Hearing loss

U.S. Preventive Services Task Force says no to hearing loss screenings

Photo credit: Bundesinnung Hörakustiker licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The U.S. Preventive Services Task Force is a federal committee that recommends what screening tests should be performed by doctors and others to keep Americans healthy and to detect asymptomatic disease. By definition, a screening test is not prompted by symptoms or patient complaints–that would be a diagnostic test–so the standard for performing a screening test is very high. The decision for USPSTF to recommend a screening test must be strongly supported by scientific evidence.

The USPSTF reviewed the literature and concluded that the evidence doesn’t yet exist for hearing loss screening. There is extensive research showing that hearing loss is strongly correlated with dementia, but the studies examining whether providing hearing aids to those with hearing loss prevents or delays dementia haven’t been completed.

I am disappointed. Many adults with hearing loss don’t know that they have hearing loss, and their lives can be improved with hearing aids. Let’s hope that when the research is completed the evidence will be clear: treating hearing loss benefits adults as well as children.

Until then, we can prevent our own hearing loss by avoiding loud noise or wearing earplugs if we can’t avoid noise exposure, and can help educate others about preventing hearing loss.

Because if something sounds loud, it’s too loud, and auditory damage will follow.

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.

Preventing hearing loss from recreational noise exposure

Photo credit: D Coetzee has dedicated this photo to the public domain

by Daniel Fink, MD, Chair, The Quiet Coalition

As I have written often, in public health prevention of disease is almost always cheaper and better than treating it after it affects someone. This is certainly true for noise-induced hearing loss, where the only current treatment is amplification using hearing aids or newer personal sound amplification products.

BioMed Central, one of the world’s leading open-access publishers of medical and scientific journals, published a recent blog post about public health interventions to prevent NIHL. A literature review found only eight studies on the subject, with effectiveness of public health interventions at encouraging use of earplugs before noise exposure being statistically significant in terms of effectiveness, but in my opinion not great enough to really protect the public.

Michael Loughran, the author of the blog post, concluded:

Overall the results tell us there are very few hearing protection interventions addressing recreational noise exposure, a global hearing health concern, and those that have tackled the issue have had mixed success. Further intervention studies should be conducted that employ randomized controlled designs, with use of systematic approaches to intervention development (e.g. the behavior change wheel), as this will help target specific behavior change techniques in an effort to increase hearing protection behaviors and raise effect sizes.

I’m a big believer in scientific research. There usually is no giant breakthrough from most research studies, but taken together they help provide useful information on which to base both public policy and personal behavior.

For prevention of NIHL, the science is clear and no further research is needed. Noise exposure causes hearing loss, which can be prevented by avoiding loud noise and prevented or reduced by wearing OSHA-rated hearing protection with a Noise Reduction Rating of 25 or greater.

More research on how best to encourage people to protect their hearing would be a good thing. But an even better thing would be for federal and state agencies to issue detailed guidelines for reducing noise exposure to prevent hearing loss, as it has been done for preventing skin cancer, and for federal, state, and local health agencies to issue regulations requiring quieter malls, stores, restaurants, concerts, sports events, vehicles, and aircraft.

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.

World Hearing Day is March 3, 2021

by Daniel Fink, MD, Chair, The Quiet Coalition

Each year the World Health Organization sponsors World Hearing Day, selecting a theme for that year’s event. Next year’s World Hearing Day on March 3, 2021, will mark the launch of the World Report on Hearing, and will be an opportunity to raise awareness of this topic among policymakers and the public. The theme for next year will be “Hearing Care for ALL!”

The WHO notes that:

  • Good hearing and communication are important at all stages of life.
  • Hearing loss and related ear diseases can be avoided through preventative actions such as: protection against loud sounds, good ear care practices, and immunization.
  • Hearing loss and related ear diseases can be addressed when it is identified in a timely manner and appropriate care sought.
  • People at risk of hearing loss should check their hearing regularly.
  • People having hearing loss or related ear diseases should seek care from a health care provider.

Our focus has been on prevention of hearing loss, not on treatment. In public health, prevention is almost always cheaper and better than treatment.

Treatment of hearing loss is currently limited to hearing aids or newer personal sound amplification products. Unfortunately, according to the World Bank approximately 10% of the world’s population lives on less than $2 a day, and 20% on less than $3.20 a day. Even the least expensive hearing aid is unaffordable for people living in poverty, and even if they were given one, batteries and maintenance would be problems.

When one is struggling to earn enough money to have food to eat, prevention of hearing loss is low down on the priority list. And in under-resourced populations, infections may be a greater cause of hearing difficulties than noise exposure. The ultimate solution will be elimination of poverty, but that may be a long time coming.

In the meantime, for those of us with adequate resources, remember that if it sounds loud, it’s too loud.

Avoid loud noise, wear hearing protection if you can’t, or face hearing loss later in life.

