MR. KOJO NNAMDIFrom WAMU 88.5 and American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Have you ever waited to cross the street next to a construction site, the jackhammer making your ears ring as you wait for the walk sign? Maybe you stood on the subway platform in New York City and felt your eardrums go numb as the train thundered into the station or maybe you have kids who play their music too loud, according to you. We're all bombarded with noise every day, but sometimes it's more than just annoying. A new study shows that a surprising one in five teenagers has some level of hearing loss. No one's confirmed that loud noise is to blame, but it's certainly a leading suspect.

MR. KOJO NNAMDIIn any case, the study reminds us that the hearing loss is not just for the elderly and it raises new questions about how we all listen to music, how we endure the sounds of city life and protect our ears from irreparable damage. Joining us to discuss this issue in our Washington studio is Dr. Janice Trent, an audiologist in private practice in Bowie, Md. Thank you very much for joining us.

DR. JANICE TRENTThank you. It's a pleasure to be here.

NNAMDIJoining us by telephone from Columbia University in New York is Dr. Robyn Gershon, professor of clinical sociomedical sciences at the Mailman School of Public Health at Columbia University. Thank you for joining us.

DR. ROBYN GERSHONThank you. My pleasure.

NNAMDIAnd joining us from studios in Boston is Dr. Josef Shargorodsky. He is an ear, nose and throat specialist at Brigham and Women's Hospital and Massachusetts Eye and Ear Infirmary. He led the team that conducted a study on hearing loss among adolescents. Dr. Shargorodsky, thank you very much for joining us.

DR. JOSEF SHARGORODSKYHi, thank you. It's my pleasure to be on the show.

NNAMDIYou looked at data from a national health survey and discovered a big spike in the number of teenagers with some degree of hearing loss. What do the numbers show?

SHARGORODSKYWell, the numbers show that in the most recent data, in 2005 and 2006, about one in five U.S. adolescents had evidence of at least some kind of hearing loss. This represented a pretty dramatic increase from the previous time that these data were put together, which was 1988 to 1994, at which time, it was about 15 percent of adolescents that showed evidence of hearing loss.

NNAMDIWere you surprised by that finding?

SHARGORODSKYIt was a little bit surprising. The number is pretty staggering, almost 20 percent of teenagers showing hearing loss. Now, even if that number was 15, it's still a high number. But it went up by 30 percent, is actually a big increase. During this time, there have been actual advances in medical care that may have led us to believe that actually prevalence may have gone down. We screen kids at birth. We also have better vaccination, better antibiotics for treatments of certain conditions that can cause hearing loss. And yet, here we are with an increase in hearing loss prevalence.

NNAMDIIndeed, Janice Trent, the jump in teenage hearing loss is especially troubling because, as Dr. Shargorodsky pointed out, medical advances and improved screening have made hearing loss much less common in young children.

TRENTThat's true. And so we are a little surprised by it. But I guess, in reality, I think many of us who are watching the kids listening to music and driving by kids in cars with loud music have known that this was coming down the pipe at some point.

NNAMDISo you were not particularly surprised by the finding that teenagers have rising rates of hearing loss?

TRENTNo, because in my private practice, I'm seeing a good number of people who are, quite frankly, in their 40s and early 50s who are coming into the office now saying, you know, I'm having trouble. I'm in the boardroom. I'm not getting all the information that I need to. Maybe I have hearing loss. And sure enough, when I test, they do have a high-frequency hearing loss. And when I do a little bit of history, I discover, lo and behold, back in the '80s they were the ones with the boom boxes or maybe they had those other little listening devices, Sony Walkman or something. And they will say, you know, yeah, you know, my mom told me to turn down the music. So, you know, I think that we're looking at something that's been growing over the past couple of years.

NNAMDIDr. Shargorodsky, did you -- can you tell from the data what caused the teenagers' hearing loss?

SHARGORODSKYNo, we don't have an exact cause. We did try to look at several potential factors. I've looked at a few demographic factors that may have changed between two time periods, such as distribution of ages, racial or ethnic backgrounds, socioeconomic backgrounds and between the sexes. And really, there haven't been significant differences between these demographic distributions between the time periods. We -- of course, with this age group, we tried to assess if noise was a factor and we did it a couple of different ways. One is that there was a question that was asked on the survey in 2005, 2006, about exposure to loud noise. Now, the problem was that question wasn't asked in the previous time period.

SHARGORODSKYBut at the same time, this question, when it was asked of this age group, it wasn't associated significantly with increase in hearing loss and -- which is a little bit concerning, except that one of the reasons, possibly, that this age group has such a high rate of hearing loss is that they don't report their noise exposure all that well. They don't consider it to be -- they don't consider loud noise to be loud noise. And so it might not accurately reflect the actual noise exposure in this age group. But we actually -- we could not identify an exact cause for this increase.

