Curbside Consultation

Making Recommendations to Reduce Noise Exposure

 

Am Fam Physician. 2021 Jan 1;103(1):57-59.

Case Scenario

A 23-year-old patient, M.P., presents to your office with upper respiratory symptoms. When you enter the room, M.P. is using earbuds to listen to music on a personal listening device. The volume is loud enough for you to hear the music but not distinguish details. After addressing the patient's symptoms, you ask about M.P.'s listening habits.

M.P. reports using earbuds to listen to music for two to three hours a day while commuting to work, exercising, or just passing time. M.P. sets the volume loud enough to hear the music over ambient noise. Is M.P. at risk of developing hearing problems, and if so, how should the patient be counseled?

Commentary

Noise-induced hearing loss has long been recognized as a preventable occupational disease, but the extent of nonoccupational noise-induced hearing loss has only recently been acknowledged as a public health problem. Audiometry data collected by the National Health and Nutrition Examination Survey identified noise-induced hearing loss in 24.4% of Americans 20 to 69 years of age.1 More than half (53%) of those reported no significant occupational noise exposure.1 An estimated 19% of American teenagers also have noise-induced hearing loss.2

Noise levels in everyday life can cause hearing loss.35 Traffic noise is 80 to 85 decibels (dB), motorcycle noise is 95 dB, a subway train is 100 dB, and a siren is 110 to 129 dB. Personal listening devices at maximum volume can reach approximately 100 to 110 dB.6 The only evidence-based safe noise dose to prevent hearing loss is a daily average of 70 dB.79 Noise risk is based on the combination of sound level and duration of exposure. A short, high-volume sound can have the same risk for hearing loss as a longer, lower-level sound if the total sound energy is equivalent. The dB scale is logarithmic. For each 3-dB increase in sound level, the exposure time must be cut in half to maintain the same energy exposure. Therefore, an average 24-hour noise dose of 70 dB is equivalent to eight hours at 75 dB or one hour at 85 dB.

The World Health Organization (WHO) recommends limiting noise exposure to one hour daily at 85 A-weighted dB to prevent hearing loss in adults.10  (A-weighting adjusts noise measurements to mimic the effects of human hearing, which is especially sensitive to frequencies heard in human speech.) Auditory damage can occur after single or very brief exposures to loud noise. Table 1 lists equivalent safe listening times based on the 3-dB exchange rate.5

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TABLE 1.

Average Noise Exposure Levels Needed to Reach Daily Noise Sufficient to Cause Hearing Loss

Average noise exposure level (A-weighted decibels)Time to reach 100% adult noise dose

70

24 hours

75 to 76

8 hours

79

4 hours

82

2 hours

85

1 hour

88

30 minutes

91

15 minutes

94

7.5 minutes

97

< 4 minutes

100

< 2 minutes


Information from reference 5.

TABLE 1.

Average Noise Exposure Levels Needed to Reach Daily Noise Sufficient to Cause Hearing Loss

Average noise exposure level (A-weighted decibels)Time to reach 100% adult noise dose

70

24 hours

75 to 76

8 hours

79

4 hours

82

2 hours

85

1 hour

88

30 minutes

91

15 minutes

94

7.5 minutes

97

< 4 minutes

100

< 2 minutes


Information from reference 5.

Anecdotally, the average American listens to a personal listening device (e.g., a smart phone) for more than four hours daily, often at high volume.11 High-volume personal listening and unprotected exposure to loud audio material (e.g., music, podcasts) increase the risk of developing permanent noise-induced hearing loss within five to 10 years.

The risk of auditory damage from personal listening devices is likely higher than from ambient noise exposure because earbuds and headphones transmit acoustic energy directly into the external auditory canals. Users of personal listening devices often

Address correspondence to Daniel Fink, MD, at djfink01@aol.com. Reprints are not available from the authors.

