Public health

New federal law deregulates and disrupts hearing aid market

Photo of Here One wireless smart earbuds courtesy of Doppler Labs

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

Who says this Congress can’t get anything done? Last week huge news appeared for 48 million Americans with hearing disorders, but the media barely noticed::

A new bipartisan law, the “Over-the-Counter Hearing Aid Act of 2017,” will deregulate the hearing aid market, dramatically lowering costs for consumers and releasing a surge of new technologies that will be sold over the counter, without a prescription. Yes, there will be losers as well as winners, but that’s the nature of change….

The new law responds to two federally sponsored reports issued last year (under the Obama Administration). The first report came from the President’s Council of Advisers on Science and Technology. The second was from the National Academy of Medicine. Passed the day before Congress adjourned, the new law creates opportunities for new technology innovators, eliminates the need to get a prescription, and dramatically cuts the cost by allowing substitutes, called “hearables” and “PSAPs” (Personal Sound Amplification Products), to be sold “over the counter.” The goal? a more efficient market that meets the needs of consumers.

As Noah Kraft, co-founder and CEO of Doppler Labs said, “[t]his industry is going to be completely disrupted. The question is by who?”

We have reported about this on several occasions over the past year, but the market disruption is getting underway much sooner that we anticipated thanks to quick action in the House of Representatives and the Senate, action that has emboldened nearly two dozen new entrants to enter the market ahead of schedule.

Who gains? 48 million Americans with incurable noise-induced hearing loss and millions more who are at risk from noise exposure. Who loses? The Big Six  who have dominated the hearing aid market for decades along with approximately 14,000 audiologists, the medical specialists whose services were previously required by the FDA to dispense and “fit” hearing aids to patients. The new Warren-Grassley OTC Act stipulates that the FDA must create a new category for “over-the-counter” hearing assistive devices and let them be sold freely, without intervention.

It’s no secret that the current Congress and the White House crave deregulation. Is deregulation potentially dangerous? Sure, but this is one instance where consumers will clearly benefit. Until now, hearing aids could cost you between $2,500 and $5,000 per ear, so $5,000 to $10,000 total. No wonder so few people have hearing aids—they weren’t covered by insurance or Medicare/Medicaid, so who could afford them? But now prices will drop to 1/10th of that—about $300 to $350 a pair–so lack of insurance coverage is less of a barrier.

We say thanks to the laudable bi-partisan cooperation between Senator Elizabeth Warren (D-MA) and Iowa Senator Chuck Grassley (R-IA) for getting this done at a time when Washington seems mired in dysfunction.

What’s the downside of this deregulatory innovation? There are many unknowns, so caveat emptor (buyer beware) and stay tuned…. But for now, it’s “Hip Hip Hooray”—or should we say, “Hear Here”!

P.S.: Our chair, Daniel Fink, MD, cautions that the real solution to the epidemic of hearing disorders in America is NOT more affordable hearing aids, but rather, a badly needed and long-awaited public health effort to prevent hearing loss—and we wholeheartedly agree with him. Prevention can be encouraged by three means:

  1. Educating people about the dangers of prolonged exposure to noise above 70 dB (permanent hearing damage occurs at levels much lower than currently recognized);
  2. Resurrecting federal efforts to reduce noise (as is being done in Europe and Asia already, where noise is recognized as a public health hazard) from obvious sources like planes, trains, trucks, consumer appliances, construction and outdoor maintenance equipment, etc.; and
  3. Educating companies in industries like aircraft manufacturing, car and truck manufacturing, mining, construction, HVAC, and appliance manufacturing, etc. that noise is harmful to public health.

Prevention can be done: currently, the European Union regulates noise emissions from 50 classes of products. According to Dr. Fink, “a hearable or PSAP is a poor substitute for well-preserved normal hearing; it’s far better to avoid loud noise or to wear earplugs!”

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.

New York City construction noise complaints soar

Photo credit: G.M. Briggs

The NY Daily News reports that “[b]ooming construction and lax efforts by city agencies to control it have led to soaring noise complaints in the five boroughs.” Once again New York State Comptroller Thomas P. DiNapoli is the source of this information, as his office audited construction noise complaints that were called into the 311 system and found that the number of complaints soared from “14,259 in 2010 to 37,806 in 2015, with the vast majority involving work taking place late at night or early in the morning.”

The Department of Environmental Protection (DEP) and Department of Buildings (DOB) are primarily responsible for dealing with construction noise complaints. The “DEP is responsible for responding to 311 construction noise complaints,” and the “DOB reviews and approves building plans; conducts building inspections; and issues permits, including those for after-hours work.” DiNapoli’s auditors “selected a sample of noise complaints for 50 incident addresses….including the 30 locations with the highest number of construction noise complaints in the city (29 of these locations were in Manhattan) and an additional five locations with the most complaints in the Bronx, Brooklyn, Queens and Staten Island.”

