“What?” – Untreated Hearing Loss and Cognitive Decline


The dreaded question that infiltrates the natural flow of conversation, forcing you to pause to repeat your last sentence or phrase. Did you hear this question frequently over the holiday season with family members or friends? Did you hear it from your spouse or kids today? Yes, some of the time it is asked due to inattention or distraction. Other times, it may come from an elderly relative who physically did not hear you clearly due the softness of your voice, the amount of background noise present or the inability to see your face for visual cues. Could this question be asked because the listener could not remember what you just said? In the last 3-4 years, a lot of research in the field of audiology has been devoted to studying the risk of untreated hearing loss on advancing cognitive decline.

Before we delve into what is causing this decline in those individuals with hearing loss who aren’t wearing hearing aids, let’s look at some facts:

  • Hearing loss affects more than 9 million Americans over the age of 65 years old.
  • Another 10 million Americans between the ages of 45 to 64 years old have hearing loss.
  • About half of individuals over the age of 75 years old have hearing loss.
  • Only about 20% of people who need to wear hearing aids are wearing them.
  • On average, individuals wait 7-10 years after their initial diagnosis of hearing aids to buy/wear hearing aids.

When comparing the number of individuals affected by hearing loss versus the number of individuals wearing hearing aids, it is shocking that there are any successful conversations over the holiday season!

Why aren’t people wearing hearing aids if they know they have hearing loss and are struggling in daily conversations with family or collegues?

There are many reasons or combinations of reasons that prevent patients from investing in their auditory health:

  • First reason, and for many the most debilitating, is cost. Hearing aids are pricy little computers that sit behind your ears. Unfortunately, most insurance companies are not helpful in footing the bill either. A lower budget option is for the individual to naturally develop their own compensatory strategies such as, turning up the television louder, saying “What?” more often, or not participating in dinner conversations.
  • Second, many people are in denial about their hearing loss. It’s so often that a spouse will blame his wife for being “too soft spoken” or blame the teenager for “talking too fast”. These claims may be true (especially with younger generations talking quickly) but it’s also possible that the listener may have experienced some age-related or noise-induced hearing loss.
  • Third, there is still (unfortunately) a stigma related to hearing aids. Eligible users fight they are not “old enough” for hearing aids or that it makes them look weak to use an aid. If the person’s experience with hearing aids is generally good (“friend wears them and likes them”), the person is more likely to adopt hearing aid use. If it is generally negative (“grandpa John used to wear those big, squealing things in his ears”), it may be harder to counter the stigma.
  • Lastly, especially with older patients, the anti-hearing aids campaign is based on cosmetic appeal. Previous generations of hearing aids were huge and bulky, filling the entire ear and squealing frequently (see #3 with grandpa John). New devices do not have this reputation and for most patients, there are a variety of style options adequate to fit the hearing loss properly.

What’s the risk of not getting hearing aids if I think or know I have a hearing loss?


Photo Credit: Starkey Hearing Technologies

Again, let me turn you to the facts, this time about untreated (untreated=not wearing hearing aids) hearing loss:

  • Adults with untreated hearing loss develop cognitive impairment 3.2 years sooner than normal hearing cohort (Lin et al, 2011, 2013).
  • Untreated hearing loss is correlated to a 36% increase in the rate of cognitive decline versus the normal hearing cohort (Lin, 2013).
  • Individuals with hearing loss experience a loss of memory and thinking capabilities 40% faster than those without hearing loss (Lin, 1997).
  • Mild hearing loss doubles the risk of dementia, with moderate hearing loss leading to three times the risk, and severe hearing loss five times the risk (Breckell).
  • Individuals with untreated hearing loss report higher incidence of depression, paranoia and anxiety.

A recent study by Dr. Helen Amieva (researcher from Neuropsychology and Epidemiology of Aging at the University of Bordeaux, France) showed similar results to the facts above. Titled “Self-Reported Hearing Loss: Hearing Aids and Cognitive Decline in Elderly Adults: A 25-year Study”, the study evaluated over 3500 adults ages 65 years and older, some using hearing aids and others not. She found that there was no difference in the rate of cognitive decline between the control group (no hearing loss present) and people who were wearing hearing aids for their hearing loss. In contrast, the untreated hearing loss group (not wearing hearing aids) was significantly associated with lower baseline scores on the Mini-Mental State Examination (MMSE). The MMSE is frequently used in studies to evaluate the degree of cognitive impairment.

