Hidden Hearing Loss

Why can’t you hear?

Photo credit: Helena Lopes from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece in the Canadian edition of Psychology Today asks “Why can’t you hear?,” but a better title might be “Why can’t you understand speech in a noisy room?”

This problem is known in audiology circles as the “speech in noise” problem. People can understand what someone is saying just fine in a quiet room, but can’t follow a conversation in a noisy one. The problem has been known for decades, but now it is thought that the cause is cochlear synaptopathy, also called hidden hearing loss because hearing test results–technically known as pure tone audiometry–are normal despite the patient’s complaints of not being able to hear.

The problem can be assessed clinically by a number of tests, including the Hearing in Noise Test and the QuickSIN test. Now researchers at the Massachusetts Eye and Ear Infirmary have developed two tests, one measuring pupillary responses and the other recording electrical signals from the ear drum.

The inability to understand speech in noise is a frustrating one. Hearing aids usually don’t help much, although newer digital hearing aids with special features claim to do better.

Much better than any hearing aid, though, is preserved natural hearing. Protect your ears. If something sounds too loud, it is too loud. Turn down the volume, use hearing protection, leave the area, or you might have speech n noise difficulty later.

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.

A test for hidden hearing loss?

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from Science Daily discusses research at the Massachusetts Eye and Ear Infirmary, trying to find a test that will diagnose hidden hearing loss. Hidden hearing loss is hearing loss not detected by routine pure-tone audiometry, so patients complain of being unable to understand speech in normal environments but their hearing test is normal.

Right now, testing for hidden hearing loss is not clinically available, so any test that may help diagnose this common condition would be welcome.

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.

Popular Science looks at hidden hearing loss

Photo credit: Maurício Mascaro from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This well-written article in Popular Science discusses hidden hearing loss. Hidden hearing loss is caused by damages to the nerve junctions between the cochlear hair cells and the auditory nerves. It’s called “hidden” because the damage isn’t detected by standard pure tone audiometry tests, only by more sophisticated testing. Patients complain that they can’t understand what people are saying in crowded or noisy situations, but the audiologist tells them, “Your hearing is fine. There’s no problem.” For decades, this was known as the “speech in noise” problem.

It turns out that there is a problem, and it’s caused by damage to the nerve junctions, which interferes with processing of the sound by the nervous system.

The problem of understanding speech in noise, which is most likely a manifestation of hidden hearing loss, isn’t rare. Approximately 10-20% of adults appear to have it, and it may even be more common in those of middle-to-older age.

More evidence supporting the need for us to protect our ears from loud noise.

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.

Hidden hearing loss

Photo credit: Daria Shevtsova from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Hidden hearing loss is the term used to describe nerve damage in the inner ear (cochlear synatptopathy) which causes hearing loss detected only by special research techniques, not by standard hearing testing (pure tone audiometry). That’s why it’s called “hidden.” The clinical manifestation of hidden hearing loss is thought to be difficulty understanding speech in a noisy environment, but auditory training might help improve understanding of speech in noisy places.

This article describes a survey of adults who were asked if they would be willing to participate in auditory training. What’s of interest to me is that 22% of adults surveyed report having difficulty understanding speech in a noisy environment. That fits with other reports I’ve seen, but I think it’s an underestimate.

Many people with hearing loss think their hearing is excellent, and I think the same is true for people asked about difficulty understanding speech in a noisy environment. Due to the stigma of hearing loss, no one wants to admit that he or she has a problem.

More importantly, if people have difficulty understanding speech in noisy environments, it would seem to be much easier to make those environments quieter, rather than offering auditory training to those with the problem.

Quieter environments would make it easier for everyone to converse, and would prevent auditory damage in those without it.

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.

New Yorker writer worries about her ears–you should be worried, too

Photo credit: Scott Robinson licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

New Yorker staff writer Amanda Petrusich is worried about what noise is doing to her ears.

She’s right to be worried. We all should be worried.

As the world has gotten louder–perhaps because “everyone knows” that 85 decibels is safe because the National Institute for Deafness and Other Communication Disorders tells us “long or repeated exposure to sound at or above 85 decibels can cause hearing loss”–a vast uncontrolled experiment is taking place in the U.S., with 320 million subjects.

Gregory Flamme and colleagues showed that 70% of adults in Kalamazoo County, Michigan got total daily noise doses exceeding Environmental Protection safe noise levels for preventing hearing loss.

Not surprisingly, researchers at the Centers for Disease Control reported a year ago that 25% of American adults have noise-induced hearing loss, including many people without any occupational noise exposure.

Remember, 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 is above 75 A-weighted decibels, which also happens to be the auditory injury threshold.

Your ears are like your eyes or your knees. You only have two of them. Keep them away from loud noise and they should last you your entire life.

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.

Noise is causing hearing loss in traffic police in India

Photo credit: GPS licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from the Indian city of Pune documents hearing loss in traffic police. Apparently car horns are the main culprit. So how bad could it be?  This bad:

A study of 46 traffic personnel “found that 39 of the 46 traffic personnel could not pick up high frequency tones, indicating alarmingly high (83%) presence of noise-induced hearing loss (NIHL) among the city’s traffic police.”

And the damage isn’t limited to hearing loss, as “the traffic personnel were also screened for hypertension,” and “13 of the 46 traffic personnel have been diagnosed with hypertension, a condition they were unaware about.

I have traveled in India, although not to Pune, and it is a noisy country. The big cities–Mumbai and Delhi–are noisier than New York City, so this report isn’t a surprise to me.

