Health and Noise

It’s time to change our definition of “old”

Annual National Veterans Golden Age Games | Defense Department photo/Army Sgt. 1st Class Michael J. Carden

by Daniel Fink, MD, Chair, The Quiet Coalition

According to Joseph Coughlin, director of the AgeLab at MIT and author of “The Longevity Economy,” a new book about marketing to aging baby boomers, it’s time to change our definition of “old.”

Coughlin claims that old age is a made-up social construct invented 150 years ago.

I’m not sure I agree with him completely, but he’s right about something. Much of what we think of as normal aging–obesity, hypertension, diabetes, weakness, disability, and early demise–isn’t normal aging but pathological aging.

I’d add hearing loss to that list.

Pathological aging stems from four factors:

  1. Abnormal exposures, e.g., sun, cigarette smoke, or noise;
  2. Poor quality nutrition, i.e. too much of the wrong nutrients (including calories) and not enough of the right nutrients;
  3. Disuse atrophy, especially for the musculoskeletal system; and
  4. Medical care based on inadequate knowledge about the best treatments for common conditions.

The treatment of hypertension is one example of the fourth factor. In the 1970s, it was thought that a normal systolic blood pressure was 100 plus the patient’s age, and that treating hypertension in the elderly was dangerous. Then a randomized trial–the Systolic Hypertension in the Elderly Program–showed that treatment of high blood pressure in older people prevented stroke. Two more recent examples are studies showing that treatment of cardiac risk factors prevents what was once thought to be inevitable heart disease as people age and then was found to reduce dementia risk, too.

Hearing loss in old age is very common. It’s called presbycusis, or age-related hearing loss. But the world’s literature–which I reviewed for a presentation I gave at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich, on June 20, 2017–shows that it isn’t normal. Without exposure to loud noise, good hearing is preserved well into old age.

In his book Coughlin discusses “transcendent design”–not just accessible design, or universal design, but:

[A]nother, even higher level of accessibility that I believe has been mistakenly lumped in with universal design: transcendent design. It’s essentially universal design that has been dialed up to 11 on a 10-point scale, with accessibility attributes so useful that they turn out to be highly desirable—even aspirational—for people with and without disabilities. If the defining, narrative-shaping forces in our older future will be those that make it easy for older adults to achieve their jobs as consumers, transcendent products and design features will be at the vanguard of this process.

Coughlin highlights, as an example of transcendent design, the OXO line of kitchen utensils, initially designed by entrepreneur Sam Farber because his wife couldn’t grip standard utensils due to arthritis. People buy OXO utensils not necessarily because they have arthritis or other grip issues, but because OXO utensils they are so good-looking and easy to use. The iPhone and Apple watch are other examples.

People with mobility, musculoskeletal, or auditory disorders don’t need special designs. They and everybody need well-designed utensils, tools, garments, furniture, and spaces that meet needs as people age and suffer inevitable temporary or sometimes permanent impairments.

Perhaps one day architects and interior designers can come up with transcendent designs for quiet restaurants, to make it possible to carry on normal conversations without straining to speak or to be heard, while enjoying the food and the company of our dining companions.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Can a machine learn to solve our speech in noise problem?

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece in The Hearing Journal asks, “Can a Machine Learn to Solve our Speech in Noise Problem?”

Maybe yes, maybe no.

The “speech in noise” problem is the difficulty many people with hearing loss–and even people with normal hearing as tested by pure tone audiometry–have  following a conversation if the room (often a restaurant or party) is noisy.

I have that problem, as many adults do, and I also have three problems with this article.

First, talking about a technological solution to the speech in noise problem without discussing how we can interfere with the development of this condition by simply making the world quieter to prevent hearing loss is irresponsible. Imagine public health officials in the 1950s focusing on making better wheelchairs, braces, and crutches for those affected by polio without also working to prevent polio by developing a vaccine. You can’t, because that would have be absurd. To prevent noise-induced hearing loss, we don’t need more research. We don’t need a vaccine. All we need is to make a quieter world, something that has been known for decades.

Second, an even better solution to the speech in noise problem would be to require quieter indoor spaces.