How come individuals with hearing loss who aren’t wearing hearing aids are experiencing faster cognitive decline than their normal hearing or hearing aid wearing cohort?

A study by Campbell and Sharma (University of Colorado) in 2014 focused on this verey question! What is happening in the brain when one sense is deprived or lost? They found that there are neuroplastic changes in the brain which allow for one well-functioning/normal sensory system (let’s say, visual) can recruit brain regions of the deprived sensory system (let’s say, auditory). They took brain recordings (CVEP-cortical visual-evoked potentials) from adults with mild-moderating hearing loss and found there was increased activity in the auditory regions in response to a visual stimulus! The visual system was stealing some of the untouched auditory system’s resources. The recruitment and plasticity of the brain could make it harder for someone to understand speech when background noise is present.

These cortical changes can negatively impact working memory and executive function, therefore contributing to cognitive decline. Not using hearing aids means that there is less auditory input or stimuli for the auditory cortex. Not stimulating parts of brain causes atrophy, a degeneration of cells.

“It’s not just about hearing well today, it’s about the long-term effects of untreated hearing loss.”

Why bother getting hearing aids if you’re making it by in daily life, turning up the radio a little louder and avoiding phone calls, when possible?

Dr. Donald Schum, the Vice President for Audiology and Professional Relations at Oticon, Inc stated, “Improved communication made possible by hearing aids resulted in improved mood, social interactions and cognitively stimulating abilities and is the most likely underlying reason for the decreased cognitive decline reported in the study.” Hearing allows you to be connected to the world around you. It allows you to feel safer and socially involved. Hearing aids are directly correlated to an overall better quality of life, combatting the loneliness, anxiety, depression and social isolation that accompanies hearing loss.

If you’re one of the individuals, waiting 7-10 years before diving into the world of hearing aids, don’t wait any longer! As Schum stated, “It’s not just about hearing well today, it’s about the long-term effects of untreated hearing loss.”


Sources and Articles:


October is Audiology Awareness Month!

October 3rd: All About Audiologists!

Hearing is a critical aspect of daily life, from communicating with a loved one to learning something new in school to recognizing the ambulance siren from down the street. Use the post below, and many more to come in October, to expand your knowledge on audiology and hearing loss.

Let’s start with the definition and scope of audiologists:

Au-di-ol-o-gists: Audiologists are the primary health-care professionals who evaluate, diagnose, treat, and manage hearing loss and balance disorders in adults and children.

What do audiologists do?


  • evaluate and diagnose hearing loss and vestibular (balance) disorders ƒ
  • prescribe, fit, and dispense hearing aids and other amplification and hearing assistance technologies ƒ
  • are members of cochlear implant teams ƒ
  • perform ear- or hearing-related surgical monitoring ƒ
  • design and implement hearing conservation programs ƒ
  • design and implement newborn hearing screening programs ƒ
  • provide hearing rehabilitation training such as auditory training and listening skills improvement ƒ
  • assess and treat individuals, especially children, with central auditory processing disorders ƒ
  • assess and treat individuals with tinnitus (noise in the ear, such as ringing)

Who do audiologists treat?

Audiologists treat all ages and types of hearing loss: the elderly, adults, teens, children, and infants.

Where do audiologists work?

ƒAudiologists work in a variety of settings, such as hospitals, clinics, private practice, ENT offices, universities, K-12 schools, government, military, and Veterans’ Administration (VA) hospitals.

Audiology is a highly recognized profession and has been ranked by U.S. News and World Report as one of the Best Careers in 2006, 2007, 2008, and 2009.


Source: What is an AuD?

The Effect of Education on the Decision to Wear Ear Plugs


As published in the Update (Volume 28, Issue 1), the official newsletter of the Council for Accreditation on Occupational Hearing Loss.

From a young age, children learn to brush their teeth every day and to sit through regular eye examinations. Unfortunately, the same kind of lifelong education is lacking for auditory health. We use q-tips regularly and attend concerts without protection — habits that unknowingly leave us susceptible to auditory damage. What if information about general ear health were provided? Would awareness catalyze action to prevent damage to hearing? How does access to resources change health behavior?

