Noise-induced Hearing Loss (NIHL)

Football stadium noise still here for another season

by Daniel Fink, MD, Chair, The Quiet Coalition

It’s been years since I’ve been to a college football game. The last games I attended were at the Los Angeles Coliseum, one of the quieter big-school stadiums, during the Pete Carroll era at USC. But I have read about and written a number of stories on stadium noise. Here is the latest story about the stadium noise at the University of Oregon’s Autzen Stadium.

This article, like every other article about stadium noise, says the same things: the noise is distracting so the coaching staff makes the team practice with loud music being blasted at them. Why is it understood that the coach should “condition” his team rather than demand that the noise level be controlled? Simply put, crowd noise shouldn’t be a factor in a football game. What Coach Riley (and everyone else attending the game) doesn’t know is that if it’s loud enough to impact play on the field, it’s loud enough to cause auditory damage.

The Quiet Coalition is still waiting for the National Collegiate Athletic Association (NCAA) and its member colleges and universities–many of which have medical schools, schools of public health, audiology programs, or all three–to do something to protect the hearing of their student athletes and those attending the games. At least this University of Tennessee audiology professor understands the problem, which is why she recommends that students use earplugs when they attend UT football games. Kudos Dr. Patti Johnstone! But rather than having students block the noise, why not demand that the university control the noise in the first instance?

And as this article shows, stadium noise is a factor in professional games, too. In fact, stadium noise probably contributed to the Los Angeles Chargers recent loss in Denver.

Should football games be decided on the field, or by the home crowd purposefully making too much noise for the visiting team to hear the play being called? Whatever happened to good sportsmanship?

Sadly, it appears the NCAA, professional football teams, and stadium owners won’t address noise until and unless someone sues them because they developed sudden hearing loss or tinnitus after attending a game. Let’s hope that happens before many players and fans suffer significant hearing loss or develop tinnitus.

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.

Here’s the best mass-media article on noise-induced hearing loss

Photo credit: rainy city licensed under CC BY-ND 2.0

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

Despite impacting 48 million Americans, noise-induced hearing loss (NIHL) has languished in the shadows for decades. But that’s changing! Check out the 17-page beautifully illustrated article in the September issue of Real Simple magazine*, a Time/Life publication with 8.5 million readers nationwide (that’s eight times larger than the New York Times readership of 1.1 million).

If you’ve been looking for a “quick overview” you can hand to friends and family who fail to understand America’s unrecognized problem with hearing loss—whether it’s your kids’ and their constant earbud (ab)use, friends who can’t understand conversations when you’re dining out, or an elderly relative who’s stopped paying attention and is increasingly depressed—this article should get the conversation started. And if they ask “what else can I read about this?” Tell them to look at this issue of Scientific American, new information from the Centers for Disease Control, and this one-page Fact Sheet on the health effects of noise that The Quiet Coalition (TQC) published in 2016.

It’s clear that NIHL is, as TQC’s chair, Daniel Fink, MD, says, “a growing problem in America nearing epidemic proportions.” But there’s a lot of work to do to get people (including the nation’s leaders) to understand that this is a legitimate public health problem. Frankly, the European Union and Asia are far ahead of us on this issue.

In the meantime, take heart: major media are beginning to notice! Congratulations to the editor of Real Simple for recognizing this growing health crisis. We are extremely grateful that her magazine cited three of TQC’s Steering Committee experts in this piece–Rick Neitzel, PhD, Arline Bronzaft, PhD, and Bradley Vite–and also
described two practical success stories. We hope Real Simple will continue to cover this issue and give it the attention it deserves.

We have only one complaint: the magazine erroneously states that 85 dB is the threshold of hearing damage. In fact, research has shown that permanent hearing damage starts at noise levels as low as 75 dB; furthermore, non-audiological health effects, such as cardiovascular effects, can be caused by noises as low as 55 dB.

*NOTE: the best place to find Real Simple magazine may be at the checkout counter at Whole Foods or a local book store. Or you can get it here.

Originally posted at The Quiet Coalition.

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.

How to motivate millennials to protect their hearing at work

by Daniel Fink, MD, Chair, The Quiet Coalition

The Quiet Coalition doesn’t spend much time worrying about occupational noise because our focus is on protecting the general public from noise. Workers’ ears are protected by regulations drafted and enforced by the Occupational Safety and Health Administration and similar state agencies. Moreover, workers generally have health care for occupational injuries, and are compensated for work-related permanent damage (including hearing loss) by state-administered workers compensation systems. If occupational hearing loss is established, hearing aids may be provided for those with occupational hearing loss.

