Hearing loss

AARP on hidden hearing loss

Photo credit: Ken Lund licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece from the AARP discusses hidden hearing loss, although it really discusses the “speech-in-noise” problem. The speech-in-noise problem has been known for decades. Namely, people, usually in mid-life or older, complain that they can’t understand speech in a noisy environment, typically a restaurant, but their hearing tests are normal.

Recent research suggests that these people suffer from what is now called hidden hearing loss. Hidden hearing loss is an inability to process speech in noisy environments. It is called “hidden” because standard hearing tests (pure tone audiometry) are normal, but more sophisticated testing used only in research settings finds abnormal processing of complex sounds. The likely cause of hidden hearing loss is damage to the nerve endings in the inner ear, called cochlear synaptopathy. This scientific article discusses the problem in greater detail.

To me, there are two takeaway lessons from the AARP piece. The first is that the speech-in-noise problem is very common in older people.

The second is that this piece is a call to action. AARP advises us to seek out quieter settings, sit in a restaurant booth, or put the noise behind us and the speaker in front of us.

But the piece assumes that noisy restaurants are an inevitable part of life.

I would advise AARP members to ask the manager to turn down the amplified music. If they refuse, walk out or threaten to file a lawsuit under the Americans with Disabilities Act. And on your way out, tell management that the restaurant is too noisy and you refuse to eat there.  Make sure to note the restaurant’s indifference to your comfort and hearing health in a detailed review on social media, and let your city council representative know about the problem, too.

Restaurant patrons used to have to dine accompanied by unwanted secondhand cigarette smoke. When secondhand smoke was found to be a Class A carcinogen with no known safe level of exposure, we were able to get smoking banned. We have a right to dine without endangering our health.

Noise is also a health hazard, to our hearing and our cardiovascular health. Just as we are entitled to smoke-free restaurants, we have a right to quieter restaurants, too.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Does loud noise in pubs affect customers?

Photo credit: Daxis licensed under CC BY-ND 2.0

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

Silencity has noted the importance of the Soundprint app in identifying restaurants that are too noisy as well as those that are quieter. The popularity of the Soundprint app  speaks to the fact that there are many people who wish to enjoy their food and conversation with their fellow diners in less noisy restaurants. Now, we learn that an organization in the United Kingdom, called Mumbli, is certifying “venues on their quality of sound.

This campaign to make London “sound better” has already measured sound levels in 300 venues and has identified those venues where “…you can have a conversation with a balance of good atmosphere and well-being.” The organization plans to rate 1,000 more venues in 2020 and extend their operation beyond London to across the UK.

What I found particularly interesting about Alice Leader’s article linked above is that she noted a study by the charity Action on Hearing Loss that eight out of ten people have cut their visits to pubs, restaurants, and cafes because of noise. Furthermore, the heading of the article “Loud noise forces 80% of customers to leave a pub” causes one to rethink that it is only those people who are interested in “fine dining” that are advocating for a “lower decibel level” in dining establishments. For those of you less familiar with the word “pub,” the more common American word is “bar.” Ms. Leader’s article also clearly links background noise to impaired hearing, well-being and productivity.

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.

 

Is your music making you deaf?

Photo credit: Harrison Haines from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Is your music making you deaf?  That’s the title of this post from BWorld online.

The answer, technically, is no. Deafness means congenital absence of hearing, or profound hearing loss. Loud music won’t make you deaf. But loud music can certainly cause hearing loss.

Hearing loss and tinnitus are occupational hazards of being a rock musician. And loud music is a threat to auditory health of concert goers and clubgoers and those who listen to loud music on their personal listening devices.

We recommend avoiding loud music all the time. There is no such thing as temporary auditory damage.

If the music (or any other sound) sounds too loud, it IS too loud. Turn down the volume, leave the area, use hearing protection, or accept that you’ll probably need hearing aids in the future.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

(Re)learning to run without headphones

by Daniel Fink, MD, Chair, The Quiet Coalition

In this delightful essay in The Atlantic, writer Talmon Joseph Smith describes what happened one day when he was out on a run and his smartphone, the source of the almost constant soundtrack accompaniment to his daily life, died. He titled his essay “Learning to Run Without Headphones,” but my guess is that he knew how to run before he discovered headphones. But he certainly rediscovered the joys of listening to the world around him and thinking his own thoughts without being distracted by a constant soundtrack.

The World Health Organization calls a music player and associated headphones or earbuds a “personal audio system.” A 2017 Nielsen survey reported in Forbes Magazine found that the average American listens to a PAS for 4.5 hours a day, up sharply from 3.8 hours daily in 2016 and only 3.3 hours daily in 2015. And a 2017 report is already out of date.

