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      Are Acoustic Markers of Voice and Speech Signals Affected by Nose-and-Mouth-Covering Respiratory Protective Masks?

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          Abstract

          Background

          Worldwide use of nose-and-mouth-covering respiratory protective mask (RPM) has become ubiquitous during COVID19 pandemic. Consequences of wearing RPMs, especially regarding perception and production of spoken communication, are gradually emerging. The present study explored how three prevalent RPMs affect various speech and voice sound properties.

          Methods

          Pre-recorded sustained [a] vowels and read sentences from 47 subjects were played by a speech production model (‘Voice Emitted by Spare Parts’, or ‘VESPA’) in four conditions: without RPM (C1), with disposable surgical mask (C2), with FFP2 mask (C3), and with transparent plastic mask (C4). Differences between C1 and masked conditions were assessed with Dunnett's t test in 26 speech sound properties related to voice production (fundamental frequency, sound intensity level), voice quality (jitter percent, shimmer percent, harmonics-to-noise ratio, smoothed cepstral peak prominence, Acoustic Voice Quality Index), articulation and resonance (first and second formant frequencies, first and second formant bandwidths, spectral center of gravity, spectral standard deviation, spectral skewness, spectral kurtosis, spectral slope, and spectral energy in ten 1-kHz bands from 0 to 10 kHz).

          Results

          C2, C3, and C4 significantly affected 10, 15, and 19 of the acoustic speech markers, respectively. Furthermore, absolute differences between unmasked and masked conditions were largest for C4 and smallest for C2.

          Conclusions

          All RPMs influenced more or less speech sound properties. However, this influence was least for surgical RPMs and most for plastic RPMs. Surgical RPMs are therefore preferred when spoken communication is priority next to respiratory protection.

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          Most cited references31

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          Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

          Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; p interaction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; p interaction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. Funding World Health Organization.
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            Is Open Access

            Acoustic effects of medical, cloth, and transparent face masks on speech signals a)

            Face masks muffle speech and make communication more difficult, especially for people with hearing loss. This study examines the acoustic attenuation caused by different face masks, including medical, cloth, and transparent masks, using a head-shaped loudspeaker and a live human talker. 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. Most masks have little effect on lapel microphones, suggesting that existing sound reinforcement and assistive listening systems may be effective for verbal communication with masks.
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              The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss

              It is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent ("see-through") surgical mask may help to overcome this issue.
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                Author and article information

                Journal
                J Voice
                J Voice
                Journal of Voice
                The Voice Foundation. Published by Elsevier Inc.
                0892-1997
                1873-4588
                16 February 2021
                16 February 2021
                Affiliations
                [* ]Department of Otorhinolaryngology & Head and Neck Surgery, European Institute for ORL-HNS, Wilrijk, Belgium
                []Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
                []Faculty of Education, Health & Social Work, University College Ghent, Gent, Belgium
                [§ ]Faculty of Psychology and Educational Sciences, School of Logopedics, Belgium
                []Phonanium, Lokeren, Belgium
                []Lab for Equilibrium Investigations and Aerospace (LEIA), University of Antwerp, Wilrijk, Belgium
                Author notes
                [** ]Address correspondence and reprint request to: Youri Maryn, GZA Sint-Augustinus, European Institute for ORL-HNS, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
                Article
                S0892-1997(21)00037-0
                10.1016/j.jvoice.2021.01.013
                7885637
                33608184
                456bde87-c64d-47d0-9b41-c00fbba36a0b
                © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 13 January 2021
                Categories
                Article

                Otolaryngology
                respiratory protection masks–speech–voice–acoustics
                Otolaryngology
                respiratory protection masks–speech–voice–acoustics

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