Hearing loss

Another Silent Spring

By Daniel Fink, MD, Chair, The Quiet Coalition

In 1962, Rachel Carson’s “Silent Spring” described the harmful effects of insecticides and herbicides on birds, beneficial insects, animals, and humans.  Her book helped start the environmental movement. For too many people, this will be another silent spring, caused not by a dearth of birds but because people can’t hear birds sing. They have hearing loss from another environmental pollutant, noise.

Carson described how nature’s balance controlled pest species naturally, and how these species became problems only when humans changed the environment. She noted the difference between apparent short-term safety of agrichemicals and longer-term danger. People could get sprayed with pesticides or even ingest them without apparent immediate harm, with cancer and birth defects coming later.

If Carson were alive today, she might write about noise pollution, which interferes with animal feeding, communication, mating behaviors, and navigation in forests, fields, and oceans, and causes hearing loss and other medical problems in humans.  In nature’s quiet, animals developed exquisite hearing to find food or avoid being eaten. An owl can find a mouse under a foot of snow, and zebras can hear lions approaching in the veldt.

Humans are also born with excellent hearing.  Brief exposure to loud noise usually doesn’t cause obvious auditory damage in humans, but longer or repeated exposure does. The relationship between noise and hearing loss was first noted in medieval times in bell ringers and miners, then in boilermakers during the industrial revolution.  Noise wasn’t a widespread problem, and except in large cities life was usually quiet.

Industrialization, mechanization, and urbanization made life noisier.  Noise was recognized as a public health hazard in the early days of interstate highways and jet travel, but was also considered an environmental pollutant. In 1972 Congress passed the Noise Pollution and Abatement Act, empowering the Environmental Protection Agency (EPA) to establish noise standards and require noise labeling for consumer and industrial products.

During the Reagan administration, however, Congress defunded EPA noise control activities. Little has been done since to control noise, and our country has gotten noticeably louder. Sound levels of 90-100 decibels or louder are reported in restaurants, clubs, retail stores, movie theaters, gyms, sports events, concerts, and parties, from sirens, vehicles, landscape maintenance equipment, and construction, and for those using personal music players.

The National Institutes of Health states that prolonged exposure to noise at or above 85 decibels can cause hearing loss. This is misleading, because no exposure time is given and hearing damage occurs at much lower levels. The 85-decibel standard is an occupational noise exposure standard, not a safe noise level for the public.. The EPA adjusted the occupational standard for additional noise exposure outside the workplace to calculate the noise level for preventing hearing loss to be a daily time-weighted average of only 70 decibels.

Hearing is the social sense, required for spoken communication. About 40 million American adults age 20-69 have noise induced hearing loss, half of them without noisy jobs. Why is this happening? They are exposed to loud everyday noise.  Cumulative noise exposure eventually causes hearing loss, affecting 25% of those in their 60s, half in their 70s, and 80% in their 80s, and is correlated with social isolation, depression, dementia, falls, and mortality. Due to denial, stigma, and cost only 20% of older Americans with hearing loss acquire hearing aids, after an average seven-year delay, and 40% of people with hearing aids don’t use them much, largely because hearing aids don’t help users understand speech well in noisy environments.

Preventing noise-induced hearing loss is simple: avoid loud noise. If it sounds too loud, it is too loud. Free or inexpensive smart phone sound meter apps make it easy to measure sound levels, but if one can’t converse without straining to speak or to be heard, ambient noise is above the auditory injury threshold of 75-78 decibels and auditory damage is occurring.

A quieter world is easily attainable. Whisper-quiet dishwashers, cars with quiet interiors and exhausts, the Airbus A380, and a few quiet restaurants and stores prove this.   Effective noise control technologies have long existed, including noise reduction via design and material specifications and sound insulating, isolating, reflecting, diffusing, or absorbing techniques.  Indoors, all that may be necessary is turning down the background music volume, which costs nothing.

In the 1950s and 1960s, half of all American men smoked and public spaces and workplaces were filled with tobacco smoke. When research showed that tobacco smoke caused cancer and heart disease, governments restricted smoking, leading eventually to today’s largely smoke-free society. Smokers can still smoke, but can’t expose others involuntarily to their smoke.

Noise causes hearing loss. Governments should set and enforce indoor and outdoor noise standards, to reduce each person’s daily noise dose. Adults have the right to make and listen to all the noise they want, but not where others can hear them. If we can breathe smoke-free air, we can make a quieter world, so future generations won’t have to endure another silent spring.

