Everyday sounds typically do not damage your hearing. However, many people participate in activities that produce harmful sound levels, such as attending loud sporting events and music concerts, and using power tools, which repeated over time will cause hearing loss. Loud sound (noise) can damage sensitive parts of the ear, causing hearing loss, ringing or buzzing in the ear (tinnitus), and increased sensitivity to sound (hyperacusis). Repeated exposure to loud noise over the years affects how well you hear later in life and how quickly you develop hearing problems, even after exposure has stopped.

You can protect your hearing. Recognize early signs of hearing loss, and take steps to protect your hearing.

Many enjoyable sounds that we hear every day are at safe levels that won’t damage our hearing. However, sounds can be harmful when they are too loud—even for a short time—or when they are long-lasting, even if they are not quite as loud. These sounds can damage part of the inner ear and cause permanent hearing loss. This permanent hearing loss can then worsen over a lifetime.

Who Is Affected?

Hearing loss from noise can happen to anyone at any age. Analysis from a nationally representative health interview and examination survey found that nearly one in four (24 percent) of U.S. adults aged 20 to 69 years has features of his or her hearing test in one or both ears that suggest noise-induced hearing loss (NIHL).

How Do We Hear?

To understand how loud noises can damage our hearing, we have to understand how we hear. Hearing depends on a series of complex steps that change sound waves in the air into electrical signals. The auditory nerve then carries these signals to the brain for us to understand.

Noise-induced hearing loss happens when tiny hair-like structures (stereocilia) that sit on top of hair cells in the inner ear are damaged by noises that are too loud and/or last for too long. When stereocilia are damaged, the hair cells can’t send information about the sound to the brain. This leads to noise-induced hearing loss. This type of hearing loss is permanent.

How Sound is Measured

Sound is measured in units called decibels. Decibel levels begin at zero, which is near total silence and the softest sound the average young person can hear. By comparison, a whisper is 30 decibels and normal conversational speech is about 60 decibels. An increase of 10 decibels means that a sound is 10 times more powerful. The sound of an ambulance siren at 120 decibels is about 1 trillion times more intense than the weakest sound the average person can hear. Sounds that reach 120 decibels are painful to our ears at close distances and are dangerous to our hearing.

The louder the sound, the shorter the amount of time it takes for possible hearing loss to occur. For example, firecrackers can reach 150 decibels, and will cause hearing damage much more quickly than exposure to a power lawn mower at 90 decibels.

Causes and Effects

Hearing loss from noise can be caused by exposure to constant loud sounds over a long period of time, such as noise in a woodworking shop.

Many everyday activities can put kids at risk for hearing loss caused by noise. These activities include:

• Listening to music at high volume through earbuds or headphones.
• Playing in a band or orchestra.
• Attending loud concerts.
• Being around loud noises at home for a long period of time, such as lawnmowers or leaf blowers.
• Riding snowmobiles or motorcycles.

Hearing loss caused by noise can be temporary. For some people, hearing returns to its normal levels after 16 to 48 hours after exposure to loud noises. Recent research suggests, however, that there still may be long-term, permanent damage even if it isn't noticeable/detectable immediately.

Hearing loss due to loud noises can also build over time, so you may not readily notice the signs. As hearing loss progresses, people might:

• Complain of ringing or buzzing in the ear—called tinnitus. Tinnitus may go away over time, but it can sometimes continue for a long time or throughout a person’s life.
• Say “What?” more often or ask others to repeat what they’ve said.
• Turn up the sound on the TV or other devices.

If you or someone you know experiences any of these signs regularly, you should get your hearing checked to determine if you have a hearing loss.

Genes

Although everyone is at risk for noise-induced hearing loss, some individuals may be at higher risk due to their genetics. Our genes, inherited from our parents, carry the information that forms the building blocks of who we are. Some people inherit genes that make them more likely to develop noise-induced hearing loss. Scientists are working to figure out which genes increase the risk.

Prevent Noise-Induced Hearing Loss

Hearing loss from noise can often be prevented. The best way to make sure that your children continue to enjoy the sounds they love throughout life is to teach them practical ways to protect their hearing. These include:

• Lower the volume.
• Move away from the noise.
• Wear hearing protectors, such as earplugs or earmuffs. If hearing protection is not available, cover your ears with your hands.

Fast Facts

• Analysis from a nationally representative health interview and examination survey found that nearly one in four (24 percent) of U.S. adults aged 20 to 69 years has features of his or her hearing test in one or both ears that suggest noise-induced hearing loss (NIHL).
• One in eight people in the United States (13 percent, or 30 million) aged 12 years or older has hearing loss in both ears.
• 100% Preventable. We can help our children avoid hearing loss caused by noise.
• 85 Decibels. Noise at this level and beyond for a prolonged period of time puts you at risk for hearing loss.

Hearing Loss Caused by Loud Sounds

• Symptoms of hearing loss from noise increase gradually. Over time, the sounds a person hears may become unclear, making it hard to understand what people are saying. Someone with hearing loss caused by noise may not even be aware of the loss.
• Hearing tests can uncover hearing loss caused by noise.

