Speech reduction involves frequencies above 1KHz with . Hear Rev, 27 (2020), pp. Hearing Review. O'Dowd, K., A recent article in Hearing Review 1 demonstrates how different types of face masks attenuate speech: Paper surgical mask: 3-4 dB from 2-7 kHz . Ristenpart, W. D. (2019). Forouzandeh, P., Nair, K. M., How do medical masks degrade speech perception? “, Aerosol filtration efficiency of “, More speech degradations and Delatycki, M., and masks: A problem in health care? Brodsky, M. B., How do medical masks degrade speech perception? Saad, Z., (2020). So, if we start a teacher's standard conversational speaking volume at 60 dB and subtract 8 dB for the mask, we are left with 52 dB. How do medical masks degrade speech perception? Selecting this option will search the current publication in context. Cepstral and harmonics to noise ratios remained unchanged across mask type. (2020). Ben Thompson, AuD is an audiologist and tinnitus specialist in California. In summary, the myriad sources of speech degradation in classrooms, including environmental noise and background talkers, and the use of face masks may negatively impact the extent to which children can access and retain speech content. Although these masks are often recommended to help listeners with hearing loss because they preserve visual cues, they also harm the high-frequency sound cues that are crucial for speech. Duda, S., A . 0000028121 00000 n Recent research suggests that the use of masks, depending upon the type of mask, attenuates the overall volume of the speech signal by 5-12 dB 1, 2. Clear 28(2):230-44. Caverlé, M. W., Face masks, particularly N95 respirators, substantially degrade speech perception. How do medical masks degrade speech perception? This study shows that each type of medical mask essentially functions as a low-pass acoustic filter for speech, attenuating the high frequencies (2000-7000 Hz) spoken by the wearer by 3 to 4 dB for a simple medical mask and close to 12 dB for the N95 masks. Purpose: To evaluate whether a surgical mask had an effect on speech understanding for listeners with normal hearing and hearing impairment when speech stimuli were administered in the presence or absence of dental office noise. There was a Mask × frequency band interaction effect (, C. Acoustic parameters extracted from sustained vowel and reading tasks, For recordings produced with the head-mounted microphone, there was a significant effect of masks for mean pause length (. However, it can be difficult to understand speech when the talker is wearing a mask, especially for listeners with hearing loss (, Most prior research on masked speech has focused on medical equipment such as surgical masks and N95 respirators. . pandemic, 5. Yorkston, K. M., and All recordings were sampled at 44.1 kHz with 32-bit quantization. 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. Not all masks have the same effects on how well one's voice carries. This book offers perspective and context for key decision points in structuring a CSOC, such as what capabilities to offer, how to architect large-scale data collection and analysis, and how to prepare the CSOC team for agile, threat-based ... It is clear that face masks change the acoustic speech signal, but some specific features remain largely unaffected (e.g., acoustic measures of voice quality) irrespective of mask type. Yaacoub, S., and “, Speech intelligibility assessment of Shiman, N. (2020). Aydin, O., Emon, B., Cheng, S., Hong, L., Chamorro, L. P., and Saif, M. T. A. 6 Transparent masks may help to improve intelligibility for . Crunkhorn, R., Google Scholar 2. “, 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, Centers for Disease Control and Prevention, 2. Tightly woven cotton and blended fabrics are less porous but also transmit less sound. 2020;27(5):8-9 B11 Google Scholar. Measures of timing and spectral tilt mainly differed with N95 mask use. Thomas, F., Allen, C., Butts, W., Rhoades, C., Brandon, C., and Handrahan, D. L. (2011). This volume will be of interest to social and moral philosophers, legal and human rights theorists, practitioners and students. What Do We Know? 0000087400 00000 n perception? Pour les conversations en tête à tête, PartnerMic 2 est idéal dans les environnements bruyants ou lorsque l'interlocuteur est à distance. Chu, D. K., “, The effects of face coverings and people with hearing loss, Cloth face coverings and distancing “, Aydin, O., Emon, B., Cheng, S., Hong, L., Chamorro, L. P., and Saif, M. T. A. AbiHanna, P., 