Noise Induced Hearing Loss (NIHL)

New drug may prevent hearing loss after noise exposure

By Daniel Fink, MD, Chair, The Quiet Coalition

For many years, a body of research has shown that chemicals with antioxidant properties might prevent or reduce hearing loss after noise exposure. In animals, noise exposure reduces levels of a chemical called glutathione peroxidase 1 (a naturally occurring enzyme). A recent report in the British journal The Lancet looks at how a similar chemical, ebselen, works in helping to reduce “both temporary and permanent noise-induced hearing loss in preclinical studies.”

It appears to work quite well.

Of course, we at The Quiet Coalition think it’s better just to avoid loud noise exposure, which is 100% safe and effective at preventing hearing loss. That said, the experimental protocol raises interesting questions about research ethics. Namely, the study tested the efficacy of different doses of ebselen after the subjects, healthy adults aged 18–31 years, were exposed to loud sound. The measure of ebselen’s success was the prevention of a phenomenon called temporary threshold shift (TTS), more completely noise-induced temporary threshold shift (NITTS). This audiometric measure has been used for decades to measure the impact of noise on humans.

Unfortunately, recent research, beginning with a 2009 report and updated last year describes a phenomenon called “hidden hearing loss,” a synaptopathy (injury to the synapses in the cochlea) caused by noise exposure. Hidden hearing loss is called that because it is not detected by standard audiometric techniques. Hidden hearing loss is the likely cause of being unable to follow one conversation among many in a noisy environment, or having a normal or near-normal audiogram but still having difficulty understanding speech.

Many experts think that there is no temporary auditory damage. That is, TTS is a real phenomenon but the use of the word “temporary” is misleading because if TTS occurs then it is likely that permanent auditory damage has also occurred.

In this study, healthy young adults were exposed to noise levels loud enough and long enough to cause TTS, likely indicating permanent auditory damage. Some of the subjects were given large enough doses of the experimental drug ebselen to prevent TTS from occurring, but whether the drug would or wouldn’t work, and at what dosage, wasn’t known when the study began. Simply put, the study exposed all subjects to the threat of auditory damage, and most likely caused auditory damage in the subjects who received the placebo or didn’t get a high enough dose of the experimental drug.

All research protocols in the U.S. must pass review by an Institutional Review Board (IRB) which must make certain that steps are taken to prevent harm to research subjects.. Under the Helsinki Declaration of the World Medical Association, and in the United States under what is called the federal “Common Rule” (45 CFR §46 et seq.), human subjects must be protected. If there is a risk of permanent auditory damage when the phenomenon of TTS is observed–and Drs. Liberman and colleagues certainly think that temporary auditory changes denote permanent auditory damage–we think the IRB should have done more to protect the subjects from any possibility of harm.

How could a study that exposes young people to noise levels loud and long enough to cause TTS pass IRB review? We hope the federal Office for Human Research Protections will let us know.

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.

“Baby Driver” highlights the problems of tinnitus

Photo credit: leadfoot licensed under CC BY 2.0

Daniel Fink, MD, Chair, The Quiet Coalition

I am not a moviegoer although my wife would say I am a movie critic, but I can’t comment on the new movie “Baby Driver” because I haven’t seen it. What I can say, based on movie reviews and this online article, is that the lead character has tinnitus from head trauma in a motor vehicle crash, and he plays music constantly to mask it.

Although there are many causes of tinnitus, the most common cause is noise, with a strong correlation between noise-induced hearing loss and tinnitus. Most people with tinnitus have at least some hearing loss, and half of people with hearing loss have tinnitus.

So, movie conventions aside, what’s the best way to avoid developing tinnitus? It’s simple–avoid loud noise and wear hearing 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 Restoration: A Step Closer?

Photo credit: Ronna Hertzano et al. licensed under CC BY 2.5

By Daniel Fink, MD, Chair, The Quiet Coalition

A recent report that scientists in Boston have caused human hair cells to regrow in the laboratory is exciting news, holding out the promise of hearing restoration in the future.

But it is important to remember two facts:

1. Development and then approval of this technology for human use are likely to be years if not decades in the future, and the technology will most likely be very expensive.

2. Noise-induced hearing loss is 100% preventable and prevention is either free or inexpensive: avoid loud noise exposure and use hearing protection (ear plugs or ear muffs) if one 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.

 

Is eating out bad for your ears?

By Daniel Fink, MD, Chair, The Quiet Coalition

We all know from personal experience that restaurants are too loud. In this piece in The Washington Post, Gail Richard, the president of the American Speech-Language-Hearing Association, writes that noise levels in restaurants are loud enough to damage one’s hearing. Specifically, Richard states that “[c]onsistently listening to noise levels above 70 decibels can cause hearing loss over time,” noting that “it is not unusual for restaurant reviewers who regularly list restaurant noise in their reviews to find levels above 70 and even 80 decibels.”

