When The City is Too Loud, How Can We Protect Hearing?

In October, Forbes Health published a ranking1 of U.S. cities according to how much risk they posed to hearing health. The ranking was based on the density of noise-producing establishments in each metro such as bars, restaurants, transportation hubs, construction sites, and sports events. Of the 100 metropolitan areas examined, the Riverside-San Bernardino-Ontario metro in California came out with the most risk, due in large part to its high density of nightclubs, mining sites, and concert venues.www.shutterstock.com.The ranking spotlights the long-standing caution of hearing health advocates that noise in communities adversely impacts the public’s hearing health. What are local governments and health professionals doing about it? DO BUSIER CITIES MEAN GREATER HEARING LOSS RISK? For Daniel Fink, MD, founder and chair of The Quiet Coalition, counting the noise-producing sites in a city is not a measure of hearing loss risk. “Just because these places exist in one city or another is irrelevant. For example, we don’t go to casinos. We don’t work in manufacturing. We don’t go to amusement parks. So the Forbes list has no meaning for me, or really for any one individual living anywhere.” Fink explained that each person has an individual noise exposure regardless of what kind of establishments are in their town. For example, factors like work, commute, and even podcast listening habits are different from person to person. He does acknowledge that while risk can’t be quantified just by counting noisy venues, city noise can damage hearing. “The issue of urban noise causing hearing loss IS an important issue,” Fink stressed. New York City noise expert Arline Bronzaft, PhD, agrees. “Hearing loss is a physiological disorder. It could happen on one occasion… One loud sound can actually cause harm to our hearing. But in a city, it’s many loud sounds. The cumulative effect over years can impede some of your hearing.” Samantha Evans, AuD, senior audiologist at University Hospitals in Cleveland, added that common noises in cities contribute to hearing loss. “Think of the constituents of cities and then think of their recreation and occupations. In Cleveland, we have a large steel mill industry; in Charlotte, N.C., there is a large textile industry. The noise in those industries have brought many people in for hearing evaluations due to difficulty hearing in conversations or in noisy environments. I have evaluated an individual who attended a concert in small night club and stood with their left ear to a speaker. He came into my office reporting his left ear felt full and he had a ringing/buzzing sound in his ear (tinnitus). He was diagnosed with a permanent hearing loss in that ear. It only took one night, one concert, for his hearing levels to decrease.” ARE NOISE LEVELS IN CITIES SAFE FOR THE PUBLIC? According to the American Speech-Language-Hearing Association (ASHA)2, three factors create risk of noise-induced hearing loss: the loudness of the noise, how close it is to the individual, and for how long the individual is exposed to it. Safe noise exposure levels are debated across the hearing health care industry, but the ASHA states that hearing loss can result if an individual is exposed to sounds at 85 dBA for over 8 hours at a time. Noise at this decibel is generally akin to that from lawn mowers, busy restaurants, or heavy vehicle traffic. The association also states that noise at 120 dBA upwards—such as from sirens and jackhammers—is not safe for any length of time. Fink believes that safe levels should be even lower. He has been looking at various noise guidelines and found that commonly accepted U.S. calculations have to be revised downwards. For example, he asserted3 that the occupational noise recommendations from the National Institute for Occupational Safety and Health were based on “an insensitive measure” of noised-induced hearing loss. “As I presented at the Acoustical Society of America meeting a year ago, the actual safe noise exposure level to prevent auditory damage may be as low as 55 dBA for a single exposure and an average 55-60 dB for 24 hours. Most cities are certainly noisier than that.” HOW LOCAL GOVERNMENTS CAN BETTER PROTECT HEARING HEALTH The Hearing Journal reached out to the public health departments of Riverside County and San Bernardino County, and both pointed to one key issue: hearing health protection is not getting the government support it needs. “Hearing loss/risk is not a metric tracked by public health at this time. Riverside University Health System does have audiologists to check hearing health but as you probably already know, they are in short supply,” said Janet Zimmerman, public relations director at the Riverside University Health System. “The services and programs offered by county public health departments are primarily directed and funded by the state, and at this time the state does not support programs or services that focus on populations with hearing impairment,” added Francis Delapaz, communications officer at the San Bernardino County Department of Public Health. Both counties do have ordinances that aim to control noise. Each of their noise codes has a set of limits for residential, commercial, and industrial zone noise, and for interior and exterior sounds. But for Bronzaft, local noise ordinances need a major refresh. She has written and spoken extensively about the adverse impact of noise on human health, and currently advocates for New York City to bring its noise legislation up to date. “We have a noise code. It needs to be updated. It was last updated in 2007 and I was very much involved in the updating,” she told The Hearing Journal. “They’re introducing legislation in New York City like noise cameras… but I have been talking to City Council people. I think we should update the entire code. So I’m advocating that when you have to make some changes piecemeal, you should look at the entire thing.” For one, according to Bronzaft, noise laws should be based on newer scientific information. “We now know that 85 dBA was too high a level to set for potential hearing loss. So the information we have now as to what could harm our hearing, how noise can harm our health… really calls for an updating of the noise laws. And that would be true in any city,” she said. “The other thing that’s key if you’re talking about hearing loss is to educate young people… You need to have schools educating children how important it is to protect their hearing.” To this end, Bronzaft has helped the NYC Department of Environmental Protection develop an updated Sound and Noise Education Module4, which can be included in K-12 learning to teach children about the impact of noise. Evans agrees and added that childhood education on hearing loss should be tailored to the audience. “It has to be meaningful for a person, individualized. You won’t get much traction talking about noise-induced hearing loss from farm equipment at a Health Fair in downtown Cleveland.” She further suggested that cities can also put up educational signage at loud areas like train stops, stadiums, nightclubs, reminding the public of the potential hearing loss risk there. “This would require someone to survey the area to evaluate the decibel level to determine if it poses a risk,” she said. PROVIDERS’ ROLE IN PROTECTING THE PUBLIC’S HEARING Besides government initiatives, can audiology professionals help safeguard the public’s hearing health in noisy cities? Evans believes so. As an example, she cited University Hospitals in Cleveland conducting free hearing screenings at various events, particularly in May, which is National Speech-Language-Hearing Month. They also participate in “Hear in CLE,” a humanitarian effort by audiologists, otolaryngologists, and other providers to provide free hearing health services to underserved communities. “In addition to reaching out to citizens of urban communities, it’s also appropriate for hearing health care providers to make connections with pediatricians and primary care physicians. These are the providers who serve as a person’s medical home and a place where education can be introduced as well,” said Evans. Bronzaft and Fink both agree that hearing health care professionals must also participate in lowering hearing loss risk, not just treating it. “I think hearing health providers must be concerned about [hearing loss] prevention as well,” Bronzaft posited. “I know the role of a doctor is to treat, but… I think research must also be used to benefit the public.” “The Center for Hearing and Communication is a wonderful example,” she said, referring to a not-for-profit organization that provides comprehensive hearing health services, from hearing testing, to auditory therapies, to family counseling. “They went into the forefront to develop something called International Noise Awareness Day, because they not only saw that their primary job was to treat hearing loss, but they also saw their goal as trying to prevent further hearing loss,” said Bronzaft. “And remember… they have doctors there that are treating people with hearing loss, but they didn’t stop there. They realized their role was also to educate in terms of prevention.

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