Infrequently Asked Questions: How do earbuds damage your hearing?

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By now, anyone with a phone and a penchant for loud music has succumbed to the habit of blaring music in their ears during a morning commute or bopping away at their desk all day long. But surely, those earbud jam sessions don't come without consequence.

We reached out to Linda Ronis-Kass, an audiologist at Penn Medicine Washington Square, for an explanation of how listening to music at a high volume through earbuds can cause hearing loss -- and potentially more.

How does listening to music at a high volume through earbuds damage your hearing?

So, the first thing I think you have to know about using earbuds instead of earphones is that earbuds, if they fit you, make a good feel of your ear. With earphones -- I’m talking about the foamy ones -- the sound leaks out a little bit. That's different than the ones over your ear made of a plastic that goes around the ear. But if you have a well-fitting earbud, all the sound you intend to go in your ear is going in your ear. And you can’t often tell how loud that is.

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I find that people – even with normal hearing – like to listen to things very loud ... With all loud sound, music and anything else, the amount of damage you can sustain is based on the time you're listening and the intensity of the sound. So, as loud as the sound is, if you listen for a very long time, you can sustain damage. But very loud noise, you can [only] listen to it for short periods of time. That’s why things like impact noise -- a firecracker going off near your head, for example -- causes immediate damage. 

Now, sometimes, what happens is you will sustain a hearing loss that’s temporary because of loud noise. For example, if you go to a concert and it’s super loud, you stay the whole time, you walk out and your ears are ringing and you go to bed that night, but when you wake up in the morning your ears have stopped ringing. So, the time you leave the concert and getting over that loud noise, your hearing is reduced. That’s called temporary threshold shift, or temporary hearing loss. But the more times you sustain exposure to loud noise, the less possibility you have for things to go back to what’s normal for you – and what’s normal for you can change, and you can suffer a permanent threshold shift or permanent hearing loss.

What's happening in your ear that the sustained listening at a high volume can cause permanent damage?

What you’re doing when you cause hearing loss, is you’re causing overstimulation of hair cells in your inner ear. And the more you give your inner ear hair cells time to recoil and relax -- what you would do with less loud noise -- the less probability you will have that the loud noise will cause sustained hearing loss. That’s why when [the Occupational Health and Safety Administration] comes out with regulations, they say ‘You can listen at X level for a certain amount of time and then you have to give yourself a break.’

How do you know if the earbuds are too loud?

I want people to understand that for long sustained noise -- music, let’s say -- when your ears are ringing, that to me is a wake-up call. If my ears are ringing this is probably too loud. And certainly if your ears are ringing after you listen to your earbuds, turn it down. 

Interestingly, there was a campaign that one of the speech and hearing organizations did many years ago called ‘Turn it to the Left.’ Because most dials, if you turn them to the left, turn things down a little bit. So I think people should keep in mind that maybe they’re so accustomed to the level they like listening to that they're not even observing whether it's too loud. You may want to do something as simple as giving it to someone else and saying ‘Do you think this is loud?’ And if the person says ‘Wow, this is really loud,’ then -- the thing is, it’s really hard to quantify. You don’t have a sound level meter that will determine how loud your ear buds are, I don’t think. So how do you know that loud is too loud?

We know that sustained exposure to loud noise is damaging to hearing -- that’s not a stretch. Everybody knows that. OSHA has determined that, and they have a very specific formula for how loud you can listen to whatever noise you’re listening to before you need a break. Because they’re preventing anyone that’s working around loud noise from sustaining hearing loss. But what I’m saying is that individuals listening to music don’t really think about that.

Do you think we’ve yet to see what the long-term impact is?

Absolutely. We still have yet to see what damage it’s doing. I also encourage anyone who thinks they have hearing loss to get a hearing test. And sometimes black and white, proving that you have done damage to your hearing, is enough info to let you know you’re not fooling around -- that you have gone a little too far and need to turn it down. So I’d suggest people set up a time to get a hearing test if they think there may be some damage.

Anything to add?

There are also very typical shapes and configurations of hearing loss that are seen with noise-induced hearing loss. So if you have your hearing test and you have a configuration that looks like one of the shapes, due to noise, that will be your answer: 'Yes, in fact, I have noise-induced hearing loss.' And that’s something we use clinically to determine the etiology of a problem, given history and complaints.

And another thing is long-term tinnitus, which is ringing in your ears. And as a clinician, I can tell you people who have ringing in their ears, noise in their ears that doesn’t stop, many people are very annoyed by that. And that’s often seen with noise-induced hearing loss. So it’s not only hearing loss itself that may bother you and other outcomes of hearing loss but having to deal with noise in your ear 24/7 is really annoying.

… I don’t ever say to people ‘don’t use earbuds.’ Cat’s out of the bag – people love doing that. But I think you can be smart about it as well as enjoy what you’re listening to.”