Tinnitus

My 4th Noise Activist Anniversary

by Daniel Fink, MD, Chair, The Quiet Coalition

Anniversaries are special. We celebrate wedding anniversaries. Alcoholics Anonymous celebrates the anniversaries of those who are in recovery. Wounded military veterans celebrate their Alive Day, the day on which they were wounded. And yesterday was my anniversary, the fourth anniversary of my becoming a noise activist.

I developed tinnitus and hyperacusis after a one-time exposure to loud noise in a restaurant on New Year’s Eve, 2007. As midnight approached, they kept turning up the music louder and louder. My wife could tell that the noise was bothering me and suggested that we leave, but I didn’t want to offend our friends who had arranged the dinner. As soon as it was polite to leave, maybe 12:30 a.m., we did. My ears were ringing when we left, and the ringing never stopped.

I also found that noise that didn’t bother others hurt my ears: Movie soundtracks, the grind of a food processor, loud exhausts and sirens, and especially noise in restaurants. I’m a doctor and have always done what I could to stay healthy. But I had no idea that a one-time exposure to loud noise could cause tinnitus and hyperacusis for the rest of my life. When my wife would suggest an evening out, I would ask, “Can’t we eat at home?”

On December 2, 2014, I read an article about hyperacusis in the New York Times science section, written by journalist Joyce Cohen, who has since become a friend. I circled it in red and gave it to my wife, saying, “Honey, this is why I don’t want to go to restaurants any more. They are all too noisy. The noise hurts my ears. Just like it says in this article.” My wife finally understood that while I might have been getting grumpier with age, my dislike of noisy restaurants was caused by an auditory disorder.

So I decided to do something to make the world a quieter place. I reached out via email to the four experts cited in Joyce’s article. One thing led to another, and I ended up serving on the board of the American Tinnitus Association and helping create The Quiet Coalition, where I am the board chair.

I learned that I wasn’t the only person in the world with auditory disorders. Hearing loss, tinnitus, and hyperacusis are all too common. But auditory disorders are invisible, and largely occur in older people, who themselves are largely invisible in our society. Except for congenital deafness, auditory disorders tend to be ignored.

It’s been quite an odyssey. I found that via the internet, I could communicate with experts in various areas of noise, across the country and even around the world. At the urging of one of them, I submitted abstracts to scientific meetings about noise. Those were accepted for presentation, and I spoke at national and international scientific meetings. I have had publications based on my talks appear in peer-reviewed medical and scientific journals, and I have been quoted in articles and have advised national and international health authorities about noise. And I have learned, through the nonprofit Hyperacusis Research, how truly life-limiting noise-induced hearing problems can be. All because I read an article and decided to do something to make the world quieter.

The world is still too noisy, and I still can’t find a quiet restaurant, but apps like iHEARu and SoundPrint are now available.

And as more evidence becomes available about noise as a health and public health hazard, I am confident that an informed public will push legislators and public health officials to eliminate unnecessary noise.

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.

Tinnitus and what to do about it

Photo credit: erik forsberg licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

I think the title of this report from the Harvard Medical School is misleading. I have tinnitus so part of my response is a personal one. To me, the most important sentence in the report is this: “There are no FDA approved treatments for tinnitus.” That means that none of the many proposed treatments for tinnitus–from a variety of vitamins and drugs, to various auditory training programs–has been demonstrated to be safe and effective, the FDA’s standard for approval. Cognitive behavior therapy may improve the ability to accept or deal with a constant ringing in the ears, but it doesn’t change the underlying symptoms.

It can be difficult to live with a constant ringing in the ears. I haven’t tried any of these unapproved treatments because I believe in evidence-based medicine, both for patients and for myself. Also, I am fortunate–my tinnitus is relatively low volume, and the only time it really bothers me is when I wake at night and it’s loud enough to cause difficulty in falling back to sleep–but the symptoms can be so bad that people commit suicide because of them. I suppose that if my symptoms were worse, I might be willing to try some of the treatments mentioned. And I would add that I know people who have had success using some of them.

Perhaps most significantly, the report neglects to mention three important facts:

1. The overwhelming cause of tinnitus is noise exposure, not the many other possible causes listed in the report. I haven’t been able to find a percentage, but my estimate is at least 80% and probably 90 or 95%.

2. The article implies that temporary tinnitus after noise exposure is a normal thing. No, temporary tinnitus indicates that one has been exposed to too loud noise, and that auditory damage has occurred.

3. Avoiding loud noise exposure will most likely prevent tinnitus from ever developing.

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 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.

Justice prevails: Federal court rules sound cannon can be excessive police force

Alex Pasternack, Fast Company, reports on a recent U.S. Court of Appeals for the 2nd Circuit decision that ruled “[a] powerful speaker that’s capable of causing hearing damage and is used by a growing number of police around the world isn’t merely a ‘communication device’ but, potentially, an instrument of excessive force.” The court was addressing the appeals of two New York City police officers who were seeking qualified immunity in a lawsuit that accused “them of using unconstitutionally excessive force when they deployed a Long Range Acoustic Device (LRAD) at a Black Lives Matter protest in 2014.”

The 2nd circuit affirmed a decision last June in which District Court Judge Robert Sweet, of the southern district of New York, ruled that the sound emitted by a long-range acoustic device (LRAD) used by the New York City Police Department to order protestors onto sidewalks “could be considered a form of force.”

Chief Judge Robert Katzmann, writiing for the 2nd circuit, found that “purposely using an LRAD in a way that can cause serious injury in order to move non-violent protesters violates the Fourteenth Amendment.” Judge Katzmann added that, “this Court’s longstanding test for excessive force claims teaches that force must be necessary and proportionate to the circumstances … [T]he problem posed by protesters in the street did not justify the use of force, much less force capable of causing serious injury, such as hearing loss.”

