Hearing loss

How to motivate millennials to protect their hearing at work

by Daniel Fink, MD, Chair, The Quiet Coalition

The Quiet Coalition doesn’t spend much time worrying about occupational noise because our focus is on protecting the general public from noise. Workers’ ears are protected by regulations drafted and enforced by the Occupational Safety and Health Administration and similar state agencies. Moreover, workers generally have health care for occupational injuries, and are compensated for work-related permanent damage (including hearing loss) by state-administered workers compensation systems. If occupational hearing loss is established, hearing aids may be provided for those with occupational hearing loss.

From time to time we will agree with the many observers who think that the occupational noise exposure limit–90 A-weighted decibels for 40 hours a week, 240 days a year, for 40 years, causing excess hearing loss in 25% of exposed workers–is set too high, but at least workers have that meager protection. There are no such protections for the public, and no compensation for hearing loss, either.

That said, we’re making an exception to share with you this well-written article in Occupational Health & Safety Magazine. It’s focused on preventing hearing loss in younger workers, but it provides good information for everyone who is concerned about their hearing.

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.

New federal law deregulates and disrupts hearing aid market

Photo of Here One wireless smart earbuds courtesy of Doppler Labs

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

Who says this Congress can’t get anything done? Last week huge news appeared for 48 million Americans with hearing disorders, but the media barely noticed::

A new bipartisan law, the “Over-the-Counter Hearing Aid Act of 2017,” will deregulate the hearing aid market, dramatically lowering costs for consumers and releasing a surge of new technologies that will be sold over the counter, without a prescription. Yes, there will be losers as well as winners, but that’s the nature of change….

The new law responds to two federally sponsored reports issued last year (under the Obama Administration). The first report came from the President’s Council of Advisers on Science and Technology. The second was from the National Academy of Medicine. Passed the day before Congress adjourned, the new law creates opportunities for new technology innovators, eliminates the need to get a prescription, and dramatically cuts the cost by allowing substitutes, called “hearables” and “PSAPs” (Personal Sound Amplification Products), to be sold “over the counter.” The goal? a more efficient market that meets the needs of consumers.

As Noah Kraft, co-founder and CEO of Doppler Labs said, “[t]his industry is going to be completely disrupted. The question is by who?”

We have reported about this on several occasions over the past year, but the market disruption is getting underway much sooner that we anticipated thanks to quick action in the House of Representatives and the Senate, action that has emboldened nearly two dozen new entrants to enter the market ahead of schedule.

Who gains? 48 million Americans with incurable noise-induced hearing loss and millions more who are at risk from noise exposure. Who loses? The Big Six  who have dominated the hearing aid market for decades along with approximately 14,000 audiologists, the medical specialists whose services were previously required by the FDA to dispense and “fit” hearing aids to patients. The new Warren-Grassley OTC Act stipulates that the FDA must create a new category for “over-the-counter” hearing assistive devices and let them be sold freely, without intervention.

It’s no secret that the current Congress and the White House crave deregulation. Is deregulation potentially dangerous? Sure, but this is one instance where consumers will clearly benefit. Until now, hearing aids could cost you between $2,500 and $5,000 per ear, so $5,000 to $10,000 total. No wonder so few people have hearing aids—they weren’t covered by insurance or Medicare/Medicaid, so who could afford them? But now prices will drop to 1/10th of that—about $300 to $350 a pair–so lack of insurance coverage is less of a barrier.

We say thanks to the laudable bi-partisan cooperation between Senator Elizabeth Warren (D-MA) and Iowa Senator Chuck Grassley (R-IA) for getting this done at a time when Washington seems mired in dysfunction.

What’s the downside of this deregulatory innovation? There are many unknowns, so caveat emptor (buyer beware) and stay tuned…. But for now, it’s “Hip Hip Hooray”—or should we say, “Hear Here”!

