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4 Ways to Protect Your Hearing

Loud noise can be very damaging to your hearing, whether it’s a loud burst or years of prolonged exposure. Sounds are measured in decibels, and those exceeding 85 decibels can hurt your ears — permanently. Common sources of loud noise include lawn mowers (106 decibels), fireworks (150 decibels) and rock concerts (120 decibels).

Approximately 15 percent of adults 18 years of age or older report some trouble hearing, and the risk rises as we age. Up to 39 percent of adults in their sixties are having problems hearing. The good news is that taking action now may protect you from hearing loss later in life.

Consider taking the following steps:

Get a baseline hearing test..

Most adults have never had a hearing test , but it pays to buck that trend. At your next annual physical, ask for a hearing test as part of your routine checkup. A hearing test gives your audiologist a baseline that they can compare with future results to monitor the progression of hearing loss.

Wear protective hearing gear.

When you are in a noisy environment, wear protective hearing gear such as earplugs or protective earphones. You likely can find ear plugs at your local drugstore or music supply shop, but you can also ask your audiologist for more information.  For people who are regularly exposed to noise, your audiologist may recommend custom ear plugs. Think “ear protection” before you’re exposed to any noisy environment, such as: Rock concerts or any type of loud performance Construction sites Noisy workplaces Airports or train and bus stations Lawn mowing or leaf blowing Auto racing Hunting or shooting 

Monitor the volume of your devices.

While you are watching TV or using mobile devices, keep the volume at a comfortable level. It should be loud enough that you do not need to strain to hear, but not so loud that when you leave the room, you can still hear it from another part of your home.

Have custom molds made for your earphones.

If you often listen to music on earphones using a portable music or video device, it’s a good idea to have custom earphone molds made. There are relatively inexpensive custom ear molds that conform to the unique shape of your ear canal and attach to the earphone’s wires. You will find the sound truly superior as the custom ear molds will block outside noise, allowing for better quality listening. A variety of custom ear molds are available for use with earphones, while others are designed for musicians and people who are exposed to noise. Your audiologist can help you select the best style for you.

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Three Ways to Protect Your Hearing at Any Age

Loud noises can strike in almost any environment. And the louder the sound, the quicker it can damage your hearing. But noise-induced hearing loss, or NIHL, is preventable. Below, we’ll share three ways you can protect your hearing at any age. Plus, for members who might already be experiencing hearing loss, Meritain Health® proudly offers a discount program for savings on hearing aids, batteries, exams and more. Adding this is a simple way for employers to provide hearing support to a benefits plan. Keep reading to see what steps you can take to protect this important and sometimes overlooked one of the five senses.

Why is hearing important to your health?

Hearing well improves how we communicate, understand others and can add to quality of life. It’s an essential part of maintaining our relationships, participating in group activities and holding our own in conversations. In addition, hearing and listening make it possible to enjoy sounds around you, like birds chirping, your favorite music or simple laughter. It can also keep you safe, allowing you to hear alarms, traffic noise and visitors at your door.

As your hearing starts to go, it affects each of these areas of your life. Not being able to hear well makes it difficult to communicate. This sometimes leads people to withdraw or isolate, increasing rates of loneliness, depression or other mental health struggles. Hearing loss also affects how the brain functions, impacting memory, cognitive thinking and even our balance. So, hearing is really important to our physical health, mental health, plus how we engage with the world around us.

Three ways to protect your hearing

Though some hearing loss may simply come with age, protecting against noise-induced hearing loss is in our control. Here are three ways to protect your hearing at any age:

• Lower the volume . This can include anything from turning down the TV, lowering the music on your stereo or headphones or using quieter power tools.
• Move away from the noise . Whenever possible, try to move as far away from the noisiest spots you encounter, like loudspeakers or blaring music at concerts or sporting events. Sounds get quieter as you move further from the source.
• Wear hearing protectors, such as earplugs or protective earmuffs . If you can’t skip noisy activities altogether, use hearing protection. Just be sure to wear these correctly so they block out noise and minimize sound getting in.

Learning more about hearing loss

If you’d like to learn more about protecting your hearing, you can visit resources from the Centers for Disease Control and Prevention (CDC). Or check out It’s a Noisy Planet , a program from the National Institutes of Health. They just wrapped up National Protect Your Hearing Month in October and have plenty of helpful tips and information all year round.

Helping our members hear loud and clear

Our discount program lets members access a variety of discounts on products and services, such as hearing aids, batteries, routine cleaning and repairs, plus cleaning and follow-ups. Offers are provided through Hearing Care Solutions and Amplifon Hearing Health Care .

Check for information in your open enrollment packets or log in to view your member materials to learn more. If you’re an employer or plan sponsor interested in finding out more, contact your Meritain Health representative.

This article is for informational purposes only and is not meant as medical advice.

https://www.cdc.gov/nceh/hearing_loss/how_do_i_prevent_hearing_loss.html

https://www.noisyplanet.nidcd.nih.gov/

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11 Ways to Preserve and Protect Your Hearing

In Hearing Health , hearing loss , Hearing Protection by audseo July 3, 2024

Our ability to hear is one of our senses that allows us to fully experience the world around us. However, in today’s noisy world, our hearing is constantly at risk of deterioration. The good news is that there are several proactive measures we can take to protect our hearing. Let’s explore 11 effective ways to protect your hearing .

1. Minimize Exposure to Loud Noise

Exposing your ears to loud noises can lead to irreversible hearing damage. Whether it’s at a concert, in a noisy workplace, or using power tools, it’s important to limit your exposure to excessive noise. When in loud environments, consider wearing ear protection such as earmuffs or earplugs to reduce the impact of noise on your ears.

2. Get Regular Hearing Check-ups

Just as you would schedule routine dental or medical check-ups, it’s important to prioritize regular hearing evaluations with a hearing health professional. By monitoring your hearing health, potential issues can be identified and addressed early. This can prevent further deterioration and help you access appropriate interventions when needed.

3. Be Mindful of Volume Levels

Whether you’re listening to music through headphones or watching television, be mindful of the volume levels. Prolonged exposure to loud music or media can contribute to hearing loss over time. Where possible, keep the volume at a moderate level, and take regular breaks to give your ears time to rest and recover.

4. Embrace Ear-friendly Activities

Engage in activities that are gentle on the ears. Instead of spending extended periods in loud environments, seek out hobbies that promote auditory health, such as nature walks, meditation, or quiet activities that allow your ears to experience restorative peace.

5. Maintain Ear Hygiene

Proper ear hygiene is essential for preventing infections that can impact hearing. Avoid using cotton swabs or other objects to clean your ears, as these can push wax deeper into the ear canal. Instead, gently clean the outer ear with a damp cloth and seek professional assistance if you experience earwax buildup or discomfort.

6. Stay Informed About Potential Hazards

Be aware of the potential hearing hazards in your environment. Educate yourself about the noise levels of common household appliances, power tools, and recreational activities. By understanding these risks, you can take proactive steps to protect your hearing and minimize exposure to harmful noise levels.

7. Implement Workplace Hearing Protocols

If you work in a noisy environment, ensure that your workplace has established hearing protection protocols. Wear earmuffs, earplugs, or other appropriate hearing protection gear as recommended, and familiarize yourself with safety measures to mitigate the impact of occupational noise.

8. Prioritize Overall Health and Wellness

Maintaining overall health and wellness can positively impact your hearing health. Regular exercise, a balanced diet, and managing conditions such as hypertension and diabetes can contribute to better blood circulation and overall well-being, which in turn supports healthy hearing.

9. Limit Earbud and Headphone Usage

Extended use of earbuds and headphones can lead to excessive sound exposure and potential hearing damage. Whenever possible, limit the duration and volume of earbuds or headphones usage to reduce the risk of long-term auditory harm.

10. Manage Stress and Mental Health

While it may not seem directly related, managing stress and prioritizing mental health can have a positive impact on your hearing health. Chronic stress has been associated with an increased risk of hearing loss and tinnitus. High stress levels can contribute to the body’s production of cortisol, which can damage the delicate structures in the ear responsible for hearing. Finding healthy ways to cope with stress, such as practicing relaxation techniques, engaging in regular physical exercise, and seeking support from friends, family, or professionals, can help reduce the risk of hearing loss.

11. Seek Professional Guidance

If you experience any changes in your hearing, such as ringing in the ears, sudden hearing loss, or difficulty understanding conversations, seek professional guidance as soon as possible. Early intervention can make a huge difference in addressing potential issues and preventing further deterioration.

Book Your Next Appointment

You can preserve and protect your hearing with a few simple steps. By prioritizing measures to minimize exposure to loud noise and booking regular check-ups, you can safeguard your hearing health. Visit us today for a hearing test, and find out more about your hearing health and hearing needs.

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Five Ways to Protect Your Hearing and Promote Ear Health

The human ear is a vital organ. It serves two critical roles in the human body: hearing and maintaining balance. Healthy hearing translates to productive living.

Therefore, ear care requires that you are vigilant in your day to day activities, and avoid situations and things that could lead to ear damage. Here are five ways in which you can ensure that your ears are healthy.

Avoid Loud Noise

Exposure to loud sounds is a leading cause of hearing problems. This noise could be from your favorite music player, machines that you operate at work, firearms, speed boats among others.

Excess exposure to these noises damages the sensitive hair cells found in the inner ear, which can lead to a permanent hearing loss. It is, therefore, imperative that you protect your ears whenever you are exposed to excess noise.

If your work involves dealing with loud machines, speak to your supervisor or manager. Let them look for ways of reducing this exposure.  They can consider minimizing the length of time that you spend with the noisy machinery. They can also look into getting other models that are less noisy, if possible. Ask for ear protection devices like ear plugs or ear muffs.

If you are the kind that listens to music from earphones and headphones, acquire the noise canceling models. Avoid having the sound at more than 60% of the volume. If someone seated next to you can hear what you are listening to, then that volume is too high and can cause ear damage. Do not increase the volume of your earphones in an attempt to block noise from your environment.

Whenever you attend events where they play loud music, keep away from the sources of excess noise like the speakers. Consider acquiring ear plugs that control the volume of music without muting it at such events.

Do Not Insert Objects in the Ear Canal

Resist the temptation to use earbuds or other sharp pointed objects to clean your ears. These objects are potentially dangerous as they can rupture your eardrums. 

The use of earbuds, fingers and other objects also puts you at a higher risk of developing infections. These can damage the delicate skin in the ear, making you more prone to infections.

Do not be obsessed with having wax free ears. A little wax is beneficial to you as it stops foreign objects from flying, crawling or being blown into your ear canal. Tea tree oil is a better option for managing wax build up. 

Do not use sharp object to attend to itching in the ears, lubricate your ears using olive oil. If the itching persists, consult a doctor.

Maintain a Healthy Diet

According to the National Campaign for Better Hearing, certain vitamins and minerals are essential for maintaining hearing health. 

Research has continued to show a connection between good nutrition and positive hearing outcomes. A great summary of studies on vitamins and antioxidants connection to hearing was published at HHTM last year.

However, always avoid using any vitamin or mineral supplements without consulting your doctor.

Give Your Ears a Break

While working in a noisy environment, give yourself a 10 minutes break every so often. Consider walking away from excess sound every 15 minutes at a noisy event.  Avoid using your earphones or headphones for more than an hour. Take a 5 minutes break every hour, even when you are using on low volume.

Give your ears a break from the noises of everyday life by visiting quiet places like secluded beaches and the woods regularly.

Have Your Ears Checked

If you are experiencing ear pain, deafness, dizziness, ringing or noises in the ear, it is advisable that you visit a doctor. A check-up will ensure that any problems are detected and addressed early enough. 

The ability to hear is one of the ways through which you interact with the rest of the world. An inability to understand others can lock you out of the joys of life; therefore, take care of your ears.

References:

• 10 Ways to Protect Your Hearing . Retrieved from Saga, March 2018
• Protecting your ears . Retrieved from Gun Safe Labs, March 2018
• Hearing loss prevention . Retrieved from Better Hearing Institute, March 2018

*featured image courtesy wikimedia commons

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7 Ways to Protect Your Ears and Prevent Hearing Loss

Posted March 27, 2023 by Amy Welman, Au.D.

Did you know that once you lose your hearing, it often can’t be restored? Protecting your hearing and ear health can help prevent hearing loss and related ear diseases as you age.

According to the U.S. National Institute on Deafness and Other Communication Disorders, about 15 percent of adults in this country have trouble hearing with one or both ears, with the greatest amount of hearing loss in the 60 to 69 age group.

Fortunately, many common causes of hearing loss can be prevented — and you don’t have to stop doing the things you love! You can keep your ears healthy by protecting them from injury and loud noises, such as concerts and fireworks shows, and staying up to date on immunizations and well visits.

While there is no set hearing screening schedule, the American Speech-Language-Hearing Association recommends annual hearing tests for adults beginning at age 60 or those at risk for hearing loss, such as people who work in noisy environments. However, if you notice a change in your hearing, or have ringing or fullness in your ears for more than 24 hours, talk to your healthcare provider.

Summa Health offers seven ways you can take steps now to protect your hearing and reduce your risk for hearing loss later in life—because protecting your hearing is important in all stages of life.

• Avoid loud activities and places whenever possible , such as lawn mowing, power tools and music concerts.
• If you can’t avoid loud noises, wear proper protection. Using hearing protection, such as earplugs or earmuffs, will help filter extreme noises and reduce your risk of hearing loss.
• Keep volume low. Keep noise levels on your devices, such as TV, radio and home sound systems at a comfortable level. If you think it’s too loud and you can hear it from another room, it probably is. Don’t forget to keep your volume down on your headphones and earbuds too.
• Give your ears a break. Give your ears periodic breaks from headphones and other loud noises to reduce your exposure. Also, limit your time exposed to noises above 85 decibels, which can cause hearing loss over time.
• Give ears time to heal. If you’ve been exposed to loud noises, try to spend some time in a quiet environment for at least a day to give your ears time to rest and recover.
• Keep up on immunizations. Some illnesses, such as measles, mumps, whooping cough and bacterial infections, can negatively affect your hearing.
• Don’t put anything in your ears. Do not put anything in your ears, including cotton swabs, which can injure the ear canal or eardrum. Instead, clean your ears with a washcloth over your finger. If you have a buildup of earwax that is affecting your hearing, contact your provider to get it removed. Don’t try to remove it yourself.

So, what is too loud?

If you think your ears will get used to loud noises, think again. In fact, if loud noises don’t bother you as much as they once did, you’ve probably already lost some of your hearing.

Over time, listening to sound that’s 85 decibels or higher can cause hearing loss or problems, such as tinnitus, which is when you experience a ringing sound in your ear that won’t go away. The louder a sound is and the longer you’re exposed to it, the more damage it can cause to your hearing.

Even lawn mowers, movie theaters, motorcycles and sporting events can reach levels over 100 decibels. So, how can you tell when a noise is hurting your hearing?

A good rule of thumb is if there’s so much noise around you that you need to talk loudly or even shout when friends are at an arm’s length away, it’s probably hurting your hearing. Another way to tell is to download a sound meter app on your smartphone that measures noise levels in decibels.

The bottom line is if it seems too loud, it probably is, and you should wear earplugs or go somewhere quieter to protect your hearing.

If you’re concerned about hearing loss, talk to your healthcare provider . Hearing loss is often gradual and can go undetected unless checked.

