Tag Archive: Dr. Daniel Fink

Au revoir to noisy vacuum cleaners?

Photo credit: Robert Scarth licensed under CC BY-SA 2.0

By Daniel Fink, MD, Chair, The Quiet Coalition

The answer is yes! Well, at least in the European Union (EU), that is. Some folks like to mock the EU and its many regulations as “the Nanny State,” but we think that regulations protecting the public from harm–be it financial harm, damage to the environment, or harm to their health–are a good thing. So new EU regulations governing vacuum cleaner noise and power consumption are good for those living in Europe and likely will have an impact on this side of the Atlantic Ocean, too.

Noise is a ubiquitous health hazard, causing hearing loss, tinnitus, and hyperacusis. Research shows that most Americans get too much noise every day and certainly appliance noise contributes to the total daily noise dose. Excessive noise exposure accounts for the recently reported high rate of noise-induced hearing loss in American adults. Quieter vacuum cleaners will help reduce the total daily noise dose.

We know that the Trump administration and Republican politicians believe in the free market, not in regulation. They like to use the pejorative phrase “job-killing regulations.” But it’s clear from past experience that regulations that benefit consumers and the environment will lead to increased sales, and increased jobs, in the United States and worldwide.

American companies ignore international regulations and international standards at their own peril. In the appliance market, this already happened with dishwashers, where over the last several years Bosch and other European manufacturers have a foothold in the American market which they gained by manufacturing and marketing quieter dishwashers. It’s happening with airplanes, where Airbus has stolen market share from once-predominant Boeing by producing quieter and more efficient planes. It happened with air conditioners, where Mitsubishi has taken the technological leadership away from Carrier, the inventor of air conditioning equipment.

We don’t think most people will rush out to buy quieter vacuum cleaners to replace their machine if it is working well, but when it comes time to replace it anyone wanting quiet–and particularly those with pets, autistic children, or elderly people at home–will choose a quieter and more energy-efficient European vacuum cleaner over its American-branded competitors.

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.

Will electric vehicles reduce city traffic noise?

Photo credit: G.M. Briggs

By Daniel Fink, MD, Chair, The Quiet Coalition

Some people put great hope in technology to solve problems of modern living. So it is with those who think that electric vehicles, whether trucks or other vehicles, will do the trick. I’m in favor of electric and hybrid vehicles for their beneficial effects in reducing the use of petroleum products and reducing gaseous and particulate emissions. Anything reducing diesel use will have a dramatic benefit in reducing particulate matter. So news that Ryder, “one of the nation’s largest medium-duty truck fleet management companies, will buy trucks from Chanje [an electric truck manufacturer], then lease and service them through its extensive network,” is welcome. But will electric vehicles reduce city traffic noise? I think not.

First, it will take years if not decades for electric vehicles to become more common. Second, and perhaps more importantly, power train noise is a small component of road traffic noise in most situations. I suppose a diesel hybrid vehicle idling on electric will be quieter than the same vehicle powered solely by a diesel engine, but adequate insulation of the engine compartment and an effective muffler system would do the trick just as well.

And of course, electric vehicles won’t do anything about horns, horn-based alerts, or sirens.

The technologies to reduce or control noise have been known for decades. Acoustics pioneer Leo Beranek published his landmark book, “Noise Reduction,” in 1960 and the successor, “Noise and Vibration Control,” in 1971. As noise pioneer Arline Bronzaft, PhD, has written, what is lacking is not the way but the political will.

Road traffic noise is a health and public health hazard, causing non-auditory health impacts like hypertension, diabetes, cardiovascular disease, and death. The European literature makes this very clear. There is no reason to think that Americans, largely of European descent and those from elsewhere, have different physiological responses to noise exposure.

If enough people loudly demand that their elected officials pass and enforce laws to make vehicles and streets quieter, our cities and their streets will become quieter. Electric vehicles may or may not play a small role in this, but they are largely irrelevant.

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.

Why is Cosmopolitan writing about hearing loss?

By Daniel Fink, MD, Chair, The Quiet Coalition

When The Quiet Coalition came together last year, there were few articles in the popular media about noise issues, and those that did appear often contained significant factual errors. But over the last few months, the number of articles has increased and errors within them have decreased. One example is a recent article in Cosmopolitan, an international women’s magazine covering fashion, beauty, and sex, which offers very sound advice about hearing protection, including the admonishment to abandon the use of earbuds.

Health education is one of the cornerstones of public health practice. It is believed that if people know what are healthy practices, they will do it. My observation is that this may be true for those at the higher end of the socioeconomic scale but doesn’t necessarily hold for the majority of people, who are either not interested, lack resources, or are too busy handling everyday life to worry about how what they do today might affect their health tomorrow. I think society has a responsibility to protect the health of all people whatever their socioeconomic status, and I believe that strict regulations are more effective in encouraging healthy behaviors than health education programs. If health education programs worked reliably, nobody would smoke, everyone would exercise, there would be no sexually transmitted diseases, and etc.

As with laws banning indoor smoking (and in some places, outdoor smoking at beaches and parks), comprehensive local, state, and federal indoor and outdoor quiet laws will be more effective than health education programs and articles in the popular media to protect the nation’s auditory health. But health education efforts about the danger of noise are a start, at least for those who read the information.

In the United States, the best example of disparate health habits correlated with educational status may be smoking, where only about 3.7% of adults with graduate degrees (and presumably higher income levels) smoke, compared to 25.6% of those without a high school diploma. This is a striking seven-fold variation. Another example is obesity, which is inversely correlated with educational status and annual income, but the relationship isn’t as strong. Nearly 33% of adults who did not graduate high school are obese, compared with 21.5% of those with a college or technical degree, and more than 33% of adults earning less than $15,000 are obese, compared with 24.6% of those earning at least $50,000 annually.

It’s clear that higher education and income levels are keys to better health. And this now likely applies to hearing health, including Cosmopolitan readers.

And that’s important. I’m an internist who believes in practicing what I preach. I don’t smoke. My body mass index (BMI) is 24.5. I walk an hour or more a day, eat at least 5 servings of fruits and vegetables daily, avoid red meat, eat lots of fish, wear a hat and long sleeves if I’m in the sun, and always use a seat belt. But I had no idea that a one-time exposure to loud noise could give me tinnitus and hyperacusis for the rest of my life. So if just one young woman who reads the Cosmopolitan article protects her hearing–and tells her friends and family to do so too–the staff at Cosmopolitan will have done a great public service.

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.

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.