Hearing loss

What are the best workout headphones?

Photo credit: CherryPoint licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

What are the best workout headphones? In my considered opinion, none. This review of workout headphones mentions noise-induced hearing loss, but misuses the 85 decibel (dBA, A-weighted decibels) occupational noise exposure as the safe listening limit.

There is a common belief that music improves athletic performance, and the louder the music the better the effort. But I have been unable to find any scientific articles supporting this belief, unless it is music with a particular beat or rhythm which, for example, might help a runner keep a steady pace.

On the other hand, the dangers of noise for hearing loss are supported by decades of scientific work and thousands of articles in peer-reviewed journals.

So skip the headphones–you can be very fit without losing your hearing.

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.

Headphones for kids: What you should know

Photo credit: ExpectGrain licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This post at SoundGuys discusses choosing headphones for kids. The author discusses a variety of considerations, including many that lead me to my opinion about headphones for kids:

Headphone use should be limited to those old enough to understand the dangers of hearing loss. Giving a younger child a pair of headphones–volume limited or not–is like giving a toddler a beer or a 9-year-old a pack of cigarettes. No one does that.

It takes years to decades of noise exposure to produce hearing loss as measured by standard audiometric techniques, but the reports of hearing loss at very early ages associated with headphone use have already begun to appear. A Dutch study in June 2018 reported increased hearing loss another auditory problems in children as young as 9 to 11, compared to those who didn’t use headphones to listen to personal music devices.

I’m not sure exactly when the idea evolved that everyone, including toddlers as young as 3, needs to entertained by audio or visual material for almost every waking hour, but I can guarantee that generations of children were raised to adulthood quite successfully without these devices. Perhaps headphone use should be regulated like driving, smoking, or drinking, each of which has an age limit at which the behavior is allowed. In the U.S., the age requirement for driving varies from 15 or so to 18 depending on the state, 18 for smoking, and 21 years old for drinking.  Laws are different in Europe and Asia, but to my knowledge there are no laws or regulations restricting headphone use or personal music device use anywhere in the world.

In the old days–whenever that was, but certainly up to a decade or two ago–children either entertained themselves by playing with blocks or toys or dolls, or were entertained by friends, parents, and others. As children got older, they entertained themselves with coloring books, and then by reading. At a meal or waiting in a line or when traveling, parents and children interacted, whether it was the parent making up a story for the toddler, or the slightly older child telling the parent or grandparent a story, or looking at and talking about what was outside the window of the car, bus, train, or airplane. Or people read books. Now I see families sitting in a restaurant with each person wearing earbuds, looking at a smart phone or listening to some content on it, instead of interacting with each other.

This can’t be good for personal and social development. It can’t be good for developing ties among family members and others. And I can guarantee that it is not good for hearing–headphone use in children will cause hearing loss in adults.

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.

How to prevent modern-day noise from damaging your hearing

by Daniel Fink, MD, Chair, The Quiet Coalition

There’s nothing new in this report from Care2, which appears to be a lifestyle website. But it offers some sound basic advice on how to protect your hearing.

I particularly like the idea of a noise vacation to give your ears a break. I would suggest a hike. You will find how quiet nature really is supposed to be.

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.

Should we focus on clinical services or on preventing hearing loss?

Photo credit: Florida Fish and Wildlife licensed under CC BY-ND 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This viewpoint article in the latest issue of The Journal of the American Medical Association by Frank Lin, MD, PhD, and colleagues at Johns Hopkins University School of Medicine and the Bloomberg School of Public Health, makes the case for expanding Medicare coverage of audiology services to help older Americans with hearing loss.

Dr. Lin and his colleagues are the leading researchers in the epidemiology of hearing loss. They have published a series of reports documenting the prevalence of hearing loss in older Americans and showing that hearing loss is strongly correlated with social isolation, depression, falls, accidents, and other conditions, all of which are associated with increased mortality in older people.

What’s missing from the article? Two things.