Dr. 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.

Originally posted at The Quiet Coalition.

Do you have hidden hearing loss?

Dstanczyk87

Photo credit: Dstanczyk87

Not sure?  One halllmark of hidden hearing loss is having difficulty hearing when you are in a noisy setting.  Recently, the Associated Press asked the Mailman Center for Child Development at the University of Miami to prepare an exercise to help readers determine how well they can hear in a noisy background. Click the link to try the exercise and see if are showing signs of hidden hearing loss.

Hearing loss may double in the U.S. by 2060

Photo credit: Thomas Widmann

CBS News reports on a new study that concludes that millions of Americans face the prospect of losing their hearing as they age. The study by researchers at Johns Hopkins University estimates that “[a]mong American adults 20 and older, hearing loss is expected to increase from 44 million in 2020 (15 percent of adults) to 73.5 million by 2060 (23 percent of adults),” with the greater increase among older Americans. As a result, “there will be an increased need for affordable interventions and access to hearing health care services.”  Says lead study author Adele Goman, “[h]earing loss is a major public health issue that will affect many more adults,” and “to address this issue, novel and cost-effective approaches to hearing health care are needed.”

Or perhaps prevention would be a better tactic?

Dr. Debara Tucci, a spokesperson for the American Academy of Otolaryngology, Head and Neck Surgery, would agree. She tells CBS News that “people aren’t doomed to lose their hearing as they age.” “The most common cause of hearing loss is prolonged exposure to loud noise,” adds Dr. Tucci, “which includes loud music and a noisy workplace.”  Prevention, then, should be a rallying call among the medical profession, particularly public health officials.  This is especially important since the litany of horribles that befalls older adults who suffer hearing loss goes well beyond difficulty hearing.  The list includes: higher incidences of depression and anxiety, higher rates of hospitalization and of falls, and even “evidence of an association between hearing loss and mental decline.”

Coupled with the recently released and updated information concerning hearing loss from the Centers for Disease Control and Prevention, this study is a wake-up call to the medical and audiology professions and the public. Simply put, there is a low-cost and 100% effective way to tackle noise-induced hearing loss–preventing it from occurring in the first instance.

 

 

 

It’s World Hearing Day!

By Daniel Fink, MD

Today, March 3, is World Hearing Day. This day is designated by the World Health Organization (WHO) to raise awareness and promote ear and hearing care around the world. The theme of this year’s World Hearing Day is “Action for Hearing Loss: Make a Sound Investment,” which aims to draw attention to the economic impact of hearing loss and cost effectiveness of interventions to address it.

I wish the WHO and the U.S. federal government paid a little more attention to prevention of hearing loss rather than dealing with the consequences after the damage has been done. The “public health mantra” is that prevention is better and cheaper than treatment, which in turn is better and cheaper than rehabilitation. I know that many people think hearing loss is part of normal aging, but several lines of evidence suggest that most hearing loss is caused by noise exposure. Presumably most people think they can just get a hearing aid when their hearing goes, unaware that hearing aids don’t work as well for hearing loss as eyeglasses work for presbyopia. And noise-induced hearing loss is entirely preventable–just avoid loud noise. If you can’t avoid noise, use earplugs.

Helen Keller said decades ago, “Blindness separates people from things. Deafness separates people from people.”  The New York Times recently had a column about blindness, the most dreaded physical disability.  If people were losing vision instead of losing hearing from noise exposure, people might be more concerned about our too noisy world.

University of Kansas “wins” title for loudest crowd roar at an indoor sports arena

by Daniel Fink, MD

Maybe one day the Guinness Book of World Records will have a category for the most people sustaining auditory damage at one time at an indoor sports event? Because that’s what happened in Lawrence, Kansas, at the University of Kansas’ Allen Fieldhouse on February 13, 2017. A new world record was set for indoor noise at a sports event: 130.4 decibels. The previous “winner,” the University of Kentucky’s Rupp Arena, set a record of 126.4 decibels just two weeks earlier.

