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REVIEW • Rev. Bras. Enferm. 76 (4) • 2023 • https://doi.org/10.1590/0034-7167-2022-0674 copiar

Efectos en la comunicación por el uso de cubrebocas: revisión integradora

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

integrar evidencias de estudios sobre efectos perceptuales auditivos y de producción del habla en situaciones de comunicación con el uso de mascarilla facial.

Métodos:

revisión integrativa de la literatura, en las bases de datos MEDLINE, Cochrane Library y Embase. La pregunta orientadora fue: ¿qué efectos en la comunicación (perceptivo-auditiva y producción del habla) se producen con el uso de mascarillas?

Resultados:

las búsquedas en bases de datos electrónicas dieron como resultado 1.478 estudios y el filtrado dio como resultado 29 estudios finales.

Conclusiones:

el uso de mascarillas tiene efectos en la comunicación, tanto en la percepción como en la producción del habla, factores que también se relacionan con la calidad de vida, el estrés y factores socioemocionales. Estos datos pueden impactar en indicadores y alertas a favor de la adopción de estrategias para gestionar el uso de mascarillas, involucrando la producción y percepción del habla al usar mascarilla en los servicios de salud.

Descriptores:
Máscaras; Comunicación; Percepción Auditiva; COVID-19; Revisión.

Title	Country/year	Design/number of patients	Intervention	Outcome	Level of Evidence
Voice Differences When Wearing and Not Wearing a Surgical Mask(²⁰20 Fiorella ML, Cavallaro G, Di Nicola V, Quaranta N. Voice differences when wearing and not wearing a surgical mask. J Voice. 2021:S0892-1997(21)00070-9. https://doi.org/10.1016/j.jvoice.2021.01.026 https://doi.org/10.1016/j.jvoice.2021.01... )	Italy, 2021	Longitudinal, case-control study n= 60	With intervention of mask use.	Mask use can induce an unconscious need to increase vocal effort, resulting in a greater risk of developing functional dysphonia.	IV
Voice Acoustics and Vocal Effort in Mask-Wearing Healthcare Professionals: A Comparison Preand Post-Workday(²¹21 McKenna VS, Patel TH, Kendall CL, Howell RJ, Gustin RL. Voice acoustics and vocal effort in mask-wearing healthcare professionals: a comparison preand post-workday. J Voice. 2021:S0892-1997(21)00151-X. https://doi.org/10.1016/j.jvoice.2021.04.016 https://doi.org/10.1016/j.jvoice.2021.04... )	USA, 2021	Cross-sectional study. n=18	No intervention	Health professionals who use masks reported greater vocal symptoms after working hours compared to pre-workdays.	IV
The Effects of the Use of Protective Face Mask on the Voice and Its Relation to Self-Perceived Voice Changes(²²22 Karagkouni O. The effects of the use of protective face mask on the voice and its relation to self-perceived voice changes. J Voice. 2021:S0892-1997(21)00149-1. https://doi.org/10.1016/j.jvoice.2021.04.014 https://doi.org/10.1016/j.jvoice.2021.04... )	Greece, 2021	Cross-sectional, observational study n=155	No intervention	Protective face mask use may result in the onset of a voice disorder, particularly in the high-risk population.	IV
The Effect of Masks and Respirators on Acoustic Voice Analysis During the COVID-19 Pandemic(²³23 Gojayev EK, Büyükatalay ZÇ, Akyüz T, Rehan M, Dursun G. The effect of masks and respirators on acoustic voice analysis during the Covid-19 pandemic. J Voice. 2021:S0892-1997(21)00397-0. https://doi.org/10.1016/j.jvoice.2021.11.014 https://doi.org/10.1016/j.jvoice.2021.11... )	Turkey, 2021	Prospective study n=204	With intervention of mask use.	Significant difference only in the Shimmer and HNR values in relation to the other analysis values.	IV
Self-Perceived Voice Handicap During COVID19 Compulsory Facemask Use: A Comparative Study Between Portuguese and Spanish Speakers(²⁴24 Polo N, Lã FMB. Self-Perceived Voice Handicap During COVID19 Compulsory Facemask Use: a comparative study between portuguese and spanish speakers. J Voice. 2021:S0892-1997(21)00264-2. https://doi.org/10.1016/j.jvoice.2021.08.003 https://doi.org/10.1016/j.jvoice.2021.08... )	Spain, 2021	Comparative observational descriptive study n = 558	With intervention of mask use.	Overall VHI scores and all-dimension scores were higher for the masked condition.	IV
Effects of Medical Masks on Voice Assessment During the COVID-19 Pandemic(²⁵25 Lin Y, Cheng L, Wang Q, Xu W. Effects of medical masks on voice assessment during the covid-19 pandemic. J Voice. 2021:S0892-1997(21)00163-6. https://doi.org/10.1016/j.jvoice.2021.04.028 https://doi.org/10.1016/j.jvoice.2021.04... )	China, 2021	Cross-sectional study n=53	With intervention of mask use.	Healthy participants showed a significantly higher sound pressure level, less perturbation and a decrease in F3 after using medical masks.	IV
COVID-19: Acoustic Measures of Voice in Individuals Wearing Different Facemasks(²⁶26 Joshi A, Procter T, Kulesz PA. Covid-19: acoustic measures of voice in individuals wearing different facemasks. J Voice. 2021:S0892-1997(21)00201-0. https://doi.org/10.1016/j.jvoice.2021.06.015 https://doi.org/10.1016/j.jvoice.2021.06... )	USA, 2021	Cross-sectional study. n=19	With intervention of mask use.	Masks tested did not have a significant impact on intensity, fundamental frequency. frequency, PPC-s, frequency of the first or second formant compared to the unmasked speech output.	IV
Acoustic voice characteristics with and without wearing a facemask(²⁷27 Nguyen DD, McCabe P, Thomas D, Purcell A, Doble M, Novakovic D, et al. Acoustic voice characteristics with and without wearing a facemask. Sci Rep. 2021;11(1):5651. https://doi.org/10.1038/s41598-021-85130-8 https://doi.org/10.1038/s41598-021-85130... )	Australia, 2021	Case-control, n=16	With intervention of mask use	The surgical mask has less impact than the KN95 on analyzed vocal aspects	IV
Are Acoustic Markers of Voice and Speech Signals Affected by Nose-and-Mouth-Covering Respiratory Protective Masks?(²⁸28 Maryn Y, Wuyts FL, Zarowski A. Are acoustic markers of voice and speech signals affected by nose-and-mouth-covering respiratory protective masks? J Voice. 2021:S0892-1997(21)00037-0. https://doi.org/10.1016/j.jvoice.2021.01.013 https://doi.org/10.1016/j.jvoice.2021.01... )	Belgium, 2021	Cross-sectional study n=50	With intervention of mask use	The surgical mask is preferred when spoken communication is a priority alongside respiratory protection.	IV