First, the report doesn’t explain that devices, whether they are hearing aids or over-the-counter personal sound amplification products, just don’t work as well as preserved normal hearing. The “elephant in the room” for hearing health care is the 30-40% non-usage rate among those who have obtained hearing aids, because in real-life situations, e.g., noisy stores or restaurants, these just don’t work as well as normal ears. The analogy I use is dentures. It really doesn’t matter if one has to have dentures made by a dentist and prosthodontist, or if one could walk into a drugstore or warehouse store and buy them. One’s natural teeth work better.

Second, the report doesn’t discuss the prevention of hearing loss. Continuing the dental analogy, it takes a lifetime of care, with daily brushing and flossing, regular cleanings, and dental work to keep one’s natural teeth one’s entire life. In contrast, avoiding noise-induced hearing loss is easy and costs nothing or very little–simply avoid exposure to loud noise. And if you can’t, wear hearing protection.

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.

The CDC is trying to prevent heart attacks. When will it try to prevent hearing loss?

by Daniel Fink, MD, Chair, The Quiet Coalition

The Centers for Disease Control has embarked on a public education campaign to reduce preventable cardiovascular mortality. They are calling it Million Hearts. Among the things people can do to prevent heart disease and fatal heart attacks are what CDC is calling “the ABCs”: a daily baby aspirin (unless there are medical reasons not to take it), blood pressure control, cholesterol control, and not smoking. Other actions include exercising, maintaining an ideal body weight, and eating a healthy diet.

Thanks to the Framingham Study, we know that heart disease and stroke are not part of normal aging but are largely preventable. Similarly, hearing loss is not part of normal aging but largely represents noise-induced hearing loss.

So when will CDC embark on a similar campaign to educate the public about preventing hearing loss? I suggest calling it the Million Ears campaign. Maybe Ten Million Ears.

A common saying is “nobody dies from going deaf,”* but that isn’t true. Hearing loss is associated with social isolation, falls, depression, and dementia in older people, all of which in turn are correlated and most likely causally related to increased mortality. Hearing loss also has major impacts on enjoyment of life and social function.

And unlike preventing heart disease and stroke, preventing noise-induced hearing loss is much easier–just avoid loud noise and wear hearing protection if you can’t.

Remember: If it sounds too loud, it IS too loud.

* The phrase “nobody dies from going deaf” is what is commonly said. The word “deaf,” however, usually denotes congenital hearing loss or severe hearing loss. The term “hearing loss” is more appropriately used for mild to moderate noise-induced hearing loss.

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.

How to prevent hearing loss when using headphones

by Daniel Fink, MD, Chair, The Quiet Coalition

Here is another article about the dangers of using headphones for hearing. I disagree with the author’s statement that “[t]here’s nothing inherently dangerous about using headphones.” That reminds me of statements in the 1950s and early 1960s that asserted there was nothing inherently dangerous about smoking cigarettes.

I think headphones and earbuds are inherently dangerous and shouldn’t be used except for noise-cancelling headphones used in noisy situations such as aircraft cabins.

Very few headphone users worry much about the sound volume when listening to music or a podcast or book, and the natural tendency is to turn up the volume enough to be able to hear what one is listening to. There is no meter on the personal audio device to let one know what the audio output is in decibels. And there is no audio dosimeter installed on most personal audio devices, be they MP3 players or smart phones, to let the user know the time-weighted average sound exposure that day or week from the device. Even if one has this type of dosimeter–several are reportedly in the development stage–they don’t measure all noise exposure, so they may give a false sense of security.

The other quibble with this article, from the UK, is that it uses the UK and EU occupational noise exposure standard of 80 decibels as a safe noise exposure level. The UK standard is technically 80 dBA, which is safer than the 85 dBA standard used in the U.S., but it is not a safe noise exposure level to prevent hearing loss. The only evidence-based safe noise exposure level to prevent hearing loss is a time-weighted average of 70 dB for 24 hours, and even that may be too high.

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.

Reducing Loud Sounds and Noise: A Health Matter

Photo credit: Paul Sableman licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The Quiet Coalition’s board member and co-founder Arline Bronzaft, PhD, has an important article in the latest issue of The Hearing Journal.

