Hearing loss is gaining traction as a public health initiative. With the backing of international research and public health professionals, more of the world’s population is becoming aware of noise hazards and learning how to prevent the long-term effects of harmful noise. Discover how public health nurses are a critical part of the solution to noise-induced hearing loss in this article from Dr. Lela Hobby, DNP, MSN, APHN-BC and Assistant Professor of Clinical Practice.
Why is Noise-Induced Hearing Loss a Public Health Issue?
Few people think about the importance of hearing until their hearing begins to fade. Since the start of the COVID-19 pandemic, more people have realized their hearing is troublesome. This makes sense because face masks muffle conversations and make lip reading impossible. Plus, public places can be very loud. We live in a world of noisy environments where quiet is the exception.
An unintended consequence of excessive noise is hearing loss, which represents a major public health issue due to its widespread impact and irreversible nature. The CDC revealed that hearing loss is the third most common chronic physical condition in the United States, after high blood pressure and arthritis. Genetics, disease, injury and certain medications can cause hearing loss, but noise-induced hearing loss is one of the most common — and preventable — types of hearing loss.
According to the World Health Organization (WHO) Fact Sheet on Deafness and Hearing Loss, “nearly 60% of hearing loss is due to avoidable causes that can be prevented through the implementation of public health measures.” Typically, measures are in place to protect hearing in the workplace, and those are usually guided by recommendations from the Occupational Safety and Health Administration (OSHA) federal agency. However, these can be difficult to monitor and enforce, and OSHA can’t control all environments, just workplaces. Public venues and leisure activities can also contribute to noise-induced hearing loss, among several other everyday causes.
Some of the Surprising Causes of Noise-Induced Hearing Loss
Many people suffering from noise-induced hearing loss can attribute the condition to their workplace. In the 2021 World Report on Hearing, the World Health Organization revealed that approximately 16% of hearing loss in adults results from exposure to excessive noise in the workplace. Hearing damage can happen in virtually any industry but is especially common in construction, manufacturing, entertainment, agriculture and aviation.
OSHA regulations attempt to protect employees’ hearing in the workplace, but the WHO pointed out that “increasing industrialization is not always accompanied by protection” in all areas of the world. In any case, few people practice hearing conservation habits beyond workplace requirements, which is worrisome considering that most people encounter harmful levels of noise in their everyday lives.
Habitual causes of noise-induced hearing loss range from household appliances to public transportation to leisure activities. Potential dangers include:
- Electronic toys
- Headphones/earbuds
- Instruments
- Lawnmowers
- Leaf blowers
- Nearby construction
- Power tools
- Recreational vehicles (jet skis, snowmobiles, ATVs, etc.)
- Sports arenas
- Target shooting/hunting
- Traffic noise
- TV/movies
- White noise machines
The widespread use of personal listening devices in particular is a rising cause for concern because earbuds and headphones bring the origin of loud music closer to the eardrum. The World Report on Hearing showed that “listeners who regularly use portable audio devices can expose themselves to the same level of sound in 15 minutes that an industrial worker would receive in an 8-hour day.”
In order to avoid hearing loss from personal listening devices, the WHO report recommended setting the volume at no more than 60% of the device’s maximum setting as well as limiting the amount of time spent listening to loud music through earbuds and headphones. Noise-canceling headphones reduce background noise so that listeners can set a lower volume on their device, which will help protect hearing.
As for other common causes of noise-induced hearing loss, it can be difficult to determine how and when hearing damage is likely to occur.
How to Know When Noise is Too Loud
The only universal measure of sound is in decibels, although the WHO is currently pursuing the global regulation of sounds through personal audio devices/systems. Generally, sounds are considered safe up to 70–75 decibels, while long or repeated exposure to sounds at or above 85 decibels can cause hearing loss, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). Noise above 85 decibels damages the sensitive structures in the ear, such as hair cells (which don’t grow back once damaged).
For reference, the NIDCD provided the following decibel ranges of familiar sounds:
- Normal conversation: 60–70
- Movie theater: 74–104
- Motorcycles and dirt bikes: 80–110
- Loud music through headphones, noise at sporting events and concerts: 94–110
- Sirens: 110–129
- Fireworks: 140–160
To determine the noise level at a particular event or location, you can download one of several apps for mobile devices. One of the best options is the Sound Level Meter app developed by The National Institute for Occupational Safety and Health (NIOSH). The free app allows users to see an instantaneous decibel reading, save past readings, set a decibel threshold and review hearing protection options.
The Sound Level Meter app is only available for Apple products. Android users can choose a sound meter app from this list provided by the HearingSol organization and approved by a hearing specialist. For those without access to a sound meter app, the NIDCD said that “a good rule of thumb is to avoid noises that are too loud, too close or last too long.” The World Report on Hearing gave additional tips; noise is too loud when:
- Voices need to be raised in order for a conversation to be understood
- It is difficult for the listener to understand what a person is saying at an arm’s length distance
- Listeners develop pain or a ringing sensation in their ear(s)
Armed with the knowledge of how loud their environment is, individuals can start to make better decisions about their hearing. Public health professionals play a crucial role in the process by educating the population about the causes, effects and prevention of hearing loss.
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Prevention Through Public Health
The current healthcare system tends to be medically based and focused on treatment. Public health nursing, however, focuses on prevention. Given that noise-induced hearing loss is the most preventable form of hearing loss, public health nurses are uniquely suited to address the situation. Public health nurses use their knowledge of nursing, social science and public health as they conduct research, educate the public and encourage preventative health.
