Noise-induced Hearing Loss (NIHL)

Should doctors screen middle-aged and older adults for hearing loss?

Photo credit: Flávia Costa licensed under CC BY 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The Quiet Coalition received an email from contacts at the CDC’s National Center for Environmental Health. The U.S. Preventive Services Task Force is again looking at whether it should recommend screening for hearing loss. The last time it did this, USPSTF didn’t recommend screening for hearing loss in adults because no benefit had been shown from screening. The email reads:

Dear Hearing and Health Partners,

The U.S. Preventive Services Task Force has shared their Draft Research Plan for Hearing Loss in Older Adults: Screening on their website here. The draft plan also includes a graphic of a Proposed Analytic Framework and a Proposed Research Approach to identify the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications for their evidence review.

According to the Task Force, The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the Task Force Recommendation Statement on this topic. There is an opportunity for public comment on this draft until December 12, 2018. The draft research plan is available on the Task Force’s website here.

Cordially,

NCEH Noise-Induced Hearing Loss Program

There is important new research available that led to the USPSTF re-evaluating its recommendation. Several researchers have shown that most Americans get too much noise every day. The CDC reported that about 25% of American adults age 20-69 had noise-induced hearing loss, many without occupational noise exposure, and many thinking that their hearing was excellent.

Also, newer research shows that hearing loss is not a benign condition. It is correlated in stepwise fashion (i.e., more hearing loss, more problems) with social isolation, depression, falls, accidents, and dementia, all of which in turn are associated with increased mortality in older Americans.

And even more recent research shows that providing older people with hearing aids delays the onset of dementia, all of which compels the conclusion that doctors should absolutely screen their middle-aged and above patients for hearing loss.

If you have any thoughts about screening for hearing loss, send a comment to the USPSTF. I will!

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.

Newly identified gene plays critical role in noise-induced hearing loss

by Daniel Fink, MD, Chair, The Quiet Coalition

This report about research done at the University of California-San Francisco describes identification of a new gene and its effects on proteins in the cochlea. The cochlea is the part of the ear where sound waves are transformed into electrical impulses which are transmitted to the brain and perceived as sound. The article notes that insights about the newly identified gene and the proteins it codes for may eventually lead to drugs to prevent hearing loss after noise exposure.

I have a much more practical suggestion that those concerned about their hearing can use today. Until that drug is available on the market–which will be years to decades to perhaps never, and who knows at what price–avoid noise-induced hearing loss by avoiding loud noise exposure. It’s simple, easy, and inexpensive. And I speak from experience–it’s what I do. I avoid loud noise, e.g., rock concerts, and if I can’t avoid loud noise, when flying in an airplane or using a power tool, for example, I wear noise-canceling headphones or insert earplugs.

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

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.

Measuring sound levels

Photo credit: Phonical licensed under CC BY-SA 4.0

by Daniel Fink, MD, Chair, The Quiet Coalition

People sometimes wonder how to measure sound levels. Until recently, one had to buy a sound meter. OSHA-certified ones can cost more than $1000, although reasonable quality sound meters have long been available for less than $100, but technology changed all that. Now there are free or inexpensive sound meter apps for both Android and Apple smartphones.

I lack both the technical knowledge and the equipment to evaluate these, but fortunately researchers at the National Institute for Occupational Safety and Health have done the work.

The apps for iPhones are more accurate than those for Android phones due to standardization of hardware and software, but there are a lot of good free apps available.  NIOSH offers one that it developed for workers but is free to all.

But you really don’t need a sound meter app to know if it’s too loud. If you need to strain to speak or to be heard at the normal social distance of 3-4 feet, the ambient noise is above 75 A-weighted decibels (dBA) and your hearing is at risk. The auditory injury threshold is only 75-78 dBA. Regardless of what your sound meter says, or even if you can somehow converse despite the noise, if the noise is loud enough to bother your ears, that also indicates that your hearing is probably being damaged.

There are individual variations in sensitivity to noise. What is loud enough to bother you may not bother someone else. It’s clear that some people are more sensitive to noise than others, just as some people don’t get a sunburn even in the brightest sun and others don’t seem to gain weight despite what they eat.

So if the noise is bothering you, either leave the noisy environment or put in your earplugs.

As I often write, “if it sounds too loud, it IS too loud.”

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.

Annoyed by restaurant playlists, a musician makes his own

Photo credit: Terje Sollie from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

The New York Times writes about the seasonal playlists that musician and composer Ryuichi Sakamoto complied for the Kajitsu restaurant in New York City.  Sakamoto approached the chef with this list because he could not bear the music the restaurant played for its customers.