Third, requiring quieter public spaces is exactly what the Americans with Disabilities Act (ADA) requires. People with hearing loss clearly meet the ADA definition of having a disability, and they require “reasonable accommodations” to allow them to fully enjoy (yes, this is the legal standard in ADA) places open to the public. I will be speaking about “Disability Rights of Ambient Noise for People with Auditory Disabilities Under the Americans with Disabilities Act” at the December meeting of the Acoustical Society of America, in New Orleans. I recent learned that my talk will be broadcast live over the internet. Details of how to listen will be posted when they become available.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

The health impact of environmental noise

by Jan L. Mayes, MSc, Aud(C), RAud, Audiologist

Environmental noise is damaging and inflicts unwanted sounds into everyday life. In 1984, Gordon Hempton, The Sound Tracker, found 20 natural locations in Washington State with noise-free intervals lasting over 15 minutes. No manmade noise at all. No planes, trains, or traffic. By 1995, only three locations were noise-free. When I employed current sound tracking in my suburban neighbourhood in the Pacific Northwest, I never had noise-free intervals last more than 4 minutes.  And I tried tracking at different times of the day, every day of the week for months.

Sociocusis is high distortion hearing loss caused by loud personal environmental noise (i.e., 75 dB average or higher). The louder the noise, the faster the damage. Noise-induced hidden hearing loss starts first. It begins with permanent rips in hearing nerves for which there are no symptoms, but damage is progressive for months after noise ends. More unprotected noise exposures causes yet more nerve damage leading to temporary or permanent inner ear hearing loss and what I call “hyper ears” (tinnitus and hyperacusis). Presbycusis, or age-related hearing loss, comes from gradual inner ear changes over time. Sociocusis, wrongly called early presbycusis, has a much greater impact on communication and music enjoyment than presbycusis alone.

There are also physical and mental health hazards from chronic environmental noise (i.e., 55 dB – 75 dB average). Health effects include stress, insomnia, learning problems in children, obesity, diabetes, high blood pressure, heart attacks, strokes, dementia, and shorter life. Blood pressure goes up with every 10 dB increase in environmental noise.

Ear protection prevents sociocusis from loud activities like nightclubs, concerts, and stadium events. Imagine if these venues were designated “Noise Hazard Zones”: no ear protection, no entry. Imagine Noise Free Zones like at Comic-Con 2017 in New York City. Imagine architects designing public spaces with quiet acoustics in the first place. Imagine if it was standard for manufacturers to make quiet products, dropping the noise hazard of everything from blenders, lawnmowers, planes, trains, and traffic.

The UK estimates noise pollution related healthcare costs at £1.09 billion annually. The EU is using urban planning and government polices to prevent environmental noise. Noise mitigation strategies include quiet asphalt, low-noise tires, traffic curfews, quieter airplanes, noise-optimized airport take-off and approach procedures, and better infrastructure planning.

But in the U.S., the FAA denies the crippling public health burden of noise pollution, and Congress hasn’t passed the Quiet Communities Act of 2016 or 2017.

Nobel Prize Winner Robert Koch predicted in 1910 that “[o]ne day man will have to fight noise as fiercely as cholera and pest.” I think the day is here.

Jan L. Mayes is an international Eric Hoffer Award winning author in Non-Fiction Health. She is also a blogger and audiologist specializing in noise, tinnitus-hyperacusis, and hearing health education. You can read more of Jan’s work at her site, www.janlmayes.com.

What’s better than a cheap hearing aid?

Photo credit: ReSound licensed under CC BY 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The New York Times asked recently why hearing aids are so expensive. They should have stepped back and asked a more important question: What’s better than a cheap hearing aid?

A: Preserved natural hearing.

As a paper I presented at the 12th Congress of the International Commission on the Biological Effects of Noise discussed, the scientific evidence suggests that significant hearing loss (25-40 decibel hearing loss) is probably not part of normal aging, but is actually noise-induced hearing loss in the vast majority of cases. Research supporting this conclusion includes studies of hearing done in populations not exposed to noise, different rates of hearing loss in males vs. females, decades of occupational studies correlating increased noise exposure with greater hearing loss, and recent laboratory experiments showing the molecular, genetic, and sub-cellular structural mechanisms by which noise damages the auditory system.

If you protect your hearing now–by avoiding noise exposure or using hearing protection (ear plugs and ear muffs) if you can’t–you shouldn’t need a hearing aid in the future.

Preserved natural hearing…it’s better than a cheap hearing aid!

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Study: Urban noise worst in poor and minority neighborhoods

Photo credit: Franck Michel licensed under CC BY 2.0

by Arline Bronzaft, Ph.D., Board of Directors, GrowNYC, and Co-founder, The Quiet Coalition

That noise is worse in poor and minority communities, especially in cities, is not new. Articles dating back to the sixties spoke to the impacts of noise in poorer communities, not just noises from outside the homes, but noises within the crowded apartments of large, urban cities. It was hypothesized that children whose classrooms were exposed to the noise of nearby elevated trains would suffer cognitively and this would result in poorer reading scores for these children.