NNAMDIRobyn Gershon, a two-part question. One, do these findings surprise you? And two, to what extent do you believe that other forms of ambient noise, if you will, are having an effect on the eardrums of these teenagers -- on the hearing of these teenagers?

GERSHONWell, I wasn't completely surprised, but I was concerned. In fact, I might even say alarmed. That's pretty significant, one in five U.S. teens. And I was very concerned about this 30 percent increase in just a 10-year period. But I'm not entirely surprised because we feel that the increased urbanization and the increase in urban soundscape decrement in quality of noise and sound in the cities could also lead to that increase loss, increased noise-induced hearing loss.

NNAMDIIf you have questions or comments for us about hearing loss among teenagers or among people in general, call us at 800-433-8850 or send us an e-mail to kojo@wamu.org or tweet@kojoshow or you can go to our website, kojoshow.org. Ask a question or make a comment there. Talk about headphones, if you will, Dr. Shargorodsky. Ear buds worse than headphones that you wear outside of your ears?

SHARGORODSKYWell, it's not something that we could assess with this study specifically. Obviously, when you put on ear buds, they're getting the sounds closer and more directly into your ear. But I think it all depends on the individual and how loud they turn up the music.

NNAMDIJanice Trent, the hearing loss among teens is in the high frequencies. What sounds do they have trouble hearing?

TRENTWell, in particular, when we're talking about those frequencies, we're looking at our consonants, the F, the S as in Sam, the TH sound. Those three sounds are very soft, but they're also very high frequency. So the kids who are having the slight to mild hearing loss are indeed not able to hear those three key sounds at a normal conversational level.

NNAMDIIn your practice, you see mostly older people, but you've been getting calls from more and more people in their 40s also. What's their complaint?

TRENTWell, here again, you know, I think the recession has kicked in and a lot of people are realizing that they may be losing their competitive edge on the job if they're not able to hear as well as they used to. And so, indeed, you know, some of them are taking it a little bit more seriously and saying, you know, let me check this out. Let me see if there's something else I can do about it.

NNAMDIHow does the normal aging process affect our hearing?

TRENTWell, it is what it is. It's an aging process. As we get older, the nerves of hearing begin to deteriorate. Generally, it happens to most people, but certainly some people who would get older, their hearing remains the same. But typically we find that the hearing loss typically deteriorates starting in the high frequencies and then begins to flatten out through the mid and the lower frequencies.

NNAMDII didn't hear that. Could you repeat it? No, I'm just kidding.

TRENTWhere have I heard that from?

NNAMDIAllow me to go -- allow me to go to the telephones. Here is Daniel in northeast Washington. Daniel, you're on the air. Go ahead, please.

DANIELThank you, Kojo. I appreciate it. In northeast D.C., we have sirens from ambulances, police, all day long. I know that the siren is about two times the legal level of decibels and the fire chief has said that all the personnel will experience hearing loss before leaving the service and that the siren -- this is not the chief, that the sirens are destructive to our hearts. They raise our adrenaline in the community and cause heart disease. There are medical conditions that indicate not using the sirens and I find it overlooked in the issue of noise.

NNAMDIWell...

DANIELAnd I know...

NNAMDII'm glad you raised that issue because, Robyn Gershon, you have been, as an occupational and environmental health expert, measuring the noise levels we encounter in everyday urban life. I'm gonna talk to you about subways later, but can you start with the sirens?

GERSHONYes. That's a great point. They are not only nuisance noises, but clearly they are excessive sources of noise. And, you know, people don't realize that once you get over a certain limit, say 75, 80, 90 decibels, it doesn't take much to be over your entire 24-hour limit for that noise. For instance, something, say, on the order of 100 decibels -- and clearly an ambulance or fire truck could reach that level, you'd only be allowed to be exposed for a few seconds.

NNAMDIAnd...

GERSHONSo it's definitely not healthy to you and it certainly can affect your hearing health.

NNAMDIAnd Daniel, if I remember you correctly, you live in the general vicinity of Providence Hospital in Northeast Washington?

DANIELRight. So...

NNAMDISo you've been listening to sirens for a number of years.

DANIELYeah, for about eight years. Since I moved here, it's been a problem. It's actually improved because the protocols have been improved and they do run sirens -- ambulances at night quietly. My point is that they can run them quietly most of the time. They have to start with the premise that we have a legal right to quiet enjoyment of our homes. The times that you see an ambulance running continuous siren block after block after block is a violation of our own noise regulations, which -- give them an exemption from noise regulations, but the exemption says not to be construed to make unnecessary noise, when it's clearly unnecessary.

NNAMDIDaniel, as a result of this, have you been experiencing any problems with hearing loss yourself?

DANIELIt's not hearing loss. I had, for sure, quite a few years of gastric problems, stress problems, which have improved because it's quiet at night. This community is disturbed unnecessarily. Remember, 80 percent of the people in emergency rooms don't even need to be there.