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How to Protect Your Hearing

Last Updated: November 2, 2021

This article was medically reviewed by Victor Catania, MD . Dr. Catania is a board certified Family Medicine Physician in Pennsylvania. He received his MD from the Medical University of the Americas in 2012 and completed his residency in Family Medicine at the Robert Packer Hospital. He is a member of the American Board of Family Medicine. This article has been viewed 117,601 times.

Hearing is one of our most important senses — it allows us to communicate, to learn, and to enjoy things like music and conversation. However, many people don't realize that they may be exposing their ears to a huge amount of potentially damaging noise (and other factors) on a daily basis. It's important to protect your hearing from noise and other damaging factors.

Understanding Hearing Loss

• Our brain registers sound thanks to a spiral-shaped organ in the inner ear called the cochlea. The cochlea is covered in thousands of tiny hairs which register sound vibrations and turn them into electrical impulses to be processed by the brain.
• When your ears are exposed to loud noises, these tiny hairs can become damaged, resulting in hearing loss. Although short, intense noises (like fireworks or a gunshot) are sometimes the cause, the most common cause is regular exposure to excessive noise (listening to music too loudly, working in a noisy environment).
• It's important to realize that once this type of hearing damage occurs, it cannot be reversed. Therefore it is very important to take measures to protect your hearing before it's too late. [1] X Research source

• Normal conversation: 60 to 65 dB
• Motorcycle or lawnmower: 85 to 95 dB
• Music at a nightclub: 110 dB
• MP3 player at maximum volume: 112 dB
• Ambulance siren: 120 dB
• Taking measures to reduce noise levels by just a few decibels can be hugely beneficial for your ears. This is due to the fact that every 3 dB increase in the noise level effectively doubles the amount of sound energy being released.
• As a result, the amount of time you can safely spend listening to a certain sound rapidly decreases the louder the sound is. For example, you can safely spend up to eight hours listening to an 85 dB sound, but you should only spend 15 minutes exposed to noise levels above 100 dB.
• If you can't hold a conversation with someone who is standing two meters away from you without shouting, the noise level is damaging to your ears.

• Depending on the issue, you may need to see an ear, nose and throat doctor (an Otolaryngologist), or a licensed audiologist.
• Each of these will perform a series of tests to determine whether your hearing has been damaged.
• While there is no cure for hearing damage, hearing aids can ease the problem by magnifying sounds as they enter your ear. Of course, they are expensive and may not always work, so it's important to protect your hearing.

Preventing Noise-Related Hearing Loss

• The volume on your MP3 player is too high if it completely drowns out all background noise, or if it feels uncomfortable to listen to. Switch to headphones instead of earphones, as these provide better sound quality at a lower volume.
• Try to follow the 60/60 rule when listening to music on an MP3 player. This means you should listen to music at no more than 60% of your music player's maximum volume, for no more than 60 minutes at a time.
• You also need to be careful when listening to music in enclosed spaces, such as in a car. Turning the volume dial down just a couple of notches can make a huge difference to your hearing. [2] X Trustworthy Source National Health Service (UK) Public healthcare system of the UK Go to source

• Nowadays, most workplaces have to follow strict regulations to protect their employees' hearing. Workers are required to wear noise canceling ear muffs or earplugs if the average daily noise level is above 85 decibels.
• However, people who are self-employed are responsible for their own hearing, so don't forget to wear hearing protection if you're doing activities like mowing the lawn or doing home improvements.
• If you are concerned about the noise levels in your workplace, speak to an occupational health and safety officer or to someone in the human resources department.

• To protect your ears while listening to live music, strategically position yourself away from any amplifiers, speakers or stage monitors. The further away you are from the source of the sound, the better.
• Take "quiet breaks." If you're spending the night at a music bar or club, try to go outside for five minutes every hour. Just giving your ears a break from the constant noise exposure will do them some good.
• Another alternative is to wear earplugs while you listen to live music. This can reduce the sound levels by 15 to 35 decibels, but shouldn't muffle your hearing or affect your enjoyment of the concert.
• If you are a musician yourself, try to avoid practicing at full performance volume and wear earplugs while playing, if possible.

• If you are pregnant, avoid loud concerts or workplace noise that exceeds 85 dB (about the level of a motorcycle engine), which has been linked to hearing loss in children. Loud noises during pregnancy has also been linked to a low birth weight and preterm delivery. [3] X Research source
• Newborns should never be exposed to sudden loud noises. Noise above 80 dB has been linked to hearing loss and infant anxiety.
• Young children have more sensitive hearing than adults, so if an environment seems loud to you, it is even louder to your child. Buy protective headphones or earplugs or avoid loud environments like rock concerts or front row seats at the fireworks display.

Avoiding Other Causes of Hearing Damage

• The most common ototoxic drugs include salicylates (such as aspirin) and anti-malarial drugs. Industrial strength chemical solvents have also been linked with hearing loss.
• To avoid hearing damage caused by drugs and chemicals, take all medications as directed and report any unusual side effects to your doctor.
• If you work with chemical solvents, talk to your occupational health and safety officer about the preventative measures you can take. [4] X Research source

• The best way to avoid hearing loss caused by these diseases is to avoid contracting these diseases in the first place.
• Get babies and children vaccinated and see a doctor immediately when you fall ill, as prompt diagnosis and treatment can prevent the development of more serious complications like hearing loss.
• Avoid STDs like syphilis by wearing condoms during sex. [4] X Research source

• Always wear a helmet when riding a bike or playing any kind of contact sports, as even a concussion can negatively affect your hearing, and always wear a seatbelt when travelling by car
• Protect your ears from otitic barotrauma (damage caused by changing air pressure) by taking all necessary precautions when scuba diving.
• Prevent yourself from falling by being aware of safety at all times. For example, do not stand on the top rung of a ladder.

• Most people don't need to clean out their ears, as your ears need a certain amount of wax for protection and any excess will naturally be expelled.
• But if you feel you have excess wax in your ears, you can get rid of it using an earwax removal kit. To use, place a couple of drops of earwax solution into your ears before bedtime, over the course of a couple of nights. The solution will soften the earwax, causing it to flow out naturally. [5] X Research source

• Get plenty of exercise. Cardio exercise like walking, running or cycling helps to improve blood flow to your ears, which is good for your hearing. It's even better if you can do your exercise somewhere nice and quiet, like the woods or a secluded beach, as this also gives your ears a break from the hustle and bustle of daily life.
• Quit smoking . A study published in the Journal of the American Medical Association found that people who smoke (or are regularly exposed to secondhand smoke) are much more likely to experience age-related hearing loss.
• Decrease your caffeine and sodium intake. Both caffeine and sodium can have a negative effect on your hearing -- caffeine decreases blood flow to the ears, while sodium increases fluid retention which can lead to swelling in the inner ear. Try switching to decaf coffee and tea and lowering your salt intake. [6] X Research source

Expert Q&A

• If your eardrum is broken, you will feel very intense pain and you won't be able to hear anything on the side with the broken eardrum. Thanks Helpful 0 Not Helpful 0
• You can protect your ears from infection by drying them after bathing. You should also avoid swimming in dirty water. Thanks Helpful 0 Not Helpful 1
• Foam earplugs are available at any drugstore. You squeeze the plug to compress it, then stick it in your ear. It will expand to fill your ear canal, muffling some sound. You will still be able to hear what's going on, just not as clearly. Earplugs only lower noise about 29 decibels. This is not enough to make you completely immune to really loud sounds. Thanks Helpful 0 Not Helpful 0

You Might Also Like

• ↑ http://www.medicalnewstoday.com/releases/103766.php
• ↑ http://www.nhs.uk/Livewell/hearing-problems/Pages/tips-to-protect-hearing.aspx
• ↑ http://pediatrics.aappublications.org/content/100/4/724.full
• ↑ 4.0 4.1 https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/ears-ways-to-protect-your-hearing
• ↑ http://www.thesurvivaldoctor.com/2012/10/29/earwax-removal-how-to-clean-out-your-ears-at-home/
• ↑ http://www.rd.com/health/wellness/protect-your-hearing/

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Loud Noise: The Not-So-Silent Killer Is Back

The fading of the pandemic means the return of ear-piercing sounds and related health issues.

We lead noisy ... I SAID, WE LEAD NOISY LIVES! Loud sounds pound our eardrums every day: traffic, TV, earbuds, the phone, the neighbor's dog, the kids shooting fireworks even when it's not July 4. And let's not forget all the nights spent leaning against the speakers at Aerosmith concerts back in the ‘70s.

For the past 16 months or so, many of us have gotten a respite from noise as the world slowed in response to the pandemic . But as life slowly revs back up this summer, it's a good time to stop and consider just what we stand to lose from an increase in volume. Indeed, loud noise is more than just a threat to your hearing and your quality of life. New research suggests it can seriously damage your health.

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Decibel levels

• Passenger jet: 106 dB* 
• Kitchen blender: 88 dB 
• Garbage truck: 100 dB 
• Power mower: 90 dB 
• Leaves rustling: 20dB 
• Quiet conversation: 50dB 
• Jackhammer: 100 dB 
• Birds chirping: 44 dB 
• Dog barking: 90 dB 
• Motorcycle: 90 dB 

  *Jet noise from 1 mile away

Noise and disease

Daily noise exposure may figure significantly in your risk of severe stroke, according to a recent study in the journal  Environmental Research .  Researchers found that living in a noisy area — like a city or next to a highway — increases your risk of severe stroke by 30 percent, while living in a quiet, green area can reduce it by up to 25 percent.

Here's how it works: An incessantly loud environment stimulates a part of the brain known as the amygdala, which regulates stress response. The brain reacts by increasing blood pressure and levels of a stress-related hormone called cortisol; both are known to cause a host of cardiovascular issues, including stroke, says Douglas M. Hildrew, M.D., medical director of the Yale Hearing and Balance Program. In fact, the American Heart Association warns of an increased risk of heart attack for those who are regularly exposed to excessive noise, the kind found near airports and highways.

Chronic stress is also a well-established contributor to deaths related to immune system suppression, diabetes , arterial plaque buildup (atherosclerosis), psychiatric illness and possibly cancer .

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Noise and your brain

Exposure to noise slowly murders the critical hair cells within your cochlea that are key to the creation of sound in your brain (although one big blast of noise can cause instant damage as well). The resulting hearing loss increases your risk of cognitive decline, Hildrew says.

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"If I need hearing aids and I don't get them, I may withdraw from conversations because I find them challenging,” he adds.

That's not a small thing. People with hearing loss tend to isolate themselves socially out of frustration or embarrassment. As a result, they often don't experience sufficient mental stimulation or social interaction to keep sharp, increasing their risk of cognitive decline , Hildrew says. Now consider that nearly 25 percent of people between the ages of 65 and 74 experience disabling hearing loss, according to the National Institute on Deafness and Other Communication Disorders . That percentage doubles for those over 75.

The pursuit of quiet

As a return to normal life brings with it a return to normal noise exposure, the question is, how loud is too loud? The line where ear damage begins is traditionally believed to be between 85 and 90 decibels (dB), says David Owen, author of  Volume Control: Hearing in a Deafening World.  That's about the level of loudness your ears absorb from a gas lawn mower. A blender, a blow-dryer and a noisy restaurant all straddle the threshold of safe listening at around 90 dB. If you're going to be exposed to this level of noise for extended periods, or anything louder for even a short time, you should wear some sort of ear protection.

Since most of us don't walk around with a decibel meter, Hildrew recommends simply taking stock of your anxiety level when surrounded by various levels of sound: If it stresses you out, turn it down or find a way to protect yourself. Here are some volume-control tips.

1. Shut car windows

Driving with the windows open may expose you to harmful levels of environmental noise. “Men are more likely to lose the hearing on the left side because they're more likely to drive with the driver's side window down,” Owen says.

2. Choose a quiet restaurant

SoundPrint, a free app (available for both iPhone and Android), allows users to measure sound-level readings at bars and restaurants and share them with fellow quiet seekers.

3. Fine-tune

If you're having trouble hearing and want to see how hearing aids might help you, try EarMachine, a free app funded by the National Institutes of Health, which turns your iPhone into a hearing device by amplifying frequencies you don't hear well and sending to your ears via your wired earphones.

4. Plug it out

Simple noise-blocking earplugs ($5 and up) are an inexpensive way to protect your hearing. Keep a pair in your pocket for when you encounter high volumes. A sampling of products to consider:

• Etymotic High-Fidelity Earplugs:  Christmas tree–shaped plugs reduce the overall level of sound but maintain almost the full sonic spectrum — unlike regular foam earplugs that disproportionately mute high-frequency sounds like birds chirping or the sounds of f, h, s or th in speech, Owen says.
• Pluggerz:  These silicone plugs block loud music or noise.
• Hearos:  Squeeze these foam plugs between your fingers and insert them into your ear canal, where they expand to provide protection for your hearing.

5. Cancel the noise

Active noise-canceling (ANC) headphones ($120 and up) contain microphones that listen to the ambient noise around you and then use  built-in electronics  to produce sound waves that cancel out that noise, so all you hear is what's coming from your headphones. (The noise-canceling feature allows you to play your entertainment device at lower levels; headphones of any kind can still cause damage if you crank up the volume.) Here are three ANC styles:

• Bose QuietComfort Earbuds:  These earbuds use a combination of active and passive noise-canceling (PNC) technology. The ANC cancels out unwanted noise, while the PNC creates a seal to block it.
• Amazon Echo Buds:  These sealed in-ear speakers use Bose noise-canceling technology and work hands-free with the Alexa app so you can simply ask your earbuds to stream music, play audiobooks, make calls or play white noise to remedy distractions.
• Samsung Galaxy Buds Live:  Wireless ergonomic buds with ANC technology can be controlled by your smartphone or adjusted by tapping the earbud to focus and amplify live sounds.

Have You Had a Baseline Hearing Test?

Everyone should have their hearing checked at age 60 to establish a baseline measurement, advises otolaryngologist Douglas M. Hildrew, M.D. “People don't come to see me until they're not healthy anymore,” he says. “They say, ‘My hearing's changed,’ and I have to figure out by how much."

If you're curious about your hearing but aren't quite ready to make a doctor's appointment, Hildrew recommends that you seek out one of several online assessments available; AARP members can take the National Hearing Test once a year, for free, by going to the site nationalhearingtest.org .

Kimberly Rae Miller writes on health and wellness for a number of national publications.

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3 Ways to Protect Your Hearing

Can you really prevent hearing loss?

And if you protect your hearing, can you ensure that you will never experience a hearing loss? There are so many factors that can effect your hearing long-term, from loud noise exposure, to genetics, to traumas. As with most things, we can only worry about the things within our control. These 3 ways to protect your hearing are tangible and effective ways to take a proactive approach to your health.

The team at Levine Hearing is committed to helping you live your healthiest and happiest life! We say all the time, “When you hear better, you feel better”. Hearing is an essential way of connecting, not just with the environment around you but most especially with the people around you. We are passionate about educating our community on ways to prevent hearing loss. We visit doctors’ offices monthly to share information for their patients, we write blogs like these and share tips with you in our office.

Control the things you can and let go of those that you can’t. Below are the three most comprehensive points that we can make about ways that you can protect your hearing.

