Amid increasing concerns that more transmissible variants of the novel coronavirus are rapidly spreading in the United States, experts have urged people to consider using higher-quality face coverings or layering masks to increase effectiveness. On Wednesday, the Centers for Disease Control and Prevention released a report encouraging Americans to wear properly fitted masks to protect themselves and, for the first time, suggested double-masking as one approach.
But for those who are starting to double-mask, the additional layers of material also come with an extra set of tautly stretched ear loops, leading to discomfort.
“My ears hurt after an hour,” one person tweeted.
Another Twitter user asked: “Does your mask hurt your ears at all? I can’t tell if it’s because I’m double masking or if I just have weird ears.”
That soreness is not unusual, according to experts, particularly if the coverings are being worn for longer stretches of time. Here are their recommendations for how to improve comfort while ensuring masks are worn properly and consistently.
Don't force yourself to double-mask
Although experts have encouraged upgrading masks, doubling up is not the only way to improve fit and protection. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston, emphasized that people should first focus on mask quality rather than how many they’re wearing.
“There are a lot of people who are wearing a mask, but it’s a thin cloth mask or something that’s chosen for style and appearance rather than for the filtering capabilities,” Sax said. “I think Step One would be to make sure that everyone has a high-quality mask.”
There are also concerns that discomfort may cause people to wear their masks incorrectly, said Neysa Ernst, nurse manager of the Biocontainment Unit at Johns Hopkins Medicine.
“People find that they can’t breathe, so what do they do? They take both masks off,” Ernst said. “So that completely negates any safety you have from the mask.”
The CDC report noted potential downsides to double-masking, including that it might impede breathing or obstruct peripheral vision for some wearers.
If wearing two masks means you’re pulling down the coverings to talk or wearing them loosely, experts say you should instead prioritize using a single, snugly fitted mask made of material that can effectively filter particles. The CDC researchers found that modifying a single surgical mask by knotting ear loops and tucking in the sides close to the face was similarly effective in boosting fit and protection.
“The most important thing is to have a good-quality mask that covers your nose and your mouth,” Ernst said.
But for people who want to double-mask, there are some simple fixes that may improve comfort without sacrificing function.
Give your ears a break
Even with single masks, one of the most common complaints among health-care workers who are wearing tight-fitting coverings for hours each day has been ear soreness, said Hana Akselrod, an infectious-disease physician at George Washington University. If you try to get a mask to fit well by having really taut ear loops, “you’re going to destroy the back of your ears,” she said.
One of Akselrod’s favorite approaches to relieving the ache is to wear a paper surgical mask with ear loops and layer a cloth mask that ties behind the head on top.
“That way, the ears really aren’t bearing any of the tension,” she said, adding that the method is “both comfortable and improves how many layers you’ve got on.”
Surgical masks with ties instead of ear loops are also used by health-care workers and can be purchased by the public.
In addition to potentially being more comfortable, some coverings that fasten around the wearer’s head have been shown in laboratory tests to fit better than masks with ear loops, said Loretta Fernandez, an associate professor of civil and environmental engineering at Northeastern University, who has been studying mask efficacy during the pandemic.
“In general, of the many masks that we tested — and there are over 50 — the ones that seemed to provide the best fit were the ones that had elastic that went around the back of the head and the back of the neck,” Fernandez said.
Still, not all masks that are secured around the head had good fit, she noted. Some masks using straps that had to be tied left gaps where air could pass through unfiltered.
Sax added that tying those masks properly could present a challenge. “You have to be able to tie a bow knot behind your head,” he said. “That’s hard for some people.”
To achieve a better fit without adding another set of ear loops, Fernandez suggested putting an elastic material that can wrap around the head, such as a neck gaiter, over a mask.
Many hacks intended to improve the fit and comfort of masks with ear loops have emerged since the beginning of the pandemic. Some users fasten the loops to their heads with hair clips, while others rely on specially designed products such as plastic mask extenders, also aptly known as “ear savers,” or head bands and hats with buttons on the sides. Creative hairstyles can even serve as fixtures for mask loops.
Experts have also suggested ways to increase layers without doubling masks. One way is to find or make a multiple-layer cloth covering that has a piece of filter material inserted to simulate the effect of a surgical mask or other medical-grade covering.
“There’s a lot of creativity right now as to what’s available and how to add layers in front of the face while still allowing people to breathe through them,” Akselrod said. “The one caveat is that there are no fully validated, neck-to-neck studies on all these modalities. So a lot of the decisions people end up making are common-sense decisions.