Risk Factors

• Noise-induced hearing loss is related to:
  • How loud the sound is (the decibel level),
  • The amount of time you are exposed to the sound, and
  • How far away you are from the sound.
• Hearing loss from noise is related to a person's genes. Some people are more likely than others to harm their hearing when they listen to certain sounds. Scientists are working to figure out which people are more at risk for this type of hearing loss.
• You may not realize it, but some common activities that children participate in can reach potentially damaging noise levels: playing band instruments; listening to music or watching television set at high volumes; attending concerts and movies; playing with loud toys; and riding off-road vehicles and snowmobiles.

How Hearing Loss Happens

To understand how loud noises can damage our hearing, we have to understand how we hear. Hearing depends on a series of complex steps that change sound waves in the air into electrical signals. The auditory nerve then carries these signals to the brain for us to understand.

Noise-induced hearing loss happens when tiny hair-like structures (stereocilia) that sit on top of hair cells in the inner ear are damaged by noises that are too loud and/or last for too long. When stereocilia are damaged, the hair cells can’t send information about the sound to the brain. This leads to noise-induced hearing loss. This type of hearing loss is permanent.

Loud Noises Damage Hearing

Hearing loss is the third most common chronic health condition in the US. Almost twice as many people report hearing loss as report diabetes or cancer. Noise exposure away from your job can damage your hearing just as much as working in a noisy place. Being around too much loud noise—like using a leaf blower
or going to loud concerts—can cause permanent hearing loss. And once it’s gone, you can’t get it back! You can have hearing loss before you even notice you’re having problems. Noise is measured in what are called decibels (dB). Over time, listening to loud sounds at high dB levels can cause hearing loss—or other hearing problems like a ringing sound in your ear that won’t go away. The louder a sound is, and the longer you are exposed to it, the more likely it will damage your hearing. The more often you are exposed to loud sounds over time, the more damage occurs. It’s important for healthcare providers to ask about hearing and to screen those who are at risk.

Healthcare providers can:

• Ask patients about exposure to loud noise and trouble hearing, and examine hearing as part of routine care.
• Provide hearing tests when patients show or report hearing problems, or refer them to a hearing specialist.
• Explain how noise exposure can permanently damage hearing.
• Counsel patients on how to protect hearing.

Problem:

Many people are exposed to noise that damages their hearing.

Hearing gets worse over time the more often people are exposed to loud sounds.

• About 53% of people ages 20-69 who have hearing damage from noise report no on-the-job exposure.
• About 24% of people ages 20-69 who report having excellent hearing have measurable hearing damage.
• About 20% of adults with no job exposure to loud sounds have hearing damage.

Hearing loss often gets worse for years before anyone notices or diagnoses it.

• People may not know that activities away from work can damage hearing just as much as noise on the job.
• People delay reporting hearing loss because they don’t know or won’t admit they have a problem.
• Less than half (46%) of adults who reported trouble hearing had seen a healthcare

Hearing loss causes many problems.

• Continual exposure to noise can cause stress, anxiety, depression, high blood pressure, heart disease, and many other health problems.
• Some people are at higher risk for hearing loss, including those who:
  • are exposed to loud sounds at home and in the community.
  • work in noisy environments (especially noise of 85 dB or more for 8 hours or longer).
  • take medicines that increase their risk.
  • are male.
  • are age 40 or older.

Hearing loss is costly.

The cost for the first year of hearing loss treatment in older adults is projected to increase more than 500% from $8 billion in 2002 to an estimated $51 billion in 2030.

SOURCE: Journal of the American Geriatrics Society, 2010

Hearing loss from loud noise can be prevented.

About 70% of people exposed to loud noise never or seldom wear hearing protection.

SOURCE: National Health and Nutrition Examination Survey, 2011-2012

People with hearing loss.

(Not able to hear high-pitched sounds)

What Can Be Done?

The Federal government is

• Monitoring the health of the nation and setting targets for improvement through the Healthy People 2020 hearing objectives.
  • Raising public awareness about the health effects of noise-induced hearing loss and how to prevent it.
  • Tracking hearing loss and establishing standards to protect hearing in places such as mines, factoriesand airports.
• Providing information to healthcare providers about effective counseling on the effects of noise exposure and correct use of hearing protection.
• Supporting research on the extent of hearing loss in America, contributing factors, and the most effective prevention strategies.

Healthcare providers can

• Ask patients about exposure to loud noise and trouble hearing, and examine hearing as part of routine care.
• Provide hearing tests when patients show or report hearing problems, or refer them to a hearing specialist.
• Explain how noise exposure can permanently damage hearing.
• Counsel patients on how to protect hearing.

Everyone can

• Avoid noisy places whenever possible.
• Use earplugs, protective ear muffs, noisecanceling headphones when near loud noises.
• Keep the volume down when watching TV, listening to music, and using earbuds or headphones.
• Ask your doctor for a hearing checkup and how to protect your hearing from noise.

Questions Healthcare Providers Can Ask Patients.

• Do you find it difficult to follow a conversation if there is background noise?
• Can you usually hear and understand what someone says in a normal tone of voice when you can’t see that person’s face?
• Do you feel frustrated with your hearing when talking to family or friends?
• Are you often exposed to loud sounds, either at work or away from work?