• Maintain Healthy Lifestyle Habits: Did you know that diabetics are twice as likely to develop hearing loss? Those with heart disease are 54% more likely to have a hearing loss. Blood flow is important for the nerves of the ears to thrive and operate correctly. This is not an effort to blame a hearing loss or even the original disease on the individual, as these condition still have genetic, environmental and socioeconomic factors at play. Still, it is important to know that a healthier body overall, is a safer environment for the ear to operate in and therefore protect your hearing. Discuss any diseases or illnesses that you may be concerned about with your primary care doctor.
• Treat Illnesses Promptly: If an infection in the ear is left unchecked, complications can arise that can cause permanent damage. Even illnesses outside of the ear can ultimately result in hearing loss. Strong antibiotics and painkillers can be ototoxic (damaging to the ear), and while these cannot be 100% avoided, the sooner you are able to treat an illness, the less likely that you will need the strongest or longest doses of medications. It is important to be aware of the side effects of drugs before taking them as well. Many medications list hearing loss and possibly tinnitus (ringing or other sound in the ear) as possible side effects. While you can’t avoid them completely, being informed can help you weigh risks as you determine which medications you are willing to take and for what duration.

What if the damage has already happened?

I say to people all the time, “You still have more hearing to lose, so protect it now!”. It is not too late! No matter what your hearing loss looks like, choosing to protect your hearing, avoiding long-term exposure to loud sounds, living a healthy lifestyle and treating illnesses promptly can all help you to preserve your current hearing.

If hearing aids are recommended, just know that wearing them will not further damage your hearing. In fact, hearing aids have built-in compression to keep loud sounds from being overamplified. I still recommend taking them out to put in custom earplugs if you know you are going to encounter noise exposure, but for every day, loud sounds, you can keep them in and they will monitor and control the volume of the sound.

Remember that our hearing screenings are always free at Levine Hearing. We would love to test you and give you a copy of the results for your records. Prevention is always the goal and we are so happy to share these ideas to protect your hearing! Don’t underestimate the importance of a baseline hearing screening. If you do encounter damage to your ears through noise, medications or illnesses, you can actually compare to your previous results. Thank you for reading and leaving any questions or comments below!

3 thoughts on “ 3 Ways to Protect Your Hearing ”

Blog is always interesting and I shared the article on tintinitis with my 80 year old Mom and she’s just now starting to experience it. Wish she didn’t live in Florida or I’d get her in your office!

So, I have irreversible nerve damage and work in a factory like environment 40-50 hours per week. I love that I can turn off my hearing aids and not hear the constant roar and sudden loud noises that happen. It’s funny, people have to actually scream to talk and be very close (with masks, of course) so when they need to communicate with me I can still make out what they are saying. Streaming calming music and meditations in my Bluetooth aids has beesuch a blessing as well while working 10-12 hr days! Thanks Levine Team for ALL YOU DO to keep me being able to stay social and keep a job because I can HEAR!!!

Oh, I’m so happy to read this, Michelle. It is an unspoken benefit that you can actually turn your ears “off” when needed and take a break from hearing. I love that you are using the streaming feature as well. Thank you for sharing!

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The Dos and Don’ts of Hearing Safety

The importance of hearing safety.

Hearing safety is vital for maintaining your hearing abilities and avoiding hearing loss. This loss significantly impacts communication, social interactions, and overall life quality. 

The Prevalence and Impact of Hearing Loss

About 10% of Americans experience hearing loss that hampers speech understanding. Noise exposure is the leading cause. Workers often develop adaptive strategies to cope with gradual hearing loss. The effects of noise, including tinnitus (persistent ringing in the ears), can be severe. However, preventing further damage is possible at any stage of hearing loss.

Explore more about different types of hearing loss . 

Understanding How the Ear Functions

• Ear Anatomy: The ear comprises the outer, middle, and inner parts. The outer ear leads to the ear canal, ending at the eardrum. The middle ear contains small bones that transmit sound to the inner ear, where the auditory nerve sends sound signals to the brain.
•  How Sound is Processed: Sound waves enter the ear, vibrate the eardrum, and go through the middle ear bones to the inner ear. Here, they become nerve impulses sent to the brain, which interprets them as sounds.
• The Impact of Loud Noise: Excessive noise damages the inner ear’s nerve endings, leading to hearing loss. This damage is cumulative and irreversible, emphasizing the importance of hearing protection.

Why Does Hearing Safety Matter? 

Here’s an in-depth look at why hearing safety matters:

• Preventing Hearing Damage: Loud sounds can harm the inner ear’s delicate hair cells, causing irreversible hearing loss. This is a global public health issue affecting millions. Noise-induced hearing loss (NIHL) is preventable mainly by safeguarding your ears.
• Maintaining Communication and Social Life: Hearing loss can hinder speech understanding, especially amid noise. This often leads to social withdrawal, diminished confidence, and relationship struggles. Protecting your ears ensures effective communication and active participation in social events.
• Avoiding Emotional and Mental Health Problems: Hearing loss connects to loneliness, anxiety, depression, cognitive decline, and higher dementia risk. Preserving your hearing is crucial for emotional and mental health.
• Enhancing Life Quality: Good hearing enriches life experiences, from enjoying music and nature sounds to engaging in conversations and learning. Protecting your ears allows you to appreciate life’s auditory aspects fully. Remember, 10% of Americans have hearing loss that impairs everyday speech understanding. Noise is the leading cause.
• Adapting to Long-term Hearing Loss: Many with long-term hearing loss adapt to its gradual onset. Noise’s impact is real and potentially devastating. Tinnitus, a constant ear ringing, can be unbearable for some. Regardless of your current hearing state, preventing further damage is crucial. Even those with severe loss should strive to preserve their remaining hearing.

In summary, hearing safety is not just about preventing hearing loss; it’s about preserving your quality of life and emotional well-being and connecting with the world around you.

Understand more about the importance of hearing health.  

Do’s and Don’ts of Ear Protection: Hearing Safety Tips

Understanding decibels and noise impact.

Recognizing which sounds are safe and pose a risk to our auditory health is essential.

• Decibel Levels Explained: Sound levels are measured in decibels (dBA). Safe sounds are typically at or below 70 dBA. Noise above 85 dBA can cause hearing loss. Examples include regular conversations (60-70 dBA), lawnmowers (80-100 dBA), motorcycles (80-110 dBA), concerts (94-110 dBA), sirens (110-129 dBA), and fireworks (140-160 dBA).
• Noise and Hearing Loss: Prolonged or intense noise exposure damages hearing. This damage is irreversible. Continual exposure above 85 decibels is hazardous. Impact sounds, like gunshots, are especially harmful. Even brief exposure can be damaging.
• Additional Effects of Noise: Beyond hearing loss, noise exposure can lead to tinnitus, anxiety, increased pulse rate, and reduced task efficiency.

Embracing effective hearing safety practices is essential for maintaining long-term ear health. These practices help you keep your hearing sharp and protected in various environments.

The Do’s of Hearing Safety Tips

• Monitor Noise Levels: Use apps like NIOSH’s Sound Level Meter to assess environmental noise risks.
• Wear Proper Ear Protection: Use earplugs or earmuffs in noisy environments, like shooting ranges or industrial settings.
• Lower Volume Settings: Keep the volume of devices at a safe level to prevent long-term hearing damage.
• Regular Hearing Check-ups: Schedule annual hearing tests, especially if you’re frequently exposed to loud noises.
• Educate Yourself and Others: Stay informed about hearing risks and share knowledge with friends and family.
• Follow Workplace Safety Protocols: Adhere to safety guidelines in noisy work environments.
• Practice Healthy Ear Care: Keep ears clean and dry. Avoid inserting foreign objects into the ear canal.
• Take Breaks from Noise: Allow your ears time to recover after exposure to loud environments.
• Use Noise-Canceling Headphones: Opt for noise-canceling headphones to enjoy audio at lower volumes.
• Stay Aware of Environmental Noise: Be conscious of noise levels in your daily surroundings and take steps to minimize exposure.

Discover more about foods for hearing health . 

The Don’ts of Hearing Safety Tips

• Avoid Excessive Noise: Steer clear of prolonged loud noises, such as concerts or fireworks, to prevent inner ear damage.
• Don’t Use Cotton Swabs: Avoid cleaning ears with swabs or picks. They can harm the ear canal and eardrum.
• Limit High-Volume Music: Keep music and podcast volumes moderate. High volumes over time can gradually damage hearing.
• Heed Warning Signs: Pay attention to hearing loss indicators. Consult an audiologist if you notice any symptoms.
• Use Hearing Protection: Always wear earplugs or earmuffs in noisy environments to protect your hearing.
• Seek Professional Help Promptly: Don’t delay treatment for hearing concerns. Early intervention is critical.
• Avoid Self-Treatment: Consult professionals for hearing issues rather than using unverified methods.
• Limit Headphone Use: Use headphones moderately and take breaks to rest your ears.
• Address Workplace Noise Risks: Engage with employers about hearing protection if your job involves loud noises.
• Prioritize Hearing Safety: Make hearing protection a daily habit to ensure long-term ear health.

By adhering to these do’s and don’ts, you can effectively protect your hearing and enjoy a lifetime of healthy auditory experiences.

Choosing the Right Safety Hearing Protection

Selecting the right hearing protection is vital to prevent noise-induced hearing loss (NIHL) and protect your ears from harmful noise levels. Here’s a guide to help you make the best choice:

Key Factors for Selecting Ear Protection

Understanding the specific factors for choosing hearing protection is vital to safeguarding your ears effectively.

• Noise Level: Know the decibel level of your environment. Concerts (90-110 dB), power tools (100-115 dB), and fireworks (up to 145 dB) are examples of high-decibel settings.
• Duration of Exposure: Longer exposure times, even to moderate noise levels, can cause hearing damage.
• Type of Noise: Different noises, like continuous or impulsive (e.g., gunshots), require specific protection types.
• Comfort and Fit: Choose a comfortable, well-fitting option to ensure effective protection.
• Noise Reduction Rating (NRR): Select a hearing protector with a suitable NRR for sufficient noise reduction.

Types of Safety Hearing Protection

Different situations call for various types of hearing protection, each with its unique features and benefits.

• Earplugs: Available in formable foam, pre-molded, and custom-made varieties. They are inserted into the ear canal, available in foam, silicone, or wax, with varying NRRs.
• Earmuffs: Cover the entire outer ear and offer higher NRR but may be less comfortable in heat.
• Dual Protection: In extremely loud environments, use earplugs and earmuffs together for maximum protection.
• Canal Caps: Feature a stiff band, useful for intermittent noise exposure.

Hearing Safety Tips on Usage and Maintenance

Maintaining your hearing protection devices is crucial for their longevity and effectiveness.

• Regular Inspection: Check for wear and tear; replace damaged protectors.
• Proper Storage: Keep in a clean, dry place.
• Education: Share knowledge about hearing safety.

When to Wear Hearing Protectors

Wear them in noisy settings like auto races, concerts, shooting sports, and loud workplaces. Keep them handy for unexpected loud noises, and cover your ears if caught off guard. Select comfortable, easy-to-use protectors and allow communication in noisy environments. Consult a hearing health professional for advice or custom-made options. Remember, proper fit and consistent use are fundamental to effective hearing protection.

By understanding the factors for selection, the types available, and their proper use and maintenance, you can effectively prevent noise-induced hearing loss and ensure a lifetime of healthy hearing.

Embrace Hearing Safety Protection with American Hearing + Audiology

Hearing safety tips are more than a precaution; they are a commitment to preserving your quality of life and maintaining your connection to the world. The first step is to understand the importance of safety hearing protection for your ears. From knowing when to wear ear protectors to choosing the right type, each action you take contributes to your auditory health. As you navigate the challenges of noise exposure in everyday life, remember that the proper guidance and tools are essential in this journey. If you’re seeking expert advice on hearing protection or need custom solutions tailored to your lifestyle, American Hearing + Audiology is here to help. Contact us for personalized assistance in choosing the ideal hearing protection and embracing a future of clear, vibrant sound. Your hearing is invaluable; let’s protect it together

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How to protect your ears: A cartoon guide

Margaret Cirino

Kaz Fantone

If you find yourself in loud clubs, concerts or cities, you might be doing more damage to your hearing than you think. People of all ages are at risk for noise-induced hearing loss, but few of us know what to do about it.

In this comic, narrated by an adorable cartoon ear, we learn about the role of hair cells in the ear, hearing issues that may be a concern and how to protect your ears. Hint: go easy on the Q-tips!

This comic is based on interviews with Barbara Kelley , executive director of the Hearing Loss Association of America, and Dr. Ariella Naim, a senior audiologist at Audio Help Hearing Center .

The comic was written and drawn by Kaz Fantone. The audio portion of this episode was produced by Margaret and Melia Agudelo and edited by Sylvie Douglis. The digital story was edited by Malaka Gharib. We'd love to hear from you. Leave us a voicemail at 202-216-9823 , or email us at [email protected] .

Listen to Life Kit on Apple Podcasts and Spotify , or sign up for our newsletter .

Preserve Your Hearing With These 10 Easy Tips

by Jonathan Lipschutz Audiologist, M.S., F-AAA, Owner | Feb 28, 2020 | Hearing Loss Prevention , Patient Resources

Although senior citizens are in the age group representing the highest risk for hearing loss, a startling prevalence of hearing loss in younger people is noted in a World Health Organization (WHO) report. The report estimated that approximately 1.1 billion teens and young adults are suffering from varying degrees of hearing loss due to frequent or prolonged exposure to loud noise from personal listening devices and noisy entertainment venues. As part of my effort to help prevent any further damage from hearing loss, here are ten easy tips for preserving your hearing.

1. Avoid Exposure to Loud and Prolonged Noise

A loud noise, such as an explosion or the firing of a weapon, can cause damage to your hearing. Just as likely, if not more so, harm can also come from moderately loud noise over a prolonged period. Avoiding these situations will help prevent hearing loss from noise damage.

2. Use Noise Protection

Those who cannot prevent extreme noise levels or prolonged moderate noise levels for various cultural, environmental, or occupational reasons can avoid damaging hearing loss by wearing noise protection. A wide variety of earplugs, ear molds, noise-canceling headphones, earmuffs, and wadding products are available to fit specific circumstances.

3. Protect Your Ears

Prolonged exposure to sub-zero weather is another common cause of hearing loss, as are traumatic injuries from sports and dangerous occupations. Protect your ears by keeping them warm and/or using proper headgear for sports and occupational activities.

4. Maintain Optimal Overall Health

Inflammation, infections, and the use of ototoxic drugs (prescription or non-prescription) are some of the overall health problems that can damage your hearing. Maintaining a lifestyle that avoids poor nutrition, smoking, illicit drugs, high levels of stress, and prolonged inactivity dramatically reduces the risk of health conditions that can damage hearing.

5. Be Conscious of Your Family History

Various types of hearing loss are a result of genetics. Knowing your family history concerning hearing loss allows audiologists to provide early intervention and treatment before hearing loss takes a more dramatic toll.

6. Know the Warning Signs of Hearing Loss

Early detection and treatment are among the best ways to head off hearing damage. Become familiar with the warning signs of hearing loss and schedule an assessment with an audiologist if you are experiencing any of them.

7. Listen to Friends and Family

Friends and family will often recognize that you have a hearing problem before you do. Untreated hearing loss continues to cause irreversible damage. Listen to family and friends when they begin to notice that you are struggling with your hearing.

