This excellent essay by Jessica Fursethon Curbed discusses urban noise levels. It’s a very comprehensive piece, discussing multiple aspects of urban noise and how it affects people.
Some urban noise is an unavoidable accompaniment to modern life, but much can be done to make cities quieter. These include enacting laws against excessive vehicle exhaust noise, horn use, aircraft noise including helicopter flights, and indoor quiet laws.
Of course, enacting laws isn’t enough. They must be actually be enforced. Crowdsourced reporting using smartphone apps can help with enforcement.
My only quibble with the Curbed article is that the author cites the Centers for Disease Control and Prevention as recommending only 85 decibels (dB) for 8 hours to prevent hearing loss, but the link is to the National Instititue for Occupational Safety and Health. While part of the CDC, NOISH is charged with making recommendations for the prevention of work-related injury and illnes, not recommendations for the general public. So NOISH’s 85 dB exposure standard, actually 85 dBA*, is an occupational noise exposure level to prevent noise-induced hearing loss in the workplace–it’s not intended to be a safe exposure threshold for the public.
Given the general misunderstanding of what is a safe noise exposure level for the average person, Furseth’s article raises important issues that I hope are starting to be taking seriously. Cities have gotten louder and the effect of increased noise on residents and visitors is something that should be given serious attention.
*A-weighted sound measurements are adjusted to reflect the frequencies heard in human speech
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.
CBS News reports on a new study that concludes that millions of Americans face the prospect of losing their hearing as they age. The study by researchers at Johns Hopkins University estimates that “[a]mong American adults 20 and older, hearing loss is expected to increase from 44 million in 2020 (15 percent of adults) to 73.5 million by 2060 (23 percent of adults),” with the greater increase among older Americans. As a result, “there will be an increased need for affordable interventions and access to hearing health care services.” Says lead study author Adele Goman, “[h]earing loss is a major public health issue that will affect many more adults,” and “to address this issue, novel and cost-effective approaches to hearing health care are needed.”
Or perhaps prevention would be a better tactic?
Dr. Debara Tucci, a spokesperson for the American Academy of Otolaryngology, Head and Neck Surgery, would agree. She tells CBS News that “people aren’t doomed to lose their hearing as they age.” “The most common cause of hearing loss is prolonged exposure to loud noise,” adds Dr. Tucci, “which includes loud music and a noisy workplace.” Prevention, then, should be a rallying call among the medical profession, particularly public health officials. This is especially important since the litany of horribles that befalls older adults who suffer hearing loss goes well beyond difficulty hearing. The list includes: higher incidences of depression and anxiety, higher rates of hospitalization and of falls, and even “evidence of an association between hearing loss and mental decline.”
Coupled with the recently released and updated information concerning hearing loss from the Centers for Disease Control and Prevention, this study is a wake-up call to the medical and audiology professions and the public. Simply put, there is a low-cost and 100% effective way to tackle noise-induced hearing loss–preventing it from occurring in the first instance.
Dr. Daniel Fink, Chair of The Quiet Coalition, writes about the “flurry of activity” at the Centers for Disease Control and Prevention (CDC) with regard to noise-induced hearing loss (NIHL). Dr. Fink states that in the past the CDC offered “a lot of information about occupational noise exposure” and “screening neonates for congenital deafness,” but had no advice for the general public about noise.
But that has changed.
From May 2016, the CDC has issued a Morbidity and Mortality Report and Vital Signs publication on NIHL, and just recently posted new or recently revised information about how loud noise damages hearing and advice to seniors on preventing NIHL. While he isn’t surprised by the CDC’s robust response to what they identify as the “third most common chronic health condition in the US,” Dr. Fink notes that he and the other founding members of The Quiet Coalition are grateful that the CDC has stepped up efforts to help protect the nation’s hearing health.
