Hearing Health Helping Others

preventing NIHL

For several summers, my husband Steve and I attended Celebrate Brooklyn Concerts in Prospect Park with friends. We always sat in the front section. None of us wore hearing protection. During many of the concerts the bass was extremely loud, causing pain in my ears. I complained about it, and would stuff napkins in my ears to try to block the sound. It never occurred to us to wear earplugs, and my guess is that many people there weren’t wearing them either.

Two summers ago we went to a David Crosby concert at Lincoln Center Out of Doors in Manhattan, and because people were blocking my view (and the concert was that good), I went close to the stage—and the speakers. The music didn’t seem loud, but two nights later I woke in the middle of the night with an alarming, high-pitched buzz in my right ear. I got out of bed and went looking for the origin of the sound—in the guest room, out the window— and woke my husband and asked him what it was. When I realized it was all in my head, I dropped to the floor in a complete panic, terrified it would never go away.

The next day I saw an ENT (ear, nose, and throat specialist) and had a hearing test that revealed a mild to moderate hearing loss in my right ear. The doctor recommended steroid shots, which didn’t help, nor did a change in diet. For the first two to three months, I had occasional bouts of severe tinnitus, and a couple of times a mild vertigo, but both eventually went away. Nowadays the tinnitus is always there, but it is rarely as debilitating as it was those first couple of months.

Despite all this, including owning earplugs, it didn’t occur to me until I worked on HHF’s “Keep Listening” campaign how damage to your hearing is cumulative, and that I’ve been doing additional damage to my hearing through some of my regular routines.

My coffee grinder, used daily, is 90 decibels or more, as is our mini food processor. (I know this thanks to the decibel measuring apps I learned about from HHF.) I now use earplugs when I run noisy appliances.

Since I developed tinnitus, restaurants are often not enjoyable because of ambient noise. At parties, it’s hard for me to follow conversations when multiple people are talking, and I often ask to have music turned down. If Steve says something to me in bed and my good ear is on the pillow, I can’t hear what he is saying.

It’s not just about losing your hearing. I’m now aware that my quality of life and overall health could be more adversely affected. The strong connection between hearing loss and dementia has also been a real eye opener. I’ve become a passionate evangelist about the importance of hearing protection and the urgent need to make everyone more aware of the dangers of noise-induced hearing loss. We need to make this issue as mainstream as wearing seatbelts or using sunscreen.

This campaign has also underscored for me the need to make our very noisy world much quieter. There is so much unnecessary excess noise in the world, including the idea that “fun equals loud.” For our collective health, and the health of all the world’s creatures, we must turn down the volume.

The chorus to one of my favorite Joni Mitchell songs applies to so many of us: “Don’t it always seem to go/That you don’t know what you’ve got/Till it’s gone.” There’s no question in my mind that if I had known what it would be like to have my hearing impaired, I would have taken many more precautions. I took my hearing for granted until I had a problem. I hope we can convince more people— especially people in their teens and 20s—to protect their ears, now, so they can keep listening.

Helen Garrett with her husband Steve.

Helping Others Has Helped Me

By Helen Garrett

Helen Garrett lives in New York and is a consultant to nonprofits on branding, marketing, and social impact campaigns. While on staff at Amnesty International USA she helped create two benefit albums, the first featuring the songs of John Lennon with artists like U2 and Green Day, and the second featuring the songs of Bob Dylan with Miley Cyrus, Adele, Sting, and others.

preventing NIHL

The Danger in Headphones

An audiologist parent teaches her children safe listening habits.

By Jan L. Mayes

The introduction of the Sony Walkman in the 1980s ushered in an era of personal audio systems, everyone walled off in their own soundscapes thanks to headphones and, now, earbuds. Yet these personal audio systems also introduced a new danger to hearing health.

Played too loud for too long, personal audio systems can help lead to permanent hearing loss. Loud sounds damage the auditory nerves, synapses, and cochlear hair cells needed for accurate sound processing. Sound and music distortion and problems understanding speech can happen before changes in noise-induced hearing thresholds can be detected on a traditional hearing test.

Loud sounds can also cause tinnitus and hyperacusis. Tinnitus is when one hears sounds, like static or whistling, in the absence of an external source. Hyperacusis, or decreased sound tolerance, feels like the volume of all sounds is stuck on loud, even for quiet sounds that don’t bother others. (I have both conditions, which often coexist.)

