Safe listening

WHO estimates that 1.1 billion young people worldwide are at risk of hearing loss due to unsafe listening practices. This includes exposure to loud sounds on personal audio devices and in noisy entertainment venues. In order to address this concern, WHO has launched the Make Listening Safe initiative. This initiative aims to reduce hearing loss caused by listening to loud sounds by promoting safe listening.

The unit of measurement used to express the intensity of a sound is the decibel (dB). A whisper is around 30 dB and normal conversation approximately 60 dB. Some common sounds and their intensities (dB) are indicated below.

The intensity of sound and the duration of exposure contribute to the overall sound energy level to which the individual is exposed; in other words, your risk of losing your hearing depends on how loud, for how long and how often you are exposed to loud sounds

The term safe listening simply refers to a specific listening behaviour that does not put your hearing at risk. Your risk of losing your hearing depends on how loud, for how long and how often you are exposed to loud sounds. These may be through personal audio devices or in entertainment venues as well as in the environment around you such as in traffic, in the workplace or at home.

Sensory cells can tolerate only a certain amount of daily noise before being damaged: this amount is called the daily sound allowance. If your cells are exposed to too much sound, you exceed your daily sound allowance which harms your ears and hearing. Over time this results in hearing loss.

Your daily sound allowance works like a monetary allowance or pocket money: you have a limited amount to spend each day. For example, the louder or longer you are exposed to high levels of sound, the more you “spend”, the faster you run out of your allowance.

To practice safe listening, you must stay within the limits of your allowance. On your personal audio device this can be easily done with the help of software that monitors your daily sound allowance. It is more difficult to monitor exposure to loud sounds in entertainment venues or the environment generally.

Hence, to practice safe listening, you should:

• Always stay within your permissible daily sound allowance.
• On some days you may visit noisy places such as a arenas hosting sporting events or concerts, discotheques, bars or even a fitness class with loud music. The high level of sound in these places also affects your daily sound allowance. For this reason, you should avoid the additional use of your ear/headphones on these days. If you choose to listen, you should reduce your listening volume and your listening time to make sure you do not exceed your daily sound allowance. Listening at a level of 80 dB for 40 hours per week can help you to listen safely.
• If you are exposed to sound in your workplace, you must take extra care and ensure that you stay well within your recommended sound allowance.

• Check out this video to learn more about safe listening levels and times:

Ears are the organs that process sounds, enabling the brain to interpret what you are hearing. Sensory cells within your ears help you listen. Listening to loud sounds over long periods of time can cause damage which can result in temporary or permanent hearing loss or a ringing sensation in the ear (tinnitus).

The hearing loss may not be noticeable initially. You may only have trouble hearing some high-pitched sounds like bells. Continued listening at unsafe levels leads to irreversible hearing loss. This can make it difficult to communicate with others, especially in noisy places like restaurants and markets.

Hearing loss can be temporary or permanent. For example, a person who attends a loud concert may come out feeling slightly deaf or experiencing tinnitus. This is a temporary hearing loss and hearing in this case usually recovers within a few hours or a day. Regular or prolonged noise exposure can cause gradual, irreversible damage to the sensory cells, leading to permanent hearing loss. While temporary hearing loss gives no indication of the degree of permanent hearing loss that might eventually be experienced, it is a good predictor of the early development of permanent hearing loss.

Therefore, it is important to be alert to early warning signs of hearing loss:

• ringing in the ears (tinnitus);
• difficulty in hearing high-pitched sounds (birds singing, doorbells, telephones, alarm clocks);
• difficulty understanding speech, especially over the telephone;
• difficulty following conversations in noisy environments, such as in restaurants, markets or at social gatherings.

If you think that you have any of these problems, you should get your hearing checked. WHO has developed the hearWHO app so you can check your hearing anytime you want.

Lengthy exposure to noise in discotheques, bars, arenas hosting sporting events or concerts has been known to result in a sensation of sound in the ears known as tinnitus. Normally tinnitus recovers within a short time. If the exposure of loud sounds continues for a long time, this can lead to permanent hearing loss which involves the damage of sensory cells. Once damaged, sensory cells which are responsible for hearing, cannot regenerate. There is no medical or surgical cure for noise-induced hearing loss.

However, hearing loss is usually slow in onset, but progresses for as long as the exposure continues. The progression of hearing loss can be prevented by avoiding loud sounds and practicing safe listening (see Question 2).

