Hyped Up Now, Hurting Later

By Yishane Lee and Lauren McGrath

In an interview, longtime healthcare professional Bob Kambic warns about the health risks of the over-amplification that is becoming increasingly common at recreational events.

What got you interested in the topic of the dangers of loud entertainment?
I am 75 and a grandfather. Recently I was in Detroit for an event in which my grandchildren participated. The finale of the event was held in Ford Stadium, a football venue. The electronically amplified sound was deafening even wearing my noise-canceling headphones.

The 30,000 or so people in the stadium were subject to what in other places would be called torture. I wondered, is there a way to tell the organizers they are harming our young citizens, the future of our country?

As a retired healthcare professional, I have a half century of experience in the healthcare field and more than 50 publications in peer-reviewed journals. This got me thinking about noise levels in entertainment venues. Raising awareness of this public health problem needs to be done.

Why is the music so loud?
Consider a musician playing an electric guitar in front of a crowd. She will hear her music from an amplifier. But she then finds that she likes it loud and turns the small knob up. After weeks or months that level is not satisfactory and she makes another turn up.

Over time, as the louder sounds gradually diminish hearing, it becomes necessary to turn the knob up more and more. For music professionals, this is called increasing the gain, which is one way to increase the volume of sound from the speakers. The other way to increase volume is to turn up the signal coming out of the speakers themselves.

When musicians play to big crowds they now have amplifiers and systems that produce thousands of watts of power and can project over 100 decibels (dB). This technology is also used for recorded music. It “entertains” but it also may harm the listeners’ ears. Musicians and their producers know that “loudness does not equal quality”—but that caution can get lost in the need to entertain.

By 2022, live music industry revenue is projected to be worth $31 billion worldwide, according to PricewaterhouseCoopers. Like other industries, the money is the driver. To me this means the live music industry will continue to use larger and louder electronic amplification.

The electronically amplified sound is now also ubiquitous at rallies and sporting events, both professional and collegiate—or even younger—to hype up the crowd.

What can we do to protect our hearing, and especially the hearing of children?
Earplugs. I was happy to see an article in a music industry publication saying that the purchase of custom musician’s earplugs is one of the best investments a music industry worker can make. They didn’t recommend earphones, mixers, digital equipment, or music instruments—just earplugs. Frequent concert-goers should also invest in custom musician’s earplugs.

For children, this is a tough question because kids don’t want to be told what to listen to and how loud the sound should be. But there are a variety of products for hearing protection. The first are simple foam earplugs, widely available at hardware stores, pharmacies, and online. The disadvantage is that they must be pushed into the ear canal and may not fit all size ears. (See “8 Pairs of Earplugs in 4 Noisy Settings,” next page.)

The next step up is over-the-ear earmuffs that cover the ear entirely. They are long-lasting and work well but they are also big and bulky.

Finally there are noise-canceling headphones made by audio or electronic equipment manufacturers. I use battery-powered noise-canceling headphones on airplanes and trains, and was wearing them at the event at the Ford Stadium. You may want to explore the varying prices and technology. Many can also play personal music through wireless and/or wired connections.

Besides using hearing protection, what else can you do?
Take action against unnecessary noise. Groups of parents can petition their schools and sports teams to reduce amplification at indoor and outdoor events. Decibel meters are inexpensive or free as smartphone apps and can be used to show managers and administrators the sound level at events, and when the volume reaches dangerous levels at over 85 dB.

The music and electronic sound industry is in control of this problem because of the amount of money in the industry, but also because well-known musicians such as Huey Lewis and Eric Clapton, who are open about their hearing loss, are helping to raise awareness. Media coverage and local action can bring attention to bear, and over time the industry may become aware of amplification as a health problem for everyone, including the audience, not just for those in the industry.

Bob (Robert T.) Kambic, MSH, is a retired health professional who worked at the U.S. Department of Health and Human Services and the Johns Hopkins University (JHU) Bloomberg School of Public Health. He is a current visiting scientist with the JHU Medical School Division of Health Sciences Informatics and plays and sings American traditional music using acoustic instruments.

