Tag Archive: hearing loss

Hidden hearing loss

Photo credit: Daria Shevtsova from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Hidden hearing loss is the term used to describe nerve damage in the inner ear (cochlear synatptopathy) which causes hearing loss detected only by special research techniques, not by standard hearing testing (pure tone audiometry). That’s why it’s called “hidden.” The clinical manifestation of hidden hearing loss is thought to be difficulty understanding speech in a noisy environment, but auditory training might help improve understanding of speech in noisy places.

This article describes a survey of adults who were asked if they would be willing to participate in auditory training. What’s of interest to me is that 22% of adults surveyed report having difficulty understanding speech in a noisy environment. That fits with other reports I’ve seen, but I think it’s an underestimate.

Many people with hearing loss think their hearing is excellent, and I think the same is true for people asked about difficulty understanding speech in a noisy environment. Due to the stigma of hearing loss, no one wants to admit that he or she has a problem.

More importantly, if people have difficulty understanding speech in noisy environments, it would seem to be much easier to make those environments quieter, rather than offering auditory training to those with the problem.

Quieter environments would make it easier for everyone to converse, and would prevent auditory damage in those without it.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

More evidence that headphone use causes hearing loss

Photo credit: Patrick Pielarski licensed under CC by 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This isn’t a scientific study, but a news report from Ireland. An audiologist recommends that parents limit children’s headphone use to one hour daily. She notes that, “ten years ago, around 5pc of people aged under 45 were fitted with hearing aids. Now, 23pc of our hearing aids are for people under 45.”

That’s a shame. Hearing aids are costly, and even the best are a poor substitute for preserved natural hearing. It takes decades for noise-induced hearing loss to become bad enough that people are willing to use hearing aids.

A Dutch study earlier this year found auditory damage from headphone use in children age 9-11, and the damage only gets worse over time.

Parents–and indeed everyone–should limit headphone use, or better yet just put the headphones in the drawer.

One doesn’t need a continuous audio track to life! But if you do, for your own sake, for your ears, please turn down the volume.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Should doctors screen middle-aged and older adults for hearing loss?

Photo credit: Flávia Costa licensed under CC BY 3.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The Quiet Coalition received an email from contacts at the CDC’s National Center for Environmental Health. The U.S. Preventive Services Task Force is again looking at whether it should recommend screening for hearing loss. The last time it did this, USPSTF didn’t recommend screening for hearing loss in adults because no benefit had been shown from screening. The email reads:

Dear Hearing and Health Partners,

The U.S. Preventive Services Task Force has shared their Draft Research Plan for Hearing Loss in Older Adults: Screening on their website here. The draft plan also includes a graphic of a Proposed Analytic Framework and a Proposed Research Approach to identify the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications for their evidence review.

According to the Task Force, The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the Task Force Recommendation Statement on this topic. There is an opportunity for public comment on this draft until December 12, 2018. The draft research plan is available on the Task Force’s website here.

Cordially,

NCEH Noise-Induced Hearing Loss Program

There is important new research available that led to the USPSTF re-evaluating its recommendation. Several researchers have shown that most Americans get too much noise every day. The CDC reported that about 25% of American adults age 20-69 had noise-induced hearing loss, many without occupational noise exposure, and many thinking that their hearing was excellent.

Also, newer research shows that hearing loss is not a benign condition. It is correlated in stepwise fashion (i.e., more hearing loss, more problems) with social isolation, depression, falls, accidents, and dementia, all of which in turn are associated with increased mortality in older Americans.

And even more recent research shows that providing older people with hearing aids delays the onset of dementia, all of which compels the conclusion that doctors should absolutely screen their middle-aged and above patients for hearing loss.

If you have any thoughts about screening for hearing loss, send a comment to the USPSTF. I will!

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Noise is killing us

Photo credit: Genaro Servín from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This wide-ranging essay from New Zealand discusses the many ways noise hurts our health, from hearing loss to diabetes and death.

A quieter environment is better for us all, and it shouldn’t take a superhuman effort to make it happen. Lowering the volume of music in public spaces is an easy first step.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

What are the best workout headphones?

Photo credit: CherryPoint licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

What are the best workout headphones? In my considered opinion, none. This review of workout headphones mentions noise-induced hearing loss, but misuses the 85 decibel (dBA, A-weighted decibels) occupational noise exposure as the safe listening limit.

There is a common belief that music improves athletic performance, and the louder the music the better the effort. But I have been unable to find any scientific articles supporting this belief, unless it is music with a particular beat or rhythm which, for example, might help a runner keep a steady pace.

On the other hand, the dangers of noise for hearing loss are supported by decades of scientific work and thousands of articles in peer-reviewed journals.

So skip the headphones–you can be very fit without losing your hearing.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Headphones for kids: What you should know

Photo credit: ExpectGrain licensed under CC BY-SA 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

This post at SoundGuys discusses choosing headphones for kids. The author discusses a variety of considerations, including many that lead me to my opinion about headphones for kids:

Headphone use should be limited to those old enough to understand the dangers of hearing loss. Giving a younger child a pair of headphones–volume limited or not–is like giving a toddler a beer or a 9-year-old a pack of cigarettes. No one does that.

It takes years to decades of noise exposure to produce hearing loss as measured by standard audiometric techniques, but the reports of hearing loss at very early ages associated with headphone use have already begun to appear. A Dutch study in June 2018 reported increased hearing loss another auditory problems in children as young as 9 to 11, compared to those who didn’t use headphones to listen to personal music devices.