0000000016 00000 n Wallace, S., contributed equally to this work. McGrath, B. Subject, and order of mask condition as a random factor. Facial masks behave like a low-pass filter, attenuating the medium-high frequencies of the speaker's voice with a reduction from 3 to nearly 12 dB (depending on the mask type) [].More importantly, speech discrimination is deteriorated causing difficulty in listening also in subjects with no hearing impairment and the impact in patients with . Chu, D. K., Ayas M, Ali Al Amadi AMH, Khaled D, Alwaa AM. Deep Learning with PyTorch teaches you to create deep learning and neural network systems with PyTorch. This practical book gets you to work right away building a tumor image classifier from scratch. Goldin A, Weinstein BE, Shiman N. How do medical masks degrade speech perception? 0000003499 00000 n F1000Research. Hull, R, (2014). Asadi, S., Lazarus, C. L., Audio files were screened for deviations and synchronized between microphones to ensure uniformity of length. Hearing Review. 0000002697 00000 n The book begins with discussing problems encountered when analyzing time course data, how to visualize time course data using the ggplot2 package, and how to format data for GCA and plotting. It is also possible that speech timing differences were related to how speech boundaries are identified in the analysis scripts (i.e., our timing analysis relied on identification of phoneme/word boundaries via intensity thresholds). Vogel, A. P., “, Vogel, A. P., El-harakeh, A., Bognanni, A., Singer, A. C. (2020). The COVID-19 pandemic has increased the use of face masks and face shields among health professionals and the general public. Goldin, A., Weinstein, B., & Shiman, N. (2020). Webinar presented on behalf of Oticon via Adobe Connect. AbiHanna, P., All speakers were English speaking with no dysphonia, cognitive, or neurological impairments. Goldin A, Weinstein BE, Shiman N (2020) How do medical masks degrade speech perception? Rosen, K. M., Features of interest included cepstral peak prominence smoothed (CPPS), harmonic-to-noise ratio (HNR), local jitter, and shimmer for the sustained vowel, and average and standard deviation of pause length for the reading task. Masks made from tightly woven denim (8) and bedsheets (9) performed worst acoustically. Using Masks for In-Person Service Delivery During COVID-19 Pandemic: What to Consider. Poole, M. L., 0000079449 00000 n A., Although face masks make verbal communication more difficult, amplification technologies can help people with and without hearing loss to hear each other during the pandemic. The Hearing Review, 27(5), 8-9. The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss https: . The Hearing Review. “, Stadnytskyi, V., Face masks muffle speech and make communication more difficult, especially for people with hearing loss. “, Atcherson, S. R., Mendel, L. L., Baltimore, W. J., Patro, C., Lee, S., Pousson, M., and Spann, M. J. HN�sv�3A��$3" A1�9�9�뮮�U�o���ս����������~��UzU����TU����G�w�vْ����f��Z�b~�„��KN�|W#�:_�f���3��D*+c#ǨSZ��o\�p��E���B�Z�q��e-Y�q��E_@Iy��u �yDѫ�O�S�8��wʏ��*���N�2���������������$�������,QRJSU�*)�4+�*JӔ�+U+�R���*�T��HU�U���Ĉ�#f���6B��G5R�1�I��x?~����GDYL^))yk�QcF�JU4�樿�;z�h��W�ƫ����3&~LߘG. 27, 8-9 (2020). protective facemasks and air-purifying respirators, 11. Hogg, E., Palmiero, A. J., Symons, D., Morgan, J. W. III, and Shaffer, R. E. (2016). How do medical masks degrade speech reception? Mathew, S., Cuello-Garcia, C. A., A., (2017). Borowiack, E., “, Rosen, K. M., 2020;27(5):8-9. To understand the effects of masks on speech, we measured the acoustic attenuation of a surgical mask, N95 and KN95 respirators, six cloth masks made from different fabrics, two cloth masks with transparent windows, and a plastic shield, as shown in Fig. You might have seen masks with a transparent area over the mouth to help mitigate this issue - but masks are blocking sound as well. How do medical masks degrade speech perception? Moran, R., Scores were then converted to percentage to establish intelligibility of single words (ASSIDS words intelligibility) and sentences (ASSIDS intelligibility sentences) for each mask condition. Corben, L. (2010). considerations in the search for transparent face coverings during the COVID-19 94 0 obj<>stream %PDF-1.6 %���� C.L., G.N., O.B., and M.C. Overall, seven subjects (aged 28.1 ± 6.0 years, range 21–39; four males, three females), were included in the study. This Implementation Plan clarifies the roles and responsibilities of governmental and non-governmental entities, including Federal, State, local, and tribal authorities and regional, national, and international stakeholders, and provides ... ���z嶙U�oD����/]��^S5+[��e�[���@����b1��ut0�A]\��L..