From time to time we will agree with the many observers who think that the occupational noise exposure limit–90 A-weighted decibels for 40 hours a week, 240 days a year, for 40 years, causing excess hearing loss in 25% of exposed workers–is set too high, but at least workers have that meager protection. There are no such protections for the public, and no compensation for hearing loss, either.

That said, we’re making an exception to share with you this well-written article in Occupational Health & Safety Magazine. It’s focused on preventing hearing loss in younger workers, but it provides good information for everyone who is concerned about their 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.

There is nothing inevitable or natural about chronic disease

Photo credit: Robbie Sproule licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This thoughtful piece talks about chronic disease, pointing out that it is not inevitable or natural. The author, Dr. Clayton Dalton, writes that:

[T]raditional cultures across the globe, from hunter-gatherers to pastoralists to horticulturists, have shown little evidence of chronic disease. It’s not because they don’t live long enough – recent analysis has found a common lifespan of up to 78 years among hunter-gatherers, once the bottlenecks of high mortality in infancy and young adulthood are bypassed. We can’t blame genes, since many of these groups appear to be more genetically susceptible to chronic disease than those of European descent.

So what is the reason for the absence of chronic illness among these cultures? “Evidence suggests it is how they live,” Dr. Dalton replies. And what factors do these different cultures share?  Dr. Dalton writes that the “common denominator [is] defined by the absence of modern banes: absence of processed foodstuffsabsence of sedentary lifestyle, and likely absence of chronic stressors.”

Dr. Dalton doesn’t specifically mention noise-induced hearing loss, but that’s another chronic disease that he could have included in his essay.

I spoke about this at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich in June. Similar to Dr. Dalton’s comments about hypertension and diabetes, I presented information showing that significant hearing loss is probably not part of normal aging, but represents noise-induced hearing loss.

A useful analogy for noise and hearing is sun and the skin. It turns out that skin and subcutaneous tissues sag as we age–that’s normal–but deep wrinkles, age spots, and skin cancers are the result of ultraviolet exposure. Similarly, I’m sure there are changes that occur in our hearing as we age, but profound hearing loss (25-40 decibel decrement in hearing) is most often the result of noise exposure.

In the end, how we live our lives matters. If we want to hear well into old age, we have to work to preserve our hearing all during our lives. How? It’s easy: avoid loud noise or wear ear 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.

Attention commuters: put down your earbuds!

 

Photo credit: Pedro Figueiredo licensed under CC BY-SA 2.0

A recent article in The Hearing Journal should give pause to mass transit commuters who use personal listening devices (PLDs) to mask background noise. Michelle Brady, AuD, Suzanne Miller, PhD, and Yula C. Serpanos, PhD, write that “[m]ass transit commuters are regularly exposed to excessive noise levels,” and note that use of PLDs “adds further stress on the auditory system as commuters listen at high volume levels to mask the background noise encountered during their daily commute.” By cranking the volume in areas of high noise, they note, commuters are “creating further risk of noise-induced hearing loss” (NIHL).

What makes NIHL insidious is that it “occurs in stages across several years,” and “[a]s such, its effects often go unnoticed.” Until they can’t be ignored, of course. The authors conducted a study on New York City commuters and found that “mass transit commuters in NYC do not completely understand the consequences of hearing loss and the proper use of PLDs.” They conclude that hearing health professionals need “to do a better job at educating the public about the risks of NIHL and safe listening habits.”

We agree that people need to be aware of the risks of NIHL, but also think there should be a role that government must play to protect citizens. And, of course, PLD manufacturers need to work with medical professionals and government to design safe PLDs that won’t deafen a generation.

 

Hearing loss is an occupational health hazard for musicians

by Daniel Fink, MD, Chair, The Quiet Coalition

It’s not surprising that hearing loss is an occupational health hazard for musicians, as highlighted in this recent report. After all, noise causes hearing loss. It doesn’t matter if the noise is from machinery in a factory, from a jet engine on the tarmac, or from loudspeakers at a rock concert. Whatever the source, the effect is the same.

And the type of music doesn’t matter, either, as noise-induced hearing loss is a problem for classical musicians, too.

The bottom line is this: hearing is precious. If hearing music is important to you–or hearing children or grandchildren speak, birds sing, whatever it is–protect your hearing.