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Celebrating the 10th Anniversary of Grace’s Law

By Jeanine and Grace Gleba

In December 2008, a small (Christmas) miracle happened in the state of New Jersey and personally for our family. It’s hard for us to believe that it has been a decade since Governor Richard Codey said these words:

Grace Gleba (red sweater on right) looks on as HAIL is signed into law.

“I want to personally thank Grace and the entire Gleba family for their years of advocacy on behalf of children with hearing loss. Grace’s tenacity, and her own example of what children can achieve with the proper treatment for hearing loss, are a major reason why kids in New Jersey will be able to receive the gift of hearing for years and years to come. Grace and her family have taken personal adversity and turned it into something positive for the people of New Jersey. We all owe her a debt of gratitude.”  

The governor spoke as we witnessed the passage of Grace’s Law S467/A1571. These bill numbers are emblazoned forever in my mind.

Grace’s Law is known as Hearing Aid Insurance Legislation (HAIL) and mandates hearing aid coverage for New Jersey children ages 15 years and younger. For our family and all of the families who advocated in the state capital of Trenton with us, it was a monumental accomplishment. In fact, it took nine years to raise awareness and fight for this law to become a reality. The statistics validate this being quite a feat as only 3 percent of all bills introduced ever become a law!

On the law’s 10th anniversary, here are 10 ways you can celebrate this landmark legislation:

1) Take a few minutes to learn the history of the bill here and here. You can read the original legislation and the most recent pamphlet that the NJ Department of Human Services’ Division of the Deaf and Hard of Hearing has produced explaining Grace's Law. Take note that as a result of the Affordable Care Act, the state has made this an essential health benefit and since 2014 there is no longer a maximum benefit limit of $1,000 per hearing aid (after deductibles, copays etc.). Now that’s something to celebrate—that children now can have even better coverage!

2) Support research toward a biological cure for hearing loss with a contribution to Hearing Health Foundation (HHF)’s Hearing Restoration Project (HRP). The HRP is a scientific consortium studying how fish, birds, and mice regenerate their hearing to replicate this phenomenon in humans.

3) Do you know a child who has benefitted from Grace’s Law and is a shining example that with their hearing aids they have overcome obstacles and achieved great things? Help them join HHF’s Faces of Hearing Loss awareness project. Their participation will show that hearing loss and related conditions can affect anyone.

4) Make a difference in someone else’s life and give the gift of sound by donating old hearing aids to Hearing Charities of America.

5) Wear earplugs for a day to gain a better understanding of living with hearing loss on a daily basis and why getting fitted for proper hearing aids can improve lives.

6) Participate in Walk4Hearing events held nationwide by the Hearing Loss Association of America.

7) Tweet a message showing your gratitude for HAIL. Tag @graceslaw and @hearinghealthfn include a link to this blog post. Here are sample tweets to get you started:

• For 10 years #GracesLaw #HAIL has helped children in NJ hear. Help spread the word by doing something from the 10 Ways to Celebrate!

• Millions of Americans experience some sort of hearing loss. #HAIL is needed in every state. #listenupamerica

• #HAIL Yeah!

• I’m celebrating #GracesLaw #anniversary by _____________.

• #GracesLaw improved my/my child’s quality of life by ____________.

• This year I am thankful for #HAIL #GracesLaw and hearing technology #gratitude

8) Advocate like we did 10 years ago! Last year, President Donald Trump signed into law the Food and Drug Administration Reauthorization Act of 2017, which includes the Over the Counter Hearing Aid Act. Next, we hope Congress will pass federal HAIL for all ages. Hearing loss doesn’t discriminate, so why does insurance coverage? Write your legislators to let them know that this is important to you.

9) Schedule a hearing exam for you or a loved one.

10) Protect your hearing or lose it. People of all ages can be affected by noise-induced hearing loss. Turn down the volume on your electronic devices. Find more ways to protect your hearing.