It was a great game, undoubtedly sold out. Kansas won in overtime, coming back from a 67-60 deficit with 1:13 to play in regulation to tie the game, and then won in overtime. The few disheartened fans who left early missed the conclusion of a one of the season’s best basketball games. Famed Kansas coach Bill Self called it “the most remarkable win I’ve ever been a part of.” But his ears, the players’ ears, the ears of team and fieldhouse staff, and those of the capacity crowd of 16,300, undoubtedly also suffered permanent auditory damage. That’s because 130.4 decibels is about as loud as a four-engine jet plane from 100 feet away, but the auditory injury threshold (the point at which a hearing injury may occur) is only 75 to 78 decibels.

Maybe one day the NCAA, which touts “Student-Athlete Well-Being” as one of its core principles, will show some concern for the auditory health of its student-athletes and ban this type of silly and dangerous competition at NCAA events.

But if not, then how about a contest to see how many NCAA student athletes and sports event attendees can be blinded at one time by the host NCAA institution shining powerful laser lights into the stands and team benches at the sports arena?  Hey, a world record is a world record, right?

Or maybe reason will prevail and the people who have the power to stop this senseless and dangerous contest will come to their senses?  They can’t say that they didn’t have notice, because my letter to the editor of The Kansas City Star was published on Monday, February 20th.  Your move, NCAA.

Dr. 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 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.

Have a friend or family member who is showing signs of hearing loss?

In “Hearing loss: Listening to the signs,” Treva Lind, The Spokesman Review, writes about the 37.5 million Americans who have some degree of hearing loss, focusing on the baby boomers who are 20 to 25% of that population.  Lind states that “[t]he American Speech-Language Hearing Association recommends that people age 50 and older have a hearing test every three years.”  She sits in on a hearing exam for 67-year-old Dale Fowler, who came to the University Hearing and Speech Clinic in Spokane, Washington to see if he needed a hearing aid, a visit scheduled at the urging of family members.  Fowler’s exam revealed that he “had some minor hearing loss at high frequencies in one ear, but it wasn’t enough to warrant a hearing aid.”  Fowler’s audiologist, Barbara Peregoy, said that his result was “common among baby boomers.”

Peregoy said that baby boomers often fall into a “gray area,” where they don’t yet need hearing aids but still have some minor hearing loss.  She then explained why people who need hearing aids don’t get them right away (cost, denial, vanity, or fear of appearing older) and the consequences of not addressing hearing loss, noting that hearing loss is a risk factor for dementia.  As for her patient Dale Fowler, although he left without a hearing aid, he did not leave empty-handed–Peregoy handed him a list of good communication skills to help him deal with his minor hearing loss.

Click the link above to read the whole piece, including Barbara Peregoy’s “Ten commandments for good communication skills.”

 

 

Is nothing safe?

They look so innocent…

Experts Warn Popping Balloons Can Lead To Permanent Hearing Loss. Arrianne Del Rosario, Tech Times, writes about an experiment conducted by researchers at the University of Alberta “to find out how noise from bursting balloons can impact hearing,” and the results were stunning.  The researchers “measured the noise levels from popping balloons in three different ways: poking them with a pin, blowing them with air until they burst, and crushing them until they exploded.”  The loudest bang came from blowing up a balloon with air until it popped.  When it did, it was recorded at almost 168 decibels, “4 decibels louder than a high-powered, 12-gauge shotgun.”

It can’t be that bad, it’s just a balloon, right?  Wrong.  Del Rosario notes that the Canadian Centre for Occupational Health and Safety recommends that “the maximum impulse level should never go beyond 140 decibels.”  She adds that “[c]onstant exposure to noise, even as low as 85 decibels — for example, the noise from cars honking their horns in a city traffic — can make a person vulnerable to hearing loss.”

Del Rosario is right that damage to hearing can occur well under 140 decibles, but wrong to imply that damage only occurs at 85 decibels or higher.  85 decibels is the industrial-strength occupational noise exposure standard. Auditory damage can begin at only 75-78 decibels.  The only evidence-based safe noise exposure level is the EPA’s 70 decibel time weighted average for 24 hours.  Cautions noted noise activist Dr. Daniel Fink, “If it sounds too loud, it is too loud.  Hearing is an important social sense, and once cochlear hair cells and auditory synaptic junctions are damaged, they are gone forever.”

Whatever the decibel reading, the problem is that each exposure to loud noise leaves a mark.  As one of the researchers, Bill Hodgetts, advised:

Hearing loss is insidious — every loud noise that occurs has a potential lifelong impact. We want people to be mindful of hearing damage over a lifetime, because once you get to the back end of life, no hearing aid is as good as the once healthy built-in system in your inner ear.

