Too loud, too long — that's a formula for hearing loss when listening with earbuds, health experts say.
Nearly 1 in 8 children and adolescents ages 6 to 19 experience some degree of hearing loss from blasting loud music through earbuds over the course of the day, according to the Cleveland Clinic. A recent review of 33 studies published in BMJ Global Health found that more than 1 billion children around the world are at risk of hearing loss from exposure to unsafe levels of sound on listening devices and at concerts and other venues. This type of hearing loss, known as noise-induced hearing loss, usually cannot be medically or surgically reversed, according to the Mayo Clinic.
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Hearing loss occurs when the fibers in the inner ear that respond to sound suffer damage. This can impact communication, language and social skills in children, the Centers for Disease Control and Prevention warns.
"These sensory cells can actually be injured by exposure to loud music or loud noise for too long," Cleveland Clinic audiologist Valerie Pavlovich Ruff said on a podcast by the health system earlier this year.
"Even a mild hearing loss due to excessive noise could lead to developmental delays in speech and language," Dr. James E. Foy, a pediatrician from Vallejo, California, told the American Osteopathic Association. "... I stress to my patients and their parents that if you can't hear anything going on around you when listening to headphones, the decibel level is too high."
Sounds above 85 decibels — equivalent to the noise of a vacuum cleaner, food processor or leaf blower — for more than two hours can be dangerous. Most earbuds, including AirPods, can crank up to 105 to 110 decibels – a level that can be damaging in as little as 5 minutes, according to Harvard Health.
In 2019, the University of Michigan began a study in conjunction with Apple to understand people's listening habits through data from their phones and Apple watches. As of 2023, it had found that 1 in 3 Americans are exposed to excessive noise levels.
Frank C. Wartinger, an audiologist who previously worked at the Children's Hospital of Philadelphia warned in 2018 that hearing damage from noise can be an "invisible ailment" in children. They may not say things like, "I can't hear very well."
CHOP warns that children may instead show some of the following symptoms:
• Increased fatigue during a busy school day or in noisy settings: Listening requires effort, so if you aren’t hearing well, you’re expending more energy to listen. At the end of the day, your listening energy may be spent.
• Distracted behavior that may resemble attention problems: When background sounds are present, children who have hearing loss may be readily distracted and have trouble paying attention. Sometimes this can happen in seemingly quiet settings as well.
• Muffled hearing or “ringing in the ears” — explained a bit differently: Children often describe a ringing in their ears (tinnitus) as it relates to a sound in their imagination. For example, they may say they hear bees, train whistles, or the wind blowing. Younger children who do not realize other people aren’t hearing the same thing may not report anything at all.
• Avoidance or sensitivity to loud sounds and settings: Your child may be especially irritable or upset when in a loud setting, like a sporting event, a noisy restaurant, or a crowded birthday party.
• Vague reports of pain or annoyance with ears or head
Earbuds pose a greater risk of hearing damage than other forms of headphones, because they deliver the sound directly into the ear canal with nothing in between to offer protection, according to the Health Hearing Foundation. The foundation recommends choosing over-the-ear headphones as a safer option than earbuds.
Other tips for reducing the risk of hearing loss from earbuds:
• Be mindful of the volume and the length of time you have been listening with earbuds.
• Use the 80/90 rule: Listen at 80% of the maximum volume for no longer than 90 minutes. Listen at louder volumes for even shorter amounts of time.
• If you can't hear what someone an arm's length away is saying, turn down the volume.
The Hearing Loss Association of America characterizes varying levels of hearing loss:
• Mild: Hearing loss of 26 to 40 decibels. People may struggle to hear sounds like whispers and the hum of a refrigerator.
• Moderate: Hearing loss of 41 to 60 decibels. People may have a hard time hearing the TV, phone calls and group conversations.
• Severe: Hearing loss of 61 to 80 decibels. People may not hear conversations in quiet environments, traffic sounds or a vacuum cleaner running.
• Profound/Deaf: Hearing loss of more than 81 decibels. At this level, people can't hear a passing motorcycle, running lawnmower or someone shouting.