Hearing loss

Better Hearing Month 2017 and the problem of noise

By David Sykes, Vice Chair, The Quiet Coalition

Every year since 1927, May has been designated “Better Hearing Month.” What better time to think about what threatens your hearing health? In fact, if you already have some hearing loss you’re one of about 48 million Americans—that’s many more than all of the people with cancer or diabetes combined.

That’s a big number, and yet hearing loss—specifically noise-induced hearing loss (NIHL)–has been overlooked and underfunded for three and a half decades.

Noise is such a simple word–why is it so complex and laden with jargon and specialists who don’t talk to one another? One group is solely concerned with how to measure it (physicists). Other groups focus on specific types and sources of noise, such as jet aircraft, or alarmed medical devices, or leaf blowers, or trains, or highway noise (engineers or advocacy groups). Others concentrate on the effects of noise on humans (doctors and public health researchers), while another group ponders how noise affects organisms other than humans, including plants, birds and other animal species, including those that live underwater (biologists). Still other groups think about how to mitigate noise (architects and designers).

The problem is that over the past three and a half decades, the subject of noise and it’s effects have been systematically ignored and underfunded by Congress and the White House. As a result, “noise”–the cause of NIHL–has become a bewilderingly fragmented field in which few people talk to others outside their own specialities. This has resulted in a subject that is hard to understand and laden with technical jargon. What is “noise”? Why does it matter? Who cares? Has the science progressed? If so, how and where?

But recently that has begun to change thanks to advances in research and to changes in federal policies from several federal agencies that have not traditionally been involved in noise and noise control. These include the Centers for Disease Control and Prevention, NASA, the Department of Health and Humans Services, the Department of Interior, the General Services Administration, the Joint Commission, and others.

In each case, a specific federal department has bitten off a chunk of the noise problem and developed guidelines and programs to fit their own needs. But put all of these disparate pieces together and you will find examples of real progress despite the fragmentation.

To help build general understanding, we ar the The Quiet Coalition have assembled some of these fragments into a diagram or a “Road Map” of noise effects (see chart above) organized by the way they are studied within various specialized fields. We hope this Road Map helps others see the big picture.

In addition to the Road Map, we have also assembled the basic facts about noise into a simple one-page “Fact Sheet” that provides detailed references to scientific literature. Both the Fact Sheet and the Road Map are starting points. At The Quiet Coalition, our goal is to synthesize the underlying scientific research on this complex and fragmented subject into a coherent picture so that we can collectively find ways to talk about it. We hope you find both the Fact Sheet and the Road Map useful as you think about hearing, hearing loss, and that elusive problem, noise.

The underlying question for each of us should be: how can we work together?

David Sykes chairs/co-chairs four national professional groups in acoustical science: The Acoustics Research Council, ANSI S12 WG44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group. He is also a board member of the American Tinnitus Association, co-founder of the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute, lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), and a contributor to “Technology for a Quieter America” (2011, National Academy of Engineering). A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.

The problems with hearing aids

Photo credit: Steve Johnson licensed under CC by 2.0

and the solutions. Manfred starts her piece with a stunning statistic: “A whopping 80 percent of adults between the ages of 55 and 74 who would benefit from a hearing aid do not use them.”  Why? For a variety of reasons: discomfort, disappointment with the sound quality, difficulty in using them, expense, and a fear of “wear[ing] something associated with ‘old.’” But what these people don’t realize, Manfred writes, is “the profound damage that uncorrected hearing loss can do to your physical, emotional and cognitive health.”

Click the link to read about the effect of hearing loss on the brain–it’s profound–and read Manfred’s responses to the various excuses people give for not getting a pair of hearing aids.  As she notes, they aren’t perfect, but it’s better to deal with little imperfection than the consequences of not wearing them.