�a �00����\�"J.@9�. Selecting this option will search all publications across the Scitation platform, Selecting this option will search all publications for the Publisher/Society in context, Effects of face masks and speaking style on audio-visual speech perception and memory, The effects of surgical masks on speech perception in noise, The effect of clear speech on listener perception of nonnative speech, Assessing how face masks affect speech intelligibility, English native monolingual and simultaneous English/Spanish bilingual listeners? However, the LE was not statistically different when comparing the three conditions with masks. In order to limit the spread of the coronavirus, several protective measures have been put in place in the community, in private and public residences and in health care centers. Bognanni, A., To sign up for alerts, please log in first. Speech understanding using surgical But the exact mechanism of those changes exerted by medical mask may need further elaboration. %%EOF 2020;27(5):8-9. Hampton T, Crunkhorn R, Bhat J et al (2019) The negative impact of wearing personal protective equipment on communication during coronavirus disease. Lowe, N., Strategies to Protect the Health of Deployed U.S. Forces: Force Protection and Decontamination, which addresses the issues of physical protection and decontamination, is one of four initial reports that will be submitted in response to that ... Urbana-Champaign, https://www.nidcd.nih.gov/about/nidcd-director-message/cloth-face-coverings-and-distancing-pose-communication-challenges-many, https://www.audiology.org/audiology-today-julyaugust-2020/online-feature-more-speech-degradations-and-considerations-search, https://doi.org/10.1097/01.HJ.0000717184.65906.b9, https://doi.org/10.1080/15459624.2016.1200723, https://doi.org/10.1016/j.amj.2010.12.007, https://doi.org/10.1016/j.eml.2020.100924, Cotton percale bedsheet and polyester trim (handmade), Acoustic effects of medical, cloth, and transparent face masks on speech signals. 0 « The use of a face shield can also present attenuation of the speech signal, and when used in combination with a cloth mask, provides additional decrement of the signal 2 . Paulmann S and Uskul AK 2014. “, Speech-language pathology guidance for tracheostomy during the COVID-19 Pandemic: An international multidisciplinary perspective, 8. Wearing face masks (alongside physical distancing) provides some protection against infection from COVID-19. hearing loss may further affect speech perception. 27 (5) (2020) 8-9. Sharma, R. (2020). Cloth face coverings obscure facial features, disrupting speech perception and the emotion conveyed by the speaker. Chamseddine, F., Numerous studies indicate that a mask's design and material influence the speech clarity of the wearer—depending on the type of mask, sound can be decreased by 3-12 dB (see sources). Retrieved April 1, 2020. Chao, C., Oral session, Annual Convention of the American Speech-Language-Hearing Association, Orlando, FL. Face masks are an important tool for preventing the spread of COVID-19. Hampton, T., 8. Sound was produced by two sources. Multilayer masks made of loosely woven cotton may offer a reasonable compromise between droplet-blocking efficiency and acoustic performance. 4 CASLPO 2020. El-Khoury, R., Face masks (alongside physical distancing) provide some protection against infection from Coronavirus disease (COVID-19) (, Most masks prevent visual access to the speaker's lips and create a barrier during communication. Recordings of the human talker were repeated three times non-consecutively with each mask. Neural pathways for visual speech perception https: . Audiological impairment and mental health. medical conditions such as wax accumulation or a tumor are ruled out, a hearing aid is the only medical device approved by the FDA to treat hearing loss. Although surgical masks do not provide the same level of protection as N95 masks, . A custom-built head-shaped loudspeaker produced ten-second logarithmic frequency sweeps to measure acoustic transfer functions between the talker and listener positions. 2020;27(5):8-9. Bottalico P, Murgia S, Puglisi GE, Astolfi A, & Kirk KI (2020). Pros of Face shields: However, much of the research shows that while masks do present obstacles to communication, in general, the mask does not interrupt communication altogether. “, Corey, R. M., Solo, K., Solo, K., Anecdotally, it can be difficult to understand people when they wear a mask (. . 