What is noise-induced hearing loss?

Every day, we experience sound in our environment, such as the sounds from television and radio, household appliances, and traffic. Normally, these sounds are at safe levels that don’t damage our hearing. But sounds can be harmful when they are too loud, even for a brief time, or when they are both loud and long-lasting. These sounds can damage sensitive structures in the inner ear and cause noise-induced hearing loss (NIHL).

NIHL can be immediate or it can take a long time to be noticeable. It can be temporary or permanent, and it can affect one ear or both ears. Even if you can’t tell that you are damaging your hearing, you could have trouble hearing in the future, such as not being able to understand other people when they talk, especially on the phone or in a noisy room. Regardless of how it might affect you, one thing is certain: noise-induced hearing loss is something you can prevent.

Who is affected by NIHL?

Exposure to harmful noise can happen at any age. People of all ages, including children, teens, young adults, and older people, can develop NIHL. Based on a 2011-2012 CDC study involving hearing tests and interviews with participants, at least 10 million adults (6 percent) in the U.S. under age 70—and perhaps as many as 40 million adults (24 percent)—have features of their hearing test that suggest hearing loss in one or both ears from exposure to loud noise. Researchers have also estimated that as many as 17 percent of teens (ages 12 to 19) have features of their hearing test suggestive of NIHL in one or both ears, based on data from 2005-2006.

What causes NIHL?

NIHL can be caused by a one-time exposure to an intense “impulse” sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a woodworking shop.

Recreational activities that can put you at risk for NIHL include target shooting and hunting, snowmobile riding, listening to MP3 players at high volume through earbuds or headphones, playing in a band, and attending loud concerts. Harmful noises at home may come from sources including lawnmowers, leaf blowers, and woodworking tools.

Sound is measured in units called decibels. Sounds of less than 75 decibels, even after long exposure, are unlikely to cause hearing loss. However, long or repeated exposure to sounds at or above 85 decibels can cause hearing loss. The louder the sound, the shorter the amount of time it takes for NIHL to happen.

Here are the average decibel ratings of some familiar sounds:

• The humming of a refrigerator
  45 decibels
• Normal conversation
  60 decibels
• Noise from heavy city traffic
  85 decibels
• Motorcyles
  95 decibels
• An MP3 player at maximum volume
  105 decibels
• Sirens
  120 decibels
• Firecrackers and firearms
  150 decibels

Your distance from the source of the sound and the length of time you are exposed to the sound are also important factors in protecting your hearing. A good rule of thumb is to avoid noises that are too loud, too close, or last too long.

How can noise damage our hearing?

To understand how loud noises can damage our hearing, we have to understand how we hear. Hearing depends on a series of events that change sound waves in the air into electrical signals. Our auditory nerve then carries these signals to the brain through a complex series of steps.

1. Sound waves enter the outer ear and travel through a narrow passageway called the ear canal, which leads to the eardrum.
2. The eardrum vibrates from the incoming sound waves and sends these vibrations to three tiny bones in the middle ear. These bones are called the malleus, incus, and stapes.
3. The bones in the middle ear couple the sound vibrations from the air to fluid vibrations in the cochlea of the inner ear, which is shaped like a snail and filled with fluid. An elastic partition runs from the beginning to the end of the cochlea, splitting it into an upper and lower part. This partition is called the basilar membrane because it serves as the base, or ground floor, on which key hearing structures sit.
4. Once the vibrations cause the fluid inside the cochlea to ripple, a traveling wave forms along the basilar membrane. Hair cells—sensory cells sitting on top of the basilar membrane—ride the wave.
5. As the hair cells move up and down, microscopic hair-like projections (known as stereocilia) that perch on top of the hair cells bump against an overlying structure and bend. Bending causes pore-like channels, which are at the tips of the stereocilia, to open up. When that happens, chemicals rush into the cell, creating an electrical signal.
6. The auditory nerve carries this electrical signal to the brain, which translates it into a sound that we recognize and understand.

Most NIHL is caused by the damage and eventual death of these hair cells. Unlike bird and amphibian hair cells, human hair cells don’t grow back. They are gone for good.

What are the effects and signs of NIHL?

When you are exposed to loud noise over a long period of time, you may slowly start to lose your hearing. Because the damage from noise exposure is usually gradual, you might not notice it, or you might ignore the signs of hearing loss until they become more pronounced. Over time, sounds may become distorted or muffled, and you might find it difficult to understand other people when they talk or have to turn up the volume on the television. The damage from NIHL, combined with aging, can lead to hearing loss severe enough that you need hearing aids to magnify the sounds around you to help you hear, communicate, and participate more fully in daily activities.

NIHL can also be caused by extremely loud bursts of sound, such as gunshots or explosions, which can rupture the eardrum or damage the bones in the middle ear. This kind of NIHL can be immediate and permanent.

Loud noise exposure can also cause tinnitus—a ringing, buzzing, or roaring in the ears or head. Tinnitus may subside over time, but can sometimes continue constantly or occasionally throughout a person’s life. Hearing loss and tinnitus can occur in one or both ears.

Sometimes exposure to impulse or continuous loud noise causes a temporary hearing loss that disappears 16 to 48 hours later. Recent research suggests, however, that although the loss of hearing seems to disappear, there may be residual long-term damage to your hearing.