Massachusetts Medical Society: No to noisy leaf blowers

Photo credit: Hector Alejandro licensed under CC by 2.0

By Jamie L. Banks, PhD, MSc, Program Director, The Quiet Coalition

Are health concerns about gas-powered leaf blowers (GLBs) gaining momentum? On April 29th, the Massachusetts Medical Society (MMS) became the second in the nation to approve a resolution against GLBs, following the lead of the Medical Society of the State of New York (MSSNY). Other physician groups, such as Utah Physicians for Healthy Environment and Fresno Madera Medical Society, have also issued warnings on the use of GLBs and other fuel-powered lawn and garden equipment. The resolution brought by the society’s Committee on Environmental and Occupational Health and its chair Heather Alker, MD, MPH, recommends that the MMS:

  • Recognize noise pollution as a public health hazard, with respect to hearing loss;
  • Support initiatives to increase awareness of the health risks of loud noise exposure;
  • Urge the maximum feasible reduction of all forms of air pollution, including particulates, gases, toxicants, irritants, smog formers, and other biologically and chemically active pollutants; and
  • Acknowledge the increased risk of adverse health consequences to workers and general public from gas-powered leaf blowers including hearing loss and cardiopulmonary disease.

The growing concern on the part of the medical community over leaf blower noise is welcome news. Commercial GLBs can produce noise of 95 decibels and higher at the ear of the operator. This noise level exceeds safe occupational levels by an order of magnitude. The close proximity use of these powerful engines exposes both workers and others in the area to prolonged periods of excessive noise, not to mention toxic air pollutants. The presence of a low frequency component in the leaf blower’s frequency band distribution (i.e., the device’s sound signature) enables it to travel over long distances and through walls and windows.

The MMS resolution notes the harms to hearing and health from excessive noise produced by GLBs. Loud noise is known to cause hearing loss, tinnitus, and hyperacusis, as well as other health problems such as high blood pressure and heart disease. In addition, loud noise has negative effects on quality of life, communication and social interaction, work productivity, and psychological well-being.

The burgeoning use of GLBs and other fossil fuel powered equipment around our homes, schools, and other public spaces is a public health hazard, and a growing number of physicians and other health professionals are becoming concerned. The moves made by MMS and MSSNY are to be lauded, and other state societies and medical groups, including the American Lung Association and American Heart Association, need to prioritize this issue.  With the body of scientific evidence on the harms associated with noise and pollution, other state and national medical societies have a critical role to play in educating government officials and the public about the connections between environmental hazards and disease and the actions we can take to reduce risks in our communities.

Jamie L. Banks, PhD, MSc, is the Executive Director of Quiet Communities, Inc. and the Program Director of The Quiet Coalition. She is an environmentalist and health care scientist dedicated to promoting clean, healthy, quiet, and sustainable landscape maintenance, construction, and agricultural practices. Dr. Banks has an extensive background in health outcomes and economics, environmental behavior, and policy.

Source: Quiet Communities

Originally posted at The Quiet Coalition.

Who should get their hearing checked? Everyone!

By Daniel Fink, MD, Chair, The Quiet Coalition

This local television anchor recommends that everyone get his or her hearing checked.

But this isn’t what the experts at the U.S. Preventive Services Task Force recommend. They reviewed the published medical literature on screening for hearing loss and concluded that, based on the literature, there is no proven benefit to screening for hearing loss in adults. People who complain of not being able to hear should be checked, they cautioned, but they found no benefit in looking for hearing loss is those who don’t have an obvious problem.

Maybe it’s time to rethink that recommendation. A recent report from the Centers for Disease Control and Prevention (CDC), Vital Signs: Noise-Induced Hearing Loss Among Adults, found the following based on recent data from the National Health and Nutrition Survey:

Results: Nearly one in four adults (24%) had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who reported excellent or good hearing had audiometric notches (5.5% bilateral and 18.0% unilateral). Among participants who reported exposure to loud noise at work, almost one third had a notch.

