Welcome back to Dr Euan's TGIF blog post!
Good news 😊 is that we can now dine in together as a household of 5! if you are all fully vaccinated!
Many of us / our children like to use ear phones in our daily lives and interactions for communication, work, music and entertainment. Here is an important and useful link to check out, especially if you have teenagers who are always on their ear phones:
"It is our attempt to reach out to educate our youth and young people on the risks of overexposure to loud music, eg MP 3 through their ear phones, as they may develop premature hearing loss due to noise damage to the inner ear hair cells. There is a direct co-relation to the volume and duration of the loud music exposure to the hearing loss sustained."
Also, in a study conducted locally in 2014, about 2,000 students were studied for the effects of their portable music player usage. Their conclusion on the music listening preferences and habits of Singapore youth who listen to music on portable music players, delivered through ear phones, showed that one in six (1/6) of our youth are at risk of developing leisure Noise-Induced Hearing Loss (NIHL), with male students at a higher risk.
Ref: Singapore Medical Journal (2014) Vol 55 (2): 72-77
Q: How Do We Hear?
We hear sound by way of vibrations (sound waves) that reach our ears. We recognise these vibrations as speech, music, or other sounds. The sound waves are processed through the middle and inner ears, and translated into neuronal signals which are transmitted to the auditory cortex of our brain.
Q: What are the parts of the Ear?
We hear sound by way of vibrations (sound waves) that reach our ears. We recognise these vibrations as speech, music, or other sounds. The sound waves are processed through the middle and inner ears, and translated into neuronal signals which are transmitted to the auditory cortex of our brain.
Outer Ear The outer ear—the part of the ear you see—funnels sound waves into the ear canal. The sound waves travel through the ear canal to reach the eardrum.
Middle Ear The eardrum vibrates from the incoming sound waves and sends these vibrations to three tiny bones in the middle ear. These bones amplify, or increase, the sound vibrations and send them to the inner ear.
Inner Ear The inner ear contains a snail-shaped structure filled with fluid called the cochlea. Sound vibrations create waves in the cochlear fluids. As the waves peak, they cause tiny hair cells to bend, which converts the vibrations into electrical signals. These tiny hair cells are called stereocilia (types of receptors that can detect sound).
Auditory Nerve The auditory nerve carries the electrical signals from the inner ear to the brain. The brain interprets the signals as sound that you recognise and understand.
Q: What does loud music do to our ears?
Loud noise is particularly harmful to the inner ear (cochlea). Such damage can lead to symptoms of hearing difficulty, tinnitus (ringing in the ears / head) and communication problems.
The inner ear is fluid filled and has a very delicate array of highly specialised hair cells, which are the most sensitive mechano-transducer cells anywhere in our body. These hair cells respond the the travelling wave in the inner ear fluids and generate minute electrical signals which travel up the auditory (hearing) nerve to the brain.
A one-time exposure to extreme loud sound or listening to loud sounds / music for a long time can cause hearing loss. Loud noise damages cells and membranes in the cochlea. Listening to loud noise for a long time can overwork hair cells in the ear, which can cause these cells to die. The hearing loss progresses as long as the exposure continues. Harmful effects might continue even after noise exposure has ceased. Damage to the inner ear or auditory neural system is generally permanent.​
However, if loud noise damages too many of the hair cells, some of them will die. Repeated exposure to loud noises will (over time) destroy more and more hair cells. This can gradually reduce your ability to understand speech in noisy places. Eventually, if hearing loss continues, it can become hard to understand speech even in quieter places.
Q: How does listening to loud music on my ear phones damage my hearing?
Much attention has been paid to work related noise exposure in industry, and Occupational Health and Safety standards and regulations are now in place to limit workers noise exposure, there is no such regulations with respect to leisure activities or recreational music.
Thus far, little attention has been paid to leisure noise-induced hearing loss.
It is known that the long term use of portable music players can in fact impair hearing function (J Otolaryngol 2007 36:181-185); in particular, MP3 players have been shown to produce significant elevation in hearing thresholds (Yonsei Med J 2009: 50: 771-776)
The most recent study on local Singaporean youth shows that a significant percentage (16.4%) of our youth listen to music on their portable music players at sound levels exceeding the industrial and workplace TWA 8 hr limit of 85 dBA.
The Time Weighted Average (TWA) is usually computed on an 8 hour work day, or TWA 8hr.
If we project the longer term effect on these youth, then we can expect 3% of our youths to develop NIHL in their lifetime due to listening to music at high levels on their portable music players.
With births and new citizens averaging 45,000 per year, we can expect up to 1,300 new cases of NIHL per year.
This is a significant number of people who will be affected by hearing loss related to loud music exposure via their portable music players and ear phones.
Q: What can we do to prevent such hearing loss?
To best tackle this problem, the basic tenets of a Hearing Conservation Programme (HCP) should be implemented, namely :
Education
Hearing Protection
Audiometric Screening
Education: more has to be done to educate our youth on the risk of "dangerous decibels." MOE can consider to implement hearing conservation curricula in our schools on a continuing basis, to encourage responsible music listening behaviour.
