UC faculty and students create videos on communicating while wearing a mask

That practice presents communication challenges which can lead to fatigued and strained vocal cords. In response, a team led by a University of Cincinnati College of Allied Health Sciences researcher created a series of educational videos offering strategies to mitigate the challenges of communicating while wearing a mask.

“My lab group was seeing that when everyone was out and about, community members would have their mask on and as soon as they go to communicate with one another, they take them off,” says Tory McKenna, PhD, assistant professor and the director of the Voice and Swallow Mechanics Lab at the UC college. “We knew that mask removal would only increase the risk of COVID-19 transmission, so we wanted to do something about it. We started looking into the existing research, and we noticed that all the previous research on masks and communication were focused only on the listener. We wanted to know how hard it is for the speaker to effectively talk through the mask and determine if they experience fatigue.”

McKenna and her team conducted a study in summer 2020 examining health care workers with and without masks throughout their workday. The workers were examined before their workday and after and had readings taken of fatigue, vocal effort and speech acoustics that helped them understanding the challenges facing mask-wearing community members.

The study, funded by the Center for Clinical and Translational Science and Training (CCTST), found that masks have a muffling effect on speech, especially higher frequency sounds like the letter “f” and letter “s.” McKenna says she and her team were surprised to find that instead of seeing people overarticulating speech while wearing masks, their acoustic tests found the opposite.

“When you’re wearing a mask, you actually mumble more,” says McKenna. “Not only is it impacting the sound frequencies, but it’s causing you to not move your mouth as much and articulate your sounds as much. Another thing we saw was a lot of vocal effort and fatigue in all of our health care workers by the end of the work day.”

In partnership with UC Health and Beyond Limits Rehabilitation in Cincinnati, 22 people from a wide variety of health care disciplines were involved in the study. Two graduate speech language pathology students were also part of the research thanks to the CCTST grant.

“I was very involved in gathering data from participants in the beginning of the project to see if there are any vocal changes when wearing masks,” says graduate student Courtney Kendall. “I helped collect a lot of that acoustic data and then, for the development of the video modules, I did a lot of editing and proofreading for the overall content of the videos.”

As part of the project, McKenna and the team virtually interviewed eight voice-specialized speech language pathologists and voice researchers across the country. They were interviewed about the challenges they were facing, professional and personal strategies they were using and what they were recommending to their patients who were trying to communicate through masks.

“After we did those interviews, we started to develop the content of these modules,” says McKenna. “The purpose of these modules wasn’t to educate other health care providers who already know things about voice and human anatomy. We wanted our modules to be available to everyone. The long-term goal was to be a community resource, so we wanted it to be accessible and understandable to any mask-wearing community member. The goal was to make sure they don’t keep pulling the mask down while talking.”

The team showed drafts and mock-ups of the videos to 10 community members who worked in jobs that required them to wear masks, such as retail and food services. Using that feedback, the final video modules were developed. The first module looks at the impact of masks on communication, the second focuses on communication strategies and voice protection for masks users while the third provides ways to implement vocal wellness strategies in the workplace.

Renee Gustin, a UC Health speech language pathologist, provided a demonstration for some of the vocal techniques in the video modules. Gustin also provided some of the ideas and strategies for the videos.

“I pulled from my clinical experience and what my patients told me all throughout COVID-19 to come up with strategies for this project to make it easier for people who talk all day with masks on,” says Gustin. “Some of the easier strategies include vocal breaks throughout the day to rest your vocal cords and voice. When you have a mask on all day, it’s hard to remember to drink water. You actually have to cue yourself to pull your mask down, go in a secure location and hydrate. There are also little vocal warm up and cool down exercises you can do, like gentle humming which is in one of our videos. Gently humming helps relax the vocal fold muscles and increases vocal fold efficiency.”

Graduate student Tulsi Patel says getting to be a part of research like this is one of the reasons why she chose to become a University of Cincinnati Bearcat.

“I didn’t think I’d be a part of research that’s so amazing and so impactful,” says Patel. “I want to work as a medical-based [speech-language pathologist], and I think this was a huge step in that direction, really focusing on health care workers and focusing on our vocal hygiene. Working on this project is helping me to reach my career goals." 

McKenna says the video modules aren’t designed as a one-size-fits-all strategy. She says they are designed to give people options and find the strategy that works best for them while communicating with a mask.

“I hope that people get some relief and that they don’t feel so inhibited and burdened by mask wearing,” Gustin says. “I also hope it gives people tips so that they keep their mask on which keeps them safe. People need to keep their mask on while talking, but by keeping it on, you don’t want to have negative side effects, which is having your voice hurt at the end of the day.”

Watch all the video modules.

McKenna and her team are presenting at the UC Health World Voice Day: One World, Many Voices Virtual Symposium on April 16, 2021. The symposium is being headed up by Rebecca Howell, MD, associate professor in the Department of Otolaryngology-Head and Neck Surgery in the UC College of Medicine and Director of the UC Health Swallowing Center. It will build on many of the strategies for voice care presented in these video modules. Find more information. 

Lead photo of Tory McKenna, PhD/Ravenna Rutledge/UC Creative + Brand