Can NIHL be prevented?

NIHL is the only type of hearing loss that is completely preventable. If you understand the hazards of noise and how to practice good hearing health, you can protect your hearing for life. Here’s how:

• Know which noises can cause damage (those at or above 85 decibels).
• Wear earplugs or other protective devices when involved in a loud activity (activity-specific earplugs and earmuffs are available at hardware and sporting goods stores).
• If you can’t reduce the noise or protect yourself from it, move away from it.
• Be alert to hazardous noises in the environment.
• Protect the ears of children who are too young to protect their own.
• Make family, friends, and colleagues aware of the hazards of noise.
• Have your hearing tested if you think you might have hearing loss.

Has a noisy situation ever left you grimacing and clutching your ears? Why do some sounds seem so loud? Many factors influence how loud a sound seems, including how long it lasts, the sound’s frequencies (or pitches), and the environment in which you hear the sound. Another important and easily measured factor is sound intensity, or volume.

We measure sound intensity (also referred to as sound power or sound pressure) in units called decibels. Decibels (dB) are named in honor of Alexander Graham Bell, the inventor of both the telephone and the audiometer. An audiometer is a device that measures how well a person can hear certain sounds. A modern version of it is still used today to diagnose hearing loss.

Decibels are different from other familiar scales of measurement. While many standard measuring devices, such as rulers, are linear, the decibel scale is logarithmic. This kind of scale better represents how changes in sound intensity actually feel to our ears. To understand this, think of a building that is 80 feet tall. If we build up another 10 feet, the building will be 12.5 percent taller, which would seem just slightly taller to us; this is a linear measurement. Using the logarithmic decibel scale, if a sound is 80 decibels, and we add another 10 decibels, the sound will be ten times more intense, and will seem about twice as loud to our ears.

Sometimes we use different versions of decibels. A-weighted decibels, or “dBA,” are often used when describing sound level recommendations for healthy listening. While the dB scale is based only on sound intensity, the dBA scale is based on intensity and on how the human ear responds. Because of this, dBA gives us a better idea of when sound can damage your hearing.

The cochlea is a snail-shaped organ inside your inner ear that allows you to hear. The cochlea can respond to a certain range of frequencies, or pitches of sound. (Read more about how we hear or watch a video on how sound travels to the brain.) The cochlea responds best to frequencies in the range of human speech. It doesn’t respond as well to frequencies that are much higher or lower. When sounds contain frequencies are too high or too low for us to hear—as in ultrasonic and infrasonic sounds—our cochlea doesn’t respond at all.

In the frequencies that our ears respond to best, measurements for dBA are just as high as they are in dB. For instance, the high-pitched E string on a violin has very similar dB and dBA levels. However, a lower frequency sound that isn’t processed as effectively through the ear will have a lower output level. For instance, the lowest note on a tuba (16Hz) will have a much lower dBA reading than a dB reading.

Even small increases in dBA level can have a big impact on your hearing health. As dBA rises, your hearing is more likely to be damaged, and more quickly than you might expect. Sound is more likely to damage your hearing if it is:

• 85 dBA and you are exposed to it for at least 8 hours.
• 100 dBA and you are exposed to it for at least 14 minutes.
• 110 dBA and you are exposed to it for at least 2 minutes.

You can measure sounds in dBA yourself with a sound level meter, such as this app made by the National Institute for Occupational Safety and Health. The app can measure sounds from 0 dBA (sounds so quiet you can barely hear them) to whispering (30 dBA), normal conversation (60-70 dBA), and even a jet taking off (140 dBA). Just remember to turn down the volume, move away from the noise, or wear hearing protectors, especially when the sound level is at or about 85 dBA!

Loud noises happen where you might not expect them, from your home kitchen to the school cafeteria.

If the dishwasher is running, you might turn up the volume on a nearby TV to hear it better. Add a blender and a vacuum cleaner, and you might turn up the volume even more. All those noises can put you at risk for hearing loss if you’re not careful.

What sounds can damage your hearing?

Sound is measured in decibels. Any sounds at or over 85 decibels can damage your hearing.

Noise adds up over a lifetime. If you are often exposed to loud sounds, your risk for permanent damage grows over time. Even a single but long-lasting or extremely loud event can cause damage.

To protect your hearing, try not to be around sounds at or above 100 decibels for more than 15 minutes. If the noise is at or above 110 decibels, try to move far away from the noise in less than a minute. Here are the decibel levels of common sounds:

• Pin drop: 0 decibels
• Whisper: 30 decibels
• Refrigerator: 40 decibels
• Normal conversation: 60 decibels
• Dishwasher: 75 decibels
• Heavy city traffic, school cafeteria: 85 decibels
• Gas lawn mower: 90 decibels
• Woodshop, snowmobile: 100 decibels
• Music player at maximum volume: 105 decibels
• Music concert: 110 decibels
• Ambulance siren: 120 decibels
• Jet engine taking off: 140 decibels
• Firecracker: 140–165 decibels

Hearing loss from too much noise may not be noticeable at first, but the damage can build over time, and it can’t be fixed.