Conclusions and Implications for Public Health Practice: Noise-induced hearing loss is a signficant, often unrecognized health problem among U.S. adults. Discussions between patients and personal health care providers about hearing loss symptoms, tests, and ways to protect hearing might help with early diagnosis of hearing loss and provide opportunities to prevent harmful noise exposures. Avoiding prolonged exposure to loud environments and using personal hearing protection devices can prevent noise-induced hearing loss.

Audiometric notch is the hallmark of noise induced hearing loss.

The CDC information that a quarter of American adults have hearing loss but don’t know it–including those who rate their hearing as good or excellent–indicates a major problem. Experts recommend checking blood pressure at every doctor visit and cholesterol at varying intervals, depending on risk factors, beginning in childhood. Screening for auditory disorders is recommended for children but not for adults. But hearing loss is like high blood pressure or high cholesterol–it is painless and asymptomatic, and unless someone checks, the patient doesn’t know that he or she has it.

Why does this matter? Most Americans, including most doctors and audiologists, don’t know that the only safe noise exposure level to prevent hearing loss is only 70 decibels time weighted average for 24 hours with the real safe noise exposure level probably even lower than that. Most Americans don’t know that we are exposed to dangerous levels of noise every day, which probably explains the recent CDC findings. If people know that they have hearing loss, perhaps they will do more to protect their ears.

Significant hearing loss with age is probably not part of normal physiological aging, but represents noise-induced hearing loss. (I will be presenting a paper on that topic at the 12th Congress of the International Commission on the Biological Effects of Noise.)  Regular hearing testing could prevent current and future generations from losing their hearing.  Why? Because noise-induced hearing loss is 100% preventable, and regular tests would let people know whether and to what degree their hearing is compromised, allowing–and encouraging–them to take action today to avoid significant hearing loss tomorrow.¹

Take the initiative with regard to your hearing health, and have your hearing tested regularly as part of a preventive health plan.

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.

¹ For those who are concerned about establishing the diagnosis of hearing loss as a pre-existing condition which might increase their insurance rates or exclude coverage for future hearing health care, they should not be worried for two reasons: (1) Medicare and Medicaid don’t have a pre-existing condition exclusion, and (2) federal and commercial insurance plans do not cover audiology services and hearing aids. Which is more important? Not establishing a pre-existing condition for something not covered by insurance, or finding out that your hearing is already being damaged and having the chance to take steps to protect your ears?

Is this the most thoughtful birthday present ever?

Photo credit: Dave Crosby licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

In California, on his or her birthday a 16-year-old gets a driver’s license and, if he or she is lucky, a car.

One Dutch town is thinking about what may be an even better birthday present, the gift of good hearing: Dutch town considers giving birthday earplugs to all 16-year-olds.

Link via @QuietEdinburgh.

The unintended consequences of CDC’s guidelines for preventing hearing impairment

by John Drinkwater, Founding Member, The Quiet Coalition

If you follow the Centers for Disease Control and Prevention (CDC) recommendations to protect your hearing then be prepared for isolation and depression. The CDC’s February 2017 issue of Vital Signs states that continued exposure to unsafe sound levels can cause stress, anxiety, depression, isolation, and other health issues. So in order to protect your hearing, the CDC recommends everyone:

  1. Avoid noisy places.
  2. Use earplugs, earmuffs and noise canceling devices when in noisy places.

Amplified sound levels at restaurants, retail stores, movie theaters, health clubs, nightclubs, and other public places often are unsafe.

Following recommendation No. 1: You don’t go.

Following recommendation No. 2: Your ears can’t function properly.

Imagine if the “solution” to second hand smoke at a restaurant was to wear a protective mask over your nose and mouth. How could you possibly communicate and enjoy your meal? Hearing “protection” simulates the effects of hearing loss and inhibits your ability to communicate and enjoy the event. It also trains your ears to get used to the effects of hearing loss and may inhibit recognizing gradual hearing impairment.

