“Pardon me?”

It’s a phrase that seems to be repeated more frequently as more Minnesotans dutifully don masks in an effort to prevent the spread of the coronavirus.

Masks can muffle speech, and their prevalence may underscore how many people unconsciously rely on lip reading and facial expressions as part of their listening technique.

“Communication is far more effortless when you watch as well as listen,” said Sarah Angerman, director of clinical programs in audiology in the University of Minnesota’s Speech-Language-Hearing Sciences Department.

“So right now there’s this triple whammy. We’re removing visual cues, the mask is deteriorating speech and now the environment is not ideal. There are plexiglass dividers and other barriers in public places that make communication more difficult,” she said.

The struggle to hear is especially troubling for older people. Hearing loss is associated with mounting years. Federal statistics show that a third of Americans between ages 65 and 74 experience some loss; by age 75, nearly half report hearing difficulties.

“Hearing loss is gradual. With aging, there’s a loss of cells in the inner ear and deterioration of the nerve fibers that attach to the cells and carry information to the brain,” explained Angerman.

She notes that face coverings themselves contribute to hearing difficulties.

“Masks literally mask the higher frequencies of speech,” she said. “It’s these higher pitches that transmit the consonant sounds of English, and that’s what carries meaning.”

Masks can also interfere with hearing aids for people accustomed to using them.

At the university’s Julia M. Davis Speech Language Hearing Center, audiologists report a slight uptick in patients choosing in-the-ear hearing aids. This style of hearing aid, which is fitted to sit inside the ear canal, is less likely to interfere with the strapped loops of masks. That makes them a preferred alternative to hearing aids that are worn behind the ear.

But many people who could benefit from hearing help turn a deaf ear to it. Angerman quotes a study that finds the average person waits seven years from when they first experience hearing difficulty until they address it.

“Statistics are also consistent that only 20% of people who would benefit from hearing aids have them,” she added.

“We know cost is a reason, but this happens in Europe, where they have coverage for hearing aids. There’s still a stigma, a self-perception among users that hearing aids make them look old. A lot of people are not ready to take action until they reach a tipping point and understand that they are missing things because they can’t hear.”

Angerman encourages people who are wondering about their hearing to take steps to determine if they can benefit from help.

“Audiology clinics are all up and running,” she said. “I can assure people that they wouldn’t be open if they didn’t have safety protocols in place.”

Kevyn Burger is a Minneapolis-based writer and broadcaster.