8. Regular Hearing Checkups

Whether you are experiencing any of the symptoms of a hearing loss or not, you should develop a habit of having regular (annual) hearing checkups to establish a hearing capacity baseline. From this baseline, audiologists can quickly identify and intervene in minor hearing loss issues before they become significant issues.

9. Follow the Advice of Your Audiologist

It accomplishes nothing to have regular checkups with an audiologist but then refuses to follow their advice. Audiologists often recommend various lifestyle changes or protective measures to prevent hearing damage. If you follow their help, you can head off damage before it gets worse.

10. Use Your Hearing Aid

Hearing aids not only allow you to hear better, but they also have a significant impact on your overall health as well. Your audiologist has fitted you with a hearing aid to improve your overall health and prevent added damage to your hearing. So, use your hearing aid.

I take stock in the adage that “an ounce of prevention is worth a pound of cure.” The team at Berkeley Hearing Center, and I want to encourage you to continue to be aware of the various ways to prevent hearing loss and make a commitment to following these ten tips. Contact us for more advice about avoiding hearing loss, or request a callback by a Berkeley Hearing Center specialist to have your questions answered or to book an appointment.

Do you know somebody that needs to see this? Why not share it?

Jonathan Lipschutz Audiologist, M.S., F-AAA, Owner

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This isn’t just a “job.” It’s an opportunity to be part of a locally respected and passionate team that has built a stellar reputation as the most caring, trustworthy, and experienced audiological groups in the San Francisco East Bay Area.

We’re now seeking somebody that wants to join our team, show us the commitment that we’ll show them, and be part of shaping the future of Audiology in the East Bay.

The truth is, we’ve developed a very special culture, and we’re absolutely committed to maintaining it. The person that we hire has to be a great fit, and we’re prepared to wait until the perfect match comes along.

Although your education and experience plays a key role in this process, your personality traits and attitude are key priorities. If this is how your co-workers and friends would describe you, then we may be the ideal match:

• Always happy, smiles a lot, positive attitude, always a pleasure to be around.
• Friendly, warm, caring, a people person – which comes across the very first time you meet someone, even on the telephone.
• Patient, compassionate, helpful especially with older people. Even temperament, calm, always pleasant, unflappable. Has a knack for being able to turn a frown into a smile.
• Committed, dedicated, a great teammate, pitches in without being asked, puts team accomplishments ahead of individual accomplishments.
• Accurate, detailed, wants to get things right, double checks their own work, makes very few mistakes
• Owns it: accepts responsibility, credits others for successes and accepts responsibility for failures. Always looking for a constructive way to solve a problem.
• Coachable, accepts feedback with a positive attitude. Always looking for ways to grow and improve.
• Reliable, dependable, doesn’t just arrive on time: often comes in a little early to make sure they’re prepared for the day; willing to stay late when there’s work that needs to be done or a patient needs us

These statements also describe the people you’ll be working alongside, meaning that you’ll quickly discover that this is much more than a group of co-workers, but it feels like “your kind of people.”

We have spoken about whether you’re the right fit for this role and you’re still reading this, which indicates that you have the personality traits/attitude that we’re looking for. So, let’s now look at the specific duties of the role.

As an Audiologist, you will be playing a key role in helping our patients to achieve a lifetime of better hearing while ensuring the highest level standards of care that our reputation has been built upon.

Your job will be to ensure that every patient feels like our only patient.

Duties include:

• Connecting Through Assessments : Initiate a bond by understanding each patient's unique hearing journey. Comprehensive assessments give insights into their personal experiences, needs, and aspirations.
• Sound Sculpting : Employ a range of audiometric tests tailored to each individual. It's about crafting a personal sound experience, enabling them to revel in every auditory detail of their surroundings.
• Navigating Choices Together : Be the guiding hand when it comes to treatment (i.e. hearing aids, ALDs, aural rehabilitation, etc). With so many choices out there, your expertise helps in ensuring every patient gets the tailored care they need and deserve.
• Ongoing Support : Build trust and demonstrate you care by being available for check-ups, reprogramming, or even a chat. Whether it's a tune-up for their device or easing their concerns, you're their go-to person.
• Heartfelt Counseling : This journey has its ups and downs. Go beyond the ‘tech’ talk. We don’t ‘sell hearing aids’, we provide the highest level of hearing healthcare. Offer a listening ear, provide support, and address emotional concerns linked to hearing challenges.
• Embracing Continuous Learning : As the audiology landscape evolves, immerse yourself in the latest advancements. And then? Share that knowledge, bringing optimism and hope to those you care for.

If the above sounds like the kind of role that you have been waiting for, at the type of practice that you want to be part of, then here’s what we’re looking for from you.

Requirements:

The ideal candidate is honorable, caring, intelligent, enthusiastic, outgoing and team oriented. You should be ready to perform medically relevant diagnostics, including audiometry and immittance, as well as treatment-focused testing such as speech-in-noise testing (QuickSIN) and loudness discomfort levels.

You are passionate about working with state-of-the-art amplification/assistive technology, improving lives with your care, counseling and technological solutions.

You will be expected to improve proficiency with hearing aid dispensing and ongoing hearing aid management with electroacoustic analysis and probe microphone measurements.

Skills expected to have mastered:

• Diagnostics: Comprehensive Hearing Assessment (Pure tone air/bone conduction audiometry, word recognition testing (quiet & noise)
• Immittance testing - tympanometry, acoustic reflexes, reflex decay
• Tinnitus Assessment, Management and Counseling
• Dispensing: Hearing Aid Sales and Counseling
• Hearing Aid Electroacoustic Analysis
• Probe Microphone/Real Ear Measurements
• Counsel/Instruct Patients in Aural Rehabilitation Skills/Techniques

As you’re still reading, then you must like the sound of our culture, believe you’re the right personality fit for the role, and have the experience/qualifications that we’re looking for. Finally, let’s discuss the wage and benefits of being part of this journey.

The base wage includes a salary of between $100,000 and $150,000 per annum based on your experience. Plus, with a generous commission structure, a take home salary of up to $300,000 per year is realistic for the right individual.

Additional benefits include:

• Competitive commission structure, offering the potential to double or even triple compensation based on clear sales goals.
• Comprehensive health insurance covering 100% of the Silver plan premium.
• Dental insurance with 90% premium coverage.
• Profit Sharing/401k plan.
• Generous paid time off and sick leave.
• Enjoy fun office events happening at least three times a year.
• Access to ongoing education, including coverage for association memberships and attendance at one conference per year.
• Opportunities for career progression.
• Monthly "non-work" lunches where we provide the food and discuss anything except work.
• Engage in community giving back and potential humanitarian trips overseas.
• Located in the vibrant city of Berkeley, with excellent food, perfect weather, exciting cultural events (concerts, sports, festivals, etc.), and easy access to both the beach and mountains.

If you believe that this is the right fit for you both you and us, then we would love to talk.

Please send your resume over as well as any additional information that you believe will make you stand out and capture our attention.

We very much look forward to hearing from you.

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How hearing works

Here’s what to know about your ears — and how what they do connects to your brain.

While our brains provide us with a tremendous amount of information about the sounds we hear and what they mean to us, at the most basic level, our auditory system answers two major questions about any sound. First, what is the sound? The auditory system must identify what tones or frequencies we are hearing. And second, where is the sound? We must be able to locate the origin of the sound in space.

Once we know what sounds we are hearing and where the sounds are coming from, our brains can begin the complex task of assigning meaning to the sounds we hear. The process of determining what a sound is begins at a flat sheet of tissue (in the cochlea of the inner ear) called the basilar membrane. The basilar membrane detects the component frequencies, or tones, of incoming sound. The special physical properties of the basilar membrane make it particularly good at frequency detection. The membrane is flexible and vibrates when sound hits it — but it doesn’t vibrate evenly all over.

One end of the basilar membrane vibrates most at low frequency tones, and the other end of the membrane vibrates most at high frequency tones. This gives the basilar membrane tonotopic organization or organization by tone, similar to a xylophone: Tones are arranged from low frequency on one end to high frequency on the other. On a xylophone, if you know which bar is vibrating and where the bar is in the instrument, you can tell what note you will hear.

Similarly, if you know that a group of neurons in the basilar membrane is active, and you know where those neurons reside in the membrane, then you can tell what tone you have heard.

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When you play an “A” note on a xylophone, the air pulsates 440 times per second, a frequency of 440 Hertz (Hz). Those pulses trigger 440 vibrations per second along the length of the basilar membrane, with the largest vibrations occurring somewhere just past the middle of the membrane — the region of the membrane whose resonant frequency is 440 Hz. Within the resonant region, a group of neurons will begin a chorus of activity, each signaling in turn so that the group collectively signals 440 times a second.

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This marvelous synchronization of vibrations in the air, in the basilar membrane, and in the activity of neurons in the resonant region is called phase-locking. Phase-locking is an important response mechanism in the auditory system; as we will see, perfect synchronization is critical to detect where a sound came from.

Locating sounds in space, the other fundamental task of the auditory system, is no mean feat; but our brains can determine the origin of a sound with astonishing accuracy, even when we cannot actually see the source. That ability depends on three independent methods for locating sound: a timing method, an intensity method, and a frequency filtering method. By using the results from all three methods, we are able to very accurately pinpoint the origin of sounds in space.

Looking for more ways to build a healthy brain? Try BrainHQ, a brain training program designed by leading scientists that rewires the brain to help you think faster, focus better, and remember more. And it may be included at no cost with your Medicare Advantage plan. Check your eligibility today .

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5 Ways to Prevent Hearing Loss

Few people are taking the steps that can protect their ears from the damage loud noise can cause, says a new study, sharing is nice.

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Wearing protective devices such as earplugs or ear muffs in noisy situations can reduce your exposure to loud sounds that can damage your hearing.

But few people appear to be taking this simple step during leisure activities, according to a new Centers for Disease Control and Prevention analysis, published in the MMWE. 

In fact, only about 8 percent of Americans reported consistently wearing protective hearing devices during loud sporting and entertainment events, according to the CDC analysis of a 2018 survey of 6,357 people across the U.S.  

That's a problem, say experts. "Sound intensity at recreational events can reach hazardous levels and may remain high for the duration of the event, thereby increasing the risk for hearing damage," the authors say.

Here, what you need to know to protect your ears from too much noise—and the surprising factors that can damage your hearing.

Most people with hearing loss are older adults, and for them, factors such as natural changes in the inner ear are common contributors.

But hearing issues can occur at any age. "Hearing loss is generally seen as a regular part of aging, but now we're starting to recognize it as a big problem" for everyone, says Paul Dybala, Ph.D., an audiologist and president of Healthy Hearing, a website devoted to educating people on hearing issues.

In fact, last spring, the World Health Organization  forecasted  that by 2050, an estimated 900 million people around the world will have a disabling hearing loss. That's a 93 percent jump from the current 466 million people.

What's behind the increase? The population of older adults is growing, WHO reports. But other hearing-harming culprits include exposure to loud sounds from personal audio devices such as smartphones and iPods, rock concerts, loud bars, and noisy workplaces; the side effects of certain medications;  ear infections ; and the persistence worldwide of illnesses such as measles,  mumps , and rubella. 

Some hearing risk factors may affect younger people disproportionately. For instance, a  WHO report  from 2015 found that almost half of those between ages 12 and 35 crank up their personal audio devices to unsafe levels.

Surprising Reasons for Hearing Loss

In a world full of noise—honking vehicles, amplified music, power mowers, and jackhammers—it's important to take steps to safeguard your hearing. But some of the sounds you'll want to protect yourself from might surprise you.

For example, you probably expect your ears to ring after a rock concert, but they might do the same after a fireworks display. In fact, hearing experts say just one exposure to a typical pyrotechnics show can permanently damage your hearing.

And according to the  CDC , having a dog barking in your ear can harm your hearing in just a couple of minutes. 

Loud bursts of noise aren't the only problem, however. Over time, even sounds that may seem innocuous, such as the constant hum of a loud window air conditioner or refrigerator, can cause damage.

How to Prevent Hearing Loss

1. Know what's risky. Sounds are measured in decibels (dBA). Though individual tolerances vary, the National Institute for Occupational Safety and Health recommends that workplace exposure be below 85 dBA throughout an 8-hour workday. Legal workplace limits are 90 dBA. (For comparison, handheld hair dryers can emit 77 to 92 dBA.)

Consumer Reports' health and safety experts say that prolonged exposure to 70 dBA—the sound produced by a shower—or less is safe for most people.

Experts generally agree that sounds exceeding 100 dBA—a level that can easily be surpassed by rock concerts, sporting events, movie theaters, gas lawn mowers and snow blowers, some MP3 players played at maximum volume, and fireworks displays—can be hazardous even in short bursts. 

2. Block out loud sounds.  If you're stuck in a noisy space, you can dampen the sound with earmuffs or earplugs. Foam earplugs are a low-tech, inexpensive way to protect your ears. You can find them at any drugstore for about $3.50 for a set of 10. Earplugs are even sold at many concerts, right alongside the T-shirts.

If you want to ensure that you get the maximum sound quality at concerts, head to an audiologist for custom-fitted earplugs. They're more expensive than the foam type but will let in a richer sound at a live show.

3. Use headphones wisely.  One-fifth of teenagers are estimated to have some form of hearing loss, which experts attribute to the ever-increasing use of headphones and earbuds.

The easiest way to help prevent hearing loss from personal listening devices such as iPhones and MP3 players is to follow the 60/60 rule: Listen at no more than 60 percent of the maximum volume for no more than 60 minutes per day. Using  over-the-ear headphones —especially the noise-canceling kind—instead of earbuds may also help prevent damage. 

4. Make sure your ears are clear.  Sometimes keeping hearing sharp means nothing more than ensuring that nothing is blocking the ear canal, such as impacted earwax .

"A percentage of people, particularly those who are younger and who have early losses, have correctable things as simple as wax," says James C. Denneny III, M.D., CEO of the American Academy of Otolaryngology-Head and Neck Surgery. This is also common in people who wear hearing aids, where the lack of air ventilation in the ears can cause wax buildup.

And if you do clean your ears with cotton swabs or use cotton balls as earplugs, any cotton residue can interfere with your hearing.

Have your doctor check your ears for an overabundance of earwax or bits of cotton if you have any concerns. "I would encourage people to at least have a basic exam to start with and then work from there," Denneny says. In both cases, your doctor can clear the way.

But do break the cotton ball/cotton swab habit; it's potentially dangerous.  Research  published in 2017 in the Journal of Pediatrics found that 34 U.S. kids are treated in emergency rooms every day as a result of injuries caused by cotton swabs in the ear. In fact, experts say, don't put any object in your ears unless it's under a doctor's supervision.

5. Punch up your healthy habits.  Making a few  lifestyle tweaks , such as improving your diet and getting more physical activity, may be good for your hearing. Last May, researchers from Harvard University published a study in The Journal of Nutrition that analyzed the eating patterns of nearly 71,000 women for 22 years. Those who followed the most healthful eating plans—including the Mediterranean diet (which emphasizes fruits, nuts, veggies, whole grains, legumes , and fish) and the DASH diet (which limits red and processed meats, sodium, and sugar )—had about a 30 percent lower risk of hearing loss than those who ate less healthfully.

The researchers think a nutritious diet may help protect against hearing loss by keeping the blood vessels that supply oxygen and nutrients to the inner ear healthy.