The Quiet Coalition has covered a number of reports about restaurant noise so this information is nothing new, but this opinion piece is a nice summary.

The only thing I disagree with is Richard’s suggestion that restaurants could provide quiet zones for customers with hearing loss or those who prefer less noisy spaces. The idea of “separate but equal” spaces embodied in quiet zones, quiet rooms, or even a request for a quiet table runs counter to the legal requirements of the Americans with Disabilities Act (ADA), which requires that places of public accommodation offer those with disabilities full and equal enjoyment. Someone with complete hearing loss in one ear would appear to meet the ADA definition of having a disability.

Simply put, we shouldn’t have to ask for a quiet table or a quiet room. All restaurants should be quiet enough to allow all customers to converse.

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.

Quiet motorcycles? Tell your neighbor to buy one of these…

Photo credit: Jan Ainali licensed under CC BY 3.0

By David Sykes, Vice Chair, and Jamie Banks, Program Director, The Quiet Coalition

You may be thinking, “quiet motorcycles…how is that possible?” In fact, they already exist—but you might have trouble getting a Harley-riding neighbor to embrace them. For many bikers, noise equals power. But in the case of electric motorcycles there is reason to believe that quiet is powerful too!

Lithium ion battery-powered motorcycles are gaining favor–Consumer Reports is impressed with them. Furthermore, the Department of Defense’s Advanced Research Projects Agency (DARPA) has been working on camo-painted, “stealth” hybrid gas/electric off-road motorbikes.

Motorcycle noise is a serious problem—especially for people who suffer from auditory disorders like partial hearing loss, tinnitus, hyperacusis, and misophonia–for whom the racket from motorcycles can be excruciatingly painful. This may be bikers themselves or people who live in neighborhoods that are regularly exposed to this type of noise. Several years ago, the U.S. National Academy of Engineering (NAE) convened a meeting about the problem of motorcycle noise and issued a report in 2014, though it seems to have fallen on deaf ears outside the NAE.

The noise has become such a problem in so many communities that even Harley-Davidson’s CEO has spoken out about Hog riders who remove their factory mufflers and install ‘straight pipes.’ Officially, the company doesn’t approve of owners tampering with the factory-installed mufflers, but after-market manufacturers are all-too-willing to meet consumer demand for more noise. The best news is that Harley-Davidson is developing an electric-powered motorcycle too.

Motorcycle noise may be a problem that regulation simply cannot fix. Given the current situation, it is unlikely the Environmental Protection Agency will be able to do anything about it. Instead, The Quiet Coalition (TQC) recommends framing motorcycle noise as a public health issue and encouraging a positive, technology-centered approach by businesses:

  • Become familiar with the large body of scientific literature indicating that loud noise is a public health problem. Authorities, including the U.S. Centers for Disease Control, publicize this information on their websites. Like tobacco smoke a generation ago, it will be necessary to engage public health officials before the motorcycle noise be addressed.
  • Urge individuals and groups that oppose motorcycle noise to encourage businesses to develop quieter, electric-powered alternatives. They are cheaper to operate (solar power is getting cheaper by the minute!) and much easier to maintain or repair (fewer moving parts!).

We believe these two steps are the best, most practical way to get action on this contentious issue and can actually lead to results. For example, The Quiet Coalition’s host, non-profit Quiet Communities, has been helping communities make the quiet transition away from fossil-fuel powered devices (namely landscape maintenance equipment) and towards advanced electric equipment and manual tools and emphasizing the compelling business model for users: the new lithium-ion-powered alternatives are cheaper to operate and maintain, they reduce air pollution, and they operate quietly. For some bikers, adopting technologically advanced, non-polluting, quiet alternatives may be appealing, especially if they have had health and hearing problems related to noisy bikes. It would be the start of a movement.

At TQC, we’re cautiously optimistic.

David Sykes chairs/co-chairs four national professional groups in acoustical science: The Acoustics Research Council, ANSI S12 WG44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group. He is also a board member of the American Tinnitus Association, co-founder of the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute, lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), and a contributor to “Technology for a Quieter America” (2011, National Academy of Engineering). 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.

Jamie Banks, PhD, MSc, is the Executive Director of Quiet Communities, Inc.. She is an environmentalist and health care scientist dedicated to promoting clean, healthy, quiet, and sustainable landscape maintenance, construction, and agricultural practices.

The high cost of hearing aids might be coming down

Photo credit: ReSound licensed under CC BY 3.0

Paula Span, the New York Times, writes about legislation making its way through Congress that could make hearing aids cheaper and more accessible. Currently, people needing hearing aids must spend at least $1,500 to $2,000 per hearing aid–double that for a pair–because the price includes bundled audiology services. But under the Over-the-Counter Hearing Aid Act of 2017, the Food and Drug Administration would be charged with creating “a regulatory category for [over-the-counter] devices and to establish standards for safety, effectiveness and labeling.”

