This roundtable discussion addresses how hearing care professionals can guide patients in properly using audio devices and hearing protection to safeguard their hearing.
With the preponderance of consumer hearables and other devices being used for everyday activities such as playing video games, taking phone calls, and noise cancelation on airplane flights, more people than ever are using devices in their ears—even if they don’t wear hearing aids. This is in addition to professionals who wear in-ear monitors and headsets and workers who must wear hearing protection on the job. This roundtable addresses how hearing care professionals can guide patients in properly using audio devices and hearing protection to safeguard their hearing.
Participating in this discussion are members of The Hearing Review editorial advisory board Bopanna Ballachanda, PhD, ABA-C, DFAAA; Marshall Chasin, AuD; and hearing health advocate Shari Eberts, who has adult onset hearing loss.
The Hearing Review: Do you think there’s a need for hearing care professionals to provide more education about which products are needed to actually protect against hearing loss in different situations?
Bopanna Ballachanda: Yes, I think that we as hearing care professionals need to provide more education about how to properly use hearing products and understand their ratings. Most hearables are not noise-abatement devices; while they are placed in the ear, they may not effectively reduce noise simply by being worn. Proper placement is crucial to prevent noise from traveling through the air-conducted channel.
Nowadays, we see bone-conduction headphones used in a variety of listening situations, such as taking phone calls. These headphones are designed for improved hearing rather than for noise abatement. Therefore, it is essential to educate the general public on how we perceive sound and the adverse effects of noise exposure. This understanding will help raise awareness about the limitations of these products.
Marshall Chasin: There is definitely a need, and I would argue that the need is comparable to the effort we expend when we see a client clinically for amplification. With hearing aid amplification we assess and verify using real ear measurement. This provides “positive” gain. Hearing protection will provide “negative” gain. The definition of gain is the difference between the input and the output, so if a hearing protector provides negative gain, this is the desired attenuation outcome that we are looking for. And we can use the same tools as with hearing aids to verify their function—namely real ear measurement.
Shari Eberts: Hearing loss is gravely misunderstood, including the fact that once hearing is damaged, the loss is usually permanent. Given the proliferation of “heavy listening” activities such as video games, phone calls, music streaming, and airplane flights, people are often overstimulating the delicate hair cells in their cochleas, creating long-term damage without realizing it. It is imperative that hearing care professionals educate their patients about how to protect the hearing that they still enjoy. This information should include a general description of how hearing can be damaged, as well as recommendations for the best ways and/or devices to help protect it.
Given the importance of this issue, this type of education should reach far beyond the hearing care community into schools and primary health settings. Given their extensive expertise, HCPs will be critical in helping to encourage their communities to implement programs such as this across the board.
HR: Are you seeing more people using hearables and other newer devices that can also function as hearing protection?
Chasin: Most of the hearables that are available have some mechanism to act as hearing protection- whether its electronically or acoustically based—and I see these everywhere. In many cases people are wearing earphones to listen to their music but they don’t realize that these same headphones have sound attenuation capabilities. This question can also be flipped around —are you seeing people using devices that can function as hearing amplifiers — and the answer is a scary, Yes!
People don’t always realize that “simple” earphones that are used to listen to music or answer telephone calls themselves provide significant amounts of amplification. As a field, I think that we are guilty of not being sufficiently aware of and assessing this risk, in order to ensure that the typical listening outputs are not excessive.
HR: What are some of the drawbacks of hearing protection that hearing care professionals should be aware of and share with patients? And are there any differences depending on the type of hearing protection?
Ballachanda: The most important question is how much noise a person is exposed to and how to reduce the levels that reach the inner ear in order to minimize damage to the inner ear organs. It’s important for patients to understand that noise, like any sound, travels to the inner ear via two pathways:
1. Air conduction, which is the normal hearing route through the outer, middle, and inner ear.
2. Bone conduction, which allows sound to reach the middle and inner ear directly, potentially causing damage. However, for sound to travel through bone conduction, it must be quite loud; lower levels may not activate this pathway, which is good news.
There are different types of hearing protection available depending on individual needs and the level of noise reduction required. This is where a qualified professional can help determine the most appropriate option for a given situation.
Chasin: The one major drawback is that more is not necessarily better. Higher “published NRR values” are misleading and, like hearing aid amplification, one needs to know in which environments the hearing attenuator will be used. Is it for listening to music while jogging? Is it to protect one’s hearing at a concert or while playing a musical instrument? Is it to listen for communication signals while working in a noisy location? Or perhaps just to sleep while traveling on a plane? Depending on the needs of the individual, different forms of hearing protection may be required. It may be that someone requires hearing protection that automatically provides slight amplification for soft level sounds and slight attenuation for louder sounds, and this positive gain/negative gain characteristic has been around for over 30 years.
Returning to the issue that “more is not necessarily better,” recall that for each 3 dB of sound attenuation, the potential for hearing loss is ½. Even a hearing protector that attenuates “only” 15 dB, such as many musicians’ earplugs, allows the user to be exposed 32 times as long as without hearing protection. If a person is only going to a 2-hour rock concert on Friday night, this may be all that they need, and they should be counseled that if they experience tinnitus then just lay off mowing their lawn until Sunday…or perhaps get someone else to do it.
While some hearing protection may be good, too much may not be. Providing someone with hearing protection on the order of 35 or 40 dB may sound impressive, but if the noise source is less than 100 dBA, this is overkill…and speaking of “overkill,” imagine going for a jog and not being able to hear the Mack truck coming up behind you.
HR: How are hearables and other newer devices that can also function as hearing protection changing the way people think about hearing health?
Chasin: Hearables are excellent products that translate a potentially boring speech by the hearing care professional into reality. As a clinical audiologist I can tell my clients all about hearing protection and other strategies until I am blue in the face, but there is nothing like a hearable that can provide both positive and negative gain that just does it for them.
HR: What can we expect to see in the future of hearing protection?
Ballachanda: Regardless of whether a sound is novel or simply noise, we are currently exposed to numerous sounds that can have effects beyond just hearing loss. These sounds may lead to additional consequences, such as fatigue, irritability, and changes in health. And this issue is not going away. Therefore, it will be important for HCPs to stay on top of advances I expect and hope to see in hearing protection that may help counteract these problems.
Chasin: The field of hearables (and hearing aids) will have more of this automatic positive gain/negative gain feature that will provide amplification where needed, and attenuation where needed. This will have positive influences on the hearing aid industry. Historically, hearing aid manufacturers were hesitant to allow their hearing aids to provide negative gain, and functionally act as hearing protection. This sometimes made the noise floor of the hearing aid audible; however, with newer algorithms such as expansion and lower noise-floor microphones this should not be as much of an issue. I can envision impending hearing aid technology that allows hearing aids to provide BOTH positive and negative gain in their WDRC circuitry as required by the individual.
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