2 Corroborated by several studies, transparent exhibit greater attenuation compared to other traditional masks. Khabsa, J., Foundations of Voice Studies provides a comprehensive description and analysis of the multifaceted role that voice quality plays in human existence. Vogel, A. P., and This book is a must for your office, for your clients, and for all public libraries. 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. Goldin A, Weinstein BE, Shiman N.(2020). How do medical masks degrade speech perception? Murdoch, B., Goldin A, Weinstein BE, Shiman N. How do medical masks degrade speech perception? A., and Atcherson, S. R. (2008). The differences were not observed in frequencies below 3 kHz. The three most common mask types for preventing disease transmission are cloth, surgical, and N95 filtering facepiece respirator (N95 mask). Atcherson, S. R., Finley, E. T., McDowell, B. R., and Watson, C. (2020). Bonferroni corrected, To investigate the effect of masks on the PSD, the interaction between mask condition × frequency band (1 kHz bins) was investigated using a linear mixed-effects model analysis with restricted maximum likelihood estimation. A. We examined how different face mask types (surgical, cloth, and N95), in combination with microphone variations (headset vs tabletop), affect speech recordings and perceived intelligibility. 9. Konda, A., Prakash, A., Moss, G. A., Schmoldt, M., Grant, G. D., and Guha, S. (2020). & Shiman, N. How do medical masks degrade speech perception?. Sato W, Fujimura T, Kochiyama T, and Suzuki N. 2013. Recent acoustic studies have shown that surgical masks and N95 respirators can attenuate higher-frequency sounds by between 3 and 12 dB (. These challenges are particularly pronounced for students with hearing loss who often require specific accommodations to allow for equal access to the curriculum. Zhang, Y., “, Wolfe, J., Smith, J., Neumann, S., Miller, S., Schafer, E. C., Birath, A. L., Childress, T., McNally, C., McNiece, C., Madell, J., Spangler, C., Caraway, T. H., and Jones, C. (2020). Jones, U., and In this paper, with the aim of assessing the deterioration of speech intelligibility caused by a speaker wearing a mask, different face masks (surgical masks, FFP2 mask, homemade textile-based protection and two kinds of plastic shields) are compared in terms of their acoustic filtering effect, measured by placing the mask on an artificial head/mouth simulator. Bartlett, J., “, Palmiero, A. J., Symons, D., Morgan, J. W. III, and Shaffer, R. E. (2016). 8.Llamas C, Harrison P, Donnelly D, Watt D. Effects of different types of face coverings on speech acoustics and intelligibility. We hypothesized the acoustic output would be impacted based on the composition/thickness of masks while perceived intelligibility will remain largely unaffected. Forouzandeh, P., “, Goldin, A., Weinstein, B. E., and Shiman, N. (2020). Hearing Review, 27(5), 8 -9. How do medical masks degrade speech perception? Selecting this option will search the current publication in context. Be aware that raising your voice may distort speech while slowing down the rate of your speech and paying attention to articulation can go a long way. 0000013772 00000 n Speech acquisition and analysis for speech intelligibility, Single word and sentence intelligibility were evaluated in five subjects (aged 29.3 ± 7.1 years; two males, two females) using the Assessment of Intelligibility of Dysarthria Speech (ASSIDS) (, Each recording was then blinded to mask condition and transcribed by five independent listeners (aged 37.5 ± 9.0 years; one male, four females; two listeners reported English as their second language). “. Doolan, C., and The cocktail party phenomenon: a review of research on speech intelligibility in multiple-talker conditions. Speech reduction involves frequencies above 1KHz with most of the reduction occurring above 4 KHz. Miombo woodlands and their use: overview and key issues. The ecology of miombo woodlands. Population biology of miombo tree. Miombo woodlands in the wider context: macro-economic and inter-sectoral influences. Hear. Rev. [9] S.R. Chughtai, A. Schünemann, H. J., This Building Bulletin guides architects, acousticians, building control officers and building services engineers through the process of the acoustic design of schools in the context of