Title	Country/year	Design/number of patients	Intervention	Outcome	Level of Evidence
Effects of face masks on acoustic analysis and speech perception: Implications for peri-pandemic protocols(³3 Magee M, Lewis C, Noffs G, Reece H, Chan JCS, Zaga CJ, et al. Effects of face masks on acoustic analysis and speech perception: Implications for peri-pandemic protocols. J Acoust Soc Am. 2020;148(6):3562. https://doi.org/10.1121/10.0002873 https://doi.org/10.1121/10.0002873... )	Australia, 2020	Cross-sectional study n=7	With intervention of mask use.	Face masks alter the speech signal, but measures of vocal quality remain unchanged.	IV
Impact of face masks in public spaces during COVID-19 pandemic on daily life communication of cochlear implant users(²⁹29 Homans NC, Vroegop JL. Impact of face masks in public spaces during covid-19 pandemic on daily life communication of cochlear implant users. Laryngoscope Investig Otolaryngol. 2021;6(3):531-9. https://doi.org/10.1002/lio2.578 https://doi.org/10.1002/lio2.578... )	Netherlands, 2020	Prospective research study n=221	No intervention.	Face mask use reduces Cochlear Implant (CI) users’ quality of life.	IV
Effect of Wearing a Face Mask on Vocal Self-Perception during a Pandemic(³⁰30 Ribeiro VV, Dassie-Leite AP, Pereira EC, Santos ADN, Martins P, Irineu RA. Effect of wearing a face mask on vocal self-perception during a pandemic. J Voice. 2020:S0892-1997(20)30356-8. https://doi.org/10.1016/j.jvoice.2020.09.006 https://doi.org/10.1016/j.jvoice.2020.09... )	Brazil, 2021	Observational, descriptive and cross-sectional study n=468	No intervention.	Face mask use increases the perception of symptoms and vocal discomfort, especially in individuals who used them for professional and essential activities.	IV
Effects of face masks on speech recognition in multi-talker babble noise(³¹31 Toscano JC, Toscano CM. Effects of face masks on speech recognition in multi-talker babble noise. PLoS One. 2021;16(2):e0246842. https://doi.org/10.1371/journal.pone.0246842 https://doi.org/10.1371/journal.pone.024... )	USA, 2021	Randomized clinical trials n= 200	With intervention of mask use.	Different types of masks show similar accuracy at low background noise levels and more apparent at high noise levels.	II
Face mask type affects audiovisual speech intelligibility and subjective listening effort in young and older adults(³²32 Brown VA, Van Engen KJ, Peelle JE. Face mask type affects audiovisual speech intelligibility and subjective listening effort in young and older adults. Cogn Res Princ Implic. 2021;6(1):49. https://doi.org/10.1186/s41235-021-00314-0 https://doi.org/10.1186/s41235-021-00314... )	USA, 2021	Non-randomized controlled trial n=180	With intervention of mask use and environmental noise addition.	Older adults showed worse general intelligibility and classified speech as more difficult to process compared to young adults	III
Impact of Masks on Speech Recognition in Adult Patients with and without Hearing Loss(³³33 Ritter E, Miller C, Morse J, Onuorah P, Zeaton A, Zanation A, et al. Impact of masks on speech recognition in adult patients with and without hearing loss. ORL J Otorhinolaryngol Relat Spec. 2022;84(4):302-308. https://doi.org/10.1159/000518944 https://doi.org/10.1159/000518944... )	USA, 2021	Case-control n=45	No intervention.	Dramatic decrease in word recognition scores when the provider utters words through an N95 mask and especially when the speaker is a woman. (p < 0.001; 95% CI:10-26%).	IV
Influence of surgical and N95 face masks on speech perception and listening effort in noise(³⁴34 Rahne T, Fröhlich L, Plontke S, Wagner L. Influence of surgical and N95 face masks on speech perception and listening effort in noise. PLoS One. 2021;16(7):e0253874. https://doi.org/10.1371/journal.pone.0253874 https://doi.org/10.1371/journal.pone.025... )	Germany, 2021	Prospective, observational study n=17	No intervention.	Face masks reduce speech perception and increase listening effort in different noise signals.	IV
