Research Profile - Now listen up!
Researchers and health advocates are expressing increasing concern about the link between overexposure to noise – largely from listening to music at unsafe levels – and the development of early hearing loss in youth.
The Hearing Foundation of Canada has developed an award-winning elementary hearing-health program, Sound Sense/Oui à l'ouie. It wanted to develop a program to reach teenagers. In 2008, the Foundation held the CIHR-funded Youth Listening Summit, with the goal of developing a program to reach this important age group. The summit brought together 30 youth participants, 10 of whom had hearing loss, and 30 professionals from a variety of relevant fields. Prior to the Summit, the youth participants tested the MP3 listening levels of 150 of their peers; the results showed that 30% of teenagers were listening at decibel levels considered dangerous.
The summit led to the development of iHearYa!, a program featuring a live assembly, interactive website and social media site. "The power of iHearYa!," says Gael Hannan of The Hearing Foundation, "lies with the fact that young people are delivering the message in the way that they know their peers will listen". The program was delivered with positive feedback in three pilot project presentations and the Hearing Foundation is now seeking funding to extend the program's reach.
Three participants in the Youth Listening Summit came together recently to discuss the problem of noise-induced hearing loss and this innovative approach to addressing it.
Participants:
Marshall Chasin is an Audiologist and the Director of Auditory Research at the Musicians' Clinics of Canada in Toronto, the Coordinator of Research at the Canadian Hearing Society, and the Director of Research at ListenUp Canada. Dr. Chasin presented a workshop at the Youth Listening Summit about the impact of noise-induced hearing loss on musicians and other people.
Robert Harrison is a Senior Scientist at the Hospital for Sick Children in Toronto, in the Neuroscience and Mental Health Program and a professor in the Department of Otolaryngology – Head and Neck Surgery, and Department of Physiology at the University of Toronto. Dr. Harrison was an advisor on the development of the summit, gave a lecture on biological and clinical aspects of noise-induced hearing loss and participated in all group discussions.
Marwa Nather was a youth participant in the Youth Listening Summit. Herself hearing impaired, she followed up her participation in the summit by helping to deliver one of the pilot presentations of I Hear Ya! to students at her high school, Dante Alighieri Academy Catholic Secondary School. Ms. Nather is now studying psychology at Trent University.
Moderator: Thank you all for being here today. I'd like to start by asking, what is the research telling us about noise-induced hearing loss among youth?
Bob Harrison (BH): There is now plenty of research going on which relates to the basic mechanisms which cause hearing impairments as a result of noise exposure. So in relation to youth and the use of MP3 players, we know a lot about what happens when the ear is stimulated with very high levels of sounds. I could talk for hours on this subject but just to say that we know what sound levels can cause damage to hearing and we know what sort of hearing deficits result from this damage. From this experimental data, we can extrapolate and confidently suppose that the levels (and duration) of sound exposures from misused MP3 players CAN cause damage to the cochlea. We know from much more applied or clinical research that young children and adolescents and adults are at risk for hearing loss because we know that the levels of sound that they are listening to on MP3 players is high enough to cause damage to the hearing.
So we have a wealth of basic and clinical research which tells us there is a potential for hearing loss in youth. More directly, there's a large number of case studies and epidemiological surveys which show that young people who have a history of using MP3 players unwisely are at risk for developing a significant hearing loss.
Marshall Chasin (MC): I do some research but I'm primarily a clinician. It's the expected norm for a 19-year old to have measurable hearing loss already. We know from large epidemiological studies that music does cause hearing loss. In other words, music is at the same level that you'd expect noise to be from a factory. If we subject someone to prolonged exposure to 85dB, which can cause permanent hearing loss, people would say: That's not loud. It's astounding how quiet 85dB is. It's maybe a dial tone on a telephone. It may be people clapping loud in an audience. It's the sound of the toilet flushing when you're very close to it. These are all 85dB. It's your MP3 player on half volume, depending on the earphone. And humans, as a rule, are not very good creatures at discerning differences of loudness. And so people will say: "Well, that doesn't sound that loud." And they're absolutely right, it doesn't sound all that loud but it is damaging, it is intense. We don't really see music in the same way that we see noise. We don't have a good gut feeling of the relationship between intensity that is causing damage, and the loudness which is where we set the volume control. Also we don't have good measuring tools that can give us good sensitive information about the problems of the inner ear.