Today, however, with modern technology allowing actual measurements to be taken in communities, we can more accurately measure community decibel levels and conduct studies as discussed here that find urban noise pollution worst in poorer, minority areas.

There is now an abundance of studies that have found that noise adversely affects mental and physical health. With better data to identify communities adversely affected by louder sounds, coupled with supportive literature linking noise to adverse mental and physical health problems, one would hope that the authors of the present research would have suggested ways to abate the noise. Sadly, the authors missed that opportunity, stressing instead that further research is required to deal with deleterious effects of noise.

One exception to the results of the research discussed above is a type of noise that tends to be an “equal opportunity offender.” Aircraft noise does not distinguish between poorer and more advantaged communities. Yet, one could say that individuals in more affluent neighborhoods are better organized to combat the overhead noises, though the citizens combating aircraft-related noises would not agree with the authors of this paper who state that “…the most successful U.S. noise reduction efforts have centered on the airline industry.”

The manner in which aircraft noise is measured by the FAA and the decibel level it has established as being intrusive falsely create the impression that far fewer people are affected by aviation noise. True, newer quieter engines are more efficient, but this does not allow one to conclude that aircraft noise is less bothersome. The use of inappropriate determinants to assess impacts, the increase in air traffic, and the new routes that have been deemed by citizens to be more intrusive speak more accurately to the adverse effects of aircraft noise.

In the end, whatever the source of noise or the community affected, one thing is obvious–environmental health researchers should go beyond publishing and seek ways to use their findings to improve the lives of individuals affected by deleterious pollutants such as noise.

Dr. Arline Bronzaft is a researcher, writer, and consultant on the adverse effects of noise on mental and physical health. She is co-author of “Why Noise Matters,” author of “Listen to the Raindrops” (children’s book illustrated by Steven Parton), and has written extensively about noise in books, encyclopedias, academic journals, and the popular press.  In addition, she is a Professor Emerita of the City University of New York and Board member of GrowNYC.

The Denialist Playbook and the FAA

Photo credit: MBisanz licensed under CC BY-SA 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

When I was sent a copy of this FAA presentation to the Congressional Quiet Skies Caucus, FAA Powerpoint PDF, I had a moment of recognition: the FAA is using a play from what I call “The Denialist Playbook.” The Oxford Dictionaries define a denialist as:

A person who refuses to admit the truth of a concept or proposition that is supported by the majority of scientific or historical evidence.

There appears to be a denialist playbook, just as there are playbooks for football teams. Just as one can recognize a screen pass play watching a football game, one can recognize the denialist plays when industries or government agencies try them. A well-documented example denialism can be found in the book “The Merchants of Doubt,” which chronicles how “Big Tobacco” issued statements and funded research to sow doubt about the dangers of cigarettes. No doubt Big Tobacco looked to the past. After all, when the lead contamination scandal unfolded in Flint, Michigan, it came to light that lead pipe manufacturers had trod the same path in the 1920s. And, of course, the conservative denial of climate change–continuing to deny that it is happening, even as the seas rise, the floods of biblical proportion inundate Houston, and the fires burn in California–would be laughable if the consequences weren’t so serious.

One version of the Denialist Playbook was described by Christie Aschwanden at Grist:

Step 1: Doubt the science.
Step 2: Question scientists’ motives and interests.
Step 3: Magnify legitimate, normal disagreements among scientists and cite gadflies as authorities.
Step 4: Exaggerate potential harms (scare the hell out of people).
Step 5: Appeal to personal freedom (I’m an American and no government official can tell me what vaccinations I need).
Step 6: Show that accepting the science would represent a repudiation of a key philosophy.

But I think that brief version omits several important basic plays from what I will call “The Complete Denialist Playbook.” Here are the playbook topics by chapter:

