Tag Archive: hearing loss

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.

What can you do to protect your children’s hearing?

Doctors say kids are at higher risk for hearing loss. Dr. Rachel Wood, an audiologist with the LSU Health and Sciences Center, studies and treats hearing loss patients, and increasingly she is seeing younger patients. Dr. Wood says that there are a “growing number of factors that cause hearing loss.” One particular concern is that “[c]hildren especially can plug into their phone and crank up the volume, turn up the sound effects on video games, or even watch rock concerts on their computers.”

Dr. Wood finds headphones to be “especially troubling,” stating:

There are tiny sensors in your inner ear that are very sensitive. Loud sounds damage those sensors, and if they’re destroyed, they will never grow back, which leads to hearing loss. The amount of damage is based on the volume of the sound and how close the sound is to your ear. Since headphones put the sound right next to those sensors, it magnifies the damage.

So what can you do to protect your child’s hearing?  Dr. Wood suggests that parents set volume limits on electronic devices such as phones.  She also advises parents to impose time limits for using headphones and have their children take a break every 30 to 60 minutes.  Finally, if your children are going to events with loud noises, such as concerts or fireworks displays, hand them a pair of ear plugs.  Purchased in bulk, ear plugs are a cheap and easy way to protect your children’s hearing.

 

 

 

Hearing loss may double in the U.S. by 2060

Photo credit: Thomas Widmann

CBS News reports on a new study that concludes that millions of Americans face the prospect of losing their hearing as they age. The study by researchers at Johns Hopkins University estimates that “[a]mong American adults 20 and older, hearing loss is expected to increase from 44 million in 2020 (15 percent of adults) to 73.5 million by 2060 (23 percent of adults),” with the greater increase among older Americans. As a result, “there will be an increased need for affordable interventions and access to hearing health care services.”  Says lead study author Adele Goman, “[h]earing loss is a major public health issue that will affect many more adults,” and “to address this issue, novel and cost-effective approaches to hearing health care are needed.”

Or perhaps prevention would be a better tactic?

Dr. Debara Tucci, a spokesperson for the American Academy of Otolaryngology, Head and Neck Surgery, would agree. She tells CBS News that “people aren’t doomed to lose their hearing as they age.” “The most common cause of hearing loss is prolonged exposure to loud noise,” adds Dr. Tucci, “which includes loud music and a noisy workplace.”  Prevention, then, should be a rallying call among the medical profession, particularly public health officials.  This is especially important since the litany of horribles that befalls older adults who suffer hearing loss goes well beyond difficulty hearing.  The list includes: higher incidences of depression and anxiety, higher rates of hospitalization and of falls, and even “evidence of an association between hearing loss and mental decline.”

Coupled with the recently released and updated information concerning hearing loss from the Centers for Disease Control and Prevention, this study is a wake-up call to the medical and audiology professions and the public. Simply put, there is a low-cost and 100% effective way to tackle noise-induced hearing loss–preventing it from occurring in the first instance.

 

 

 

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.

Have a friend or family member who is showing signs of hearing loss?

In “Hearing loss: Listening to the signs,” Treva Lind, The Spokesman Review, writes about the 37.5 million Americans who have some degree of hearing loss, focusing on the baby boomers who are 20 to 25% of that population.  Lind states that “[t]he American Speech-Language Hearing Association recommends that people age 50 and older have a hearing test every three years.”  She sits in on a hearing exam for 67-year-old Dale Fowler, who came to the University Hearing and Speech Clinic in Spokane, Washington to see if he needed a hearing aid, a visit scheduled at the urging of family members.  Fowler’s exam revealed that he “had some minor hearing loss at high frequencies in one ear, but it wasn’t enough to warrant a hearing aid.”  Fowler’s audiologist, Barbara Peregoy, said that his result was “common among baby boomers.”

Peregoy said that baby boomers often fall into a “gray area,” where they don’t yet need hearing aids but still have some minor hearing loss.  She then explained why people who need hearing aids don’t get them right away (cost, denial, vanity, or fear of appearing older) and the consequences of not addressing hearing loss, noting that hearing loss is a risk factor for dementia.  As for her patient Dale Fowler, although he left without a hearing aid, he did not leave empty-handed–Peregoy handed him a list of good communication skills to help him deal with his minor hearing loss.

Click the link above to read the whole piece, including Barbara Peregoy’s “Ten commandments for good communication skills.”

 

 

Consumer Reports looks at affordable solutions to hearing loss:

No More Suffering in Silence? Julia Calderone, Consumer Reports, has written a thoughtful piece about hearing loss and the toll it takes on those who suffer from it.  Calderone states that hearing loss “has long been thought of as an inevitable part of getting older, more a nuisance than a life-altering medical condition—at least by those not experiencing it.”  But that opinion is changing, she asserts, as “the President’s Council of Advisors on Science and Technology (PCAST) and the National Academy of Sciences (NAS) have published reports calling untreated hearing loss a significant national health concern­, one that’s associated with other serious health problems, including depression and a decline in memory and concentration.”

