Science Is Just the Start

My path to outreach, advocacy, and activism around too much noise, and the successes—and ongoing challenges—so far.

By Daniel Fink, M.D.

I’m a retired internist and have always tried to live a healthy lifestyle, but I had no idea that a one-time noise exposure could cause auditory symptoms for the rest of my life.

Unfortunately, that’s exactly what happened to me at a New Year’s Eve dinner in Los Angeles, where I live, in 2007. As midnight approached, the restaurant kept turning the music up.

Daniel Fink, M.D., in front of the Swiss Alps. He says he recorded daytime sound pressure levels of 42 dBA in the Alps, with the noise coming from the wind and distant road traffic noise, and nighttime levels of 30 dBA. A-weighted decibels, or dBA, emphasize the frequencies heard in human speech.

My wife could tell I was uncomfortable and suggested that we leave, but I didn’t want to offend our friends. When we finally left, my ears were ringing (that’s called tinnitus) and I later found that everyday sounds that didn’t bother others were actually painful for me (that’s called hyperacusis).

I wish I could say that I suffered in silence, but the world is too noisy for that. I became reluctant to go to restaurants. I started using earplugs at movies and sports events. I asked my wife, “Am I becoming grumpier as I get older?” and she immediately responded, “It’s too late for that, dear!”

In December 2014 I read an article about hyperacusis in The New York Times. I circled it in red and showed it to my wife, saying, “This is why I don’t want to go to restaurants anymore. They are all too noisy and it hurts my ears.”

I had recently left the board of a local environmental nonprofit, after my term concluded, so I had some extra time and energy and decided to see what I could do to make the world a quieter place.

First, I had to learn about the adverse effects of noise. This wasn’t something I had learned in medical school or during residency training. Fortunately, the world’s scientific literature is now available to anyone with a device, internet connection, and search engine.

When I read that noise not only caused hearing loss, tinnitus, and hyperacusis, but also had non-auditory health effects, I knew I had to do something.

What Could I Do?

Just knowing the science was not enough. I had to engage in outreach, advocacy, and activism. Outreach is letting people know important information. Advocacy is the act or process of supporting a cause. Activism is direct action in support of or in opposition to one side of an issue.

My activism is admittedly atypical. Instead of speaking at public meetings, writing letters and emails, organizing a petition, or getting neighbors to put up lawn signs, I focused on learning the facts about noise and then bringing those facts to the attention of those able to change public policy. I realized I needed to flip the typical activist mantra of “think globally, act locally” on its head, thinking locally but acting globally.

Policy change has to come from the top. I wanted to easily find a quiet restaurant in which to enjoy both a meal and conversation with my wife. I started with a presentation to my local health and safety commission about restaurant noise in January 2015, but quickly learned that it would be difficult to change people’s
minds about noise when 85 decibels (dB) was regarded as the safe noise level.

The National Institute on Deafness and Other Communication Disorders’ (NIDCD) webpage on noise-induced hearing loss stated, “Know which sounds are dangerous (those at or above 85 decibels).” Plus, I could see it would be difficult to convince people that I wasn’t just a chronic complainer when the Acoustical Society of America and the America National Standards Institute define noise as “unwanted sound.”

I needed to change the nature of the conversation. I found a long-forgotten 1974 Environmental Protection Agency report online providing the only evidence-based safe noise level to prevent hearing loss as “70 dB time-weighted average” for 24 hours. In other words, our average exposure over the course of a day should be limited to 70 dB.

I realized what had happened: The NIDCD was citing the recommended occupational noise exposure level as the sound pressure level at which auditory damage begins. But the recommended occupational noise exposure level doesn’t fully prevent hearing loss in exposed workers, and it certainly isn’t safe for the public.

In 2015 I was among those who brought to the CDC’s attention the fact that noise caused hearing loss in the general public, not just among workers in the workplace. (It’s also worth noting that noise exposure for the public occurs 24 hours a day and seven days a week, not just eight hours daily on weekdays at the workplace.) That led to the CDC embarking on both research and public health education about the dangers of non-occupational noise exposure.

Also in 2015, I was elected to the board of the American Tinnitus Association. I was no longer a lone-wolf activist. In 2016, some of my noise colleagues and I started The Quiet Coalition, under the auspices of the existing nonprofit Quiet Communities Inc. (QCi), to focus specifically on making the world a quieter place.

That year I also submitted an abstract about the safe noise level to the Institute for Noise Control Engineering. To my surprise, the abstract was accepted for presentation. I submitted a manuscript based on my talk to the American Journal of Public Health (AJPH). Again to my surprise, the editor told me that if I rewrote it as an editorial, it would be published.