  1. Deny that there is a problem. Climate change denialism may be the most salient current example, but the FAA does this to a certain extent on Slide 4, when it states, “[a] factor of 20 decrease in community noise exposure has been accompanied by increased community concerns.” The FAA is staying that there isn’t a problem, when numerous media reports across the country document that aircraft noise is a major problem.
  2. When it becomes obvious that there is a problem, claim that it isn’t a major or real problem.
  3. Ignore those who complain about a problem, especially if they are young, women, or members of minority groups. This happened with the water problems in Flint, Michigan.
  4. State that there must be something wrong with those who complain about a problem. This was done by the conservative Mercatus Center in its “NIMBY report.
  5. Reluctantly admit that there might be a problem, but it isn’t associated, statistically correlated, and certainly not causally related with what reputable scientists think is the causative agent.
  6. Find fake experts who have views contrary to established knowledge but really are not experts in the field, even though they may have a PhD after their names.
  7. Fund research to find alternative explanations for the causation of the problem.
  8. Fund (in many cases through hidden funding mechanisms) consensus statements or even research that will obscure the true nature of the problem, i.e., sow confusion or doubt about the causal relationship.
  9. Cherry-pick the data and select research or quotes taken out of context to discredit established researchers and the scientific consensus to create an appearance of conflict or controversy when among experts there is none.
  10. Fund cultural or social organizations whose support can then be enlisted in fighting any regulatory efforts to control or ameliorate the problem. Philip Morris, among others, did this.
  11. Fund legitimate researchers looking for funding so that they will be reluctant to criticize their funding source or do research that may endanger their funding source.
  12. When the problem is so obvious that it can’t be denied, finally admit that there might be a problem, but insist that it isn’t a big problem.
  13. Offer alternative solutions to the problem which mask the real cause, e.g., soda makers funding youth exercise programs as a solution to the epidemic of obesity in young people, rather than admitting that sodas are a major, if not the major, contributor to obesity in your people.
  14. Invoke American freedoms to fight any regulatory efforts. Again, the tobacco industry did this, funding fake “Astroturf” organizations protesting that restrictions on smoking interfered with smokers’ right to smoke.
  15. Insist that the data are not robust enough and that more research is needed, which, of course, will take many years.
  16. Keep insisting that there is still doubt about the level of proof even when the overwhelming majority of scientists and even the public are convinced. The Heartland Institute, for example, still claims that there is doubt about whether smoking causes lung cancer.

It is the “more research” strategy that the FAA is adopting. On Slide 11 concerning cardiovascular health, the FAA states that “[e]xisting health study cohorts are being used to evaluate linkages between health outcomes a noise exposure while accounting for a wide range of factors,” with the research completion anticipated in 2020.

I have read some of the salient literature about aircraft noise and cardiovascular health, and attended several sessions on this topic and spoke with the world’s leading researchers in this field at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich in June, 2017. While there is always a need for more research, there is no need for further research into this particular topic because there is no doubt that aircraft noise causes cardiovascular disease. The basic physiologic mechanisms of how noise in general and aircraft noise specifically causes involuntary physiologic responses in the neuroendocrine and parasympathetic nervous systems have been well-described. A large number of epidemiology studies, using a variety of study designs, in a large number of countries, in different population groups, have shown that aircraft noise causes hypertension and cardiovascular disease. There can be no rational doubt about this relationship. These studies have been reviewed by Hammer et al., Basner et al., Munzel et al., and many others. As Basner noted in an editorial, the evidence is strong enough that most experts in the field think causality has been established.

In Europe, the adverse effects of noise on health are well-known, as summarized in a World Health Organization monograph on the “Burden of Disease from Environmental Noise.”  The European Union is dealing with this in its European Noise Directive.

There is NO need to reinvent this wheel on this side of the Atlantic Ocean, unless scientists can prove Americans are biologically different from Europeans. The FAA insisting that more research is needed to document the health dangers of aircraft noise exposure in the face of hundreds of articles in peer-reviewed scientific and medical journals is like the National Cancer Institute suddenly insisting that more research must be done to prove the dangers of smoking. How many more Americans must have their health damaged by aircraft noise–or even killed by it–before the truth is acknowledged? It is time for the FAA to act to protect the health of those exposed to aircraft noise, and if the FAA won’t act, for America’s congressional representatives to take action.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Originally posted at The Quiet Coalition.

How quiet should it be?

Lake Verynwy, Wales, Oct. 2017 | Photo credit: Dr. Daniel Fink

by Daniel Fink, MD, Chair, The Quiet Coalition

I recently wrote about measuring sound on an alpine hike, noting that the reading of the ambient noise level, which was in the low 40 decibels, was much quieter than we hear in our urbanized settings. I also noted that noise exposure, as part of the total daily noise dose, is what causes noise-induced hearing loss.

Another important adverse effect of noise–especially nighttime noise–is disruption of human activities, including sleep disruption. A measure of the noise impact on sleep is called the LDN, How quiet is it in a non-urban setting?