Smartphone apps are available that allow you to track your in-ear sound exposure while listening to music. Normally, if you increase the volume above a certain threshold, apps prompt a message to help you adhere to safe listening levels. These apps can be downloaded on your phone and used every time you listen to music with your headphones.

In 2015 WHO launched the Make Listening Safe initiative with the overall vision to ensure that people of all ages can enjoy listening with the full protection of their hearing. The objective of the initiative is to reduce the risk of hearing loss posed by exposure to unsafe levels of sound in entertainment venues and to ensure that listeners of all ages can listen to music safely on their personal audio devices. As part of this initiative WHO, in collaboration with the International Telecommunications Union (ITU), has developed the global standard for safe listening personal audio devices. Once adopted by governments and manufacturers, this standard will ensure that personal audio devices on the market facilitate users’ safe listening behaviours.

When choosing your personal audio devices, you will then be able to ask for devices that comply with this global standard.

• Keep the volume down, by staying within the 80 dB limit as far as possible for no longer than 40 hours per week.
• Wear earplugs when visiting discotheques, bars, arenas hosting sporting events and concerts other noisy places.
• Use noise-cancelling earphones/headphones, as these can reduce the need to raise the volume when you are in a noisy environment, such as when travelling on a train or bus.
• Monitor and respect safe listening levels, and stay within your daily sound allowance.
• Limit the daily use of your personal audio devices.
• Limit time spent engaged in activities in noisy places:
  • take short listening breaks (go to a quiet place or corner and allow your ears to rest)
  • move away from loud sounds by keeping a distance between yourself and the sound source such as speakers
  • reduce your frequency of visiting noisy places, if possible.
• Get regular hearing check-ups.

You can find more information on how to make listening safe in the following two videos:

• https://youtu.be/6zggzoKaYpU
• https://youtu.be/xV-PNR_Ffg8

As parents you need to play an active role in educating your children about safe listening and monitoring their exposure to loud noise; you also need to be role models of safe listening for your children. You should make sure that your children avoid the use of headphones when possible and use only headphones that provide information about the risks for hearing loss. Parents should also ensure that their children do not increase the volume when they are not supervised. Some devices may be equipped with parental control that allows parents to control the loudness level of the device.

As a teacher you can educate children and adolescents about the possible dangers of exposure to loud sounds from the misuse of personal audio devices and be encouraged to develop safe listening habits. Such information should be part of the health education curriculum and also be taught as part of music and dance classes.

You may have a significant opportunity to educate and counsel adolescents and young adults regarding hearing protection. You can convey appropriate messages about the risks and promote healthy listening habits among users. You can also advise people about the importance of regular hearing checks and guide them about where and how they can get these. If you suspect that any person has hearing loss, they should be referred to the proper health facility where they can receive diagnostic and rehabilitative services.

Managers of venues in which noise levels are high – nightclubs, discotheques, bars, pubs, cinemas, concerts, sporting events and even fitness classes – have an important role to play in ensuring the personal safety of people who frequent such venues. To make listening safe, you can: monitor and apply the safe noise limit set by the establishment itself; make use of sound limiters to control noise levels in such settings; provide free earplugs to all patrons along with information about their proper use as well as “chill out” rooms, where volume levels are monitored and safe; and prominently display messages about the risk of hearing loss during moments when the volume goes beyond safe levels.

As a manufacturer of personal audio devices, you will have the technical know-how to design these devices with appropriate safety features. For example, devices can display an on-screen message displaying the average dB level at different volume settings, along with a warning to keep the output below 80 dB. Such measures offer protection and help raise awareness about the harmful effects of loud music and other noise. You can also provide prominent warning labels on the products themselves, as well as on the external packaging and accompanying information materials.

Governments are encouraged to develop stricter laws and rigorously enforce already existing legislation regarding non-occupational noise. They should ensure that the personal audio devices available in the country should comply with existing safe listening standard. Governments must also raise awareness about the issue through targeted public information campaigns highlighting the potential consequences of hearing loss.

Efforts should be made to made to integrate ear and hearing care into the health care strategy of the country. Such efforts must focus on prevention of hearing loss as well as its early identification and appropriate management. Governments can ensure that hearing devices and services required by people with hearing loss should be accessible to them, as part of universal health coverage.