Tag Archive: Dr. Daniel Fink

Noisy restaurants redux

Photo credit: James Palinsad licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

Both my parents served in the U.S. Army in World War II, met while in the service, and married shortly after the war ended. I was born a few years later. So I am a “baby boomer,” but I’m not a regular reader of BOOMER Magazine. That said, this article in BOOMER Magazine about noisy restaurants clearly defines the issue, even as it fails to deliver the right solutions.

The article talks about the heartbeat of a restaurant, i.e., the unique ambience. Unfortunately, in many restaurants that heartbeat is far too loud. The problem is that many baby boomers have significant (25-40 decibel) hearing loss, which makes it impossible to understand speech in a noisy environment. And in many cases, noise levels in restaurants and bars are loud enough to cause further hearing loss, discomfort, and even pain.

Many of us boomers are in our mid to late 60s. We may think of ourselves as “forever young,” but the reality is that (with graying and/or thinning hair, thickening middles, and bifocals) we are not the “demographic” that marketers and retailers want, even if many of us have a lot more money and a lot more time in which to spend it that younger people do. For many baby boomers our mortgages are paid off, the kids are done with college, and we’ve funded our retirements. And members of this demographic are looking for restaurants in which we can enjoy a meal AND a conversation with family and friends. But as long as the restaurants are busy–and they sure were in west Los Angeles last night–the restaurateurs and barkeeps have no reason to make things quieter.

This December I will be speaking on the disability rights aspects of ambient noise at the meeting of the Acoustical Society of America in New Orleans. It’s my position that the answer to excessive restaurant noise isn’t eating earlier, or choosing a quieter restaurant (a near impossibility in many cities, including mine), or grinning and bearing it, as BOOMER Magazine suggests, it’s making restaurants quieter. In many cases, this doesn’t cost anything: just turn down–or turn off–the music!

I’m a doctor with tinnitus and hyperacusis, not a lawyer. But it seems to me that those of us with partial hearing loss, tinnitus, and hyperacusis meet the Americans with Disabilities Act (ADA) definition of having a disability. The ADA defines an individual with a disability as “a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.” If I’m correct, ADA regulations should require “places of public accommodation”–including restaurants and bars–to be quiet enough to allow those with auditory disorders to converse while enjoying a meal or a drink. That is, people with partial hearing loss, tinnitus, and/or hyperacusis should be protected under the ADA.

For those concerned that indoor quiet laws will hurt business, I turn to the example of no-smoking laws that were imposed on restaurants and bars. Restaurant proprietors and especially bar owners foresaw calamity, but a multitude of studies showed no impact on revenues. My guess is that if some smokers chose not to go to restaurants or bars, they were replaced by those who didn’t want a side order of secondhand smoke with their steak frites. Or the smokers learned to smoke before or after dinner, or to step outside if they wanted to smoke. And that’s what I predict will happen when indoor quiet laws are passed: diners will still go to restaurants, maybe even more of them.

Until reason prevails and restaurants are required to meet reasonable decibel limits, we must ask restaurant owners and managers to turn down the volume.  And if they want our business, they will do it. But what if our requests fall on deaf ears? The next step may be pursuing legal remedies under the ADA to require restaurants to provide a soundscape that protects everyone’s ears.

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.

Scientists discover that eardrums move in sync with eyes

By Daniel Fink, MD, Chair, The Quiet Coalition

Aylin Woodward, New Scientist, reports on new research that shows that our eardrums appear to move to shift our hearing in the same direction that our eyes are looking. Jennifer Groh, the lead researcher, believes “that before actual eye movement occurs, the brain sends a signal to the ear to say ‘I have commanded the eyes to move 12 degrees to the right’.” Why? She opines that “[t]he eardrum movements that follow the change in focus may prepare our ears to hear sounds from a particular direction,” noting that one reason why the eyes and ears move together may be to help “the brain make sense of what we see and hear.”