Hearing Protection: it is shown that almost 60% of students listened to music on the MP3 players at a TWA 8hr level that exceeded 85 dBA. Interestingly, in keeping with the typical high risk behaviour of young males, it has been shown that male youth are definitely more likely to listen to music at louder volume cf their female counterparts. In the local study in 2014, Malay males were the most likely to listen to loud music on their MP3 players, so perhaps more education and targeted interventions are needed.
Audiometric Screening: this is an important component of any Hearing Conservation Programme (HCP), as it may help detect hearing loss at an early stage. Such early detection can provide opportunities for measures to be taken to prevent further noise injury and subsequent hearing loss.
So the next time, you are tempted to RAMP UP the volume on your portable music player ..........well, think again! Try to enjoy your music at lower levels. Sometimes, less is more especially when it comes to protecting your hearing.
Please do share this URL with your younger friends / co-workers or relatives; it is a collaborative effort of many top Universities and institutions to highlight and educate:
Meanwhile, here are some references listed below as you may want to look up to learn more on this topic. If you or your loved one is experiencing any symptoms of hearing loss, do consult your GP or ENT Specialist for a check-up.
Well, have a good weekend ahead, folks!
References:
1. Low WK, Pang KY, Ho LY, Lim SB, Joseph R. Universal newborn hearing screening in Singapore: the need, implementation and challenges. Ann Acad Med Singapore 2005; 34:301-6.
2. Nelson DI, Nelson RY, Concha-Barrientos M, Fingerhut M. The global burden of occupational noise-induced hearing loss. Am J Ind Med 2005; 48:446-58.
3. Dalton DS, Cruickshanks KJ, Wiley TL, et al. Association of leisure-time noise exposure and hearing loss. Audiology 2001; 40:1-9.
4. Niskar AS, Kieszak SM, Holmes AE, et al. 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 2001; 108:40-3.
5. Zenner HP. [Leisure time noise. Hearing damage in every 10th adolescent is possible]. HNO 1999; 47:225. German.
6. Peng JH, Tao ZZ, Huang ZW. Risk of damage to hearing from personal listening devices in young adults. J Otolaryngol 2007; 36:181-5.
7. Toh ST, Lu P, Ong M, Seet B. Prevalence of hearing disorders in Singapore military conscripts: a role for routine audiometry screening? Singapore Med J 2002; 43:622-7.
8. Ministry of Education. Speech by Mr Heng Swee Keat, Minister for Education, at Ngee Ann Polytechnic 50th Anniversary Celebrations Launch Event on 25 Apr 2013, 1700 hrs, Ngee Ann Polytechnic Convention Centre. In: Ministry of Education, Singapore: Speeches [online]. Available at: http://www.moe.gov.sg/media/speeches/2013/04/25/speech-by-mr-heng-swee-k.... Accessed September 3, 2013.
9. Catalano PJ, Levin SM. Noise-induced hearing loss and portable radios with headphones. Int J Pediatr Otorhinolaryngol 1985; 9:59-67.
10. US Department of Health and Human Services. Occupational Noise Exposure – Revised Criteria 1998. Ohio: National Institute for Occupational Safety and Health; 1998.
11. Ministry of Manpower, Singapore. Workplace Safety and Health Guidelines. Hearing Conservation Programme. Singapore: Ministry of Manpower; 2010.
12. International Organization for Standardization. Acoustics – Determination of occupational noise exposure and estimation of noise-induced hearing impairment. Geneva: International Organization for Standardization, 1990.
13. Kim MG, Hong SM, Shim HJ, et al. Hearing threshold of Korean adolescents associated with the use of personal music players. Yonsei Med J 2009; 50:771-6.
14. McNeill K, Keith SE, Feder K, Konkle AT. Michaud DS. MP3 player listening habits of 17 to 23 year old university students. J Acoust Soc Am 2010; 128:646-53.
15. Levey S, Levey T, Fligor BJ. Noise exposure estimates of urban MP3 player users. J Speech Lang Hear Res 2011; 54:263-77.
16. Singapore Department of Statistics. Census of the population 2010. Advance Census Release. Singapore: Ministry of Trade & Industry; 2010.
17. Manpower Research and Statistics Department. Singapore Yearbook of Manpower Statistics, 2010. Singapore: Ministry of Manpower; 2010.
18. Folmer RL, Griest SE, Martin WH. Hearing conservation education programs for children: a review. J Sch Health 2002; 72:51-7.
19. Folmer RL. The importance of hearing conservation instruction. J Sch Nurs 2003; 19:140-8.
20. Harris CR, Jenkins M, Glaser D. Gender Differences in Risk Assessment: Why do Women Take Fewer Risks than Men? Judgment and Decision Making 2006; 1:48-63.
21. Helleman HW, Jansen EJ, Dreschler WA. Otoacoustic emissions in a hearing conservation program: general applicability in longitudinal monitoring and the relation to changes in pure-tone thresholds. Int J Audiol 2010; 49:410-9.
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