The National Institute for Occupational Safety and Health (NIOSH), a part of the CDC charged with conducting research and making recommendations for the prevention of work-related injury and illness, is highly critical of earplugs and earmuffs and recommends they should only be used when engineering controls are not feasible to reduce noise levels. According to NIOSH, the noise reduction rating system (NRR) used for earmuffs and earplugs greatly overstates “protection” and therefore is not NIOSH approved. Workers often do not use hearing protectors properly, and they interfere with communication. If earplugs are removed for a short period in order to communicate, there can be immediate and irreparable injury. Even double protection (earplugs and earmuffs) is inadequate when exposure exceeds 105 dB.

Manufacturers mislead the public with overstated marketing claims. A Dow Industrial company markets their “Professional Earmuff” as “Our Highest-NRR Rated Earmuff (30 Decibels), Patented Twin Cup Design.” The really small print in the inside of the box states the Company:

[M]akes no warranty as to the suitability of NRR as a measure of actual protection from any noise level since such protection depends on the sound level (loudness), how long you listen to the loud sound, and how well you fit the earplugs (sic) in your ears…The NRR is based on the attenuation of continuous noise and may not be an accurate indicator of the protection attainable against impulsive noise such as gunfire…[Company] recommends reducing the NRR by 50% for estimating the average amount of noise reduction provided.

Furthermore, no type of hearing protection or noise canceling device protects against low frequency sounds, which travel through your body causing stress and may damage unborn children. Accordingly, NIOSH’s primary recommendation of the most effective way to prevent noise-induced hearing loss (NIHL) is to “remove hazardous noise from the workplace or remove the worker from hazardous noise.”

If you follow the primary CDC and NIOSH guideline, avoiding noisy places, it results in the same isolation, depression, and other issues associated with hearing impairment. The only healthy solution is requiring safe amplified sound levels so no hearing protection is necessary–it doesn’t cost anything to Turn Up the Quiet.™ There are many architecturally safe and pleasing ways to reduce sound levels in public places: breaking up an open floor plan, using materials that absorb or diffuse sound on wall and ceiling surfaces, installing carpeting, curtains, and tapestries, and using attractive acoustic panels, to name a few. It is also good for business.

After meeting with a local health club, they agreed to institute a new “quiet” class with no amplified music on a trial basis. Management was surprised to hear positive comments from members who had simply stopped coming to classes due to the unsafe volumes. They learned that some members with hearing aids took them out, put in earplugs, and still found the classes unbearable. In a few months they added two more quiet classes.

It’s OK to ask the grocery store, the clothing store, and other retailers to turn off the amplified music while you are shopping. Many will happily accommodate you, and it encourages others to do the same. Some businesses are establishing regular “quiet” hours of operation and finding more satisfied, and even new, customers who spend more time at the establishment.

In addition, “silent discos” are gaining popularity, where instead of amplifying music through speakers it is “silently” delivered via Wi-Fi to smartphones for patrons to listen without disturbing others. The local mayor wants to try it as part of the Summer Concerts in the Park series. It will allow those who may not want amplification to enjoy the Park, and won’t interfere with nearby businesses or residents. The same technology can be applied to other music events such as outdoor exercise, and speech events, such as public ceremonies, political speakers, and other large public gatherings.

These and other creative ways to avoid unsafe levels will allow all of us to fully participate and enjoy public gatherings without the risk of injury.

John Drinkwater is a composer, musician, and attorney with a background that includes science and architecture studies. He is the founder of secondhandsound.org, and he also owns the trademark Turn Up the Quiet™ All Rights Reserved.

Originally posted at The Quiet Coalition.

Text Copyright 2017 John Drinkwater
Photo Copyright 2014 secondhandsound.org
All rights reserved

What Your Patients Don’t Know Can Hurt Them

Photo Credit: Flávia Costa licensed under CC BY 3.0

By Daniel Fink, MD, Chair, The Quiet Coalition

It looks like the truth about noise-induced hearing loss is finally getting out.  This article in The Hearing Journal, which claims to be “the most respected journal in hearing health care,” discusses the fact that noise causes hearing loss.  While hardly an earth shattering assertion, the article notes that “[h]earing loss has long been thought to be an unpleasant but inevitable side effect of aging.”  But, the article continues, “within the past year, two reports from the Centers for Disease Control and Prevention (CDC) have documented the startling degree to which noise—both in the workplace and elsewhere in our daily lives—contributes to hearing damage.”

