Teens at Risk: Audiologists Respond Audiologists are weighing in on the research on teen hearing loss published two months ago in the Journal of the American Medical Association (JAMA) and its implications for the profession. The study, described in Part 1 of this series (The ASHA Leader, Sept. 21), showed a 31% overall rise in ... Features
Features  |   October 01, 2010
Teens at Risk: Audiologists Respond
Author Notes
  • Marat Moore, managing editor of The ASHA Leader can be reached at mmoore@asha.org.
    Marat Moore, managing editor of The ASHA Leader can be reached at mmoore@asha.org.×
Article Information
Hearing & Speech Perception / Hearing Disorders / School-Based Settings / Features
Features   |   October 01, 2010
Teens at Risk: Audiologists Respond
The ASHA Leader, October 2010, Vol. 15, 8-10. doi:10.1044/leader.FTR1.15122010.8
The ASHA Leader, October 2010, Vol. 15, 8-10. doi:10.1044/leader.FTR1.15122010.8
Audiologists are weighing in on the research on teen hearing loss published two months ago in the Journal of the American Medical Association (JAMA) and its implications for the profession. The study, described in Part 1 of this series (The ASHA Leader, Sept. 21), showed a 31% overall rise in the prevalence of hearing loss in teens aged 12 to 19 from 1988–1994 to 2005–2006.
Most of the hearing loss was slight, between 15 and 25 dB—but the prevalence of mild and worse (25 dB or greater) hearing loss increased 77%. The study also found that unilateral hearing loss was more common than bilateral (for reasons unknown), and that individuals reporting an income below the national poverty level in the 2005–2006 survey cycle had a significant risk of hearing loss.
The study’s Aug. 18 publication triggered a media blast—ASHA media efforts alone reached a broadcast and online audience of nearly 45 million people. This media exposure pushed noise-induced hearing loss—and audiologists—into the national spotlight and sparked discussions on how to protect the hearing of young Americans. Audiologists are taking that conversation further, exploring with colleagues and ASHA their ideas for strategies to educate people of all ages about the impact of hazardous noise on hearing health and quality of life.
The ASHA Leader interviewed six audiologists in a variety of settings—private practice, academia, occupational audiology, and educational audiology—for their perspectives on the impact of potentially accelerated hearing loss in the rising generation, and for their ideas for next steps audiologists can take to continue to play a visible role in addressing the problem of noise-induced hearing loss. The interviews follow on pages 8–10.
What’s their bottom line? These professionals say:
  • The time is ripe for audiologists to make connections in school systems and offer themselves as a resource.

  • Parents need to understand the risk factors and have their child’s hearing screened if the child is in a high-risk group.

  • The cultural dimension in an individual’s exposure to dangerous levels of sound must be considered.

  • Educational audiologists are few in number, and need the support of all audiologists in a unified campaign.

  • School-based speech-language pathologists could help link science teachers and administrators with audiologists in educational outreach to middle schools and high schools.

  • Our goal should be the eradication of noise-induced hearing loss in our children’s lifetime.

