Audiologist Dr. Maria Roa discusses noise-induced hearing loss and offers some advice on how to prevent it.
Shelby Stockton (00:00):
Welcome to the South Florida ENT Audio blog. I'm Shelby Stockton. May is Better Speech and Hearing Month. And in this two-part series, I sat down with audiologist Dr. Maria Roa to discuss hearing loss. In this first part, Dr. Roa talks about noise-induced hearing loss and offers some advice on how to prevent it. You may think you know enough about this subject, I know I did. I talk with a lot of audiologists. But Dr. Roa offers new information on how you can protect yourself and your ears from suffering from hearing loss in the future.
Dr. Roa, how are you today?
Dr. Maria Roa (00:32):
I'm doing fantastic. How are you?
Shelby Stockton (00:34):
I'm all right. I'm all right. I probably don't need to educate you on this, but May is Better Speech and Hearing Month. So let's talk about this. What is noise-induced hearing loss and can we prevent it?
Dr. Maria Roa (00:50):
That is such a great question and such a relevant question because we're seeing a lot more young people coming into the clinic and telling us things like, "I went to a party for 15 minutes and now my ears are ringing, or I feel like there's wax in my ears, I'm all clogged up." Or a lot of the times people come in because they feel like they can hear, but they're not quite understanding the words, and that's a classic sign of noise-induced hearing loss.
So what's really interesting is after they're tested and diagnosed with any amount of hearing loss, these type of people are actually shocked. They feel like really throughout their life, they haven't been exposed to much noise at all. They'll say things like they weren't in the military, they don't shoot guns, they don't go to concerts very often. I feel like what stands out to us as dangerous noise.
But when I probe them further, I actually end up finding out that they might go to Orangetheory for an hour five days a week, or they work at a hair salon, or a dental office, or a bar. Maybe they're a sports fan and they have season tickets to the Heat games, or they go boating every weekend. And that's that aha moment. Because believe it or not, that's actually really noisy. When we think about all of this is we want to know how it starts. And the best example I can give, and the one that I give to my patients is when you leave a concert and your hearing is all muffled and you've got ringing in your ears for a few hours, that's actually what you call a temporary threshold shift. So when loud sounds bombard your ears, it pushes over those tiny delicate sensory hair cells that are in your inner ear that are responsible for transmitting sounds to the brain.
For the hair cells, it's a traumatic experience so they can remain bent over even after there's no noise. And that's actually what leads to that sense of ringing, fullness and temporary loss of hearing. But that temporary bending of hair cells does repair in less than 24 hours. When the hair cells don't repair, it becomes a permanent noise-induced hearing loss. And over time, data does show us that if you experience temporary threshold shifts frequently, it can become permanent.
This is so interesting to me because there are so many individuals that experience a temporary threshold shift whose hair cells recover. But that experience does leave behind some subtle neural changes that result in communication degradation over time. These are people that report lots of difficulty hearing a noise, for example, or they rely on close captionings when they're watching TV. But when we test their hearing and your average run-of-the-mill audiological booth, the test results actually come back normal. So it's actually very surprising because there's nothing that we can really say to them.
But if we were to put these people in a research lab with methods that aren't really available yet clinically, we can actually see deficits in their auditory system and their ability to process sound. So nowadays that's called hidden hearing loss. And unfortunately, there's nothing that we can do about it, at least not yet. I also have to say that I'm probably one of those people because before I found this career, I used to abuse my ears all the time with so much noise. And again, when you're younger you don't think that this kind of stuff is going to catch up to you. I've definitely been put in the booth and my thresholds are fantastic. I'm within normal limits, but I'm one of those people that suffers so much in noise, and I totally rely on close captioning. I do not hear that well, but it's just not caught yet in our testing.
So when we're talking about things like hidden hearing loss, or noise-induced hearing loss, there are absolutely ways that we can prevent it. There's a very careful balance between the loudness level and the duration of the exposure. So first, before you dance between that fine line, it's really important to learn how to identify what loud noise levels look like. And in general, this falls into two categories. Now, everybody for the most part can identify high intensity sounds. This is something like a gunshot, so it's very obvious that it's loud, it's dangerous. Majority of people absolutely use hearing protection for this kind of stuff. But there's also long duration sounds, and those are the ones that are insidious. Because someone might not necessarily perceive it as being loud, so they subject themselves to it for a longer period of time.
The best example is all of the young people nowadays listening to music through earbuds. We know that this can actually be quite dangerous. So actually when we're talking about something like AirPods, the maximum volume clocks in between 102 and 112 decibels. And according to OSHA, you've got 15 minutes or less of listening to that at a max volume before it starts to damage your hearing. So that's pretty significant, and a lot of people don't realize that.
Now in general, sounds over 85 decibels can lead to noise-induced hearing loss. Again, depending on the time that you're exposed to that sound. And there are lots of organizations out there that produce these safety limits for us to follow. One of them being OSHA, the most conservative one being NIOSH, which is the National Institute for Occupational Safety and Health. To just give you an idea they say, "Okay, 85 decibels. You can be in that environment for about eight hours."