NNAMDIWell, I'm interested in that because -- Robyn Gershon, to what extent is this problem exacerbated for people who live in the area of emergency centers and hospitals?

GERSHONWell, clearly, it's not a good thing. And I heard that they've made the ambulance sirens louder because cars are so, like, built tighter now and so they can't -- they themselves are quieter inside. And so, in order to hear what's going on, they make the sirens even louder. I think it's a travesty because I'm sure that those drivers are getting really an occupational exposure that will definitely impact the hearing health certainly, you know, 10 years down the road or 15 years down the road.

GERSHONThe quality of life is definitely impacted and living near those kinds of places can certainly affect, if not your hearing health, it can certainly affect your stress levels as it had for the caller, headaches, sleep quality, quality of life in general, even your communications in your own apartment or your own household. So I think the adherence to the strict noise regulations -- in New York City, we have new regs that came on board that are very stringent. But I noticed that also, that at least for -- in the daytime at least, the ambulances are really seemingly too loud to me. And I'm sure they're over the limit.

NNAMDIThank you very much for your call, Daniel. We move onto Ian in Silver Spring, Md. Ian, you're on the air. Go ahead, please.

IANHi there. Can you hear me okay?

NNAMDIYes, we -- yes, Ian, I can. Stop.

IANWonderful.

NNAMDII'm not that old.

IANYou have no idea how close to home this hits for me. I mean, this -- I hope to hear this type of topic again elsewhere. I'll just try to give you my brief little background because I can make it -- and then after that, I'll quickly ask something. As someone who's totally blind, I play jazz and gospel drums in the area here and you wouldn't think maybe that, you know, a drummer would be the first person to say it. But it drives me crazy that -- you know, I feel that so often so many people in so many places have, what I call, the stadium mentality.

IANYou know, everybody's playing or catering to the stadium of millions. And, you know, you've got a place that's got a low ceiling, that's not cool. That's going to rip somebody's hearing apart. That's going to damage somebody's hearing, if it's anything other than, you know, a sensible decibel level. Or if it's not outside. Even if it is outside, you can very easily be -- and I'm always kind of appalled at -- like, wow, you know, is it just my imagination? I guess not. So, you know, what can people -- what can we do to, you know, that's one thing and...

NNAMDIDr. Shargorodsky, it's generally believed that people who are -- who are not sighted, who don't see, have sharper hearing that most of us. And you add to that the fact Ian is actually a drummer himself, he seems to be hearing a lot more than the most of us are hearing, both professionally because of being a drummer and as a part of his condition. What do you say to somebody like Ian?

SHARGORODSKYWell, I think hearing is important to everyone, but especially to him, obviously, because he is not able to see and so he needs that sense. So the main thing is -- and for Ian, he's acutely aware of this, but to be careful around loud noise. It's -- people very much underestimate the importance of hearing. And obviously, as someone who needs it more, it's more important. But in general, people underestimate it and people underestimate the significance that hearing loss can have in their life.

SHARGORODSKYOne example is one of the senior authors on this study that we did, Dr. Evie from Vanderbilt, he did a study a few years ago with MTV where they surveyed teenagers about how important hearing loss was as a health condition and they rated it extremely low. I mean, they rated it way past acne as an important health condition. And so, I think, people really underestimate the points of hearing and really underestimate how loud the noise is around us.

NNAMDIDo you think it's because teenagers don't notice it or do you think that they're just not good at assessing their own behavior when it comes to loud noise because it's not really on their radar screen?

SHARGORODSKYI think it's probably both. I mean, teenagers, they might be less careful then other age groups in several respects. And I think noise exposure is probably just one of those. It's -- there's a social component to it as well, listening to loud music. And it's certainly not discouraged in many places to listen to loud music. I mean, we keep getting louder and louder devices that are offered to us anytime you go to an electronics store. And you can certainly get, you know, surround sound systems, even movie theaters are getting louder. And so I think it's good for this kind of information to get out there, to let people be aware that this is actually a problem.

NNAMDIGoing to take a short break. When we come back, we will continue this conversation on hearing noise and inviting your calls at 800-433-8850. Ian, thank you very much for your call. You can also join the conversation at our website kojoshow.org. I’m Kojo Nnamdi.

NNAMDIWe're discussing hearing loss and what's to blame for it with Dr. Robyn Gershon, a professor of clinical sociomedical sciences at the Mailman School of Public Health at Columbia University. Dr. Janice Trent is an audiologist in private practice in Bowie, Md. And Dr. Josef Shargorodsky is ear, nose and throat specialist at Brigham Women's Hospital and Massachusetts Eye and Ear Infirmary. He leads a team that conducted a study on hearing loss among adolescents. Is it possible, Dr. Shargorodsky, that ear infections as a child can play a part in teenage hearing loss?