Audiologists are front and center in this national discussion. In Part 3 of this series, the Leader will profile programs such as ASHA’s “Listen to Your Buds” and others—including “Dangerous Decibels”—and provide a full list of resources to those members committed to making a difference on the issue of noise-induced hearing loss.
Brian Fligor, ScD, CCC-A
Director of Diagnostic Audiology,
Children’s Hospital Boston
Instructor in Otology and Laryngology,
Harvard Medical School
We know that hearing loss is related primarily to two factors—age and noise. Given that the recent JAMA study evaluated teenagers, age-related hearing loss is factored out. So it’s likely from noise—from many sources. It’s not all about headphones. But with 90% of teens using portable listening devices (PLDs), it would not be unreasonable to expect an acceleration of age-related changes in hearing due to what these one in five teens have been doing to their hearing health during their first two decades. What if their lifestyle choices cause them to have hearing more like 30- or 40-year-olds than like teenagers? Their “ear age” may have greatly outpaced their chronological age. That could mean that at age 30 or 40, they may have the hearing of a 50- or 60-year-old. They may need hearing aids at much younger ages.
This study also could affect our thinking about the standard of “audiometric zero,” which is based upon screened 18-year-olds who supposedly have pristine hearing. We use that measure to determine our expectations for age-related hearing loss. This study says that one in five teens tested didn’t have pristine hearing—that’s a huge number.
The JAMA study was unable to show any causal link for hearing loss, with the exception of children with a lower socioeconomic status. That factor is something we know to have a very robust effect, but it’s hard to explain why your hearing is worse if you are poor. I was concerned about the paper’s inability to show cause and effect related to the use of firearms, which was not shown to be a significant predictor of hearing loss in this study. That finding makes me wonder if the questions they asked were not sensitive enough to show cause, because use of firearms is the leading cause of recreational noise-induced hearing loss (NIHL).
Here’s the good thing—because this research appeared in JAMA, hearing health is in the public’s mind. Awareness is a great thing, but it’s important that it not be overblown. The amount of hearing loss is not outrageous. Most of the hearing loss is slight.
As a first step, parents need to ensure that teens see an audiologist to establish a baseline hearing level. Audiologists can then recommend a hearing loss prevention program if, for example, a child is playing percussion in a marching band. My message to parents is simple—respect your child’s hearing. People need to take responsibility for hearing health for themselves and their children, but it’s up to us to give them educational tools for making better hearing health decisions. Audiologists also should consult with industry to help develop technical tools that help consumers use their devices more responsibly.
Audiologists are uniquely suited to help children and teens get preventive hearing care, not so different from preventive dental care. Musicians, teens who use PLDs heavily, or any at-risk individuals need an audiologist like everyone else needs a dentist.
The public awareness brought about by the JAMA research offers us a great opportunity—audiologists could partner with science teachers and speech-language pathologists in the schools, and they could contact their administrators about bringing in an audiologist. We could participate in science fairs in middle school and high school, and we could do in-service training for biology and physics teachers.
The time is ripe for audiologists to make connections in the school system and offer ourselves as a resource. Our participation also may encourage some students to have an interest in audiology at a time when there is a critical need to promote careers in audiology and hearing science.
Mary McDaniel, AuD, CCC-A
Occupational Audiologist Pacific Hearing Conservation Seattle, Wash.
For decades we have known the effects of noise on hearing and that noise-induced hearing loss often is preventable. To think that noise-induced hearing loss is primarily an occupational hazard is a misconception. We live and play in a noisy world, and noise damage knows no age boundaries.
It is tragic that hearing loss prevention isn’t part of every child’s school curriculum. We must teach our children at an early age about how to prevent noise-induced hearing loss. This effort also can be accomplished through a media campaign that would serve to educate parents and the public.
Young people often underestimate the impact of noise and hearing loss on their lives. Even a slight loss can affect an individual’s ability to discriminate sounds, perhaps missing the punch line of a joke or the details of a school assignment. Hearing loss will affect both their social and academic lives, and will be with them throughout their lifespan.
The most important strategy that could be implemented through both the media and the nation’s schools is a program of education and motivation about the potential hazard of noise in our lives. There’s absolutely no reason that a school-based SLP could not assist in this process, unless it might be because of a bulging caseload! We also could enlist parents or teachers’ aides to spread the word.
One of the most significant things about this research is the attention that it brings to noise-induced hearing loss. This current research illuminates a problem that will affect our society for years to come.
Our goal should be to eradicate noise-induced hearing loss in our children’s lifetimes.
Janice Trent, AuD, CCC-A
Private-practice Audiologist
Hearing Health Care Services LLC
Bowie, Md.
The JAMA research dovetailed with the findings of a report by the Kaiser Family Foundation published in January that looked at the use of all media by children 8 to 18 years old. They found that kids were engaged with entertainment media an average of 7.5 hours a day—using earbuds with all types of media including laptops, television, video games, and personal listening devices like iPods and MP3 players.
It’s a bombardment of the auditory system. And classrooms are another source of noise. After doing a radio talk show interview on the impact of the JAMA research, I received an e-mail from a teacher who said he wished we had addressed school cafeteria noise. It was a stressor for him and he wondered about the impact of high noise levels on digestion.
We need to make a bigger statement about protecting hearing health—and not just to kids in the schools. The question for adults is, have we been too tolerant of noise? If adults are not modeling hearing conservation, why should we expect our children to protect their ears?
We also need to consider the cultural dimension in the audiological context. I’m African American and a preacher’s wife. One of the things I have found is that in many evangelical churches the music is too loud. I have done breakfast workshops with area ministers talking about noise levels, the impact on their congregants, and strategies to change the listening environment. I’m not trying to curtail the spirit, but a 150-voice choir does not need an amplifier set at maximum volume.
After another radio talk show interview, a blogger wrote to ask, can you do something about the volume of music at bar mitzvahs? I was reminded that loud music has infiltrated our lives in many different areas. As audiologists, we are the professionals to address publicly the issue of sociocusis in our communities and its impact on the auditory system.