One reason hearing aids would be significantly cheaper if this bill is enacted is that consumers would not have to go to an audiologist to get them, as they are required to do today. Rather, consumers could opt to purchase audiology services to help adjust each device, but they wouldn’t be required to do so.

And lowering the cost is important as hearing aid wearers tend to be older and “Medicare coverage of hearing aids [is] prohibited by law.” But can consumers adequately adjust their own hearing aids? Swan reports on an Indiana University double-blind clinical trial where researchers worked with participants who never wore hearing aids before. The researchers “compared the experiences of those randomly assigned to full-bore audiology services and those making over-the-counter selections,” and determined that “[i]t didn’t matter whether the audiologist fitted them or the consumer made his own choice…[t]hey both were effective, and they didn’t differ.” Given that hearing loss has a profound effect on overall health and not just hearing health, providing a low-cost option to seniors makes a lot of sense.

But Daniel Fink, MD, Chair of The Quiet Coalition, says that hearing aids do not work as well as people may suspect, which is why many people who have them rarely use them. Rather than focusing all of our attention and resources on treating hearing loss after it occurs, Dr. Fink believes we should also be focusing our efforts on preventing hearing loss in the first instance. As Dr. Fink notes, noise causes hearing loss, tinnitus, and hyperacusis, and we could greatly diminish the instances of these disorders by reasonably regulating noise and making people aware that loud sound today means hearing loss tomorrow.

Gene may hold key to hearing recovery

Photo credit: Max Pixel licensed under CC0 1.0

by Daniel Fink, MD, Chair, The Quiet Coalition

A recent discovery may explain why noise exposure makes some deaf but not others. Researchers at the University of Rochester Medical Center found that a gene with a possible role in human longevity may also play a role in protecting outer hair cells in the cochlea from damage by noise.

Noise-induced hearing loss is the most common cause of hearing loss. Approximately one-third of Americans reaching retirement age have hearing loss, but two-thirds do not. Little is understood about why noise damages hearing in some people but not in others, and this gene may explain part of this puzzle.

Of course, while scientists are trying to figure this out, we can all avoid noise-induced hearing loss entirely simply by avoiding exposure to loud noise, or wearing ear plugs if we can’t. The only evidence-based safe noise level to avoid hearing loss remains a time-weighted average of 70 decibels a day, as I wrote about in the American Journal of Public Health earlier this year.

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. Dr. Fink is a graduate of the University of Rochester School of Medicine and Dentistry.

Millions of people don’t protect their ears

Photo credit: Quinn Dombrowski licensed under CC BY-SA 2.0

By Daniel Fink, MD

Noise is a medical and public health problem, and yet people ignore it at their own peril. Most of us are exposed to too much noise every day. That may explain why the Centers for Disease Control and Prevention found that about 25% of adults age 20-69 had hearing loss, and that many people with hearing loss didn’t know they had it.

Which is why a recent article by Mark Fischetti in Scientific American,A Loud Warning: Millions of People Do Not Protect Their Ears,” is particularly disturbing. Fischetti reports that while “many people know that they should use earplugs or earmuffs when mowing the lawn or partying at the club,” they don’t protect their ears against noise at home or at work. If you click the link to the article, you’ll see a frightening infographic that very clearly shows that millions of Americans are at risk of losing their hearing or suffering other hearing damage because they fail to protect their ears.

Maybe if people knew that noise caused hearing loss, tinnitus, and hyperacusis–none of which can be cured–they might be motivated to protect their hearing and fight for quiet.

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.

Better Hearing Month 2017 and the problem of noise

By David Sykes, Vice Chair, The Quiet Coalition

Every year since 1927, May has been designated “Better Hearing Month.” What better time to think about what threatens your hearing health? In fact, if you already have some hearing loss you’re one of about 48 million Americans—that’s many more than all of the people with cancer or diabetes combined.

That’s a big number, and yet hearing loss—specifically noise-induced hearing loss (NIHL)–has been overlooked and underfunded for three and a half decades.

Noise is such a simple word–why is it so complex and laden with jargon and specialists who don’t talk to one another? One group is solely concerned with how to measure it (physicists). Other groups focus on specific types and sources of noise, such as jet aircraft, or alarmed medical devices, or leaf blowers, or trains, or highway noise (engineers or advocacy groups). Others concentrate on the effects of noise on humans (doctors and public health researchers), while another group ponders how noise affects organisms other than humans, including plants, birds and other animal species, including those that live underwater (biologists). Still other groups think about how to mitigate noise (architects and designers).