My guess is that for our primate ancestors, and then for primitive humans, there was a survival advantage to hearing sound from something that had been seen. Friend or foe? Food or predator? It will be interesting to see where this research leads, particularly as Woodward writes that the study might help develop better hearing aids, “which must locate where sounds are coming from to work well.”

Research is always good. That’s how we learn about how the world works. But we don’t need any more research to know that noise is a health and public health hazard, and that we need to press our elected officials to make the world quieter now.

Because no matter how good the technology becomes, preserved normal hearing is far better than any hearing aid. And far cheaper, 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.

New hearing aid filters out noise (but not as well as your own ears and brain)

Photo credit: Steve Johnson licensed under CC by 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Engineers at Columbia University School of Engineering and Applied Science have made an advance in hearing aid design that reportedly will allow users to better understand speech in noisy environments by combining auditory and neurological signal processing techniques. No doubt the millions of people who suffer with hearing loss appreciate the efforts to tackle this health issue. But why do we see article after article focusing on funding for treatments or cures of hearing loss but nothing about funding hearing loss prevention?

We think the better option is to prevent noise-induced hearing loss by avoiding exposure to loud noise. The human ear and brain are designed to process incoming sound well and probably do this better than any electronic gizmo can. Research shows that noise damages not just the ear but directly damages the brain as well, at least in animal models.

And for those who already have hearing loss–and even for those who don’t–quieter indoor and outdoor environments will allow everyone to converse more easily. The techniques for creating indoor quiet are well known: eliminate noise sources if possible, isolate noise sources that can’t be eliminated, use sound absorbing materials on floors, walls, ceilings, and furniture, and use architectural features to break up reflected sound waves. And while some may balk at the cost of implementing these techniques, there is one no cost option everyone can use: turn down the volume of amplified sound from rock concert levels to hearing preservation levels!

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.

 

Bicyclists at risk of hearing loss

By Daniel Fink, MD, Chair, The Quiet Coalition

A new study shows that bicycle riders may be at risk of hearing loss, and the culprit is wind noise. The study by Dr. Michael Seidman, an ear specialist who also is a bicycle rider, measured sound levels in a wind tunnel, finding that under many conditions noise level were high enough to cause auditory damage. The measurements need to be replicated on the road, which is a more challenging endeavor.

To me, the important thing to note is how Dr. Seidman conceived of the study: he was out riding with his brother and found that they had to shout at each other to be heard over the wind noise. He states that “OSHA, the Occupational Safety and Health Administration, says you can be exposed to 85dB of loudness for an eight-hour time period at work. But that does cause noise-induced hearing loss — we know that it does,” he said. “So anything over 85dB causes noise-induced hearing loss.”

I wrote about the 85 dB (actually A-weighted decibels, or dBA) occupational standard in the American Journal of Public Health, in which I noted that 85 dBA “is not a safe noise exposure level for the public.” Humans have difficulty understanding speech if the ambient noise is above 75 decibels. (Technically, those are A-weighted decibels, or dBA. That information is in Figure D-1 in the 1974 EPA “noise levels” monograph.) And Flamme et al. discussed the fact that the auditory injury threshold is only 75-78 dBA.

So, as Dr. Seidman realized, if it sounds too loud, it IS too loud. You don’t need a sound meter to know that. If you have to strain to speak or to hear conversation, the ambient noise is above 75 dBA and your hearing is being damaged.

What should bicyclists do to protect their hearing? Earplugs are an obvious choice, but Dr. Seidman says that they are illogical because “It’s not a good idea to wear earplugs when you ride — you can’t be aware of your surroundings.” He suggests that helmet design could address wind noise (but apparently isn’t offered at this time), but adds that accessories are available, such as AirStreamz Pro Cycling Wind Noise Reducer  by Cat-Ears, which are attached to eyeglasses or helmet straps and help to deflect noise.

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.