Incredibly, the inspectors found there was “no excessive noise” for 211 of the 250 complaints, “and only three complaints resulted in violations being issued by DEP.”  Actually, it’s not so incredible, as the Comptroller’s Office notes that the “inspectors did not visit the locations until an average of five days after the noise was reported, and there were “no reports of meter readings performed at the sites to determine if noise levels were excessive.” In addition, “[w]hen making decisions to grant after hours work variances, DOB officials did not consider construction noise complaints made to 311, nor did they consider construction noise citations issued by DEP.” It’s not exactly surprising that noise complaints increased, given how few violations were issued.

As with his report about bars and nightclubs, DiNapoli made recommendations to address the increase in construction noise complaints. The DOB agreed to all three recommendations directed to them, while the DEP agreed to three out of six. Now we wait to see if it makes a difference.

Thanks to Jeanine Botta for the link to the Comptroller’s press release.

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.

London’s poised to do something about noise

Photo credit: Majophotography licensed under CC BY-SA 3.0 ES

By Daniel Fink, MD, Chair, The Quiet Coalition

In the U.S., noise is widely considered “just a nuisance,” but in Europe noise pollution is recognized as a major health hazard. In the current political climate, and with the current administration and Environmental Protection Agency administrator, we don’t expect anything to be done about noise here–just as climate change is viewed in Washington as a Chinese hoax–but other countries and regions accept the science.

The World Health Organization’s Global Burden of Disease report quantified the numbers of productive years of life lost due to noise. The European Noise Directive tells governments what to do about environmental noise. And now London is proposing a comprehensive environmental strategy, which includes very strong actions to deal with environmental noise.

We think London’s comprehensive environmental strategy is a wonderful model for cities and states in the U.S. to follow.

Please share this link with your state and local representatives or your governor.

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.

Another adverse effect of traffic noise

By Daniel Fink, MD, Chair, The Quiet Coalition

New research in Denmark shows that people exercise less when they live near noisy roads. The researchers found that for every 10 decibel increase in traffic noise, people were 5% less likely to exercise.

In general, a few simple habits can have a dramatic effect on health and longevity:

  1. Don’t smoke
  2. Eat fruits and vegetables
  3. Maintain a healthy weight, and
  4. Exercise regularly.

Anything that discourages healthy habits–and traffic noise now seems to fall into this category–is bad for health.

And the reason why traffic noise seems to decrease exercise? It isn’t clear. It may be that traffic noise disrupts sleep, so people exposed to the noise just lack the energy to get moving, but whatever the reason this study provides yet another reason why cities must control traffic noise.

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 the excreta of technological civilization

Photo credit: G.M. Briggs

Jonathan Power, author and former foreign affairs columnist for The International Herald Tribune, writes about favorite sounds and the scourge that is noise. Power’s favorite sounds “are the quiet sounds of the English Lake District,” which he contrasts with the sound of noise: cars and trucks, airplanes and builders, canned music in cafes, a symphony playing an atonal concerto.  “Noise,” he concludes, “is the excreta of technological civilization,” adding that “[o]ne study predicts that exposure to loud music will cause 50 million Americans to suffer heavy hearing loss by 2050.”

Power looks at the health effects of noise–not just damage to hearing, but also “high blood pressure, disturbed sleep and even heart disease.” He writes about the fight against another runway at Heathrow and the political fight that was lost–or is it?–by the tens of thousands living near the airport, while noting that smaller battles can be won. And while noise “is never likely to compete with other political issues such as unemployment and nuclear weapons in North Korea,” Power notes that politicians are sensitive to political pressure. Moreover, he lists measures that have been tried and tested in various places which can be borrowed wherever we live, like Switzerland’s ban on the driving of heavy trucks at night and on Sundays, or the U.S.’s and UK’s modification of noise regulations in 1976 which required older aircraft to comply with noise limits set for new aircraft.

Power calls for us to put these and other examples on social media and, more importantly, to “demand MORE, and distribute your demands far and wide.”  In the end, if we want to enjoy our favorite sounds, we have to fight for the right to hear them.

How to deal with noisy neighbors

By Arline L. Bronzaft, PhD, Board of Directors, GrowNYC

Alexandra Levine’s recent article on noisy neighbors revealed how New York Today readers have dealt with noisy neighbors. While simply speaking to your “noisy” neighbor may result in a lessening of the din, there are many times when polite requests don’t work. Some residents, we learn from the article, turn to shaming their neighbors into quieting down. I have heard about others who “fight back” by inflicting similar intrusive sounds on the offensive neighbors. I do not suggest this latter response because I believe people inflicted by noise have a better case when they don’t engage in similar offensive behavior.