High blood glucose levels and smoking may damage these blood vessels as well. In fact, according to the American Diabetes Association, hearing loss is twice as common in people with type 2 diabetes as it is in others. And a large study from Japan , published in March in the journal Nicotine & Tobacco Research, suggested that smoking is associated with a higher risk of hearing loss.

For these reasons, experts say, it's important to eat right , aim to quit smoking if you do smoke, and  incorporate exercise —which can help reduce the risk of type 2 diabetes—into your regular routine.

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How to Protect Your Hearing: 3 Ways

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National Research Council (US) Committee on Disability Determination for Individuals with Hearing Impairments; Dobie RA, Van Hemel S, editors. Hearing Loss: Determining Eligibility for Social Security Benefits. Washington (DC): National Academies Press (US); 2004.

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2 Basics of Sound, the Ear, and Hearing

In this chapter we review basic information about sound and about how the human auditory system performs the process called hearing. We describe some fundamental auditory functions that humans perform in their everyday lives, as well as some environmental variables that may complicate the hearing task. We also discuss the types of hearing loss or disorder that can occur and their causes.

INTRODUCTION TO SOUND 1

Hearing allows one to identify and recognize objects in the world based on the sound they produce, and hearing makes communication using sound possible. Sound is derived from objects that vibrate producing pressure variations in a sound-transmitting medium, such as air. A pressure wave is propagated outward from the vibrating source. When the pressure wave encounters another object, the vibration can be imparted to that object and the pressure wave will propagate in the medium of the object. The sound wave may also be reflected from the object or it may diffract around the object. Thus, a sound wave propagating outward from a vibrating object can reach the eardrum of a listener causing the eardrum to vibrate and initiate the process of hearing.

Sound waves can be mathematically described in two ways, that is, in two domains. In the time domain, sound is described as a sequence of pressure changes (oscillations) that occur over time. In other words, the time-domain description of a sound wave specifies how the sound pressure increases and decreases over time. In the frequency domain, the spectrum defines sound in terms of the tonal components that make up the sound. A tonal sound has a time-domain description in which sound pressure changes as a regular (sinusoidal) function of time. If one knows the tonal components of sound as defined in the frequency domain, one can calculate the time-domain description of the sound. Using the same analytic tools, the frequency domain representation of a sound can also be calculated from the time-domain description. Thus, the time and frequency domain descriptions of sound are two different ways of measuring the same thing (i.e., the time and frequency domains are functional equivalents). Thus, one can describe sound as temporal fluctuations in pressure, or one can describe sounds in terms of the frequency components that compose the sound.

Largely because tonal (sinusoidal) sounds are the bases of the frequency domain description of sound, a great deal of the study of hearing has dealt with tonal sounds. However, everyday sounds are complex sounds, which are made up of many tonal frequency components. A common complex sound used to study hearing is noise. Noise contains all possible frequency components, and the amplitude of the noise varies randomly over time. A noise is said to be “white noise” if it contains all frequency components each at the same average sound level.

A sound waveform has three basic physical attributes: frequency, amplitude, and temporal variation. Frequency refers to the number of times per second that the vibratory pattern (in the time domain) oscillates. Amplitude refers to sound pressure. There are many aspects to the temporal variation of sound, such as sound duration. Sound pressure is proportional to sound intensity (in units of power or energy), so sound magnitude can be measured in units of pressure, power, and energy. The common measure of sound level is the decibel (dB), in which the decibel is the logarithm of the ratio of two sound intensities or two sound pressures. Frequency is measured in units of hertz (Hz), cycles per second. Measures of time are expressed in various temporal units or can be translated into phase measured in angular degrees. Below are some definitions of terms and measures used to describe sound.

• Sound pressure (p): sound pressure is equal to the force (F) produced by the vibrating object divided by the area (Ar) over which that force is being applied: p = F/Ar.
• DekaPascals or daPa; the Système International unit of pressure. One daPa = 100 dynes per cm 2 , and one atmosphere = 10132.5 daPa.
• Sound intensity (I): sound intensity is a measure of power. Sound intensity equals sound pressure squared divided by the density ( p o ) of the sound-transmitting medium (e.g., air) times the speed of sound (c): I = p 2 / p o c. Energy is a measure of the ability to do work and is equal to power times the duration of the sound, or E = PT, where P is power and T is time (duration) in seconds.
• Decibel (dB): dB = 10*log 10 (I/I ref ) or 20*log 10 (p/p ref ), where I is sound intensity, p is sound pressure, ref is a referent intensity or pressure, and log 10 is the logarithm to the base 10. When p ref is 20 micropascals, then the decibel measure is expressed as dB SPL (sound pressure level).
• Hertz (Hz): hertz is the measure of vibratory frequency in which “n” cycles per second of periodic oscillation is “n” Hz.
• Phase (angular degrees): one cycle of a periodic change in sound pressure can be expressed in terms of completing the 360 degrees of a circle. Thus, half a cycle is 180 degrees, and so on. Thus, time (t) within a cycle can be expressed in terms of phase (θ, expressed in degrees), θ = 360 o (t)(f), where f = frequency in Hz, and t = time in seconds.
• Tone (a simple sound): a tone is a sound whose amplitude changes as a sinusoidal function of time: Asin(2 πft + θ), where sin is the trigonometric sin function, θ = peak amplitude, f = frequency in Hz, t = time in seconds, and θ = starting phase in degrees.
• Complex sound: any sound that contains more than one frequency component.
• Spectrum: the description of the frequency components of sound; amplitude spectrum describes the amplitude of each frequency component; phase spectrum describes the phase of each frequency component.
• Noise: a complex sound that contains all frequency components, and whose instantaneous amplitude varies randomly.
• White noise: a noise in which all of the frequency components have the same average level.

The term “noise” can refer to any sound that may be unwanted or may interfere with the detection of a target or signal sound. In some contexts, a speech sound may be the signal or target sound, and another speech sound or a mixture of other speech sounds may be presented as a “noise” to interfere with the auditory processing of the target speech sound. Often a mixture of speech sounds is referred to as “speech babble.”

The Auditory System

The ear is a very efficient transducer (i.e., a device that changes energy from one form to another), changing sound pressure in the air into a neural-electrical signal that is translated by the brain as speech, music, noise, etc. The external ear, middle ear, inner ear, brainstem, and brain each have a specific role in this transformation process (see Figure 2-1 ).

The anatomy of the auditory system. From Yost (2000, p. 66). Reprinted with permission of author.

The external ear includes the pinna, which helps capture sound in the environment. The external ear canal channels sound to the tympanic membrane (eardrum), which separates the external and middle ear. The tympanic membrane and the three middle ear bones, or ossicles (malleus, incus, and stapes), assist in the transfer of sound pressure in air into the fluid- and tissue-filled inner ear. When pressure is transferred from air to a denser medium, such as the inner ear environment, most of the pressure is reflected away. Thus, the inner ear offers impedance to conducting sound pressure to the fluid and tissue of the inner ear. The transfer of pressure in this case is referred to as admittance, while impedance is the restriction of the transfer of pressure. The term “acoustic immittance” is used to describe the transfer process within the middle ear: the word “immittance” combines the words impedance and admittance (im + mittance). As a result of this impedance, there is as much as a 35 dB loss in the transmission of sound pressure to the inner ear. The outer ear, tympanic membrane, and ossicles interact when a sound is present to focus the sound pressure into the inner ear so that most of that 35 dB impedance loss is overcome. Thus, the fluids and tissues of the inner ear vibrate in response to sound in a very efficient manner.

Sound waves are normally transmitted through the ossicular chain of the middle ear to the stapes footplate. The footplate rocks in the oval window of the inner ear, setting the fluids of the inner ear in motion, with the parameters of that motion being dependent on the intensity, frequency, and temporal properties of the signal. The inner ear contains both the vestibular system (underlying the sense of balance and equilibrium) and the cochlea (underlying the sense of hearing). The cochlea has three separate fluid compartments; two contain perilymph (scala tympani and scala vestibuli), similar to the body's extracellular fluid, and the other, scala media, contains endolymph, which is similar to intracellular fluids.

The scala media contains the sensorineural hair cells that are stimulated by changes in fluid and tissue vibration. There are two types of hair cells: inner and outer. Inner hair cells are the auditory biotransducers translating sound vibration into neural discharges. The shearing (a type of bending) of the hairs (stereocilia) of the inner hair cells caused by these vibrations induces a neural-electrical potential that activates a neural response in auditory nerve fibers of the eighth cranial nerve that neurally connect the hair cells to the brainstem. The outer hair cells serve a different purpose. When their stereocilia are sheared, the size of the outer hair cells changes due to a biomechanical alteration. The rapid change in outer hair cell size (especially its length) alters the biomechanical coupling within the cochlea.

The structures of the cochlea vibrate in response to sound with a particular vibratory pattern. This vibratory pattern (the traveling wave) allows the inner hair cells and their connections to the auditory nerve to send signals to the brainstem and brain about the sound's vibration and its frequency content. That is, the traveling wave motion of cochlear vibration helps sort out the frequency content of any sound, so that information about the frequency components of sound is coded in the neural responses being sent to the brainstem and brain.

The fact that the different frequencies of sound are coded by different auditory nerve fibers is referred to as the place theory of frequency processing, and the auditory nerve is said to be “tonotopically” organized in that each nerve fiber carries information to the brainstem and brain about a narrow range of frequencies. In addition, the temporal pattern of neural responses of the auditory nerve fibers responds to the temporal pattern of oscillations of the incoming sound as long as the temporal variations are less than about 5000 Hz.

In general, the more intense the sound is, the greater the number of neural discharges that are being sent by the auditory nerve to the brainstem and brain. Thus, the cochlea sends neural information to the brainstem and brain via the auditory nerve about the three physical properties of sound: frequency, temporal variation, and level. The biomechanical response of the cochlea is very sensitive to sound, is highly frequency selective, and behaves in a nonlinear manner. A great deal of this sensitivity, frequency selectivity, and nonlinearity is a function of the motility of the outer hair cells.

There are two major consequences of the nonlinear function of the cochlea: (1) neural output is a compressive function of sound level. This means that, at low sound levels, there is a one-to-one relationship between increases in sound level and increases in neural output; however, at higher sound levels, the rate at which the neural output increases with increases in sound level is lower. (2) The cochlea and auditory nerve produce distortion products. For instance, if the sound input contains two frequencies, f1 and f2, distortion products at frequencies equal to 2f1, 2f2, f2-f1, and 2f1-f2 may be produced by the nonlinear function of the cochlea. The distortion product 2f1-f2 (the cubic-difference tone) may be especially strong and this cubic-difference distortion product is used in several measures of auditory function.

At 60 dB SPL the bones of the skull begin to vibrate, bypassing the middle ear system. This direct vibration of the skull can cause the cochlea to vibrate and, thus, the hair cells to shear and to start the process of hearing. This is a very inefficient way of hearing, in that this way of exciting the auditory nervous system represents at least a 60 dB hearing loss.

There are many neural centers in the brainstem and in the brain that process the information provided by the auditory nerve. The primary centers in the auditory brainstem in order of their anatomical location from the cochlea to the cortex are: cochlear nucleus, olivary complex, lateral lemniscus, inferior colliculus, and medial geniculate. The outer, middle, and inner ears along with the auditory nerve make up the peripheral auditory system, and the brainstem and brain constitute the central auditory nervous system. Together the peripheral and central nervous systems are responsible for hearing and auditory perception.

• AUDITORY PERCEPTION

In the workplace, hearing may allow a worker to:

Communicate using human speech (e.g., communicate with a supervisor who is giving oral instructions);

Process information-bearing sounds (e.g., respond to an auditory warning);

Locate the spatial position of a sound source (e.g., locate the position of a car based on the sound it produces).

There is a wealth of basic knowledge about how the auditory system allows for communication based on sound, informative sound processing, and sound localization. Listeners can detect the presence of a sound; discriminate changes in frequency, level, and time; recognize different speech sounds; localize the source of a sound; and identify and recognize different sound sources.

The auditory system must often accomplish these workplace tasks when there are many sources producing sound at about the same time, so that the sound from one source may interfere with the ability to “hear” the sound from another source. The interfering sound may make it difficult to detect another sound, to discriminate among different sounds, or to identify a particular sound. A hearing loss may make it difficult to perform one or all of these tasks even in the absence of interfering sounds but especially in the presence of interfering sounds.

Sound Detection

The healthy, young auditory system can detect tones in quiet with frequencies ranging from approximately 20 to 20000 Hz. Figure 2-2 displays the standardized average thresholds for detecting tonal sounds of different frequencies when the sounds are approximately 500 milliseconds (ms) in duration. The sounds to be detected can be presented over calibrated headphones (minimal audible pressure, MAP, measures) or from a loudspeaker in a calibrated free-field environment (minimal audible field, MAF, measures). The headphones can be circumaural, that is, with a headphone cushion that fits around the pinna and the earphone speaker resting against the outside of the outer ear canal, or they can be insert earphones whose earphone loudspeaker fits within the outer ear canal. The thresholds are expressed in terms of decibels of SPL, where zero (0) dB SPL means that the sound pressure level is 20 micropascals (i.e., the referent sound pressure (p ref ) is 20 micropascals). Upper limits of hearing, indicating the maximum SPL that the auditory system can tolerate, are also indicated in Figure 2-2 . Thus, the dynamic range of hearing covers approximately 130 dB in the frequency region in which the human auditory system is most sensitive (between 500 and 4000 Hz). The thresholds for detecting a tonal sound increase as the duration of the sound to be detected decreases at durations shorter than 500 ms, but remain approximately constant as the duration increases above 500 ms.

The thresholds (in dB SPL) of detecting tones and for discomfort and pain are shown as a function of tonal frequency. The MAP thresholds for Sennheiser and TDH are thresholds for two types of circumaural headphones.

The detection of tones as characterized by the data of Figure 2-2 is the basis for the primary measure of hearing loss or impairment, the audiogram. The audiogram is a plot of the thresholds of hearing referenced to the appropriate MAP or MAF thresholds shown in the figure. Thus, a person with no hearing loss at all will have a flat audiogram at zero dB HL (dB HL means decibels of hearing level, in which the reference decibel values are the appropriate MAP or MAF dB SPL values shown in Figure 2-2 ). A person with a 40 dB hearing loss would be said to have a threshold of 40 dB HL. If the tone being detected is 500 Hz, the threshold for detecting the tone in terms of SPL would be 50 dB SPL, since according to Figure 2-2 , the threshold for detecting a 500 Hz tone is 10 dB SPL. Thus, the 40 dB hearing loss (40 dB HL) plus the 10 dB SPL threshold yields a threshold of 50 dB SPL.

In many cases, the average threshold (either in dB SPL or dB HL) for several different frequencies may be obtained to provide an estimate of overall auditory sensitivity or overall hearing loss. In this case, the threshold is referred to as a pure-tone average (PTA) threshold, in which the frequencies used for the threshold averaging are listed in abbreviated form; for example, a PTA threshold obtained at 500 Hz (.5 kHz), 1000 Hz (1 kHz), and 2000 Hz (2 kHz) would be listed as PTA 512, or sometimes PTA (512).

Many of the measurements made in hearing and the equipment used to make these measurements have been standardized by the American National Standards Institute (ANSI, see references). ANSI standards represent documents that have been reviewed by the ANSI process so that the standards represent a consensus of the best and most accurate data, method, or equipment needed to address a particular practical problem or need. Appendix B is a list of the major ANSI standards that are mentioned in this report, with descriptions of each standard. For instance, ANSI S3.6-1996 provides specifications for how audiometers, which are used by audiologists to measure the audiogram, should be built, as well as the standard thresholds of hearing used in the calculation of dB HL. A sample of an audiogram can be seen in Chapter 3 .