But there’s no reason to believe that ears in India are different from ears in the U.S. Traffic noise causes hearing loss and other health problems in the U.S., too.

Perhaps India–and the U.S.–should follow Kathmandu’s successful effort at eradicating traffic noise, because it can be done if the political will exists.

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.

How likely are you to get tinnitus from clubbing?

by Daniel Fink, MD, Chair, The Quiet Coalition

This article from the UK asks the question: How likely are you to get tinnitus from clubbing?

The article points out that there really isn’t any way to predict who will develop tinnitus, i.e., ringing in the ears, after noise exposure, and that’s the most important thing to know.

I didn’t know that a one-time exposure to loud noise could cause tinnitus the rest of one’s life. I developed tinnitus (and hyperacusis, a sensitivity to noise that doesn’t bother others, with noise causing pain in the ear) after a one-time exposure to loud music in a restaurant on New Year’s Eve ten years ago.

Fortunately, there is one simple rule to protect your ears: if it sounds too loud, it IS too loud.

If you can’t carry on a conversation without straining to speak or to hear, the ambient noise is above the auditory injury threshold of 75 A-weighted decibels, and your hearing is being damaged.

Research done over the last decade strongly suggests that there is no temporary auditory damage. In animal models, loud noise damages the synapses (nerve junctions) in the ear before it damages the hair cells. This damage isn’t detected by standard hearing tests (pure tone audiometry) but likely is the major reason why adults have difficulty following one conversation among many in a noisy environment.

Remember, your ears are like your eyes or your knees–God only gave you two of them! Take care of them, and they will last you your whole life.

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.

Four in 10 UK adults unknowingly endanger their hearing on a daily basis

Photo credit: Gary J. Wood licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This report states that 40% of adults in the United Kingdom (England, Scotland, Wales) unknowingly endanger their hearing on a daily basis.

This finding fits neatly with Dr. Gregory A. Flamme’s report that 70% of U.S. adults get total noise doses exceeding safe limits and Dr. Richard Neitzel’s similar finding in a Swedish population.

This isn’t rocket science–noise exposure for the ear is like sun exposure for the skin. If you don’t want deep wrinkles, age spots, and skin cancers when you get older, wear a hat, long sleeves, sunscreen, and avoid the sun.

If you don’t want hearing aids when you get older, avoid noise exposure.

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.

Will earbuds ruin my hearing?

Photo credit: Marcus Quigmire licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The headline for this article in Time magazine is “Will earbuds ruin my hearing?” The short answer is that it’s not the earbuds or headphones that damage hearing, but the noise emanating from them. The longer answer follows.

The article widely cites Dr. Robert Dobie at the University of Texas Health Science Center at San Antonio who says that earbud use isn’t a problem.

It also cites Harvard researcher Dr. M. Charles Liberman, who, with Dr. Sharon Kujawa, discovered the phenomenon now known as hidden hearing loss. This is damage to nerve junctions (synapses) in the ear, called hidden because it is not detected by standard hearing tests.

Dr. Liberman says that earbud use might be a problem.

Dr. Dobie’s assertion that earbud use isn’t a problem sounds just like the doctors in the 1950s and 1960s who insisted that smoking cigarettes wasn’t harmful to health. We now know differently.

My conclusion is that noise causes hearing loss. The human ear was not designed to withstand loud noise exposure because such a tolerance offered no evolutionary advantage. As I wrote in the January 2017 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 day. I further explained, in a requested blog post for AJPH, that the real safe noise exposure level is probably lower than that.

We know, from decades of research on occupational noise exposure that led to the occupational safety criteria for noise exposure, from the work of Liberman and colleagues, and from hundreds or thousands of studies showing that noise damages hearing in animals and humans with the cellular and sub-cellular mechanisms of how this occurs now precisely understood that noise causes hearing loss.

If you believe Dr. Dobie, continue to listen to your personal music player using earbuds or headphones.

If you don’t want hearing aids when you are older (and I don’t think hearing loss is part of normal aging, as I said at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich in June 2017) my advice is not to use earbuds.

Your ears are like your eyes or your knees. God only gave you two of them. Protect them and keep them safe and working well your entire life.

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.

Groundbreaking research proves restaurants are too noisy

by Daniel Fink, MD, Chair, The Quiet Coalition

New York based researcher Greg Scott presented a groundbreaking study Tuesday, December 5th, at the 174th meeting of the Acoustical Society of America in New Orleans, Louisiana. Mr. Scott reported actual decibel measurements, obtained using the free IOS SoundPrint app he developed, on almost 2,000 restaurants and bars in New York City. The average sound level was 78 A-weighted decibels (dBA) in restaurants, and 81 dBA in bars.

Even people with normal hearing can’t understand speech if the ambient noise is above 75 dBA, which is also the auditory injury threshold (the noise level at which hearing damage begins). People with moderate hearing loss–25-40 dB decrement in hearing–need ambient noise lower than 60 dBA to be able to understand speech.

The SoundPrint app is easy to use and can help find quieter restaurants and the rare quiet bar. But it is clear to me–as I stated in my own talk, which preceded Greg’s–that high ambient noise in restaurants and retail stores is a disability rights issue for people with hearing loss, tinnitus, and hyperacusis. The Americans with Disabilities Act (ADA) guarantees people with disabilities the full and equal enjoyment of places of public accommodation, which are basically any facility open to the public. If one can’t hear in a noisy place, one’s ADA rights are being violated. It is likely that legal action will be required to make these places quieter.

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.