On December 16, 2016, an article appeared in the New York Times, Americans’ Hearing Loss Decreases Even With Ubiquitous Headphones, which focused on a study by Howard J. Hoffman, MA, et al. (Hoffman) that appeared in the respected medical journal JAMA Otolaryngology–Head & Neck Surgery. The study found that there was a declining prevalence of hearing loss in U.S. adults. The results were considered surprising, as the study showed that the rate of hearing loss in adults age 20-69 had decreased from 15.9% to 14.1%. The researchers, epidemiologists, and statisticians at the National Institute for Deafness and Other Communication Disorders, who conducted the study, are among the best in the world, and the data came from the Centers for Disease Control and Prevention’s well-respected National Health and Nutrition Surgery.
The results were considered surprising because two other recent federal reports, one in October 2015 from the President’s Council of Advisors on Science and Technology (PCAST) and the other in June 2016 from the National Academy of Science’s Institute of Medicine (IOM) (since renamed the Health and Medicine Division), emphasized that hearing loss, especially in older Americans, was a major national problem. Both of these reports cited an analysis by Frank Lin, MD PhD, Johns Hopkins University, that showed that 48 million Americans suffered significant hearing loss, with the prevalence increasing sharply with age.
I am personally involved in the question of what the facts are, since in an editorial in the January 2017 issue of the American Journal of Public Health I write about the inappropriate use of the 85 decibel occupational noise exposure standard, which should not be applied to the general public, citing Lin’s research and other studies that show increased hearing loss in young people age 12-19.
So, what do the data really show?
I am not an epidemiology expert like Mr. Hoffman and his distinguished co-authors. Their methods appear sound, their data sources as good as one can find in the epidemiology of hearing loss. The first caveat is that this study, as with all studies of the epidemiology of hearing loss in the pubic, is based on survey methodology. A group of 3831 participants are the study population, from which conclusions about the entire U.S. population were drawn. It would be too costly to test hearing in millions of people.
The second caveat is that there are newer techniques, currently only used in research and not yet in clinical use, demonstrating that before hearing loss can be detected by standard hearing tests (called pure tone audiometry), a phenomenon dubbed “hidden hearing loss” may have taken place. Hidden hearing loss has been found in young people and older adults. So while Hoffman’s study is encouraging, it may not be able to completely report what is really happening with Americans’ hearing.
The third point–not a caveat–is that Hoffman et al. studied adults age 20-69 and did not include young people under age 20. Those under age 20 may be the group most at risk of hearing loss due to ubiquitous use of personal music players at loud volumes. Two studies, using lower thresholds for measuring hearing loss than Hoffman et al. or Lin et al. used, found high levels of subclinical hearing loss (hearing loss greater than 15 decibels but less than 25 decibels) in young Americans. One from 1998 found that 15% of young people had measurable hearing loss, and the other from 2010 showed an increase in the prevalence of hearing loss to almost 20%. This is worrisome because studies of auditory acuity in young people traditionally found excellent hearing.
The fourth point also isn’t a caveat, but a quote from the last line of Hoffman’s abstract: “Despite the benefit of delayed onset of HI (hearing impairment), hearing health care needs will increase as the US population grows and ages.”
It’s great news that the percentage of Americans age 20-69 with hearing loss (the epidemiology term for this is “prevalence”) has decreased from 15.9% to 14.1%. But that still means that there are millions of Americans with hearing loss–and that’s too many! Further, subclinical hearing loss appears to be increasing in young Americans, and, as the Hoffman study notes, hearing loss in older Americans is a significant health problem.
Finally, a point of contention: noise exposure is a major cause of hearing loss, and not aging as is implied in the study. Why would men have nearly twice as much hearing impairment (18.6%) as women (9.6%)? Is it an effect of testosterone levels on the auditory system, in which case one might actually expect hearing to improve as men get older, or is it the result of more noise exposure from work and recreational activities in men than women? Noise and hearing loss are still major problems in the U.S. and in the world, and the non-auditory effects of noise on health, which are coming into greater focus, continue unabated.
So yes, the prevalence of hearing loss in American adults may be declining, but when Lin’s analysis showed that approximately 25% of adults in their 60s, 33% of adults in their 70s, and half of those over age 80 have significant hearing loss–data cited in the PCAST and IOM Committee reports–it is obvious that there is still a major problem and still much to be done to prevent noise-induced hearing loss here and abroad.