Calderone not only treats hearing loss with the seriousness it deserves, she offers solutions to sufferers, particularly those who can’t afford to buy hearing aids, which “cost an average of $4,700 per pair in 2013.”  This is a very steep price, particularly since hearing aids are usually not covered by health insurance or Medicare.  To help with those who need hearing aids but can’t afford them, Calderone reviews a handful of hearing aid alternatives, namely personal sound amplification products (PSAPs), to see if they can fill the gap for those who need hearing aids but can’t afford to buy them.

Two PSAPs not covered in Calderone’s review are also worth considering: Doppler Labs HERE One and Nuheara’s IQbuds.  Neither company markets their PSAPs as a hearing aid or hearing aid substitute, but at around $300 a pair they offer personal amplification and soundscape management to people who might have no other options.

And a final thought about the sorry state of hearing health in the U.S.: For people who are suffering noise-induced hearing loss (NIHL), the personal and economic costs could have been avoided in the first place because NIHL is 100% preventable.

 

Hearing Loss Is Growing


From the book The Human Body and Health Revised by Alvin Davison, 1908 / Public Domain

And Experts Say Earphones Are Part Of The Problem.

Mack interviews audiologist Michele Abrams who spoke about limiting exposure to damaging sound:

When we think about decibel levels, when we think of loudness levels, it’s really incremental.  It’s a logarithmic scale. It’s not a linear scale. So we know that 85 db is that critical level. Eighty-five db, eight hours a day, that’s your maximum. If it’s 90 db — five db greater — you have to cut your time in half.

While generally informative, Abrams’ comment unfortunately identifies 85 db, eight hours a day as the “critical level.”  But this noise exposure level is too high.  It was developed solely as an occupational noise exposure standard and should never be applied to the general public, certainly not to children.  As Dr. Daniel Fink, a noted noise activist, wrote in, “What Is A Safe Noise Level For The Public?”:

In the absence of a federal standard, an occupational standard meant to prevent hearing loss appears to have become the de facto safe level for all public noise exposures. This is demonstrated by the use of 85 decibels as a safe sound level by hearing health professionals and their organizations, in media reports, and in publications, most often without time limits; by its use as a volume limit for children’s headphones marketed to prevent hearing loss, again without exposure times; and by general acceptance of higher indoor and outdoor noise levels in the United States.

*   *   *
Eighty-five decibels is not a safe noise exposure level for the public. In 1972, the National Institute for Occupational Safety and Health developed an 85 A-weighted decibel recommended exposure level to reduce the risk of hearing loss from occupational noise exposure. … Even with strict time limits, this standard does not protect all workers from hearing loss.

So what is a safe noise level for the public?  Dr. Fink states:

In 1974 the Environmental Protection Agency’s (EPA’s) Office of Noise Abatement and Control (ONAC) adjusted the National Institute for Occupational Safety and Health recommendation for additional exposure time: 24 instead of 8 hours daily and 365 instead of 240 days annually.  The EPA calculated the safe noise level for the public to prevent hearing loss to be a 70-decibel time-weighted average for a 24-hour period… The EPA did not adjust for lifetime noise exposure, now almost 80 years versus 40 work-years, so the real average safe noise level to prevent hearing loss is probably lower.

One thing is clear, allowing children to use earbuds or headphones without limiting volume and time exposure is a recipe for hearing loss.  Since the federal government has abdicated its authority to regulate noise, and manufacturers are unlikely to design products that limit the user’s ability to deliver as many decibels as he or she wants, parents must step in to protect their children’s hearing.  Here’s something that will help: Don’t allow your children to wear earbuds and headphones.  Tell them that if they want to listen to music they must play it through a speaker.  While this may be unpopular, know that you will be giving your children an important gift–the ability to listen to and enjoy music throughout their lifetimes.

 

 

Anemic? See your doctor and get your iron tablets, stat:

Iron Deficiency Anemia Tied to Hearing Loss.  Iron deficiency anemia should be relatively easy to manage. So see your doctor, get a blood test, and manage your anemia.

That said, Dr. Daniel Fink, a leading noise activist, cautions that the study appears to be a preliminary one. The study reviewed data from approximately 300,000 deidentified adult patient records at Milton K. Hershey Medical Center in Harrisburg, Pennsylvania. The diagnosis of hearing loss was made by mention of one or more diagnostic codes for hearing loss on at least one encounter. The diagnosis of iron deficiency anemia was made from laboratory tests. Then statistical analyses were performed. No audiometric tests were done, and the prevalence of hearing loss was much lower than that reported in other studies.  Dr. Fink thinks this report might help guide future research, but the fact remains that noise exposure, not iron deficiency anemia, is the major cause of hearing loss in the United States.

Age doesn’t matter,

you could have hidden hearing loss (and not know it). WMAR Baltimore reports on hidden hearing loss, a relatively recently discovered hearing breakthrough that explains how people who pass hearing tests have problems hearing in noisy environments.  WMAR interviewed audiologists about this breakthrough, who said that “why patients can’t decipher speech in noisy situations has been unexplained, but a new breakthrough is changing that.”  The researchers who made the hidden hearing loss breakthrough studied young adults who were regularly overexposed to loud sounds, and found that “hidden hearing loss is associated with a deep disorder in the auditory system.”

