More than a billion young people may be at risk of deafness from wearing headphones at full volume or going to entertainment venues with loud music.

About 25 decibels is a low voice conversation in a library.

At 50 or 60 decibels the traffic of a noisy street sounds and, at more than 100, there is a disco or the noise of a drill.

For the scientific community, any prolonged exposure to sound that exceeds 80 decibels begins to put hearing health at risk, whether in the short, medium or long term.

The ear suffers and is damaged.

A scientific review published in the journal

estimates that between 670 and 1.35 billion adolescents and young adults worldwide are at risk of hearing loss from exposure to unsafe listening practices.

Specifically, 23.8% of young people who use personal audio devices at high intensity, such as loud music through headphones, and almost half of those who go to noisy entertainment venues, such as bars or nightclubs, are at risk of suffering from some type of deafness or hearing damage.

Experts warn of "the urgent need" to promote safe listening habits.

The damage to hearing health is influenced by the intensity of the noise and the exposure time.

According to a report by the World Health Organization (WHO), people who use portable audio devices can be exposed, in 15 minutes of music at 100 decibels, to the same sound level as a worker in the industrial sector in an eight-day shift. working hours at 85 decibels.

The volume limits of the typical listener are between 75 and 105 decibels, thresholds that, for the WHO, are "reason for concern".

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Hearing loss, a silent epidemic

The intensity and exposure time go hand in hand and, although the susceptibility threshold varies in each person, reaching high decibels for a long time takes its toll on health.

Specifically, it is the cochlea, that snail-shaped structure in the inner ear, that most suffers the impact of noise: its hair cells, which are the ones that transmit information to the brain through the auditory nerve, suffer this exposure and they crystallize the damage, for example, through tinnitus (an intense ringing in the ear).

The WHO estimates that more than 430 million people in the world have a disabling hearing loss.

The study authors considered unsafe listening practices to exceed, for example, 80 decibels for 40 hours per week.

And they focused on two risk phenomena: the use of audio devices, such as mobile phones or music players with headphones, and attendance at noisy entertainment venues, such as discos, bars or clubs.

The scientists reviewed the evidence available since the turn of the century in four languages ​​and compiled some thirty studies from which they could recalculate the prevalence of young people exposed to risky listening practices.

After analyzing the sample and taking into account that the estimated global population of people between the ages of 12 and 34 is, in 2022, 2.8 billion, the researchers concluded that between 670 and 1.350 million people worldwide "could be at risk of hearing loss due to willful and unsafe recreational listening practices.”

“If people are exposed to loud sounds, the sensory cells and other structures in the ear can become fatigued and eventually damaged.

Sensory cell fatigue often results in tinnitus [tinnitus] and/or temporary hearing loss.

If people are regularly exposed to loud or prolonged sounds, this damage can become permanent, leading to irreversible hearing loss, tinnitus, or both,” explains Lauren Dillard,

Scientists consider these prevalence figures to be “high”, although they admit that the calculation is “approximate”.

The heterogeneity of the studies included in the review and "the lack of a standardized research methodology", they assume, are limitations of their research.

Studies in low-income countries, for example, were also not included, so it is possible that the global burden “does not capture unsafe listening practices” in these countries, they confess.

The availability of sources of information to assess exposure to noisy places was also limited and it is likely, they acknowledge, that there are "demographic and personal differences" in perception of danger and risk behaviors.

The range of prevalence of these unsafe listening practices, although it is very wide, does not differ much from what the scientific community already assumed, admits Luis Lassaletta, president of the Otology Commission of the Spanish Society of Otorhinolaryngology.

“It is difficult to make an estimate, but it coincides with what we think.

This study is very useful for reinforcing the work to raise awareness of the risks of noise”, assesses the expert, who has not participated in the research.

Jacinto García Lorenzo, head of Otolaryngology at Hospital del Mar, agrees, however, that the overall estimate of the study seems "imprecise": "The quality of the estimate of exposure to headphones is better,

but it is a bit of an exaggeration that half of the world's population of that age is exposed to harmful noise levels in places of entertainment”.