This article was repurposed with permission from Jeanine and Grace Gleba. Jeanine Gleba serves as a public member on the NJ State Audiology and Speech-Language Pathology Advisory Committee. Grace Gleba is a student in the Schreyer Honors College at Pennsylvania State University, where she is majoring in communications sciences and disorders with a minor in health administration and policy.

Receive updates on life-changing hearing research and resources by subscribing to HHF's free quarterly magazine and e-newsletter.

Suffering After Sacrifice

By Lauren McGrath

Every Veterans Day, Hearing Health Foundation (HHF) celebrates the brave individuals who have served and sacrificed to defend our country. We are grateful to our active military members and veterans for their courageous protection of American values and freedoms.

As we honor those who have served in the U.S. Armed Forces, we acknowledge a tragic and troubling health problem. An astounding number of veterans—60% of those returning from Iraq and Afghanistan—live with tinnitus and noise-induced hearing loss. In 2017, the Veterans Administration reported 1.79 million disability compensation recipients for tinnitus and 1.16 million compensation recipients for hearing loss, the number one and two disabilities, respectively. In an HHF video about hearing loss treatment, Retired Army Colonel John Dilliard, Chair-Elect of HHF’s Board of Directors, explains, “The noise from repeated gunfire and high-frequency, high-performance aircraft engines takes its toll on the human hearing mechanisms.” Col. Dillard lives with both tinnitus and hearing loss following 26 years of service.

John Dillard and fellow soldiers, Fort Irwin National Training Center, 1977.

Dr. Bruce Douglas, 93, remembers the moment his hearing became severely compromised while serving in the Navy during the Korean War. “On what was my 26th birthday, after pulling the trigger on the M1 rifle with no protection (none of us had any) multiple times, I was left with tendonitis in both knees—and worse, permanent, chronic tinnitus due to acoustic trauma. My hearing went downhill ever after, and every imaginable kind of sound and sensation has resulted from my tinnitus,” Douglas writes in the Fall 2018 issue of Hearing Health.

Hearing protection training must start as soon as one enters the military. But there is a misconception that hearing protection inhibits vital communication and mission readiness because hearing signs of danger is imperative to survival. “Soldiers want to be able to hear the snap of the twig and want to be able to be situationally. As a result, they are often resistant to wearing hearing protection,” Col. Dillard says.

Fortunately, sophisticated hearing protection technology does exist so that military personnel do not have to choose between protecting their ears or their lives. Examples include noise-attenuating helmets, which use ear cups to protect against hazardous sound, and Tactical Communication and Protective Systems, which protect against loud noises while amplifying soft ones.

The U.S. military continues to work toward safer hearing in the service. The U.S. Army has developed the Tactical Communication and Protective System (TCAPS), which are earbuds that dampen dangerous noises to safe levels using microphones and noise-canceling technology, while also providing amplification of softer sounds and two-way communication systems. An initiative by the U.S. Air Force called Total Exposure Health (TEH), meanwhile, focuses on overall health both on and off the job, will measure cumulative noise exposure over the course of 24 hours. These developments and others, which HHF applauds, are covered in greater detail in Hearing Heath’s Fall 2017 issue.

As greater preventative technology for our military becomes available, HHF remains dedicated to finding better treatments and cures for tinnitus and hearing loss to benefit the lives of millions of Americans, including veterans, a disproportionately affected group. We hope you will join us in remembering their sacrifices with gratitude and compassion.

Sudden Hearing Loss Is a Medical Emergency

By Donna Rohwer

Mondays are always bad, right? I awoke deaf in my left ear—completely deaf. I asked my husband if he thought it was anything to worry about and he said, “Not yet.” I thought the same and appreciated the confirmation. We didn’t know then that sudden hearing loss is a medical emergency.

Sudden Sensorineural Hearing Loss (SSHL)

Damage to the inner ear, the cochlea, or related nerve pathways cause SSHL. A loss of 30 decibels or more in three consecutive frequencies in one or both ears within several days is considered SSHL. Immediate treatment can make partial or total recovery more likely. Unfortunately, many medical professionals— from emergency room to waiting room—don’t recognize SSHL or know how to treat it. As a result, many patients lose the opportunity for recovery because they don’t get the right treatment within the critical time. In my case, I received treatment within a week—it wasn’t optimal, but better than many. I had no significant recovery.  