Kids are more sensitive to auditory damage from loud sounds, because hearing systems develop into their teen years. Hearing damage also has greater lifelong consequences when it begins during early learning and education. Plus, their ears have to last a lifetime.

There are no national sound limit requirements for personal audio system manufacturers. In 2008 and 2017, research showed personal listening above the 50 percent volume setting puts users at significant risk of noise-induced auditory damage. Difficulty understanding speech leads to social isolation and hurts the quality of life for children, teens, and adults.

Parenting as an Audiologist

As an audiologist, I know firsthand the dangers of noise to hearing health, including among children. Ever since my own children were little I have emphasized safe listening skills. The risk may be even more acute with personal audio systems as you cannot easily recognize when kids are listening too loud. Speakers blasting from a bedroom are one thing, but headphones or earbuds that are even a little too loud can be harder to discern.

Parents ideally should talk about safe versus harmful sound levels long before their kids’ personal listening habits start. From the time they were toddlers, my kids and I went on “soundwalks” and talked about sounds we hear in everyday life. Which sounds did they like? Which sounds were uncomfortable or too loud?

To handle unwanted sounds, I taught them to use their “finger plugs.” Sticking your fingers in your ears works like earplugs (although you have to drop whatever you’re holding). I also taught them that cupping your hands over your ears hardly muffles the sound waves, so better to use your fingers.

I created a family hearing protection toolkit, with different types of earplugs for different situations. There were earmuffs my kids could use if they were at a loud activity, such as a sporting event. They knew my spouse and I use high fidelity or musicians’ earplugs for concerts, movies, or other loud situations like large parties where we still want to be able to communicate.

For noisy, everyday situations where communicating isn’t as critical, such as in the presence of loud appliances

For noisy, everyday situations where communication isn’t so critical, inexpensive foam earplugs can protect your hearing.

or yard tools, my kids learned that foam earplugs could do the trick. They learned that hearing protection needs to seal like swim goggles to block out harmful sound waves.

50 Percent Max

I had my kids wait until they seemed old enough to be responsible for their hearing health before they were allowed to use personal audio systems—for them, this was about ages 10 to 12.

I explained the risk from high volume listening. I told them about cases where patients cried in my office because they wished their tinnitus would go away or that they could hear better. They say to me, if only they had known loud sound was dangerous.

My kids and I talked about how personal listening is an individual activity where users can change safety settings or turn volume up anytime or to whatever level they want. I emphasized how I hoped they would commit to listening safely to prevent lifelong noise-induced auditory problems.

We sat together while they accessed their devices’ settings and turned down built-in volume limits. Volume limiting headphones for kids are available, but they often allow unsafe volumes—85 decibels—and so the safe listening these products advertise just isn’t accurate.

Since earbuds aren’t recommended until age 13, my kids used headphones before they reached their teenage years. And because they saw us using them, my kids wanted their own specialized musicians’ earplugs right when they turned 13 years old.

With their headphones or earbuds on, I asked my kids to begin with the volume at zero and slowly turn it up to find their lowest comfortable volume. They both have typical hearing, so around 20 percent of the maximum volume setting sounded good to them.

This became their usual listening level. They could turn the volume up if they wanted to listen louder for a favorite song or when singing, dancing along, or exercising. But I asked them to follow a 50 percent maximum rule. This gave them a safe, soft-to-louder dynamic volume range for personal listening while protecting their auditory health.

My children are now young adults. Fortunately, they still use their personal audio systems at under 50 percent maximum volume.

Set Limits

The World Health Organization’s World Report on Hearing, released in March 2021, suggests that personal listening limits of up to 60 percent of the maximum volume—an 80 decibel (dB) average—is safe. But this recommendation allows higher limits than the more protective 70 dB average for sensitive groups at greater risk, like kids, and a 75 dB average for adult users.

As I report in a January 2020 American Family Physician article, coauthored with fellow noise activist Daniel Fink, M.D., the maximum average daily safe listening limit to prevent hearing loss in healthy adults is 70 dBA. (A-weighted decibels, or dBA, are adjusted for human hearing.)

