Tag Archive: Dr. Daniel Fink

Who should get their hearing checked? Everyone!

By Daniel Fink, MD, Chair, The Quiet Coalition

This local television anchor recommends that everyone get his or her hearing checked.

But this isn’t what the experts at the U.S. Preventive Services Task Force recommend. They reviewed the published medical literature on screening for hearing loss and concluded that, based on the literature, there is no proven benefit to screening for hearing loss in adults. People who complain of not being able to hear should be checked, they cautioned, but they found no benefit in looking for hearing loss is those who don’t have an obvious problem.

Maybe it’s time to rethink that recommendation. A recent report from the Centers for Disease Control and Prevention (CDC), Vital Signs: Noise-Induced Hearing Loss Among Adults, found the following based on recent data from the National Health and Nutrition Survey:

Results: Nearly one in four adults (24%) had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who reported excellent or good hearing had audiometric notches (5.5% bilateral and 18.0% unilateral). Among participants who reported exposure to loud noise at work, almost one third had a notch.

Conclusions and Implications for Public Health Practice: Noise-induced hearing loss is a signficant, often unrecognized health problem among U.S. adults. Discussions between patients and personal health care providers about hearing loss symptoms, tests, and ways to protect hearing might help with early diagnosis of hearing loss and provide opportunities to prevent harmful noise exposures. Avoiding prolonged exposure to loud environments and using personal hearing protection devices can prevent noise-induced hearing loss.

Audiometric notch is the hallmark of noise induced hearing loss.

The CDC information that a quarter of American adults have hearing loss but don’t know it–including those who rate their hearing as good or excellent–indicates a major problem. Experts recommend checking blood pressure at every doctor visit and cholesterol at varying intervals, depending on risk factors, beginning in childhood. Screening for auditory disorders is recommended for children but not for adults. But hearing loss is like high blood pressure or high cholesterol–it is painless and asymptomatic, and unless someone checks, the patient doesn’t know that he or she has it.

Why does this matter? Most Americans, including most doctors and audiologists, don’t know that the only safe noise exposure level to prevent hearing loss is only 70 decibels time weighted average for 24 hours with the real safe noise exposure level probably even lower than that. Most Americans don’t know that we are exposed to dangerous levels of noise every day, which probably explains the recent CDC findings. If people know that they have hearing loss, perhaps they will do more to protect their ears.

Significant hearing loss with age is probably not part of normal physiological aging, but represents noise-induced hearing loss. (I will be presenting a paper on that topic at the 12th Congress of the International Commission on the Biological Effects of Noise.)  Regular hearing testing could prevent current and future generations from losing their hearing.  Why? Because noise-induced hearing loss is 100% preventable, and regular tests would let people know whether and to what degree their hearing is compromised, allowing–and encouraging–them to take action today to avoid significant hearing loss tomorrow.¹

Take the initiative with regard to your hearing health, and have your hearing tested regularly as part of a preventive health plan.

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.

¹ For those who are concerned about establishing the diagnosis of hearing loss as a pre-existing condition which might increase their insurance rates or exclude coverage for future hearing health care, they should not be worried for two reasons: (1) Medicare and Medicaid don’t have a pre-existing condition exclusion, and (2) federal and commercial insurance plans do not cover audiology services and hearing aids. Which is more important? Not establishing a pre-existing condition for something not covered by insurance, or finding out that your hearing is already being damaged and having the chance to take steps to protect your ears?

Top researchers work toward treatments, but prevention remains the best medicine.

By Daniel Fink, MD, Chair, The Quiet Coalition

Humans are born with only 15,000 cochlear hair cells. When these are destroyed by noise they don’t regenerate, unlike cochlear hair cells in other animals, such as chickens. If a way can be found to regenerate human cochlear hair cells, perhaps hearing can be restored.

A recent report from Harvard and MIT holds promise for treating hearing loss in the future. Researchers there were able to increase the number of stem cells from mouse cochlear hair cells in vitro using a cocktail of small-molecule chemicals. It’s hard to do basic science research on humans–one can’t hurt people doing research–but mice share 99% of our genetic material, and being small and inexpensive, they are good substitutes in the lab. The researchers hope to begin testing their approach in humans in 18 months.