College students are a population at high risk for noise-induced hearing loss due to noise exposure at bars, concerts, workout classes, and sporting events. Beyond a general risk, over half of college students voluntarily expose themselves to harmful levels of music and noise.1 The reality of college students’ elevated risk to hearing damage raises the following important research questions: Are college students taking preventative action to protect their hearing? What would motivate them to do so? My three-part study evaluated the decisions of college students to wear or not wear hearing protective devices when attending on-campus music concerts.

The first part of the study took place at a concert at a private Midwestern university. An exit survey, completed by 149 students, gauged how much students knew about auditory health, the dangers of loud music, and their decisions to wear (or not) ear plugs. The students attending the concert were not given any information about the risk of entering without hearing protection nor were they provided with ear plugs. The results were unsurprising. Only around five percent of students reported wearing hearing protection during the concert.

Part two of the study was conducted at the following campus-wide concert. A group of 36 students attended a voluntary session before the concert on noise-induced hearing loss and the harmful effects of attending the concert without protection. The students were provided with ear plugs. After the concert, the students took a survey which asked whether they wore the ear plugs that were provided and if there were any noticeable changes in their hearing abilities as a result of the concert. The results from the second part of the study showed that, with face-to-face education and the provision of free ear plugs, overScreen Shot 2016-03-23 at 11.27.48 PM half (55.6%) of the students reported wearing hearing protection at the concert. Education and resources together catalyzed preventative action in a high-risk population.

However, would the strategy be as effective without a face-to-face presentation on noise-induced loss? The last part of the study, conducted at the succeeding concert, employed a different educational strategy. Signs and handbills displayed noise-induced hearing loss facts as well as risks of attending the concert without protection. Over 2,000 students walked by the signs and picked up the handbills, three-fourths of those picking up a pair of ear plugs on their way into the concert venue. Volunteers were available to demonstrate or assist on how to properly insert the ear plugs. As attendees exited the venue, a survey evaluated whether the attendee wore the ear plugs, why or why not, and if there were any noticeable changes in hearing abilities as a result of the concert. Of the 152 students surveyed, almost 50% reported to have worn ear plugs at the concert (see Figure 1).

Why did students choose to wear or not wear free ear plugs provided on-site? The majority of college students reported their motivation to wear ear plugs came from the availability Screen Shot 2016-03-23 at 11.27.36 PMof resources and the loud concert environment. A smaller percentage chose not to wear hearing pr
otection because ear plugs distorted the quality of the music and made it difficult to converse with friends. Overall, the top two concerns that students identified as reasons to not wear ear plugs (“Music sounds distorted…” and “Uncomfortable to wear”) could be addressed by the use of musicians’ ear plugs. Unlike the standard (and highly affordable) plugs used in the present study, musicians’ ear plugs, which fit comfortably in the canal, would allow for sound to be attenuated without a reduction in sound quality.

As audiologists attempt to broaden awareness of the field while encouraging preventative health behaviors, it is important to evaluate whether national educational campaigns could have a significant impact on changing attitudes and actions towards auditory health. The results of the study suggest that, at least in the setting of campus concerts, providing education and resources has an impact on an individual’s decision to take preventative action for their auditory health. Face-to-face education, such as an in-person presentation, showed to be more effective in motivating students to wear ear plugs than indirect educational strategies, such as pamphlets. The availability and allocation of resources is another important factor to consider for audiologists interested in promoting public health. Beyond education strategies, the present study suggests that, if resources to promote hearing health are made available, individuals are likely to take advantage of them. Evidence for the impact of education and resource allocation gives promise to audiologists’ efforts to promote positive health behavior. Perhaps it will be a hearing test that finally joins the ranks of other annual doctor’s appointments.



1 Rawool VW, Colligon-Wayne LA. Auditory lifestyles and beliefs related to hearing loss among college students in the USA. Noise Health 2008;10:1-10

Author Bio:

Elizabeth Marler is a first year graduate student in the AuD program at Purdue University in West Lafayette, IN. She is a graduate of Truman State University in Kirksville, Missouri, where she conducted her research. Elizabeth has presented this research at the 2015 Missouri Speech-Language-Hearing Association annual conference, the 2015 American Speech-Language-Hearing Association annual conference and will present at the American Academy of Audiology Conference in April. emarler@purdue.edu

The Marketing of Q-Tips—A Brief History

1923: Leo Gerstenzang, upon observing his wife apply wads of cotton to toothpicks, invented the first ready-to-use cotton swab, marketing as baby care accessories. He introduced Baby Gays, the first sanitized cotton swaps made of wood and single-sided. When Baby Gays came out, there was no discouragement of putting them inside of ears.