The doctor, who did not participate in the study, insists, however, that the research will be "relevant because it confirms that noise is harmful and that there is more and more exposure in leisure environments."

The WHO estimates that more than 50% of people between the ages of 12 and 35 listen to music through their personal audio devices at a volume that poses a risk to their hearing.

Hearing loss and tinnitus

In practice, the damage can translate into temporary hearing loss or acute tinnitus (tinnitus, which sounds like a constant buzzing or ringing in the ear).

In addition, exposure early in life can make people more vulnerable to age-related hearing loss in the long term.

Specifically, in children, scientists also recall that hearing loss implies a reduction in school performance, motivation and concentration.

In adults, the implications of hearing impairment range from decreased psychosocial well-being to increased risk of serious conditions, such as cognitive impairment.

The

research also warns of so-called "hidden hearing loss" or cochlear synaptopathy, which is like a previous step to damage to hair cells.

“These are people exposed to noise who, without having real damage to the hair cells, have previous problems in the connection between these cells and the auditory nerve”, explains Lassaletta.

In a traditional audiometry, she adds, this alteration would not be seen;

only if an audiometry is done in noisy conditions, this damage could be localized.

"You lose hearing quality, not quantity," summarizes García Lorenzo.

The authors admit that the scientific conclusions on the dimension of the impact on health of these practices are variable.

In fact, they point out, "evidence showing consistent associations between adolescents' exposure to recreational noise and permanent hearing loss is scant."

Dillard cautions, however, that experimental studies have found “physiological damage to the auditory system” after exposure to loud noise: “Signs of temporary damage may appear immediately after exposure, including tinnitus and hearing changes , but they resolve in a few days.

However, there is also some evidence that continuous exposure to loud noise can cause permanent damage throughout life.

Whether permanent or temporary, the damage exists and can already be seen in the consultations, say the external experts consulted.

"We are seeing that the age of presbycusis [progressive loss of hearing capacity] is coming forward," insists Lassaletta.

This damage, together with the uncomfortable tinnitus, have an impact beyond the auditory sphere.

“There is more risk of poor mental health.

Tinnitus is very frequent, but those who have it persistently sometimes need psychological support due to the impact they have”, adds the doctor.

“Trivialization and mockery”

Doctors regret "the trivialization and mockery" of hearing problems and call for more social awareness measures, as well as policies, the study authors urge, to promote safe listening habits and change individual behaviors.

“Check your listening levels in your device settings and if it tells you you are at unsafe levels, turn the volume down.

Consider using headphones that reduce background noise, as this will help you hear at lower, safer levels because you won't need to turn up the volume to drown out background noise.

If your ears ring or it's hard to hear after listening to music on headphones or attending a concert, it's a sign that the music is too loud,” advises Dillard.

At street level, Lassaletta points out that, as a general rule, "the recommendation is not to use the device for more than 60 minutes at more than 60% of its intensity."

And it encourages lowering the volume of the music in the headphones — “if you recognize the song from the next door on the subway, it is because that person has it very loud”, he exemplifies — or protect their ears at concerts.

In Switzerland, for example, there is a regulation on sound in recreational spaces and venues are required to limit average sound levels per hour to 100 decibels and to provide earplugs free of charge, among other measures.

Lassaletta adds that it is key to uncover and show, without shame, hearing problems and the effects of being exposed to high levels of noise for a long time.

Every time, she says, more familiar faces are coming out to say it out loud.

Like AC/DC singer Brian Johnson: the tinnitus he suffers from has even forced him to suspend concerts.

In 2015, the singer and guitarist of SKA-P, Pulpul, explained in a statement that the persistence of indomitable tinnitus kept him away from the stage: “I hope you can understand me.

I have not been silent for more than 20 years and the worst thing is that the army of crickets grows in number as time goes by.

I know many musicians suffer from tinnitus and move on because our life without music is an empty life, but I did the same thing and it just got worse.

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