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.

Poor hearing associated with brain changes

Photo credit: Andrea Piacquadio from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Bryan Pollard, founder of Hyperacusis Research, Ltd., is an electrical engineer. Almost every time I have discussed something with him, he asks me an important question: “What’s the cause? What’s the effect?”

It is very easy to make a mistake thinking that an association is causal when it is not.

One of the best ways to avoid making this mistake is to study a phenomenon over time. If a factor in some research subjects is associated with changes over time, and absence of that factor is not associated with the change being examined, causality is more likely.

A good example of this question is the association of hearing loss with the development of dementia. Maybe hearing loss causes dementia because there is decreased nerve stimulation of certain parts of the brain related to auditory and speech processing, but maybe the brain changes are independent of hearing loss or perhaps even the cause of the hearing loss.

This recent report in JAMA Otolaryngology-Head and Neck Surgery, with an accompanying editorial, uses the study of brain changes over time to try to answer this question. The research was done on the well-studied population of the Baltimore Longitudinal Study of Aging. Hearing tests and studies of brain tissue using specialized research techniques were done. Imaging was done by MRI at the National Institute of Aging.

Results showed that poorer hearing at baseline was associated with specific changes in portions of the brain processing auditory input, but not in other areas of the brain. The editorial notes the limitations of the study and its preliminary nature, but the report is another piece of the puzzle linking hearing loss to dementia.

For at least five years, I have been saying, “If it sounds too loud, it IS too loud.” But based on the accumulating evidence of the dangers of noise for hearing loss, and then the impact of hearing loss on social function, economic success, and the development of dementia, I’ve decided to change my advice.

Now I would say, “If it sounds 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.

Could a drug being developed to prevent hearing loss help fight COVID-19?

Photo credit: Martin Lopez from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

As those who follow my writings know, I’m a big believer in the old public health principle that prevention of disease is almost always better and cheaper than treating it. That principle applies to hearing loss. Preserved normal hearing is much better than the best hearing aid, and costs almost nothing–just avoid loud noise or use hearing protection.

But we follow developments in treating or preventing hearing loss caused by noise exposure. The Holy Grail for this research is a drug that people could take after noise exposure, to prevent any lasting auditory consequences. One of these drugs under development is called Ebsalen.

This new report in the peer-reviewed online journal ScienceAdvances discusses repurposing Ebsalen to fight COVID-19 infection.

We think that may be a better use of Ebsalen than its originally intended use.

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.

 

 

 

 

Noise and air pollution may be preventable causes of dementia

Photo credit: Elina Krima from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Noise and air pollution may be preventable causes of dementia. This new study from the Alzheimer’s Association International Conference, reported by Med Page Today, discusses risk factors contributing to dementia. Other than rare genetic conditions, most cases of dementia have multifactorial causation. This makes prevention difficult because multiple risk factors must be addressed.

In general, a healthier lifestyle, including not smoking, eating a Mediterranean style diet, daily exercise, and other similar behaviors, have been shown to reduce or delay the onset of dementia. The new study found that risk factors contributing to dementia include hearing loss, social isolation, depression, and air pollution. These factors have now also been added to the Lancet Commission’s list of key modifiable risk factors for dementia.

Although the study doesn’t mention noise explicitly, noise causes hearing loss. Hearing loss in turn is associated, likely causally, with social isolation. People who can’t understand what others are saying tend to avoid social interaction because it’s too stressful or too embarrassing not to understand what others are saying. Social isolation in turn leads to depression.

With regard to hearing loss, researchers think the loss of auditory input caused by hearing loss also causes changes in the brain that contribute to the development of dementia. Previous studies led by researchers from Johns Hopkins have shown that hearing impairment in people 45-65 years old is related to a progressive loss of nerve cells in brain structures and reduced microstructural integrity that may indicate early Alzheimer disease.

The precise mechanisms by which air pollution contributes to dementia are unclear, but there are strong correlations between levels of pollutants and dementia. Much if not most of urban air pollution comes from particulate matter emitted by internal combustion engines. These are also a major cause of urban noise.

Reducing noise will prevent hearing loss and its consequences. And if noise from vehicles and other engines is reduced, air pollution will also be reduced.

As we have been saying for some years now, a quieter world will be a healthier world for all.

And, one hopes, it will also be a world with less dementia.

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.

Dementia isn’t inevitable, and neither is hearing loss

Photo credit: Andrea Piacquadio from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This new study from the Alzheimer’s Cohorts Consortium, published on an open access basis in the medical journal Neurology, reports that dementia rates appear to be on the decline in Europe and North America. Analyzing results from seven different research studies, the Consortium found that the incidence of dementia declined 13% per decade in the last 40 years, with a confidence interval of 7-19% per decade. The decline was more pronounced in men than in women.