SHARGORODSKYWell, certainly they can. And looking at the two sets of data that we examined, there actually has been a decrease in how many kids have had multiple, being three or more, infections between the two time periods. The number of kids having multiple ear infections had actually come down between the time periods. And in the most recent time period, actually wasn't significantly associated with increased hearing loss risk. Now, that might be because of the number of kids that actually have had that many ear infections and there might just not of been enough of them tested.

SHARGORODSKYBut it shows that there's been a difference in -- a significant difference in the number of kids that have experienced the -- that number of ear infections. And so, yes, so ear infections do -- can predispose a child, especially when they get them repeatedly or if it's a chronic condition can predispose a child to hearing loss.

NNAMDIJanice Trent, are we all subconsciously adapting to increasing noise in the general environment?

TRENTI really think we are. I think especially those people who are living in metropolitan areas, you know, we were all bombarded with a lot of sounds. Whether you're getting on the metro -- I think Dr. Gershon did a great survey. Just going through daily activities. I was on a blog one day and a gentleman said, you know, I'm so tired of going to these weddings, and in particular he said, bar mitzvah's where the music is so loud, that it's very disturbing. And I'd echo that also in some of our churches. The music is also very, very loud. And so as a result, I think, that we've gotten -- we've established this kind of tolerance. When you go to concerts, jazz sets, the music is very, very loud and we tend, as adults, to sit in there and say, okay, well, it's loud, but this is the way it's supposed to be, rather than going and asking for the music to be turned down. And because we, as adults, have adapted, we are not teaching our children to learn to turn down the music to reduce the exposure to noise.

NNAMDIRobyn Gershon, we've mentioned earlier that you have been measuring the noise levels that we encounter in everyday urban life and you started with the New York City subway. Why did you start there?

GERSHONWell, we started there because the subway workers came to us because we're occupational health researchers. They came to us to say that they're concerned a lot of their workers are going deaf. And, of course, they're still employed. They're under age 65. Many of them were in their early 50s, I would say. And we said, well, that's interesting. We're not really surprised. We ride the subway. We know how noisy it is. But we had a little bit of trouble working with the MTA, which, of course, manages the New York City transit system here in New York. And they really didn't want us studying their workers and I can completely understand that. And so we thought, well, let's just study it from perspective of the ridership. And that's how that (unintelligible) .

NNAMDIWhat can you, therefore, tell us about the noise levels in the New York subway and other public transportation?

GERSHONThey're too loud. They're way too loud. And they're too loud -- just as Janice was saying, clubs, pubs, movie theaters, they're way too loud. In our case, because we have such an old system, they're really very excessively loud. Most of our levels were over 80 decibels. We had spikes as high as 120 decibels, as high as a gunshot sound so they were way too high. And for most of our riders, they're riding an hour or more a day. And at those levels, they should not be exposed to that much noise. And then, of course, they have all the other noises in their lives. So it was excessive.

NNAMDIOn to the telephones again. Here is Scott in Silver Spring, Md. Scott, your turn. Go ahead, please.

SCOTTHi, Kojo, thank you so much for having this program. It's really timely. I wanted to point out two gaps in the regulatory system that could be very helpful to pay attention to. One of them is back in the '70s, congress passed a law called the quiet communities act, that gave EPA the authority to regulate noise sources in our environment. Like, for example, they regulated noise from portable air compressors and required that they be made quieter. And they were going to regulate other things, like medium and heavy trucks, which we hear all the time driving down the highways and down our streets. But what happened was, in -- when Reagan came in in 1981, he defunded that office. So the office still exists at EPA, but it has zero funds and hasn't had any funding for 30 years. But they have the power to regulate noise sources and should be given the -- given more money to go ahead and do the work they're -- that they were told to do by Congress.

NNAMDIOkay.

SCOTTThe other...

NNAMDIGo ahead, please.

SCOTT...the other thing is -- go ahead.

NNAMDINo, you go ahead.

SCOTTYeah, the other thing I wanted to mention is, I work with construction workers and construction workers have a lot of hearing loss. And one of the reasons is that back in the 1980s OSHA put out a rule that required that industrial work places have to have comprehensive programs to protect the hearing of workers that were exposed above 85 decibels and said, we'll eventually get to requiring this for constructions sites, and they never did it. So there's two regulatory gaps that, I think, have played a big role in hearing loss and also environmental exposure to noise that need to be paid attention to. And maybe we could move forward on that if there's enough public support.

NNAMDIWell, I'd like to talk to all of our guests about that, starting with you, Robyn Gershon. Cities and counties often set limits on nuisance noises, like the aforementioned construction work or the aforementioned loud parties or for that matter, weddings and bar mitzvahs, but are there any limits on general ambient noise levels?

GERSHONWell, the earlier caller made such a good point. In 1982, that office from EPA essentially became debunked, which was very problematic. OSHA, of course, regulates work place noise, but I'm not convinced that it does it very well. And they certainly leave out large gaps, like the construction workers. In New York City, we have our local laws and many other cities do, of course. The problem, I think, is enforcement and what they consider to be excessive.

