Tag Archive: Dr. Daniel Fink

Can noise cause fertility problems?

By Daniel Fink, MD, Chair, The Quiet Coalition

A report in the New Scientist indicates the answer is “maybe.” Researchers in Denmark conducted a study that found an exposure-response relationship between noise and difficulty getting pregnant. The researchers made their discovery by analysing data from the Danish National Birth Cohort, a project that ran from 1996 to 2002, and focusing on women who had tried to get pregnant during the project “if traffic noise data was available for where they lived.” The study was controlled for factors like poverty levels and nitrogen oxide pollution.

Earlier research had suggested that 80% of women who were actively trying to get pregnant usually did so within six menstrual cycles, but the research team found that “for every 10 decibels of extra traffic noise around a woman’s home, there was a 5 to 8 per cent increased chance of it taking six months or longer.”  The article notes that it “is unclear whether traffic noise may be affecting women or their partners.”

New Scientist quotes Rachel Smith of Imperial College London, who finds the link between traffic noise and health worrying. Says Smith, “[b]ecause traffic noise is common, even a small effect on health could feasibly have a large impact across a population.”

Just as the Danish study was released, a South Korean study was reported that focused on long-term exposure to a noisy environment and male infertility.  The study by researchers at Seoul National University, which ran for eight years from 2006-2013, looked “at male infertility by analyzing data from 206,492 men aged 20-59 and calculating the participants’ levels of noise exposure.”  3,293 of the participants had an infertility diagnosis.

The researchers “found that, after taking into account factors such as age, income, BMI and smoking, men who were exposed to noise over 55 dB at night (a level equivalent to a suburban street or an air conditioner and above the World Health Organization night noise level) had a significantly higher chance of being diagnosed as infertile.”  Dr. Jin-Young Min, the study’s co-author, noted that infertility was becoming a significant public health issue, adding that it was known noise affected male fertility in animals, but his study was the first to show the risk of environmental noise on male infertility in humans.

Both studies’ findings have to be replicated in other countries and by other researchers, but the data keep mounting and show that environmental noise pollution is a ubiquitous, pervasive, and dangerous health problem.

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.

 

Revisiting the routine audiological test

By Daniel Fink, MD, Chair, The Quiet Coalition

An audiology examination involves examination of the ear to inspect the ear drum, and then tests based on the patient’s complaints. Routine audiology testing includes pure tone audiometry, i.e., can the patient hear sound at different standard frequencies at different volumes? The recording of these responses is graphed into an audiogram:

Image credit: Courtesy of Dr. Stephane Maison

Tests of speech comprehension can also be performed.  But more detailed tests, such as DPOAE (Distortion Product Oto-Acoustic Emissions), and BAER (Brainstem Auditory Evoked Responses) are not routinely done. They are reserved to further investigate suspected problems, or used as research techniques.

But none of these tests can detect the phenomenon of “hidden hearing loss,” a synaptopathy caused by noise damage to slow response nerves and nerve junctions in the cochlea.

Dr. Stephane Maison, a leading researcher at Harvard Medical School and the Eaton-Peabody laboratory at the Massachusetts Eye & Ear Infirmary, recently published two important papers. The first, Toward a Differential Diagnosis of Hidden Hearing Loss, documented hearing loss in young musicians that was not detected by standard pure-tone audiometry but was detected by more sophisticated tests. In his paper, Dr. Maison wrote that his study “aimed to test the hypothesis that ‘hidden hearing loss’ is widespread among young adults with normal audiometric thresholds, especially those who abuse their ears regularly.” To test this theory, they “recruited young adult subjects and divided them according to noise-exposure history into high-risk and low-risk groups.” What he and his team found were “significant deficits in difficult word-recognition tasks in the high-risk group that were associated with significant elevation of pure-tone thresholds at frequencies higher than those normally tested and with changes in auditory evoked potentials consistent with the presence of cochlear synaptopathy, also known as hidden hearing loss.”

In the second paper in The Hearing Journal, he recommends that additional tests should be added to the current audiometry protocol to detect hidden hearing loss. Dr. Maison argues that early detection must be done since “[n]oise damage early in life likely accelerates the age-related further loss of hair cells and cochlear neurons, even in the absence of further ear abuse,” and suggests that additional tests be administered to identify hidden hearing loss, noting that “recent animal research has reported regeneration of cochlear nerve synaptic connections with inner hair cells after noise exposure.” He concludes that “[c]larification of the true risks of noise, and the true prevalence of noise-induced damage, are important to public policy on noise abatement, to raising general consciousness about the dangers of ear abuse and to preventing a dramatic rise in hearing impairment in the future.”

Click the links above to read Dr. Maison’s papers. They are well worth your time.

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.

 

Gene may hold key to hearing recovery

Photo credit: Max Pixel licensed under CC0 1.0

by Daniel Fink, MD, Chair, The Quiet Coalition

A recent discovery may explain why noise exposure makes some deaf but not others. Researchers at the University of Rochester Medical Center found that a gene with a possible role in human longevity may also play a role in protecting outer hair cells in the cochlea from damage by noise.

Noise-induced hearing loss is the most common cause of hearing loss. Approximately one-third of Americans reaching retirement age have hearing loss, but two-thirds do not. Little is understood about why noise damages hearing in some people but not in others, and this gene may explain part of this puzzle.

Of course, while scientists are trying to figure this out, we can all avoid noise-induced hearing loss entirely simply by avoiding exposure to loud noise, or wearing ear plugs if we can’t. The only evidence-based safe noise level to avoid hearing loss remains a time-weighted average of 70 decibels a day, as I wrote about in the American Journal of Public Health earlier this year.

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. Dr. Fink is a graduate of the University of Rochester School of Medicine and Dentistry.

Millions of people don’t protect their ears

Photo credit: Quinn Dombrowski licensed under CC BY-SA 2.0

By Daniel Fink, MD

Noise is a medical and public health problem, and yet people ignore it at their own peril. Most of us are exposed to too much noise every day. That may explain why the Centers for Disease Control and Prevention found that about 25% of adults age 20-69 had hearing loss, and that many people with hearing loss didn’t know they had it.

Which is why a recent article by Mark Fischetti in Scientific American,A Loud Warning: Millions of People Do Not Protect Their Ears,” is particularly disturbing. Fischetti reports that while “many people know that they should use earplugs or earmuffs when mowing the lawn or partying at the club,” they don’t protect their ears against noise at home or at work. If you click the link to the article, you’ll see a frightening infographic that very clearly shows that millions of Americans are at risk of losing their hearing or suffering other hearing damage because they fail to protect their ears.

Maybe if people knew that noise caused hearing loss, tinnitus, and hyperacusis–none of which can be cured–they might be motivated to protect their hearing and fight for quiet.

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.

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.