Noise-induced Hearing Loss (NIHL)

March 3 is World Hearing Day

by Daniel Fink, MD, Chair, The Quiet Coalition

For the past several years, the World Health Organization has sponsored World Hearing Day, one day during the year when WHO draws attention to hearing health issues.

Each year WHO selects a theme for its communications. This year, the theme is “Hear the future.” With the theme “Hear the future,” World Hearing Day 2018 will draw attention to the anticipated increase in the number of people with hearing loss around the world in the coming decades. It will focus on preventive strategies to stem the rise and outline steps to ensure access to the necessary rehabilitation services and communication tools and products for people with hearing loss.

There are many causes of hearing loss–congenital conditions, repeated ear infections, head trauma, degenerative genetic conditions, various chronic diseases, and ototoxic drugs among them–but the most common cause of hearing loss is noise exposure.

Which should give us a sense of hope in the fight against hearing loss, because unlike other causes, noise-induced hearing loss is 100% preventable.

Remember: if it sounds too loud, it IS too loud!

Your ears are like your knees or your eyes: you only have two of them. Take good care of them, protect them from loud noise, and you will be able to hear well all your 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.

A wave of hearing loss in young people is being predicted

and the cause of this epidemic, says Teresa Cowie, Radio New Zealand, is damaging levels of sound from personal audio devices and noisy venues, like nightclubs. Will it really be an epidemic? Cowie cites the World Health Organization, which puts the number of at risk teenagers and young adults at more than a billion. Who are these at-risk young people? Mostly 12-to-35 years olds in well off countries who listen to unsafe levels of sound on their personal audio devices and smart phones.

So how does the WHO and other health organizations know that an epidemic is on the way? Cowie interviewed Peter Thorne, an audiology professor at Auckland University, who said “[t]here are some studies where younger people coming into the workforce, areas where they might take audiograms or do hearing tests – like the military for example – and those studies have shown a proportion of youth coming in with hearing losses.”

Thorne notes that the rules for limits on sound volume are voluntary for the manufacturers of personal audio devices, but the WHO is “currently review regulations around the volume levels devices should be allowed to reach.”

Let’s hope that the Centers for Disease Control and Prevention and other government agencies join in the effort to regulate the sound levels on these devices. Noise-induced hearing loss is 100% preventable, after all, and given that there is no effective treatment or cure for hearing loss, anything less than a robust response would be criminal.

 

 

Loud music can damage classical musicians’ hearing, too

Photo credit: Derek Gleeson licensed under CC BY-SA 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

When we think of music damaging the ears, we think of rock musicians, many of whom unfortunately have noise-induced hearing loss or tinnitus, or of young people going to clubs or rock concerts. We don’t think of classical musicians.

But loud noise doesn’t discriminate–it can damage anyone’s ears, including workers, hunters, and yes, even a professional viola player.

These two reports describe an ongoing legal case in London, where a viola player has sued the Royal Opera House for damage he claims occurred during a Wagner performance, despite wearing ear plugs.

The Royal Opera House is claiming that such damage isn’t possible, and that it isn’t responsible, but I would disagree. It’s hard to study the effects of intermittent or impulsive noise exposure even in the occupational setting, but several facts are well-established:

  1. extremely loud sound can cause mechanical disruption to structures in the inner ear;
  2. there are marked variations in individual sensitivities to noise damage, which are not well understood; and
  3. many people do not get sufficient protection from ear plugs due to poor fit or improper use, even with instruction and practice.

The resolution of this case is not up to us but within the purview of the court.

But the lesson we can all learn is that “if it sounds too loud, it IS too loud.”

And if noise is bothersome, that’s the signal to leave immediately, before your ears are damaged. After all, unlike knees or hips, they can’t be replaced.

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.

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.

London Underground noise could damage hearing

by Daniel Fink, MD, Chair, The Quiet Coalition

Anyone who has ever taken the Underground (the subway, also known colloquially as the Tube) in London, as I have, knows that the trains there are noisy. Some lines date back to Victorian times, and on many lines the cars are decades old.

This report from the BBC documents how loud–greater than 105 decibels on many lines.

Transport for London, the quasi-governmental agency operating the Underground, downplays the risk. London Underground’s Nigel Holness said it monitored noise levels on the network and was investigating other ideas to “further reduce noise.” He added that, “[w]hile customers travelling on our network can experience noise, higher volumes tend to be for short periods of time and Health & Safety Executive guidance on noise suggests it is highly unlikely to cause any long-term damage to customers’ hearing.”

I would disagree.

The United Kingdom’s Health and Safety Executive, its equivalent of the U.S. Occupational Safety and Health Administration, offers a “Noise Exposure Daily Reckoner” that allows workers, or in this case commuters using the Underground, to calculate their daily noise doses. Only 15 minutes at 105 decibels gives the exposed person a total daily noise dose of 90 decibels. That’s enough noise exposure to cause hearing loss over time. Those who spend an hour a day get the equivalent of a total daily noise dose of 96 decibels, which for sure will cause noise-induced hearing loss over time.

Many London commuters probably spend that much time each day in the Underground and in other trains or buses, maybe even more for those with long commutes.

