systematic review Materials and Methods . The titles and abstracts screening was carried out for the inclusion of articles using eight electronic databases spanning the period from 1 st January 2020 to 30 th April 2021. Ten articles (eight published & two in pre-print) that met the inclusion criteria were considered for this systematic review and the pooled age range was 18–69 years. Results . Three primary studies from the USA, two each from Australia & Italy, one each from Brazil, China, and Germany were found to have investigated the influence of wearing N95, KN95, surgical and fabric masks on voice related measures. The users significantly reported vocal fatigue, discomfort, and also perceived voice problems. Attenuation of speech sound amplitude was highest for the transparent mask followed by cloth mask, N95, KN95, and surgical mask. Conclusion . The World Health Organization (WHO) has been repeatedly endorsing the need to use a face mask in the current COVID-19 pandemic. However, for an unintruded voice production, the surgical mask is recommended for everyone, including healthcare professionals when they are not in close contact with patients, and not involved in aerosol-generating procedures. For teachers, doing direct teaching (offline classes), ‘surgical mask’ can reduce the vocal load of teachers, smoothen the teacher-student interaction and thereby facilitate better learning by the students. Additionally, it would be useful to protect oneself from the risk of developing voice problems by following standard vocal healthcare tips.

Reliability of Acoustic Measures in Dysphonic Patients With Glottic Insufficiency and Healthy Population: A COVID-19 Perspective

“… 22 In previous studies of healthy populations or simulation situations, acoustic correlates of vocal quality, including the CPP, maximum phonation time, F0, Jitt, Shim, and HNR, were not statistically different between the masked and unmasked conditions. 6 , 7 , 8 , 11 , 12 , 13 , 15 Although a study showed that Jitt and Shim increased by wearing the mask, CPP remained unchanged by wearing the mask, which is in accordance with the current results. 14 Furthermore, the cutoff scores of the CPP measures were similar to those of a previous Korean study (9.9995 dB for sustained vowel, 7.668 dB for running speech), which was performed during the prepandemic period.…”

“… 27 They are known to degrade speech perception, discrimination, and intelligibility with environmental noise, inducing substantial increase in self-perception of vocal changes, vocal effort, and communication stress. 8 , 9 , 28 , 29 , 30 , 31 Moreover, they increased perceived vocal symptoms and difficulties in coordinating speech and breathing during speech production, especially for professional voice users. 32 The effect of wearing masks on speech production and voice parameters needs to be investigated in order to interpret the voice outcome measured in different conditions.…”

“…Acoustically, they function as a low-pass filter on acoustic signals, although discrepancies among different types of masks have been reported. 6 , 7 , 8 It was also shown that each type of mask serves as a low-pass filter attenuating the high frequencies from 2 to 7 kHz. 9 , 10 Another study demonstrated that the most substantial attenuation was above 4 kHz, although the cloth masks showed significant variation.…”

How the COVID-19 Pandemic Muted and Remixed the World’s Acoustics for a While

“…The systematic review conducted by Shekaraiah and Suresh suggests that wearing masks results in vocal fatigue, discomfort, and perceived voice problems, which may be due to the attenuation that all types of facemasks introduce in the audible frequency range. In this sense, surgical masks would offer the least attenuation loss and therefore put the least strain on the speaker's voice [119]. We can obtain some details in the study carried out by the University of Illinois, which shows the attenuation the mask produces in the frequency range above 1000 Hz, which coincides with the range of maximum voice emission, being more pronounced at the front [120,121].…”

Impact of prolonged wearing of face masks – medical and forensic implications

“…Impact on Face: Wearing masks for long hours leads to physiological and psychological stress. The usage of PPE and masks are associated with unpleasant effects such as headache [32], acne [33], and skin breakdown [34], obstructing vision and communication [35]. Wearing face masks has been shown to reduce the accuracy of facial identification in forensic examinations [36].…”