Sound Advice on Protecting Your Child's Hearing with Valerie Pavlovich Ruff, AuD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials podcast. I'm John Horton, your host. If you wonder whether your kid is listening to music too loud on their headphones, let me solve that mystery for you. They probably are, and their hearing is paying the price. It's estimated that one in eight young people between the ages of six and 19 have hearing loss due to music blaring through earbuds or headphones. The numbers keep getting worse, too, as most children spend a few hours a day wearing audio devices. Today, we're going to talk with audiologist Valerie Pavlovich Ruff about the damage that's being done to young eardrums, and get some tips to protect those ears. Dr. Ruff is one of the many experts at Cleveland Clinic who visit our weekly podcast to offer advice to help families like yours. You want to listen to this conversation, but maybe turn the volume down just a little bit to be on the safe side.

Welcome to the podcast, Dr. Ruff. Thanks for joining us today.

Valerie Pavlovich Ruff:

Oh, thank you so much for having me. I am so excited to be here.

John Horton:

Our topic, kids playing music too loud, seems pretty timeless. True story here. My father used to cut the power to my bedroom back in the day when I blasted Springsteen a bit too loud over the speakers. Clearly, this isn't a new issue, but I do get the sense that current concerns over bumping tunes and hearing loss have a little more oomph behind them. Why is that?

Valerie Pavlovich Ruff:

Well, I think it's because all of these personal devices are now available, and you can't even go to the grocery store and not see somebody walking around with AirPods or some listening device in their ear, listening to music. It's not always going to concerts. Music is just readily available 24/7 for people today.

John Horton:

It even seems like, like you said, those headphones are always on. I've got kids that are college age, and they live with them on. They just walk through the house with them on, everything. It never seems to stop.

Valerie Pavlovich Ruff:

It doesn't, and you think about other things besides just music. You've got these gamers that are wearing headphones while they're playing their games, and those are pretty loud, or can be loud. Kids go to arcades where there's all these electronic machines that they're playing games on, and kids are yelling and screaming. There's just so much noise around us, and as pleasant as music is, it can injure the ears if it's too loud.

John Horton:

Well, let's spend a little of time on that here. Walk us through how listening to loud music affects your hearing long term. What kind of damage is being done there?

Valerie Pavlovich Ruff:

The ear is a very sensitive organ, and inside the ear, I'm not talking about the eardrum, there's three parts to the ear: the outer ear, which helps direct sound into the ear canal. And then you have the eardrum, which is a very sensitive structure, but that's not where the damage occurs. The damage occurs in the sensitive cells of the inner ear, and like any other muscle in the body, if you pound it and work it, and work it and work it, it gets tired, and these sensory cells can actually be injured by exposure to loud music or loud noise for too long. It is definitely a relationship between the amount, or the level of the sound, and the duration of the exposure. The louder the sound, the less time you can safely listen to that sound.

John Horton:

Now, this is going to sound weird, but is that damage that you can see, or is it just a cumulative effect, and it just loses its ability to help you hear?

Valerie Pavlovich Ruff:

That's a great question, because you can't see it. You can't see it. It is completely embedded in the temporal bone in your head. You would never know that you had that damage unless you are experiencing, maybe, some symptoms like ringing in the ears. Ringing in the ears is a big one. Imagine after leaving a concert, your hearing's muffled, your ears are ringing. That's an indication that you've put too much sound into that inner ear, and that is where the damage occurs. It may not appear until years later, in fact. These young ears are aging 50% faster by overloading the inner ear with too much loud noise. You've got younger people that are going to start having problems like difficulty understanding speech in noisy environments, and tinnitus, ringing in the ears, just difficulty communicating with people when there's a crowd around them.

John Horton:

That 50% faster statistic I really found interesting, and that came up when I was researching this ahead of time, too. They equated it to, if you start this when you're 20, by the time you're 50, you might have the hearing of an 80 plus year old, which really puts it into perspective a little bit.

Valerie Pavlovich Ruff:

It does, because that noise is cumulative over a lifetime, and noise-induced hearing loss doesn't discriminate by age or gender or nationality, whatever. Our ears, they're the only ones we get, and noise induced hearing loss is the only type of hearing loss that is actually preventable. It is in our power to prevent damage to our ears due to noise.

John Horton:

Once this damage is done inside the ear, in the inner ear, can it be reversed, or is your hearing just forever going to be more limited?