The problem is that over the past three and a half decades, the subject of noise and it’s effects have been systematically ignored and underfunded by Congress and the White House. As a result, “noise”–the cause of NIHL–has become a bewilderingly fragmented field in which few people talk to others outside their own specialities. This has resulted in a subject that is hard to understand and laden with technical jargon. What is “noise”? Why does it matter? Who cares? Has the science progressed? If so, how and where?

But recently that has begun to change thanks to advances in research and to changes in federal policies from several federal agencies that have not traditionally been involved in noise and noise control. These include the Centers for Disease Control and Prevention, NASA, the Department of Health and Humans Services, the Department of Interior, the General Services Administration, the Joint Commission, and others.

In each case, a specific federal department has bitten off a chunk of the noise problem and developed guidelines and programs to fit their own needs. But put all of these disparate pieces together and you will find examples of real progress despite the fragmentation.

To help build general understanding, we ar the The Quiet Coalition have assembled some of these fragments into a diagram or a “Road Map” of noise effects (see chart above) organized by the way they are studied within various specialized fields. We hope this Road Map helps others see the big picture.

In addition to the Road Map, we have also assembled the basic facts about noise into a simple one-page “Fact Sheet” that provides detailed references to scientific literature. Both the Fact Sheet and the Road Map are starting points. At The Quiet Coalition, our goal is to synthesize the underlying scientific research on this complex and fragmented subject into a coherent picture so that we can collectively find ways to talk about it. We hope you find both the Fact Sheet and the Road Map useful as you think about hearing, hearing loss, and that elusive problem, noise.

The underlying question for each of us should be: how can we work together?

David Sykes chairs/co-chairs four national professional groups in acoustical science: The Acoustics Research Council, ANSI S12 WG44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group. He is also a board member of the American Tinnitus Association, co-founder of the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute, lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), and a contributor to “Technology for a Quieter America” (2011, National Academy of Engineering). 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.

Massachusetts Medical Society: No to noisy leaf blowers

Photo credit: Hector Alejandro licensed under CC by 2.0

By Jamie L. Banks, PhD, MSc, Program Director, The Quiet Coalition

Are health concerns about gas-powered leaf blowers (GLBs) gaining momentum? On April 29th, the Massachusetts Medical Society (MMS) became the second in the nation to approve a resolution against GLBs, following the lead of the Medical Society of the State of New York (MSSNY). Other physician groups, such as Utah Physicians for Healthy Environment and Fresno Madera Medical Society, have also issued warnings on the use of GLBs and other fuel-powered lawn and garden equipment. The resolution brought by the society’s Committee on Environmental and Occupational Health and its chair Heather Alker, MD, MPH, recommends that the MMS:

  • Recognize noise pollution as a public health hazard, with respect to hearing loss;
  • Support initiatives to increase awareness of the health risks of loud noise exposure;
  • Urge the maximum feasible reduction of all forms of air pollution, including particulates, gases, toxicants, irritants, smog formers, and other biologically and chemically active pollutants; and
  • Acknowledge the increased risk of adverse health consequences to workers and general public from gas-powered leaf blowers including hearing loss and cardiopulmonary disease.

The growing concern on the part of the medical community over leaf blower noise is welcome news. Commercial GLBs can produce noise of 95 decibels and higher at the ear of the operator. This noise level exceeds safe occupational levels by an order of magnitude. The close proximity use of these powerful engines exposes both workers and others in the area to prolonged periods of excessive noise, not to mention toxic air pollutants. The presence of a low frequency component in the leaf blower’s frequency band distribution (i.e., the device’s sound signature) enables it to travel over long distances and through walls and windows.

The MMS resolution notes the harms to hearing and health from excessive noise produced by GLBs. Loud noise is known to cause hearing loss, tinnitus, and hyperacusis, as well as other health problems such as high blood pressure and heart disease. In addition, loud noise has negative effects on quality of life, communication and social interaction, work productivity, and psychological well-being.

The burgeoning use of GLBs and other fossil fuel powered equipment around our homes, schools, and other public spaces is a public health hazard, and a growing number of physicians and other health professionals are becoming concerned. The moves made by MMS and MSSNY are to be lauded, and other state societies and medical groups, including the American Lung Association and American Heart Association, need to prioritize this issue.  With the body of scientific evidence on the harms associated with noise and pollution, other state and national medical societies have a critical role to play in educating government officials and the public about the connections between environmental hazards and disease and the actions we can take to reduce risks in our communities.

Jamie L. Banks, PhD, MSc, is the Executive Director of Quiet Communities, Inc. and the Program Director of The Quiet Coalition. She is an environmentalist and health care scientist dedicated to promoting clean, healthy, quiet, and sustainable landscape maintenance, construction, and agricultural practices. Dr. Banks has an extensive background in health outcomes and economics, environmental behavior, and policy.

Source: Quiet Communities

Originally posted at The Quiet Coalition.