Moderator: So we have the knowledge, we have the research – how do we get the message out?
BH: There is a need for public awareness, for educational programs to inform at-risk individuals. Marshall Chasin does it for musicians, for example, and we want to do it for young people who are, if you like, ignorant of what they're doing to their hearing. We want to take what we know and we want to prevent the hearing loss. So the Hearing Foundation of Canada organized this "I Hear Ya" Youth Summit. One of the main reasons for it was to try and work out what would be the best way of getting the message across to adolescents.
Moderator: So Marwa, this is where you came in. How did you get involved in the Summit?
Marwa Nather (MN): When I took the device that is used to measure the sound of MP3s to my school, to find the loudness that people were hearing. I found that most were using sounds over 85dB. And I remember I had a sheet saying the normal decibels hearing and the loudness that would cause hearing loss and when I showed it to the students, they were actually very shocked. I didn't see that they would change the loudness that they are listening at, but after the presentation that I did at my school after the Hearing Summit, I noticed many people who were actually trying to lower the volumes.
Moderator: So why do you think they were ready to change just then but not before when you first did this experiment with the measuring device? What made the difference?
MN: I believe that it was because I spoke of a personal experience and maybe they're afraid that it would happen to them too.
Moderator: Tell me more about your participation in this Summit. What was it like?
MN: Well, it was my first time meeting other people with hearing loss and it made me realize that it wasn't an easy thing and that other people really do need to be aware of the loudness that they're hearing in order to prevent hearing loss.
Moderator: Part of the Summit was trying to figure out how this program for teenagers should look. So what things did the youth think would be important for the "I Hear Ya" program for it to work?
MN: Some of the things were to put a ban on high-powered MP3 player or saying the maximum loudness that it should be. And maybe that could give people a warning. And another thing was educational programs at school. Make special classes or, for example, in Sciences, maybe provide a unit about hearing loss and about the ear.
Moderator: Bob, what do you think? This is a bit of a different approach to knowledge translation, I think, involving the youth so strongly. Do you think it makes a difference?
BH: Well, I think Marwa was an important participant; as she mentioned, she represented one who has a hearing loss. And a lot of young people don't have that contact or, even if they do, they don't actually understand what it can mean to have a hearing loss. So there was that shock and awe factor. We thought that getting youth involved in the development of "I Hear Ya" would actually tell us -- and it actually did tell us – more about the way young people communicate and influence each other. For example, this notion that they're using social media to send messages, we felt that this was important to understand and how better to do this than by involving the young people themselves?
Moderator: What do you think changed as a result of their involvement?
BH: Well, I think there are a few things that I got from this. First of all was that youth are going to be more influenced by their own peer group perhaps than by some old professor like Marshall Chasin coming in and giving them a lecture. And so, getting the message spread among themselves is likely more influential. The other thing I found was that you need -- and I use the words "shock and awe" -- you need to sort of exaggerate things a bit and make it a very strong message, as opposed to, "You might get a hearing loss if you do this." You've really got to hit these young people with a very strong message. Subtlety is out of the window, I think, when you're trying to influence kids.
MC: I agree totally with Bob. Even though I'm a really dynamic speaker, nobody is going to listen to a mid-50s guy who represents their dad or mom or whatever; they're going to listen to Marwa, people her age, peers. We've seen this in the musical field for years. In 1990, less than a third of those that I tried to bully into getting earplugs actually got them. By 1999, however, the last time we did the review, about 96 percent of those same people did get them and it wasn't that the old fogies were becoming better salespeople but other people have stepped up to the plate, such as Pete Townsend of the Who, other rock-and-rollers, the Tragically Hip, who are really cool and groovy – and it's these people who have turned something around from being not so cool to, now it's cool to protect your hearing.
MN: People are very ignorant of hearing loss, of the idea of getting hearing loss. I remember when I was back in high school, every time I'd mention to someone: "Your music's so loud and you might get a hearing loss", the response was usually: "Oh, I'm so young, I'm not going to get a hearing loss."
Moderator: So how do you tell them that, no, it's what they're doing now that will harm their hearing?