I hadn’t thought about this until last night. My wife and I are traveling in a remote part of Wales, staying at a hotel overlooking Lake Vyrnwy, a manmade reservoir supplying water to Liverpool 75 miles away. It took more than an hour of driving on one-lane country roads to get here. (It wasn’t that far, but at 25 mph, it took a while.) I woke up at night and realized how quiet it was: no sirens, no cars, no airplanes, no helicopters, no horn-based alerts when the neighbor’s son comes home from partying at 2 a.m. Curious, I fired up my Faber Sound Meter 4 app on my phone and measured the ambient noise at 33.7 C-weighted decibels. It was so quiet that the sound meter said there wasn’t enough data to report an A-weighted measurement. (I don’t understand the technical details of why this wouldn’t work.) Unweighted decibels measured 35.4.

Why is this important? Sleep disruption causes a stress response, a neuroendocrine response with increases in stress hormones and a parasympathetic nervous system response, with increased blood pressure and pulse. These involuntary physiological responses are what cause the increased morbidity and mortality reported from transportation noise exposure (and are discussed by Hammer, et al., and Basner, et al.). Yes, the experts think the evidence is strong enough to support a statement of causality, not just a statistical association or correlation. Even sounds as low as 32-35 decibels can disrupt sleep, causing microarousals as measured by EEG monitoring.

And now I know the answer to my question.  How quiet should it be? At night the natural sound level should be under 40 decibels, probably under 35 decibels, and not urban nighttime noise levels of 55 to 65 decibels.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Hearing loss a big problem for farmers and ranchers

by Daniel Fink, MD, Chair, The Quiet Coalition

This report discusses the problem of occupational hearing loss in farmers and ranchers. You may be confused, thinking farmers and ranchers must surely work in some of the most peaceful workplaces that exist. And that may be true part of the time, but they also use heavy equipment (tractors, harvesters, etc.) for long periods of time. Says Dr. Richard Kopke, M.D., FACS, chief executive officer of the Hough Ear Institute in Oklahoma City, “[e]xposure to tractors, forage harvesters, chain saws, combines, grain dryers, even squealing pigs and guns, can lead to significant hearing loss.”

Dr. Kopke offers advice to farmers and ranchers on how to avoid hearing loss, including the same point I always make: if you have to raise your voice to be heard, the ambient noise is above 75 A-weighted decibels and hearing loss is occurring.

But it’s not just farmers and ranchers at risk of noise-induced hearing loss. It’s everyone.

Hearing is precious. Speech is the main way humans communicate and relate to one another. As Helen Keller said (paraphrasing), “blindness separates people from things, but deafness separates people from people.”

It’s National Protect Your Hearing Month. Once hearing is lost, the only treatment is a hearing aid (or a cochlear implant for the severely impaired). If it sounds too loud, it IS too loud! Turn down the volume, leave or move away, or insert ear plugs or use ear muff hearing protection.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Yet another reason to protect your hearing

by Daniel Fink, MD, Chair, The Quiet Coalition

October is National Protect Your Hearing Month, and Jane Brody’s column in the September 26, 2017, New York Times science section gives yet another reason to protect your hearing: hearing loss is tied to cognitive decline. In fact, studies are underway to determine if preventing hearing loss or treating hearing loss will prevent cognitive decline, because the correlation between hearing loss and cognitive decline is well established.

I try to lead a healthy life. I never smoked. I walk an hour or more every day. I eat 5-7 servings of fruits and vegetables daily. My BMI is 24.5. I wear a hat and long sleeves to protect me from the California sun. I always use my seat belt when driving or riding in a car. But I knew little about the importance of protecting my hearing.

Unfortunately, my ignorance hurt me. A one-time exposure to loud noise one New Year’s Eve left me with permanent tinnitus and hyperacusis. I started wearing ear plugs at movies and sports events, and dined out rarely because almost all restaurants are painfully noisy for me. Then three years ago, after reading a different piece in the New York Times science section on hyperacusis, I was motivated to become a noise activist and to learn more about preventing auditory damage.

Researchers are working on drugs and other treatments to reverse noise-induced hearing loss, tinnitus, and hyperacusis, but currently the only treatments for hearing loss are hearing aids or, for the most severely affected, cochlear implants. And hearing aids aren’t like eyeglasses or contact lenses for common visual problems. They just don’t work as well as people would like to help them understand speech.

When I learned how bad noise is for the ears, that the only safe noise exposure level to prevent hearing loss is 70 decibels daily average noise exposure, that most Americans are exposed to dangerously high noise levels in everyday life, that many American adults have noise-induced hearing loss because of the excess noise exposure, and that hearing aids don’t work particularly well in helping people with hearing loss understand speech, I realized I had to protect my hearing.

Now I use earplugs at the movies, at sports events, even if I have to go to a noisy restaurant. And if I use a power tool, or even bang in one nail with a hammer, I use ear plugs or ear muff hearing protection. You should, too!

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.