Noise bothers people but it’s more than a nuisance. It is a public health hazard causing auditory disorders, such as hearing loss, tinnitus, hyperacusis, and non-auditory health problems, like hypertension, diabetes, heart disease, stroke, and death.

The scientific data about these problems and the causal nature of the relationships between noise and human disease is overwhelming.

There is always a need for more research, but there can be no rational doubt about the data. And the engineering techniques to make things quieter have been known since the 1960s. Making the world quieter is a political problem, not a scientific problem.

Those of us old enough to remember when restaurants, offices, planes, trains, and buses were filled with unwanted cigarette smoke know that banning smoking in public spaces has made the air we breathe cleaner, with dramatic impacts on health and well-being.

As with smoke, it will be with noise. If enough people complain to enough elected officials, or run for public office on a platform of making the world a quieter place, it can be made quieter, 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.

The best ear protection for babies and toddlers

Photo credit: Fimb licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

As a newly minted grandfather, I worry even more about the world and the future, and what it will hold for our grandson and for all children and grandchildren, especially about keeping him safe and healthy. The Centers for Disease Control and the American Academy of Pediatrics have lots of advice about avoiding sun exposure, but little to nothing about avoiding noise exposure.

This report reviews four earmuff-style hearing protective devices–that’s the correct term, not headphones–that are good for babies and toddlers.

A few quibbles. The article doesn’t state how these were evaluated. NIOSH and OSHA evaluate hearing protective devices and assign a Noise Reduction Rating-NRR, but this evaluation appears to be the opinion of one audiologist.

And while I’m glad that the industrial-strength 85 decibel sound exposure level wasn’t mentioned as the noise level at which hearing damage occurs, the 70 decibel standard cited may be too low. Sound above 70 decibels for short time periods probably won’t cause hearing loss. It’s a time-weighted average sound exposure of 70 decibels for the whole day that prevents noise-induced hearing loss. Noise dose calculators like this one can help one understand what constitutes safe noise exposures.

More information about noise and children’s hearing is provided by the American Academy of Otolaryngology-Head and Neck Surgery.

Parents and grandparents should remember that to protect children’s hearing, if it sounds too loud, it IS too loud.

Common recreational activities, including using certain toys, birthday and other parties with amplified music, sports events, air shows, car races, and children’s action movies, are often dangerously loud.

And headphones should probably not be used by children for personal music players or digital devices, with or without an 85 decibel volume limit.

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.

Headphone volume may cause harm to hearing

Photo credit: Kaboompics .com from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Here is yet another report, this time from Baylor University, that headphone use may cause harm to hearing.

I agree with everything stated in the report except for the assertion that 85 decibels is the dangerous sound level. This standard is derived from occupational noise exposure levels, and in 2016, NIOSH reiterated that this is not a safe noise exposure level for the public.

And headphone use may be different because the sound source is only millimeters away from the ear drum, with the external auditory canal being even shorter in children than in adults.

Personally, I would advise against the use of headphones and ear buds, period.  If you insist on using them keep in mind that if you can’t hear ambient noise when listening to content or music using headphones or earbuds, the volume is too high and is almost certainly causing hearing loss.

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.

Annoyed by restaurant playlists, a musician makes his own

Photo credit: Terje Sollie from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

The New York Times writes about the seasonal playlists that musician and composer Ryuichi Sakamoto complied for the Kajitsu restaurant in New York City.  Sakamoto approached the chef with this list because he could not bear the music the restaurant played for its customers.

Not every restaurant can have a music pro compile its playlist, but at the least they can turn down the volume and let their customers enjoy their conversation.

And you don’t need a sound meter to know if it’s too loud or not. If you can’t carry on a normal conversation without raising your voice to be heard, or you strain to hear your dining companions, the ambient noise level is above 75 A-weighted decibels.

Not by coincidence, that is also the auditory injury threshold, the sound level at which hearing damage begins.

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.