As the intensity of a tone increases, so does its subjective loudness. Loudness is a subjective indication of the magnitude of sound. One measure of loudness level is the phon. A phon is the subjective loudness of a test sound that is judged equally loud to a standard sound. The standard sound is a 1000 Hz tonal sound presented at some SPL.

For instance, if a test sound is judged to be equally loud to the 1000 Hz standard sound presented at 40 dB SPL, the test sound is said to have a loudness of 40 phons. A sound that has a loudness of 40 phons is usually judged to be very quiet. A standardized method for determining the loudness of complex sounds in phons has also been developed (American National Standards Institute, 2003). The perceived loudness of sound will double for about every 10 dB increase in sound level (e.g., a 60 dB SPL sound may be subjectively twice as loud as a 50 dB SPL sound). People with a hearing loss experience discomfort at about the same SPL as people without hearing loss. Because people with hearing loss have elevated thresholds but have the same upper limit of audibility as people with normal hearing, the change in loudness grows more rapidly as a function of increasing sound level above threshold for a person with a hearing loss than for a person without a hearing loss. This rapid growth of loudness is referred to as loudness recruitment, and it is experienced by almost all people with sensorineural hearing loss.

As the frequency of a sound changes, so does its subjective pitch. Pitch is the subjective attribute of sound that allows one to determine if the sound is high or low along a single perceptual dimension. The pitch of a test sound can be determined by the frequency of a tonal sound that is judged to be subjectively equal in pitch to the test sound. For instance, a test sound is said to have a pitch of 400 Hz if it is judged equal in pitch to a 400 Hz tone. In addition to being measured in hertz, pitch can also be measured using the 12-note or other musical scale.

While loudness is highly correlated with sound intensity and pitch with frequency, loudness and pitch are subjective attributes of sound that may be correlated with each of the physical attributes of sound: level, frequency, and temporal properties. So for instance, a change in sound frequency may result not only in a change in pitch, but also in a change in loudness.

The presence of another sound (masking sound) presented at the same time as a tone that is to be detected (signal tone) may increase the threshold of the signal tone above that measured in quiet. In this case, the signal tone is being masked by the other sound. Most masking occurs (i.e., thresholds are increased the most) when the masking sound contains the same frequency components as the signal tone. For instance, less masking occurs when a 300 Hz masker masks a 1000 Hz signal than when the masker and signal are both 1000 Hz. Thus, there is a region of frequencies near that of the signal frequency (a band of frequencies with the center of the band being the frequency of the signal) that are critical for masking the signal, and the width of the critical band increases as the frequency of the signal increases. For instance, for a 1000 Hz signal, as long as the masker contains frequencies between approximately 936 and 1069 Hz (a 133-Hz-wide critical band, with 1000 Hz in the geometric center of the band), the masker will be effective in masking the 1000 Hz signal. Maskers with frequencies higher than 1069 Hz or lower than 936 Hz will be less effective in masking the 1000 Hz signal. Thus, a white noise filtered so that the noise contains frequency components between 936 and 1069 Hz will be maximally effective in masking a 1000 Hz tonal signal. If the noise has a bandwidth that is narrower than the critical band, the signal is easier to detect, but if the bandwidth is wider than the critical band, then there is no change in signal detection performance.

For listeners with normal hearing, when the power of the noise in the critical band is equal to the power of the tonal signal, then the signal is usually at its masked threshold. Over a considerable range of frequency, level, and duration, and when the signal and masker occur at the same time, each decibel increase in the level of a masking sound requires approximately a decibel increase in signal level in order for the signal to remain just detectable in the presence of the masker. That is, the signal-to-noise (S/N) ratio required for signal detection remains relatively constant over a large range of frequency, overall level, and duration.

People with hearing loss often have wider critical bands than people with normal hearing, which means that the signal can be masked by sounds with frequencies farther from the signal frequency. The wider critical band obtained for people with hearing loss is usually found for signals whose frequency content is in the spectral region of their loss. This means that people with hearing loss often require a more intense sound to detect a signal masked by other sounds, especially when the signal contains frequencies that the person with a hearing loss has difficulty detecting in quiet.

The description of masking provided above applies to situations in which the masker and signal are presented at the same time. Masking can occur when the signal is turned off before the masker is turned on (backward masking) and when the masker is turned off before the signal is turned on (forward masking). Less masking occurs for forward and backward masking than for simultaneous masking. There is very little if any masking (i.e., the threshold for detecting a sound is the same as it was in quiet) if the masker and signal are separated by more than about 250 ms. Since people with hearing loss often have difficulty sorting out the temporal properties of sound, they can experience elevated forward and backward masked thresholds, compared with those measured for people with normal hearing.

Thus, a young otologically healthy person in the workplace can detect a signal sound over the frequency range of 20 to 20000 Hz, but the level of the signal sound required for detection depends on such variables as the frequency of the sound, the duration of the sound, and the nature of any other sound that may be present at or near the same time as the signal sound that may mask the signal sound. Masking means the detection threshold of a signal sound has been elevated by the presence of the masking sound. Loudness and pitch refer to subjective attributes of sound that are highly correlated with sound level and frequency, respectively. Sounds that are spectrally similar are more likely to mask each other than are sounds that are not spectrally similar. Signals are most difficult to detect when a masker and signal occur at the same time, but masking can occur when the signals and maskers do not temporally overlap. All of these measures of auditory perception can be adversely affected if a person has a hearing loss.

Sound Discrimination

Over a range of frequencies (approximately 500 to 4000 Hz) and levels (approximately 35 to 80 dB SPL) in which humans are most sensitive, listeners can discriminate a change of about one decibel in sound level and about a half of a percent change in tonal frequency. For instance, a 50 dB SPL sound can be just discriminated from a 51 dB SPL sound, and a 2000 Hz tone can be just discriminated from a 2010 Hz tone. A hearing loss can lead to elevated level and frequency difference thresholds, making it difficult for the person with a hearing loss to discern the small differences in level and frequency that often accompany changes in the speech waveform.

Long-duration sounds require a larger change in duration for duration discrimination than do shorter duration sounds, although the exact relationship between duration and duration discrimination depends on many factors. Listeners can discriminate a sound whose overall level fluctuates (the sound is amplitude modulated) from a sound whose overall level is steady over time, when the rate of amplitude fluctuation is less than about 50 cycles per second. A sound that is amplitude modulated consists of a carrier sound that has its level varied by a different function, called the modulator. Thus, the level of the carrier sound increases and decreases over time in a manner determined by the modulator.

All of these measures of sound discrimination do not change appreciably as a function of the presence of masking sounds as long as the signal sound is readily detectable. Many people with hearing loss, especially the elderly, have difficulty processing the temporal structure of sounds. These people usually have high temporal difference thresholds, and they require slow rates of amplitude fluctuation to discriminate a fluctuating sound from a steady sound. Thus, people with such losses may not be able to follow some of the rapid fluctuations in sound intensity that are present in many everyday sounds, such as speech and music.

Thus, in the workplace, very small changes in sound level, frequency, and duration can be discriminated even when some masking sounds also exist. As long as the level of a sound does not vary too rapidly, listeners in the workplace should be able to determine that the sound is fluctuating in level (in loudness). People with a hearing loss often perform less well in these auditory discrimination tasks than people with normal hearing.

Sound Identification

Almost all of the research on sound identification has involved speech sounds. The recognition or intelligibility of speech sounds has been studied for a wide range of conditions. These conditions include both alterations of the speech sounds (e.g., whether there is a masking sound present) and aspects of the requirements of the listening task (e.g., the extent to which memory is required). In many speech recognition tasks, listeners are asked to identify phonemes (e.g., vowels), words, nonsense words, or sentences. The recognition task can be open set, in which the listeners are not aware of the set of speech utterances that will be presented, or closed set, in which the speech utterances are known (i.e., come from a list of words or sentences that the listener is aware of). Masking sounds are usually white noise, speech spectrum noise, or other speech sounds.

Speech recognition or identification is usually measured in one of two ways: the percentage of utterances correctly identified or the level of some stimulus parameter (e.g., the level of a masking noise) yielding a particular percentage-correct speech identification value (e.g., 50 percent correct identification). The speech recognition threshold (SRT) is the level of the speech signal expressed in dB required for a criterion level of performance (e.g., 50 percent correct identification). The term “signal-to-noise ratio” (S/N ratio) is used for the ratio of the speech signal level to masker level (S/N ratio is usually expressed in decibels, and as such S/N ratio is the decibel difference between the level of the speech signal and the masker), when noise is used to mask the ability of listeners to recognize speech and when the levels of the speech and masker are expressed in decibels. In some tasks, another sound (e.g., a brief acoustic click) may be embedded in the speech sound and the detection of the click is used as a measure of how salient different parts of the utterance may be (e.g., if the click is not readily detected, then it may be inferred that the information temporally surrounding the click was crucial for speech processing).

Intelligibility of speech processed in quiet by listeners with normal hearing is somewhat resistant to many forms of physical alterations. Speech can be filtered (allowing only selected frequencies to be presented), speeded up or slowed down, clipped in amplitude, etc., and still be intelligible in a quiet listening environment. However, speech is susceptible to masking or interference from other competing sounds, especially other speech sounds. Several different methods have been proposed to determine the intelligibility of speech in the presence of competing sounds. The articulation index (AI, now called speech intelligibility index, SII), which was devised at Bell Laboratories for developing the telephone system in the 1930s and 1940s, is one method that is currently used (see American National Standards Institute, 2002) to estimate speech intelligibility for situations in which the physical properties (e.g., the spectrum) of the speech and interfering sounds are known. One rule of thumb for listeners with normal hearing is that for a broadband masking stimulus such as a white noise, approximately 50 percent intelligibility occurs when only the speech and noise information is provided and the overall levels of the speech words or syllables and noise are about equal (i.e., when the S/N ratio is zero dB). However, many conditions can alter the relationship between S/N ratio and performance. Listeners with hearing loss often have much more difficulty in recognizing speech that is altered, and their S/N ratio is usually greater than zero dB.

Many different speech tasks and speech utterance lists have been developed to assess the ability of listeners, especially those with hearing losses, to process speech. These tests allow one to determine more precisely how different components of speech (e.g., vowels versus consonants) are processed or the extent to which familiarity with words influences speech intelligibility. There are many variables that might make it easy or hard to recognize a speech utterance. Speech tests are usually designed to determine if only one or maybe a small number of variables affect the ability of the subject or patient to recognize speech. For instance, many speech tests are intended to determine how much difficulty a person with a high-frequency hearing loss might have in recognizing speech. If the speech test consists of words that the patient is not familiar with, then poor performance on the test might indicate a difficulty with vocabulary rather than a hearing loss. Using test words in a language in which the patient is not fluent could also confound the assessment of hearing loss. Thus, many different speech recognition tests have been developed for the purpose of assessing hearing loss, to help ensure that the results are valid indicators of the relationship between speech recognition and hearing loss. Additional description of several speech intelligibility tests is provided in Chapters 3 and 7 .

Processing speech in the workplace can be compromised when competing sounds are present. Sound reproduction systems do not have to be high fidelity to provide for acceptable speech intelligibility in the absence of competing sounds for people with normal hearing, but for people with hearing loss, such high fidelity may be essential for speech communication. However, the higher the fidelity of the reproduction system, the better speech recognition is likely to be when interfering sound sources are present. Hearing loss can lead to a significant loss of speech recognition even with high-quality amplification systems.

Sound Localization

Sound itself has no spatial dimensions, but the source of a sound can be located in three spatial dimensions as a function of the auditory system's ability to process the sound emanating from a sound source. These dimensions are azimuth—the direction from the listener in the horizontal plane (see Figure 2-3 ); elevation—the vertical or up-down dimension; and range—distance or the near-far dimension. A different set of cues is used by the auditory system to locate sound sources in each spatial dimension. Sounds from sources located off-center in the azimuth direction arrive at one ear before they arrive at the other ear, and the sound at the near ear is more intense than the sound at the far ear. Thus, interaural differences of time and level are the two cues used for azimuthal (directional) sound localization; interaural time is the major cue for locating low-frequency (below 1500 Hz) sound sources, and interaural level is the main cue at high frequencies. The interaural level difference results from the fact that the head and body provide an acoustic “shadow” for the ear farther away from the sound source. This “head shadow” produces large interaural level differences when the sound is opposite one ear and is high frequency. Human listeners can discriminate a change in sound source location of about 1-3° angle.

Azimuth: Overhead view of the listener.

As sound travels from its source to the outer ears of a listener, it passes over and around (is diffracted by) many parts of the body, especially the pinna. These body parts attenuate and slow down the sound wave in a manner that is specific to the frequency of the sound and to the relationship between the location of the sound source and the body, especially the relative vertical location of the source. The head-related transfer function (HRTF) describes the spectral changes that a sound undergoes between the sound source and the outer ear canal. High-frequency sounds are attenuated in a frequency-specific manner that is dependent on the vertical location of the sound source relative to the body. That is, different HRTFs are produced for different vertical sound source locations. In particular, there are spectral regions of low amplitude (spectral notches or valleys) whose spectral loci are vertical-location-specific. Thus, these spectral notches in the HRTF can be a cue for vertical location. The spectral cues associated with the HRTF are probably also used to help discriminate sounds that come from in front of a listener from those that come from behind. For instance, a sound coming from directly in front of a listener will provide the same interaural time and level differences as a sound coming from directly behind. Spectral cues derived from the HRTF can assist in reducing front-back localization errors.

Faraway sounds are usually softer than near sounds, and this loudness cue can be used to determine the distance of a sound source, assuming the listener has some knowledge about the nature of the source (i.e., some knowledge about how intense the sound is at the source). If there is any reflective surface (e.g., the ground), then the reflection from a near sound source is almost as intense as the sound that arrives at the ears directly from the source, whereas for a faraway sound the reflected to direct sound level ratio is lower. Thus, the ratio of reflected to direct sound level can be a cue for sound source distance perception, and distance perception is poorer in conditions in which there are no reflections.

Locating sound sources can be more difficult for people with hearing loss. This is especially true for listeners with unilateral hearing loss. If a single hearing aid or cochlear prosthesis is used, it may provide only limited assistance for sound localization, since binaural processing is required to locate sounds in the horizontal plane. However, fitting each ear with a hearing aid or cochlear prosthesis does not always assist the patient in sound localization. In most cases, the two aids or prostheses do not preserve all of the acoustic information required by the auditory system to localize a sound source.

In reverberant spaces, such as a room, the sound waveform reflects off the many surfaces, resulting in a complex pattern of sound arriving at the ears of a listener. Listeners are usually not confused about the nature of the actual sound source, including its location, in many reverberant spaces, presumably because the auditory system processes the first sound arriving at the ears and inhibits the information from later-arriving reflected sounds. Since the sound from the source will arrive at the listener before that from any longer-path reflection, auditory processing of the direct sound takes precedence over that of the reflected sound, usually allowing for accurate sound processing even in fairly reverberant environments. Another aspect of sound reflections is that the sound in a reflective space remains in the space after the sound production ends, due to the sound continuing to reflect off the many surfaces. The reverberation time is the time (measured in seconds) that it takes the level of this reverberant or reflected sound to decay by a specified number of decibels, which is usually 60 dB. Rooms that are large and reflective have long reverberation times. People with hearing losses often perform very poorly in reverberant spaces, and the poor performance may persist even when they use a hearing aid or cochlear prosthesis. That is, people with hearing loss have difficulty recognizing speech signals when the reverberation time is long, especially if the acoustic environment is also noisy.

