Noise-induced hearing loss

Noise-induced hearing loss (NIHL) is an increasingly prevalent disorder that results from exposure to high-intensity sound, especially over a long period of time.

Description

NIHL is a preventable hearing disorder that affects people of all ages and demographics.

Mechanism

NIHL occurs when too much sound intensity is transmitted into and through the auditory system. An acoustic signal from an energy source, such as a radio, enters into the external auditory canal, and is funneled through to the tympanic membrane (eardrum). The tympanic membrane acts as an elastic diaphragm and drives the ossicular chain of the middle ear system into motion. Then the middle ear ossicles transfer mechanical energy to the cochlea by way of the stapes footplate hammering against the oval window of the cochlea. This hammering causes the fluid within the cochlea (perilymph and endolymph) to push against the stereocilia of the hair cells, which then transmit a signal to the central auditory system within the brain. When the ear is exposed to excessive sound levels or loud sounds over time, the overstimulation of the hair cells leads to heavy production of reactive oxygen species, leading to oxidative cell death. In animal experiments, antioxidant vitamins have been found to reduce hearing loss even when administered the day after noise exposure.^[1] They were not able to fully prevent it.

Some of the abnormalities include metabolic exhaustion of the hair cells, structural changes and degeneration of structures within the hair cells, morphological changes of the cilia, ruptures of cell membranes, and complete degeneration and loss of hair cells, neural cells and supporting cells.

NIHL is therefore the consequence of overstimulation of the hair cells and supporting structures. Structural damage to hair cells (primarily the outer hair cells) will result in hearing loss that can be characterized by an attenuation and distortion of incoming auditory stimuli.

Types

The ear can be exposed to short periods in excess of 120 dB without permanent harm — albeit with discomfort and possibly pain; but long term exposure to sound levels over 80 dB can cause permanent hearing loss.^[2]

There are two basic types of NIHL:

• NIHL caused by acoustic trauma and
• gradually developing NIHL.

Acoustic trauma

NIHL caused by acoustic trauma refers to permanent cochlear damage from a one-time exposure to excessive sound pressure. This form of NIHL commonly results from exposure to high-intensity sounds such as explosions, gunfire, a large drum hit loudly and firecrackers.

Gradually developing NIHL

Gradually developing NIHL refers to permanent cochlear damage from repeated exposure to loud sounds over a period of time. Unlike NIHL from acoustic trauma, this form of NIHL does not occur from a single exposure to a high-intensity sound pressure level. Gradually developing NIHL can be caused by multiple exposures to any source of excessive volume, such as home and vehicle stereos, concerts, nightclubs, excessive noise in the workplace, and personal media players. The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) states that exposure to 85 dB(A) of noise, known as an exposure action value, for more than eight hours per day can result in permanent hearing loss (Occupational Health and Safety Administration [OSHA], 2002). Since decibels are based on a logarithmic scale, every increase of 3 decibels SPL results in a doubling of intensity, meaning hearing loss can occur at a faster rate. Therefore, gradually developing NIHL occurs from the combination of sound intensity and duration of exposure.

Both NIHL caused by acoustic trauma and gradually developing NIHL can often be characterized by a specific pattern presented in audiological findings. NIHL is generally observed to affect a person’s hearing sensitivity in the higher frequencies, especially at 4000 Hz. "Noise-induced impairments are usually associated with a notch-shaped high-frequency sensorineural loss that is worst at 4000 Hz, although the notch often occurs at 3000 or 6000 Hz, as well" (Gelfand, 2001, p. 202). Doctoral students at the University of Iowa have termed this notch, specific to a noise-induced etiology, a "muna." The symptoms of NIHL are usually presented equally in both ears (Gelfand). Not all audiological results from patients with NIHL match the above description. Often a decline in hearing sensitivity will occur at frequencies other than at the typical 3000–6000 Hz range. Variations arise from differences in people’s ear canal resonance, the frequency of the harmful acoustic signal, and the length of exposure (Rösler, 1994). As harmful noise exposure continues, the commonly affected frequencies will broaden and worsen in severity (Gelfand). "NIHL usually occurs initially at high frequencies (3, 4, or 6 kHz), and then spreads to the low frequencies (0.5, 1, or 2 kHz)" (Chen, 2003, p. 55).

Prevention

NIHL can easily be prevented through the use of some of the most simple, widely available and economical tools. This includes but is not limited to ear protection (i.e. earplugs and earmuffs), education, and hearing conservation programs. Earplugs and earmuffs can provide the wearer with at least 5 to 10 dB SPL of attenuation (Gelfand, 2001). According to a survey by Lass, Woodford, C. Lundeen, D. Lundeen and Everly-Myers (1987), which examined high school students’ attitudes and knowledge concerning hearing safety, 66% of the subjects reported a positive response to wearing hearing protection devices if educated about NIHL. Unfortunately, more often than not, individuals will avoid the use of ear protection due to embarrassment, lack of comfort, and reduced sound quality.