1927: A print advertisement read, “Every mother will be glad to know about Q-tips Baby Gays (the Q stands for “quality”), sanitary boric tipped swabs for the eyes, nostrils, ears, gums, and many other uses.”


Over the years, many things changed about the Q-Tip, including the material and marketing for multiple uses. One thing didn’t change: the absence of a warning.

1970s: This was the first time Q-Tips warned against using the swabs in the canal. On the front of the box, it did say, “For adult ear care”, but the back began to caution against sticking things inside the ears: “The careful way to clean ears: hold swap firmly and use a soft touch. Stroke swab gently around the outer surfaces of the ear, without entering the ear canal”

1980’s: A television advertisement featuring Betty White encouraged the use of cotton swaps on eyebrows, lips and ears. Branded “the safe swab”, Q-Tips were marketed as a multi-use care accessory for any age.

1990: A piece published by the Washington Post made a comparison that telling people to use the swabs on the “outer surfaces of the ear without entering the ear canal” was like asking smokers to dangle cigarettes from their lipswithout lighting them.

Today, the warnings are explicit: “Do not insert swab into ear canal”. Despite this explicit message, Q-tips are still marketed as a tool for cleaning and implied as a tool to clean your ears.

75c62c554d75ab89a37c1b02ed48956dEven if Q-Tip manufacturers changed their marketing strategies, it would be difficult to change how people perceive the brand. The only way to change this perception is to take the product off the market. But since Q-Tips have been around since the early twenties…this long-standing product is destined to keep its place on the shelf.

The Q-Tip Addiction

There it is again. That itchy, nagging feeling. It seems to come every day. There is only one thing that can alleviate the feeling: Q-Tips. The dependence on Q-Tips is prevalent but the addiction isn’t something that has come forth in recent years. In 1923, Leo Gerstenzang, upon observing his wife apply wads of cotton to toothpicks, invented the first ready-to-use cotton swab. He marketed them as baby care accessories. Since then, the Q-Tip has truly expanded its use from a baby care accessory…marketing towards everything from a makeup accessory to an ear-cleaning device.


The Q-Tip, when used in the ear, is extremely dangerous to your health. If you’re a loyal patron of the cheap multi-use cotton swabs, your addiction arises from one of these reasons:

  1. A perception that ear wax is dirty or unnecessary. Many people believe that ear wax is a gross, unhygienic visitor of our ears.
  2. The itch-scratch cycle. The more you use Q-Tips, the more your ears itch. The more your ears itch, the more you use Q-Tips. The more you use…
  3. Using Q-Tips feels GREAT…so you do it again. This is due to the number of highly sensitive nerve endings in your ear that are connected to many internal organs. The stimulation of these nerves is pleasurable and addicting.


Q-tips are great, right? Cleaning out unnecessary earwax, stimulating our sensitive, never-touched nerves and taking care of that annoying itch. WRONG! Unfortunately Q-Tips are doing more harm than good for our ears. First, Q-Tips tend to push earwaxfig-3-cartilage-and-bone further into the ear. The ear canal is one-third bony and two-thirds cartilaginous. The part made of cartilage is closer to our pinna (outer ear ) and contains the glands that produce the earwax. The part of the canal surrounded by bone sits further into the ear, right next to the eardrum. Using a Q-Tip can push this earwax into the bony portion of the ear canal, making it impossible for the ear to naturally rid itself of the wax. Second, too much cleaning can lead to ear and skin complications, everything from ear infections to eczema present in the outer ear. Lastly, using Q-Tips increases the chances of poking a whole in the eardrum. Doctors and audiologists have heard hundreds of stories of someone knocking someone’s arm while they were using a Q-Tip…causing a perforation (hole) in the tympanic membrane (eardrum). Therefore, it’s probably safest to follow the old adage of putting “nothing in your ear smaller than your elbow.