This is great news for millions of Americans with hearing loss. It’s possible that with additional advances, one day their hearing could be restored. But I have one problem with the report: The researchers are developing a treatment, probably not an inexpensive one, for a problem that is entirely preventable.

The public health mantra is that prevention is always better and cheaper than treatment, which in turn is better and cheaper than rehabilitation. Noise-induced hearing loss is 100% preventable. How? Avoid loud noise. If you can’t avoid noise exposure, use hearing protection (earplugs and ear muff hearing protective devices). You can find these in your drugstore, in “big box” home improvement stores like Home Depot or Lowe’s, or online. There is even an online retailer devoted only to hearing protection.

So kudos to the researchers at Harvard and MIT. No doubt their work and the work of other researchers will eventually help the millions of Americans who already suffer from hearing loss and other hearing damage. But let’s put time, money, and effort in promoting a cheaper and safer approach to hearing health–prevention. No more research is needed, and we can avoid hearing loss today.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area.  He serves on the board of the American Tinnitus Association and 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.

Originally posted at The Quiet Coalition.

Another Silent Spring

By Daniel Fink, MD, Chair, The Quiet Coalition

In 1962, Rachel Carson’s “Silent Spring” described the harmful effects of insecticides and herbicides on birds, beneficial insects, animals, and humans.  Her book helped start the environmental movement. For too many people, this will be another silent spring, caused not by a dearth of birds but because people can’t hear birds sing. They have hearing loss from another environmental pollutant, noise.

Carson described how nature’s balance controlled pest species naturally, and how these species became problems only when humans changed the environment. She noted the difference between apparent short-term safety of agrichemicals and longer-term danger. People could get sprayed with pesticides or even ingest them without apparent immediate harm, with cancer and birth defects coming later.

If Carson were alive today, she might write about noise pollution, which interferes with animal feeding, communication, mating behaviors, and navigation in forests, fields, and oceans, and causes hearing loss and other medical problems in humans.  In nature’s quiet, animals developed exquisite hearing to find food or avoid being eaten. An owl can find a mouse under a foot of snow, and zebras can hear lions approaching in the veldt.

Humans are also born with excellent hearing.  Brief exposure to loud noise usually doesn’t cause obvious auditory damage in humans, but longer or repeated exposure does. The relationship between noise and hearing loss was first noted in medieval times in bell ringers and miners, then in boilermakers during the industrial revolution.  Noise wasn’t a widespread problem, and except in large cities life was usually quiet.

Industrialization, mechanization, and urbanization made life noisier.  Noise was recognized as a public health hazard in the early days of interstate highways and jet travel, but was also considered an environmental pollutant. In 1972 Congress passed the Noise Pollution and Abatement Act, empowering the Environmental Protection Agency (EPA) to establish noise standards and require noise labeling for consumer and industrial products.

During the Reagan administration, however, Congress defunded EPA noise control activities. Little has been done since to control noise, and our country has gotten noticeably louder. Sound levels of 90-100 decibels or louder are reported in restaurants, clubs, retail stores, movie theaters, gyms, sports events, concerts, and parties, from sirens, vehicles, landscape maintenance equipment, and construction, and for those using personal music players.

The National Institutes of Health states that prolonged exposure to noise at or above 85 decibels can cause hearing loss. This is misleading, because no exposure time is given and hearing damage occurs at much lower levels. The 85-decibel standard is an occupational noise exposure standard, not a safe noise level for the public.. The EPA adjusted the occupational standard for additional noise exposure outside the workplace to calculate the noise level for preventing hearing loss to be a daily time-weighted average of only 70 decibels.

Hearing is the social sense, required for spoken communication. About 40 million American adults age 20-69 have noise induced hearing loss, half of them without noisy jobs. Why is this happening? They are exposed to loud everyday noise.  Cumulative noise exposure eventually causes hearing loss, affecting 25% of those in their 60s, half in their 70s, and 80% in their 80s, and is correlated with social isolation, depression, dementia, falls, and mortality. Due to denial, stigma, and cost only 20% of older Americans with hearing loss acquire hearing aids, after an average seven-year delay, and 40% of people with hearing aids don’t use them much, largely because hearing aids don’t help users understand speech well in noisy environments.