GERSHONIt could be excessive when there is somebody on the street playing a loud, you know, car music or dogs barking, but is it hazardous? It's a nuisance and is it hazardous? Maybe it's both. I'm not sure. I know in New York City, that the largest number of 3-1-1 calls is about noise complaints. I think our regulations are really not up to par. In fact, in Europe, they have much, much better regulations about this kind of ambient or community level noise.

NNAMDIJanice Trent, same question for you.

TRENTWell, I do think that we're exposed to entirely too much noise. And I think that there are some regulations in place. I know that, in many industries, employees do have to wear ear protection, if they're exposed to 85 db or more. And so we do know that the regulations state that 85 db -- if you're exposed to 85 db, you can only be in that environment for eight hours a day. And then, as it goes up in decibels, I think, maybe 90 you can be exposed for four hours.

TRENTAnd there are different regulations, but the amount of time that you're allowed to be exposed to that noise is limited. But most of the time, in most industries, they're supposed to have regulations in place. But I think that Dr. Gershon brings on a good point, that a lot of -- this is not being monitored appropriately. And as a result, people are suffering hearing losses as a result of that.

NNAMDIOh, okay. Since we've kind of established that, Josef Shargorodsky, can you talk a little bit about what other factors, besides loud noise, contribute to hearing loss?

SHARGORODSKYWell, it depends somewhat on the age group, but we've studied several potential risk factors and identified a few. For example, in older age groups, we've identified some dietary factors, such as foliate intake as possibly lowering risks of hearing loss. Certain medications, there are certainly well known antibiotic and chemotherapy drugs that can affect hearing. And more recently, we've identified some pain medications that can also increase the risk of hearing loss. There are many other possible factors. Heavy metal exposure, for example, has been identified as possibly affecting hearing for example, lead and so there are many other things out there that we probably don't know about yet that can affect hearing loss.

NNAMDIYou say the fact that -- the fact that Americans are taking more medications these days could be a factor in hearing loss?

SHARGORODSKYCertainly it's a possibility. A lot of it hasn't been studied. We've been able to look at a few medications, but they're many medications that have never been looked at, in terms of their association with certain health conditions, such as hearing loss. And so the ones that we were able to look at, we did find associations. And so it's a little bit worrisome that people are taking more medications. There may be other health risks out there.

NNAMDIWe have a lot of callers. Let me return to the phones with Katie in Columbia, Md. Katie, thank you for calling.

KATIEThanks for taking my call, Kojo. I'm calling because I'm an attorney and I work with veterans. And most of what I try to do is to connect the veteran's disabilities to their military service. And hearing loss is a constant fight with the VA. And it seems like what happens -- and I'm asking this question is -- it seems like a lot of times the hearing loss due to noise exposure starts in the high frequencies and maybe the veteran doesn't really notice it for years or maybe decades until it starts to get worse and then tries to get service connection. And the VA says, well, it's been way too long since your service and so it can't possibly be related. So that was my question, is whether that's accurate. And my...

NNAMDIJanice Trent...

KATIE...my second point is...

NNAMDIOh, okay.

KATIE...that when it comes to the veterans of today, I know that there's hearing protection now, but I wonder whether any hearing protection can be enough when you consider the kind of noise that veterans today or tomorrow's veterans rather, folks in Iraq and Afghanistan, are dealing with.

NNAMDIJanice Trent, is it possible that the noise can start in such high frequencies that the person doesn't really realize it until much later in life?

TRENTSure, it is. But, you know, hopefully what happens is that before these military people are released from the military that they have a hearing test. Those individuals that had hearing tests before they got discharged are then -- and had a documented hearing loss are able to go back, you know, when they are much older and get hearing assistance. Many times, you can get hearing aids through the VA for free, but all too frequently -- I have several VA people who come through my office. They were not tested before they were discharged and because there's no documentation of their hearing loss on discharge, even if it's a small hearing loss -- because there's no documentation. That's why they have problems.

NNAMDIIs there anything that people like that can do, Josef Shargorodsky?

SHARGORODSKYWell, like the other panelist said, is getting the hearing tested is important early on. It's hard to say what will happen to their hearing down the road. And what they can do -- obviously, they should get -- if they notice their hearing deteriorating, they need to get tested and see if they need treatment, such as hearing aids, something like that. But it's also a little bit of a question mark of what happens down the road because as this study shows, that the hearing loss starts out very slight. But there are...

NNAMDIThat's what I wondering. Are teenagers with mild hearing loss more likely to have more severe hearing loss than their peers when they get older?

SHARGORODSKYSo we don't have data following people over a very long period of time. But there are actually animal studies that were done here in Boston that show that early noise exposure and damage from early noise exposure actually predisposes to accelerated hearing loss later in life. And so it may be hard to prove right now, coming out of the military, that they have, you know, severe -- that they're predisposed to severe hearing loss. But in 20 years or 30 years, they may actually have a much higher chance of having severe hearing loss compared to an average person.

