Leisure Noise and Hearing
10 October 2017 (online)
The relationship between leisure noise and hearing has been a topic of research in the audiological literature for the past several decades. During this time, researchers have sought to establish how exposure from leisure noise compares to that from occupational sources,   and whether noise-induced hearing loss is increasing as a result of our exposure to leisure noise.  Several evidence-based hearing health programs and campaigns have been developed as a result, including Dangerous Decibels (dangerousdecibels.org), Plug'em, (plugem.co.uk), and our own HEARsmart (hearsmart.org).
Mounting campaigns to raise awareness about hearing health is difficult, and undertaking the supporting research is also challenging because the studies are nearly always retrospective and often rely on human memory and recall of past events. Sometimes an element of exaggeration, hype, and even moralization can creep into the literature. Not only is this unhelpful for those of us seeking answers to questions of leisure noise and hearing, it also can lead to mistrust in the very people we are trying to reach.
In this issue, I have compiled a body of work from leading researchers around the world that eschews the hype and reflects the breadth and quality of work being done in the area of leisure noise. My aim was to provide readers with a good cross section of current research that sets out the potential risk that leisure noise exposure poses to hearing. Perhaps more importantly, these articles also offer suggestions for ways we can minimize and manage that risk.
First up is an article by a group of distinguished U.S. researchers, led by Deanna Meinke, who have put together a comprehensive account of research relating to recreational firearm exposure. They outline the challenges of measuring gun-related noise, demonstrate the very real risk that impulse noise poses to shooters, and present strategies for mitigating this risk. I imagine that many readers will come to regard this article as their go-to reference when advising clients who wish to know more about firearm exposure. The article ends with a call to arms for clinicians: “Aim to be an informed resource in your community.” With this article in your hands, that aim should be a whole lot easier to achieve!
The second article, by Gilliver and colleagues, presents the results of a large-scale Australian survey on the use of personal listening devices (PLDs). This topic seems to attract great media attention, perhaps because of the visual ubiquity of earbuds and headphones and the preponderance of young people who use them. PLDs are often the leisure-noise scapegoat, and in this article, the authors seek to clarify the extent to which this is warranted. They conclude that although PLD use throughout the community is widespread, high-risk PLD use is relatively low. Although participants' hearing was not directly assessed, an association between risky PLD use and self-reported listening difficulties suggests that hearing may be impacted. The article concludes with evidence-based recommendations for clinicians and hearing health promoters on how to initiate effective conversations about excessive PLD use with clients and the community.
The third article, by Fulbright and colleagues, presents the results of a study into the relatively new topic of hidden hearing loss, thought to be a result of noise-induced cochlear synaptopathy. It is exciting to be drawn into the throes of this new research area, in which researchers are grappling to find the truth by employing a wide range of behavioral, self-report, and electrophysiological methods in different age groups with varying noise exposure histories. Not surprisingly, researchers have been reporting conflicting results and proposing a range of explanations for their findings. This article is no exception: making use of both behavioral and electrophysiological measures, it provides yet more evidence of the elusive nature of the dose–response relationship between noise exposure and cochlear injury in humans.
The authors of article 4 (Carter and Black) and article 5 (Hunter) have tackled the neglected issue of leisure noise exposure for young adults with hearing loss. Because most of the leisure noise research looks at effects on normal hearers, and because much of the general audiological literature focuses either on young children or older adults, the cohort studied in these articles is a breath of fresh air. Readers will also notice that both articles include qualitative data, a methodology that deserves greater attention. Although our discipline (and many others) tends to emphasize the rigor of numbers, taking the time to talk to people and look for patterns in their words can often provide insights that numbers cannot.
Carter and Black's findings suggest that awareness about noise-related risks to hearing are similar in young people with and without hearing loss, and yet self-protective behavior remains minimal. Because many individuals with hearing loss rely on amplification of sound by hearing aids, clinicians need to consider the potential impact of leisure noise on clients' hearing and find ways to balance the need for both audibility and suitable hearing protection in high-noise environments.
Hunter shows that people with hearing problems exhibit a range of different attitudes and behaviors in relation to noise exposure. Perhaps most surprisingly, she found that despite some people acknowledging that their problems were noise-related, they continued to expose themselves to excessive noise levels. The variety of responses and the failure of some young people to regard their symptoms as a wake-up call suggests that the challenge we face as hearing health promoters is every bit as difficult as suspected.
The final article in the collection is from Welch and Fremaux, who outline a new model of loudness in the context of music venues. It is a thought-provoking read that brings together physiology, classical conditioning, and the literature on emotional responses to music. The authors make a compelling case that loud music is a kind of vicious cycle of adaptation, conditioning, and expectation. Thinking about loudness in this way can help us to understand why music is often played at such high levels, but it also can help us to think about new ways we might address the management of sound levels at music venues and identify the audience most likely to respond to our hearing loss prevention messages.
The six articles presented here are the result of many years of research and many hours of writing, editing, and revising. I would like to thank the reviewers for their time and expertise, but most of all, I would like to thank the authors who contributed their work and engaged so willingly in the process of creating this issue. Finally, I encourage clinicians and researchers to consider their role in the promotion of hearing health. Often we are focused on our own practice, but occasionally it is good to look beyond our boundaries and seek opportunities to broaden our reach beyond fitting devices or measuring noise levels. I urge all of us to promote hearing health and encourage behavior change wherever we can—not only in individuals, but also in the wider community. Talk to your clients, your clients' families, your students, and your research participants, and do not be afraid to discuss sound levels with your child's school principal, your partner's garage band, your neighborhood café owner, or your local government representatives. Sustainable change is possible, but not before we all send out a few more ripples, both upstream and downstream.
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