MN: Honestly, the only way that I can get to them is by showing them what I'm going through, especially if I'm at class and have to use an FM system or I have to raise my hand a couple of times to ask for the teacher to repeat something, then they actually get it and say: Okay, well, we don't really want to go through that.
BH: Young people are immortal, so the idea of hearing loss, as Marwa has said, is something that they associate with older people. But it's not something that's in their experience, which is why Marwa and others like her are very important: to show people that you can have a hearing loss as a young person.
MC: There's no way that we're going to change the view of a teenager, as Bob and Marwa pointed out. I think a multi-factorial approach may be able to work. Getting someone who's cool and groovy out there, Justin Bieber, or someone like him, would do infinitely more than anyone else but even with him, there's only so much that Justin Bieber can do. You'd have to have a multi-factorial approach, statistics with examples and signs of hearing loss, coupled maybe with some manufacturers designing MP3 players with lights going off or a vibration going on if a level exceeded a certain preset level.
BH: One of the things that I have often advised clinicians or parents to do, which is a little bit along the lines of "direct advice from adults isn't going to work," is go to the fancy package your new MP3 player came in and you will find in the box a warning from the manufacturers and, in many cases, they are very extensive and well-written warnings. That sort of direct information from manufacturers in the devices probably does influence to a certain extent young kids.
Moderator: Bob, you've mentioned that you wanted to do some research to the effect of "I Hear Ya" and see how effective it is. So have you been able to do that?
BH: We actually haven't got the "I Hear Ya" programs really up and running yet. You know, we're still at that pilot stage. And once we do have things moving ahead then, certainly, we will want to gain evidence that it's working, by which I mean that the important messages about the risks of hearing loss are effective.
Moderator: Marwa, you made one of the program's pilot presentations at your school. So what do you think? Raising awareness is one thing, getting people to actually change something, a whole other thing. What's the necessary step to get to that changing behaviour?
MN: Students, you have to scare them, show them that this is going to happen. They still won't really understand it. They have this idea that it's not going to happen to them. Or they also say "We're going to enjoy our youth now and then we're going to worry about the future later." But they don't know that the present, actually what happens now, is going to affect their future.
MC: Another approach one could take is that there's nothing inherently wrong with MP3 players or portable music as long as it's done correctly. There's nothing inherently wrong with listening through earphones as long as it's done in moderation. The one thing that I found has been very useful is to say to them: "There's nothing wrong with listening to music. Enjoy it thoroughly. Your favourite song comes on, turn up the volume and enjoy it – just turn it back down to a more reasonable level afterwards." I talk about the '80/'90 rule – 80 percent volume for 90 minutes a day will give you one half of your daily dose of music exposure.
BH: One of the things that Marwa mentioned was that there may not be an immediate perceived hearing loss in youth that are using MP3 players dangerously. And this is one problem because, in many cases, the hearing loss don't become evident to an individual until much later on in their life. So you can have damage to the inner ear that is not revealed by a clinical test or is not evident to the individuals themselves. But the damage is occurring and it will become evident to them much later on in life. Many studies are now indicating that people in their 30s are now having hearing loss that is not age-related. They have a hearing loss that you would normally expect to get at 60 or 70. It is a premature type of age-related hearing loss that is almost certainly due to noise exposure. But this is one of the problems: the immediate effects of noise-induced hearing loss are very often not immediately apparent in young people.
Moderator: Before we go, I'd just like to ask each of you for a statement wrapping up the value of things like the Summit when you're targeting youth.
MN: I would say that it's better to pay now than wait until later to see the results because, later, it's going to be too late and you don't want to have the experience in hearing loss for the rest of your life, especially at a young age.
MC: Prevention is the cornerstone, coupled with early intervention, good education, a multi-factorial approach, more family physicians involved and more aware of the problems when they see the kids.
BH: As Marshall mentioned, a multi-pronged approach to this issue is required. We need to have education of health-care professionals, parents, courses in schools. The peer-to-peer influence is what we were probing at the Youth Listening Summit and it told us that kids talk to each other in very influential ways. They have social media, you know, Twitter, Facebook, all these ways of communicating and, in order to get a message out to youth in general, we wanted to capitalize on this information transmission mode. That, for me, was quite a very important aspect of the Youth Listening Summit. It told us more about how youth might influence each other in sending this important message about being careful about noise exposure levels.