Powered air-purifying respirators used during the SARS-CoV-2 pandemic significantly reduce speech perception

• Published in: Journal of occupational medicine and toxicology (London, England) Vol. 16; no. 1; pp. 43 - 11
• Main Authors: Weiss, Roxanne, Guchlerner, Leon, Weissgerber, Tobias, Filmann, Natalie, Haake, Birgit, Zacharowski, Kai, Wolf, Timo, Wicker, Sabine, Kempf, Volkhard A J, Ciesek, Sandra, Stöver, Timo, Diensthuber, Marc
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30-09-2021; BioMed Central; BMC
• Subjects: Acoustic insulation; Acoustic properties; Aerosols; Attenuation; Communication; Coronaviruses; COVID-19; Disease transmission; Epidemics; Evaluation; FFP3 respirator; Headsets; Health aspects; Hearing; Infections; Insulation; Interpersonal communication; Medical personnel; Ostomy; Pandemics; PAPR; Pattern recognition; Perception; Personal protective equipment; Powered air-purifying respirator; Protective equipment; Respirators; Respiratory diseases; Safety and security measures; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Social aspects; Software; Sound attenuation; Speech; Speech perception; Speech recognition; Surgeons; Torso; Viral diseases; Germany; China; COVID-19; Personal protective equipment; SARS-CoV-2; FFP3 respirator; Powered air-purifying respirator; PAPR
• ISSN: 1745-6673; 1745-6673
• DOI: 10.1186/s12995-021-00334-y

Due to the coronavirus disease 2019 (COVID-19) pandemic, interventions in the upper airways are considered high-risk procedures for otolaryngologists and their colleagues. The purpose of this study was to evaluate limitations in hearing and communication when using a powered air-purifying respirator (PAPR) system to protect against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission and to assess the benefit of a headset.
Acoustic properties of the PAPR system were measured using a head and torso simulator. Audiological tests (tone audiometry, Freiburg speech test, Oldenburg sentence test (OLSA)) were performed in normal-hearing subjects (n = 10) to assess hearing with PAPR. The audiological test setup also included simulation of conditions in which the target speaker used either a PAPR, a filtering face piece (FFP) 3 respirator, or a surgical face mask.
Audiological measurements revealed that sound insulation by the PAPR headtop and noise, generated by the blower-assisted respiratory protection system, resulted in significantly deteriorated hearing thresholds (4.0 ± 7.2 dB hearing level (HL) vs. 49.2 ± 11.0 dB HL, p < 0.001) and speech recognition scores in quiet (100.0 ± 0.0% vs. 2.5 ± 4.2%, p < 0.001; OLSA: 20.8 ± 1.8 dB vs. 61.0 ± 3.3 dB SPL, p < 0.001) when compared to hearing without PAPR. Hearing with PAPR was significantly improved when the subjects were equipped with an in-ear headset (p < 0.001). Sound attenuation by FFP3 respirators and surgical face masks had no clinically relevant impact on speech perception.
The PAPR system evaluated here can be considered for high-risk procedures in SARS-CoV-2-positive patients, provided that hearing and communication of the surgical team are optimized by the additional use of a headset.