Noise is a significant source of hearing loss, but you can protect your hearing. An important first step is to understand how noise causes hearing loss.

Loud Noise Can Cause Hearing Loss Quickly or Over Time

Hearing loss can result from a single loud sound (like firecrackers) near your ear. Or, more often, hearing loss can result over time from damage caused by repeated exposures to loud sounds. The louder the sound, the shorter the amount of time it takes for hearing loss to occur. The longer the exposure, the greater the risk for hearing loss (especially when hearing protection is not used or there is not enough time for the ears to rest between exposures).

Here are some sources of loud noise that you may be exposed to. If you are repeatedly exposed to them over time, they can cause hearing loss.

Everyday Activities

• Music from smartphones and personal listening devices, particularly when the volume is set close to the maximum
• Fitness classes
• Children’s toys

Events

• Concerts, restaurants, and bars
• Sporting events, such as football, hockey, and soccer games
• Motorized sporting events, such as monster truck shows, stock car or road races, and snowmobiling
• Movie theaters

Tools and More

• Power tools
• Gas-powered lawnmowers and leaf blowers
• Sirens
• Firearms
• Firecrackers

Common Sources of Noise and Decibel Levels

Sound is measured in decibels (dB). A whisper is about 30 dB, normal conversation is about 60 dB, and a motorcycle engine running is about 95 dB. Noise above 85 dB over a prolonged period of time may start to damage your hearing. Loud noise above 120 dB can cause immediate harm to your ears.

The table below shows dB levels and how noise from everyday sources can affect your hearing.

The time estimates listed in the “Typical Response” column are based on the NIOSH exchange rate of 3 dB.

Sounds May Be Louder Than What You Hear

How loud something sounds to you is not the same as the actual intensity of that sound. Sound intensity is the amount of sound energy in a confined space. It is measured in decibels (dB). The decibel scale is logarithmic, which means that loudness is not directly proportional to sound intensity. Instead, the intensity of a sound grows very fast. This means that a sound at 20 dB is 10 times more intense than a sound at 10 dB. Also, the intensity of a sound at 100 dB is one billion times more powerful compared to a sound at 10 dB.

Two sounds that have equal intensity are not necessarily equally loud. Loudness refers to how you perceive audible sounds. A sound that seems loud in a quiet room might not be noticeable when you are on a street corner with heavy traffic, even though the sound intensity is the same. In general, to measure loudness, a sound must be increased by 10 dB to be perceived as twice as loud. For example, ten violins would sound only twice as loud as one violin.

The risk of damaging your hearing from noise increases with the sound intensity, not the loudness of the sound. If you need to raise your voice to be heard at an arm’s length, the noise level in the environment is likely above 85 dB in sound intensity and could damage your hearing over time.

Noise can damage hair cells, membranes, nerves, or other parts of your ear, causing temporary or permanent hearing loss. Learn how this happens so that you can prevent hearing loss.

Hearing Loss Can Be Temporary or Permanent

Hearing loss is a decrease in your ability to hear or understand speech and sounds around you. Hearing loss can happen when any part of the ear or the nerves that carry information on sounds to your brain do not work in the usual way. In some cases, hearing loss can be temporary. However, it can become permanent when vital parts of the ear have been damaged beyond repair. Damage to any part of the ear can lead to hearing loss.

Loud noise is particularly harmful to the inner ear (cochlea). A one-time exposure to extreme loud sound or listening to loud sounds for a long time can cause hearing loss. Loud noise can damage 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 stopped. Damage to the inner ear or auditory neural system is generally permanent.

Damaged Hair Cells in Your Ears Can Lead to Hearing Loss

The average person is born with about 16,000 hair cells within their cochlea. These cells allow your brain to detect sounds. Up to 30% to 50% of hair cells can be damaged or destroyed before changes in your hearing can be measured by a hearing test. By the time you notice hearing loss, many hair cells have been destroyed and cannot be repaired.

After leaving a very loud event, such as a concert or football game, you may notice that you don’t hear as well as before. You might not hear whispers, sound might seem muffled, or you may hear ringing in your ears. Normal hearing usually returns within a few hours to a few days. This is because the hair cells, similar to blades of grass, will bend more if the sound is louder. But they will become straight again after a recovery period.

However, if loud noise damaged too many of the hair cells, some of them will die. Repeated exposures to loud noises will eventually destroy many hair cells. This can gradually reduce your ability to understand speech in noisy environments. Eventually, if hearing loss continues, it can become hard to understand speech even in quieter places.

Noise Can Also Damage Nerves in Your Ears

In addition to damaging hair cells, noise can also damage the auditory nerve that carries information about sounds to your brain. Early damage may not show up on your hearing test, but can create a ‘hidden hearing loss’ that may make it difficult for you to understand speech in noisy environments. The cumulative effect of noise affects how well you might hear later in life and how quickly you might develop hearing problems, even after exposure has stopped.

How Do We Hear?

We hear sound because of vibrations (sound waves) that reach our ears. We recognize those vibrations as speech, music, or other sounds.

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 (types of receptors that can detect sound) to bend, which converts the vibrations into electrical signals.

Auditory Nerve
The auditory nerve carries the electrical signals from the inner ear to the brain, which interprets the signals as sound that you recognize and understand.