I’m not sure exactly when the idea evolved that everyone, including toddlers as young as 3, needs to entertained by audio or visual material for almost every waking hour, but I can guarantee that generations of children were raised to adulthood quite successfully without these devices. Perhaps headphone use should be regulated like driving, smoking, or drinking, each of which has an age limit at which the behavior is allowed. In the U.S., the age requirement for driving varies from 15 or so to 18 depending on the state, 18 for smoking, and 21 years old for drinking.  Laws are different in Europe and Asia, but to my knowledge there are no laws or regulations restricting headphone use or personal music device use anywhere in the world.

In the old days–whenever that was, but certainly up to a decade or two ago–children either entertained themselves by playing with blocks or toys or dolls, or were entertained by friends, parents, and others. As children got older, they entertained themselves with coloring books, and then by reading. At a meal or waiting in a line or when traveling, parents and children interacted, whether it was the parent making up a story for the toddler, or the slightly older child telling the parent or grandparent a story, or looking at and talking about what was outside the window of the car, bus, train, or airplane. Or people read books. Now I see families sitting in a restaurant with each person wearing earbuds, looking at a smart phone or listening to some content on it, instead of interacting with each other.

This can’t be good for personal and social development. It can’t be good for developing ties among family members and others. And I can guarantee that it is not good for hearing–headphone use in children will cause hearing loss in adults.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

The CDC is trying to prevent heart attacks. When will it try to prevent hearing loss?

by Daniel Fink, MD, Chair, The Quiet Coalition

The Centers for Disease Control has embarked on a public education campaign to reduce preventable cardiovascular mortality. They are calling it Million Hearts. Among the things people can do to prevent heart disease and fatal heart attacks are what CDC is calling “the ABCs”: a daily baby aspirin (unless there are medical reasons not to take it), blood pressure control, cholesterol control, and not smoking. Other actions include exercising, maintaining an ideal body weight, and eating a healthy diet.

Thanks to the Framingham Study, we know that heart disease and stroke are not part of normal aging but are largely preventable. Similarly, hearing loss is not part of normal aging but largely represents noise-induced hearing loss.

So when will CDC embark on a similar campaign to educate the public about preventing hearing loss? I suggest calling it the Million Ears campaign. Maybe Ten Million Ears.

A common saying is “nobody dies from going deaf,”* but that isn’t true. Hearing loss is associated with social isolation, falls, depression, and dementia in older people, all of which in turn are correlated and most likely causally related to increased mortality. Hearing loss also has major impacts on enjoyment of life and social function.

And unlike preventing heart disease and stroke, preventing noise-induced hearing loss is much easier–just avoid loud noise and wear hearing protection if you can’t.

Remember: If it sounds too loud, it IS too loud.

* The phrase “nobody dies from going deaf” is what is commonly said. The word “deaf,” however, usually denotes congenital hearing loss or severe hearing loss. The term “hearing loss” is more appropriately used for mild to moderate noise-induced hearing loss.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

How to prevent hearing loss when using headphones

by Daniel Fink, MD, Chair, The Quiet Coalition

Here is another article about the dangers of using headphones for hearing. I disagree with the author’s statement that “[t]here’s nothing inherently dangerous about using headphones.” That reminds me of statements in the 1950s and early 1960s that asserted there was nothing inherently dangerous about smoking cigarettes.

I think headphones and earbuds are inherently dangerous and shouldn’t be used except for noise-cancelling headphones used in noisy situations such as aircraft cabins.

Very few headphone users worry much about the sound volume when listening to music or a podcast or book, and the natural tendency is to turn up the volume enough to be able to hear what one is listening to. There is no meter on the personal audio device to let one know what the audio output is in decibels. And there is no audio dosimeter installed on most personal audio devices, be they MP3 players or smart phones, to let the user know the time-weighted average sound exposure that day or week from the device. Even if one has this type of dosimeter–several are reportedly in the development stage–they don’t measure all noise exposure, so they may give a false sense of security.

The other quibble with this article, from the UK, is that it uses the UK and EU occupational noise exposure standard of 80 decibels as a safe noise exposure level. The UK standard is technically 80 dBA, which is safer than the 85 dBA standard used in the U.S., but it is not a safe noise exposure level to prevent hearing loss. The only evidence-based safe noise exposure level to prevent hearing loss is a time-weighted average of 70 dB for 24 hours, and even that may be too high.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Headphone volume may cause harm to hearing

Photo credit: Kaboompics .com from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

Here is yet another report, this time from Baylor University, that headphone use may cause harm to hearing.

I agree with everything stated in the report except for the assertion that 85 decibels is the dangerous sound level. This standard is derived from occupational noise exposure levels, and in 2016, NIOSH reiterated that this is not a safe noise exposure level for the public.

And headphone use may be different because the sound source is only millimeters away from the ear drum, with the external auditory canal being even shorter in children than in adults.

Personally, I would advise against the use of headphones and ear buds, period.  If you insist on using them keep in mind that if you can’t hear ambient noise when listening to content or music using headphones or earbuds, the volume is too high and is almost certainly causing hearing loss.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Can preventing hearing loss now prevent dementia later?

Photo credit: Monica McGivern licensed under CC BY-ND 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

We have written about this report before but important news bears repeating: A study using functional MRI techniques found that relatively young people with very mild hearing loss were using parts of their brain not normally used to try to understand speech. The researchers think that this added stress on the brain now may lead to an increased rate of dementia later.

The relationship between hearing loss and dementia is being studied in many ways. It has long been known that there was a correlation between hearing loss and dementia, with studies showing that people with worse hearing are more likely to develop dementia.

And one large study is trying to see if giving hearing aids to older people with hearing loss prevents dementia.

But it’s a whole lot easier–both a whole lot better, and a whole lot cheaper–to just avoid hearing loss by avoiding loud noise now. Hearing loss, after all, is not an inevitable part of aging.

Remember: if it sounds too loud, it IS too loud.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He 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 also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.