Noise-induced Hearing Loss (NIHL)

Is the New York Philharmonic dangerously loud?

Photo credit: Shinya Suzuki licensed under CC BY-ND 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

One usually associates loud music with rock concerts and not classical music played by one of the world’s leading symphony orchestras, but that has changed. This report by Corinna da Fonseca-Wollheim, a New York Times music critic, says the New York Philharmonic is playing too loudly. Her concern is the effect loud playing has on the quality of the music, not preventing noise-induced hearing loss.

When I attend a concert, my concerns are about both.

I have hyperacusis, a condition where sound levels not bothersome to others cause discomfort and pain for me. And I know that noise causes hearing loss, tinnitus, and hyperacusis.

When Essa-Pekka Salonen was music director, the Philharmonic’s sound levels weren’t a problem. But under his successor, the wonderful Gustavo Dudamel, they are.

Don’t get me wrong. I love Dudamel’s conducting, and most of the time the orchestra’s sound is exquisite. But he plays some pieces about 10 decibels louder than Maestro Salonen did, e.g., Stravinsky’s Firebird Suite.

Now I make sure to bring a pair of earplugs with me when we go.

Because if something sounds too loud, it IS too loud.

And with louder symphony orchestras, hearing loss and other auditory problems aren’t just a worry for the musicians. They might be problems for the audience, 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 loss is no joke: 40% of hearing disabled can’t get jobs

Photo credit: Andreas Klinke Johannsen licensed under CC BY-SA 2.0

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

According to Cornell researchers cited in this news item from NPR, fewer than 40% of people with a hearing disability work full time. This startling statistic was uncovered by Cornell’s Yang-Tan Institute’s analysis of 2016 American Community Survey data. Wow!

If you, like we at The Quiet Coalition, are concerned about the burgeoning and long-ignored problem of noise-induced hearing loss in the U.S., that’s a very scary prospect. Even with unemployment in the U.S. currently at an historic low of 3.5%, people with hearing disorders still suffer an employment rate of 10 times that!

Hearing is precious, we all know that. But it’s also an economic necessity, especially if you need to earn a living. So remember: protect your own and your family members’ hearing, because exposure to high levels of noise—at work, at home, or at play—is dangerous, unhealthy, and could also be economically disastrous.

As our chairman, Dr. Daniel Fink says: “If it sounds too loud it IS too loud.”

Carry hearing protection with you, always. It really matters.

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 “rock out” with headphones without damaging your hearing? You can’t!

Photo credit: bruce mars from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

In this article from the Cleveland Clinic, Sandra Sandridge, PhD, Director of Clinical Services in Audiology, offers advice on protecting hearing when using ear buds or headphones to listen to music.

She first notes that hearing loss is 100% preventable, and this might be the only statement that is accurate. Unfortunately, the advice she gives to prevent noise-induced hearing damage is not.

This piece is like an article fifty years ago advising smokers on how to smoke safely. One can’t! There is no such thing as a safe cigarette, and there is no such thing as safe headphone or ear bud use.

Dr. Sandridge notes that many headphones and ear buds can be too loud–most personal music players put out 100-110 decibel sound and some player-headphone combinations can reach 120 to 130 dB–but she implies that 85 decibels is the sound level at which auditory damage begins.

That’s not the cutoff between safe and unsafe sound levels. It’s derived from the NIOSH recommended exposure level for occupational noise, an exposure level that doesn’t prevent hearing loss.

Even in children age 9-11, who haven’t been using headphones very long, auditory damage is already present.

The only way to prevent auditory damage is not to use ear buds or headphones. Or to use Dr. Sandridge’s language:

The only way to rock out with ear buds or headphones without damaging your hearing is not to rock out with them!

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 loss associated with depression

by Daniel Fink, MD, Chair, The Quiet Coalition

I’m not sure this new report on the association between hearing loss and depression in older Hispanic people in JAMA Otolaryngology adds much to our knowledge of how hearing loss affects people. It has been known for some years that hearing loss is associated with depression in older people. The report extends the research to Hispanic people in several large cities, but as best as I can tell, that’s the only new information. The authors claim that this study’s importance is that it measured hearing loss rather than relying on reports of hearing difficulties, but some earlier studies did that, too.

In older people it’s hard to tell if the hearing loss was caused by noise or not, because over time changes indicating hearing loss from noise lose specificity as hearing loss becomes worse. But my analysis of the literature suggests that what is commonly called age-related hearing loss, as in the JAMA Otolaryngology article, is really noise-induced hearing loss, which is entirely preventable.

Now that the connection between hearing loss and depression is clear, doesn’t it make sense for government and the medical community to commit resources to educate the public about the dangers of noise-induced hearing loss? A host of health concerns will diminish or disappear if we focus on stopping noise-induced hearing loss.

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 evidence that headphone use causes hearing loss

Photo credit: Patrick Pielarski licensed under CC by 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This isn’t a scientific study, but a news report from Ireland. An audiologist recommends that parents limit children’s headphone use to one hour daily. She notes that, “ten years ago, around 5pc of people aged under 45 were fitted with hearing aids. Now, 23pc of our hearing aids are for people under 45.”

That’s a shame. Hearing aids are costly, and even the best are a poor substitute for preserved natural hearing. It takes decades for noise-induced hearing loss to become bad enough that people are willing to use hearing aids.

A Dutch study earlier this year found auditory damage from headphone use in children age 9-11, and the damage only gets worse over time.

Parents–and indeed everyone–should limit headphone use, or better yet just put the headphones in the drawer.

One doesn’t need a continuous audio track to life! But if you do, for your own sake, for your ears, please turn down the volume.

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.

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.