If ears bled from unsafe personal listening with headphones or earbuds, maybe there would be mandatory manufacturing safety standards to better protect public health. Imagine riding a 10 speed bike, but it cuts your legs if you use 5th gear or higher. As a retired audiologist and parent, I think everyone needs a better margin of safety to protect their hearing health.
There are a lot of great things about personal audio system technology. But personal listening systems are inherently unsafe because the design exposes users to high sound pressure levels. Loud to extremely loud personal listening is linked to a rising global epidemic of characteristic noise-induced hearing loss, tinnitus, and other hearing health damage. It’s not too late for prevention.
We’ve known the link between unsafe personal audio systems and user hearing problems for decades. In 2008, scientists predicted 5 to 10% of people worldwide were at risk of noise-induced hearing loss from personal listening. In 2020, the World Health Organization estimated that nearly 50% of children, teens, and young adults worldwide use personal audio systems at volume settings loud enough to cause hearing loss.
What margin of safety do you want for your personal listening?
What margin of safety do you want for any children and teens in your life?
Contents
- Hearing Health Hazards
- Personal Audio System Safety Tips
- Safer Personal Listening Habits
- Personal Listening Volume Safety Chart
- Better Margin of Safety Needed for Children and Teens
- References
Hearing Health Hazards
At any age, amplified audio from personal listening is like bringing a rock concert to your ear canals. Even if you like it, sound energy is still called noise when it’s harmfully loud. Risk of hearing loss and tinnitus is similar to amplified music exposure at concerts, clubs, and pubs.
- 4x higher risk of hearing loss compared to non-users.
- 28% higher risk of tinnitus compared to 8% in non-users.
- Characteristic noise-induced hearing health damage in personal listening users as young as 6 years old, e.g. hidden hearing loss.
- Highest risks or loudest listening linked to:
- ages 12-35 years old.
- cell phones.
- music.
- gaming.
- poorly fitting headphones or earbuds without sound isolating features.
- 1-3+ hours of daily personal listening.
- 50%+ volume setting.
Listen to some audio examples at my blog Noise & Hearing Damage Simulations or at my SoundCloud. (Use a low comfortable volume!)
The Environmental Protection Agency (1974, USA) and World Health Organization (1999-2018) established that over their lifetime, adults will not likely develop noise-induced hearing loss at daily average exposures below 70 dB (Leq,24-hour). But noise damage can cause hearing loss and hidden hearing loss, including tinnitus, hyperacusis, impaired speech understanding, and distorted pitch perception (diplacusis). Hidden hearing loss can develop while hearing thresholds still test within the normal range on a standard audiogram.
Neitzel & Fligor (2019) looked specifically at risk of hearing loss from personal audio systems. They recommended manufacturers offer unsafe listening alerts at 75 dB (Leq,24-hour) for adults and 70 dB (Leq,24-hour) for noise sensitive people like children, teens, or anyone with pre-existing sensorineural hearing loss, tinnitus, and/or hyperacusis. Even these alert settings are likely not safe enough.
In Noise and the Brain, renowned Canadian researcher Jos. J. Eggermont identifies the auditory injury threshold at 75 – 78 dB regardless of listening time. This was first documented decades ago by Kryter, famed American noise scientist. Eggermont also identifies potential risk from 65+ dB amplified noise exposures during hearing system developmental periods in children and teens, which continue into the late teens to early 20s.
Noise-induced impairments include progressive hearing nerve degeneration and permanently “stunted” sound processing connections in the brain which happen long before damage develops in the inner ears (cochleas).
Table: Amplified Audio Risk to Hearing Health
| Estimated Intensity | Perceived Loudness | Noise-Induced Hearing Health Risks Include* |
| 100 dB+ | Extremely Loud | Immediate injuries can include burst eardrum(s). Temporary hearing changes linked to permanent hearing nerve degeneration. Neurosensory hearing loss. Hidden hearing loss, e.g. tinnitus, hyperacusis, pitch distortion or diplacusis. |
| 80 dB+ | Very Loud | Temporary hearing changes linked to permanent hearing nerve degeneration. Neurosensory hearing loss. Hidden hearing loss, e.g. tinnitus, hyperacusis, pitch distortion or diplacusis. |
| 75-78 dB Auditory injury threshold regardless of listening time. | ||
| 70 dB+ | Loud | Hidden hearing loss, e.g. tinnitus, hyperacusis, pitch distortion or diplacusis. Low risk of hearing loss. |
| <70 dB | Quiet to Moderately Loud | Safer for adult hearing health. |
| <65 dB** | Quiet to Moderately Loud | Safer for noise sensitive people, e.g. children to teens, anyone with pre-existing sensorineural hearing loss, tinnitus, and/or hyperacusis. |
**Pienkowski (2017) identifies average exposures <50 dB (Leq,24-hour) may be needed to protect developing hearing systems from different noise pollution sources, e.g. traffic, public transit, home appliances.
Table: Personal Listening Risk to Hearing Health by Years of Use
Noise damage happens fastest in the early years of exposure. This is highlighted by studies showing characteristic noise-induced hearing health damage in <5 years of using personal listening systems. Early studies show that compared to children who didn’t use personal listening systems, 11 year olds using around 50% volume for about an hour daily had higher rates of tinnitus, which has lifelong negative consequences.