However, the effectiveness of hearing protection programs is hindered by poor compliance in the use of hearing protection devices due to communication difficulties, comfort issues, individuals’ attitudes about protecting themselves from noise-induced hearing loss, and individuals’ perceptions about how others who do not use hearing protection will view them if they choose to use hearing protection.

Hearing loss in the workplace

About 30 million workers are exposed to hazardous noise, with an additional 9 million exposed to solvents and metals that put them at risk for hearing loss.^[3] Occupational hearing loss is one of the most common occupational diseases. 49% of male miners have hearing loss by the age of 50.^[3] By the age of 60, this number goes up to 70%.^[3] The following is a list of occupations that are most susceptible to hearing loss:^[3]

• Agriculture
• Mining
• Construction
• Manufacturing
• Utilities
• Transportation
• Military
• Musicians
• Orchestra conductors

Hearing loss for musicians

Musicians, from classical orchestras to rock groups, are exposed to high decibel ranges.^[4][5] Although some rock musicians experience noise-induced hearing loss from their music,^[6] it is still debated as to whether classical musicians are exposed to enough high-intensity sound to cause hearing impairments.^[7]

Music-induced hearing loss is still a controversial topic for hearing researchers.^[8] While some studies have shown that the risk for hearing loss increases as music exposure increases,^[8] other studies found little to no correlation between the two.^[8] Experts at the 2006 "Noise-Induced Hearing Loss in Children at Work and Play" Conference agreed that further research into this field was still required before making a broad generalization about music-induced hearing loss.^[8] Given the extensive research suggesting that industrial noise exposure can cause sensorineural hearing loss a link between hearing loss and music exposures of similar level and duration (to industrial noise) seems highly plausible. Determining which individuals or groups are at risk for such exposures may be a difficult task. Recent research suggests that despite concerns about the proliferation of personal music players, that in fact disco's, concerts and live music events may be more hazardous to youth's hearing^[9].^[10]

Workplace standards

The Occupational Safety and Health Administration (OSHA) describes standards for occupational noise exposure in articles 1910.95 and 1926.52 [1]. OSHA states that an employer must implement hearing conservation programs for employees if the noise level of the workplace is equal to or above 85 dB(A) for an averaged eight-hour time period (Gelfand, 2001). OSHA also states that "exposure to impulsive or impact noise should not exceed 140 dB peak sound pressure level" (CFR 1910.95(b)(2)). The United States Department of Defense (DoD) instruction 605512 has some differences from OSHA 1910.95 standard, for example, OSHA 1910.95 uses a 5 dB exchange rate and DoD instruction 605512 uses a 3 dB exchange rate.

Hearing conservation programs in the workplace and in the general population seek to increase compliance and effectiveness of hearing protection protocols through audiometric screening tests and education on the dangers of noise exposure.

Employees are required to wear hearing protection when it is identified that their eight-hour time weighted average (TWA) is above the exposure action value of 90 dB. If subsequent monitoring shows that 85 dB is not surpassed for an eight-hour TWA, the employee is no longer required to wear hearing protection (OSHA 3074, 2002 (Revised)).

Mitigation

For people living with NIHL, there are several management options that can improve the ability to hear and effectively communicate. Management programs for people with NIHL include counseling and the use of hearing aids and FM systems.^{[clarification needed]} With proper amplification and counseling, the prognosis is excellent for people with NIHL. The prognosis has improved with the recent advancements in digital hearing aid technology, such as directional microphones, open-fit hearing aids, and more advanced algorithms. Annual audiological evaluations are recommended to monitor any changes in a patient’s hearing and to modify hearing-aid prescriptions.

There is evidence that hearing loss can be minimized by taking megadoses of magnesium for a few days, starting as soon as possible after exposure to the loud noise.^[11][12] A magnesium-high diet also seems to be helpful as an NIHL-preventative if taken in advance of exposure to loud noises.^[13] Consuming sizable amounts of magnesium can be potentially harmful, so this treatment should be followed with caution.^[14]

There are currently no medical options for NIHL from noise-exposure which occurred more than a week previously. However, current research for the possible use of drug and genetic therapies look hopeful (National Institute on Deafness and Other Communication Disorders [NIDCD], 2006).