P.S.: Our chair, Daniel Fink, MD, cautions that the real solution to the epidemic of hearing disorders in America is NOT more affordable hearing aids, but rather, a badly needed and long-awaited public health effort to prevent hearing loss—and we wholeheartedly agree with him. Prevention can be encouraged by three means:

  1. Educating people about the dangers of prolonged exposure to noise above 70 dB (permanent hearing damage occurs at levels much lower than currently recognized);
  2. Resurrecting federal efforts to reduce noise (as is being done in Europe and Asia already, where noise is recognized as a public health hazard) from obvious sources like planes, trains, trucks, consumer appliances, construction and outdoor maintenance equipment, etc.; and
  3. Educating companies in industries like aircraft manufacturing, car and truck manufacturing, mining, construction, HVAC, and appliance manufacturing, etc. that noise is harmful to public health.

Prevention can be done: currently, the European Union regulates noise emissions from 50 classes of products. According to Dr. Fink, “a hearable or PSAP is a poor substitute for well-preserved normal hearing; it’s far better to avoid loud noise or to wear earplugs!”

In addition to serving as vice chair of the The Quiet Coalition, David Sykes chairs several professional organizations in acoustical science: The Acoustics Research Council, American National Standards Institute Committee S12, Workgroup 44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group—a partner of the American Hospital Association. He is the lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), a contributor to the National Academy of Engineering report “Technology for a Quieter America,” and to the US-GSA guidance “Sound Matters”, and co-founded the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute. He recently retired from the board of directors of the American Tinnitus Association. 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.

There is nothing inevitable or natural about chronic disease

Photo credit: Robbie Sproule licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This thoughtful piece talks about chronic disease, pointing out that it is not inevitable or natural. The author, Dr. Clayton Dalton, writes that:

[T]raditional cultures across the globe, from hunter-gatherers to pastoralists to horticulturists, have shown little evidence of chronic disease. It’s not because they don’t live long enough – recent analysis has found a common lifespan of up to 78 years among hunter-gatherers, once the bottlenecks of high mortality in infancy and young adulthood are bypassed. We can’t blame genes, since many of these groups appear to be more genetically susceptible to chronic disease than those of European descent.

So what is the reason for the absence of chronic illness among these cultures? “Evidence suggests it is how they live,” Dr. Dalton replies. And what factors do these different cultures share?  Dr. Dalton writes that the “common denominator [is] defined by the absence of modern banes: absence of processed foodstuffsabsence of sedentary lifestyle, and likely absence of chronic stressors.”

Dr. Dalton doesn’t specifically mention noise-induced hearing loss, but that’s another chronic disease that he could have included in his essay.

I spoke about this at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich in June. Similar to Dr. Dalton’s comments about hypertension and diabetes, I presented information showing that significant hearing loss is probably not part of normal aging, but represents noise-induced hearing loss.

A useful analogy for noise and hearing is sun and the skin. It turns out that skin and subcutaneous tissues sag as we age–that’s normal–but deep wrinkles, age spots, and skin cancers are the result of ultraviolet exposure. Similarly, I’m sure there are changes that occur in our hearing as we age, but profound hearing loss (25-40 decibel decrement in hearing) is most often the result of noise exposure.

In the end, how we live our lives matters. If we want to hear well into old age, we have to work to preserve our hearing all during our lives. How? It’s easy: avoid loud noise or wear ear protection if you can’t.

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 is an occupational health hazard for musicians

by Daniel Fink, MD, Chair, The Quiet Coalition

It’s not surprising that hearing loss is an occupational health hazard for musicians, as highlighted in this recent report. After all, noise causes hearing loss. It doesn’t matter if the noise is from machinery in a factory, from a jet engine on the tarmac, or from loudspeakers at a rock concert. Whatever the source, the effect is the same.

And the type of music doesn’t matter, either, as noise-induced hearing loss is a problem for classical musicians, too.

The bottom line is this: hearing is precious. If hearing music is important to you–or hearing children or grandchildren speak, birds sing, whatever it is–protect your hearing.