Powered air-purifying respirators used during the SARS-CoV-2 pandemic significantly reduce speech perception(³⁵35 Weiss R, Guchlerner L, Weissgerber T, Filmann N, Haake B, Zacharowski K. Powered air-purifying respirators used during the SARS-CoV-2 pandemic significantly reduce speech perception. J Occup Med Toxicol. 2021;16(1):43. https://doi.org/10.1186/s12995-021-00334-y https://doi.org/10.1186/s12995-021-00334... )	Germany, 2021	Cross-sectional study n = 10	No intervention.	The assessed powered air-purifying respirator system can be considered for high-risk procedures in SARS-CoV-2 positive cases in conjunction with a hearing protector.	IV
The cafeteria study: Effects of facial masks, hearing protection, and real-world noise on speech recognition(³⁶36 Barrett ME, Gordon-Salant S, Brungart DS. The cafeteria study: effects of facial masks, hearing protection, and real-world noise on speech recognition. J Acoust Soc Am. 2021;150(6):4244. https://doi.org/10.1121/10.0008898 https://doi.org/10.1121/10.0008898... )	USA, 2021	Cross-sectional study n=34	With intervention of mask use and environmental noise addition.	Speech recognition in real-world listening environments can be hindered by PPE worn by speakers and listeners.	IV
The impact of face masks on the recall of spoken sentences(³⁷37 Truong TL, Beck SD, Weber A. The impact of face masks on the recall of spoken sentences. J Acoust Soc Am. 2021;149(1):142. https://doi.org/10.1121/10.0002951 https://doi.org/10.1121/10.0002951... )	Germany, 2021	Non-randomized controlled trial n=32	No intervention.	Listeners remembered significantly fewer words when the phrases were spoken with a face mask.	III
Influence of Protective Face Coverings on the Speech Recognition of Cochlear Implant Patients(³⁸38 Vos TG, Dillon MT, Buss E, Rooth MA, Bucker AL, Dillon S, Pearson A, Quinones K, Richter ME, Roth N, Young A, Dedmon MM. Influence of protective face coverings on the speech recognition of cochlear implant patients. Laryngoscope. 2021;131(6):E2038-E2043. https://doi.org/10.1002/lary.29447 https://doi.org/10.1002/lary.29447... )	USA, 2021	Prospective cohort study n=23	No intervention.	The type and combination of protective face coverings used have differential effects on the attenuation of speech information, influencing the speech recognition of patients with hearing loss.	IV
Communication with face masks during the COVID-19 pandemic for adults with hearing loss(³⁹39 Poon BT, Jenstad LM. Communication with face masks during the covid-19 pandemic for adults with hearing loss. Cogn Res Princ Implic. 2022;7(1):24. https://doi.org/10.1186/s41235-022-00376-8 https://doi.org/10.1186/s41235-022-00376... )	Canada, 2022	Cross-sectional study n=656	No intervention.	Increased public awareness and use of a transparent mask were determined to be examples of practical supports for effective social interaction.	IV
How Face Masks Interfere With Speech Understanding of Normal-Hearing Individuals: Vision Makes the Difference(⁴⁰40 Sönnichsen R, Llorach Tó G, Hochmuth S, Hohmann V, Radeloff A. How face masks interfere with speech understanding of normal-hearing individuals: vision makes the difference. Otol Neurotol. 2022;43(3):282-8. https://doi.org/10.1097/MAO.0000000000003458 https://doi.org/10.1097/MAO.000000000000... )	Germany, 2022	Prospective cohort study n=15	Different experimental conditions with and without simulated face masks using the audio-visual version of the female German matrix test.	Face mask use by the speaker leads to a deterioration in speech understanding by the listener.	IV