Author disclosure: Dr. Fink serves as an expert consultant to the World Health Organization on its Make Listening Safe program and as a subject matter expert on noise and the public to the National Center for Environmental Health at the Centers for Disease Control and Prevention. Dr. Fink served on the board of the American Tinnitus Association from 2015 to 2018. Jan Mayes served on the board of the Right to Quiet Society in 2019 and discloses receiving royalties for hearing health–related audiology books.

References

show all references

1. Carroll YI, Eichwald J, Scinicariello F, et al. Vital signs: noise-induced hearing loss among adults—United States 2011–2012. MMWR Morb Mortal Wkly Rep. 2017;66(5):139–144....

2. Shargorodsky J, Curhan SG, Curhan GC, et al. Change in prevalence of hearing loss in US adolescents. JAMA. 2010;304(7):772–778.

3. Flamme GA, Stephenson MR, Deiters K, et al. Typical noise exposure in everyday life. Int J Audiol. 2012;51(suppl 1):S3–S11.

4. Neitzel RL, Gershon RRM, McAlexander TP, et al. Exposures to transit and other sources of noise among New York City residents. Environ Sci Technol. 2012;46(1):500–508.

5. Mayes JL. Urban noise levels are high enough to damage auditory sensorineural health. Sound and the Healthy City, special issue of Cities & Health. 2019. Accessed November 2, 2020. https://www.tandfonline.com/doi/full/10.1080/23748834.2019.1577204

6. National Institute on Deafness and Other Communication Disorders. Noise-induced hearing loss. Accessed November 2, 2020. https://www.nidcd.nih.gov/health/noise-induced-hearing-loss

7. Fink DJ. What is a safe noise level for the public? Am J Public Health. 2017;107(1):44–45.

8. World Health Organization. Environmental noise guidelines for the European region. Updated May 31, 2019. Accessed November 2, 2020. https://www.euro.who.int/__data/assets/pdf_file/0008/383921/noise-guidelines-eng.pdf?ua=1

9. Kardous C, Themann CL, Morata TC, et al.; Centers for Disease Control and Prevention. Understanding noise exposure limits: occupational vs. general environmental noise [science blog]; February 8, 2016. Accessed November 2, 2020. https://blogs.cdc.gov/niosh-science-blog/2016/02/08/noise/

10. Śliwińska-Kowalska M, Zaborowski K. WHO environmental noise guidelines for the European region: a systematic review on environmental noise and permanent hearing loss and tinnitus. Int J Environ Res Public Health. 2017;14(10):1139.

11. McIntyre H. Americans are spending more time listening to music than ever before. November 9, 2017. Accessed November 2, 2020. https://www.forbes.com/sites/hughmcintyre/2017/11/09/americans-are-spending-more-time-listening-to-music-than-ever-before/#759b8c8b2f7f

12. Ramakers GGJ, Kraaijenga VJC, Cattani G, et al. Effectiveness of earplugs in preventing recreational noise-induced hearing loss: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2016;142(6):551–558.

13. Michels TC, Duffy MT, Rogers DJ. Hearing loss in adults: differential diagnosis and treatment. Am Fam Physician. 2019;100(2):98–108. Accessed November 2, 2020. https://www.aafp.org/afp/2019/0715/p98.html

14. World Health Organization. Check your hearing; 2020. Accessed November 2, 2020. https://www.who.int/health-topics/hearing-loss/hearwho

15. Wu P-z, O'Malley JT, de Gruttola V, et al. Age-related hearing loss is dominated by damage to inner ear sensory cells, not the cellular battery that powers them. J Neurosci. 2020;40(3):6357–6366.

16. Henry JA, Griest S, Zaugg TL, et al. Tinnitus and hearing survey: a screening tool to differentiate bothersome tinnitus from hearing difficulties. Am J Audiol. 2015;24(1):66–77.

17. Han BI, Lee HW, Kim TY, et al. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5(1):11–19.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.

 

 

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