Combating Adolescent Hearing Loss in an Ever-Louder World

Frank Wartinger, AuD


September 12, 2016

Editorial Collaboration

Medscape &

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Hi. I'm Frank Wartinger, doctor of audiology with The Children's Hospital of Philadelphia, speaking about noise-induced hearing loss and healthy hearing habits.

Noise's Irreparable Impact

Noise-induced hearing loss can come from sudden-impact sounds, such as explosions or gunfire, or from long-duration exposure to loud sounds. Noise affects the ear through mechanical and metabolic damage to the sensory hair cells in the cochlea. The extent of the noise damage is determined not only by the intensity of the sound but also by the duration of the exposure.

Other hearing disorders, such as tinnitus (a ringing or buzzing sound in the ear), hyperacusis (an abnormal perception of loudness), and diplacusis (an abnormal perception of pitch) can also come from noise exposure.

Noise-induced hearing loss is 100% preventable with simple patient education and no- or low-cost solutions. Healthy People 2020 has released two goals pertaining to this issue.[1] One is to increase the proportion of adolescents who use hearing protection, and the other is to decrease the proportion of adolescents with a measurable hearing loss. In 2011, Henderson and colleagues[2] reported that approximately 1 in 5 adolescents in the United States have a permanent hearing loss that can be attributed to noise exposure.

Listening to music through earphones has become ubiquitous, especially with teenagers. Approximately 90% of adolescents report the use of earphones. In a 2011 study, Vogel and colleagues[3] reported that approximately 1 in 4 adolescents would self-report usage habits of music-listening through earphones that puts them at risk for significant hearing loss.

There are many other sources of dangerous noise levels. For instance, recreational sounds, shooting, and use of firearms during hunting can be very dangerous. Long-duration events, such as concerts, auto races, and sporting events, carry a large risk for hearing loss, especially for those who attend these events frequently.

Those who participate in music performance can develop noise-induced hearing disorders, not only because of the frequent exposure to concert noise but also because of the long hours of rehearsal, both individually and with groups.

Occupational noise exposure should not be ignored for children. Many teenagers hold summer jobs in which they either use or work in close proximity to very loud equipment, such as lawn care work and construction jobs.

Strategies for Preventing Hearing Loss

Figure. Safe listening limits. Source: The Children’s Hospital of Philadelphia

When a patient presents to your office with noise concerns or with questions about healthy hearing habits, the first step is education. There are three steps to prevent noise-induced hearing loss. First, turn it down; second, walk away; and third, wear hearing protection.

If the individual has control over a sound, they can simply turn it down to protect their ears and to enjoy that sound for a longer period of time. If they don't have control over the sound but they can remove themselves from it, walking away is often the healthiest option.

In many cases, though, neither of those are options because the person wants to remain in the room. If it's a concert or an event that they want to be part of, or if it's an occupational situation where they can't leave their job, then wearing hearing protection allows them to enjoy that situation or to finish their workday without damaging their hearing.

When a patient presents with noise-induced hearing disorders such as tinnitus or hearing loss secondary to a noise exposure, they should be referred to an audiologist. An audiologist would perform a comprehensive audiologic evaluation, provide counseling as needed, and consider hearing protection devices if applicable.

Generic hearing protection devices are available commercially. Those include foam earplugs or earmuffs. An audiologist can make custom hearing protection devices for those who are involved in music performance or those who require more comfort because they're using hearing protection devices for a longer period of time.

Other Web-based resources are available to share with your patients. Those include Noisy Planet from the National Institutes of Health; Dangerous Decibels, a great resource for younger children; and, the American Academy of Audiology's website.

In summary, noise-induced hearing loss is completely preventable with education and by sharing that you can turn down the sound, walk away from the sound, and protect your hearing when needed. Thank you for watching.