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Prevention education should include keeping ears healthy. Although the majority of patient presentations are noise-induced, some simple measures could shield the ear. Wearing earplugs or earmuffs while in a noisy working environment or engaged in a recreational activity, chore, or hobby that encompasses loud noise could prevent damage to the ear, says Kathleen Yaremchuk, MD, vice chair of the department of otolaryngology — head and neck surgery at the Henry Ford Hos- pital in Detroit. Yaremchuk is a member of the subcommittee for the Medical Aspects of Hearing Loss for the American Academy of Otolaryngology in Alexandria, VA.
People hear because sound waves travel through the air into the ear opening through the ear canal to the eardrum. As the eardrum vibrates, the sound travels to the small bones of the middle ear, which transmits them to the nerves in the inner ear. The vibrations create nerve impulses that go directly to the brain so that the sound can be interpreted. Hearing loss from noise occurs when the nerve endings in the inner ear are destroyed.
"The hearing damage that we sustain because of noise is cumulative, so it is over a lifetime," explains Yaremchuk. A person may have worked in a factory where loud machinery was present, been in the military where firearms were used, and have a woodworking shop set up in the basement at home with electric saws. All those activities create a person’s total exposure or life history. That’s why it is important for people to protect their ears when using a snow blower, lawn mower, or chain saw and even while sitting in the stands at a rock concert or auto race, she adds.
Single incidents, such as a firecracker or gun going off near the ear, can cause damage as well. When the ear rings, it is a sign that the person has sustained a concussion to their ear, says Yarem-chuk. According to the American Academy of Otolaryngology, noise may be harmful under the following conditions:
• A person has to shout to be heard.
• The noise hurts their ears.
• They have difficulty hearing several hours after exposure to the noise.
• They experience ringing in their ears.
"There are different increments of sound with sound measured in decibels. When we talk about safety, there is individual susceptibility to noise," says Yaremchuk. However, the longer a person is exposed to loud noise, the more damaging it can be. According to experts, continuous exposure to sound at 85 decibels is dangerous. Lawn mowers, shop tools, and truck traffic have a decibel level of 90; chain saws and snowmobiles are about 100 decibels; auto horns and loud rock concerts are 115 decibels; and jet engines and gun muzzle blasts are 140 decibels.
Get a baseline
Anyone who’s occupationally or nonoccupationally exposed to loud noise should have a hearing test, advises Yaremchuk. This will create a baseline from which a person can measure their hearing in regular testing to make sure they are not allowing further damage to occur. The frequency of hearing tests depends on what the baseline shows, but if loss is indicated, the tests usually are recommended every one or two years.
People usually experience warning signs of hearing loss during conversations. They can’t hear when someone is talking and frequently have to ask the person to repeat what was said. Also, they notice that people tap them on the shoulder to get their attention before speaking because they don’t hear otherwise. "It is a lot easier to know that you are losing your sight. You pick up the newspaper and you can’t read it, but when you lose your hearing, you don’t know what you are missing. For the majority of people, it is gradual," says Yaremchuk.
Hearing loss is like standing in water up to the chin with 80% of the body covered, she says. The person is OK; but if the water rises two or three more inches, he or she is in trouble. It is the same with hearing loss. All of a sudden, people notice that they can’t hear, and think that the loss has occurred only during the past year. Yet it probably has happened over 30 or 40 years and has just gotten to the point where conversational speech is difficult to hear, says Yaremchuk.
People lose their connection to others when they can’t hear because they can’t communicate. "Quality of life is very important and shouldn’t be underestimated. When people are unable to hear on a telephone, it is very problematic," says Yaremchuk. Therefore, communication is the key reason to get a hearing aid. If people with hearing loss work or are involved in lots of social activities, then a hearing aid is important. However, if they are older, live by themselves, turn the TV or radio up as loud as they want, and don’t go out much, then a hearing aid is of little benefit, says Yaremchuk.
The best scenario is for people to make a habit of reaching for the earplugs or earmuffs when around loud noise. "It is just like if you are in a car, you wear a seat belt, and if you are going somewhere where there will be noise, have earplugs with you," says Yaremchuk. n
For more information on preventing hearing loss, contact:
• Kathleen Yaremchuk, MD, Vice Chair, Department of Otolaryngology — Head and Neck Surgery Henry Ford Hospital, Member Subcommittee for the Medical Aspects of Hearing Loss, American Academy of Otolaryngology — Head and Neck Surgery Inc., One Prince St., Alexandria, VA 22314, Telephone: (703) 836-4444. Web: www.entnet.org.