July 13, 2020 By

How to Improve Communication through Masks and Barriers

Written By: Donald M. Goldberg

Don Goldberg models a face shield behind Plexiglas as an alternative to masks and other sound-muffling protective gear.

As we navigate new waters, communication access should be on top of the minds of those who work with children who are deaf and hard of hearing. In a therapy setting, new considerations for cleaning and social distancing are forcing us to become creative with how we work with children. In the classroom, use of remote microphone systems and proper acoustics has become even more critical for the successful reception of sound signals.

Face Masks and Shields

Masks have incredible ramifications for kids with hearing loss. For the time being, we assume that everyone’s going to be wearing masks, and definitely in a hospital setting where I work with kids, PPE is required. Most people wear a surgical mask or a cloth mask, which qualifies as PPEs. But as an audiologist, I have been very discriminating with my feedback loop to see how I sound, and the cloth masks have been horrible for me because I feel so muffled and distorted. In fact, very recent research has been published that shows how much sound is lost from the use of specific masks.

The heart and soul of listening and spoken language is to get the best signal to a child’s brain. So literally the goal of being six feet away and the idea of talking to a deaf kid with a mask on, is sort of against everything that makes me feel comfortable doing therapy.

Instead, I have started using face shields. This isn’t a perfect solution; I can hear that I’m still being slightly attenuated and distorted, but I feel better talking to a kid with a shield because masks can be intimidating. With the shield, the children I work with can see Dr. Don’s face. It’s less intimidating, it’s still protective, and a “better signal” is being transferred. And to be even safer, I have used a Plexiglas barrier whenever I switch from a face mask to a face shield.

With the shield, I still have to make sure I keep my chin level covered so I don’t expose myself from the bottom up. Physical distancing is still so very important. Some groups are advocating for clear face masks for those who are deaf, but that is still problematic. The plastic has to be protective material, and as you speak it still fogs up. With a shield, you are protected, the child can read your lips, and nothing fogs up.

Physical Space

If at all possible, make the room you’re conducting therapy in as empty as possible. My therapy space is packed with 35 years of toys that are really well organized, but there’s so much vertical stacking of material that after each patient, I would have to clean every horizontal surface (according to hospital policy). Fortunately, there was an empty space next door I have been able to use. Essentially it’s a pretty barren room with a table and chairs, and nothing else. When I do come in, I just have a therapy basket of materials and it’s really easy to wipe down to sanitize and protect the area for the next child and parent.

Consider adding a Plexiglas barrier. I have a low table because I want to be clearly near the children I’m working with. We’re playing with toys, we’re teaching these kids language and we’re teaching them how to listen. I have installed a Plexiglas barrier, and I love the idea that we can be protected by the Plexiglas, just like we are protected in the grocery store, but I’ll still be able to move toys and other props as well as conduct evaluations from around the barrier!

For example, during an evaluation, I need to interact with the child. I need an easel that they can see clearly because they need to see photographs that I’m going to say, tell me about what the little girl’s doing. I also might need to use a CD player. I’ve calibrated the loudness of the signal to where the child sits. If you’re playing a CD and it’s being broadcast (via teletherapy), you would not meet the calibration requirements and that would invalidate the testing. Face-to-face evaluation of speech, language, and auditory abilities is still critical for many of our patients or clients.

And it’s not just all about what they’re hearing. It’s also about what they’re saying. And little kids are not always the loudest talkers. My use of a face shield is making it more comfortable for them to speak and especially for my understanding of what they are saying to me.

With a face shield and Plexiglas barrier, I have a good sound signal without a mask so they child can hear what I am saying. I am not going to be in the “airspace” of the child because of the shield. From the therapy standpoint, a face shield and Plexiglas barrier will be more than enough protection because the kids sitting up at the table are playing with toys. And my Plexiglas barrier is easily braced on the table with a clamp. So I can move it to a high table if I have a kid in a high chair or booster. I can be near the child (within ear shot, as Dan Ling would say). I think it’s incredibly safe and it may be a solution for others doing therapy and evaluations.

Remote Microphones and Classroom Acoustics

 Just as important in the clinical setting, sound signals are also critical in the classroom as well. If a teacher is required to wear PPE in a classroom (as with the kids themselves), the best recommendation is that the teacher should seek approval to wear a face shield. With the face shield, the teacher can easily use a boom microphone, which could go around the ear and the mic would be positioned next to their mouth. This is the perfect solution for the best auditory signal because the mic is where it needs to be to pick up the voice—the microphone is as close to the mouth as possible. So let’s stop using lavalier or “clip on” microphones positioned further from the mouth!

The other thing to include in our upcoming school planning should be a pass-around microphone. It used to be that the child was merely placed at the front of the classroom. But that doesn’t help them hear what’s happening at the back, and that distance makes it hard for everyone, but especially a child with hearing loss. A pass-around microphone will allow every kid in the room who’s getting a turn to talk to have their voice amplified and delivered to the deaf kid. You would have to wipe down the microphone after every use. But the best way to ensure a full auditory signal is to have as many people as possible taking turns talking into a microphone as closely as possible. So the boom and remote microphones, in my opinion, are truly non-negotiable when children return to the classroom.

The other thing when you think about classrooms is room acoustics. We also need to keep in mind the reverberation of the room and the noise present. We need acoustic ceiling tile; we need carpeting; and we need rules for classroom doors to be closed. There may be some security rules in schools, but unless there’s a rule that the door has to be cracked, closing the door, even in an quiet hallway, is the better way to go for a child with a hearing loss in the classroom.

Donald M. Goldberg, Ph.D., is Professor and Chair of the Department of CSD at the College of Wooster (Ohio) and on the professional staff at the Cleveland Clinic Foundation

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