How can you protect yourself? It’s easy. The auditory injury threshold is only 75-to-78 A-weighted decibels. That’s about the level at which ambient noise makes conversation difficult. If you are having a hard time having a conversation because of the ambient noise around you, it’s too loud. And if something sounds too loud, it IS too loud! Turn down the volume, leave the noisy place, always carry earplugs with you, and use them!

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.

“Health attacks” by inaudible sonic waves are real

Photo credit: Tess Watson licensed under CC BY 2.0

James Hamblin, The Atlantic, writes about the attacks on American and Canadian diplomats in Cuba in his article, “What Are Sound Weapons?” Hamblin starts his piece by describing the incidents which caused several Havana-based diplomats to suffer headaches, balance issues, and even severe hearing loss. Secretary of State Rex Tillerson, Hamblin notes, refered the to incidents as “health attacks.” And the AP reported that “U.S. officials concluded that the diplomats had been attacked with an advanced sonic weapon that operated outside the range of audible sound and had been deployed either inside or outside their residences.”

The weaponization of “energy waves with frequencies outside the range that the human ear can detect” is not new, writes Hamblin, and the health effects from exposure to inaudible sonic waves are real. Hamblin shares the story of residents of Kokomo, Indiana, who in 2001 experienced “annoyance, sleep disturbance, headaches, and nausea.” The U.S. National Institutes of Health investigated the matter but “couldn’t pin down the cause of the Indiana residents’ symptoms as infrasound.” The report, however, “did confirm that infrasound can cause fatigue, apathy, hearing loss, confusion, and disorientation.”

In the end, U.S. officials don’t know if Cuba is responsible or some third party, with the suggestion offered that the actor could have been “Russia, China, North Korea, Venezuela, or Iran.” But Hamblin adds that the attack is hardly sophisticated, as “[n]oise-induced hearing loss affects around one in four people,” although the source of noise is more mundane for most of us: loud concerts, shooting guns, and everyday failures to protect our hearing. Says Hamblin, “fascination with this sort of attack can be a reminder that it is worth arming ourselves in daily life against the more quotidian forms of sonic weaponry.”

PSAPs appear to work (but preventing hearing loss is better)

Photo credit: Hadley Paul Garland licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

Personal sound amplification products (PSAPs) appear to work. What is a PSAP? It’s really a hearing aid but it’s called a PSAP to avoid federal and state regulations. PSAPs can be sold directly to consumers without a physician or audiologist evaluation, and they are much cheaper than conventional hearing aids–in the range of $350 a pair instead of $3000 apiece.

This Research Letter in a recent issue of JAMA compared five PSAPs with a conventional hearing aid. The Johns Hopkins research team reported that some of the PSAPs worked quite well. Four of the PSAPs are traditional “behind the ear” devices that look like cheaper, less well made versions of traditional hearing aids, but one, the Etymotic Bean, might be placed into the newer category of “hearables” that are marketed as “smart earbuds.”

Why is this report important? PSAPs were strongly recommended by two recent expert federal reports (a report from the President’s Council of Advisors on Science and Technology in October 2015​ and a report from the National Academy of Medicine) as a solution–perhaps the solution–to the nation’s epidemic of hearing loss in older Americans.

To some they are the holy grail for hearing loss, enabling all to hear well without spending thousands of dollars. To others, especially audiologists and hearing aid dispensers, they are an existential threat. If grandma and grandpa can buy much cheaper hearing aids on their own from Amazon or Costco, why see an audiologist or hearing aid dispenser? Just buy your PSAPs online or at your nearby big box store.

Unfortunately, neither federal report mentioned the prevention as a solution for hearing loss. As I said in my presentation at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich on June 20, 2017, significant hearing loss is probably not part of normal aging but is noise-induced hearing loss caused by a lifetime of excessive noise exposure.