But how can you get that earwax out of your ears?? You don’t! Cerumen, or earwax, is actually good for your ear canals. Like tears help lubricate and protect our eyeballs, earwax acts a self-cleaning agent to protect, lubricate and provide antibacterial properties to the canal. Earwax traps dirt and contaminants (EVEN BUGS) before they have the ability of reaching your inner ear. Some people are REALLY waxy though…and the need to remove earwax seems more imminent. Excessive earwax can be genetic or it can be caused by irritated ear canals. Using your earbuds to much or a skin condition like eczema can cause irritated ear canals. If you’re susceptible to excess earwax, it is possible you could experience impacted cerumen. Impacted cerumen can impact the ability to hear, causing earaches, fullness in the ears, tinnitus (ringing), itching and coughing.

So how do you clean out that pesky, annoying earwax? You don’t! Ears are self-cleaning so routine bathing should take care of any remaining earwax in the canal. Old earwax is typically transported out the ear with chewing movements (it dries out, flakes off and falls out naturally). If you have excess cerumen, you should visit your primary care physician for them to remove the wax or help you create a cerumen management plan. It is not uncommon to have “waxy ears”! It is likely that your physician (or audiologist) will suggest wax-softening drops (such as Debrox) to soften the wax so they can remove the cerumen with ease. Skin in the ear canal is extremely sensitive and thin. Earwax that has been in the canal for a while is likely to attach to the canal wall and tear the skin during removal. The softening process is extremely important for diabetics, as tearing the ear canal skin off the wall can cause bleeding that may not be easily stopped.

Improper use of Q-Tips causes an “earache for patients and a headache for doctors.” Here are some things NOT to do:

  1. Don’t use Q-tips!! If you can’t go cold turkey because of your addiction, at least limit your cleaning. Also, line up a fingernail at the point where the cotton meets the Q-Tip stick to ensure it doesn’t go too deep.
  2. Don’t try flushing out your earwax at home. Flushing out the ear canal runs the risk of eardrum rupture.
  3. Don’t use ear candles! The most common injuries with ear candles include burns, obstruction of the ear canal with the wax or a perforation of the eardrum. Since 1996, the FDA has taken regulatory actions against ear candles because they are considered an “imminent danger to health.”


So if Q-Tips are so bad, why are they still being sold?!

The FDA says Q-Tips are “used to apply medications to, or to take specimens from, a patient.” This is the same description seen for cotton balls. Although the Consumer Product Safety Commission is tracking all injuries related to cotton balls, it is not for cotton swabs. A 2011 study by Henry Ford Hospital found a direct association between the use of cotton swabs inside ears and ruptured eardrums. They also noted in their study that more than 50% of patients seen in otolaryngology clinics, regardless of their primary complaint, admit to using cotton swabs to clean their ears. Despite how many individuals use Q-Tips, it’s hard to know the exact number of injuries. As FDA spokeswoman, Deborah Kotz, said, “It would be very tedious to figure out how many injuries associated with cotton swabs were reported each year.” But we don’t need the figures to know that Q-Tips are one of the top contributors to ear problems.


Stop the addiction. Quit the Q-Tips.




Huffington Post

Washington Post

Life Hacker





Equalize: Early and Often

What is the most common scuba diving injury??

Decompression sickness? Cuts from coral reefs? Animal attacks?


Me holding a sea cucumber. Also pictured: scuba buddy, Zorg. Catalina Island, CA. 

No, in fact, the most common injury is of the EAR.

From swimmer’s ear to barotrauma, ear injuries are frequent but preventable with an increase focus on ear anatomy and awareness of what could go wrong.


The most common type of ear injury is a barotrauma, or an injury related to pressure. Just like the pressure you experience in an airplane, scuba divers feel the same pressure on their ears as they descend in the water. This pressure occurs because the air pressure of the middle ear is not equal to the pressure of the external environment. The middle ear consists of three bones (called the ossicles), which are suspending in an air-filled space. This space is connected to the external environment by a thin omiddle-ear-pressurepening called the Eustachian tube. The Eustachian tube, which connects the middle ear to the back of the throat, it normally closed. Scuba divers are overly aware of the Eustachian tube, as they are taught to “equalize early and often”. Equalizing the ears acts as a preventative measure to make sure the pressure of the middle ear and the external environment are always equal.


How do I equalize?