In the course of their preventative work, public health nurses utilize a population-based framework with interventions on three levels: individual, community and systems. The most effective prevention campaigns include interventions on every level.
Individual-level
Public health nurses can work one-on-one with their patients and community to encourage healthy hearing habits. Some of these recommendations might be to:
- Check the volume on children’s electronic games and other noisy toys
- Learn about the potential dangers of wearing earbuds and listening to loud music
- Set noise machines to a low volume, especially around babies
- Keep televisions, radios and music players at a reasonable volume
- Use ear protection at concerts, music festivals, bars and other venues with loud music
- Find the type of ear protection best suited to an individual’s needs and style
- Schedule regular hearing screenings
- As they plan community-level interventions, public health nurses are trained to consider individuals and determine what their needs are. Then, the focus moves toward community stakeholders and how to get them involved.
Community-level
Community interventions can take many forms and appear in many places. Each intervention involves the collaboration of public health nurses, healthcare providers, community organizations and other stakeholders. In the fight against noise-induced hearing loss, some of the community-level interventions are:
- School programs that educate children and administrators about hearing and noise-induced hearing loss
- Hearing screenings in schools (this usually happens around the third grade, depending on the state)
- Encouraging hospitals and pediatric doctors to screen newborns and young children for hearing issues to try and identify those issues sooner
After researching and initiating these interventions, public health nurses help secure the funding for programs and screenings to take place. They provide outcomes-based justification for the cost of interventions so that state legislatures and national organizations can offer social and financial support.
Systems-level
With the backing of local, state and federal systems, public health nurses can inform preventative campaigns that reach a wider audience. One example of a campaign against noise-induced hearing loss is It’s a Noisy Planet. Protect Their Hearing® (or Noisy Planet for short). The campaign is a collaboration between the federal government, the NIH, the U.S. Department of Health and Human Services and the NIDCD.
Noisy Planet provides tools and information to parents, adults, educators and children so that children can adopt healthy hearing habits at a young age. After an evaluation in 2012, the campaign’s wide variety of multimedia resources was proven to be effective in reaching its target audience; a mix of broadcast media, social media, conferences, videos, handouts, posters and more reached over six million U.S. citizens.
Another systems-level campaign provides young adults in Switzerland with free foam earplugs at clubs or concerts. In 2015, Switzerland’s largest concert promotion company, Good News, partnered with the Hear the World Foundation, which is part of Sonova, a global leader in hearing solutions. The partnership protects the hearing of over 500,000 music fans every year.
Between navigating the three levels of public health intervention and collaboration with community and government stakeholders, public health nurses have a plethora of avenues to pursue in making a difference in their communities. Becoming a public health nurse first requires the right degree, and then there are diverse and growing career options available to these professionals.
Becoming a Public Health Nurse
A bachelor’s degree in nursing is the minimum required education level for a public health nurse. A CCNE-accredited, online RN to BSN program is a great option for working nurses who would like to move into public health careers. In a BSN program, aspiring professionals will gain crucial knowledge of evidence-based practice, health promotion, disease prevention, community-based nursing and more.
The comprehensive approach from a BSN program is necessary because public health nursing looks very different than bedside nursing. When patients are discharged from the hospital or leave their doctor’s office, they return to their home communities. There, they need access to public programs, social support and home healthcare to recover from injuries, prevent diseases and maintain their health.
Public health nurses can help provide these resources through work in education, outreach, case management, nurse surveillance/research and more. They might utilize their expertise in settings such as schools, early intervention programs, disaster preparedness workshops, prevention programs, screening campaigns and other grant-funded special programs.
Public health nurses can choose to work with virtually any population. Some of the communities most in need include:
- Disadvantaged youth
- New mothers
- Teen mothers
- The unhoused
- Early intervention
- Hospice patients
- Recovering addicts
- Immigrants
- Refugees
- Survivors of abuse and assault
In their roles as advocates, public health nurses make a valuable contribution to health equity for any population they serve. The Public Health Foundation (PHF) included several advocacy-related goals for public health professionals in their 2021 Core Competencies. Among the list of competencies, the PHF said that public health professionals are in a position to promote social and environmental justice, improve community resilience and reduce barriers to healthcare. Advancing health equity for marginalized populations is just one reason that many working nurses are interested in transitioning to a public health career.
Another benefit of public health careers is that the work schedule is typically less demanding than careers with direct patient contact. Public health nurses can work as staff for larger health care providers, as part of a government agency, for organizations or in educational roles. These roles tend to have a regular schedule and tend to earn about the same annual salary as registered nurses. Public health nurses can expect to make an average base salary of $61,783 per year, PayScale reported. Skills in community health, patient education and case management were correlated to pay that was above average.
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About the Author
Dr. Lela Hobby, DNP, MSN, APHN-BC, Assistant Professor of Clinical Practice, is a board-certified, advanced-practice public health nurse who has experience developing and implementing community-based health promotion programs.
She received a bachelor’s in nursing from Medical College of Georgia, a master’s in family health nursing with a minor in nursing education from the University of San Diego and a doctorate in nursing practice in public health from the University of Massachusetts, Amherst.
Before coming to UWF in 2010, she was a clinical instructor in public health nursing at the University of Massachusetts, Amherst. Dr. Hobby teaches online courses in the RN to BSN program at UWF.