Specialists Sound a New Alarm as Hearing Damage Surfaces in Youth

Ravi Samy, MD, in the EARLAB at the UC Academic Health Center. Photos by Cindy Starr.

Ravi Samy, MD, in the EARLAB at the UC Academic Health Center. Photos by Cindy Starr.

This time the canary in the coal mine is a buzzing or ringing sound in your teenager’s ears. It’s called tinnitus, and it is likely a warning sign that damage is occurring because of too much exposure to too much noise.

Ravi Samy, MD, FACS, an otolaryngologist with the Neurosensory Disorders Center at the University of Cincinnati Gardner Neuroscience Institute, is seeing increasing numbers of young adults who are experiencing tinnitus.

“A lot of this is probably the tip of the iceberg,” says Samy (pronounced SAH-mee), who is chief of the Division of Otology/Neurotology in the Department of Otolaryngology at UC and director of the Adult Cochlear Implant Program for UC Health. “We don’t know what the long-term ramifications are. Exposure to harmful sound levels is cumulative. It takes years or even decades for the damage to become serious. But I think the data is growing that our use of cell phones, MP3 players and other electronic devices is having an impact.”

In 2015, the World Health Organization warned that more than a billion teenagers and young adults face the risk of hearing loss because of exposure to unsafe levels of sound. The warning is being underscored by new research.

A study published this month by researchers at McMaster University, located in Ontario, Canada, found that of 170 middle school and high school students, 28 percent had developed persistent tinnitus. The researchers also found that the students with tinnitus had less tolerance for loud noise than the students who did not have tinnitus. The study was published in the journal Scientific Reports.

Also this year, researchers conducted a clinical trial at an outdoor music festival in Amsterdam, the Netherlands, and found that ear plugs are effective in preventing short-term hearing loss after exposure to loud music. The results were published in JAMA Otolaryngology Head & Neck Surgery.

Tinnitus caused by exposure to loud noise sometimes will go away on its own. If it persists, it is likely to be permanent. Samy advises people who are bothered by permanent buzzing or ringing in their ears to use a masking device, such as a fan or white noise machine, especially when going to sleep.

Hearing loss is not always immediate

The sources of loud noise are everywhere, from movie theaters to concerts to the earbuds that seem to be permanently lodged in young people’s ears. And what is harmful is not always apparent. Just as sun exposure accumulates over time and can eventually lead to skin cancer, noise exposure can lead to hearing loss years or decades later. Sensory hearing loss occurs when the tiny hair cells in the cochlea, in the inner ear, die off, leaving fewer cells to sense fluid waves created by sound.

“A child has a lot of reserve, a lot of hair cells,” Samy says. “It’s hard to tell a teenager to turn down the music because it will impact him when he’s 60. What’s 60? It seems like forever in the future. But an ounce of prevention is worth a pound of cure. If you can you help young people now, they are less apt to be wearing hearing aids down the road.”

Samy says it is not uncommon for people to have “ringing in their ears” for two to three days after attending a concert or other event with loud noise. “You can experience a temporary threshold shift, meaning you have damage to your hearing in the short run,” Samy says. “It’s a way the body protects itself. But if the temporary shifts turn into long-term shifts, that’s a danger.”

Meanwhile, the effects of noise exposure may not initially show up in routine hearing testing.  Brian Earl, PhD, director of the EARLAB in UC’s Department of Communication Sciences & Disorders, is studying  “hidden” hearing loss — the loss of auditory neurons that connect the inner ear to the brain. Animal experiments have shown that advanced tests of auditory nerve activity are required to detect this neural hearing loss. “You don’t need a lot of neurons to pass a hearing test,“ Earl says.“But you do need a lot to hear in a noisy restaurant. ”

Ravi Samy, MD, right, with Brian Earl, PhD, director of the EARLAB, and doctoral candidate Ivy Schweinzger. The bright red area on the scan shows the noise-induced loss of auditory neurons in an animal model.

Ravi Samy, MD, right, with Brian Earl, PhD, director of the EARLAB, and doctoral candidate Ivy Schweinzger. The bright red area on the scan shows the noise-induced loss of auditory neurons in an animal model.

Setting benchmarks for safety

tinnitus sidebar1Sound is measured in decibels. A whisper is 30 decibels, a normal conversation 60 decibels. “Prolonged exposure to anything above 85 decibels is considered damaging,” Samy says. “And we’re in an era when MP3 players can reach 105 decibels. It’s hard to say how much of the problem we’re seeing is due to MP3 players, but it’s happening.”

In an interview on NBC’s Today, NBC News Medical Contributor Natalie Azar, MD, advocated the “60/60 rule.” That means listening to your MP3 at 60 percent of its maximum for no more than 60 minutes a day.

WHO also recommends restricting the use of personal audio devices to less than one hour per day.

Samy says society has made great strides over the last several decades in protecting soldiers and factory workers from damaging noise exposure. “The top two complaints of war fighters in Afghanistan and Iraq are hearing loss and tinnitus,” Samy says. “The military has a huge interest in hearing preservation, in preventing hearing loss, and it is doing a good job. The next hurdle is to help people on the civilian side. Our daily noise exposure is much greater than we realize.”

tinnitus sidebar2With people living longer and longer, auditory damage in the young today could mean a public health crisis in the future. “We are going to see a huge number of people who need hearing aids and cochlear implants,” Samy says. “There is also a growing amount of data showing that significant hearing loss can worsen the progression of Alzheimer’s and other dementias, and can lead to social isolation and depression.”

Ironically, Samy himself has had tinnitus for 20 years. He sleeps with a fan to help camouflage the ringing in his ears. Unable to pinpoint the cause, he says it is the likely result of his days as a musician, his passion for rock concerts while in college, or heredity. Sensory hearing loss runs in his family.

With a measure of hearing loss already chalked up against him, Samy walks the walk. When he and his wife went to hear his favorite band, U2, play an indoor concert, he wore ear plugs.

— Cindy Starr

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