To open the Eustachian tube, or “equalize”, you can swallow, move the jaw or perform the Valsalva maneuver. The Valsalva is a common technique for scuba divers, completed by pitching your nose and exhaling forcefully with a closed mouth. These procedures will cause air from your throat to enter the middle ears. You may hear a soft pop or click when this happens.


Why should I equalize?


The first 14 feet (beginning of the dive) is where the ear is most at risk because of the rapid relative gas volume change. If you do not equalize on your descent, here is what happens:

  • At one foot below the surface:
    • The water pressure outside of your eardrums is 0.445 psi more than in your middle ears. The eardrums flex inward.
  • At four feet:
    • The pressure difference is now 1.78 psi. Your eardrums bulge into your middle ears. The round and oval windows between the middle and inner ears also bulge in. Mucus begins to fill your Eustachian tube. You begin to feel pain and it is very difficult to equalize.
  • At six feet:
    • There is a 2.67 psi difference. Your eardrum stretches further and its tissues begin to tear. Small blood vessels in your ear may expand or break. Your Eustachian tube is locked shut by the pressure in your middle ear, making it impossible to equalize. Pain increases.
  • At eight feet:
    • There is a 3.56 psi difference. Middle-ear barotrauma occurs causing blood and mucus to fill the middle ear. Fluid (not air) equalizes the pressure on your eardrums. Pain subsides but there is a feeling of fullness in your ears that remains for over a week.
  • At ten feet:
    • The difference in pressure is 4.45 psi. It is possible that your eardrums could perforate, causing water to flood the inner ear. The sudden influx of cold water against your balance mechanism may cause extreme dizziness (especially if only one eardrum breaks). Trying to equalize at this point could cause inner ear barotrauma due to the rupture of the round window, which sits between the middle and inner ears. This inner ear barotrauma may cause temporary or permanent hearing loss.


Common Injuries to the Ear:

Otitis Externa: Otherwise known as swimmers ear, otitis externa is an inflammation of the external ear due to infection. This is usually the cause of the ear remaining moist after immersion to water. The ear canal may become red, itchy or swollen. Prevention is the key!


Barotitis Media: Middle ear barotrauma is the most commonly reported injury by scuba divers. Symptoms, which can take a day or two to develop, include: a feeling of fullness, muffled hearing, and/or a feeling of fluid in the ears. It is suggested to stop diving (and other pressure changing activities—like flying) and see an otolaryngologist or an ear, nose and throat doctor.


Inner Ear Barotrauma: This inner ear damage can occur when divers attempt to forcefully equalize their ears. This unnecessary force causes the middle ear to overpressurize and can result in damage to the round and oval windows. These windows separate the middle from the inner ear. Many with inner ear barotrauma experience dizziness, vomiting, hearing loss and a ringing in the ears. See an audiologist or ear, nose and throat doctor if you’re experiencing these symptoms.


Tympanic Membrane Rupture: Another barotraumatic injury, this one causing a rupture of the eardrum (tympanic membrane). This can occur in as little as 7 feet of water. A TM rupture can result in pain and bleeding. See an ENT or medical practitioner for a consultation. Some ruptures can heal independent of intervention and some necessitate surgery to patch the hole.


External Ear Canal Superficial Vessel Rupture: Occurring more in divers who wear hoods, overpressure in the external ear canal can cause the blood vessels in the ear canal to rupture or burst. Individuals may notice a small amount of blood exit the ear.


If you ever experience ear pain, an injury, bleeding or hearing loss after scuba diving, see a medical professional (audiologist, otolaryngologist and/or an ENT) immediately. Stop diving until you get a medical consultation.


10 tips for Easy Equalizing:

  1. equalization-while-divingListen for the pop or click in both ears! This means both Eustachian tubes are open.
  2. Equalize early and often!
  3. Equalize at the surface or “pre-pressurize”. This will help you get past the critical first few feet of your descent, when you are busy clearing your mask or dumping your BC.
  4. Descend feet first. Air rises up the Eustachian tubes and mucus tends to drain downward. Many studies show that a Valsalva maneuver requires 50% MORE force when you’re in a head-down position than a head-up position.
  5. Look up. Extending your neck tends to open your Eustachian tubs.
  6. Use a descent line to control the speed of your descend.
  7. Stop if it hurts. Do not descend any more if you have not equalized your ears. This will help avoid barotrauma.
  8. Avoid milk and other dairy products before diving…it can increase your mucus production.
  9. Tobacco and alcohol can also affect your mucus membranes causing a blockage in your Eustachian tubes. So avoid it before diving!
  10. Keep your mask clear: water up your nose can irritate your mucus and cause more clogging blockage.