SSHL Is LOUD, Isolating, and Devastating

The shocking thing to SSHL patients is how LOUD everything becomes. Sounds distort and blend together, sound direction is lost, and every sound seems magnified. The tinnitus is sudden and loud, with whooshing, popping, and other sounds. The tinnitus often worsens with activity or background noise, and goes long into the night. Some people don’t feel well, see well, sleep well, or balance well. SSHL strains relationships and many people simply stop participating in activities. I felt as if I had lost my life.  

SSHL Can Be Life-Threatening

I consoled myself at first that my condition wasn’t life-threatening. Within weeks, however, I no longer wanted to go on living. I later learned that many people respond this way. Physicians recognize the psychological impact when someone loses a limb. Losing the sense of hearing, suddenly, is not dissimilar. I didn’t know how to live with SSHL, or where to turn for support. I felt abandoned until I received the mental health support I urgently needed.

Alone at the Table

I have slowly reclaimed my life through the support of family, friends, and several Facebook groups. I also have used a cognitive therapy course for tinnitus, antidepressants (briefly), and months of working through the process. But there are still moments. My passion is recreational poker. I recently played with a mixed group, some with typical hearing, some with hearing loss. The hearing people were talking, but the background noise kept me from understanding them, and I don’t know ASL. I felt alone at the table—caught somewhere between the hearing world and the deaf world.

What Do We, as SSHL Patients, Want?

We want non-ENT medical professionals to learn about SSHL and treat it as a medical emergency. We want ENT doctors to recognize the psychological aspects of SSHL and refer us to appropriate resources. We want hearing loss advocates to see that SSHL has unique challenges different from other kinds of hearing loss. Lastly, we want a cure.

You can empower work toward better treatments and cures for hearing loss and tinnitus. If you are able, please make a contribution today.

Eight Pairs of Earplugs in Four Noisy Settings: My Hearing Protection Experiment

By Kayleen Ring

Before my 2018 summer internship at Hearing Health Foundation (HHF) in New York City, I underestimated the importance of protecting my ears, often leaving myself at risk for damage from noise at concerts, sporting events, and other loud places. I took my typical hearing for granted until learning that hearing loss is largely caused by noise exposure and can negatively impact the brain function of young adults, even in its mildest forms. But I was also encouraged to discover noise-induced hearing loss (NIHL) is preventable. Earplugs in particular are a convenient, low-cost tool for hearing preservation.

To improve my own hearing health and to create awareness about NIHL, I experimented with different types of earplugs in various loud settings. Expecting no more than a handful of foam options, I was excited to learn what an assortment of earplugs is available—each with different shapes, sizes, and features. Previously, my earplug experience had been limited to basic foam pairs to drown out my college roommates’ snoring!

I evaluated each personal earplug use experience with a 1 to 10 rating—10 being highest—for effectiveness, comfort, and ease of use. The Noise Reduction Rating (NRR) metric indicates how much noise is blocked out by the pair of earplugs.

Setting: Concerts

Just one loud concert (decibel levels up to 120 dB) can cause permanent damage to your ears. I tested earplugs at two musical events.

1. Eargasm High Fidelity Ear Plugs

• NRR: 16 dB

• Effectiveness: 10

• Comfort: 10

• Ease of Use: 10

At first, I worried wearing earplugs at a performance by one of my favorite artists would negatively affect my concert experience, but this pair allowed me to hear and enjoy the music perfectly at a reduced volume. They were so comfortable I forgot they were in my ears! They were easy to remove using the pull tab and I  also liked the carrying case they come in, because it fits in my small bag and keeps the earplugs hygienic for reuse.