Treating hearing loss may help prevent dementia

By Daniel Fink, MD, Chair, The Quiet Coalition

A recent Canadian newspaper article discussing a report in The Lancet, the premier British medical journal, about preventing dementia.

The Lancet article highlights the importance of treating hearing loss for possibly preventing dementia. If you’re interested in dementia, know someone with dementia, or want to see what you can do to avoid developing dementia yourself, I recommend the Lancet article. It summarizes a large body of research in a readable fashion that should be accessible even to the lay reader.

There are many factors correlated with dementia risk, including genes, blood lipid levels, and diseases or conditions such as diabetes, hypertension, obesity, and factors such as social isolation and cigarette smoking. The association between hearing loss and dementia is well-known and research is under way to see if treating hearing loss reduces the risk of dementia. Despite only correlations, and no clear understanding of how hearing loss may increase the risk, the Lancet authors think the scientific evidence is strong enough to recommend treatment of hearing loss as a possible prevention measure for dementia.

Of course, the only treatment for hearing loss is hearing aids, with cochlear implants reserved for the more severely impaired. We think that people with hearing loss should use hearing aids just to be able to hear others, whether hearing aids prevent dementia or not.

That said, hearing aids are a poor substitute for preserved natural hearing.

Perhaps the Lancet article should have gone a step further and highlighted the importance of preventing noise-induced hearing loss (NIHL) to delay or avoid the onset of dementia. After all, we think it’s significantly better to prevent NIHL than to treat it, and that’s simple: avoid exposure to loud noise or wear ear protection when you cannot.

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.

When “good news” is bad news

Daniel Fink, MD, Chair, The Quiet Coalition

This article in JAMA Otolaryngology about hearing loss in young people age 12-19 is getting press as good news. Researchers at the University of California (both the Los Angeles and San Francisco medical schools) analyzed audiometric test data on young Americans from the National Center for Health Statistics collected by National Health and Nutrition Survey (NHANES). The researchers concluded that the prevalence of hearing loss as measured by standard pure tone audiometry had not increased despite wider use of headphones and earbuds to listen to personal music players.

We don’t think this is good news at all.

First, the researchers state that the prevalence of hearing loss in 2009-2010 is 15.2%. Hearing only worsens with age, so based on the data, it appears that about one-sixth of young people are likely to have profound hearing loss in mid-to-late life. If they were losing their vision instead, would anyone think this was good news?

Second, the subjects hearing was assessed by standard pure-tone audiometry. These traditional tests do not detect hidden hearing loss, which indicates nerve damage (synaptopathy) caused by noise exposure. Only techniques that are now considered research techniques will detect this early auditory damage.

Third, the authors note that there was increased risk of hearing loss in racial/ethnic minorities and those from low socioeconomic backgrounds. Isn’t hearing health an issue for this group of Americans too?

Finally, the researchers discuss the many limitations of this type of data analysis, which means that no definite conclusions can be drawn from this study.

In the end, the article generated a lot of “good news” headlines and in doing so has done a disservice to all young people, because those headlines and the cursory reports that followed downplay the dangers of increased headphone and earbud use. This is particularly galling and irresponsible when one recognizes that noise-induced hearing loss is 100% preventable.

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.

Swiss study confirms transportation noise causes health problems

Daniel Fink, MD, Chair, The Quiet Coalition

It is well-known in Europe that transportation noise causes adverse health effects, including sleep loss, diabetes, hypertension, obesity, cardiovascular disease, and death. The World Health Organization’s European Office published a monograph on the burden of disease from noise, and the European Noise Directive lays out a government plan to deal with the problem. Studies in the UK, Germany, the Netherlands, and other countries have consistently shown this, most often with a relationship between greater noise exposure and worse health outcomes.

