Noise-Induced Hearing Loss

Hearing plays an essential role in communication, speech and language development, and learning.
Even a small amount of hearing loss can have profound, negative effects on speech, language
comprehension, communication, classroom learning, and social development. Studies indicate that
without proper intervention, children with mild to moderate hearing loss, on average, do not
perform as well in school as children with no hearing loss. This gap in academic achievement
widens as students progress through school. 1,2
An estimated 12.5% of children and adolescents aged 619 years (approximately 5.2 million) and
17% of adults aged 2069 years (approximately 26 million) have suffered permanent damage to
their hearing from excessive exposure to noise. 3,4
Hearing loss can result from damage to structures and/or nerve fibers in the inner ear that respond to
sound. This type of hearing loss, termed noise-induced hearing loss, is usually caused by exposure
to excessively loud sounds and cannot be medically or surgically corrected. Noise-induced hearing loss
can result from a one-time exposure to a very loud sound, blast, or impulse, or from listening to loud
sounds over an extended period.

Preventing Noise-Induced Hearing Loss

Hearing loss caused by exposure to loud sound is preventable. 5 To reduce their risk of noiseinduced hearing loss, adults and children can do the following:

Understand that noise-induced hearing loss can lead to communication difficulties, learning
difficulties, pain or ringing in the ears (tinnitus), distorted or muffled hearing, and an inability
to hear some environmental sounds and warning signals

Identify sources of loud sounds (such as gas-powered lawnmowers, snowmobiles, power

tools, gunfire, or music) that can contribute to hearing loss and try to reduce exposure

Adopt behaviors to protect their hearing:

o

Avoid or limit exposure to excessively loud sounds

Turn down the volume of music systems

Move away from the source of loud sounds when possible

Use hearing protection devices when it is not feasible to avoid exposure to loud
sounds or reduce them to a safe level5

Seek hearing evaluation by a licensed audiologist or other qualified professional, especially if

there is concern about potential hearing loss

About Hearing Loss

How Hearing Loss Occurs
Hearing loss can result from damage to structures or nerve fibers in the inner ear that respond to
sound. This type of hearing loss, termed noise-induced hearing loss, is usually caused by
exposure to excessively loud sounds and cannot be medically or surgically corrected. 1
Sound intensity is measured in decibels with a sound level meter. Noise-induced hearing loss can
result from a one-time exposure to a very loud sound (at or above 120 decibels), blast, impulse, or
by listening to loud sounds (at or above 85 decibels) over an extended period. The louder the
sound, the shorter the time period before hearing damage occurs. 2

Signs and Symptoms of Hearing Loss

Because the damage from noise exposure is usually gradual, a person might not notice or might
ignore signs of hearing loss until more pronounced symptoms of permanent hearing loss become
evident.3 Noticeable signs of hearing loss can include the following 2:

Muffled or distorted hearing

Difficulty hearing sounds such as birds singing, crickets chirping, alarm clocks, watch alarms,
telephones, or doorbells

Difficulty understanding speech during telephone conversations or while participating in

group conversations

Pain or ringing in the ears (tinnitus) after exposure to excessively loud sounds

If a child or adolescent experiences any of these signs, he or she should tell a parent, teacher, or
other trusted adult. Often, family members, coworkers, or friends are the first to notice hearing
problems in others. The only accurate way to determine the extent and degree of hearing loss is
through evaluation by an expert trained to test hearing (audiologist) or other qualified
professional.2

How Much Noise Is Too Much?

Noise exposures add up throughout daily activities. However, certain events, behaviors, and
environmental factors in and out of the school setting can expose young people to unsafe sound
levels:

Exposure to sound levels that exceed safe listening levels, such as at rock concerts or band
practice, can cause hearing damage if it occurs frequently or for long periods of time. 4

Listening to portable media devices such as compact disc and MP3 players at high volume
levels (above 85 decibels) for long periods of time can cause similar damage. 5

In the school setting, children and adolescents can be exposed to sounds that can damage
their hearing, such as in band or shop class or attending school events (dances, athletic
events) with excessive sound levels.

Construction and maintenance activities in or around the school can also expose students to
harmful sound levels.

Based on the recommended exposure limits identified in the National Institute for Occupational
Safety and Health (NIOSH) Revised Criteria for a Recommended Standard: Occupational Noise
Exposure, the table below provides some common sound sources, their corresponding sound
intensities (in decibels), and the duration of exposure limits before hearing damage begins.
Table 1: Sound, Sound Intensity, and Recommended Exposure Limits

Safe Sound Level

Sound
Intensity
(Decibels)

Recommended
Exposure Limits
For Repeated
Exposures*

Comments

Any duration

None

3540

Any duration

None

Typical library sound levels

40

Any duration

None

Typical unoccupied classroom

46

Any duration

None

Normal conversational speech

60

Any duration

None

Battery-powered pencil sharpener

71

Any duration

None

Sound Source Examples

Quietest sound heard by person

with normal healthy hearing
Quiet empty classroom that meets
U.S. acoustical standard

Potentially Hazardous Sound Level

Sound Source Examples

Sound
Intensity
(Decibels)

Recommended
Exposure Limits
For Repeated
Exposures*

Comments

School cafeteria

85

8 hours

Prolonged exposures might cause slight

hearing loss. Hearing protection should be
used if regularly exposed to this sound
level beyond the exposure limit.