The inconvenient truth about hearing aids is that they don’t work very well at helping users understand speech in normal, everyday situations. For obvious reasons, there is little peer-reviewed research on this topic in the audiology literature, but two studies report approximately 40% non-usage rates. There is no reason to expect–especially without any training and teaching by an audiologist–that PSAP users will have any greater success.

Needing hearing aids or PSAPs in old age to treat hearing loss is not normal, just as needing complete dentures in old age because of tooth loss from poor dental care is not normal. Both are the only remedies available when we have failed to protect what Mother Nature gave us. But it’s much better to protect your ears and preserve your hearing than to use even the best hearing aid or the less costly PSAP alternatives.

The time to start protecting your ears is now! If it sounds too loud, it IS too loud. Avoid loud noise, and if you can’t avoid it, wear 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.

The NIH recognizes noisy restaurants are a problem

Photo credit: Alan Light licensed under CC BY 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

With this web content posted last year as part of its Dangerous Decibels program, the National Institute for Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, finally recognizes that restaurant noise is a problem. Unfortunately, NIDCD persists in stating that

Research shows that long or repeated exposure to sounds at or above 85 decibels can cause noise-induced hearing loss. Signs of having been exposed to too much noise include not hearing clearly or having ringing in your ears after leaving a noisy environment.

We disagree. By the time one can’t hear clearly or experiences tinnitus, it’s too late–permanent hearing damage has occurred. The damage occurs because 85 decibels is not a safe noise level for the public. As I wrote in the American Journal of Public Health, the only evidence-based safe noise exposure level to prevent hearing loss is 70 decibels time-weighted average for a 24-hour period. The 85 decibel standard NIDCD relies on is an occupational noise exposure level, and that standard fails to prevent hearing loss in all exposed workers. The National Institute for Occupational Safety and Health agrees, and the auditory injury threshold, discussed by Flamme, et al., is only 75-78 A-weighted decibels (dBA).

A simple rule to protect hearing is “if it sounds too loud, it IS too loud.” If you can’t carry on a normal conversation without straining to speak or to be heard, the ambient noise level is above 75 dBA (see figure D-1, “Information on Levels of Environmental Noise Requisite to Protect Public Health and Welfare with an Adequate Margin of Safety”) and auditory damage is occurring. And, unfortunately, many if not most restaurants are noisier than 75 dBA.

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 unintended consequences of (failed) diplomacy

 

U.S. Embassy in Havana, Cuba (photo: U.S. State Department)

, McClatchy, reports on the mystery surrounding a sonic device used against U.S. and Canadian diplomats stationed in Cuba that caused hearing loss. Johnson writes that it is known that the “U.S. military deploys nonlethal noise and radiation weapons to incapacitate aggressors,” like a device that “can hit you with sound that will make you not be able to stand up” or that can “literally heat up water molecules under the skin’s surface.” And, of course, “[r]esearchers have also experimented with ultrasonic and infrasonic frequencies above and below the level at which humans can hear,” which, in some cases, “can cause physical discomfort at high intensity.” “They call them brown tones,” said Vahan Simidian, the CEO of HPV Technologies Inc., a firm that makes “long-range speakers that can send sound as far as two miles.” Why do they call them brown tones? Because they “can make you sick to your stomach.” And you can guess what happens next.

But the device used in Cuba was different. How? This device caused hearing loss in those it targeted. So why did Cuba purposefully deafen the diplomats? Vince Houghton, an intelligence historian employed by the International Spy Museum, speculates that it was a run-of-the-mill harassment campaign that got out of hand. Says Houghton:

The most likely scenario to me is this was used to harass, to annoy, to kind of goof off and be, like, ‘Ha ha! Let’s make them sick to their stomach. Let’s make them dizzy.’ And then, ‘Oh crap, it went too far…’

Houghton also believes that someone else was involved in developing this weapon, because the technology would be too “resource intensive” for “cash-strapped Cuba.”