NNAMDIKatie, does that answer your question?

KATIEOh, sort of. But part of the problem for my veterans is that they got out so long ago, they had a whispered voice hearing test which apparently was not very useful. But my second question was about whether any hearing protection that the military has today can suffice with as loud as IUDs are and everything else.

NNAMDIJanice Trent, care to take a...

TRENTYou know, I really am not sure about that. But I do know that they -- they are using insert ear phones and then they use headsets on top of that. So I know that the military is trying to ensure that their ears are protected.

KATIEOkay. Thank you very much.

NNAMDIKatie, thank you very much for your call. We move onto Jay in Washington D.C. Jay, you're on the air. Go ahead, please.

JAYHey, Kojo. Thank you so much. Love your show. Love your show. Long time fan. I am a -- I own a -- I'm a local here in D.C. and started Ear Piece earlier this year and the reason's hearing protection. And the reason that I did this is that I felt like what was being provided for people in sort of the -- for their -- to what all of the callers have said up to this point, sort of like all the elements in your life that are so loud, we live in an orally toxic environment, is that nothing was out there for people.

JAYAnd I just wanted to share my -- the observation that I've made, that, you know, it's two pieces to that, is that we -- up-to-date, we haven't provided people with hearing protection that they can use meaningfully, where they can still hear, that's comfortable, that's not -- that doesn't stick out of their ears. And that we haven't communicated very effectively with people to get them to do that.

JAYAnd I just wanted to sort of run that by your doctors, in that -- the message is always, you know, hearing health, you're going to lose your hearing, this is what you've got to do to make sure that, you know, you're not deaf. And that, you know, no pun intended, usually falls on deaf ears. But when you switch that discussion to, this really improves the quality of your life to actually protect your hearing, what I've found is that there is just an enormous reception to that. And that -- and I think...

NNAMDIHere's...

JAY...that's exactly what...

NNAMDI...here's Janice Trent.

TRENTYou know, I applaud you. I appreciate what you're saying, you know. But part of this is the media. I applaud Kojo for doing this today. We have not had this conversation and we need to have the conversation. You know, we've got something going on now politically with someone who -- why should we be having a conversation about it at all? Yet politica -- but in terms of really getting the information out to people to let them know about the importance of hearing, we haven't done it enough. In terms of pieces that will protect your hearing, there are so many -- there's so much material available, so many resources available.

TRENTThe issue is having access to the media so that the media can -- so that we can convey to the population the importance of hearing and the availability of protecting their hearing. But the resources are there. It is simply a matter of having people to be energized, to be concerned and to ask the questions and indeed to have media to be involved in the process of saying, hey, this is important and this is something we really need to look at.

NNAMDIObviously, we're talking about if somebody talks about burning a Koran it can dominate the entire...

TRENTThere you go.

NNAMDI...media conversation...

TRENTAnd it's -- there you go.

NNAMDI...when matters of importance to our well-being and our health don't tend to dominate the conversation.

TRENTThere you go, exactly. Exactly.

NNAMDIGot to take a short break. Jay, thank you very much for your call. If you've already called, stay on the line. We will try to get to your call. We're discussing hearing loss and whether loud noise is to blame, especially for hearing loss among teenagers. You can still call us, 800-433-8850. If the lines are busy, then shoot us an e-mail to kojowamu.org or tweet @kojoshow or go to our website, kojoshow.org.

NNAMDIWe're discussing hearing loss with Robyn Gershon, professor of clinical sociomedical sciences at the Mailman School of Public Health at Columbia University. Janice Trent is an audiologist in private practice in Bowie, Md. and Josef Shargorodsky is an ear, nose and throat specialist at Brigham and Women's Hospital and Massachusetts Eye and Ear Infirmary. Dr. Shargorodsky led the team that conducted a study on hearing loss among adolescents. Before I go back to the phones, it's my understanding there are different kinds of hearing loss. Can you explain exactly what happens inside the ear, Josef Shargorodsky?

SHARGORODSKYSure. So different kinds of hearing loss, it's a big topic. But really, on a hearing test, what you see is the frequencies and the intensity. And so what you're seeing is high frequency versus lower frequencies and that basically -- inside the ear, that kind of goes along with the physiology of hair cells and how the hearing organ or the cochlea is built. Generally, when people lose hearing with age, with noise and with a lot of different factors, the high frequencies are usually the ones that go first. And so when people lose hearing, it's usually higher frequencies and it starts out at lower intensities. That's with chronic (word?) or aging and then the hearing becomes more -- or hearing loss becomes more severe.

NNAMDIHere is Rick in Fredericksburg, Va. Rick, you're on the air. Go ahead, please.