Preventing noise-induced hearing loss is simple: avoid loud noise. If it sounds too loud, it is too loud. Free or inexpensive smart phone sound meter apps make it easy to measure sound levels, but if one can’t converse without straining to speak or to be heard, ambient noise is above the auditory injury threshold of 75-78 decibels and auditory damage is occurring.

A quieter world is easily attainable. Whisper-quiet dishwashers, cars with quiet interiors and exhausts, the Airbus A380, and a few quiet restaurants and stores prove this.   Effective noise control technologies have long existed, including noise reduction via design and material specifications and sound insulating, isolating, reflecting, diffusing, or absorbing techniques.  Indoors, all that may be necessary is turning down the background music volume, which costs nothing.

In the 1950s and 1960s, half of all American men smoked and public spaces and workplaces were filled with tobacco smoke. When research showed that tobacco smoke caused cancer and heart disease, governments restricted smoking, leading eventually to today’s largely smoke-free society. Smokers can still smoke, but can’t expose others involuntarily to their smoke.

Noise causes hearing loss. Governments should set and enforce indoor and outdoor noise standards, to reduce each person’s daily noise dose. Adults have the right to make and listen to all the noise they want, but not where others can hear them. If we can breathe smoke-free air, we can make a quieter world, so future generations won’t have to endure another silent spring.

Dr. Fink is a leading noise activist based in the Los Angeles area.  He serves on the board of the American Tinnitus Association and 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.

Originally posted at The Quiet Coalition.

The CDC takes on noise-induced hearing loss

Photo credit: Raed Mansour

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.

It’s World Hearing Day!

By Daniel Fink, MD

Today, March 3, is World Hearing Day. This day is designated by the World Health Organization (WHO) to raise awareness and promote ear and hearing care around the world. The theme of this year’s World Hearing Day is “Action for Hearing Loss: Make a Sound Investment,” which aims to draw attention to the economic impact of hearing loss and cost effectiveness of interventions to address it.

I wish the WHO and the U.S. federal government paid a little more attention to prevention of hearing loss rather than dealing with the consequences after the damage has been done. The “public health mantra” is that prevention is better and cheaper than treatment, which in turn is better and cheaper than rehabilitation. I know that many people think hearing loss is part of normal aging, but several lines of evidence suggest that most hearing loss is caused by noise exposure. Presumably most people think they can just get a hearing aid when their hearing goes, unaware that hearing aids don’t work as well for hearing loss as eyeglasses work for presbyopia. And noise-induced hearing loss is entirely preventable–just avoid loud noise. If you can’t avoid noise, use earplugs.

Helen Keller said decades ago, “Blindness separates people from things. Deafness separates people from people.”  The New York Times recently had a column about blindness, the most dreaded physical disability.  If people were losing vision instead of losing hearing from noise exposure, people might be more concerned about our too noisy world.

Do We Hear too Much Noise Every Day?

Dr. Daniel Fink believes the answer is yes. Noted noise activist, Daniel Fink, MD, Founding Chair of The Quiet Coalition, writes about his thesis that the general public is exposed to entirely too much damaging noise every day. He notes that noise is a public health hazard, yet the federal government, which adopts standards to protect the public for food, water, and motor vehicles and makes recommendations or guidelines for dietary intakes of vitamins, salt, and sugar, has issued no federal standard regulating noise exposure or recommending noise limitations for the public.  In his piece, Dr. Fink describes his quest to find the noise level that will protect hearing, and he reveals how a recent important but ignored study has confirmed his suspicions that hearing damage can occur at lower decibel levels than previously suspected.

Click the link above to read more about Dr. Fink’s mission to warn medical professionals, the government, and the public about the dangers of noise and how we can protect our hearing.

Despite complaints, restaurant noise continues unabated

by Daniel Fink, MD

Ever since I developed tinnitus and hyperacusis from a one-time exposure to loud restaurant noise, I have been looking for a quiet restaurant (see the Acknowledgements section at the end of my editorial in the January 2017 American Journal of Public Health, “What Is a Safe Noise Level for the Public?“).

It turns out I’m not the only one complaining about restaurant noise.