The Cuban government responded by stating that it “has never permitted, nor will permit, that Cuban territory be used for any action against accredited diplomatic officials or their families, with no exception.” Meanwhile, The Washington Post reports that “investigators were looking into the possibilities that the incidents were carried out by a third country such as Russia, possibly operating without the knowledge of Cuba’s formal chain of command.”

The only good news from this twisted tale is that the unknown sonic device was probably intended only to harass, not disable. But when we read this piece our first thought was this: what if the resources marshalled to create this and the other appalling sound-based weapons were spent instead on educating the public on how to protect their hearing or distributing ear protection to vulnerable populations? That is, why do we accept that there is always money for weapons, but so little for public health?

Thanks to Bill Young, PhD, a noise reduction advocate from Stamford, Connecticut, for the link to The Washington Post article.

The deafening killer….finally, an elected official gets it right

This photo has been released into the public domain by its author, Arpingstone.

By Daniel Fink, MD, Chair, The Quiet Coalition

Councillor Adam Swersky, from the London Borough of Harrow, wrote this indictment of noise pollution in The New Statesman.

Finally, an elected official seems to understand that noise is a ubiquitous pollutant with adverse health impacts, and with special impacts on the less fortunate in society.

Since he sits on the borough council, he is in a position to do something about it, too.

American politicians, take note.

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.

Why is Cosmopolitan writing about hearing loss?

By Daniel Fink, MD, Chair, The Quiet Coalition

When The Quiet Coalition came together last year, there were few articles in the popular media about noise issues, and those that did appear often contained significant factual errors. But over the last few months, the number of articles has increased and errors within them have decreased. One example is a recent article in Cosmopolitan, an international women’s magazine covering fashion, beauty, and sex, which offers very sound advice about hearing protection, including the admonishment to abandon the use of earbuds.

Health education is one of the cornerstones of public health practice. It is believed that if people know what are healthy practices, they will do it. My observation is that this may be true for those at the higher end of the socioeconomic scale but doesn’t necessarily hold for the majority of people, who are either not interested, lack resources, or are too busy handling everyday life to worry about how what they do today might affect their health tomorrow. I think society has a responsibility to protect the health of all people whatever their socioeconomic status, and I believe that strict regulations are more effective in encouraging healthy behaviors than health education programs. If health education programs worked reliably, nobody would smoke, everyone would exercise, there would be no sexually transmitted diseases, and etc.

As with laws banning indoor smoking (and in some places, outdoor smoking at beaches and parks), comprehensive local, state, and federal indoor and outdoor quiet laws will be more effective than health education programs and articles in the popular media to protect the nation’s auditory health. But health education efforts about the danger of noise are a start, at least for those who read the information.

In the United States, the best example of disparate health habits correlated with educational status may be smoking, where only about 3.7% of adults with graduate degrees (and presumably higher income levels) smoke, compared to 25.6% of those without a high school diploma. This is a striking seven-fold variation. Another example is obesity, which is inversely correlated with educational status and annual income, but the relationship isn’t as strong. Nearly 33% of adults who did not graduate high school are obese, compared with 21.5% of those with a college or technical degree, and more than 33% of adults earning less than $15,000 are obese, compared with 24.6% of those earning at least $50,000 annually.

It’s clear that higher education and income levels are keys to better health. And this now likely applies to hearing health, including Cosmopolitan readers.

And that’s important. I’m an internist who believes in practicing what I preach. I don’t smoke. My body mass index (BMI) is 24.5. I walk an hour or more a day, eat at least 5 servings of fruits and vegetables daily, avoid red meat, eat lots of fish, wear a hat and long sleeves if I’m in the sun, and always use a seat belt. But I had no idea that a one-time exposure to loud noise could give me tinnitus and hyperacusis for the rest of my life. So if just one young woman who reads the Cosmopolitan article protects her hearing–and tells her friends and family to do so too–the staff at Cosmopolitan will have done a great public service.

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.