Higher intensity exposures may not be safe for auditory health regardless of listening time. Even 70 dBA exposure

Use Your Fingers, and More Tips

Headphone users should be old enough to accept responsibility for their hearing health. (My children were about 10 and 12.) Here is my additional advice:

» Always listen at a low, comfortable volume. » Avoid listening above 50 percent volume whenever possible. » Turn on or turn down built-in volume limiting settings or safe listening features. » Use well-fitting headphones or, when age 13 or older, earbuds with noise canceling or noise isolating features. » When in loud noise, use earplugs or earmuffs. Some can safely connect to personal audio systems. Finger plugs are always on hand (pun intended). » Check hearing with the hearWHO app, available at who.int/health-topics/hearingloss/hearwho. » Support protective national sound limit requirements for personal audio system manufacturers. —J.L.M. may not be safe for certain exposed populations, such as children or people with preexisting hearing impairments.

Since there are no universal manufacturing standards, the actual volume varies a lot between different audio devices, headphones, and earbuds. Noise canceling or noise isolating features help people listen more comfortably at lower volumes when there is ambient environmental noise. You don’t have to turn it up too loudly (and unsafely) to hear over outside sounds.

Stock earbuds tend not to fit well, so people use a higher volume to drown out other sounds. Deeper in-ear or canal-fit earbuds are better for safer listening.

I should emphasize that headphones or earbuds are not hearing protection. Never slip earbuds under the cup of an earmuff or use earbuds as earplugs.

What if you have already been using personal audio systems at over 50 percent of the volume? It’s never too late to listen more safely and stop any auditory damage from getting worse. If concerned, people of any age can do a quick hearing screening using the hearWHO app (who.int/health-topics/hearing-loss/hearwho). If the results show a problem, follow up with a hearing healthcare professional.

Science is clear on the danger of noise to hearing. It is long overdue for federal authorities to require mandatory sound level limits for personal audio systems. Options should be protective enough for children and other users to prevent noise-induced auditory damage.

It’s also time for mandatory noise control on a global scale instead of relying on education plus motivation on the part of children and teens to listen safely. Let’s better protect the hearing health of current and future generations.

Jan L. Mayes is a science reporter for the Quiet Coalition, part of Quiet Communities Inc. in Boston. A resident of Vancouver, Canada, she is a retired audiologist and award-winning author with special interests in noise, tinnitus, and hyperacusis. A version of this originally appeared on her website janlmayes.com/news. For references, see hhf.org/summer2021-references.

Share your story: Tell us how you teach safe listening habits at editor@hhf.org.

preventing NIHL

Kelly Culhane (far left) visited the Centers for Disease Control and Prevention in 2019 to present her prevention project to CDC principal deputy director Anne Schuchat, M.D.

Banding Together to Prevent Hearing Loss in Young People

By Kelly Culhane

Six years ago, at the beginning of my freshman year of high school when I was 14, I was searching for a topic for my Girl Scout Gold Award project when I heard an interview on National Public Radio. The interview was with Adele Sandberg, the founder of Ear Peace Save Your Hearing Foundation, an educational nonprofit.

Sandberg was talking about noise-induced hearing loss (NIHL) in children, saying she uses pipe cleaners to demonstrate to elementary school students the permanent damage done by loud sounds to the tiny sensory hair cells in our ears, how that affects our hearing, and how simple it is to protect our hearing.

It was a fascinating interview. For the first time I really understood that young people could experience permanent hearing damage due to loud noise. I decided to make NIHL the focus of my Gold Award project and contacted Sherilyn M. Adler, Ph.D., the executive director of Ear Peace Foundation, who has mentored me ever since.

I wanted to educate my peers and speak directly to them about the dangers of NIHL and the importance of protecting their hearing from a young age, so I focused on posters, videos, and social media to reach the younger age groups. “Band Together to Protect Your Hearing” was a 12-minute film about NIHL that I created—from storyboard to script writing to video editing—for Ear Peace Foundation. It’s used as part of their Protect-a-Band program to prevent hearing loss among young musicians.

I also created a short public service announcement, “Anything Goes Pizza,” a comedic video that highlighted the issue of hearing damage due to noise (a young pizza guy, who likes to listen to loud music on his earbuds, drastically misinterprets a pizza order). I also did video interviews with audiologists and my jazz band director on integrating learning about NIHL into the curriculum.