How can you protect yourself? It’s easy. The auditory injury threshold is only 75-to-78 A-weighted decibels. That’s about the level at which ambient noise makes conversation difficult. If you are having a hard time having a conversation because of the ambient noise around you, it’s too loud. And if something sounds too loud, it IS too loud! Turn down the volume, leave the noisy place, always carry earplugs with you, and use them!

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.

PSAPs appear to work (but preventing hearing loss is better)

Photo credit: Hadley Paul Garland licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

Personal sound amplification products (PSAPs) appear to work. What is a PSAP? It’s really a hearing aid but it’s called a PSAP to avoid federal and state regulations. PSAPs can be sold directly to consumers without a physician or audiologist evaluation, and they are much cheaper than conventional hearing aids–in the range of $350 a pair instead of $3000 apiece.

This Research Letter in a recent issue of JAMA compared five PSAPs with a conventional hearing aid. The Johns Hopkins research team reported that some of the PSAPs worked quite well. Four of the PSAPs are traditional “behind the ear” devices that look like cheaper, less well made versions of traditional hearing aids, but one, the Etymotic Bean, might be placed into the newer category of “hearables” that are marketed as “smart earbuds.”

Why is this report important? PSAPs were strongly recommended by two recent expert federal reports (a report from the President’s Council of Advisors on Science and Technology in October 2015​ and a report from the National Academy of Medicine) as a solution–perhaps the solution–to the nation’s epidemic of hearing loss in older Americans.

To some they are the holy grail for hearing loss, enabling all to hear well without spending thousands of dollars. To others, especially audiologists and hearing aid dispensers, they are an existential threat. If grandma and grandpa can buy much cheaper hearing aids on their own from Amazon or Costco, why see an audiologist or hearing aid dispenser? Just buy your PSAPs online or at your nearby big box store.

Unfortunately, neither federal report mentioned the prevention as a solution for hearing loss. As I said in my presentation at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich on June 20, 2017, significant hearing loss is probably not part of normal aging but is noise-induced hearing loss caused by a lifetime of excessive noise exposure.

The inconvenient truth about hearing aids is that they don’t work very well at helping users understand speech in normal, everyday situations. For obvious reasons, there is little peer-reviewed research on this topic in the audiology literature, but two studies report approximately 40% non-usage rates. There is no reason to expect–especially without any training and teaching by an audiologist–that PSAP users will have any greater success.

Needing hearing aids or PSAPs in old age to treat hearing loss is not normal, just as needing complete dentures in old age because of tooth loss from poor dental care is not normal. Both are the only remedies available when we have failed to protect what Mother Nature gave us. But it’s much better to protect your ears and preserve your hearing than to use even the best hearing aid or the less costly PSAP alternatives.

The time to start protecting your ears is now! If it sounds too loud, it IS too loud. Avoid loud noise, and if you can’t avoid it, wear hearing protection.

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.

We can curse those who made us deaf

Photo credit: Thomas Leuthard licensed under CC BY 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

There is a high likelihood that a large percentage of Americans will suffer significant (25-40 decibel) noise-induced hearing loss as we age because we are exposed to too much noise.

Fortunately, as this lively video shows, we will still be able to curse those who made us deaf using American Sign Language.

WARNING: The language and gestures on this video are explicit. They are not appropriate for those under 18 years of age and may upset others. Definitely NSFW.

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 hearing aid filters out noise (but not as well as your own ears and brain)

Photo credit: Steve Johnson licensed under CC by 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Engineers at Columbia University School of Engineering and Applied Science have made an advance in hearing aid design that reportedly will allow users to better understand speech in noisy environments by combining auditory and neurological signal processing techniques. No doubt the millions of people who suffer with hearing loss appreciate the efforts to tackle this health issue. But why do we see article after article focusing on funding for treatments or cures of hearing loss but nothing about funding hearing loss prevention?

We think the better option is to prevent noise-induced hearing loss by avoiding exposure to loud noise. The human ear and brain are designed to process incoming sound well and probably do this better than any electronic gizmo can. Research shows that noise damages not just the ear but directly damages the brain as well, at least in animal models.

And for those who already have hearing loss–and even for those who don’t–quieter indoor and outdoor environments will allow everyone to converse more easily. The techniques for creating indoor quiet are well known: eliminate noise sources if possible, isolate noise sources that can’t be eliminated, use sound absorbing materials on floors, walls, ceilings, and furniture, and use architectural features to break up reflected sound waves. And while some may balk at the cost of implementing these techniques, there is one no cost option everyone can use: turn down the volume of amplified sound from rock concert levels to hearing preservation levels!

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 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.