And I and others have said before, but it bears repeating: noise-induced hearing loss is 100% preventable. If people avoid noise exposure and protect their ears from noise, they should be able to preserve natural hearing well into old age, rather than needing to rely on assistive hearing devices. The only evidence-based safe noise level remains a 70-decibel time-weighted average for a 24-hour period.
Dr. 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 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 Centers for Disease Control and Prevention (CDC) has issued an announcement about National Protect Your Hearing Month, stating that it is “a time to raise awareness about the causes and prevention of noise-induced hearing loss.” Noise-induced hearing loss “can result from occupational noise exposures, leisure activities such as sporting events or concerts, or use of personal listening devices.” Whatever the cause, it is permanent and irreversible. More importantly, noise-induced hearing loss is completely preventable.
The CDC notes that noise-induced hearing loss affects people in all age groups. During 2001 to 2008, one in five Americans over the age of 12 years had hearing loss in at least one ear, and one in eight had hearing loss in both ears. The CDC adds that prevalence of hearing loss is expected to increase.
Thanks to Daniel Fink, M.D. for the link. Dr. 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.
Hearing loss.Zhai Yun Tan, Kaiser Health News, writing for PBS News Hour, examines hearing loss, which the Centers for Disease Control and Prevention has identified as “the most common work-related injury with approximately 22 million workers exposed annually to hazardous levels of occupational noise.” ‘[I]n an effort to reduce these numbers,” she writes, “the Labor Department launched a challenge earlier this summer called ‘Hear and Now,’ in which it is soliciting pitches for innovative ideas and technology to better alert workers of hazardous noise levels.”
Critics have countered that technology to address the problem already exists. The real problem, they claim, is that the maximum noise exposure level and Occupational Safety and Health Administration (OSHA) regulations are outdated. Among other things, the OSHA regulations “use sound level limits that don’t factor in the noise exposures that occur beyond the workplace — at restaurants, concerts and sporting venues, for instance — that can add to workers’ cumulative risks of harm.” OSHA officials offered that “the agency will issue a request for information later this year about current regulations at construction sites to figure out if more stringent protections are needed and how companies are complying,” but Tan notes that “[a] similar call for information was issued in 2002, but no changes resulted from the action.”
Tan suggests that employers will have to assume more responsibility in educating workers, as some workers do not use hearing protection at work because they are not aware of the risk. Click the link above to learn more, including Tan’s report about Jeff Ammon, a former construction worker who can no longer work due to hearing loss and hyperacusis, a condition marked by sensitivity to environmental noise.
Yesterday, the Centers for Disease Control and Prevention (CDC) posted content on its website addressing Environmental Noise Exposure and Health. This content looks at a number of issues, including what is hearing loss, sources of environmental noise, and the public health burden from noise and hearing loss.
Under a section titled “Recommendations and Guidelines,” the CDC discusses noise exposure limits. The CDC notes that the Environmental Protection Agency identified 70 dB as the average exposure limit to environmental noise for the general public, as did the World Health Organization (WHO), which “recommend[ed] that noise exposure levels should not exceed 70 dB over a 24-hour period, and 85 dB over 1 hour period to avoid hearing impairment.” Occupational noise exposure limits established by the Occupational Safety and Health Administration and National Institute for Occupational Safety and Health for an 8-hour workday are also mentioned.
Kudos to the CDC for posting this material on their site and giving noise exposure the attention it deserves. Noise-induced hearing loss and other injuries are mostly preventable, and the failure to educate the public on appropriate exposure limits is significant. As the CDC states, the “National Health Interview Survey (NHIS) found that in 2014, an estimated 21.0% of adults aged ≥18 years had difficulty following a conversation amid background noise, 11.2% had ringing in the ears [ed. note: tinnitus], and 5.9% had sensitivity to everyday sounds [ed. note: hyperacusis].” In short, noise-induced hearing loss, tinnitus, and hyperacusis affect more than a third of the population of the United States. Given the CDC’s mission to control and prevent disease and injury, one hopes this is the first of many steps taken to educate the public, advise federal, state, and local governments, and rein in a preventable health epidemic.