Prevention and early detection of hearing loss are important. If you have any signs of hearing loss or if you are at risk for hearing loss, get your hearing tested.

10 Signs of Hearing Loss

If you have any of these signs or symptoms, you may have hearing loss caused by noise:

1. Speech and other sounds seem muffled
2. Difficulty hearing high-pitched sounds (e.g., birds, doorbell, telephone, alarm clock)
3. Difficulty understanding conversations when you are in a noisy place, such as a restaurant
4. Difficulty understanding speech over the phone
5. Trouble distinguishing speech consonants (e.g., difficulty distinguishing the difference between s and f, between p and t, or between sh and th in speech)
6. Asking others to speak more slowly and clearly
7. Asking someone to speak more loudly or repeat what they said
8. Turning up the volume of the television or radio
9. Ringing in the ears
   Loud noise can cause ringing, hissing, or roaring in the ears (a condition called tinnitus). This usually occurs immediately after you are exposed to the loud noise, but then it usually, though not always, goes away. However, it can be an indication of early hearing damage.
10. Ringing in the ears
11. Hypersensitivity to certain sounds (certain sounds are very bothersome or create pain)
    After you are exposed to loud noise, sounds that seem normal to most people may start to sound unbearably loud to you (a condition called hyperacusis). People with this increased sensitivity to sound may experience discomfort or physical pain. And it may be a sign of hearing damage.

If you have any signs of hearing loss, get tested by a qualified healthcare provider.

Ringing in the ears

Loud noise can cause ringing, hissing, or roaring in the ears (a condition called tinnitus). This usually occurs immediately after you are exposed to the loud noise, but then it usually, though not always, goes away. However, it can be an indication of early hearing damage.

Hypersensitivity

After you are exposed to loud noise, sounds that seem normal to most people may start to sound unbearably loud to you (a condition called hyperacusis). People with this increased sensitivity to sound may experience discomfort or physical pain. And it may be a sign of hearing damage.

Prevention and Early Detection of Hearing Loss are Important

Don’t wait until you show signs of hearing loss. Have your hearing examined by your doctor during your regular checkup. A basic hearing evaluation usually includes a quick look in the ear with an special light for looking into the ear canal (otoscope) and other checks to assess the sounds you can hear.

Your doctor may refer you to a hearing specialist (audiologist) or other healthcare provider who is qualified to test hearing if you

• Have a history of exposure to loud noise,
• Feel your hearing has changed, or
• Have family or friends that say you have difficulty hearing and communicating with them (those around us can be the first to notice our hearing problems).

The audiologist may have you listen to different sounds through headphones to determine the softest sounds you can hear, or have you repeat lists of words or complete other special tests.

Children Should Have Their Hearing Tested

Children should have their hearing tested before they enter school or any time there is a concern about the child’s hearing. Children who do not pass the hearing screening need to get a full hearing test as soon as possible.

Are You at Risk for Loud Noise-Related Hearing Loss?

The following conditions and exposures can increase your risk for noise-induced hearing loss.

• Genetics and individual susceptibility to noise
• Long-standing (chronic) conditions, such as diabetes and high blood pressure
• Injuries to the ear
• Organic liquid chemicals, such as toluene
• Certain medicines

Medicines that damage the ear are called ototoxic. The damage can result in hearing loss, ringing in the ears, or loss of balance. More than 200 medicines are ototoxic. They include certain antibiotics (for example, gentamicin), cancer treatment drugs (for example, cisplatin and carboplatin), pain relievers that contain salicylate (for example, aspirin, quinine, loop diuretics), and many other medicines.

Tips for People at Risk for Noise-Related Hearing Loss

• Avoid noisy places whenever possible.
• Use earplugs, protective earmuffs, or noise-canceling headphones when around loud noises.
• Keep the volume down when using earbuds or headphones.
• Ask your doctor for a hearing checkup if you suspect you have had hearing loss.

Regular Check-Ups Can Help Identify Early Hearing Loss

Regular check-ups are especially important if you are at risk for hearing loss, such as

• If you have a family history of hearing loss not associated with noise exposure,
• If you work in a noisy environment,
• If you engage in noisy activities or hobbies, and
• If you take medicines that place you at greater risk for hearing loss (for example, certain antibiotics, cancer treatment drugs, pain relievers, and more).

Did You Know That Noise Can Cause Other Health Problems Too?

• Anxiety
  Exposure to noise can increase stress, anxiety, loss of sleep, and fatigue.
• Heart Disease
  Noise can also cause elevated blood pressure, heart disease, and increased heart rate.
• Damage to the Developing Baby During Pregnancy
  Excessive noise during pregnancy may damage the newborn’s hearing.
• Learning and Language
  Noisy homes and environments can interfere with learning and language development in children. Even a mild hearing loss can harm a child’s ability to speak, learn, and interact with others.
• Isolation and Depression
  Untreated hearing loss, especially in older adults, can lead to social isolation, depression, dementia, falls, inability to work or travel, and reduced physical activity.

The effect of noise on hearing depends on how loud it is (sound intensity) and how long it lasts (duration). Avoiding noisy situations is the best prevention. If you can’t avoid the noise, use adequate hearing protection.