Hearing Loss Is Growing


From the book The Human Body and Health Revised by Alvin Davison, 1908 / Public Domain

And Experts Say Earphones Are Part Of The Problem.

Mack interviews audiologist Michele Abrams who spoke about limiting exposure to damaging sound:

When we think about decibel levels, when we think of loudness levels, it’s really incremental.  It’s a logarithmic scale. It’s not a linear scale. So we know that 85 db is that critical level. Eighty-five db, eight hours a day, that’s your maximum. If it’s 90 db — five db greater — you have to cut your time in half.

While generally informative, Abrams’ comment unfortunately identifies 85 db, eight hours a day as the “critical level.”  But this noise exposure level is too high.  It was developed solely as an occupational noise exposure standard and should never be applied to the general public, certainly not to children.  As Dr. Daniel Fink, a noted noise activist, wrote in, “What Is A Safe Noise Level For The Public?”:

In the absence of a federal standard, an occupational standard meant to prevent hearing loss appears to have become the de facto safe level for all public noise exposures. This is demonstrated by the use of 85 decibels as a safe sound level by hearing health professionals and their organizations, in media reports, and in publications, most often without time limits; by its use as a volume limit for children’s headphones marketed to prevent hearing loss, again without exposure times; and by general acceptance of higher indoor and outdoor noise levels in the United States.

*   *   *
Eighty-five decibels is not a safe noise exposure level for the public. In 1972, the National Institute for Occupational Safety and Health developed an 85 A-weighted decibel recommended exposure level to reduce the risk of hearing loss from occupational noise exposure. … Even with strict time limits, this standard does not protect all workers from hearing loss.

So what is a safe noise level for the public?  Dr. Fink states:

In 1974 the Environmental Protection Agency’s (EPA’s) Office of Noise Abatement and Control (ONAC) adjusted the National Institute for Occupational Safety and Health recommendation for additional exposure time: 24 instead of 8 hours daily and 365 instead of 240 days annually.  The EPA calculated the safe noise level for the public to prevent hearing loss to be a 70-decibel time-weighted average for a 24-hour period… The EPA did not adjust for lifetime noise exposure, now almost 80 years versus 40 work-years, so the real average safe noise level to prevent hearing loss is probably lower.

One thing is clear, allowing children to use earbuds or headphones without limiting volume and time exposure is a recipe for hearing loss.  Since the federal government has abdicated its authority to regulate noise, and manufacturers are unlikely to design products that limit the user’s ability to deliver as many decibels as he or she wants, parents must step in to protect their children’s hearing.  Here’s something that will help: Don’t allow your children to wear earbuds and headphones.  Tell them that if they want to listen to music they must play it through a speaker.  While this may be unpopular, know that you will be giving your children an important gift–the ability to listen to and enjoy music throughout their lifetimes.

 

 

What’s missing from this story about stadium noise in Atlanta?

Aaron Rodgers: It’s loud in Atlanta, whether it’s all natural or not.  How about a discussion about the dangers of stadium noise?  It’s nowhere to be found. Instead, this NBC post focuses on noise as a tactic and the stupidity of getting caught juicing natural crowd noise with fake crowd noise over the stadium speakers. To wit:

The Falcons were stripped of a fifth-round pick in the 2016 NFL draft and fined $350,000 after an investigation revealed that they had been using fake crowd noise while the opposing offense was on the field during the 2013 and 2014 seasons.

And? Were the Falcons penalized for injuring the hearing of every person in the stadium, or were they fined for violating whatever passes for sportsmanship in football?

This chest thumping over which stadium can produce the most noise–as if that’s a measure of anything good–would be merely pathetic if it weren’t so dangerous.

Age doesn’t matter,

you could have hidden hearing loss (and not know it). WMAR Baltimore reports on hidden hearing loss, a relatively recently discovered hearing breakthrough that explains how people who pass hearing tests have problems hearing in noisy environments.  WMAR interviewed audiologists about this breakthrough, who said that “why patients can’t decipher speech in noisy situations has been unexplained, but a new breakthrough is changing that.”  The researchers who made the hidden hearing loss breakthrough studied young adults who were regularly overexposed to loud sounds, and found that “hidden hearing loss is associated with a deep disorder in the auditory system.”

It’s never too late to protect the hearing you have.  Exposure to loud sounds damages hearing.  Period.