A picture of me scuba diving on Catalina Island, CA.

A note from the author:

“I received my scuba certification the summer of 2013 on Catalina Island. Upon training, I was asked to learn the anatomy of the ear and common issues that can go wrong due to poor or incorrect equalization. Since this was around the origin of my interest in audiology, I paid special attention to common ear injuries and issues that occur. I hope to be able to increase knowledge, awareness and concern of ear anatomy and injuries so individuals will not negatively impact their auditory health due to their hobbies and habits.”


Click here for a diver’s guide to ears: https://www.diversalertnetwork.org/medical/articles/download/DiversGuidetoEars.pdf


Fear the Ear (Buds)

Hear Today, Gone Tomorrow.” “Listen to Your Buds.” “Make Listening Safe.” These are just a few of many campaigns to discourage individuals, especially young teenagers, from improper use of ear buds and headphones.


Why is this message so prevalent in media today?

Since their creation in 1910 by Nathaniel Baldwin, headphones have always been a danger to our hearing. The advent of the ear buds style headphones has brought the risk of hearing loss to more probable level. Ear buds, which sit further in the ear canal, are more powerful and dangerous than in the past. Ear buds do a poorer job at cancelling background noise in comparison to the old-style supra-aural (over the ear) headphones. “Hearing loss among today’s teens is about 30 percent higher than in the 1980s and 1990s,” says Dr. Sreekant Cherukuri, an ear, nose and throat specialist from Munster, Indiana. This higher prevalence of hearing loss is directly related to the increase of the availability of technology causing an increase of use of personal music players. “Probably the largest cause [of hearing damage] is millennials using iPods and [smartphones],” says Dr. Cherukuri. Listening to your iPod at more than 50% (which is over 80 dB) for 15 minutes can have a devastating and permanent effect on your hearing abilities, according to the National Institute of Health.

Is the message actually prevalent in the media?

If you Google “noise-induced hearing loss”, “safe listening iPod” or “ear buds bad”, the number of educational campaigns and websites dedicated to the dangers of loud noises will make you think you’ve been missing the daily commercials or public health announcements in the media. Although different groups have attempted different campaigns to reduce the number of individuals at risk for noise-induced loss, the prevalence is simply increasing. The World Health Organization estimates that over 1.1 billion people worldwide are at risk for hearing loss due to unsafe listening practices.

Despite the attempts at reducing this dangerous health behavior, teenagers and young adults are listening to their iPods TOO loud. A study in 2010 in the American Journal of Audiology estimated around one-third of college students were occasionally using their MP3 players at maximum volume levels. Another study in 2011 appearing in the Journal of Speech, Language and Hearing Research suggests that nearly 60% of students at a major New York City college were found listening to their personal devices with headphones at volumes greater than 85 dB.

These statistics indicate that knowledge and awareness about noise-induced hearing loss are low amongst teens. The lack of knowledge catalyzes a lack of concern for noise-induced loss. A survey of Teens and Adults about the Use of Personal Electronic Devices and Headphones in 2006 identified that 47% of teens say they are not concerned about hearing loss from the use of personal audio technology. This attitude is common amongst young adults, as it is hard to foresee long-term consequences of present decisions. The Today Show interviewed a 22 year old with noise-induced hearing loss who summed up the perspective of teens worldwide, “You don’t think anything is going to happen.”

What happens to the ears?

