Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 30;16(1):43.
doi: 10.1186/s12995-021-00334-y.

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

Roxanne Weiss  1 , Leon Guchlerner  1 , Tobias Weissgerber  2 , Natalie Filmann  3 , Birgit Haake  4 , Kai Zacharowski  4 , Timo Wolf  5 , Sabine Wicker  6 , Volkhard A J Kempf  7   8 , Sandra Ciesek  9   10   11 , Timo Stöver  1 , Marc Diensthuber  12
Affiliations

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

Roxanne Weiss et al. J Occup Med Toxicol. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: COVID-19; FFP3 respirator; PAPR; Personal protective equipment; Powered air-purifying respirator; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The powered air-purifying respirator (PAPR) composed of two main components, a translucent head top (A) and the blower-assisted respiratory protection system (B), represents an enhanced personal protective equipment (PPE) for use in high-risk surgical procedures (C)
Fig. 2
Fig. 2
Measurement of the acoustical properties of the powered air-purifying respirator (PAPR) system. A Illustration of the PAPR system on a head and torso simulator used for measurements. B One-third octave band noise levels (dB SPL) of the PAPR system (black line) and the noise floor of the anechoic chamber (grey line). C Frequency spectrum of the sound insulation (dBr) of the PAPR calculated as difference between the transfer functions to the position of the left eardrum with and without PAPR system
Fig. 3
Fig. 3
Impact of the powered air-purifying respirator (PAPR) on hearing performance in normal-hearing subjects (n = 10). A Boxplots of hearing thresholds (dB HL) with PAPR (white), without PAPR (grey) and with PAPR + headset (plaid) using tone audiometry. The vertical bar (***) applies for “without PAPR” vs. “with PAPR” and for “without PAPR” vs. “with PAPR and headset”. B Boxplots of speech recognition scores (%) for numbers and monosyllabic words (Freiburg speech test) without PAPR (black), with PAPR (grey) and with PAPR + headset (white) at 65 dB. C Boxplots of speech reception thresholds (SRTs) in dB SPL with PAPR (straight striped), without PAPR (white) and with PAPR and headset (plaid) as well as with attenuation of PAPR (oblique plaid), with attenuation of a surgical face mask (oblique striped) and with attenuation of an FFP3 respirator (grey) obtained with the German matrix test. Box plots show minima, maxima, interquartile range and median. Significant differences not indicated in the graph: without PAPR vs. with PAPR, without PAPR vs. with PAPR and headset, without PAPR vs. S: PAPR / L: PAPR, S: SFM / L: SFM vs. with PAPR, S: SFM / L: SFM vs. with PAPR and headset, S: SFM / L: SFM vs. S: PAPR / L: PAPR, S: FFP3 / L: FFP3 vs. with PAPR, S: FFP3 / L: FFP3 vs. with PAPR and headset, S: FFP3 / L: FFP3 vs. S: PAPR / L: PAPR (p < 0.001, respectively). S = speaker, L = listener, SFM = surgical face mask, FFP3 = FFP3 respirator. *p < 0.05; ***p < 0.001
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W, China Novel Coronavirus Investigating and Research Team A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Qiu C, Deng Z, Xiao Q, Shu Y, Deng Y, Wang H, Liao X, Liu H, Zhou D, Zhao X, Zhou J, Wang J, Shi Z, Long D. Transmission and clinical characteristics of coronavirus disease 2019 in 104 outside-Wuhan patients, China. J Med Virol. 2020;92(10):2027–2035. doi: 10.1002/jmv.25975. - DOI - PMC - PubMed
    1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. World Health Organization . Coronavirus disease 2019 (COVID-19) Situation Report - 73. 2020.
    1. Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd RL, Sajjadi H, Jackler RK. Letter: precautions for endoscopic Transnasal Skull Base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87(1):E66–E67. doi: 10.1093/neuros/nyaa125. - DOI - PMC - PubMed

LinkOut - more resources