The AJPH editorial appeared online in December 2016, and it has now been cited 72 times in peer-reviewed scientific and medical literature. It led to an invitation to serve as an expert consultant to the World Health Organization for its Make Listening Safe program.

In 2019 I submitted an abstract to the Acoustical Society of America (ASA) about a new definition of noise—“noise is unwanted and/or harmful sound”—with the crucial addition of “harmful.” I presented the new definition and then published it. The definition hasn’t made it to the dictionary yet, but it was the first sentence of the January 2022 American Public Health Association policy statement, “Noise as a Public Health Hazard.” 

I once saw a presentation by Paul Farmer, M.D., Ph.D., whom The New York Times termed “a pioneer of public health” in his February 2022 obituary. He asked the audience, “Can one person make a difference?” He cited Mahatma Gandhi, Nelson Mandela, and Martin Luther King Jr. Farmer certainly made a difference, with his efforts to improve global health for the poor. More recently, so did climate change activist and Swedish teen Greta Thunberg.

I’m definitely not in that league, and I want to emphasize that I didn’t work alone, but always had support and advice from a small group of colleagues. The late Bryan Pollard of Hyperacusis Research introduced me to QCi founder Jamie Banks, who in turn introduced me to David Sykes, whose suggestions and encouragement led to presentations at national and international noise meetings. Gina Briggs finds items to write about, and posts almost daily blog posts, many of which have been written by pioneering noise researcher Arline Bronzaft. (All of us are now part of QCi.) Noise experts around the world have generously shared their expertise with me, and told me when I was wrong.

I Count These as Successes

• The CDC recognized non-occupational noise exposure caused hearing loss in the public.

• The NIDCD removed language from its webpage on noise-induced hearing loss that implied that auditory damage began at 85 dB.

• The CDC now states (as of 2019): “Noise above 70 dB over a prolonged period of time may start to damage your hearing.”

• The International Telecommunications Union included recommendations for lower noise exposure levels for children and other sensitive users in its Guidelines for Safe Listening Devices/Systems.

• A question about screening for hearing loss in middle-aged and older adults was referred to the U.S. Preventive Services Task Force, which reconsidered its recommendation even if the literature still didn’t support screening.

• The U.K. Advertising Standards Authority took action against Amazon for falsely advertising that headphones with an 85 dB volume limit were safe for toddlers and children.

• And now googling the term “safe noise level” gives results that say 70 dB is the safe limit, often mentioning my 2017 editorial, instead of the occupational limit of 85 dB.  

But So Far These Remain Failures

• Restaurants are still too noisy. Gas-powered leaf blowers are still used in my city, despite an ordinance banning their use.

• Despite my efforts, the Federal Trade Commission hasn’t taken enforcement action against the vendors of the 85 dB headphones; and the Consumer Product Safety Commission hasn’t put warning stickers reading “This product may cause hearing loss” on personal listening devices.

• Movies and sports events are still too loud. So are weddings and birthday parties. The world remains noisy.

Quiet Activism

I’m not giving up. As I write this in the fall of 2022, I am also preparing for the December meeting of the ASA in Nashville, where I will be presenting three papers.

I will next submit manuscripts to the ASA’s journal, Proceedings of Meetings on Acoustics. A publication lends greater credibility to what I have to say, and then I can send that link around in future emails to policy makers, government representatives, and other activists.

How will I measure success? When the world becomes a quieter place.

As intermediate steps, I’d like to see 1) the Surgeon General issue a Call to Action to Prevent Noise-Induced Hearing Loss, just like the Call to Action to Prevent Skin Cancer, and 2) the HealthyChildren.org website run by the American Academy of Pediatrics share as much advice for parents about noise and the ear as it does about sun and the skin.

Please join us to make the world quieter, and to make it a better place for those with auditory disorders like hearing loss, tinnitus, or hyperacusis. I encourage you to use your talents and contacts to advocate for quieter spaces. As noise activists—or is it quiet activists?—we really can make a difference.

Daniel Fink, M.D., is the founding chair of The Quiet Coalition, the interim chair of Quiet Communities Inc.’s Health Advisory Council, and a former board member of the American Tinnitus Association. He serves as an expert consultant to the World Health Organization on its Make Listening Safe Program, and as a subject matter expert on noise and the public to the National Center for Environmental Health at the Centers for Disease Control and Prevention. This is based on his presentation at the 13th Congress (e-Congress) of the International Commission on Biological Effects of Noise in June 2021.  This appeared in the Winter 2023 issue of Hearing Health magazine. 

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