Noise-induced Hearing Loss (NIHL)

Inventors receive patent for new online hearing test

Photo of the National Technical Institute for the Deaf | Photo credit: DanielPenfield licensed under CC BY-SA 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Faculty inventors at the National Technical Institute for the Deaf, located at the Rochester Institute of Technology, received a patent for a new online hearing test.

One of the difficulties in performing at-home testing of hearing using a home computer is standardization of the equipment. The new online hearing test, using speech comprehension as a measure, may overcome this problem.

We’ll have to wait to see how this works in real life when and if the test is introduced for public use.

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.

October is National Protect Your Hearing Month

by Daniel Fink, MD, Chair, The Quiet Coalition

October is National Protect Your Hearing Month!

As I have noted before, I’m not a big believer in special months or days to celebrate or honor or remind us of people or things that should be celebrated or honored or observed every day, but the special days and months may serve as a useful reminder of the people or things. Hearing protection is one of those things that should be observed every day.

Hearing loss represents the cumulative impact of a lifetime of noise exposure, just as skin discoloration, deep wrinkles, and skin cancers represent the cumulative impact of a lifetime of sun exposure.

The basics of hearing protection are very easy:

  1. Avoid noise exposure, or wear hearing protection (ear plugs or ear muffs) if you can’t.
  2. The only evidence-based noise exposure level to prevent hearing loss is a daily average of 75 decibels.
  3. If a noise sounds loud, it is too loud and your hearing is at risk.

I would add a caveat and some scientific information to support my three points.

The caveat: The commonly cited 85 decibel noise level is not a safe noise exposure level for the public, but an occupational noise exposure level that doesn’t protect all exposed workers from hearing loss. Don’t believe the National Institute on Deafness and Other Communication Disorders or misinformed audiologists when they promulgate dangerous misinformation with statements like, “[l]ong or repeated exposure to sounds at or above 85 dBA can cause hearing loss (dBA means A-weighted decibels. A-weighting adjusts sound measurements for the frequencies heard in human speech.) Auditory damage probably begins at sound exposure levels far below 85 decibels, and after only one hour of exposure to 85 decibel sound it’s impossible to achieve the safe daily average of 70 decibels for 24 hours.

The science: A literature review, now confirmed by research published this year, demonstrates that there is no such thing as age-related hearing loss. Hearing loss is not part of normal aging but largely represents noise-induced hearing loss.

More science: Noise exposure in daily life is loud enough to cause hearing loss. A 2017 CDC study showed that about 25% of American adults age 20-69 had noise-induced hearing loss, many without significant occupational exposure to noise.

Your ears are like your knees–you only have two of them. So protect them, because unlike your knees, your ears can’t be replaced.

Protect your ears and protect your hearing during National Protect Your Hearing Month, and during every month!

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.

New research developments in tinnitus, noise-induced hearing loss

Photo credit: hov1s@ licensed under CC BY-NC-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This quite technical article from a research group in Taiwan describes new research developments and remaining gaps in assessment, treatment, and prevention of noise-induced hearing loss and tinnitus.

To me, the most important information in the article is contained in two lines in the conclusion at the end of the paper:

All people are exposed to noise. However, while the pathogenesis of NIHL is complex, cochlear neuropathy is largely preventable.

I came to the same conclusion in a literature review that was presented at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich in 2017.

And researchers at the Massachusetts Eye and Ear Infirmary recently came to the same conclusion analyzing human cochlear tissue and comparing changes found with ante-mortem hearing tests and exposure histories.

The authors of the article above state that “[s]tudies must continue to investigate ways to reduce NIHL,” but I would disagree with that statement. We have known for decades how to reduce and even prevent noise-induced hearing loss: avoid exposure to loud noise or wear hearing protection if you can’t.

Only about 8% of American adults reported using hearing protection when attending loud sporting or entertainment events. So studies about how to convince people to protect their hearing may be of some value, although regulation of product noise and use of noisy devices, as has been implemented in Europe, would be far more effective.