Band class

90

2 hours

Hearing protection should be used if

regularly exposed to this sound level
beyond the exposure limit.

100

15 minutes

Wood or metal shop, power tools,

snowmobile

Hearing protection should be used if

exposed to this sound level beyond the
exposure limit.

Hazardous Sound Level

Sound Source Examples

Sound

Recommended

Comments

Intensity
(Decibels)

Exposure Limits
For Repeated
Exposures*

Personal stereo system at high

volume

105

5 minutes

Hearing protection should be used if

exposed to this sound level beyond the
exposure limit.

Chainsaw, loud rock concert

110

1.5 minutes

Hearing protection should be used if

exposed to this sound level beyond the
exposure limit.

Ambulance siren

120

9 seconds

Hearing protection should be used if

exposed to this sound level beyond the
exposure limit.

Firecrackers, firearms

140-165

Immediate hearing Hearing protection should be used

damage possible whenever exposed to this sound level.

*NIOSH Recommended Exposure Limits (RELs) are based on repeated exposures occurring over a period of years.
For example, repeated exposure to 85 decibels during an 8-hour workday over a period of years or repeated
exposure to 90 decibels during a 2-hour period over a period of years are potentially hazardous. Hearing damage
from noise adds up over time. Single, one-time exposures do not pose an immediate risk of hearing loss unless
sound levels equal or exceed 140 decibels.
American National Standards Institute (ANSI) S12.60 (2002).
Hearing protection devices include earplugs and earmuffs that are made to reduce the loudness of sound.
Earplugs are placed in the ear canal so that they totally block the canal, reducing the loudness of sound. Earmuffs
fit completely over both ears, fitting tightly to reduce the sound loudness. It is recommended that earplugs and
earmuffs be used together when noise exposure is particularly high. Cotton in the ears, winter ear warmers, and
audio headphones are not appropriate hearing protection devices. 6

Promoting Hearing Health in Schools

The following are some steps schools can take to prevent noise-induced hearing loss, by limiting
exposure to excessive noise on school property, screening for existing noise-induced hearing loss,
and teaching students how to protect their hearing.

Establish Policies That Promote the Hearing Health of Students and Staff
School districts can adopt policies and procedures to minimize excessive noise during the school
day and protect the hearing of their students and staff. For example, schools can

Eliminate or reduce construction and maintenance activities during school hours

Set noise level standards for events such as school dances

Ensure that hearing protection devices are available to students, that students are instructed
on their proper use, and that these devices are required in classes or activities where students
are exposed to potentially unsafe noise levels (e.g., music classes, marching band, industrial
arts, and technology education classes).

Implement policies consistent with National Institute for Occupational Safety and Health
(NIOSH) recommendations to support hearing loss prevention programs for school employees 1

Establish and Maintain Routine Hearing Screening for All Students

Many schools provide hearing screening as part of required student health assessments. Hearing
screening, especially at an early age, provides the opportunity to detect a student's hearing loss or
previously unrecognized hearing loss and intervene to limit further loss and improve
learning.2,3According to the American Academy of Pediatrics (AAP), hearing screening should be
conducted

At school entry for all children

At least once at ages 6, 8, and 10

At least once during middle school

At least once during high school

For any student entering a new school system without evidence of a previous hearing
screening

Hearing screening might be required more often for students with other known health or learning
needs; speech, language, or developmental delays; or a family history of early hearing loss. 4-6
Hearing screening programs should be consistent with the AAP Criteria for Successful Screening
Programs in Schools2 to ensure that

Screening tests are accurate and reliable

The school hearing screening site is suitable and appropriate for screening

Persons who screen students' hearing are well-trained and qualified professionals

Community and healthcare provider referral mechanisms are in place so that those with
identified hearing loss can receive additional evaluation and diagnosis, and appropriate
treatment if needed.

Student screening results are communicated effectively by the school to students, parents,
and healthcare providers

Effective treatment and early intervention benefit those with identified hearing loss or
hearing difficulties

Appropriate educational interventions are implemented to reduce the negative effects of

hearing loss on student learning

The benefits of hearing screening outweigh the cost of implementing the screening program

Screening programs might not capture all cases of noise-induced hearing loss. Any student or
school personnel reporting hearing difficulties or tinnitus (especially after loud sound exposure)
should be referred to an audiologist for further evaluation.

Implement Hearing Loss Prevention Education

Education about noise and its effects on hearing, health, and learning can begin in elementary
school.7 Studies have shown that people who are educated about noise-induced hearing loss and
hearing loss prevention are more likely to use hearing protection devices in future occupational and
recreational settings.8,9 Comprehensive hearing loss prevention programs include instruction for
students on

Normal hearing (auditory) function

Types of hearing loss and their causes

Common sources of noise that can contribute to hearing loss

Noise and its effects on hearing and quality of life

Warning signs of noise-induced hearing loss

Recommendations for preventing hearing loss10-12

Hearing loss prevention education can be part of a schools health education curriculum or
integrated across curricula and other school programs by health professionals and trained
volunteers, teachers, and parents. For example,

School nurses, physicians, audiologists, speech-language pathologists, or well-trained

volunteers can help provide accurate information and interactive activities

Teachers can be taught how to reduce loud sounds in the school environment and model
good hearing protection behavior and attitudes

Education also can be provided for parents, encouraging them to practice hearing loss
prevention at home and to teach it to their children 13