As a member of the board of directors of GrowNYC, where I oversee its noise activities, I am often asked to intervene on behalf of New York City residents whose requests to their neighbors–and even to the managing agents of their buildings–to “quiet it down” have gone unheeded. In writing to the managing agents on behalf of the people who have sought my assistance, I urge them to direct their attention to my research and writings on the adverse effects of noise on health. I explain that noise is not just an annoyance—it’s a health hazard–and that those in charge of managing buildings must familiarize themselves with the deleterious effects of noise so that they do not dismiss noise complaints, as many do.

When we talk about noise we are not necessarily talking about loud sounds, as bothersome sounds can disturb sleep, rest, or simply reading or watching television. Noise is defined as unwanted, unpredictable, and uncontrollable sound. Short of the harmful effects of noise on health that are discussed in the research, noise diminishes one’s quality of life.

I include GrowNYC’s Noise brochure which discusses health effects of noise and ways to lessen noise with my letters to managing agents. I also point out that under the the warranty of habitability clause in their leases residents in both rental buildings and cooperative dwellings are entitled to “reasonable quiet” in their homes. In follow-up phone calls to my initial letters, I explain the word “reasonable.” One could say that a reasonable person would be bothered by footsteps from the above apartment at six a.m. in the morning. Unreasonableness, on the other hand, would be a complaint of a toy dropped by a visiting grandchild once and only once.

I will then direct the telephone conversation to the specific noise problem and ways to abate it. I ask if the required carpeting is in place in the apartment and if the superintendent or managing agent has gone to the apartment to hear the noise. I, too, have dealt with a sex complaint that was handled by suggesting that the couple who was the source of the noise move their bed several inches from the wall so that it would no longer bang against it during sex. Often, I suggest that all residents receive flyers that speak to the harmful effects of noise and what can be done to lessen noises in their own apartments.  Finally, I stress that neighbors should be informed that living together in a building means respecting the rights of others, and this includes greater quiet in apartments.

New Yorkers face so much noise as they traverse the streets of our city. When they get to their apartments and close their doors, they hope for some quiet. Let’s join together and provide quiet for our neighbors and in return hope they will do the same for us.

Dr. Arline Bronzaft is a researcher, writer, and consultant on the adverse effects of noise on mental and physical health. She is co-author of “Why Noise Matters,” author of “Listen to the Raindrops” (children’s book illustrated by Steven Parton), and has written extensively about noise in books, encyclopedias, academic journals, and the popular press.  In addition, she is a Professor Emerita of the City University of New York and Board member of GrowNYC.

The NIH recognizes noisy restaurants are a problem

Photo credit: Alan Light licensed under CC BY 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

With this web content posted last year as part of its Dangerous Decibels program, the National Institute for Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, finally recognizes that restaurant noise is a problem. Unfortunately, NIDCD persists in stating that

Research shows that long or repeated exposure to sounds at or above 85 decibels can cause noise-induced hearing loss. Signs of having been exposed to too much noise include not hearing clearly or having ringing in your ears after leaving a noisy environment.

We disagree. By the time one can’t hear clearly or experiences tinnitus, it’s too late–permanent hearing damage has occurred. The damage occurs because 85 decibels is not a safe noise level for the public. As I wrote in the American Journal of Public Health, the only evidence-based safe noise exposure level to prevent hearing loss is 70 decibels time-weighted average for a 24-hour period. The 85 decibel standard NIDCD relies on is an occupational noise exposure level, and that standard fails to prevent hearing loss in all exposed workers. The National Institute for Occupational Safety and Health agrees, and the auditory injury threshold, discussed by Flamme, et al., is only 75-78 A-weighted decibels (dBA).

A simple rule to protect hearing is “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 level is above 75 dBA (see figure D-1, “Information on Levels of Environmental Noise Requisite to Protect Public Health and Welfare with an Adequate Margin of Safety”) and auditory damage is occurring. And, unfortunately, many if not most restaurants are noisier than 75 dBA.

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.

The deafening killer….finally, an elected official gets it right

This photo has been released into the public domain by its author, Arpingstone.

By Daniel Fink, MD, Chair, The Quiet Coalition

Councillor Adam Swersky, from the London Borough of Harrow, wrote this indictment of noise pollution in The New Statesman.

Finally, an elected official seems to understand that noise is a ubiquitous pollutant with adverse health impacts, and with special impacts on the less fortunate in society.

Since he sits on the borough council, he is in a position to do something about it, too.

American politicians, take note.

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.