We need to talk aggressively about prevention—and not just screening, but a full diagnostic evaluation. Most insurance will pay for that, similar to a complete vision evaluation. We need to start looking more broadly at all environments: classrooms, the workplace, recreational activities, transportation, and the home environment.
I applaud the JAMA study, but we also need to let the public know that researchers in our discipline have done great research on these issues.
So many people do not understand noise-induced hearing loss or its risk factors. We have to educate the public about the impact of noise. Audiologists are the go-to people on noise-induced hearing loss—we’re out there on the front lines making the diagnoses and encouraging prevention, and with the recent rise in public awareness, it’s time to ramp up our efforts on these issues and try to make a real difference.
Dennis Hampton, PhD, CCC-A
Private-practice Audiologist
Westchester Audiology Center
White Plains, N.Y.
The JAMA article confirms that hearing loss appears to be on the increase and a significant cause of the increase appears to be hearing loss we inflict on ourselves. Our ears don’t care whether the toxic noise levels are from the factory floor or motorcycle noise, Beethoven or rap.
Is the use of personal headsets by teens a cause? Years ago, that question was answered when Maurice Miller, an audiologist from New York, studied the output levels of the Sony Walkman portable tape player (Hearing Loss Magazine, 2006). He found that users of personal headsets often set the Walkman at levels that could damage hearing. Today, it’s MP3 players, plus rock concerts and all the other sources of noise around young adults.
We no longer have to debate whether personal headphones (and loud music) causes hearing loss. Our job is to spread that message to other health care providers, educators, and to teens and young adults.
This also is an opportunity to reinforce our belief that hearing screening, which takes place in the primary school setting in most states, should be a part of a person’s health examination throughout the lifespan. Unfortunately, only about 10% of physicians actually screen for hearing loss.
The publication of this research is an opportunity, then, for us to prevent hearing loss by increasing public awareness, educating health care providers and the public, and encouraging regular hearing screenings.
In my practice, we mail newsletters to our patients and local physicians, and we will review this research in an upcoming article, written for physicians, that will address the role of the family physician in screening for and preventing patients’ hearing loss.
School-based speech-language pathologists and educational audiologists could have an important role in bringing this research to the attention of science teachers--and school nurses and health teachers. Hearing loss prevention could be incorporated into the science and health curricula. Local SLPs might also recruit a local audiologist as the hearing expert to talk to students in science and health classes.
And why not invite an audiologist to be the commencement speaker at graduation! Graduates, go out into the world--but protect your hearing!
John Ribera, PhD, CCC-A
Director of Audiology
Department of Communicative Disorders and Deaf Education
Utah State University
Logan, Utah
With the development of portable devices that deliver favorite tunes, there is nothing to dampen the sound between the transducers of these devices (earphones that fit in the concha) and the eardrum. If there is high ambient noise, the tendency is to mask the unwanted sounds by raising the volume even higher.
If we fail to turn the tide, adolescents and young adults will begin to experience hearing loss much earlier in life, a condition that is crucial because their academic performance can be adversely affected. Hearing loss also can affect daily activities, social interactions, career progression, and quality of life.
We must do more to educate and motivate our youth to think about exposure to dangerous levels of noise. This effort needs to be a multifaceted approach that targets not just youth, but also parents, teachers, and administrators, and other groups that reach young people to help create a new culture and way of thinking about hearing conservation.
In Europe there is pressure to require manufacturers of personal listening devices to cap volume levels. This approach might be one to consider in this country. I suggest that young listeners use the 60/60 rule—no higher than 60% of maximum volume for no more than 60 minutes.
Classroom presentations on youth hearing health and noise-induced hearing loss can help bring about change. Where there are no educational audiologists, speech-language pathologists could help bring other audiologists to the schools to spread the word.
Also, young people usually have heroes in sports and entertainment. The more stars and celebrities who are willing to speak on behalf of hearing conservation, the better. I think ASHA and other organizations have stepped up to the plate by developing materials and websites like “Listen to Your Buds” geared to youthful listeners. Audiologists and speech-language pathologists should always be vocal advocates for hearing conservation and educating the public about the importance of preserving the ability to communicate.
Tena McNamara, AuD, CCC-A
President-elect, Educational Audiology Association
Assistant Professor, Eastern Illinois University
When we were growing up, when the stereos went up, the windows went down. Now the sound is going directly into the ears of young people. I work at a special-education co-op and on a college campus, and I see college kids working out in the gym with earbuds on and the levels set at high intensities—which is likely to be a dangerous combination because blood flow increases to the limbs and away from the ears. Some of the oxygen to the cochlea may be depleted, making hair cells more susceptible to noise-induced hearing loss.
We need a strong education campaign. It’s hard for educational audiologists—we’re spread so thin. Sometimes we have one professional for every 20,000 to 30,000 students. All audiologists should be involved. We need a team effort led by audiologists with school-based speech-language pathologists, teachers, and administrators. An initial step would be to gather materials and resources to use for in-service training with school districts. We could then implement hearing conservation programs, and put posters and other materials around the schools with the message: Turn it down!
Kids are surrounded by electronics, and they don’t realize the consequences to their health. Hearing loss is permanent, and at present there is no cure. Hearing decreases with age, so if you’re starting out with a slight or mild loss at 20, you don’t have the best prognosis.
Hearing conservation has been with us for years. We’re really good at promoting it one-on-one, but now we need to step up and expand our efforts and do it in a unified way. This is not just an issue with teenagers. ASHA has the “Listen to Your Buds” campaign that reaches out to young children. We also need to heighten public awareness among adults. We need a public campaign that reaches all age groups.
Media Alert for Audiologists

Audiologists wishing to connect with media representatives to spread the message about the importance of hearing conservation can contact ASHA’s public relations unit by e-mailing pr@asha.org.

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October 2010
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