Hospital Noise

Why hospitals should let you sleep

Photo credit: Ivan Obolensky from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece by Austin Frakt in the New York Times discusses the need for hospital patients to get more sleep, and the many things that disrupt a patient’s sleep when they are in the hospital. The list of culprits is obvious: alarm noise, carts in the hall, blood draws, vital signs measurements, and so on.

Uninterrupted sleep is important for everyone, not just hospital patients. Anything that interrupts sleep–horns, sirens, road traffic noise, train horns, aircraft noise, horn-based alerts, patrons exiting a nightclub or bar at closing time–is a health hazard.

I have no doubt that if enough people complain to enough elected officials about health problems caused by noise, governments at the local, state, and national levels will take action to make our cities and towns quieter.

It worked for smoke-free restaurants, workplaces, airplanes, and in some states even smoke-free beaches and parks.

Let’s all resolve to work together for a quieter world in the New Year.

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.

Hospitals can be made quieter

by Daniel Fink, MD, Chair, The Quiet Coalition

This BBC report informs us that hospitals can become quieter. Anyone who has been in a hospital–and I have spent decades working in them–knows that despite signs encouraging quiet, they have become noisier. And studies document that, too.

But with a little effort, they can be made quieter.

Most people aren’t aware of major efforts–coordinated over the last several years and involving specialty societies and expert groups setting goals and developing standards to be implemented by hospitals, health care professionals, emergency services responders, and an informed public–that have dramatically improved medical care and patient outcomes for serious medical problems. When someone calls 911 to report a heart attack or stroke, an entire team is mobilized to treat the patient with clot-busting drugs as quickly as possible, ideally within only 60 minutes of the event. These “Code White”, “Code Stroke”, or “Stroke Attack” programs mean that the patient usually walks out of the hospital not only alive but with minimal or even no residual effects from the heart attack or stroke.

If the health care system can organize itself to treat these serious medical problems so quickly that the patients recover without harm, it should be able to work towards making hospitals and other health care facilities quieter. This isn’t rocket science. It’s basic acoustic engineering.

Members of The Quiet Coalition also serve on committees for the Facilities Guidance Institute, which sets standards for health care facilities. There are guidelines and standards for noise levels. The next edition of the guidelines, set to be published in 2022, will address the noise issue more vigorously.

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.

MRIs are dangerously noisy

Photo credit: liz west licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

MRI noise is in the news in two recent reports.

People magazine reported the story of a woman who suffered permanent auditory damage from an MRI, developing hyperacusis (a sensitivity to noise, which causes pain) and tinnitus. The Quiet Coalition’s Bryan Pollard, an expert on hyperacusis, is quoted in the article.

And researchers from SUNY Buffalo and China wrote about MRI noise in The Hearing Journal.

Standard MRIs produce noise in the 110-115 decibel range, and newer more powerful MRIs are even louder. Knowing this, I have several quibbles with the information in The Hearing Journal article. Namely, the article cites occupational noise exposure standards, but these use A-weighted decibels (dBA) to reflect the frequencies of human speech. MRI noise is low frequency noise, so occupational noise limits may not protect hearing adequately. And occupational standards are not safe standards for the public. At least 25% of workers exposed to sound at occupational noise exposure standards will develop hearing loss.

Most importantly, for many people the auditory damage caused by MRI noise isn’t hearing loss but tinnitus and hyperacusis, as in the People magazine article. Exactly how noise causes tinnitus and hyperacusis isn’t yet known, but the mechanisms are likely different from cochlear hair cell damage causing noise-induced hearing loss.

Finally, the authors talk about temporary auditory damage, but many researchers think that any temporary auditory changes indicate that permanent damage has been done.

I can’t find any large-scale studies of auditory problems after MRIs–the equipment manufacturers wouldn’t be excited about funding such a study, and radiologists are interested in the image, not in the patient’s hearing–but anecdotal reports from audiologists indicate that this is a problem for too many people undergoing diagnostic MRIs.

So if you need an MRI, be sure to ask for “dual protection”– ear plugs and ear muffs. NIOSH recommends dual protection for noise exposure over 100 dBA.

And if you suffer auditory damage from an MRI, be sure to file a report with the FDA. That’s the only way the government will be induced to issue appropriate patient safety regulations.

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.

Alarming: No end to hospital noise

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

Three years ago, the voluntary hospital accreditation body in the U.S. known as The Joint Commission issued a “National Patient Safety Goal” about the problem of “alarm fatigue” in American hospitals.  When the Joint Commission speaks, hospitals usually listen because their ability to participate in the Medicare program depends on the Commission’s approval. So what’s happened?

In a word: nothing. Last week, in a paper presented at the Acoustical Society of America meeting in New Orleans, the distinguished researcher and former ASA president Ilene Busch-Vishniac spoke about this continuing failure to address patient safety in hospitals.

What’s alarming about this situation is that 11 years ago Dr. Busch-Vishniac, when she was Dean of Johns Hopkins’ School of Engineering, published a nationally recognized paper on this very problem, a paper that has become a classic in her own field. Furthermore, in 2011 she was recognized for this work and invited by the Food and Drug Administration, the Joint Commission, and the Association for the Advancement of Medical Instrumentation to speak to national leaders of the healthcare profession about this problem at the first national meeting convened to focus on the problem of “alarm fatigue.” Thereafter Dr. Busch-Vishniac has continue to write and speak about the subject, for instance in this piece last year.

Noise in hospitals—of which “alarm fatigue” is the most egregious example—is a problem precisely because it endangers the health and even the survival of the thousands of people whose health is already severely compromised (they are hospitalized, after all). It’s critically important.

What this deplorable situation illuminates is the long-standing refusal of federal, state and local agencies in America to recognize that noise is, as one prominent medical authority stated, “much more than a nuisance.” Indeed, it is a serious public health problem. Why can’t the most “at risk” population in America—people hospitalized for their illnesses—have access to the peace and quiet they need to recover? If you are bothered by noise—from aircraft, or from motorcycles, or from leaf blowers or from any other source—keep in mind that you are not alone: even the sickest among us who are being treated in hospitals cannot escape the din.

Nobody is listening—yet—despite the evidence. In the meantime, we congratulate courageous and stubborn researchers like Dr. Busch-Vishniac who continue to push for change.  We need you, Dr. Busch-Vishniac. The money to fund research is hard to come by, but please don’t give up!

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.