Not every restaurant can have a music pro compile its playlist, but at the least they can turn down the volume and let their customers enjoy their conversation.

And you don’t need a sound meter to know if it’s too loud or not. If you can’t carry on a normal conversation without raising your voice to be heard, or you strain to hear your dining companions, the ambient noise level is above 75 A-weighted decibels.

Not by coincidence, that is also the auditory injury threshold, the sound level at which hearing damage begins.

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

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.

Going to a music festival this summer?

Make sure you go prepared with first-rate hearing protection. Cory Rosenberg, Mother Nature Network, writes about the growing popularity of music festivals and the potential harm they may cause.  Says Rosenberg, “live concerts have played a large part in the rise of noise-induced hearing loss over the past few decades for music fans and musicians alike.”

Rosenberg’s piece is pretty thorough, but he makes one glaring error when he says “[c]onsistent exposure to noise levels that reach 85 decibels A-weighted (dBA) is considered harmful.” As Dr. Daniel Fink has noted repeatedly, 85 dBA is an occupational noise exposure limit that was not intended, and is not appropriate, for the general public.

That proviso aside, if you are planing on going to a music festival this summer, you should give Rosenberg’s piece a read.

Noise kills

Photo credit: Pete G licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Most people, including most doctors, don’t know that noise causes both hearing damage–hearing loss, tinnitus and hyperacusis–as well as a whole host of non-auditory health problems, including hypertension, diabetes, obesity, heart attack, stroke, and death.

These non-auditory health effects are discussed in this article that reviews the current literature.

The European Union understands the dangers that noise exposure poses, and it is taking steps to protect the public via the Environmental Noise Directive.

If enough Americans make sure their elected representatives know that they are worried about how noise affects us, maybe the U.S. will become quieter and healthier, too.

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.

Hearing-related problems are common among preschool teachers

Photo credit: woodleywonderworks licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Anyone who has seen a bunch of schoolchildren, in a park or a museum or a zoo–perhaps anywhere other than a library–knows that they can be noisy. And noise exposure causes hearing problems.

This report from Sweden discusses the high prevalence of hearing-related problems among preschool teachers there, including hearing loss, difficulty understanding speech, and sensitivity to noise.

The findings have to be replicated in other countries–maybe Swedish kids are noisier than others?–but the report shows that noise is a ubiquitous occupational hazard, even for preschool teachers.

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’s Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

A simple treatment may minimize hearing loss triggered by loud noise

Photo credit: ZaldyImg licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This report discusses a simple treatment that may minimize hearing loss triggered by loud noise.

It’s interesting that the sense of fullness in the ear after loud noise exposure is actually caused by swelling in the inner ear. Many people report this sensation, and a decreased ability to hear, after attending a rock concert or using loud power tools.

I have the same comments about this report as I made about the many similar previous reports of treatments to prevent hearing loss after noise exposure:

1. This is a very preliminary report. Even if this report is confirmed by other studies, it will take years if not decades for the treatment to be approved for human use.

2. In this case, injecting a solution through the ear drum into the middle ear isn’t as easy as one might think. The ear drum is very sensitive and contact causes pain. So I’m not sure how people are going to be able to do this.

3. Finally, other than for the soldiers who may not be able to avoid noise exposure, for most people it’s easy to avoid noise exposure–avoid loud noise or use hearing protection if you can’t.

Prevention of a problem is a whole lot better than trying to treat it.

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.

Quieter kitchens are possible

Photo credit: Bill Wilson licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This article is about making commercial kitchens quieter but the same principles apply to home kitchens.

Noise from blenders, mixers, and clanging pots and pans is loud enough to cause hearing damage.

We should probably put in our earplugs before kitchen appliances, and shouldn’t turn up the music loud enough to be heard over 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.

Portable listening devices are too loud

by Daniel Fink, MD, Chair, The Quiet Coalition

This paper in BMC Public Health reports that sound levels from portable listening devices (also called personal music players) are loud enough to damage hearing.

It’s long past time for regulators to take steps to protect the hearing of our young people, who are the predominant users of these devices. What are they waiting for?

I have predicted an epidemic of noise-induced hearing loss in young people for three years, since I became a noise activist and learned how damaging noise is for hearing.

So far there are only anecdotal reports of more cases of hearing loss and tinnitus in younger people in their teens, twenties, and thirties, but when the epidemiology reports come out, I will say, “I told you so.”

But that will give scant satisfaction, because it will be too late for those with hearing loss. The damage will have been done, and there is no cure. There is only one certain way to avoid noise-induced hearing loss: avoid loud sound.  Always.

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.