RICKThank you for taking my call, Kojo. Yeah. I'm 50 years old. And about a year ago, I started noticing a ringing in my ears and it's getting worse progressively. I -- I drive a service truck for a living so I hear a lot of noise. I also play percussion in a Celtic band with a bagpiper so it doesn't help very much either. And I was wondering, I -- I've tried a few dietary supplements to try and eliminate the ringing, but it's just getting -- it drives me nuts. And I think -- if you could -- I'll take my answer off the air. I appreciate it.

NNAMDIAny suggestions at all, Josef Shagorodsky?

SHARGORODSKYSure. There really is -- it's no cure for this condition. It's called tinnitus or ringing in the ears. There are certain things that people try, but the first step is to go and have a physician take a look because there are different things that can cause it. And usually it's related to noise exposure or hearing loss and people develop this chronically, but there are some actually more dangerous acute conditions that can cause this as well. And so it's important to get it looked at by a physician.

SHARGORODSKYThere are also things, such as muscle tension, that are very -- that are mild and can be treated that need to evaluated for as well. But in most cases of ringing in the ears or tinnitus, there really isn't a cure and it's something that people experience. And people tend to get used to it, but it's very annoying for the period -- for a period of time. And it's usually worse at night when all the other noise goes away. And so one thing that we recommend is for people to use kind of ambient noise, such as a -- like one of those recordings of ocean sounds or having the TV on quietly to distract from it. But those kinds of cases of tinnitus, there really isn't a cure for.

NNAMDIAnd Robyn Gershon, we got this e-mail from Kent. "As a parent of two children, five and eight years old, and having noticed the increasing loudness of movies, are there specific suggestions for everyday situations, for example carrying an inexpensive SPL meter foam earplugs for kids?" What advice can you give, Robyn Gershon, for people of all ages who may be worried about their hearing? Are there ways to protect your ears?

GERSHONAbsolutely. And in fact, when I go to movies now, I certainly wear hearing protection. I have all kinds of different ones, some very high end, but some that are very cheap that I can get in the local drugstore for, you know, $2 or $3. Obviously, the more high end ones protect much broadly -- much more broadly. They can even be noise canceling so they can cancel out the background and you can still hear conversational voice. I definitely think that having children wearing hearing protection is a very, very good idea. In fact, I think for most of us, it's a good idea.

NNAMDIDoes loud noise and hearing loss affect our general health, Robyn Gershon?

GERSHONAbsolutely. It has been shown to increase blood pressure. It's related to neuroendocrine disorders, increases your stress levels, affects your sleeping, quality of sleeping, in fact, your blood pressure, if you are sleeping and you hear loud noises and you sleep right through it. So unfortunately, the research in the area, just as that EPA office closed down, there's almost no funding. I noticed that, Dr. Shargorodsky, your research was funded, I guess, internally at your institution, which is very admirable.

GERSHONBut these kinds of cities where we have so much missing data, especially the impact on very young children, there's just no research funding for it in this country.

NNAMDIAnd Janice Trent, Kent also wants to know, "When one loses high frequency hearing, does turning the volume up simply create an illusion of hearing more or better since much all of the increased volume is in the low frequencies?"

TRENTWell, you are going to hear a little bit more. You -- but you can get some distortion if you're turning it up too loud. But, yes. Turning it up is going to make it easier for you to hear.

NNAMDIOn to Pamela in Hagerstown, Md. Pamela, you're on the air. Go ahead, please.

PAMELAOkay. Hi. Thank you for taking my call. I'm a musician and former teacher. I have about 74 percent hearing loss. And one of the most upsetting things with it, and I think teenagers especially need to understand this, most people believe that hearing loss is only loss of volume, and oh, well, I'll get a hearing aid when I'm older. But I have also tinnitus and I've developed hyperacusis, which means the music -- I can no longer listen to music for very long. It's often distorted. And it just wants to make me weep because I can't practice my music. And I think if these teenagers who are so in love with their music understood that they may one day not be able to understand their music any longer, it could be a very powerful publicity campaign.

NNAMDIA very powerful deterrent. Josef Shargorodsky, what do you think?

SHARGORODSKYI agree with you completely. There are so many important aspects to hearing. And besides just the loudness, it's also the clarity that you can lose. And so it's -- in which case, just turning it up won't even fix the problem. So this is a very important problem and I think it is underestimated at this point in our society. So it's great that shows such as this one are paying so much attention to it right now.

NNAMDIWe got this from Mary from Alexandria. "Your discussion is focusing on hearing loss caused by noise from some outside source, subway construction, ambulance, all the things that have been around for decades. What about what has changed in the last 20 years? iPods, mobile phones, these are all new technologies and the volume is controlled by the individual using them. I'm a little surprised at how little of your discussion has focused on personal responsibility for one's own hearing loss." Janice Trent, where does the personal responsibility fit in, especially when we're talking about teenagers?

TRENTWell, personal responsibility is very important, but it is also education and awareness. So I question sometimes whether people understand that when they're in the subway and, you know, the subway may be a hundred decibels, and because you want to hear your personal music, you turn up the volume on your personal music. Now, you are really doing damage. Just a couple minutes of that and you have done personal damage. And it is important. But I think here again, it's an issue that people are just not educated. Now, the logic also says that you should be getting a headache. Some -- there should be discomfort.