Personal Audio System Safety Tips
My recommendations include the urgent need for mandatory safety standards for personal audio system manufacturers. Design flaws include dangerously high output and stock earbuds with poor sound isolation. Manufacturers falsely advertise “safe” headphones. There is no independent testing. Device setting options for unsafe listening warnings are dangerously high at 75 to 80 dB weekly average exposure (Lex,40-hour).
Without more protective manufacturing standards, we are left to rely on safer personal listening habits.
- Avoid use of cell phones or mobile phones for personal listening until late childhood or teen years, if possible. Output is high even at lower volume settings, compared to other devices.
- Use well-fitting styles of headphones or deeper-fitting earbuds with noise canceling or sound isolating features.
- Earbud styles are generally ok to use starting around age 13+, if no recent history of ear infections or other individual reasons not to use this style.
- Under device settings, always turn on/turn down any built-in volume/output limiting settings or safer listening features, e.g. to the lowest decibels or loudness levels possible. Volume can sometimes be locked under parental controls, if needed.
- Warning: Even at the lowest personal audio system settings or so called “safe” sound allowances, users can be exposed to harmfully loud sound energy without getting any unsafe listening alerts. Don’t rely on manufacturer built-in alerts or warnings when choosing listening levels.
- Use safer personal listening habits even if using noise-limiting headphones or earbuds falsely advertised as “safe”, e.g. 85 dB limit. Too many of these headphones fail to limit audio output when tested independently. All the headphones wirecutter.com recommends includes independently tested noise-limiting headphones for children as well as options for gaming and other activities.
- For noisy hobbies or jobs, it is better to use hearing protection like earplugs or earmuffs with built-in wired or wireless radio, music, or personal listening connectivity. This allows safer listening while protecting hearing health, e.g. woodworking, manufacturing, mowing lawn.
Safer Personal Listening Habits
My guidelines are intended to help protect people’s hearing health while enjoying personal listening. I still long for mandatory output limits that should expand the safe volume range beyond 50%. Weak personal listening guidelines jointly developed by the World Health Organization and manufacturer special interest group (International Telecommunication Union) are archaic and won’t make listening “safe.”
I recommend a better margin of safety to prevent noise-induced tinnitus, hyperacusis, or hidden hearing loss as well as hearing loss. Personal listening needs to be safer to protect our total hearing health.
- The less time spent personal listening, the lower the risk of hearing loss.
- Use the lowest functional personal listening setting or the lowest volume that you can hear or understand clearly, generally as low as possible below 50% volume. (50% volume is around 70 dB.)
- Avoid personal listening at loud to full-on volume settings. If it sounds loud, it’s likely causing hearing damage.
- Loud personal listening at 50 to 60% volume settings might cause permanent hearing health problems like tinnitus, hyperacusis or decreased sound tolerance, and/or impaired speech understanding, even without any measurable hearing loss.
- Singing along, humming, dancing, exercising, or moving your body while personal listening is likely safer. It’s ok to turn up the functional volume a bit if needed, as long as you turn it back down after.
- Very loud personal listening at 60% and higher volume settings puts the user at highest risk of permanent hearing nerve degeneration and neurosensory hearing loss along with risk of tinnitus, hyperacusis, pitch distortion, and/or impaired speech understanding.
- If you get an unsafe personal listening warning, turn down the volume, and start using safer personal listening habits.
- Turn down the volume and start listening softer if you notice any signs of early noise damage after loud personal listening, even if they don’t last long, e.g. muffled hearing, distortion, tinnitus or ringing in the ears, hyperacusis or sound sensitivity.
- Don’t share earbuds. It’s not cool to share earwax, and might increase risk of ear infections.
- Don’t play audio unplugged through device speakers in public, quiet, or natural spaces. It is rude to impose personal music or audio on others.
- Rest your ears as much as possible with unplugged time in soft soundscapes.
- It’s never too late to start safer personal listening.
Personal Listening Volume Safety Chart
Devices have visual displays with volume setting indicators, e.g. number of bars. There are no manufacturing standards, so sound output can vary a lot depending on the device and headphone/earbud combination.
| User Volume Setting | Estimated Loudness (Average Intensity dB=decibels) | Personal Listening Hearing Health Risk |
| 80%- Full On | Extremely Loud (>100 dB) | Extremely unsafe |
| > 60% | Very Loud (> 80 dB) | Very unsafe |
| 60% | Loud (~80 dB) | Unsafe |
| 75-78 dB Noise Auditory Injury Threshold No Matter How Short the Listening Time | ||
| 50% | Loud (~70 dB) | Unsafe |
| < 50% | Quiet to Moderately-Loud (<70 dB) | Safer for adults |
| Margin of Safety Below 70 dB (Leq,24-hour) | ||
| <40-45% | Quiet to Moderately Loud (<65 dB) | Safer for children, teens and anyone with pre-existing sensorineural hearing loss, tinnitus, and/or hyperacusis |
Better Margin of Safety Needed for Children and Teens
Thanks in large part to unsafe personal listening systems, noise-induced hearing loss has become a young person’s disease. Too many people are ignoring the danger in headphones, even letting little ones start personal listening as young as 3 years old.