Ears are extremely complex and delicate structures. When sound is introduced into the ear, there are many structures of our inner ear that can be affected or damaged. The inner ear houses the hearing organ, called the cochlea, which transforms sound (traveling acoustically through the movement of air molecules) into electrical nerve impulses so information can reach the brain. The cochlea is similar to a piano or keyboard, organized tonotopically, or from low pitches to high pitches. The high pitches are closest to the entrance/base of the cochlea and the low pitches are at the top of the cochlea. Each key on the cochlea keyboard has hair cells that act as sensory receptors, moving and transforming the sound to nerve impulses. When loud sound enters the ear, there are two potential structural effects:

  1. Stereocilia, the hair-like projections that sit on top of the hair cells, can be bent or torn off with high levels of sound. Unlike in birds, once these stereocilia are torn off, damaged or die, they are unable to grow back.
  2. The connection point between the hair cell and the auditory nerve, call the synapse, is especially vulnerable to noise. “You can lose up to 90 percent of your cochlear nerve fibers without a change in the ability to detect a tone in quiet,” Dr. Charles Liberman, director of Massachusetts Eye and Ear Infirmary’s Eaton Peabody Laboratory said. “Tone detection in quiet is the basis of the threshold audiogram — the gold standard test of hearing function. The fact that thresholds may transiently elevate and then recover within hours or days after an acoustic overexposure doesn’t mean that the inner ear has recovered.” This phenomen has been recently coined as hidden hearing loss. If a hair cell has lost its synapse, it no longer responds to sound and within a few months or years, the neuron will simply disappear. This reduces the amount of the information channels for auditory information to get to the brain. Once it disconnects, there is no possibility for reconnection.

The higher pitches, near the entrance of the cochlea, are generally affected first. Higher pitches do not just refer to the impossibly high dog whistles. There are many consonants (k, t, th, s, sh) that exist in the high pitches. A reduction in hearing abilities can cause speech to sound mumbled.
Another common symptom of noise-induced loss is tinnitus. Tinnitus is ringing or buzzing in the ears when there is no external stimulus or sound. Tinnitus can be occasional or constant, in one ear or both. Tinnitus is a debilitating symptom that can impact an individual’s life, from hearing soft speech to sleeping.

How can we fix this?

As of now, there is no solution for noise-induced damage to the inner ear structures.

There is talk of trying to regrow hair cells that have died off due to noise damage. The University of Kansas is currently conducting a clinical trial but has not had conclusive conclusion yet.

Prevention is the best defense our ears have against noise-induced hearing loss.

Here are some tips for reducing your risk for attaining noise-induced loss:

  1. Use the 60-60 rule: keep volume below 60% and listen for less than 60 minutes a day. There is a feature to limit the volume on your iPod/iPhone so you don’t accidentally turn it up too loud.
  2. Buy background-cancelling headphones so you don’t have to compensate for loud noises around you.
  3. Carry hearing protective devices with you when you attend bars, concerts, sporting events, workout classes and other dangerous listening environments. Advocate for your hearing at these places! Is the music TOO loud at your Jazzercise class? Ask your teacher to turn it down and/or do not be close to the speaker.
  4. Turn down your car radio! Make sure you would be able to hear someone talking to you from the backseat. If you can’t pass that test, your music is too loud.




Acoustical Society of America (ASA). “Noise-induced ‘hidden hearing loss’ mechanism discovered.” ScienceDaily. ScienceDaily, 7 May 2014.

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No ear lids

Julian Treasure’s vision is to make the world sound beautiful, by helping individuals to make and receive sound consciously, and companies to discover that good sound is good business. Through his research as a business sound expert, Treasure talks through how to make the most of the sound we hear on the daily basis. As stated in the video below, “ears are made not for hearing but listening.” So much of what we hear on a daily basis is noise. This noise reduces the health and quality of life to 25% of the population of Europe.

“Your ears are always on. You have no ear-lids.” 

And in today’s society, the noise is coming through a pair of headphones, which is causing three adverse effects on the individual:

  1. Schizophonia (a sound is presented that doesn’t match a physical, present representation. Therefore, what you see and what you hear are different)
  2. Compression (squash music to fit into our pocket-can cause people to be tired and irritable because you are forced to fill in the missing pieces)
  3. Deafness due to noise induced hearing disorder (1 in 6 of american teenagers currently have this) A recent study showed that 61% of college freshmen had damaged hearing!

Are we raising a generation of deaf people?

Here are some simple ways to help with the headphone issue:

  1. Get professional hearing protectors for loud environments (bars, clubs, concerts, tractor pulls, whatever)
  2. Purchase a good quality of headphones so they do not require very loud sounds
  3. Move away from sound source if it’s too loud.

Take it from Julian Treasure himself:

For more information on Julian Treasure and his sound expertise, visit his website by clicking here.