Tag Archive: Dr. Daniel Fink

Can a machine learn to solve our speech in noise problem?

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece in The Hearing Journal asks, “Can a Machine Learn to Solve our Speech in Noise Problem?”

Maybe yes, maybe no.

The “speech in noise” problem is the difficulty many people with hearing loss–and even people with normal hearing as tested by pure tone audiometry–have  following a conversation if the room (often a restaurant or party) is noisy.

I have that problem, as many adults do, and I also have three problems with this article.

First, talking about a technological solution to the speech in noise problem without discussing how we can interfere with the development of this condition by simply making the world quieter to prevent hearing loss is irresponsible. Imagine public health officials in the 1950s focusing on making better wheelchairs, braces, and crutches for those affected by polio without also working to prevent polio by developing a vaccine. You can’t, because that would have be absurd. To prevent noise-induced hearing loss, we don’t need more research. We don’t need a vaccine. All we need is to make a quieter world, something that has been known for decades.

Second, an even better solution to the speech in noise problem would be to require quieter indoor spaces.

Third, requiring quieter public spaces is exactly what the Americans with Disabilities Act (ADA) requires. People with hearing loss clearly meet the ADA definition of having a disability, and they require “reasonable accommodations” to allow them to fully enjoy (yes, this is the legal standard in ADA) places open to the public. I will be speaking about “Disability Rights of Ambient Noise for People with Auditory Disabilities Under the Americans with Disabilities Act” at the December meeting of the Acoustical Society of America, in New Orleans. I recent learned that my talk will be broadcast live over the internet. Details of how to listen will be posted when they become available.

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.

Being able to hear the music

by Daniel Fink, MD, Chair, The Quiet Coalition

My father used to say that people don’t know how important some things are until we don’t have them. He wasn’t talking about physical things, but about health, love, and security. Well, money and food, too.

The same is true of music. Those of use born with normal hearing don’t appreciate how wonderful it is to enjoy music, whatever type of music we like to listen to.

But for someone born with profound hearing loss, cochlear implants offered her the opportunity to hear music for the first time.

After seven years, she wrote this wonderful essay, which we want to share with you.

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 reason to avoid fast food and chain restaurants

Photo credit: Mike Mozart licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

My wife and I don’t eat in restaurants much anymore–the vast majority are just too noisy to enjoy both the meal and the conversation–and we don’t patronize fast food or chain restaurants. Burgers and fries and sodas are just not healthy food, and I try to stay healthy.

But for those who do, according to Culture Cheat Sheet noise is a major problem, joining a list of complaints that includes dirty spaces, bad service, and bad food. Culture Cheat Sheet cobbled together survey results from Consumer Reports, the American Customer Satisfaction Index, and Temkin Experience Ratings to come up with their report on the most hated restaurant and fast food chains.

Most fast food and chain restaurants use a formula of tasty but unhealthy food with too much fat, too much sugar, too much salt, and too many calories at a relatively low price to lure customers.

Research shows a clear correlation between the density of fast food restaurants in neighborhoods–largely poor neighborhoods populated by African-American and Hispanic people–and obesity. The epidemic of obesity in the U.S. is related to changes in eating patterns–fast food, sugary sodas, bigger portions–and decreased exercise.

But now it appears that these restaurants also serve up a side order of hearing loss with their food. Because noise is causing an epidemic of noise-induced hearing loss, too.

And that’s another reason to avoid these restaurants.

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.

What’s better than a cheap hearing aid?

Photo credit: ReSound licensed under CC BY 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The New York Times asked recently why hearing aids are so expensive. They should have stepped back and asked a more important question: What’s better than a cheap hearing aid?

A: Preserved natural hearing.

As a paper I presented at the 12th Congress of the International Commission on the Biological Effects of Noise discussed, the scientific evidence suggests that significant hearing loss (25-40 decibel hearing loss) is probably not part of normal aging, but is actually noise-induced hearing loss in the vast majority of cases. Research supporting this conclusion includes studies of hearing done in populations not exposed to noise, different rates of hearing loss in males vs. females, decades of occupational studies correlating increased noise exposure with greater hearing loss, and recent laboratory experiments showing the molecular, genetic, and sub-cellular structural mechanisms by which noise damages the auditory system.

If you protect your hearing now–by avoiding noise exposure or using hearing protection (ear plugs and ear muffs) if you can’t–you shouldn’t need a hearing aid in the future.

Preserved natural hearing…it’s better than a cheap hearing aid!

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.

Coping with hearing loss and noisy restaurants is not a game

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from CNN discusses a novel strategy to help people with hearing loss understand speech: a game to train the brain to process speech better.