What follows is a well-reasoned and complete discussion about noise-induced hearing loss. The article cites the new acting director of the CDC, Ann Schuchat, MD, and Rick Neitzel, PhD, the public health researcher and a co-founder of The Quiet Coalition. The only criticism I might offer is that the article doesn’t clearly state that the only safe noise level to prevent hearing loss is a daily average of 70 decibels time weighted average (see, “What Is a Safe Noise Level for the Public?“) and that the auditory injury threshold is only 75-78 A-weighted decibelsThose caveats aside, click the first link above to read the article.  It’s well worth your time.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area.  He serves on the board of the American Tinnitus Association and is the interim chair of Quiet Communities’s Health Advisory Council and 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.

Korean study finds 2 in 10 students hard of hearing

Photo credit: Republic of Korea licensed under CC BY-SA 2.0

and, sadly, that school checkups failed to identify adolescents with hearing loss.  Korea Biomedical Review reports that “[i]nadequate hearing tests done by schools have been unable to find many teens with hearing problems resulting from the portable audio system and frequent visits to Internet cafes.”  The results call into question “statistics at Korea’s Center for Disease Control and Prevention (KCDC) and school tests conducted in 2010.”

The implications are significant:

The [study] found that 12.7 percent of seventh-grade students and 10.4 percent of 10th-grade students fell into the World Health Organization’s category of hearing loss (cannot hear at 15 decibels). When the high frequency is included, 17.9 percent of the 7th graders and 16.5 percent of 10th graders belong to the category of possible noise-induced hearing loss.

By contrast, school tests conducted in 2010 only found 5.4% of students with hearing loss.

The researchers cautioned that “[h]earing impairment can affect a student’s academic performance and can continue to create barriers to communication in social life and the workplace,” adding that “[t]he social cost of neglecting this problem can reach up to 72.6 billion won ($63.6 million).”

Meanwhile, in the U.S., are hearing exams required in primary schools?  They should be, because regular hearing exams would identify children at risk of hearing loss and would make children aware of the importance of protecting their hearing.

Remember all those concerts you went to?

does, and he still is a regular concert goer since he’s been a music journalist for more than 30 years. He saw a lot of great shows, but he also learned the hard way that loud concerts take their toll. And he shares his hard-won knowledge in his excellent article, “You’re Losing Hearing Faster Than You Think.”

Browne starts his piece with a discussion about the increase in hearing loss, stating that it is “likely due to a constant assault of noise” and adding that we have “become so accustomed to blaring sound” that our definition of what is loud has changed. He interviews Robert Jackler, chair of otolaryngology at Stanford, who asks, “Are we going to see people lose their hearing at an earlier age, and lose it more severely as time goes by?,” and emphatically answers, “Yes.”

Browne talks about his concern for his own hearing as well as his daughter’s, adding that for as long as he knew him, his father wore a hearing aid. Browne looks at the stigma attached to hearing aids, noting that there is no stigma attached to wearing eyeglasses. Along with the stigma, there are the psychological manifestations of hearing loss, namely isolation and depression. This discussion follows Browne’s visit to an audiologist and his “sobering” results–a diagnosis of sloping high-frequency loss.

In light of his audiology exam, Browne’s goal for himself was to prevent further damage. To do that, his audiologist suggests two options: The first was to get fitted ear plugs to wear at loud events, and the second, which Browne found depressing, was that he consider getting hearing aids.

In the end, Browne opts for the ear plugs, “for now,” and he lists six things everyone can do to protect their hearing, including downloading a decibel meter and wearing ear plugs. To read the entire article and see the full list of protective steps, click the second link above.