But now let's say that we increase that by 10 decibels so that it's 95, it goes from eight hours down to one hour. To give you an idea of what this sounds like, a hair dryer averages at around 95 decibels. So imagine that. I do my hair every morning. That's not what we would tend to consider very loud. Now, let's take that 95 and just add five more decibels. Make it a 100. It goes down from one hour to 15 minutes. So obviously it's a very careful balance between the exposure level and the time that you're allowed to listen to it a day.
So we do have these organizations that tell us what we should follow. But that can be difficult to do in an organic setting when you're out and about. We're not really thinking of that. So there are some things that we can do to make that a little bit easier.
The first way that you can tell that an area is too loud is number one, if you feel like you're needing to speak up. If you're screaming at the person in front of you, that's a red flag.
Number two is if you feel like you need to move closer to them to hear them better. But let's say that they're three feet away, really, if that person is talking normally, you should be able to hear them well. So again, that's another red flag.
Probably one of the easiest ways to help you measure these levels is by using technology. So both Apple and Android phones have lots of applications available that you can download to help you manage these noise levels. But probably one of my favorite ones, the one that I use personally, is my Apple Watch. Because there's a decibel tracker built into it, at least for the newer models, I think in the last two years. And really, it's just ongoing in the background, and it's picking up everything and your surroundings. And once it gets to a level that's too loud, too noisy, if you enable your alerts, it will tell you that you need to get out of there or you need to do something, use some hearing protection because you're kind of getting into that danger zone.
Another nice thing that I've realized that we can do with phones, at least with the iPhone, is that you can actually go into your settings and adjust your headphones settings so that you're not able to make sound louder than 85 decibels.
And another really practical way to manage this too is by using noise-canceling headphones. Because when we ask our patients, "Well, why are you putting your headphones at full blast?" It's usually that they're in a noisy place like the gym and all that background noise is interfering. So they're making up for that difference by turning up the volume.
But nowadays, the AirPod Pros, they've got some noise-canceling technology. You could purchase good Bose headphones or Sony ones. Anything that's really going to help you cut out that background noise is going to be good because then you don't have to put it at such a loud volume level.
But of course, there are so many times when we can't really control the sound around us. In that case, you do have to take some actions to protect yourself. The first thing that you can practically do is increase the distance between yourself and the noise source. So let's say that you're at a concert. Let's not stand right in front of that speaker. Actually, every time that you double the distance away from the noise source, the decibel level drops by six. And again, six might not sound so significant. But when we were looking at that other example, it could actually make a huge difference in the amount of time that you could be there. So that's huge.
Another thing that you can easily do is take frequent breaks. So if you are at a noisy bar, leave for a second. Go take a bathroom break. Take a few minutes to go to the bathroom, give your ears some time to rest or step outside. That's also very helpful.
And probably one of the most important things that you can do, and the most effective thing that you can do is actually use hearing protection, which I think is hard to nail into people. Because again, I think that we're conditioned to only use hearing protection when we're shooting guns, or doing super, obviously loud stuff. No one thinks to wear hearing protection when they're going to a bar, or going to a movie theater. But it's actually very well worth it. Well, let me back up and say that there's different types of hearing protection that you could use there. There's stuff that you could buy over the counter, like little plugs. And that's plenty fine, as long as you're squishing them well enough and getting them deep inside your ears, that's going to take away majority of that danger.
But that's going to cut out a lot of sound. And if you're a person that's fairly active, going to maybe sporting events, concerts, or maybe you're a musician, you don't actually want all the sound to be cut out, you want to be able to enjoy that music, or you want to be able to hear certain things. So what I've found to be very popular has been filtered custom earplugs, which you do have to go see an audiologist for. So basically what that means is that an audiologist takes an impression of your ear [inaudible 00:13:01]. Now they send that impression to a company, and then you get a custom plug made. But you can buy different filters that are intended for different purposes. So you could buy a filter that's intended for very loud, dangerous impulse noises, like if you're going to go shoot a gun. But you could also have a music filter that allows more sounds through so that you can still enjoy that experience.
You could do it for if you're doing work on the lawn. There's filters for so many different things. I feel like people really get a lot more use out of that because they're still able to enjoy their environments without feeling like they can't hear anything.
So to basically sum it up, definitely, definitely well worth it to invest in some earplugs. Remove yourself from noise when it's too loud and track it as best you can, use the technology that's around you because this is 100% preventable. And we're seeing this more and more.
Shelby Stockton (14:05):
Thank you for listening to the first episode of our two-part series with Dr. Roa. Go to part two to learn about treatments for hearing loss, over-the-counter hearing aids versus prescription hearing aids, and a personal story that may hit home for anyone experiencing hearing loss personally or with a family member.