This is a widely known but poorly understood problem–sometimes called the “Speech in Noise problem”–with people with hearing loss, but it can also affect people with normal or adequate hearing as tested by standard hearing tests (“pure tone audiometry”) who nonetheless can have problems understanding speech.

The problem is worse for those with hearing aids, which is probably why up to 40% of people with hearing aids don’t use them–they just don’t help understand speech in everyday situations. As hearing loss blogger Shari Eberts has written, hearing aids just are not like eyeglasses.

Some research supports a central cause for this, i.e., deficiencies in brain processing of auditory signals as people age. Other research puts the problem in the periphery, i.e., the ear. And the research on hidden hearing loss puts the problem in between, in the nerves connecting the ear to the brain. Most likely the explanation involves all three.

Even though the computer game reported in this story may eventually help people who struggle to understand speech, dealing with hearing loss and noisy restaurants isn’t a game.

The real answer isn’t brain training. It’s quieter restaurants, stores, and other public places.

Quieter indoor places will not only help those who already have hearing loss understand speech, they will prevent hearing loss in those still with good hearing.

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 Denialist Playbook and the FAA

Photo credit: MBisanz licensed under CC BY-SA 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

When I was sent a copy of this FAA presentation to the Congressional Quiet Skies Caucus, FAA Powerpoint PDF, I had a moment of recognition: the FAA is using a play from what I call “The Denialist Playbook.” The Oxford Dictionaries define a denialist as:

A person who refuses to admit the truth of a concept or proposition that is supported by the majority of scientific or historical evidence.

There appears to be a denialist playbook, just as there are playbooks for football teams. Just as one can recognize a screen pass play watching a football game, one can recognize the denialist plays when industries or government agencies try them. A well-documented example denialism can be found in the book “The Merchants of Doubt,” which chronicles how “Big Tobacco” issued statements and funded research to sow doubt about the dangers of cigarettes. No doubt Big Tobacco looked to the past. After all, when the lead contamination scandal unfolded in Flint, Michigan, it came to light that lead pipe manufacturers had trod the same path in the 1920s. And, of course, the conservative denial of climate change–continuing to deny that it is happening, even as the seas rise, the floods of biblical proportion inundate Houston, and the fires burn in California–would be laughable if the consequences weren’t so serious.

One version of the Denialist Playbook was described by Christie Aschwanden at Grist:

Step 1: Doubt the science.
Step 2: Question scientists’ motives and interests.
Step 3: Magnify legitimate, normal disagreements among scientists and cite gadflies as authorities.
Step 4: Exaggerate potential harms (scare the hell out of people).
Step 5: Appeal to personal freedom (I’m an American and no government official can tell me what vaccinations I need).
Step 6: Show that accepting the science would represent a repudiation of a key philosophy.

But I think that brief version omits several important basic plays from what I will call “The Complete Denialist Playbook.” Here are the playbook topics by chapter:

  1. Deny that there is a problem. Climate change denialism may be the most salient current example, but the FAA does this to a certain extent on Slide 4, when it states, “[a] factor of 20 decrease in community noise exposure has been accompanied by increased community concerns.” The FAA is staying that there isn’t a problem, when numerous media reports across the country document that aircraft noise is a major problem.
  2. When it becomes obvious that there is a problem, claim that it isn’t a major or real problem.
  3. Ignore those who complain about a problem, especially if they are young, women, or members of minority groups. This happened with the water problems in Flint, Michigan.
  4. State that there must be something wrong with those who complain about a problem. This was done by the conservative Mercatus Center in its “NIMBY report.
  5. Reluctantly admit that there might be a problem, but it isn’t associated, statistically correlated, and certainly not causally related with what reputable scientists think is the causative agent.
  6. Find fake experts who have views contrary to established knowledge but really are not experts in the field, even though they may have a PhD after their names.
  7. Fund research to find alternative explanations for the causation of the problem.
  8. Fund (in many cases through hidden funding mechanisms) consensus statements or even research that will obscure the true nature of the problem, i.e., sow confusion or doubt about the causal relationship.
  9. Cherry-pick the data and select research or quotes taken out of context to discredit established researchers and the scientific consensus to create an appearance of conflict or controversy when among experts there is none.
  10. Fund cultural or social organizations whose support can then be enlisted in fighting any regulatory efforts to control or ameliorate the problem. Philip Morris, among others, did this.
  11. Fund legitimate researchers looking for funding so that they will be reluctant to criticize their funding source or do research that may endanger their funding source.
  12. When the problem is so obvious that it can’t be denied, finally admit that there might be a problem, but insist that it isn’t a big problem.
  13. Offer alternative solutions to the problem which mask the real cause, e.g., soda makers funding youth exercise programs as a solution to the epidemic of obesity in young people, rather than admitting that sodas are a major, if not the major, contributor to obesity in your people.
  14. Invoke American freedoms to fight any regulatory efforts. Again, the tobacco industry did this, funding fake “Astroturf” organizations protesting that restrictions on smoking interfered with smokers’ right to smoke.
  15. Insist that the data are not robust enough and that more research is needed, which, of course, will take many years.
  16. Keep insisting that there is still doubt about the level of proof even when the overwhelming majority of scientists and even the public are convinced. The Heartland Institute, for example, still claims that there is doubt about whether smoking causes lung cancer.