If You Need to Shout…the Sound is Too Loud

Even without a device to measure sound, you can typically tell if the noise around you is too loud. If you or others need to shout in order to be heard or cannot understand each other even at arm’s length away, the sound is too loud and may damage your hearing over time.

5 Ways to Protect Your Hearing

1. Turn the volume down.
2. Walk away from the loud noise.
3. Take breaks from the noise.
4. Avoid loud, noisy activities and places.
5. Use hearing protection.

Recommendations to Help Prevent Hearing Loss from Loud Noise

At Home

• Turn down the volume of the TV, radio, or music.
• If listening to loud music, take listening breaks to reduce your exposure.
• Use quieter products (power tools, toys, recreational vehicles) whenever they are available. (For more, visit CDC’s Buy Quiet webpage.)
• Reduce equipment noise by replacing worn, loose, or unbalanced machine parts. Keep equipment well lubricated and maintained.
• Use hearing protection devices (such as earplugs and earmuffs) when you cannot avoid loud sounds.
• Make hearing protection convenient. Stash earplugs in your car or workshop for easy access.
• Keep children away from loud music or equipment at home.

At Public Events

• Move or stay far away from the loudest sound-producing source—such as loudspeakers or cannons at college stadiums—especially if attending with children.
• Limit the length of time of exposure to loud sounds.
• Pay attention to signs and information flyers warning of possible loud noise and the use of hearing protection.
• Bring hearing protection devices with you. Keep them in your car, pockets, or other easy to access place.

What about During Pregnancy and for Infants and Children?

During pregnancy, use the same precautions specified above for at home and public events. Also try to avoid your body touching the source of the noise (i.e., vibration).

For children and infants, also use the same precautions specified above. And keep children away from high noise levels, such as from very loud toys.

Use Hearing Protection

The best way to protect your hearing from noise is to avoid noisy activities. When you can’t avoid loud noise, use hearing protection. Hearing protection devices reduce the level of sound entering your ear. They do not block out sound completely. Hearing protection that does not fit properly will not protect your hearing.

Look for Noise Reduction Ratings

Hearing protection devices come with different noise reduction ratings. The noise reduction rating is usually labeled on the device container (it may say “NRR”) and it indicates the amount of potential protection the device provides.

Noise reduction ratings are measured in decibels (dB). Most hearing protection devices have ratings that range from 0 dB to 35 dB. A noise reduction rating is a “best case” rating measured in a laboratory; the actual sound reduction provided by the protector may be much less. It is best to choose a hearing protector that is comfortable and convenient, and that you are willing to wear consistently when exposed to noise. If you want to know exactly how much noise reduction you are getting, you can have the device “fit-tested” by a hearing professional.

Choose the Right Hearing Protection

The choice of hearing protection device depends on your personal preferences of comfort and where you will wear it. How well the protection works depends on whether you wear it consistently and correctly. The most common types of hearing protection devices include earplugs, earmuffs, and specially made devices.

Insert-Type Earplugs

These devices provide an air-tight seal in the ear canal. They are generally cheap, effective, and easy to use. They can be any of the following types:

• Pre-molded (pliable devices of fixed proportions)
• Formable (usually made of expandable foam)
• Custom-molded (to fit precisely the size and shape of an individual’s ear canal)
• Canal caps (earplugs on a flexible plastic or metal band) (During quiet times, when not needed, you can leave the canal caps hanging around your neck so they will be easy to find when needed.)

Earmuffs

Earmuffs come in many models designed to fit most people. They block out noise by completely covering the outer ear. Some earmuffs also include electronic parts to help users communicate or to block sound impulses or background noise. However, earmuffs might not work as well for people with heavy beards, sideburns, or glasses (which can create gaps between the earmuff cushion and your skull).

Note: Wearing both earmuffs and earplugs can reduce the sound further. However, the noise reduction ratings for the two do not add together.

Specially Made Devices

You can also get specially made hearing protection devices. They can be styled and sized specifically for a person’s individual ear. They can also have special features:

• Custom earplugs molded to fit your ear exactly.
• Earmuffs with built-in radios or communication devices that allow you to listen at a safe level while still protecting you from the loud noise outside (such as at sporting events).
• “Level-dependent” hearing protectors (such as earmuffs) that do not block sound when the environment is quiet, but block loud sounds. These can be very useful for hunters.
• Lightweight active noise cancellation headphones for reducing low-frequency noise (for example, in airplane cabins). Noise cancelling devices work best for low-pitched droning sounds, such as from car and airplane engines and air conditioners. (These devices do not have a noise reduction rating.)
• Uniform-attenuation earplugs for musicians and concert attendees. These devices act just like turning down the volume on a stereo (in other words, the sound intensity is decreased).

Sound Level Meters Can Help Measure Noise

You can use a sound level meter to measure noise around you. You don’t have to be a health professional to own one, either.

You can find free sound level meters developed as apps for smartphones. These smartphone apps typically display noise levels in decibels, and they can even show you the risk for hearing loss. Smartphone apps must be calibrated to ensure that the readings are accurate.

Protect your hearing from getting worse and learn ways to help you hear better and adapt to your hearing loss.