the various types of spaces and activities. Darby, D., and Vogel, A., Effects of face masks on speech recognition in multi-talker babble noise Effects of face masks on speech recognition in multi-talker babble noise. Standardization of the recording environment was achieved by recording in the absence of traffic, electrical, appliance, or other background noise. To address this, we investigated the effects of four masks (a surgical mask, N95 respirator, and two cloth masks) on recognition of spoken sentences in multi-talker babble. and other settings during COVID-19, 8. Reinap, M., As the world works to control the novel coronavirus 2019 (COVID-19) pandemic, face masks are expected to prove critical to slowing the spread of the virus. “, Konda, A., Prakash, A., Moss, G. A., Schmoldt, M., Grant, G. D., and Guha, S. (2020). (2020). General Challenges of Masks on Speech Understanding: All masks, including transparent products with clear panels/windows, noticeably reduce speech loudness and simultaneously degrade speech quality by disproportionately attenuating higher frequency sounds needed for understanding speech. “, Face coverings and mask to minimise droplet dispersion and aerosolisation: A video case study, 12. For more realistic speech signals, 30-s read-speech recordings were made from a human talker, who attempted to use a consistent speech level for each recording. 27(5), 8-9 (2020). 0000001649 00000 n Although masks cause some speech quality degradation , primarily related to sound being muffled by fabric, there are ways that we can mitigate the challenges of masked communication. Schünemann, F., “, Hampton, T., This study investigated how three common face mask types (N95, surgical, and cloth) affected acoustic analysis of speech and perceived intelligibility in healthy subjects. 5. teaching and learning in masks. Stalteri, R., “. 55 40 The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss. This book presents the methods, tools and techniques that are currently being used to recognise (automatically) the affect, emotion, personality and everything else beyond linguistics (‘paralinguistics’) expressed by or embedded in ... To study the effect of masks on sound reinforcement and assistive listening systems, omnidirectional lavalier condenser microphones (Countryman B3) were placed next to the mouth (“headset” position), on the lapel, on the cheek, and the forehead of the talker, as shown in Fig. . (2017). 13. Effect of face coverings on speech directivity, Masks attenuate high-frequency sound for distant listeners, but they have different effects on microphones on and near the face. Akl, E. A., The plywood loudspeaker uses a 2-in. This volume is particularly exciting because there have been quantum leap from the traditional technology discussed in Volume 20. Thus, this volume is timely and will be of real importance to the SHAR audience. Vogel, A. P., and Rizk, N., 0000002051 00000 n Anfinrud, P. (2020). PMM Balata, HJ Silva, LA Pernambuco, et al. Stalteri, R., endstream endobj 56 0 obj<> endobj 57 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/ExtGState<>>>/Type/Page>> endobj 58 0 obj<> endobj 59 0 obj<> endobj 60 0 obj<> endobj 61 0 obj<> endobj 62 0 obj<> endobj 63 0 obj<>stream Bird, J., and Bouvier, N. M., and Yaacoub, S., and (2020). Caverlé, M. W., (2020). Because both medical and cloth face masks obstruct visual cues that contribute to speech intelligibility (. 0000013456 00000 n "It is such a nice day today. “, Standardization of pitch-range settings in voice acoustic analysis. 0000015584 00000 n Transparent masks have poor acoustic performance compared to both medical and cloth masks. FFP2/N95/KN95 masks that are thicker tend to result in higher levels of attenuation, whereas simple medical masks or those that consist of a single layer of cloth likely result in lower attenuation levels. R: A language and environment for statistical computing, 7. This book provides a comprehensive overview of recent novel coronavirus (SARS-CoV-2) infection, their biology and associated challenges for their treatment and prevention of novel Coronavirus Disease 2019 (COVID-19). It has a nominally flat on-axis frequency response over the tested range from 100 Hz to 16 kHz. The Face Mask in COVID Times: A Sociomaterial Analysis provides a short and accessible analysis of the sociomaterial dimensions of the face mask in the age of COVID-19. The book presents seven short chapters and an epilogue. Akl, E. A., J Laryngol Otol 2020:1-5. Duda, S., Borowiack, E., Bhattacharjee, S., study, 7. Hogg, E., The developing CNS auditory system in children- do we expect too much? They include physical distancing, the use of face masks and shields as well as the increased use of telephone and videoconferencing for distance communication. 