1. Pearson, Linda J. RN, FNP, MSN, DNSc(c), Editor-in-Chief

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I love spending time with my 85-year-old father-in-law, but his hearing loss is the most frustrating part of our relationship. His, and others', hearing difficulties don't have to be eventualities of aging. By teaching young patients how to protect their hearing, we can prevent this common malady.


Do your patients have NITS?

When my 12-year-old son turned down his headset "because he didn't want to end up like Grandpa," I felt a surge of relief. Noise-induced hearing loss is a progressive injury that begins when you're young.


A Centers for Disease Control and Prevention study estimates that more than 5 million children suffer from noise-induced threshold shift (NITS), meaning that children have permanent problems hearing certain sound pitches. 1 When NITS-affected children hear sounds, the sounds may be distorted, which can affect their understanding of speech.


Regular exposure to loud noise worsens NITS because it injures the ears' hair cells. For example, children can get NITS for a few days from listening to loud music on a headset for 2 hours or standing next to speakers at a loud concert for just 7 minutes.


They'll know they've damaged their ears' hair cells if they experience ringing, buzzing, pain, or a muffled sound in their ears. Prolonged exposure destroys hair bundles, damages neural connections, and decreases blood flow to the cochlea. Eventually, accumulated damage to the sensory hearing cells leaves a noticeable hearing loss.


Know Your Decibels

We can't escape loud noise: City traffic hums at 89 decibels, lawn mowers roar at 90 decibels, and the chatter in some restaurants measures more than 90 decibels. A background noise level that requires a child to shout to a friend standing a foot away is usually more than 85 decibels.


The Occupational Safety and Health Administration (OSHA) uses a 5-decibel rule to prevent hearing loss. To protect hearing, OSHA recommends limiting exposure to noise based on the noise's approximate decibel measurement. You can safely listen to a 90-decibel noise for 4 hours. For every additional 5 decibels, halve your time exposure. For example, safe exposure to a 95-decibel noise is 2 hours, and safe exposure to a 120-decibel noise (such as a loud concert) is 10 minutes. Prolonged exposure to noises above 80 to 90 decibels can cause irreversible, gradual hearing loss.


If you can't talk a child out of limiting his exposure to loud noise, using earplugs is the next best solution. Tell parents to set a good example by wearing ear plugs during high noise exposures, such as when vacuuming. Don't let children or their parents leave your office without a quick comment on the importance of preventing hearing loss. Explaining the physiological damage to the ear may help them hear your message loud and clear.



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1. Niskar AS, Kieszak SM, Holmes AE, et al.: Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: The third national health and nutrition examination survey, 1988-1994, United States. Pediatrics 2001; 108( 1):40-43. [Context Link]