I can’t access the report myself, so I don’t know if they only surveyed PAS users or the entire population. If the survey group included the entire population, including people like me who never listen to a PAS, the number of hours PAS users listen to their devices is much greater than 4.5 hours daily.

PAS use has already been shown to cause hearing loss and tinnitus (ringing in the ears) in children as young as 11. It’s probably doing the same to adult ears, too.

The tag line on a popular credit card advertisement asks, “What’s in your wallet?” Concerning PAS use, I would ask, “What’s in your ears?” If you’re turning up the volume loud enough to drown out the rumble in the subway car, or other conversations in the bus, on your daily commute, or traffic noise when running or walking, you’re probably damaging your hearing.

And just as important, you’re missing out on important time with your own thoughts, as well as the sounds of nature if you’re outdoors.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

March 3rd is World Hearing Day

by Daniel Fink, MD, Chair, The Quiet Coalition

Each year the World Health Organization designates March 3 as World Hearing Day. WHO also chooses a theme each year. For this year’s World Hearing Day, the theme is “Don’t let hearing loss limit you. Hearing for life.”

In the United States, the Centers for Disease Control and Prevention works with the WHO to help support and promote World Hearing Day, and The Quiet Coalition in turn works with CDC to help spread the word.

Our focus is on prevention of hearing loss and other auditory disorders like tinnitus and hyperacusis. We suggest installing a sound level meter on your smartphone. The app from CDC’s National Institute for Occupational Safety and Health is accurate and free.

But you don’t need a sound meter to know if it’s too loud. If you can’t carry on a conversation at the normal social distance of 3-4 feet, the ambient noise is above 75 A-weighted decibels* and your auditory health is in danger.

One simple rule can help preserve your hearing: if it sounds too loud, it IS too loud!

Turn down the volume of amplified sound, insert earplugs, leave the noisy environment, or be at risk for needing hearing aids later.

*A-weighting adjusts sound measurements for the frequencies heard in human speech.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

NIDCD Director Tucci says hearing health is a global priority

Photo courtesy of theNational Institute on Deafness and Other Communication Disorders

by Daniel Fink, MD, Chair, The Quiet Coalition

Debara Tucci, MD, M.S., M.B.A., Director of the National Institute on Deafness and Other Communication Disorders, issued a statement on February 27 concerning the World Health Organization’s World Hearing Day, which is observed on March 3 every year. In her statement, Dr. Tucci highlighted NIDCD’s “research and initiatives to prevent, detect, and treat hearing loss in the United States and beyond.”

I would hope that among these initiatives is the provision of accurate health education information to the public. Unfortunately, information on NIDCD websites and NIDCD’s Noisy Planet site still contains inaccurate and misleading information about the 85 decibel (dB) sound level. For example, the NIDCD site includes statements like “long or repeated exposure to sound at or above 85 decibels can cause hearing loss” and “[k]now which noises can cause damage (those at or above 85 dBA).” And Noisy Planet says that “[r]esearchers have found that people who are exposed over long periods of time to noise levels at 85 dBA or higher are at a much greater risk for hearing loss.”

As I have written in the American Journal of Public Health, 85 dB without an exposure time limit is not a safe noise exposure level for the public. The difference between an occupational noise exposure level and a possible exposure level for the public was discussed in the NIOSH Science Blog on February 8, 2016.

The NIDCD’s 85 dB “standard” is derived from the National Institute for Occupational Safety and Health’s 85 dBA (A-weighted decibels*) recommended occupational exposure level. This level does not protect all exposed workers from noise-induced hearing loss. The only evidence-based safe noise exposure level to prevent hearing loss was calculated by the Environmental Protection Agency in 1974: a time-weighted average of 70 decibels for 24 hours.

The World Health Organization only recommends one hour at 85 dBA to prevent hearing loss. Mathematically, this is the same as the EPA’s 70 decibels for a day. That’s sound advice!

Unfortunately, because the NIDCD uses 85 dB, this has become the de facto federal standard for noise exposure. It is widely if incorrectly cited by audiologists in media reports and in their online advertising as a safe noise level or the level at which auditory damage begins and is used as a volume limit for headphones advertised as “safe” for children’s hearing, without an exposure time being specified;

I wish Dr. Tucci and NIDCD would disseminate useful and correct information to the public, rather than continuing to imply that 85 dB is a safe noise exposure level for the public. It just isn’t.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Harvard Medical School looks at hearing and brain health

Photo credit: A Health Blog licensed under CC BY-SA 2.0

by David M. Sykes, Vice Chair, The Quiet Coalition

Harvard Medical School publishes a number of useful, consumer-oriented newsletters and blogs on issues related to health. Sometimes they touch on noise-induced hearing loss and other hearing-related concerns. In this recent blog, James Maple, MD, discusses hearing health and its relationship to brain function. If you’re looking for some insight into this issue that avoids the hype, this is a good place to start. Research has recently shown that there is a clear correlation between diminished hearing and decline in cognitive function. Research is ongoing to determine whether there is a clear causal link between the two and how it might work. What is clear is that that preventing hearing loss is important.