Valerie Pavlovich Ruff:

There are two different types of noise-induced hearing loss. One results in something called a temporary threshold shift. That's that one concert that you just went to and your ears are muffled and ringing. Spending time in quiet for some time after allows the ear to recover from that incident. Repeated exposures to that sound level causes injury to the ear that is irreparable. You cannot fix it. Those sensory cells will no longer allow you to hear at certain frequencies. They're just gone.

John Horton:

Wow. It sounds like, from what you just said, if you have that burst, you get some loud noises, or you're at a concert, or even if you're listening to headphones for a little bit, and you let your ears rest and recover afterwards, they should get back pretty much to 100% after that. It's just, if you just continually bombard that inner ear with this noise, that damage just becomes a little more permanent.

Valerie Pavlovich Ruff:

Yes. If you give yourself a period of rest after a noisy situation, your ear can recover. But then, that repeated exposure over the course of a lifetime, for instance, if you played in band in high school, and then you go into a job in construction, and now you're exposed to more noise, your ears are going to be more sensitive to that noise because of its previous exposure to noise. It's cumulative.

John Horton:

Yeah, and you see some of it... obviously, we're talking a little bit about headphones and earphones, but some of it is just life. Like you said, it you're working construction, or you're in a spot where there's noise all the time, this is a reality that you're dealing with. But then, with the music, we're doing it to ourselves, and just forcing it in there.

Valerie Pavlovich Ruff:

The creation of those earbuds, now you're presenting that music at the level of the ear. When you were playing your speakers, it had to travel from the speakers to your ears. Now, we're just blasting everything directly into the ear, and that certainly is having an impact on our internal structures.

John Horton:

Well, and I can say, when I was blasting my speakers, it wasn't just hitting my ears. It was definitely hitting my father's, and he was taking action at the time. Little did I know he was saving me, but it didn't feel that way.

Valerie Pavlovich Ruff:

Of course.

John Horton:

When we're talking about this noise, how loud is too loud when it comes to your ear health?

Valerie Pavlovich Ruff:

If you look at OSHA, which is the Occupational Safety and Health Administration, they say that 85 dB is safe for 40 hours. That's a typical work week. The way decibels work is, if you add 3 dB, the safe exposure time is cut in half. That means, if you're listening at 88 dB, you're only safe for four hours, and at 91 dB, you're only safe for two hours, and at 94 dB, you're only safe for one hour. You have to consider that relationship between the time and the duration of the exposure. Now, the World Health Organization is a little more conservative. They use 80 dB for 40 hours, which is 5 dB softer. I like to be even more cautious, and for young children, I would say 75 dB would be it for a maximum noise exposure level, if possible.

John Horton:

Let's try to get a little perspective as to what that level of noise is. I think you threw a couple of numbers out there. Let's go with the 80, which I think you said is the World Health Organization. What would be the equivalent of an 80 decibel noise?

Valerie Pavlovich Ruff:

A noisy restaurant, perhaps, would be around 80 dB. That is, if there's no live music being played. I'm not talking about a sports bar.

John Horton:

Just chatter.

Valerie Pavlovich Ruff:

Yeah, just your general chatter could be that. If you think about traffic, road traffic, that runs around 85 dB. It really depends on the environment that you're in, but around 80 dB, I would say a noisy restaurant would be around that. Perhaps loud traffic might still fall around 80 dB.

John Horton:

When you start getting into those louder things, I know you always see lawnmowers. What do those come in at?

Valerie Pavlovich Ruff:

Lawnmowers come in closer to 90, 91 dB. I applaud people who are wearing earmuffs when they're mowing their lawn. It really depends, too, on how long it takes you to mow your lawn. If you're listening at 91 dB, and it takes you more than an hour and a half, two hours, you want to do something to protect your ears. Leaf blowers are even louder than lawnmowers. They're around 100 dB. Do you think about, blow your leaves and wearing hearing protection?

John Horton:

No, people don't, and with a lot of that stuff, you just don't do it. You go out and you figure you're outside, you're cutting the lawn. It's part of the ambience, I guess.

Valerie Pavlovich Ruff:

I guess.

John Horton:

It's not working.

Valerie Pavlovich Ruff:

Some people are even listening to music while they're mowing the lawn, so how much louder do they have to make the music to hear it over the sound of the lawnmower? This is where noise-canceling products come into play. If you're using noise-canceling headphones to cancel out the noise of the lawnmower, you can listen to music at a softer level.