Because if a noise sounds loud, it is too loud, and your auditory health is at risk.

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.

Noise and air pollution may be preventable causes of dementia

Photo credit: Elina Krima from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Noise and air pollution may be preventable causes of dementia. This new study from the Alzheimer’s Association International Conference, reported by Med Page Today, discusses risk factors contributing to dementia. Other than rare genetic conditions, most cases of dementia have multifactorial causation. This makes prevention difficult because multiple risk factors must be addressed.

In general, a healthier lifestyle, including not smoking, eating a Mediterranean style diet, daily exercise, and other similar behaviors, have been shown to reduce or delay the onset of dementia. The new study found that risk factors contributing to dementia include hearing loss, social isolation, depression, and air pollution. These factors have now also been added to the Lancet Commission’s list of key modifiable risk factors for dementia.

Although the study doesn’t mention noise explicitly, noise causes hearing loss. Hearing loss in turn is associated, likely causally, with social isolation. People who can’t understand what others are saying tend to avoid social interaction because it’s too stressful or too embarrassing not to understand what others are saying. Social isolation in turn leads to depression.

With regard to hearing loss, researchers think the loss of auditory input caused by hearing loss also causes changes in the brain that contribute to the development of dementia. Previous studies led by researchers from Johns Hopkins have shown that hearing impairment in people 45-65 years old is related to a progressive loss of nerve cells in brain structures and reduced microstructural integrity that may indicate early Alzheimer disease.

The precise mechanisms by which air pollution contributes to dementia are unclear, but there are strong correlations between levels of pollutants and dementia. Much if not most of urban air pollution comes from particulate matter emitted by internal combustion engines. These are also a major cause of urban noise.

Reducing noise will prevent hearing loss and its consequences. And if noise from vehicles and other engines is reduced, air pollution will also be reduced.

As we have been saying for some years now, a quieter world will be a healthier world for all.

And, one hopes, it will also be a world with less dementia.

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.

Age-related hearing loss is almost certainly noise induced

Photo credit: Andrea Piacquadio from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Hearing loss in old age is often called age-related hearing loss or presbycusis. This implies that hearing loss is part of normal aging, just like the need for bifocals called presbyopia. This article in the Society for Neuroscience’s journal reports that what is commonly called age-related hearing loss is really hair cell loss, indicative of auditory damage caused by noise

That was my conclusion based on a literature review, presented at the 12th Congress of the International Commission on the Biological Effects of Noise in Zurich in 2017.

Another recent report, this time in The Conversation, discusses research in fruit flies that may shed light on what the author calls age-related hearing loss. I don’t know how much noise fruit flies are exposed to–laboratory facilities are not quiet–but I suspect that the effects of whatever molecular changes occur in human ears with aging are compounded by cumulative noise exposure over one’s lifetime

Our ears are like our eye and our knees–we only have two of each. We don’t stare into the sun. We wear sunglasses when outdoors in bright light. In fact, sun exposure causes cataracts. We try not to injure our knees, although these can be surgically replaced.

And we need to protect our ears so they last us a lifetime.

Avoiding noise-induced hearing loss is simple: avoid exposure to loud noise, and if one can’t avoid that, use hearing protection.

Because if a noise 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.

Headphone use causes hearing loss

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from the Sydney Morning Herald discusses headphone use causing hearing loss. It uses a term I hadn’t heard before–“headphone culture”–to describe the ubiquitous use of personal audio systems to provide a continuous soundtrack for daily life. There is mounting evidence that noise exposure in everyday life is loud enough to cause hearing loss in a majority of urban dwellers, and that exposure is exacerbated by using headphones or earbuds to listen to music or podcasts for hours a day.

The only quibble I have with the article is that it cites the occupational noise exposure levels of 80 or 85 decibels as being the safe sound threshold. This just isn’t true. Noise exposure levels that don’t even protect all exposed workers from noise-induced hearing loss certainly aren’t safe for the public!

The problem with listening to a personal audio device using headphones or earbuds is that to overcome ambient noise so one can hear what one is listening to, as when walking down the street or riding a bus or subway to work, the volume has to be turned up to dangerously loud levels.