It’s never too late to protect the hearing you have.  Exposure to loud sounds damages hearing.  Period.

 

Declining prevalence of hearing loss in U.S.? What do the data really show?

by Daniel Fink, MD

On December 16, 2016, an article appeared in the New York Times, Americans’ Hearing Loss Decreases Even With Ubiquitous Headphones, which focused on a study by Howard J. Hoffman, MA, et al. (Hoffman) that appeared in the respected medical journal JAMA Otolaryngology–Head & Neck Surgery. The study found that there was a declining prevalence of hearing loss in U.S. adults. The results were considered surprising, as the study showed that the rate of hearing loss in adults age 20-69 had decreased from 15.9% to 14.1%. The researchers, epidemiologists, and statisticians at the National Institute for Deafness and Other Communication Disorders, who conducted the study, are among the best in the world, and the data came from the Centers for Disease Control and Prevention’s well-respected National Health and Nutrition Surgery.

The results were considered surprising because two other recent federal reports, one in October 2015 from the President’s Council of Advisors on Science and Technology (PCAST) and the other in June 2016 from the National Academy of Science’s Institute of Medicine (IOM) (since renamed the Health and Medicine Division), emphasized that hearing loss, especially in older Americans, was a major national problem. Both of these reports cited an analysis by Frank Lin, MD PhD, Johns Hopkins University, that showed that 48 million Americans suffered significant hearing loss, with the prevalence increasing sharply with age.

I am personally involved in the question of what the facts are, since in an editorial in the January 2017 issue of the American Journal of Public Health I write about the inappropriate use of the 85 decibel occupational noise exposure standard, which should not be applied to the general public, citing Lin’s research and other studies that show increased hearing loss in young people age 12-19.

So, what do the data really show?

I am not an epidemiology expert like Mr. Hoffman and his distinguished co-authors. Their methods appear sound, their data sources as good as one can find in the epidemiology of hearing loss. The first caveat is that this study, as with all studies of the epidemiology of hearing loss in the pubic, is based on survey methodology. A group of 3831 participants are the study population, from which conclusions about the entire U.S. population were drawn. It would be too costly to test hearing in millions of people.

The second caveat is that there are newer techniques, currently only used in research and not yet in clinical use, demonstrating that before hearing loss can be detected by standard hearing tests (called pure tone audiometry), a phenomenon dubbed “hidden hearing loss” may have taken place. Hidden hearing loss has been found in young people and older adults. So while Hoffman’s study is encouraging, it may not be able to completely report what is really happening with Americans’ hearing.

The third point–not a caveat–is that Hoffman et al. studied adults age 20-69 and did not include young people under age 20. Those under age 20 may be the group most at risk of hearing loss due to ubiquitous use of personal music players at loud volumes. Two studies, using lower thresholds for measuring hearing loss than Hoffman et al. or Lin et al. used, found high levels of subclinical hearing loss (hearing loss greater than 15 decibels but less than 25 decibels) in young Americans. One from 1998 found that 15% of young people had measurable hearing loss, and the other from 2010 showed an increase in the prevalence of hearing loss to almost 20%. This is worrisome because studies of auditory acuity in young people traditionally found excellent hearing.

The fourth point also isn’t a caveat, but a quote from the last line of Hoffman’s abstract: “Despite the benefit of delayed onset of HI (hearing impairment), hearing health care needs will increase as the US population grows and ages.”

It’s great news that the percentage of Americans age 20-69 with hearing loss (the epidemiology term for this is “prevalence”) has decreased from 15.9% to 14.1%. But that still means that there are millions of Americans with hearing loss–and that’s too many! Further, subclinical hearing loss appears to be increasing in young Americans, and, as the Hoffman study notes, hearing loss in older Americans is a significant health problem.

Finally, a point of contention: noise exposure is a major cause of hearing loss, and not aging as is implied in the study. Why would men have nearly twice as much hearing impairment (18.6%) as women (9.6%)? Is it an effect of testosterone levels on the auditory system, in which case one might actually expect hearing to improve as men get older, or is it the result of more noise exposure from work and recreational activities in men than women? Noise and hearing loss are still major problems in the U.S. and in the world, and the non-auditory effects of noise on health, which are coming into greater focus, continue unabated. 

So yes, the prevalence of hearing loss in American adults may be declining, but when Lin’s analysis showed that approximately 25% of adults in their 60s, 33% of adults in their 70s, and half of those over age 80 have significant hearing loss–data cited in the PCAST and IOM Committee reports–it is obvious that there is still a major problem and still much to be done to prevent noise-induced hearing loss here and abroad.

And I and others have said before, but it bears repeating: noise-induced hearing loss is 100% preventable. If people avoid noise exposure and protect their ears from noise, they should be able to preserve natural hearing well into old age, rather than needing to rely on assistive hearing devices. The only evidence-based safe noise level remains a 70-decibel time-weighted average for a 24-hour period.

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.