It is the “more research” strategy that the FAA is adopting. On Slide 11 concerning cardiovascular health, the FAA states that “[e]xisting health study cohorts are being used to evaluate linkages between health outcomes a noise exposure while accounting for a wide range of factors,” with the research completion anticipated in 2020.

I have read some of the salient literature about aircraft noise and cardiovascular health, and attended several sessions on this topic and spoke with the world’s leading researchers in this field at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich in June, 2017. While there is always a need for more research, there is no need for further research into this particular topic because there is no doubt that aircraft noise causes cardiovascular disease. The basic physiologic mechanisms of how noise in general and aircraft noise specifically causes involuntary physiologic responses in the neuroendocrine and parasympathetic nervous systems have been well-described. A large number of epidemiology studies, using a variety of study designs, in a large number of countries, in different population groups, have shown that aircraft noise causes hypertension and cardiovascular disease. There can be no rational doubt about this relationship. These studies have been reviewed by Hammer et al., Basner et al., Munzel et al., and many others. As Basner noted in an editorial, the evidence is strong enough that most experts in the field think causality has been established.

In Europe, the adverse effects of noise on health are well-known, as summarized in a World Health Organization monograph on the “Burden of Disease from Environmental Noise.”  The European Union is dealing with this in its European Noise Directive.

There is NO need to reinvent this wheel on this side of the Atlantic Ocean, unless scientists can prove Americans are biologically different from Europeans. The FAA insisting that more research is needed to document the health dangers of aircraft noise exposure in the face of hundreds of articles in peer-reviewed scientific and medical journals is like the National Cancer Institute suddenly insisting that more research must be done to prove the dangers of smoking. How many more Americans must have their health damaged by aircraft noise–or even killed by it–before the truth is acknowledged? It is time for the FAA to act to protect the health of those exposed to aircraft noise, and if the FAA won’t act, for America’s congressional representatives to take action.

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.

Originally posted at The Quiet Coalition.

How quiet should it be?

Lake Verynwy, Wales, Oct. 2017 | Photo credit: Dr. Daniel Fink

by Daniel Fink, MD, Chair, The Quiet Coalition

I recently wrote about measuring sound on an alpine hike, noting that the reading of the ambient noise level, which was in the low 40 decibels, was much quieter than we hear in our urbanized settings. I also noted that noise exposure, as part of the total daily noise dose, is what causes noise-induced hearing loss.

Another important adverse effect of noise–especially nighttime noise–is disruption of human activities, including sleep disruption. A measure of the noise impact on sleep is called the LDN, How quiet is it in a non-urban setting?

I hadn’t thought about this until last night. My wife and I are traveling in a remote part of Wales, staying at a hotel overlooking Lake Vyrnwy, a manmade reservoir supplying water to Liverpool 75 miles away. It took more than an hour of driving on one-lane country roads to get here. (It wasn’t that far, but at 25 mph, it took a while.) I woke up at night and realized how quiet it was: no sirens, no cars, no airplanes, no helicopters, no horn-based alerts when the neighbor’s son comes home from partying at 2 a.m. Curious, I fired up my Faber Sound Meter 4 app on my phone and measured the ambient noise at 33.7 C-weighted decibels. It was so quiet that the sound meter said there wasn’t enough data to report an A-weighted measurement. (I don’t understand the technical details of why this wouldn’t work.) Unweighted decibels measured 35.4.

Why is this important? Sleep disruption causes a stress response, a neuroendocrine response with increases in stress hormones and a parasympathetic nervous system response, with increased blood pressure and pulse. These involuntary physiological responses are what cause the increased morbidity and mortality reported from transportation noise exposure (and are discussed by Hammer, et al., and Basner, et al.). Yes, the experts think the evidence is strong enough to support a statement of causality, not just a statistical association or correlation. Even sounds as low as 32-35 decibels can disrupt sleep, causing microarousals as measured by EEG monitoring.