TRENTSo common sense says that, you know, if you're getting a headache, if you're feeling some discomfort, by golly, turn the thing down. But in the absence of that, we've got to have some education. We've got to say, you know, this is noisy, this is dangerous. And if you're going to use these personal listening devices you are causing more damage and you've got to turn everything down.

NNAMDIOn to Frank in Washington, D.C. Frank, your turn. Go ahead, please.

FRANKThank you for taking my call, Kojo. I just recently went to a Labor Day picnic and I was surprised at the number of children and infants that are being exposed to high decibels of noise. There was a rock band in the park area with these large loudspeakers and my wife and I went to the rear of the park to get away from it. But in walking through, I noticed a lot of children.

FRANKSecondly, I've reached the frustration point where when I leave the house, I just automatically put in a set of earplugs. (laugh) Because when you're walking down the street D.C., if you're at a bus stop and these buses come in, as soon as they put on the brakes, nine times out of ten, it's a very high frequency squeal that reaches the threshold of pain. And nobody seems to mind that at all. And I'm wondering if there are any standards for the manufacture of brakes, why in...

NNAMDISpeaking...

FRANK...recent years these buses have become so loud, as well as the truck brakes.

NNAMDISpeaking of...

FRANKThank you. I'll take my answer...

NNAMDISpeaking of the...

FRANK...off the air.

NNAMDIThank you very much for your call, Frank. Speaking of that, Robyn Gershon, allow me to add this e-mail we got from Lydia. "What about the effect of noise inside subway cars. Now, I'm not talking about loud tourists or groups of teenagers. I'm talking about the loud sound that seems to be generated by the actual train car when it seems to be going around a curve. I don't know that anyone has ever measured the decibel levels inside the cars, but I find it irritating enough to wear earplugs during my commutes to and from work. Has anyone else noticed the loudness of metro or subway cars or am I just being particularly sensitive?"

GERSHONOh, absolutely. We did, of course, measure the inside of not only subways, but buses, trams, the ferries and above-ground railroads. And inside the car is extremely high. In fact, in our study, it was 79.3 decibels. On the platform, it was 81.1. It was barely significantly different between those two. So it's very, very loud inside. And I agree with the other caller about the buses. I noticed that, too. And of course, we measured at the bus stops and on the bus, as I said, and they were extremely loud. The average decibels on the bus stops were 75 and -- 75 inside the bus and 76 on the curb and I believe it's those airbrakes.

GERSHONAnd I also don't understand why they have to be so loud. I understand mechanical equipment is inherently noisy, you know, machinery, metal on metal. That's the problem, of course, with the subways. But there seems to be, at least for some of these things, a way to get them much lower. And with regards to that loud noise with the children at the street fair, I think parents -- this gets back to what Janice said. Parents absolutely have to become educated and then they have to help educate their kids. I find it curious that CDC thinks that noise-induced hearing loss is one of their top ten priorities and yet I see very little going in terms of public health prevention in this area.

NNAMDIAnd we got this e-mail from Terry in D.C., Janice Trent. "I use a white noise machine to help my son get a good night's sleep. Is there any potential risk to that? It's not very loud, but is there any risk from the continued sound?"

TRENTNot that I know of, no. I think as long as the sound is low, then I think the child is okay. I just think it's interesting that we have trouble adjusting to just quiet. For some reason, we all have to have noise. And at some point, we have to start going back to the concept of just learning how to be still and appreciate quiet. And I think if we can learn how to appreciate quiet, we'll appreciate sounds a little bit more. But when we're constantly being bombarded with sounds, it creates a standard that possibly isn't necessary.

NNAMDIJanice Trent is an audiologist in private practice in Bowie, Md. Thank you very much for joining us.

TRENTYou're welcome. It was a pleasure to be with you.

NNAMDIRobyn Gershon is a professor of clinical sociomedical sciences at the Mailman School of Public Health at Columbia University. Thank you very much for joining us.

GERSHONMy pleasure.

NNAMDIAnd Josef Shargorodsky is an ear, nose, and throat specialist at Brigham and Women's Hospital and Massachusetts Eye and Ear Infirmary. Dr. Shargorodsky, thank you for joining us.

SHARGORODSKYThank you. And thank you for your attention to this subject.

NNAMDI"The Kojo Nnamdi Show" is produced by Diane Vogel, Brendan Sweeney, Tara Boyle, Michael Martinez, and Ingalisa Schrobsdorff. Diane Vogel is the managing producer. Dorie Anisman has been on the phones. The engineer today, Tobey Schreiner. Podcasts of all shows, Real Audio archives and CDs are available, as always, at our website kojoshow.org and free transcripts are also available at our website kojoshow.org. Thank you all for listening. I'm Kojo Nnamdi.