From the beginning, I knew it would be difficult to convince teens that NIHL is a serious problem for them. Many teens find the idea of hearing loss at a young age hard to believe, most likely because they haven’t noticed a problem yet and think of it only as an old person’s issue.

I also made sure to model hearing safety by using hearing protection myself on a daily basis—at jazz band rehearsal, pep rallies, concerts, and loud movie theaters. I keep earplugs in a holder on my keychain at all times. My whole family now carries earplugs. We also realized that my brother, who continues to play jazz in college, has tinnitus.

It was gratifying that, after becoming aware of NIHL through my project, a friend in the marching band was motivated to have his hearing tested. It showed that he already had some permanent hearing damage in one of his ears due to excess sound levels.

My friend changed his behavior and, from then on, took careful steps to protect his hearing by using earplugs during rehearsals and performances. It’s my goal to help more young people understand that they can continue to safely enjoy their passion for music.

Awarded a prestigious Girl Scout Gold Award in 2018, Kelly Culhane is starting her third year at the University of Florida on the premed track, majoring in psychology and specializing in behavioral and cognitive neuroscience. She and Sherilyn M. Adler, Ph.D., coauthored a paper on preventing NIHL in young people and presented a poster at the International Commission on Biological Effects of Noise conference in June 2021. See earpeacefoundation.org. HHF is proud to join with Culhane, Adler, and Ear Peace Save Your Hearing Foundation on prevention efforts. For references, see hhf.org/summer2021-references.

preventing NIHL

Common Decibel Levels

A whisper is about 30 decibels (dB), normal conversation is about 60 dB, and a motorcycle engine running is about 95 dB. Noise above 70 dB over a prolonged period of time may start to damage your hearing. Loud noise above 120 dB can cause immediate harm to your ears.

Loud Noise Can Cause Hearing Loss Quickly or Over Time

The Centers for Disease Control and Prevention website provides detailed information on noise-induced hearing loss.

Hearing loss can result from a single loud sound (like firecrackers) near your ear. Or, more often, hearing loss can result over time from damage caused by repeated exposures to loud sounds. The louder the sound, the shorter the amount of time it takes for hearing loss to occur. The longer the exposure, the greater the risk for hearing loss (especially when hearing protection is not used or there is not enough time for the ears to rest between exposures).

How loud something sounds to you is not the same as the actual intensity of that sound. Sound intensity is the amount of sound energy in a confined space. It is measured in decibels (dB). The decibel scale is logarithmic, which means that loudness is not directly proportional to sound intensity. Instead, the intensity of a sound grows very fast. This means that a sound at 20 dB is 10 times more intense than a sound at 10 dB. Also, the intensity of a sound at 100 dB is one billion times more powerful compared to a sound at 10 dB.

Two sounds that have equal intensity are not necessarily equally loud. Loudness refers to how you perceive audible sounds. A sound that seems loud in a quiet room might not be noticeable when you are on a street corner with heavy traffic, even though the sound intensity is the same. In general, to measure loudness, a sound must be increased by 10 dB to be perceived as twice as loud. For example, 10 violins would sound only twice as loud as one violin.

The risk of damaging your hearing from noise increases with the sound intensity, not the loudness of the sound. If you need to raise your voice to be heard at an arm’s length, the noise level in the environment is likely above 85 dB in sound intensity and could damage your hearing over time.

The effect of lower noise levels over long periods is the same as louder noise levels over a shorter period. You can use a sound level meter to measure noise around you. Free sound level meters developed as smartphone apps are available. Some of these apps can predict your maximum allowable daily noise dose, like the National Institute for Occupational Safety and Health Sound Level Meter app developed for Apple iOS devices to help promote better hearing health and prevention efforts. (See cdc.gov/niosh/topics/noise/app.html.)

The U.S. Environmental Protection Agency and the World Health Organization recommend maintaining environmental noises below 70 dBA (A-weighted decibels) over 24 hours (75 dBA over 8 hours) to prevent noise-induced hearing loss. The EPA also specified limits for speech interference and annoyance at 55 dBA for outdoor activities and 45 dBA for indoor activities.

Noise is a significant source of hearing loss, but you can protect your hearing.

This is used with permission from the Centers for Disease Control and Prevention website page “What Noises Cause Hearing Loss?” at cdc.gov. A-weighted decibels, or dBA, emphasize the frequencies heard in human speech. For references, see hhf.org/summer2021-references.