2. Moldex Pocket Pak Squeeze

• NRR: 27 dB

• Effectiveness: 8

• Comfort: 9

• Ease of Use: 9

The triple-flange design, neck cord, and carrying case provided a secure earplug experience at an even louder concert where sound levels spiked to 120 dB. Unprotected exposure to noise at this level, which is equivalent to that of ambulance sirens or thunderclaps, can damage hearing in seconds. Fortunately, the ridged edges on the earplugs I used made inserting them far easier and faster than foam earplugs that need to be shaped prior to use.

Setting: Group Fitness

At a popular group fitness class, I recorded sound decibel levels and the results showed extremely loud and dangerous levels of noise. The average was 91 dB and the max was 119 dB over the one-hour class period. For a healthier workout, I wore earplugs.

3. Mack’s Blackout Foam Earplugs

• NRR: 32 dB

• Effectiveness: 9

• Comfort: 10

• Ease of Use: 9

These were excellent because I was able to hear the music and the trainers’ instructions, just at a lower volume. Less distracted by the loud music than usual, I was able to focus more carefully on my workout and form. They fit snugly and stayed in place over the course of the 60-minute, high-intensity session.

4. EarPeace “HD” High Fidelity Earplugs

• NRR: 19 dB

• Effectiveness: 10

• Comfort: 10

• Ease of Use: 8

I was particularly impressed that this pair included three set of filters offering different levels of protection. I used the highest decibel filter, 19 dB, and found the class music was still clear and enjoyable. My only challenge was properly inserting the very small filters.

Setting: Restaurants

When I didn’t intern at HHF this summer, I worked at a restaurant on Long Island, New York, that was always busy, sometimes bursting with chatty customers waiting three hours for service. Beyond the crowds, the restaurant had live musical performances that amplified an already loud environment. This is dangerous for workers and patrons alike. Here, the earplugs I wore still allowed me to hear clearly and hold a conversation.

5. Etymotic ER20XS High-Fidelity Earplugs (NRR: 13 dB)

• NRR: 13 dB

• Effectiveness: 8

• Comfort: 8

• Ease of Use: 9

The Etymotic earplugs had the positive qualities of the typical high-fidelity earplugs and included three interchangeable eartips, a hygenic carrying case, and a neck cord, providing a secure and effective earplug experience.

6. EarPeace “S”High Fidelity Earplugs

• NRR: 19 dB

• Overall Effectiveness: 10

• Comfort: 10

• Ease of Use: 10

This pair was great. They reduced the noise perfectly so it was at a comfortable yet still audible volume. The dual-flange design and soft silicone material made the earplugs fit well, were comfortable and easy to use.

Setting: New York City Subway

Decibel levels on the subway platforms trains are extremely high and can cause hearing damage, especially for frequent riders and employees. For my tests, I sat inside the 34th St-Penn Station 1/2/3 subway station across the street from the HHF office, where I was greeted by screeching trains, talkative tourists, and a steel drums player.

7. Moldex Sparkplugs

• NRR: 33 dB

• Overall Effectiveness: 9

• Comfort: 10

• Ease of Use: 9

The Sparkplugs blocked out noise while allowing me to hear conversations and train announcements. They were easy to mold into my ears, allowing for optimal noise reduction. The pattern on the earplugs is colorful and fun, making them appealing for children, and easily locatable in your bag.

8. Alpine Plug & Go

• NRR: 30 dB

• Overall Effectiveness: 8

• Comfort: 8

• Ease of Use: 8

These foam earplugs reduced volume but the noise was muffled. Consequently, these would be a great option for more sedentary activities, like sleeping and flying, where you are aiming to block out all noise. The foam was comfortable and fit snugly in my ears, but was challenging to mold.

The reviews and ratings here are based on my individual experiences and are not intended to encourage or discourage anyone’s use of specific earplugs. High ratings are not product endorsements. As someone newly informed about the dangers of noise, it is my hope my summer intern experiment for HHF will raise awareness and inspire others to investigate hearing protection that best meets their needs.

Kayleen Ring is a former marketing and communications intern at HHF. She studies marketing in the honors program at Providence College in Rhode Island.