Noise-Induced Hearing
Loss in Adolescents
Kristen Williams, MD
Thursday February 3, 2011
Legislative Advocacy
Department of Pediatrics
Background
Current
Pediatric Literature on NIHL
Advocacy
Our
and Legislation
Role as Pediatricians
 Sound
• Intensity (loudness) = dB
 An increase in 10dB = 2x louder
 Normal conversation ~60dB
• Tone = Hz
 Low bass 50-60Hz, high pitched >10000 Hz
 Normal Hearing Range: 20 -20000 Hz
 Normal speech: 500 - 3000 Hz
 Normal testing range: 250 – 8000 Hz at 25dB or lower
 CDC
NOISE METER
 Conductive
Hearing Loss
• Mechanical problem in the outer or middle ear
 Ex: Ossicles not conducting properly, fluid in the
middle ear
 Sensorineural
Hearing Loss
• Problem in the inner ear; i.e. injured hair cells
 Common
Causes
• Genetic/Congenital
• Infectious (OM, measles, meningitis)
• Toxic (medications)
• Traumatic (acoustic, barotrauma, perforation)
• Age related (presbycusis) – Minor decreases in
hearing common after age 20
• Other: acoustic neuroma, idiopathic
• Temporary: allergies, wax, infections, fluid,
foreign body, medications

One of the most common PREVENTABLE
occupational illnesses
• In 1998, 48% of US adults had some hearing loss due to
occupational noise exposure (35% of those were 18-29yo)
• In 2001, 12.5% of children aged 6-10 (5.2million), and
17% of 20-69yo (26million) had permanent damage

10 million Americans have irreversible NIHL, 30
million are exposed daily
• Dangerous noise exposure can occur one time as an
intense sound or can accumulate over time (>85dB)
• Permissible exposure
 114b dB (1/4hr/day), 110dB (1/2hr/d), 100dB (2hr/d), 85dB
(<8hr/d)
 Symptoms:
• High frequency sounds often lost first (e.g., fish vs.
fist); change in quality of sound, tinnitus
• Usually develops over a long period of time and is
usually painless.
 Therefore, mostly ignored because there are no visible
effects
 Effects of Hearing Loss
• Problems with communication, socialization and
relationships, academic achievement, and vocational
choices
 Hearing Screens
• Newborn,2-3y, yearly 4-7, 8, 10, entering a new
school
• Risk assessments:
 Parental/Patient concern (take seriously!), family
history, genetic syndromes, physical findings, head
trauma, chemotherapy, recurrent otitis media
 Testing
• All ages: ABR (auditory brainstem response),
evoked OAEs (otoacoustic emissions)
• 4y +: audiometry

Survey of college students in June 2010: Majority use
personal listening devices
• 1/3 report being distracted while wearing (less aware of
•
•
•
•
•
•
enviroment). 51% use while walking, 18% while driving
62% needed to have conversations repeated while wearing
headphones
1/3 reported soreness after use
1/3 reported using PLD at max volume levels
Those who used earbuds were most likely to increase their
volume settings, especially after listening for period of time
(second to temporary threshold shifts)
Increase number of teens reported symptoms of poor hearing:
distortion, tinnitus, hyperacusis
Few used protective behaviors: decreased volume, taking
breaks, using a noise-limiter
 In
2001, date published from the NHANES III
study (1988-1994 data) reported that 12.5%
of U.S. children (~5million) had NITS (noise
induced threshold shifts) in at least one ear.
• Prevalence: Boys 14.8% vs. girls 10.1%
• 15% of 12-19yo vs. 8% 6-11yo
• Of those with NITS, 57% had slight shifts, 19% had
mild, and 5% had moderate-profound
• 88% had one frequency (3, 4, or 6kHz) affected, 3%
had all 3
 Threshold shifts at 6kHz were most common – this
frequency is usually not tested in standard screening
hearing exams
 In
2008, a study using the 1999-2004
NHANES data published that 16% of adults
(29 million) had speech frequency hearing
loss (0.5-4 kHz) and 8.5% of 20-29yo did as
well. Once again, males were affected more
than females.
 The authors felt that the increase in prevalence of hearing
loss was in part due to the increased aging population and
growing use of personal listening devices.
 Also noted was that hearing loss was also associated with
smoking, DM, and cardiovascular disease.
 In
January 2011, another report based on
NHANES data from 2005-2005 of teens (1219yo), did not show an overall significant
increase in NITS, HFHL, or LFHL from the
prior years. However, it did report an
increase in exposure to loud noise/music
and an increase in NITS in females who used
less hearing protective devices compared
to their male counterparts.
• A similar study using the same data did show HFHL
when including testing at 8kHz.
 In
2003, despite continued efforts to
standardize regulations concerning
occupational and leisure noise, adults
continued to develop NIHL (although with
decreased incidence), therefore showing
that the present health promotion initiatives
seemed insufficient.
• Norway’s NIOSH estimated at that time 10% of youth
will have 10dB NIHL after 10yrs of music exposure.
• The hearing shifts in teens at that time was similar to
that of 20-30year old age-related threshold shifts.