Take Steps to Keep It from Getting Worse

There is no medical or surgical treatment for hearing loss caused by noise. Damaged hair cells do not grow back. As much as possible, you should try to protect your hearing. If you do have hearing loss, you should take steps to keep it from getting worse.

• Avoid noisy places whenever possible.
• Use earplugs, protective ear muffs, or noise-canceling headphones when around loud noises.
• Keep the volume down when listening through earbuds or headphones.
• Ask your doctor for a hearing checkup if you suspect you have hearing loss.

If you develop a sudden hearing loss, contact your doctor immediately. Some treatments may help minimize the damage and reduce the severity of the hearing loss.

Many people with hearing loss can still hear some sounds. If you already have a hearing loss, there are ways to help you make the most out of the hearing you have. Read about the methods and devices below that can help.

Things You Can Do to Help Compensate for Your Hearing Loss

• Look at the speaker.
  Your brain can pick up a lot of information from visual cues that can supplement what you hear to help you understand the message. Everyone reads lips more than they realize, and facial expressions and body language can provide helpful cues as well.
• Find the best location for listening.
  Placing yourself between the speaker and sources of background noise makes it much easier to hear and understand what is being said. Practice finding the best locations for different situations. For example, sit across from your host in a restaurant, or stay in a room apart from the music at a party.
• Choose favorable listening environments whenever possible. The physical characteristics of a room can make it easier or harder to hear. For example, choose restaurants with better lighting or meeting rooms with carpeted floors and acoustic ceiling tiles that reduce the echo (or reverberation) in a room.
• Pay attention to the conversation.
  It is easier to understand a conversation context than to understand a statement that has no background to help you know what it is about.
• Alert others to your hearing difficulty.
  Speakers can use strategies to help you hear better as well, such as making sure they have your attention before they speak and giving you a clear view of their face.
• Use closed captioning.
  Use closed captioning (CC) when you watch TV, movies, and online videos. Closed captioning can enhance your ability to understand the program.

Consider Using a Device to Help You Hear

If you already have a hearing loss, hearing devices can help you make the most out of the hearing you have.

• Hearing Aids
  Hearing aids make sounds louder. They can be adjusted to work best for your specific hearing loss. Making sounds louder can make them easier to understand. However, hearing aids may also make background sounds louder. If you have a hearing loss that distorts sounds, a hearing aid will not make sounds clearer.
• Assistive Listening Devices
  These devices help you hear sounds in specific everyday activities. Telephone amplifiers can make it easier to hear on the phone. A flashing or vibrating alarm clock can help you wake up in the morning. Loop, FM, and infrared systems can transmit sound to some types of earphones and certain hearing aids. They can help you hear television broadcasts, movies, and meetings in public places.
• Cochlear Implants
  These devices are for people who have very severe hearing loss. They stimulate the auditory nerve directly. Surgery is required to insert them.
• Personal Sound Amplification Products (PSAPs)
  PSAPs allow people with normal hearing to hear better in specific situations. They might be used when hunting or bird-watching, for example, or to better hear a conversation or performance from a distance. PSAPs are not intended to compensate for hearing loss, and they are not individually programmed like hearing aids. However, they can be useful in some circumstances.

Preteens are at an important stage in their lives. They are starting to make some of their own choices. At the same time, they are still listening to you. That’s why this is a great time to teach them that exposure to loud noises can damage their hearing and that noise-induced hearing loss:

• Can build over time.
• Is permanent.
• Is preventable.

The ability to hear well helps kids succeed in school, in sports, and in their personal relationships. Many everyday sources of noise, however, can potentially damage hearing. Noisy environments that can put your children (and you!) at risk include:

• School cafeterias and food courts.
• Band or orchestra rehearsal.
• Concerts (all types of music).
• Sporting events.
• Workshop tools and yard equipment.
• Portable listening devices (smartphones, tablets, computers, etc.).

Hearing Loss Adds Up Over Time.

Noise-induced hearing loss happens when tiny sensory hair cells in the inner ear are damaged by noises that are too loud and/or last for too long. The effects of noise damage on hearing add up over a lifetime. If kids are around loud sounds regularly, the risk for hearing damage increases with age.

Hearing Loss Can Last Forever.

Noise-induced hearing loss is permanent. Many people don’t know that the damage that loud noises can cause may affect their ability to hear now and later in life.

Even when young people understand the risk of this type of hearing loss, they may not always remember to be careful. Pass on the message that protecting your hearing can be as simple as turning down the volume on music devices, moving away from the source of noise, and wearing earplugs or earmuffs in noisy environments.

Hearing Loss Is Preventable.

Keep in mind that noise-induced hearing loss is preventable. To protect their hearing, encourage your kids to:

• Lower the volume.
• Move away from the noise.
• Wear hearing protectors, such as earplugs or earmuffs.

Kids Are Listening and Watching.

Research shows that kids make better health decisions when their parents and other adults actively talk to them about such issues. Talk with the kids in your life about the causes and prevention of noise-induced hearing loss so that healthy hearing habits become a natural choice early on.

Children also learn through observation and imitation. Set a good example: adopt healthy hearing habits yourself, and your kids might just do the same.