And even strict adherence to recommended occupational noise exposure levels doesn’t protect all exposed workers from hearing loss.

Noise is different from other occupational exposures, e.g., ionizing radiation or toxic solvents, in that exposure continues outside work, all day long, all year long, for an entire life. I haven’t found a similar study for the UK, but Flamme et al. in the U.S. showed that 70% of adults in quiet Kalamazoo County, Michigan–where there is no Underground and the Subway is a fast-food restaurant chain–received total daily noise doses in excess of Environmental Protection Agency safe noise exposure levels. There is no reason to think that London is any quieter. I know from my personal observations in London, and from following reports from Pipedown about too-loud background music in the UK and from Action on Hearing Loss’s campaign for quieter restaurants, that noise exposure is certainly a problem there.

As Transport for London might say, “Mind the gap.” But in this case, the gap is going to be in its riders’ hearing.

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.

Gene therapy is great, but can anyone afford it?

by Daniel Fink, MD, Chair, The Quiet Coalition

Science holds great promise for treatments and cures. Among the areas of research in treating or curing hearing loss or even total deafness is gene therapy. Scientists at Columbia University and Stanford University and elsewhere are already working on this.

The main concern I have about gene therapy is its cost. A new treatment for a rare form of blindness costs $850,000. A recently approved gene therapy for a rare form of leukemia costs $500,000.

No one can predict how much a gene therapy treatment for hearing loss or deafness will cost, but the ballpark is several hundred thousand dollars. For a condition affecting 50 million Americans, that’s more than our country can afford. Insurance premiums would have to increase ten or one hundred times if health insurance or pharmacy benefits paid for the drug, or there would be prohibitive cost sharing. Out of pocket costs would be more than anyone except a few multimillionaires or billionaires could afford.

And the sad part is that the overwhelming majority of hearing loss in adults–I estimate up to 90% of all cases of adult hearing loss–is noise-induced hearing loss, which is 100% preventable.

My advice: avoid loud noise. If it sounds too loud, it IS too loud. Protect your ears. Like your eyes and knees, God only gave you two of them, and they have to last a whole lifetime!

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.

Ringing ears is a sign of permanent damage to hearing

by Daniel Fink, MD, Chair, The Quiet Coalition

This article from the Cleveland Clinic makes the point that ringing in the ears–the technical term is tinnitus–after loud noise exposure indicates that permanent damage has occurred to the ears.

That’s good to know. I didn’t know that before a one-time exposure to loud noise ten years ago caused tinnitus for the rest of my life.

But I disagree strongly with two things Sharon A. Sandridge, PhD, Director of Clinical Services in Audiology at the Cleveland Clinic, says in the online article.

One is her statement, “[a]s you get older, it’s natural to experience some hearing loss.”

No, it’s not natural to experience hearing loss with age. Hearing loss with age is very common, but it is not part of normal healthy aging, representing largely noise-induced hearing loss. I spoke about this last year at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich.

Dr. Sandridge’s second erroneous statement, with much more serious implications, is “[a] majority of people are safe listening to 85 dB for eight hours.”

This is just wrong! The National Institute for Occupational Safety and Health (NIOSH) doesn’t think so and neither do I.

Eighty-five decibels–actually 85 A-weighted decibels (dBA) which usually measure 5-7 decibels lower than unweighted sound measurements–is the occupational noise exposure standard from NIOSH that even with strict time limits doesn’t protect all exposed workers from hearing loss.

The mathematics of the logarithmic decibel scale mean that after 2 hours of 85 dBA noise exposure, it is impossible to attain the only evidence-based safe noise level to prevent hearing loss, 70 decibels time-weighted average for 24 hours.

Most Americans are exposed to too much noise. Because of that, about 25% of American adults have noise-induced hearing loss, including many without any occupational exposure.

We’re running a great natural experiment–does noise exposure cause hearing loss?–and the answer is obviously “yes”.

And statements like those of “experts” like Dr. Sandridge, minimizing the health risks of noise exposure, are unfortunately part of the problem.

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.

Australians are in danger of hearing loss

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from the National Acoustic Laboratory at Australia’s Macquarie University found that 1 in 10 Australians used personal listening devices (PLDs) at dangerously high volumes.

Not surprisingly, those who reported using the devices at high volumes also reported more difficulty hearing things.

Only the abstract is available without a subscription, so I can’t comment on details of the study, which would be stronger if actual hearing tests had been done on the subjects, but the final line of the abstract is one that I agree with entirely:

Although PLD use alone is not placing the majority of users at risk, it may be increasing the likelihood that individuals’ cumulative noise exposure will exceed safe levels.

And that’s the problem with studies focusing just on personal listening device use. They are only one small part of the total daily noise dose. Flamme, et al., found that 70% of adults in Kalamazoo County, Michigan received total daily noise doses exceeding the Environmental Protection Agency’s safe noise limit of 70 decibels time weighted average for a day. That’s why the Centers for Disease Control (CDC) recently reported that almost 25% of American adults had noise-induced hearing loss, many if not most without occupational exposure.

As the CDC states, noise-induced hearing loss is preventable. No noise, no hearing loss.

Protect your ears now and you won’t need hearing aids later.

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.