It is never acceptable for any police force to use sound cannons against non-violent protestors. Period.

How a YouTube-inspired prank ruined a young girl’s life

 

photo credit: Edvvc licensed under CC BY-SA 3.0

Laurie Redmond writes about how a stupid prank by YouTube “trickster” Rick Lax inspired a miscreant to copy a video the aptly named Lax posted of his “prankster pal,” Ryan Hamilton, blasting his girlfriend with an air horn to get her to put down her phone.  Redmond notes that the video “entitled ‘How to get your girlfriend to put her phone down,’ has an astounding 246m views.” Sadly, one of the viewers was her 12-year old daughter Cindy’s friend’s ex-stepfather, who decided to play the prank on Cindy.

But after this miscreant played his prank, things fell apart for Cindy who eventually was diagnosed with “hyperacusis, or noise-induced pain.” As a result of this “prank,” Cindy has a “burning pain in her ears all the time…[and] [w]ith all noise louder than ordinary conversation, she feels like she is being stabbed in the ear. Her ears ring.”

Redmond has since learned that another “YouTube prankster, an F-list celebrity named Jake Paul, was sued for wrecking someone’s ears with an air horn.”  And yet the air horn “prank” videos remain on YouTube and Facebook, even though they “recently removed Tide Pod challenge videos so as not to encourage dangerous stunts.” Redmond asks what it will take to have these dangerously stupid and vile videos off of social media.  We would suggest litigation might do the trick, while recognizing how terrible things are when the only option is litigation.

MRIs are dangerously noisy

Photo credit: liz west licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

MRI noise is in the news in two recent reports.

People magazine reported the story of a woman who suffered permanent auditory damage from an MRI, developing hyperacusis (a sensitivity to noise, which causes pain) and tinnitus. The Quiet Coalition’s Bryan Pollard, an expert on hyperacusis, is quoted in the article.

And researchers from SUNY Buffalo and China wrote about MRI noise in The Hearing Journal.

Standard MRIs produce noise in the 110-115 decibel range, and newer more powerful MRIs are even louder. Knowing this, I have several quibbles with the information in The Hearing Journal article. Namely, the article cites occupational noise exposure standards, but these use A-weighted decibels (dBA) to reflect the frequencies of human speech. MRI noise is low frequency noise, so occupational noise limits may not protect hearing adequately. And occupational standards are not safe standards for the public. At least 25% of workers exposed to sound at occupational noise exposure standards will develop hearing loss.

Most importantly, for many people the auditory damage caused by MRI noise isn’t hearing loss but tinnitus and hyperacusis, as in the People magazine article. Exactly how noise causes tinnitus and hyperacusis isn’t yet known, but the mechanisms are likely different from cochlear hair cell damage causing noise-induced hearing loss.

Finally, the authors talk about temporary auditory damage, but many researchers think that any temporary auditory changes indicate that permanent damage has been done.

I can’t find any large-scale studies of auditory problems after MRIs–the equipment manufacturers wouldn’t be excited about funding such a study, and radiologists are interested in the image, not in the patient’s hearing–but anecdotal reports from audiologists indicate that this is a problem for too many people undergoing diagnostic MRIs.

So if you need an MRI, be sure to ask for “dual protection”– ear plugs and ear muffs. NIOSH recommends dual protection for noise exposure over 100 dBA.

And if you suffer auditory damage from an MRI, be sure to file a report with the FDA. That’s the only way the government will be induced to issue appropriate patient safety regulations.

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.

Musician wins landmark case over damaged hearing

Photo credit: MITO SettembreMusica licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The BBC reports that a viola player who suffered a life-changing hearing injury at a rehearsal of a Wagner opera is entitled for compensation for his injury.

This is the first time that acoustic shock has been recognized as a compensable work-related condition.

A one-time exposure to extremely loud noise–often caused by a blast injury but possible from other loud noise–physically disrupts the structures in the inner ear. In many if not most cases, they can’t recover from the trauma.

Even if the noise isn’t 130 decibels, it can still cause lifelong hearing loss, tinnitus, or hyperacusis.

I have been unable to find more than anecdotal reports in the medical literature of this type of auditory damage, and in science the operative phrase is “the plural of anecdotes isn’t data,” but we all need to be aware of the dangers of noise.

As violist Chris Goldscheider unfortunately learned, if it sounds too loud, it is too loud.

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.

 

Turn that down! We can prevent hearing loss

Photo credit: Anthony from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Dr. Vic Snyder, a former congressman from Arkansas who is now a medical director at the Blue Cross/Blue Shield affiliate there, has it exactly right: hearing loss (and tinnitus) can be prevented by turning down the volume, walking away from noise sources, and using 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.

It’s Tinnitus Awareness Week

Photo credit: Frmir licensed under CC BY-SA 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

As described on this link, it’s Tinnitus Awareness Week from February 5-11, 2018.

Tinnitus is commonly called ringing in the ears, although technically it is the perception of sound when there is no external sound source. Noise exposure–either chronic or a one-time exposure to loud noise–is the most common cause of tinnitus, although there are many other causes.

The American Tinnitus Association has lots of information available on its website. I serve on ATA’s board and have tinnitus myself.

If you have tinnitus, the most important things to know are that help is available–check the ATA website–and that you should protect your ears from noise to keep your tinnitus from getting worse.

And if you don’t have tinnitus, protect your ears from noise so you don’t ever develop 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.