It is difficult to find the cause for the decline, but the researchers think it is due to a focus on treating cardiovascular risk factors, including reductions in smoking, better blood pressure control, and the use of antithrombotic medication. The article states, “[w]hile none of these has been specifically intended to halt cognitive decline, decades of cardiovascular risk management have likely had substantial effects on brain health, supported by reduction of small-vessel disease on brain imaging in more recent years.“

Why am I writing about a decline in dementia in a blog about noise issues?

Is it because research shows that hearing loss is a possible contributing factor to the development of dementia? No, although that statement is accurate.

The reason is that dementia used to be thought of as an inevitable part of aging, but that’s not true. Many cases of dementia have a vascular cause, and can be prevented by treating cardiovascular risk factors.

Similarly, hearing loss is thought to be part of normal aging, as shown by the use of the terms “age-related hearing loss” and “presbycusis”.

I presented a paper at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich in 2017, reviewing literature that showed that hearing loss was not an inevitable part of aging but largely represented noise-induced hearing loss. A recent research paper from the Massachusetts Eye and Ear Infirmary confirms that conclusion using ear tissue from post-mortem specimens.

I’ve said this before, but it bears repeating: If a noise sounds too loud, it is too loud.

If you protect your hearing–by avoiding loud noise and using hearing protection when you can’t–you should be able to hear well when you get old. And maybe you’ll reduce your chance of developing dementia, 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 coronavirus affect the auditory system?

This image is in the public domain

by Daniel Fink, MD, Chair, The Quiet Coalition

Does coronavirus affect the auditory system and the vestibular system that regulates balance? Two recent articles suggest that it might. The research is very preliminary and based on small numbers of subjects, so the results must be interpreted with extreme caution.

The only problem may be that the treatments for coronavirus may also cause auditory damage, especially certain antibiotics with known auditory nerve toxicity, and also unproven therapies like hydroxychloroquine.

The best way to avoid having your auditory system affected by coronavirus is to avoid getting sick.

Follow the recommendations of public health experts, shown to be effective in European and Asian countries: wear a mask, maintain social distance, avoid large crowds and indoor spaces if possible, don’t touch your face, and wash your hands frequently.

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.

Age-related hearing loss is almost certainly noise induced

Photo credit: Andrea Piacquadio from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Hearing loss in old age is often called age-related hearing loss or presbycusis. This implies that hearing loss is part of normal aging, just like the need for bifocals called presbyopia. This article in the Society for Neuroscience’s journal reports that what is commonly called age-related hearing loss is really hair cell loss, indicative of auditory damage caused by noise

That was my conclusion based on a literature review, presented at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich in 2017.

Another recent report, this time in The Conversation, discusses research in fruit flies that may shed light on what the author calls age-related hearing loss. I don’t know how much noise fruit flies are exposed to–laboratory facilities are not quiet–but I suspect that the effects of whatever molecular changes occur in human ears with aging are compounded by cumulative noise exposure over one’s lifetime

Our ears are like our eye and our knees–we only have two of each. We don’t stare into the sun. We wear sunglasses when outdoors in bright light. In fact, sun exposure causes cataracts. We try not to injure our knees, although these can be surgically replaced.

And we need to protect our ears so they last us a lifetime.

Avoiding noise-induced hearing loss is simple: avoid exposure to loud noise, and if one can’t avoid that, use hearing protection.

Because if a noise 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.

Headphone use causes hearing loss

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from the Sydney Morning Herald discusses headphone use causing hearing loss. It uses a term I hadn’t heard before–“headphone culture”–to describe the ubiquitous use of personal audio systems to provide a continuous soundtrack for daily life. There is mounting evidence that noise exposure in everyday life is loud enough to cause hearing loss in a majority of urban dwellers, and that exposure is exacerbated by using headphones or earbuds to listen to music or podcasts for hours a day.

The only quibble I have with the article is that it cites the occupational noise exposure levels of 80 or 85 decibels as being the safe sound threshold. This just isn’t true. Noise exposure levels that don’t even protect all exposed workers from noise-induced hearing loss certainly aren’t safe for the public!

The problem with listening to a personal audio device using headphones or earbuds is that to overcome ambient noise so one can hear what one is listening to, as when walking down the street or riding a bus or subway to work, the volume has to be turned up to dangerously loud levels.

For parents, the problem with children using headphones so they can listen to music or watch a video without disturbing others is that the parents can’t monitor the sound level or what their children are listening to.

The article discusses safer headphones with a volume limit, but my conclusion is that listening to music or podcasts or audiobooks using headphones or earbuds is as bad for the ears as smoking is for the lungs and heart.

Most volume limiting headphones use the occupational 85 decibel recommended exposure level as the volume limit and that simply won’t prevent hearing loss.

There is no safe cigarette, and headphones or earbuds with a volume limit may be safer than those without a volume limit, but they are certainly not safe.

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.