An earlier article in this same publication gives an overview of the emerging market for personal sound amplification products, a market that opened last month thanks to the Warren-Grassley Act passed in 2017 and signed into law in 2018.  This law enables high tech “hearing assistive devices” to be sold over the counter without a prescription at drug stores, via online stores, etc.—for 1/10th the price of typical hearing aids. So now for a few hundred dollars you can purchase hearing assistive devices, try them out, and decide whether they’ll help you (or someone you know whom you suspect needs them). This article provides a useful, non-hyped description of PSAPs that makes good background reading before you begin shopping.

David Sykes chairs several professional organizations in acoustical science: QCI Healthcare Acoustics Project, ANSI Committee S12-WG44, the Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Committee. He is lead author of “Sound & Vibration 2.0” (Springer, 2012), a contributor to the NAE’s “Technology for a Quieter America” and the GSA’s “Sound Matters,” and co-founded the Laboratory for Advanced Research in Acoustics at Rensselaer Polytech. A graduate of UC-Berkeley with advanced degrees from Cornell, he is a frequent organizer of professional conferences in the U.S., Europe, Asia and the Middle East.

Can hearing aids help prevent dementia?

Photo credit: Vilma Liella licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Can hearing aids help prevent dementia? This comprehensive article in the New York Times magazine section discusses the research suggesting that they might.

Of course, it’s far better to prevent hearing loss in the first place by avoiding loud noise exposure or using earplugs if one can’t avoid the noise. And it’s far cheaper, too.

There are smart phone sound meter apps to measure ambient noise levels, but one doesn’t need a sound meter to know if it’s too loud. If the noise is loud enough to interfere with conversation at the normal social distance of 3 to 4 feet, it’s loud enough to damage your hearing.

Just remember: if it sounds too loud, it is too loud!

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Even with noise limits, loud noise at events still causes hearing damage

Photo credit: Wendy Wei from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This article from the Netherlands reports that even with a regulatory maximum noise level for events and concerts, auditory damage still occurred. The Dutch Ministry of Public Health, Welfare, and Sports set the maximum noise level for events and concerts at 103 decibels (dB).

The U.S. Occupational Safety and Health Administration permissible exposure levels for noise are 1.5 hours at 100 A-weighted decibels (dBA) and one hour at 105 dBA. A-weighting adjusts the frequencies of sound for those heard in human speech. A-weighted sound measurements almost always are lower than unweighted measurements, with the exact difference depending on a variety of factors.

So 103 dB is pretty high, loud enough to cause hearing loss.

The problem with the Dutch noise levels was that the Dutch regulators somehow assumed that those attending loud events would be wearing hearing protection, but neglected to include this important requirement in information distributed to the public. About half of Dutch concertgoers never wear hearing protection, so they must be sustaining auditory damage, including noise-induced hearing loss and tinnitus.

The trade association representing music venues, concert halls, and event organizers maintains that it is the responsibility of those attending events and concerts to protect their own hearing, but I disagree. I think it’s the responsibility of governments and public health authorities to protect the public, or at least to give them complete and accurate information. Not “caveat auditor”!

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Warning labels work

Photo credit: Aeveraal licensed under CC BY-SA 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Consumers want relevant information about products they buy, and warning labels work. That’s the message inherent in this New York Times report on food warning labels for salt, fat, sugar, and calories in Chile. Chile has one of the highest obesity rates in the world. With health care costs for obesity-related medical care soaring, the government decided to take action and began requiring black octagonal warning labels on the front of food packages. The laws also banned junk food sales in schools, and prohibited television ads for unhealthy food between 6 a.m. and 10 p.m.

Of course, the big multinational food companies who market candy, snacks, sodas, and fruit juices protested and lobbied against the legislation, but it passed and was signed into law.

Guess what? Junk food consumption is down 25% in Chile, and other countries are contemplating passing similar legislation.

I am convinced that if warning labels were required on personal listening devices and accessories like earbuds and headphones, people would use them less. I would suggest the following: WARNING: USE OF THIS DEVICE CAN CAUSE HEARING LOSS.  But I’m sure other wording might be more effective.

It’s obvious that the device manufacturers, like the junk food vendors, don’t care about consumers. All they care about is profits. It’s up to governments to protect their citizens, as Chile has done. That’s their job.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.