Authors	Country/year	Design/number of patients	Intervention	Outcome	Level of Evidence
The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario(⁴¹41 Bandaru SV, Augustine AM, Lepcha A, Sebastian S, Gowri M, Philip A, et al. The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario. J Laryngol Otol. 2020:1-4. https://doi.org/10.1017/S0022215120002108 https://doi.org/10.1017/S002221512000210... )	India, 2020	Prospective observational study n=20	No intervention.	PPE use significantly impairs speech perception. Increased speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7%).	IV
Acoustic voice analysis in the COVID-19 era(⁴²42 Cavallaro G, Di Nicola V, Quaranta N, Fiorella ML. Acoustic voice analysis in the COVID19 era. Acta Otorhinolaryngol Ital. 2021;41(1):1-5. https://doi.org/10.14639/0392-100X-N1002 https://doi.org/10.14639/0392-100X-N1002... )	Italy, 2020	Cross-sectional study n=50	With intervention of mask use.	None of the variations in the acoustic analysis of the voice detected wearing a surgical mask and not wearing a surgical mask was statistically significant.	IV
Association of In-Ear Device Use With Communication Quality Among Individuals Wearing Personal Protective Equipment in a Simulated Operating Room(⁴³43 Nguyen DL, Kay-Rivest E, Tewfik MA, Hier M, Lehmann A. Association of in-ear device use with communication quality among individuals wearing personal protective equipment in a simulated operating room. JAMA Network Open. 2021;4(4):e216857. https://doi.org/10.1001/jamanetworkopen.2021.6857 https://doi.org/10.1001/jamanetworkopen.... )	Canada, 2021	Clinical trial n=12	With intervention of mask use and addition of in-ear device.	New in-ear device associated with better communication and reduced listening effort for healthcare professionals in the operating room.	IV
Impact of Face Masks on Speech Acoustics and Vocal Effort in Healthcare Professionals(⁴⁴44 McKenna VS, Kendall CL, Patel TH, Howell RJ, Gustin RL. Impact of face masks on speech acoustics and vocal effort in healthcare professionals. Laryngoscope. 2022;132(2):391-97. https://doi.org/10.1002/lary.29763 https://doi.org/10.1002/lary.29763... )	USA, 2022	Quasi-experimental and between-subject design n=21	With intervention of mask use.	Face masks represent an additional barrier to effective communication that mainly affects spectral characteristics, vowel space measurements and vocal effort.	III
Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID-19 Era(⁴⁵45 Heider CA, Álvarez ML, Fuentes-López E, González CA, León NI, Verástegui DC, et al. Prevalence of voice disorders in healthcare workers in the universal masking covid-19 Era. Laryngoscope. 2021;131(4):E1227-E1233. https://doi.org/10.1002/lary.29172 https://doi.org/10.1002/lary.29172... )	Chile, 2021	Cross-sectional study n=218	No intervention.	Health workers in high-risk hospital units during the COVID-19 pandemic are at risk of vocal disorders.	IV
The Impact of Masking Habits on Voice in a Subpopulation of Healthcare Workers(⁴⁶46 Hamdan AL, Jabbour C, Ghanem A, Ghanem P. The impact of masking habits on voice in a sub-population of healthcare workers. J Voice. 2022:S0892-1997(21)00380-5. https://doi.org/10.1016/j.jvoice.2021.11.002 https://doi.org/10.1016/j.jvoice.2021.11... )	Lebanon and USA, 2022	Cross-sectional study n=178	No intervention.	Mask use during the COVID-19 pandemic was associated with a high prevalence of fatigue, exertion, and abnormal VHI-10 scores.	IV
Acoustic characteristics of fricatives, amplitude of formants and clarity of speech produced without and with a medical mask(⁴⁷47 Nguyen DD, Chacon A, Payten C, Black R, Sheth M, McCabe P, et al. Acoustic characteristics of fricatives, amplitude of formants and clarity of speech produced without and with a medical mask. Int J Lang Commun Disord. 2022;57(2):366-80. https://doi.org/10.1111/1460-6984.12705 https://doi.org/10.1111/1460-6984.12705... )	Australia, 2022	Cross-sectional study n=16	With intervention of mask use.	The root mean square amplitude of all included fricatives was significantly lower in surgical mask and KN95 mask compared to the unmasked condition.	IV

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