For parents, the problem with children using headphones so they can listen to music or watch a video without disturbing others is that the parents can’t monitor the sound level or what their children are listening to.

The article discusses safer headphones with a volume limit, but my conclusion is that listening to music or podcasts or audiobooks using headphones or earbuds is as bad for the ears as smoking is for the lungs and heart.

Most volume limiting headphones use the occupational 85 decibel recommended exposure level as the volume limit and that simply won’t prevent hearing loss.

There is no safe cigarette, and headphones or earbuds with a volume limit may be safer than those without a volume limit, but they are certainly not safe.

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.

 

Early signs of hearing damage seen in young concert goers

Photo credit: Thibault Trillet from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This report in The Conversation, a UK website, discusses research showing that young adults who regularly attend loud clubs and rock concerts have evidence of hearing loss. The hearing loss found falls into the “hidden hearing loss” category, so-called because it is not detected by standard hearing tests (“pure tone audiometry”), but only by techniques currently used only in research. These tests found subtle hearing loss and decreases in auditory signals sent to the brain. There were equal amounts of damage in musicians and non-musicians alike. It looks like all the young adults had too much noise exposure.

Hidden hearing loss is now thought to be the cause of the “speech in noise” problem, where middle-aged and older adults have difficulty following one conversation among many in a noisy environment. That’s a complex task for the ear and the brain, requiring lots of auditory information to be processed centrally. When the ear and brain are damaged, that doesn’t happen.

The only quibble I have with The Conversation’s report is that the authors make the common mistake of citing occupational noise exposure levels when talking about noise exposure in the public. Occupational noise exposure limits don’t protect workers from noise-induced hearing loss, and the UK’s 85 decibel exposure limit cited is certainly not safe for hearing.

The only noise exposure level that prevents hearing loss is a daily average of 70 decibels, which is much less noise than most urban dwellers around the world get every day.

Prevention of noise-induced hearing loss–hidden or not–is simple: avoid loud noise exposure and use hearing protection if you can’t.

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.

More about fireworks and hearing loss

Photo credit: ViTalko from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

WTOP is an all-news radio station in the Washington, D.C. metropolitan area. They recently ran this report on fireworks and hearing loss, citing the president of the American Academy of Audiology.

July 4th may be past, but according to the Consumer Product Safety Commission almost 200 people go to emergency rooms with injuries from fireworks every day in July.

Fireworks are dangerous for the ears, as well as for the fingers and eyes. The impulsive noise from fireworks can cause permanent hearing loss after only one exposure.

I agree with most fire chiefs and emergency room physicians and think it’s best to leave fireworks displays to professionals.

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.

The CDC says “Protect your hearing”

by Daniel Fink, MD, Chair, The Quiet Coalition

The National Center for Environmental Health at the Centers for Disease Control and Prevention advises everyone to protect his or hearing during July, which is Fireworks Safety Month:

Of course, we agree.

We only have two ears, and unlike our knees, they can’t be replaced.

I’ll go one step further and recommend that fireworks on July 4th be left to professionals and not used at home. Every year, people lose fingers or eyes because they or someone who loves them sets off fireworks at home, with disastrous consequences.

Please stay safe this fireworks season and protect your ears, too.

Thanks to the CDC for helping educate Americans about how to protect our auditory health.

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.

Fireworks noise can damage your ears

Photo credit: ViTalko from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from KCBD in Texas discusses the dangers of fireworks noise for auditory health. The audiologist interviewed, Leigh Ann Reel, Ph.D., is especially concerned about impulsive noise, as from an explosion. One exposure at close range can cause permanent hearing loss, tinnitus, or hyperacusis.

Fire departments and public health authorities generally recommend leaving fireworks displays to the professionals, but in many states and localities personal use of fireworks is legal and enforcement of fireworks bans is spotty.

I would prefer quiet fireworks, as have been mandated in many parts of Europe, both for people and for their pets.

Please stay safe.

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.