Discussion/Recommendations
• “Chronic exposure to less intense sounds (i.e., loud
•
•
•
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music) can painlessly accumulate over time leading to
irreversible damage.”
“There is a need for hearing conservation programs,
increased screening, and public health initiatives.”
“Hearing loss prevention through modifiable risk factor
reduction and screening should begin in young
adulthood.”
“Studies show that hearing conservation programs aimed
at youth about damaging noise can have a positive impact
on behavior.”
“Keep cranking up the volume on your earbuds and your
next fitting could be for a hearing aid.”
 In
2009, a panel comprised of health care
professionals, educators, researchers,
and those involved in youth advocacy
and the entertainment industry met to
discuss strategies to prevent NIHL,
especially from personal media devices.
• The conclusion was that changes needed to be
made at the manufacturing level and public
health level.
 “Decibel
Bud”
 www.ListenToYourBuds.org
 “Turn
it to the Left”
 Arkansas
and NY are considering
proposals that would place restrictions
on pedestrians, runners, and cyclists
using headphones.
 ASHA
2011 Public Policy Agenda
“The time may be right for federal
initiatives in the form of new policies or
funding opportunities. ASHA will
monitor federal activities and support
those that will effectively prevent noiseinduced hearing loss.”

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
Do you have a problem hearing over the phone?
Do you have trouble following the conversation when 2 or
more people are talking at the same time?
Do people complain that you turn the TV volume up too
high?
Do you have to strain to understand conversation?
Do you have trouble hearing in a noisy background?
Do you find yourself asking people to repeat themselves?
Do many people you talk to seem to mumble?
Do you misunderstand what others are saying and respond
inappropriately?
Do you have trouble understanding the speech of women
and children?
Do people get annoyed because you misunderstand what
they say?
 If
you have to shout to hear yourself or
someone else, the volume is too loud.
 If you have ringing in your ears, decreased
hearing, or fullness after any exposure,
avoid it in the future.
 Check the volume limit on your personal
music player.
 Use protective headphones.
 Take breaks
 Let your PMD know if you have persistent
ringing or suspect any hearing loss.
[1] Demillo, Andrew. “Fight on distracted walking widens.” Newsday 25 Jan 2011. Print.
[3] Niskar, A. S., S. M. Kieszak, et al. (2001). "Estimated prevalence of noise-induced hearing
threshold shifts among children 6 to 19 years of age: the Third National Health and
Nutrition Examination Survey, 1988-1994, United States." Pediatrics 108(1): 40-43.
[4] Borchegrevink, H.M. (2003). “Does health promotion work in relation to noise?” Noise
and Health 5(18): 25-30.
[5] Agrawal, Y., E. A. Platz, et al. (2008). "Prevalence of hearing loss and differences by
demographic characteristics among US adults: data from the National Health and
Nutrition Examination Survey, 1999-2004." Arch Intern Med 168(14): 1522-1530.
[6] Vogel, I., J. Brug, et al. (2008). "MP3 players and hearing loss: adolescents' perceptions of
loud music and hearing conservation." J Pediatr 152(3): 400-404.
[7] Vogel, I., J. Brug, et al. (2009). "Strategies for the prevention of MP3-induced hearing loss
among adolescents: expert opinions from a Delphi study." Pediatrics 123(5): 1257-1262.
[8] Ha, Peter. “Custom-Made Headphones: Listen Up Before It’s Too Late.” Time 26 April
2010. Print.
[9] Hoover, A. and S. Krishnamurti (2010). "Survey of college students' MP3 listening: Habits,
safety issues, attitudes, and education." Am J Audiol 19(1): 73-83.
[14] Snyder, N. (2010). “Capitol Hill Office Debuts Decibel-Detecting “Bud.” ASHA 15(8): 2223.
[15] Moore, Marat. (2010). “Teens at Risk.” ASHA 15(11): 1,4,38.
[17] Henderson, E., M. A. Testa, et al. (2011). "Prevalence of noise-induced hearing-threshold
shifts and hearing loss among US youths." Pediatrics 127(1): e39-46.