And now I know the answer to my question.  How quiet should it be? At night the natural sound level should be under 40 decibels, probably under 35 decibels, and not urban nighttime noise levels of 55 to 65 decibels.

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.

Hearing loss a big problem for farmers and ranchers

by Daniel Fink, MD, Chair, The Quiet Coalition

This report discusses the problem of occupational hearing loss in farmers and ranchers. You may be confused, thinking farmers and ranchers must surely work in some of the most peaceful workplaces that exist. And that may be true part of the time, but they also use heavy equipment (tractors, harvesters, etc.) for long periods of time. Says Dr. Richard Kopke, M.D., FACS, chief executive officer of the Hough Ear Institute in Oklahoma City, “[e]xposure to tractors, forage harvesters, chain saws, combines, grain dryers, even squealing pigs and guns, can lead to significant hearing loss.”

Dr. Kopke offers advice to farmers and ranchers on how to avoid hearing loss, including the same point I always make: if you have to raise your voice to be heard, the ambient noise is above 75 A-weighted decibels and hearing loss is occurring.

But it’s not just farmers and ranchers at risk of noise-induced hearing loss. It’s everyone.

Hearing is precious. Speech is the main way humans communicate and relate to one another. As Helen Keller said (paraphrasing), “blindness separates people from things, but deafness separates people from people.”

It’s National Protect Your Hearing Month. Once hearing is lost, the only treatment is a hearing aid (or a cochlear implant for the severely impaired). If it sounds too loud, it IS too loud! Turn down the volume, leave or move away, or insert ear plugs or use ear muff 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.

The wrong answer to the restaurant noise problem

Photo credit: Jeremy Keith licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This report from the United Kingdom discusses expensive new headphones which can help someone understand conversations in a noisy restaurant.

This is the wrong answer to the restaurant noise problem.

Why should someone have to spend £400–about $530 at current exchange rates–just to be able to understand a conversation in a restaurant in London?

The right answer is making restaurants quieter, by reducing background music levels and adding sound-absorbing materials, so everyone can have a conversation without straining to speak or to be heard.

Noisy restaurants are a major disability rights issue for those with hearing loss, tinnitus, and hyperacusis. And it is an important issue for older Americans, many of whom have significant (25-40 decibel) hearing loss.

I will be speaking about the problem of restaurant noise at the December 2017 meeting of the Acoustical Society of America in New Orleans.

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.

Yet another reason to protect your hearing

by Daniel Fink, MD, Chair, The Quiet Coalition

October is National Protect Your Hearing Month, and Jane Brody’s column in the September 26, 2017, New York Times science section gives yet another reason to protect your hearing: hearing loss is tied to cognitive decline. In fact, studies are underway to determine if preventing hearing loss or treating hearing loss will prevent cognitive decline, because the correlation between hearing loss and cognitive decline is well established.

I try to lead a healthy life. I never smoked. I walk an hour or more every day. I eat 5-7 servings of fruits and vegetables daily. My BMI is 24.5. I wear a hat and long sleeves to protect me from the California sun. I always use my seat belt when driving or riding in a car. But I knew little about the importance of protecting my hearing.

Unfortunately, my ignorance hurt me. A one-time exposure to loud noise one New Year’s Eve left me with permanent tinnitus and hyperacusis. I started wearing ear plugs at movies and sports events, and dined out rarely because almost all restaurants are painfully noisy for me. Then three years ago, after reading a different piece in the New York Times science section on hyperacusis, I was motivated to become a noise activist and to learn more about preventing auditory damage.

Researchers are working on drugs and other treatments to reverse noise-induced hearing loss, tinnitus, and hyperacusis, but currently the only treatments for hearing loss are hearing aids or, for the most severely affected, cochlear implants. And hearing aids aren’t like eyeglasses or contact lenses for common visual problems. They just don’t work as well as people would like to help them understand speech.

When I learned how bad noise is for the ears, that the only safe noise exposure level to prevent hearing loss is 70 decibels daily average noise exposure, that most Americans are exposed to dangerously high noise levels in everyday life, that many American adults have noise-induced hearing loss because of the excess noise exposure, and that hearing aids don’t work particularly well in helping people with hearing loss understand speech, I realized I had to protect my hearing.

Now I use earplugs at the movies, at sports events, even if I have to go to a noisy restaurant. And if I use a power tool, or even bang in one nail with a hammer, I use ear plugs or ear muff hearing protection. You should, too!

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.