Restaurant noise is the number one complaint of diners in New York, San Francisco, Portland OR, and Boston.  In fact, the Boston Globe just recently wrote about diners’ dislike of restaurant noise in a piece titled, “Listen up: Restaurants are too loud!

Restaurant owners may think that noise increases food and beverage sales, and decreases time spent at the table, and they are right.  But what they cannot measure is how many meals are lost because people like me don’t go to noisy restaurants with family or friends, choosing to dine at home, instead, where we can converse as we enjoy our meal. Perhaps restauranteurs should consider that we middle-aged folks are more likely to spend money in restaurants than other demographic groups.  After all, for many of us our kids are done with college, our mortgages are paid off, we’ve been saving for retirement, and we have the disposable income to enjoy a nice meal out more frequently than in our youth.  If there were quieter restaurants, we might dine out more often instead of avoiding them because we would rather not have a side of hearing loss with our steak frites.

I guess that as long as the restaurants are busy, they will stay noisy. But if enough of us speak up–in the restaurants and to our elected representatives, asking them to pass laws requiring some limits on indoor noise–restaurants will eventually get quieter.

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.

University of Kansas “wins” title for loudest crowd roar at an indoor sports arena

by Daniel Fink, MD

Maybe one day the Guinness Book of World Records will have a category for the most people sustaining auditory damage at one time at an indoor sports event? Because that’s what happened in Lawrence, Kansas, at the University of Kansas’ Allen Fieldhouse on February 13, 2017. A new world record was set for indoor noise at a sports event: 130.4 decibels. The previous “winner,” the University of Kentucky’s Rupp Arena, set a record of 126.4 decibels just two weeks earlier.

It was a great game, undoubtedly sold out. Kansas won in overtime, coming back from a 67-60 deficit with 1:13 to play in regulation to tie the game, and then won in overtime. The few disheartened fans who left early missed the conclusion of a one of the season’s best basketball games. Famed Kansas coach Bill Self called it “the most remarkable win I’ve ever been a part of.” But his ears, the players’ ears, the ears of team and fieldhouse staff, and those of the capacity crowd of 16,300, undoubtedly also suffered permanent auditory damage. That’s because 130.4 decibels is about as loud as a four-engine jet plane from 100 feet away, but the auditory injury threshold (the point at which a hearing injury may occur) is only 75 to 78 decibels.

Maybe one day the NCAA, which touts “Student-Athlete Well-Being” as one of its core principles, will show some concern for the auditory health of its student-athletes and ban this type of silly and dangerous competition at NCAA events.

But if not, then how about a contest to see how many NCAA student athletes and sports event attendees can be blinded at one time by the host NCAA institution shining powerful laser lights into the stands and team benches at the sports arena?  Hey, a world record is a world record, right?

Or maybe reason will prevail and the people who have the power to stop this senseless and dangerous contest will come to their senses?  They can’t say that they didn’t have notice, because my letter to the editor of The Kansas City Star was published on Monday, February 20th.  Your move, NCAA.

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.

In a followup to his post on looking for a quiet car,

Dr. Daniel Fink, Chair of The Quiet Coalition, has written a post about disturbing noises automobile manufacturers purposefully add to their cars: There’s More To Car Noise Than Interior Sound. Dr. Fink’s second post was prompted by a reader who noted that while “[d]esign of the quietest interior possible has become highly competitive,” little thought is given to “the effect that automotive lock, locating, and security technology have on the residential soundscape.”  Simply put, automobile manufacturers have adopted sound as a default to confirm a car door is locked or to locate a car in a parking lot without thinking about the effect of adding all of these audible honks and beeps and warnings to an already noisy soundscape.

Fortunately, there are some steps car owners can take to disable or modify the audible alerts, but not without difficultly.  Click the link above to get Dr. Fink’s list of questions to ask about audible alerts before buying a car.

Looking For A Quieter Car?

By Daniel Fink, MD

As automobile makers have focused on fuel efficiency to meet federally mandated fuel efficiency standards, interior quiet has suffered.  But it is still possible to find quieter, more comfortable cars.

GM’s Buick Division might be a good place to start.  And these four links offer some other possibilities:

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.