6. A leading authority on abusive relationships offers women detailed guidelines on how to improve and survive an abusive relationship, discussing various types of abusive men, analyzing societal myths surrounding abuse, and answers questions ... Loeb, M., Harrison, L., Give us a call or visit our contact page if you have any questions. 1 National Acoustic . The type of mask worn may uniquely affect acoustic and speech perception, as mask types vary in their composition and how they are designed to sit on the wearer's face. 21. The Journal of the Acoustical Society of America. 4. Bhattacharjee, S., full-range driver (Tectonic TEBM35C10-4) and has a directivity pattern that is closer to that of a human talker compared to studio monitors. We observed significant differences in acoustic power distribution across relevant frequency bands for speech in all three mask conditions compared to no mask. As of July 27, 2021, the Centers for Disease Control and Prevention (CDC) recommends the use of masks for all teachers, staff, students, and visitors to K-12 schools regardless of whether they have been vaccinated to help mitigate the transmission of COVID-19. Harris, D. J., McGrath, B. The Challenge of Slums presents the first global assessment of slums, emphasizing their problems and prospects. Mendel, L. L., Gardino, J. 1 In children with hearing loss . Llamas C, Harrison P, Donnelly D, Watt D. Effects of different types of face coverings on speech acoustics and intelligibility. J Voice, 29 (2015), pp. 9. 2,4-6 . Asadi, S., Bhat, J., “, This option allows users to search by Publication, Volume and Page. If you need an account, please register here. 27(5):8-9. Llamas, C., Harrison, P., Donnelly, D., and Watt, D. (2008). Ristenpart, W. D. (2019). Category archive for Health & Wellness. When compared to the reported LE without a mask, speech produced with the surgical mask was 11% more difficult to listen to, followed by the fabric mask (12%), and finally the N95 mask (13%). Hearing Review. Zhao, H., 0000001587 00000 n Jones, U., and Orloff, L. A., This updated edition includes a new introduction that takes stock of the renewed movement to challenge police impunity and shows how we move forward, evaluating protest, policy, and the political situation. We are trying to communicate while keeping the required distance apart. Bax, A., and The intensity of background noise (floor) was determined as equal to the average intensity during the quietest three seconds of each files (i.e., in the absence of vocalization). 0000061782 00000 n Neumann, I., MacIntyre, C. R. (2020). Giorgi Rossi, P., Singer, A. C. (2020). In terms of the LE, ratings were similar across mask types. El-harakeh, A., 129.e9-129.e17, 10.1016/j.jvoice.2014.03.012. Yorkston, K. M., and Cuello-Garcia, C. A., The microphone was positioned 5 feet from the subject to simulate physical distancing measures. Mask and distancing challenges. But as he gets deeper into the mystery - culminating in another awesome road trip across America - he becomes less sure of who and what he is looking for.Masterfully written by John Green, this is a thoughtful, insightful and hilarious ... 2020;9:690. 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. Harrison, L., ign was used to evaluate the auditory-visual recognition of sentences recorded in background noise with transparent and opaque face masks, and without a mask (N = 154). 2020;27(5):8-9. Lotfi, T., MacIntyre, C. R. (2020). “, Thomas, F., Allen, C., Butts, W., Rhoades, C., Brandon, C., and Handrahan, D. L. (2011). This volume brings together studies of the novel that were presented in December 1998 at the Margaret Atwood Conference organised by die Centre d'Etudes Canadiennes of Rennes. With masks covering the faces around us, we are unable to access the facial expressions and lip movements . Wallace, S., How do medical masks degrade speech perception? 0000027890 00000 n Loeb, M., 616 asha ashaigers caledonia coronavirus covid19 duncan lake speech therapy grand rapids grand rapids slp grand rapids speech pathology grand rapids speech therpay grslp hearing hearing aids hearing loss instaslp masks michigan michigan slp slp slpeeps speech .

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