See also

• Don't Lose The Music
• H.E.A.R.
• List of occupational health and safety awards
• NIOSH Power Tools Database
• Safe-In-Sound Award
• Tinnitus
• Youth hearing conservation programs

Notes

1. ^ Yamasoba, T. et al. Role of glutathione in protection against noise-induced hearing loss. Brain Research
2. ^ http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9735 OSHA 29 CFR 1910.95(b)(2)
3. ^ ^{a b c d} "Work-related hearing loss." NIOSH Publication No. 2001-103: 2001
4. ^ Jansson, E.; Karlsson, K. (1983-01-01). "Sound Levels Recorded Within the Symphony Orchestra and Risk Criteria for Hearing Loss" (PDF). Scandinavian Audiology (Taylor & Francis) 12 (3): 215–21. doi:10.3109/0105398309076249. PMID 6648318. http://pdfserve.informaworld.com/678995_731321620_786794683.pdf. Retrieved 2009-06-15. 
5. ^ Maia, Juliana Rollo Fernandes; Russo, Ieda Chaves Pacheco (March 2008). "Study of the hearing of rock and roll musicians". SciFLO Brazil 20 (1). doi:10.1590/S0104-56872008000100009. ISSN 0104-5687. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-56872008000100009&lng=en&nrm=iso&tlng=en. Retrieved 2009-06-15. 
6. ^ "Rock and Roll Hard of Hearing Hall of Fame". Guitar Player. 2006. Archived from the original on 2009-03-04. http://web.archive.org/web/20090304062146/http://www.guitarplayer.com/article/rock-and-roll/Apr-06/19732. 
7. ^ Ostri, B.; N. Eller, E. Dahlin, G. Skylv (1989-01-01). "Hearing Impairment in Orchestral Musicians" (PDF). International Journal of Audiology 18 (4): 243–9. doi:10.3109/14992028909042202. http://pdfserve.informaworld.com/884955_731321620_907441041.pdf. Retrieved 2009-06-17. 
8. ^ ^{a b c d} Morata, Thais (2007). "Young people: Their noise and music exposures and the risk of hearing loss". International Journal of Audiology (Informa Healthcare) 46 (3): 111–2. doi:10.1080/14992020601103079. ISSN 1708-8186. PMID 17365063. 
9. ^ Fligor BJ, 2009. Risk for noise-Induced hearing loss from use of portable media players: A summary of evidence through 2008. Perspectives on Audiology 5(1): 10-20.http://accperspectives.asha.org/cgi/content/abstract/5/1/10
10. ^ Williams W (2005). Noise exposure levels from personal stereo use. International Journal of Audiology, 44(4):231–236.
11. ^ Magnesium: a New Therapy for Idiopathic Sudden Sensorineural Hearing Loss. Department of Otolaryngology. (2002).
12. ^ Noise-induced hearing loss. Nelson T.J.
13. ^ Therapeutic effect of parenteral magnesium on noise-induced hearing loss in the guinea pig. Department of Otorhinolaryngology. (2002).
14. ^ Magnesium. University of Maryland Medical Center. 2009.

References

• American Academy of Audiology. (2003). Preventing Noise-Induced Occupational Hearing Loss. Retrieved March 3, 2007, from http://www.audiology.org/searchresults.htm?query=noise%20induced%20hearing%20loss
• Chen, & Tsai. (2003). Hearing Loss among Workers at an Oil Refinery in Taiwan. Archives of environmental health, 58(1), 55-58.
• Fausti, S., Wilmington, D., Helt, P., Helt, W., & Konrad-Martin, D. (2005). Hearing Health and Care: The Need for Improved Hearing Loss Prevention and Hearing Conservation Practices. Journal of Rehabilitation Research & Development, 42(4), 45-62.
• Gelfand, S. (2001). Auditory System and Related Disorders. Essentials of Audiology: Second Edition (p. 202). New York: Thieme.
• Lass N.J., Woodford C.M., Lundeen C., Lundeen D.J., & Everly-Myers D. (1987) A Survey of High School Student’s Knowledge and Awareness of Hearing, Hearing Loss, and Hearing Health. The Hearing Journal, June 15–19.
• National Institute for Occupational Safety and Health. (2000). Work-Related Hearing Loss (Brochure). Washington, DC: National Institute for Occupational Safety and Health.
• National Institute on Deafness and Other Communication Disorders. (2006). Noise-Induced Hearing Loss. Retrieved March 3, 2007.
• Occupational Safety & Health Administration. (2002). Hearing Conservation. Retrieved March 3, 2007, from http://www.osha.gov/Publications/OSHA3074/osha3074.html
• Rösler, G. (1994). Progression of Hearing Loss Caused by Occupational Noise. Scandinavian Audiology 23, 13-37.

External links

• Noise-Induced Hearing Loss Information from the National Institutes of Health (NIH).
• How to Prevent Noise-Induced Hearing Loss from the American Academy of Family Physicians.
• Dangerous Decibels Includes general information and a "virtual exhibit" as well as resources for teachers.
• NIOSH Noise and Hearing Loss Prevention Topic Page
• NIOSH Power Tools Sound Pressure and Vibrations Database
• New York City construction noise control products and vendor guidance sheet