John Horton:

Well, and we're going to get to those tips here in a few minutes. Now, as we're talking about all these things that can damage your ears and affect your hearing, what are some signs that you're in an environment that's just too loud for your ears, or you've got the volume cranked up just a little too high?

Valerie Pavlovich Ruff:

Sometimes it's actually how your ears feel. I can tell when something's so loud because it makes me want to cover my ears. Some people like loud sound, so for them, the biggest sign is that they have to raise their voice to be heard if they're talking to somebody, or they have to try to move away from the noise to have a conversation. If someone's at an arm's length from you and you have to raise your voice for them to hear you, it's probably too loud.

John Horton:

What about how you feel? You had mentioned before that ringing in the ears. Are there other pain points that you might have?

Valerie Pavlovich Ruff:

It's interesting that you mentioned that, because if you're actually going to a live music venue, sometimes you can feel the vibrations of the bass. When you can feel the music, it's too loud. It's absolutely too loud, and the ear actually processes sound the best at softer sound levels. Our ears were never intended to listen to loud sounds.

John Horton:

So then, why do we enjoy listening to things so loudly? I've got to say, I will crank out my car radio all the time. Nice day, the windows are down, the sound is up, and it just feels so good. Why are we drawn to that?

Valerie Pavlovich Ruff:

I just don't even know. I guess those things bring people pleasure, and it's hard to resist that. You could say the same thing about people who like to do other things that are unhealthy for them, and they do them anyway because it brings pleasure.

John Horton:

Now, as you mentioned, the world in general can be a pretty noisy place, and noisy enough to damage our hearing, but earbuds and headphones are a whole different point of concern. What makes them so potentially destructive to hearing?

Valerie Pavlovich Ruff:

When you are around a loud noise in the environment, you can't turn it down. One of the things you can do is walk away. You've got to teach these children to turn things down, because now, like I said, they're at ear level. They're not 100 yards away. They are going directly into the ear, and the closer you get to that eardrum, the less sound pressure you need to actually hear. Putting those devices in the ear and then cranking it up is just a formula for injury to the inner ear.

John Horton:

Yeah, it just seems like it's so close, and so just targeted, it seems like, that it's just pounding your inner ear.

Valerie Pavlovich Ruff:

That's correct. Over the ear headphones are a little bit better. They even cover the ear, so they can get rid of some environmental or ambient noises around you. I know that Apple came out with these noise-canceling ear pods now, which are brilliant if people can learn to monitor their sound level of listening. The downfall to that is if they're walking on the sidewalk and they're listening, and now, they have no ambient noise because of the noise cancellation, and it becomes a safety issue of not being able to hear traffic and things like that.

John Horton:

Now, when you said the over the ear ones, you're talking about those big, puffy ones that almost look like you have ear muffs on, right?

Valerie Pavlovich Ruff:

Yes.

John Horton:

Those could be a little better, because it sounds like with the noise-canceling aspect, it will allow you then to keep the music a little softer because you're blocking out all that other noise.

Valerie Pavlovich Ruff:

That's correct.

John Horton:

Now, you see a lot of people with those really loose ear buds that look like they're practically ready to fall out. I read where those are almost worse, because one, you're getting the outside noise still coming in, and two, you are probably turning the music up really, really loud to hear, because they're not in there quite a snug.

Valerie Pavlovich Ruff:

Actually, my AirPods don't fit well at all. When I walk and I listen to a podcast, if I'm in a neighborhood, I have the level at one setting. As soon as I get on a main road, I feel myself wanting to crank it up, because I can't hear it because of the traffic. It is problematic, because you are more likely to turn them up so that you can hear the music over the ambient noise.

John Horton:

It sounds like you need to invest in a better pair of ear headphones, or earbuds.

Valerie Pavlovich Ruff:

Oh, yes. My kids have the noise-canceling kind, but mom doesn't.

John Horton:

That's always the way it works. Well, I was going to ask, when it does come to those audio devices like earphones or headphones, is there one type that's just better when it comes to protecting your hearing long term?

Valerie Pavlovich Ruff:

Any type of headphone that has a sound limiter on it, or will limit the output of it is preferred. I'm not going to name a device specifically, but there are products out there that have limiters on them so that you cannot exceed a certain level. That's what I would recommend. There's even apps on the phone. I love my Apple Watch, because it alerts me when I'm in an environment that's loud, and sometimes, I know before it even alerts me. There's a lot of different ways to monitor how loud you're listening.

John Horton:

Are there also time limits you should set as far as how long you're in an environment like that and when you should shut it off, or how long you should listen to music?