Children and teens need a better margin of safety. As discussed, their hearing systems are still developing from their ears to their brain. And there are serious negative lifelong impacts from early-onset hearing loss. For example, impaired language and cognitive development, speech communication breakdowns, problems with social development and interpersonal relationships, and poorer mental health (e.g. anxiety, depression). Tinnitus and hyperacusis are also linked to lifetime negative impacts, including increased risk of anxiety and depression. Quality of life suffers at home, school, play, and later work.
I recommend parents delay personal listening as long as possible and limit time spent personal listening as much as possible. It’s important to teach children and teens facts about noise-induced hearing health hazards and safer personal listening habits, including how to find their lowest functional listening volume and safer volume setting range for their audio. Ongoing supervision or check-ins are also key.
| Age | Prevalence of Personal Audio System Users |
|---|---|
| 6 | 29% |
| 9 | 59% |
| 12 | 80% |
| 12-19 | 85-95% |
Conclusion
Public health initiatives telling the public to make listening “safe” have failed spectacularly, given the root cause of hearing health damage is use of inherently unsafe personal audio systems.
Tordrup et al. (2022) estimate noise prevention programs and universal school-aged and adult hearing screening for early identification and intervention could result in economic and healthcare benefits or savings of up to $15 for every $1 invested.
We need to lobby harder with authorities and decision-makers. We need to urgently protect current and future generations with mandatory safety standards for personal audio systems. Manufacturers should be required to design safer products which should also improve the user experience, e.g. wider safe volume setting range and lower risk of public hearing health damage.
If you’re worried about your hearing health, talk to your health care provider or audiologist. If old enough, it’s possible to do a self-test, e.g. hearWHO app as a hearing screening. This shouldn’t replace professional healthcare for any concerns.
For more information, check out my blog on teaching children and teens about safer personal listening. I’ve also shared a pdf example of a Parent-Child-Teen Personal Listening Agreement at my shared folder on google.
References
- Eggermont, J.J. (2014). Noise and the brain: Experience dependent developmental and adult plasticity. Cambridge, Massachusetts: Academic Press.
- Environmental Protection Agency. (1974). Information on levels of environmental noise requisite to protect public health and safety with an adequate margin of safety. United States Environmental Protection Agency; EPA/ONAC 550/9-74-004.
- Feder, K., Marro, L., McNamee, J. & Michaud, D. (2019). Prevalence of loud leisure noise activities among a representative sample of Canadians aged 6-79 years. JASA, 146(5): 3934-3946, https://doi.org/10.1121/1.5132949
- Mayes, J. & Fink, D. (2021). Unsafe at any sound: Hearing loss and tinnitus in personal audio system users. Proceedings of Meetings on Acoustics. 43, 040003. https://doi.org/10.1121/2.0001452
- National Institute for Occupational Safety and Health. (1998). Criteria for a Recommended Standard: Occupational Noise Exposure. Cincinnati, OH. https://www.cdc.gov/niosh/docs/98-126/pdfs/98-126.pdf
- Neitzel, R.L. & Fligor, B.J. (2019). Risk of noise-induced hearing loss due to recreational sound: Review and recommendations. JASA, 146(5): 3911-3921. https://doi.org/10.1121/1.5132287
- Pienkowski , M. (2017). On the etiology of listening difficulties in noise despite clinically normal audiograms. Ear & Hearing, 38(2):135-148 https://dx.doi.org/10.1097/AUD.0000000000000388
- Pienkowski, M. (2021). Loud music and leisure noise is a common cause of chronic hearing loss, tinnitus, and hyperacusis. International Journal of Environmental Research and Public Health, 18(8): 4236. https://pubmed.ncbi.nlm.nih.gov/33923580/
- SCENIHR (2008). European Commission—Scientific committee on emerging and newly identified health risks. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function. http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_018.pdf
- Swierniak, W., Gos, E., Skarzynski, P.H., Czajka, N. & Skarzynski, H. (2020). Personal music players use and other noise hazards among children 11 to 12 years old. Int J. Environ Res Public Health, 17(18): https://pubmed.ncbi.nlm.nih.gov/32971992
- Tordrup, D., Smith, R., Kamenov, K., Bertram, M., Green, N., Chadra, S. & WHO HEAR Group. (2022). Global return on investment and cost-effectiveness of WHO’s HEAR interventions for hearing loss: a modelling study. The Lancet. 10(1), e52-e62. https://doi.org/10.1016/S2214-109X(21)00447-2
- World Health Organization (1999). Guidelines for community noise.
- World Health Organization. (2018). Environmental noise guidelines for the European region. WHO Regional Office for Europe. https://www.euro.who.int/en/publications/abstract/environmental-noise-guidelines-for-the-european-region-2018
- World Health Organization. (2020). World Report on Hearing. License CC-By-NC-SA 2.0 IGO. https://www.who.int/publications/i/item/world-report-on-hearing