The detection of a signal sound source at one spatial location in the presence of a masking sound source at another spatial location is improved when the signal and masking sound sources are further apart. That is, the ability to detect a masked signal can be enhanced if the masking sound source is spatially separated from the signal sound source. The improvement in detection threshold as a function of spatial separation is referred to as the spatial masking-level difference. Thus, a variable that could affect speech recognition is the spatial separation of the test signal and other sound sources in the listening environment. Patients fitted with two hearing aids can sometimes take advantage of detecting sounds based on their spatial separation, whereas this becomes more difficult if the patient only uses one hearing aid.

Listening systems that make full use of the spectral information contained in HRTFs of individual listeners can produce sound over headphones that provides a percept as if the sound was emanating from an actual sound source located at some point in space (e.g., in a room). Systems that use HRTF technology can produce a virtual auditory environment for headphone-delivered sounds. Such HRTF-based systems can be used for testing and experimentation, eliminating the need to have specialized calibrated rooms for presenting sounds from different locations.

Thus, in the workplace, listeners can determine the location of sound sources located in all three spatial dimensions. The ability to detect a signal source can be improved if potential masking sound sources are spatially separated from the signal sound source. Having a hearing loss can compromise a person's ability to locate sounds, and hearing aids may not assist him or her in locating sound sources.

Sound Source Determination

Colin Cherry (1953) pointed out that even at a noisy cocktail party, the human listener is remarkably good at determining many of the sources of sounds (different people speaking or singing, clanging glasses, music from a stereo loudspeaker, a slammed door, etc.), even when most of the sounds from these sources are occurring at approximately the same time. Bregman (1990) referred to this cocktail party effect as “auditory scene analysis.” Since the sounds from many simultaneously presented sound sources arrive at the ears of a listener as a single sound field, it is the auditory system that must determine the various sound sources—that is, determine the auditory scene. Little is known about how the auditory system accomplishes the task of auditory scene analysis, but several potential cues and neural processing strategies have been suggested as ways in which the sources of many sounds can be processed and segregated in a complex, multisource acoustic environment. People with hearing loss often remark that they have problems in noisy situations, such as at a cocktail party, implying that they are not able to determine the auditory scene as well as people without hearing loss.

Thus, listeners with normal hearing can use many potential cues to determine many of the sources of sounds in the workplace, even when the sounds from the sources overlap in time and perhaps in space.

• CAUSES OF HEARING LOSS

In general, hearing loss can be caused by heredity (genetics), aging (presbycusis), loud sound exposure, diseases and infections, trauma (accidents), or ototoxic drugs (drugs and chemicals that are poisonous to auditory structures). Hearing loss can categorized into the following ranges based on PTAs (PTA 512):

• slight (16-25 dB hearing loss)
• mild (26-40 dB hearing loss)
• moderate (41-55 dB hearing loss)
• moderately severe (56-70 dB hearing loss)
• severe (71-90 dB hearing loss)
• profound (greater than 90 dB hearing loss)

The loss can be caused by damage to any part of the auditory pathway. Three major types of hearing loss have been defined: conductive, sensorineural, and mixed. Conductive hearing loss refers to damage to the conductive system of the ear—that is, the ear canal, tympanic membrane (eardrum), and ossicles (middle ear bones)—and can include fluid filling the middle ear space. Sensorineural hearing loss indicates a problem in the inner ear, auditory nerve, or higher auditory centers in the brainstem and temporal lobe. Mixed hearing loss designates that the hearing loss has both a conductive and sensorineural component. Treatments for hearing loss involve surgery, hearing aids of various types, cochlear prostheses, medication, and various forms of habilitation and rehabilitation.

Conductive Hearing Loss

If a problem arises in the external or middle ear, a conductive hearing loss occurs that is largely due to the outer and middle ear's no longer being able to overcome the loss in sound transmission from the outer to the inner ear. Many conductive hearing losses, due to such causes as a perforation in the tympanic membrane, loss of ossicular continuity, or increased stiffness of the ossicular chain, can be repaired surgically, restoring the conductive hearing loss. During an acute ear infection, fluid can accumulate in the middle ear, resulting in a temporary conductive hearing loss. If the ear develops chronic otorrhea (drainage of purulent fluid), an infected skin cyst (cholesteatoma) may be the cause. A conductive hearing loss without ear pain is the usual course of this disease, but medical attention must be sought to prevent extensive damage to the ossicles and inner ear. Such conductive losses can produce up to a 60 dB hearing loss.

Sensorineural Hearing Loss

Sensorineural hearing loss is caused by problems associated with the neural transduction of sound. Diseases and disorders that damage the cochlea and auditory nerve result in a sensorineural hearing loss. In the past, sensorineural hearing loss was referred to as “nerve deafness”; however, in most instances of sensorineural hearing loss, the auditory nerve is intact and an impairment in the hair cells within the inner ear results in the hearing loss. Loss of hair cells and the neurotrophic factors that they produce eventually lead to nerve cell loss. Because the hair cells and auditory nerve complex relay information in a frequency-specific manner to the brainstem and brain, loss of hair cells in a particular part of the cochlea will cause hearing loss in a particular frequency region. Hair cell damage at the base of the cochlea near the stapes causes high-frequency hearing loss, while hair cell loss away from the base (near the apex) leads to low-frequency hearing loss. Sensorineural hearing losses due to cochlear damage can occur at any frequency and can range from mild to profound.

Presbycusis and noise exposure are the most common causes of adult hearing loss. Both result in an initial high-frequency sensorineural deficit, caused by damage to hair cells at the base of the cochlea. In presbycusis, other cells in the inner ear are also affected in many cases; these include the nerve cells that innervate the hair cells and cells in the structure known as the stria vascularis. In individuals with these conditions, other parts of the inner ear still function, allowing for the normal perception of low-frequency sounds. The primary difficulty for such a person lies in an inability to distinguish high-frequency sounds, such as the consonants of speech that are crucial for human communication. As the conditions progress, middle- and low-frequency hearing can also deteriorate. Traditional acoustic amplification (hearing aids) is often ineffective at making speech sounds understandable to individuals with high-frequency hearing loss when the loss becomes severe (Ching, Dillon, and Byrne, 1998; Hogan and Turner, 1998). In individuals who have profound sensorineural hearing loss across the frequency range, hearing aids may not be as effective in improving hearing as a cochlear implant. Infections (viral or bacterial), disorders such as Meniere's disease and autoimmune inner ear disease, hereditary disorders, trauma, and ototoxic drugs are other causes of sensorineural hearing loss.

Acoustic trauma can be a significant problem in the workplace. If the level of sound is intense, especially if the sound lasts for a long time, listeners exposed to such intense sounds may experience either a temporary or a permanent threshold shift—that is, their threshold for detecting sound is either temporarily or permanently elevated above that measured in quiet and before the exposure. A temporary threshold shift (TTS) can recover to normal detection threshold after a few minutes to a few days, depending on the parameters of the exposing sound and their relationship to those of the sound to be detected. Permanent threshold shifts (PTS) never recover and therefore indicate a permanent hearing loss that can range from mild to severe.

There is a trade-off between sound level and duration in terms of producing TTS and PTS. The greater the level or the longer the duration of the exposing sound, the greater the threshold shift and the longer it takes to recover from TTS. Most TTS occurs at frequencies the same or slightly higher than the frequency of the exposing sound. The Occupational Safety and Health Administration (OSHA) and the National Institute of Occupational Safety and Health provide regulations and guidance (e.g., Occupational Safety and Health Administration, 2002) for occupational noise exposure to mitigate its effects in the workplace.

Etiology of Severe to Profound Hearing Loss

It is estimated that 1 person in 1,000 has a severe to profound hearing loss. The number with bilateral (both ears) profound deafness is lower. Loss of hearing has a significant impact on the development of speech and spoken language skills, which are dependent on the age of onset of deafness. Children born with bilateral profound hearing loss or who acquire profound loss before the acquisition of speech and spoken language (approximately age 2 years) are identified as prelingually deafened. Children and adults deafened at any age after developing speech and spoken language are referred to as postlingually deafened.

High-risk factors for congenital hearing loss include a family history of congenital hearing loss or delayed-onset sensory hearing loss of childhood, physical findings (birthweight less than 1,500 grams, craniofacial anomalies, the variable physical signs of Waardenburg's syndrome), and maternal prenatal infections (cytomegalovirus, syphilis, rubella, herpes).

Prelingual deafness can also arise from severe vital function depression at birth when Apgar scores are in the 0 to 3 range at five minutes. Hyperbilirubinemia severe enough to require exchange transfusion; treatment of postnatal infection with ototoxic drugs, such as gentamicin, tobramycin, kanamycin, and streptomycin; systemic infections including meningitis, congenital syphilis, mumps, and measles all can result in bilateral profound deafness. Closed head trauma and neurodegenerative diseases including Tay-Sachs disease, neurofibromatosis, Gaucher's disease, Niemann-Pick disease, and myoclonic epilepsy are rare additional etiologies of deafness that manifest themselves in childhood.

Genetic causes for prelingual and postlingual deafness are thought to account for 50 percent of the sensorineural hearing loss in childhood. The remainder are either environmental (about 25 percent) or sporadic idiopathic (about 25 percent). Genetic hearing loss can be congenital or delayed, progressive or stable, unilateral or bilateral, syndromic or nonsyndromic. The majority of genetic hearing losses are thought to be recessive (about 75 percent); 20 percent are attributable to dominant genes and a small percentage are X-linked disorders. Autosomal dominant disorders include Waardenburg's syndrome (20 percent associated with hearing loss); Stickler's syndrome (sensorineural or mixed hearing loss, 15 percent); branchiootorenal syndrome; Treacher Collins syndrome (sensorineural or mixed hearing loss); neurofibromatosis II; and dominant progressive hearing loss. Autosomal recessive disorders associated with sensorineural hearing loss are Pendred's syndrome, Usher syndrome, and Jervell and Lange-Nielsen syndrome. Sex-linked syndromes associated with sensorineural hearing loss are Norie's syndrome, otopalatodigital syndrome, Wildervaank's syndrome, and Alport's syndrome. Most hereditary hearing loss in early childhood is “nonsyndromic,” that is, there are no other apparent abnormalities. While mutations in any of dozens of genes can cause hearing loss, a gene that controls the production of a protein called connexin 26 is responsible for a large proportion of such cases, with studies on various populations reporting differing prevalences (Dahl et al., 2001; Erbe, Harris, Runge-Samuelson, Flanary, and Wackym, 2004; Gurtler et al., 2003; Nance, 2003).

Recently a condition termed “auditory neuropathy” (Starr, Picton, Sininger, Hood, and Berlin, 1996) has been identified in individuals with severe to profound hearing loss. Patients with this condition typically show severely distorted or absent auditory brainstem response (explained in Chapter 3 ) with recordings showing prominent cochlear microphonic (CM) components, and normal otoacoustic emissions. The otoacoustic emissions and CM findings in patients with auditory neuropathy usually indicate that the cochlear hair cells, at least the outer hair cells, are functioning normally while the abnormal auditory brainstem response is indicative of disease in the inner hair cells, auditory nerve, or brainstem. Some theorize that the disorder is a specific neuropathy of the auditory nerve; thus the name of the disorder (Starr et al., 1996; Starr, Picton, and Kim, 2001). Starr et al. (2001) have found indirect evidence of peripheral nerve involvement based on sural nerve biopsy or nerve conduction velocity measures. More recently, they have documented specific neuropathy of the auditory nerve in a patient with well-documented clinical signs of auditory neuropathy on audiological tests (Starr et al., 2003). Such histological findings (fair to good hair cell populations along with poor ganglion cell and nerve fiber survival) have been reported previously (Hallpike, Harriman, and Wells, 1980; Merchant et al., 2001; Spoendlin, 1974; see Nadol, 2001, for a review of these pathologies in humans). However, others suggest that there is a “general lack of anatomic foundation for the label” (Rapin and Gravel, 2003, p. 707) because of difficulty in documenting specific peripheral neuropathy in patients, especially at the level of the auditory nerve.

When auditory neuropathy exists , neither the auditory brainstem response nor the otoacoustic emissions can be used to determine the degree of hearing loss. The degree of hearing loss in patients with this condition can be anywhere from none to profound (Sininger and Oba, 2001). The hearing loss of patients with auditory neuropathy can fluctuate dramatically and rapidly, sometimes within a single day (Sininger and Oba, 2001). In rare cases, increases in core temperature from fever can bring on severe to profound hearing loss that will return to prefever levels as the condition resolves (Starr et al., 1998). Recent publications report that cochlear implants have been effective in individuals displaying signs of auditory neuropathy (Peterson et al., 2003; Shallop, Peterson, Facer, Fabry, and Driscoll, 2001). This finding could be due to electrical synchronization of the neural response, or it may suggest that the etiology of profound deafness could be located in the inner hair cells.

An excellent review of sensorineural hearing loss in children can be found in a chapter by Brookhouser (1993).

Although many diseases and disorders can induce hearing loss, relatively few result in profound sensorineural deafness. Infections, immunemediated disorders, trauma, idiopathic and hereditary disorders, and ototoxic agents are the most common etiologies of bilateral profound hearing loss in adults.

The most common infections associated with profound hearing loss are bacterial and viral meningitis. Neural syphilis can produce progressive bilateral fluctuating hearing loss and spells of vertigo. If not treated with long-term antibiotics and steroids, profound hearing loss can occur. Even with treatment, some individuals continue to lose hearing.

Idiopathic disorders of cochlear otosclerosis and Meniere's disease can produce profound bilateral hearing loss infrequently. Immune-mediated bilateral sensorineural hearing loss has recently been recognized as a cause of profound deafness. A history of rapid progressive hearing loss in both ears over weeks to months is the hallmark of this disease (McCabe, 1979). Fluctuation of hearing and spells of vertigo may occur. Other autoimmune disorders, such as Cogan's syndrome, Wegener's granulomatosis, and systemic lupus, also can result in profound hearing loss.

Aminoglycoside antibiotics have long been associated with ototoxicity. These drugs concentrate in perilymph and have a longer half-life in this fluid than in blood. In renal failure their levels are elevated. Aminoglycosides are directly toxic to outer hair cells, but they can also affect ganglion cells. Ototoxicity has been observed within the “safe” limits of nephrotoxicity. The effects can be observed even after discontinuing the drug. The agents associated with the highest degree of toxicity of the inner ear include kanamycin, tobramycin, amikacin, neomycin, and dihydrostreptimycin. (Some families may have a genetic disposition to developing deafness with these drugs.) The only treatment is to discontinue the drug. Antimetabolites such as Cisplatin and nitrogen mustard are also ototoxic. The risk to hearing is related to the amount of a given dose rather than cumulative amount.