Valerie Pavlovich Ruff:

The time limit is all, like I said, dependent on the level that you're listening. If you're listening at just over 50% of your volume, say 60%, you could probably safely listen to that music most of the day. If you're going to crank it up to 90%, you've got to limit yourself to an hour and a half, two hours max, and then, either turn it down or take them off.

John Horton:

You said that 50%, 60% volume is probably about that sweet spot as to where you should try to stay?

Valerie Pavlovich Ruff:

If you're listening to music through AirPods, headphones, whatever, if you have to take it out to hear someone who's standing a foot away from you, or an arm's length away, you've got it too loud.

John Horton:

If your kid has it cranked up a little too high, what are some signs, as you go by them, that hey, maybe they need to adjust that a bit?

Valerie Pavlovich Ruff:

Well, if you walk by them and you can hear their music, that's a big one. It's way too loud if you can hear them as you're walking by, if you can hear the music as you're walking by them. If you walk by them and tell them something, or ask them something, and they don't respond or don't hear you, that's another sign that they're probably listening too loudly.

John Horton:

It sounds like the best thing you can do is start adjusting that now, and getting used to it, because a lifelong effort that you need to make to protect your ears.

Valerie Pavlovich Ruff:

It really is. I'm a certified trainer for a program called Dangerous Decibels. We go into fourth grade classrooms. We're trying to catch these kids when they're younger. Cause the research is great. Kids in the ages of six to 19, they're starting to really feel the impacts of noise, so if we can teach them young... the other thing that would be really nice is if the parents would model that behavior.

John Horton:

I'm guilty of this all the time. As I said, my wife can usually hear me coming home when I turn the corner. It sounds like haha turn the volume down a bit.

Valerie Pavlovich Ruff:

You've driven on the highway, and on the highway, you turn the radio up. Even if your windows are up, you turn the radio up because of the traffic noise, at least 85 dB around your car, the road noise. And then, you put your car away for the night. You come back to the car in the morning and you turn it on, and "Oh, it's so loud." Of course, not mine, but my husband's car is like that.

John Horton:

I've had that happen more than once, and it startles you. I guess it's a sign that you probably are listening way too loud, if it scares you when you put it on the next day.

Valerie Pavlovich Ruff:

You turn your car on, and boom. Yeah, I get you.

John Horton:

Dr. Ruff, you've given us some absolutely fabulous advice today as far as how we should be listening, and things that we can do. I'm hoping that everybody heard it, I guess not so loud and clear.

Valerie Pavlovich Ruff:

Yeah.

John Horton:

Before we say our goodbyes, though, do you have any other words of wisdom when it comes to headphone use, or just hearing in general?

Valerie Pavlovich Ruff:

I'm fascinated by the ear, actually. It can't be replaced. It's the only ears you get. It's real important that you're cognizant of the environments that you're in, and if you are using earbuds, headphones, you've got to just train yourself to listen to the music at a softer level so that you can enjoy hearing for a lifetime.

John Horton:

One more thing, since I've got you. How often should you get your hearing tested just to see whether or not maybe you've been listening a little too loud, and it's starting to have an effect?

Valerie Pavlovich Ruff:

One of the first things that brings people into my office is tinnitus. Their ears are ringing. Our kids don't get tested beyond grade school, actually. They don't get tested again in high school. When we get adults, hearing is usually not checked until somebody has a problem. I would like to live to see the day we check the hearing annually, like we do our eyes and our physicals. Our ears are that important that I would recommend an annual hearing test if it's possible.

John Horton:

It sounds like something we could all shoot for, to make sure that we can hear all the wonderful things in the world for as long as we're kicking on.

Valerie Pavlovich Ruff:

That's right.

John Horton:

Thank you very much for joining us today. This has been just an absolutely fascinating talk. I promise you, I'm going to try to turn down the dial a little bit.

Valerie Pavlovich Ruff:

That sounds like a plan. Thank you.

John Horton:

Thanks a lot, Dr. Ruff.

Valerie Pavlovich Ruff:

Thank you.

John Horton:

Listening to music is one of life's great joys, but if it's done in a damaging way for the ears, that joy may lessen over time. Consistently taking steps to protect hearing is the best way to maintain it throughout life. Keep on rocking, just do it a little smarter. If you liked what you heard today, please hit the subscribe button, and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts, or visit ClevelandClinic.org/HEpodcast. This podcast is for informational purposes only, and is not intended to replace the advice of your own physician.