At the 12th Congress of the International Commission on the Biological Effects of Noise (ICBEN) meeting in Zürich in June–the world’s largest meeting on the health effects of noise–Swiss researchers presented the results of a study done in their country. The results are from an integrated research approach dubbed SiRENE (the acronym roughly translates to Short and Long Term Effects of Transportation Noise Exposure) looking at noise exposure, sleep patterns, clinical testing for sleep disorders and glucose metabolism, mathematical modeling of noise exposure for the Swiss population, and determination of noise-induced health risks for the Swiss population. The study is ongoing, but interim reports at ICBEN were consistent with reports from other countries: transportation noise exposure caused cardiovascular disease, hypertension, diabetes, and increased the risk of dying from a heart attack by 4% for each 10 decibel increase in road noise at home.

We are certain transportation noise has the same adverse health effects on Americans even if the research here is limited. Perhaps the best-known American study of the effect of transportation noise on health was done by Correia et al, looking at hospital admissions in the Medicare population in people living near airports. That study was limited in its scope and methods, but not surprisingly, transportation noise exposure increased hospital admissions here, 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.

New Zealand researchers agree: hearing loss is probably a dementia risk factor

By Daniel Fink, MD, Chair, The Quiet Coalition

Many people don’t understand the process of medical and scientific research and how different hypotheses are developed and tested, using different methods in different human populations with animal studies when possible, until a consensus is reached. This was how researchers–including doctors, epidemiologists, researchers using animal models, and scientists doing basic research at the cellular, molecular, and genetic levels–figured out that cigarette smoke causes cancer and many other diseases, and how it does this. Despite the broad scientific and public health consensus, there are still skeptics, such as those at the conservative Heartland Institute, who say there is still doubt about whether smoking causes lung cancer. There is also a Flat Earth Society. Many Americans think that evolution is an unproven theory despite more than a century of research and strong evidence supporting evolution.

For the rest of us who believe in evidence-based science and evidence-based social and economic policies, our understanding of reality is always evolving based on the evidence. Sometimes something long thought to be true is found not to be correct after all. In medicine, one of the best examples may be ulcers in the stomach and small intestine, which for decades were thought to be caused by too much stomach acid but were found to be caused by bacteria. Australians Barry Marshall and J. Robin Warren won the Nobel Prize in 2005 for making this discovery. But most of the time an early hypothesis is confirmed by one study, and then another, and then by studies in animal models, and then by basic science research, until a broad consensus is reached.

This is what is happening with the hypothesis that hearing loss is associated, probably causally, with dementia. Dr. Frank Lin at Johns Hopkins University may be the best-known researcher in this field but other researchers in other countries are studying the same question. This report from New Zealand discusses what is being done there. And this report from the UK discusses research presented there.

It’s always good to have confirmation of research by different researchers using different techniques in different populations. Such confirmation helps validate initial findings in one population and helps move our understanding forward. We know that noise exposure causes hearing loss. If hearing loss is shown to be causally associated with the development of dementia, then preventing hearing loss should help to also prevent dementia. One theory is that the brain needs input to maintain function, and without auditory input and/or social connections, brain function declines. Another theory is that whatever degenerative process causes hearing loss also causes loss of mental function. Ongoing studies, providing hearing aids to those with hearing loss but not to others and then measuring intellectual function over time, may elucidate the cause-effect relationship. Regardless, we don’t need to wait for more evidence for the link. Preserving one’s hearing should be enough reason to avoid loud noise or to wear ear plugs if you can’t.

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.

New drug may prevent hearing loss after noise exposure

By Daniel Fink, MD, Chair, The Quiet Coalition

For many years, a body of research has shown that chemicals with antioxidant properties might prevent or reduce hearing loss after noise exposure. In animals, noise exposure reduces levels of a chemical called glutathione peroxidase 1 (a naturally occurring enzyme). A recent report in the British journal The Lancet looks at how a similar chemical, ebselen, works in helping to reduce “both temporary and permanent noise-induced hearing loss in preclinical studies.”

It appears to work quite well.