• TINNITUS AND HYPERACUSIS

Ear disorders cause many different symptoms, including hearing loss, tinnitus, pain, otorrhea (ear drainage), facial nerve paralysis, vertigo, and disequilibrium. Most of these symptoms are only tangentially relevant to the work of the committee, which is limited to the effects of hearing loss. In contrast, tinnitus and a related symptom, hyperacusis, may be considered by some to be “hearing impairments,” although neither tinnitus nor hyperacusis is mentioned in the current SSA regulations covering hearing impairment. We therefore offer a brief discussion in this section, concluding that most people with tinnitus or hyperacusis are not disabled (as that term is defined by SSA) and that the tests audiologists and otolaryngologists use to detect and measure abnormal function of the ear cannot separate people with tinnitus or hyperacusis who are disabled from those who are not disabled. For these reasons, these symptoms are not discussed in detail in later chapters, and we make no recommendations for procedures SSA might use in evaluating claims for disability based on tinnitus or hyperacusis. More extensive discussions are available in books edited by Tyler (2000) and Snow (2004), and in an earlier NRC report (National Research Council, 1982).

Tinnitus is a sensation that often is associated with suffering, which may occasionally be severe enough to preclude work. Sensation and suffering are separate aspects of tinnitus and should not be confused.

Tinnitus sensation is the perception of sound when there is no external acoustic stimulus, and it can be either objective or subjective. Objective tinnitus occurs in rare cases when there is an internal acoustic stimulus. For example, turbulent blood flow in an artery close to the ear can make a pulsing sound that is audible not only to the person whose ear is affected, but also to a physician applying a stethoscope to the patient's head. Subjective tinnitus almost always occurs when there is no acoustic stimulus at all, and only one person can hear the sound. People with subjective tinnitus typically describe their sensations as ringing, buzzing, humming, whistling, or hissing sounds. Most people with tinnitus also have hearing loss that is measurable by audiometry; however, many people with hearing loss do not have tinnitus, and no objective audiological or medical test has been shown to predict whether a person with hearing loss will have subjective tinnitus. In other words, the ears of people with hearing loss and subjective tinnitus are not different, as far as we know, from the ears of people with hearing loss alone.

When asked to match their tinnitus sensations to tones presented from an audiometer, most people select tones that are close to the frequencies they have difficulty hearing. The intensity of an external tone matched in loudness to a person's tinnitus is usually less than 10 dB above that person's threshold for the tone. Although there is no objective test that can demonstrate whether a person has tinnitus or not, tinnitus matching results that are repeatable and consistent with the patterns described above can sometimes offer evidence that corroborates a person's claim to have tinnitus. However, tinnitus matching tests are not well standardized or widely used. Most importantly, they can at best describe tinnitus sensation and say nothing about tinnitus suffering.

The distribution of tinnitus suffering can be described as a pyramid. At its broad base are the majority of people with tinnitus, who find that it does not interfere significantly with their daily lives and never seek medical attention. The next level includes those who visit a physician, but only to find out whether their tinnitus is a sign of some serious medical problem. A smaller group of people with tinnitus complain of substantial difficulty with activities of daily life, especially sleep disturbance, trouble concentrating, emotional problems (anxiety, depression, etc.), and trouble understanding speech (Tyler and Baker, 1983). Since most people with tinnitus also have audiometrically measurable hearing loss, it is difficult to know whether tinnitus per se interferes with speech understanding. As stated by Stouffer and Tyler (1990), “it seems likely that patients confuse the effects of tinnitus on speech understanding with the effects of hearing loss on speech understanding.” At the narrow top of the pyramid are a very few persons who are severely disabled; cases of suicide have been reported, but almost exclusively in people who have many other risk factors for suicide, such as male sex, advanced age, social isolation, and especially depression (Lewis, Stephens, and McKenna, 1994).

Tinnitus sensation (as measured in the audiology booth using matching tests) and tinnitus suffering (as assessed by self-report) are uncorrelated (Baskill and Coles, 1999). Tinnitus sufferers differ from nonsufferers not in the pitch or loudness of the sounds they hear, but in the nature of their reaction, coping, and adjustment to tinnitus sensations. Patients who go to specialized tinnitus treatment clinics are very frequently found to meet formal psychiatric criteria for diagnosis of major depressive disorder, and about half of these have a history of major depression or anxiety disorder prior to the onset of tinnitus (Sullivan et al., 1988; Zoger, Svedlund, and Holgers, 2002).

Audiologists and otolaryngologists can provide useful information regarding the existence, perceptual qualities, and causation of tinnitus, but a person's claim to be disabled by tinnitus might best be supported by psychiatric or psychological evidence, as well as by corroborative reports of employers, coworkers, family, and others; audiologists and otolaryngologists cannot provide objective evidence to support or refute such a claim. We note in passing that the American Medical Association's Guides to the Evaluation of Permanent Impairment (American Medical Association, 2001) permit physicians to add up to 5 percent to a person's “binaural hearing impairment” score if that person has tinnitus that interferes with activities of daily living. This could increase a person's “whole person impairment” by no more than 2 percent, unless that person also had impairments in other domains (such as the “mental and behavioral” domain).

Most people with tinnitus do not choose to be treated, in large part because no treatment has been demonstrated to permanently eliminate tinnitus sensation (Dobie, 1999). Masking therapy (the covering up of tinnitus with external sound) can temporarily reduce or eliminate tinnitus sensation while the masking noise is present. Tinnitus suffering is frequently addressed through psychological counseling and antidepressant or antianxiety drugs (Snow, 2004).

Hyperacusis

The word “hyperacusis” has sometimes been used to refer to “an exceptionally acute sense of hearing” (Dorland, 1974), but it is doubtful that there are actually people who hear so well that their thresholds are distinctly separate from, and better than, the normal distribution of hearing thresholds in young healthy adults. More commonly, clinicians use the term to refer to a relatively rare condition of abnormal intolerance of even moderately loud sounds, such as conversation, traffic, and music (the terms “hyperacusis” and “phonophobia” are often used interchangeably), usually accompanied by avoidance behavior (e.g., wearing earplugs at all times, staying at home, severing social relationships). People who complain of intolerance to everyday sounds usually have bother-some tinnitus as well, but they represent less than 1 percent of tinnitus patients at one national center (Vernon and Meikle, 2000). There is no widely used criterion for the diagnosis of hyperacusis, although some clinicians have used “loudness discomfort levels” (LDLs) for this purpose. People with normal hearing, and most people with hearing loss, report that they can tolerate tones up to 90-105 dB HL in the audiometry booth, while most patients who complain of severe sound intolerance have LDLs below 85 dB HL (Hazell, Sheldrake, and Graham, 2002). Most of these patients have required treatment for psychological problems prior to the onset of hyperacusis (Hazell and Sheldrake, 1991). Treatment of hyperacusis has usually consisted of desensitization to gradually increasing sound levels or treatment of underlying psychiatric disorders.

No objective audiological or medical test can distinguish people who complain of hyperacusis from other people. It is far from clear that hyperacusis should even be considered an ear disorder. As in the case of tinnitus, the best evidence supporting or refuting claims of disability based on hyperacusis is likely to come from psychiatrists and psychologists and from lay persons who can corroborate the claimed disability.

Adults and children depend on hearing for their ability to function in work, school, and other daily activities, to be able to communicate using speech, and to better process information about objects in their environments. Using hearing to function in the world means detecting, discriminating, localizing, and identifying sound produced by the many sound sources that constantly surround one. There are many causes of damage to the auditory system that result in a hearing loss that reduces one's ability to detect, discriminate, localize, or identify sound. These losses can adversely effect an adult's ability to work and a child's ability to process sound.

Most of the description of sound, the auditory system, and auditory perception is derived from Yost (2000).

• Cite this Page National Research Council (US) Committee on Disability Determination for Individuals with Hearing Impairments; Dobie RA, Van Hemel S, editors. Hearing Loss: Determining Eligibility for Social Security Benefits. Washington (DC): National Academies Press (US); 2004. 2, Basics of Sound, the Ear, and Hearing.
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8 Tips to Prevent Hearing Loss at Work 

It’s a well-known fact that exposure to loud noises can permanently affect your hearing. While there are many ways to control the amount of noise we are exposed to in our daily lives, many people are faced with exposure to loud noises as a result of their job. In fact, the Center for Disease Control (CDC) estimates that over 22 million workers are exposed to potentially damaging levels of noise at work each year . Whether you work around large machinery, firearms, or even loud music—knowing how to prevent hearing loss at work is important to maintaining your health and wellbeing.   

If your job exposes you to loud noise levels, you might be wondering, “How do I protect my hearing at work?” We understand your concern and want to help. In this article, you’ll learn eight methods for preventing hearing loss in the workplace.  

What is Noise Induced Hearing Loss? 

Noise Induced Hearing Loss (NIHL) is caused by unprotected exposure to loud noise. Without proper preventative measures, your risk of hearing loss increases the longer you are exposed to loud noises. And the louder a sound is, the less time it takes to damage your hearing permanently. NIHL can be caused by a single loud event, or by exposure to loud noises for prolonged periods of time.  

If you have noticed any of these symptoms, you may be affected by NIHL:  

• Difficulty understanding conversations in loud or crowded environments    
• Missing words and saying “what?” often   
• Trouble hearing on the phone   
• Needing higher volume on tv, stereo, etc. than others   
• Having to concentrate harder to hear others   
• Mishearing parts of words   
• Not hearing sounds that others near you report hearing 

Occupations With Dangerous Noise Levels 

When thinking about loud work environments, a few occupations likely come to mind immediately, like musicians or construction workers. When you consider that it’s a combination of volume and duration, however, some jobs with potentially damaging noise levels may surprise you.  

Some workers who are at a high risk for NIHL include:  

• Miners 
• Construction, site prep, and demolition workers 
• Manufacturing workers  
• Airport ground crews 
• Metal and iron workers 
• Musicians, stage and sound crews 
• Racecar drivers and pit crews 
• Landscapers 
• First responders 
• Equipment operators (farms, warehouses, hydro-electric dams, etc.)  
• Road, bridge and tunnel builders 
• Shipyard and railway workers 
• Traders on stock exchange floor 

It’s important to note that in addition to loud noises, certain workplace environments can also amplify sounds and contribute to noise-induced hearing loss. This can be particularly prevalent in environments with brick or tiled walls and a high volume of constant noise, such as: 

• Retail stores 
• Restaurants 
• Arcades 
• Nightclubs 
• Casinos 
• Schools 
• Daycares 

The continuous drone of loud voices in these settings can take a toll on your ears, leading to sound fatigue and potentially causing harm to your hearing. 

Prevent Hearing Loss at Work with Smart Habits 

Many people work in loud environments. Whether the dangerous noise levels are coming from machinery, construction equipment, or alarms sounding, personal habits can reduce the effects of these noises on your hearing health.    

Wear Ear Protection 

Most work environments with high noise levels should provide ear protection. Businesses that routinely have dangerous noise levels are required by the Occupational Safety and Health Administration (OSHA) to provide their workers with ear protection. ( More on that here. ) 

Make sure to use well-fitting headphones or earplugs whenever you find yourself working around loud noises. 

Different types of sound exposure require different types of protection. While those one-size-fits-all disposable ear plugs may be easy to come by, they may provide insufficient protection, especially if they are not properly inserted in the ear. Using custom-made earplugs, which have been molded to each of your ears will provide the best protection from loud noise exposure in the workplace. Certain styles can address specific sound ranges, and some are even electronic, offering a hearing assist and blocking noise all with one effective and comfortable device.  

Noise-cancelling headphones also vary widely in quality and effectiveness. It’s important to read all of the product information before purchasing ear-protecting headphones, to ensure they have the level of protection necessary for your particular type of exposure.  

Limit Exposure to Noise 

Giving your ears a rest from the constant onslaught of dangerous noise levels can go a long way toward lowering your risk of hearing loss while on the job. This is especially important when dealing with hours-long exposure, which is common in many fields of work. Stepping outside or moving to a quieter area can give your ears the opportunity to recoup.  

In addition, if you have a variety of projects at home or at work that involve loud noises, break them up as much as you can, by building in quieter activities to limit the duration of your exposure.  

Cancel Noise Rather than Compete with It 

When working around loud noises, you might be tempted to drown it out by listening to your favorite music with earbuds or headphones. However, this can be even more problematic as the high volume necessary to overcome the external noise may end up causing additional damage to your hearing. To avoid this, it’s best to use noise-cancelling headphones or earplugs rather than trying to compete with the noise. This will effectively reduce the noise without sacrificing the health of your hearing.  

Keep the Volume Down  

When it comes to listening to music with headphones or earbuds, or using any kind of earpiece walkie-talkies or headset at work, volume levels can’t be stressed enough. If the people near you can hear your audio, while you’re using a personal listening device, it’s too loud. Before putting your headphones on or earbuds in, adjust the volume so that it’s too low, then slowly turn it up until you reach a comfortable and safe listening level.  

If you’re finding it hard to hear your personal devices at a safe volume, instead of turning the volume up, it’s best to either listen later, or speak with your employer to find a safe and effective solution.   

Get Annual Hearing Exams to Screen for NIHL and Monitor Overall Hearing Health 

Having a baseline to determine your level of hearing loss is important. If you work around loud noises, get your hearing tested by a hearing health professional before or at the first onset of possible NIHL symptoms, such as ringing in your ears, or sounds seeming muffled or dull.

The earlier NIHL is diagnosed, the sooner you can take the steps necessary to prevent further irreversible hearing loss. In addition, your doctor will also be able to screen for other types of hearing loss to keep your hearing health on track. 

Make Changes to Your Environment

In addition to the personal habits that you can put into place to protect your hearing, there are many ways you and your employer can maintain safe noise levels in the work environment. This two-pronged approach gives you the ultimate protection from hearing loss.  

Report Malfunctioning Machines  

Well-oiled, properly maintained equipment and machinery will tend to run more quietly. Reporting unusual noises will help ensure essential equipment remains in good working order, which will help it last longer, and reduce the risk of NIHL for you and your coworkers.  

Use Noise Barriers and Sound Baffles 

If it’s not practical to put distance between you and the source of the loud noise, you can block or deaden the sound with barriers and sound baffles. These measures don’t negate the need for wearing ear protection, but they will create added protection for prolonged exposure to potentially harmful noise levels.  

Know OSHA Noise Standards 

Employers have a responsibility to ensure that you have a safe work environment . OSHA outlines safety requirements with which employers must comply. It’s a good idea to understand the occupational noise requirements and how noise levels are measured , so that you know that your workplace is in compliance and safe. There may be additional noise safety measures to which you and your fellow employees are entitled. Many times, just politely letting your employer know you are aware of the codes and your rights will convince them to comply. However, if your employer does not make the necessary adjustments to maintain a healthy and safe workplace, you can file a complaint with the US Department of Labor.  

Trust Your Hearing Health to Audibel and Embrace the Joy of Hearing 

NIHL cannot be reversed, but it can be prevented and treated. The sooner you catch it, the sooner you can regain access to all the nuances in the music you love, the tender, whispered words of a loved one, and the critical conversations—or all the conversations—with your colleagues or friends.  

At Audibel, we focus on one thing—Hearing Health. Our hearing healthcare providers will assess your current hearing level, provide a tailored solution for any hearing loss, and continue to monitor your hearing health with regular exams. We encourage you to take proactive steps to preserve your hearing by meeting with one of our hearing healthcare providers at any of our clinics conveniently located throughout the United States. Don’t wait until it’s too late—act now to protect your hearing for years to come. 

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