Of course, we at The Quiet Coalition think it’s better just to avoid loud noise exposure, which is 100% safe and effective at preventing hearing loss. That said, the experimental protocol raises interesting questions about research ethics. Namely, the study tested the efficacy of different doses of ebselen after the subjects, healthy adults aged 18–31 years, were exposed to loud sound. The measure of ebselen’s success was the prevention of a phenomenon called temporary threshold shift (TTS), more completely noise-induced temporary threshold shift (NITTS). This audiometric measure has been used for decades to measure the impact of noise on humans.

Unfortunately, recent research, beginning with a 2009 report and updated last year describes a phenomenon called “hidden hearing loss,” a synaptopathy (injury to the synapses in the cochlea) caused by noise exposure. Hidden hearing loss is called that because it is not detected by standard audiometric techniques. Hidden hearing loss is the likely cause of being unable to follow one conversation among many in a noisy environment, or having a normal or near-normal audiogram but still having difficulty understanding speech.

Many experts think that there is no temporary auditory damage. That is, TTS is a real phenomenon but the use of the word “temporary” is misleading because if TTS occurs then it is likely that permanent auditory damage has also occurred.

In this study, healthy young adults were exposed to noise levels loud enough and long enough to cause TTS, likely indicating permanent auditory damage. Some of the subjects were given large enough doses of the experimental drug ebselen to prevent TTS from occurring, but whether the drug would or wouldn’t work, and at what dosage, wasn’t known when the study began. Simply put, the study exposed all subjects to the threat of auditory damage, and most likely caused auditory damage in the subjects who received the placebo or didn’t get a high enough dose of the experimental drug.

All research protocols in the U.S. must pass review by an Institutional Review Board (IRB) which must make certain that steps are taken to prevent harm to research subjects.. Under the Helsinki Declaration of the World Medical Association, and in the United States under what is called the federal “Common Rule” (45 CFR §46 et seq.), human subjects must be protected. If there is a risk of permanent auditory damage when the phenomenon of TTS is observed–and Drs. Liberman and colleagues certainly think that temporary auditory changes denote permanent auditory damage–we think the IRB should have done more to protect the subjects from any possibility of harm.

How could a study that exposes young people to noise levels loud and long enough to cause TTS pass IRB review? We hope the federal Office for Human Research Protections will let us know.

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.

Noise exposure directly damages rat brains. What does it do to humans?

Daniel Fink, MD, Chair, The Quiet Coalition

The evidence keeps mounting, almost on a daily basis, that noise is a health and public health hazard. Just last month, an article by researchers in Italy found that noise exposure directly damaged rat brains, producing changes in DNA, neurotransmitters, and even morphological changes. (For those who might be skeptical of this report, there is an existing body of research on the effects of noise on the brain. I don’t understand the details of the newer scientific studies, and I’m always cautious because studies have shown that positive results get reported more frequently than negative results, but taken together with the new report, there is a large amount of research pointing to a direct effect of noise on the brain.)

The Italian study exposed rates to noise of 100 decibels for 12 hours. That level exceeds exposure levels for most humans–certainly for a half-day period–but probably not cumulatively for many who attend clubs, rock concerts, or have noisy hobbies such as woodworking or motorcycle riding.

Humans and rats are genetically very similar–experts argue about whether the rat and human genomes are 97% or 99% similar, and about how to measure this similarity–but regardless of the exact percentage, we’re not talking about applying data from a roundworm to humans. The basic similarities are there in organ and cellular biochemistry, structure, and function. So it’s very likely that noise is also a direct toxin to the human brain, with similar genetic, neurotransmitter, and morphological changes, and most likely at lower noise exposure levels, too.

So what can we do? The solution is simple: avoid loud noise exposure, and wear hearing protection if you can’t.

And one last thing–encourage legislators, regulators, and public health authorities to do more to protect us from exposure to unnecessary noise.

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.