Hearing preventive care is a paradigm shift

An entire generation is systematically damaging their hearing. Hearing disorder – audiopathy – is among the leading incurable chronic disabilities of our time.

Joe Miller and I started discussing ACEMg's potential impact on hearing care shortly after his article reporting ACEMg lab data was published in 2007. Joe called ACEMg a paradigm shift. We laughed. Not because it was funny, but because it was likely true. And hard.

Thomas S. Kuhn published The Structure of Scientific Revolutions in 1962, arguing that science progresses through what he called paradigm shifts that disrupt dominant frameworks. None of that mattered enough to stop us. We kept going. And here we are.

We're making too much noise to hear the alarming messages about progressive deafness.

Hearing loss from noise exposure was already a big problem two decades ago, and it's continued getting worse faster. It's high time to confront the fact that hearing loss is a pandemic, a public health crisis with generational social and economic consequences.

I say this as the leader of a company built on several decades of pathbreaking auditory neuroscience medical research, starting in the lab and progressing to an open-label, post-marketing, long-term observational study to become the first hearing preservation supplement backed by clinical and real-world effectiveness data. At every step, researchers are trained to be careful. We say "may", "could", and "further research is needed."

Enough of that.

The hearing loss data has been shouting at us for decades. We don't need more. I live with the reality every day in email messages and conversations, not only with older adults, but with parents about their children and people in their twenties and thirties who do all sorts of things for a living, and whose education, lives, and livelihoods are already compromised by permanent hearing damage and other incurable neurological consequences that often come along with it.

The current paradigm has us thinking that hearing loss is inevitable and happens mainly to old people. That's incorrect. Hearing loss happens at all ages. Today, young adults have old ears; the average 25-year-old today has the hearing profile of a 40-year-old from a generation ago.

Staying quiet is irresponsible. I'm here to talk about it and why it's happening, do what I can to stop passive acceptance of hearing loss as a normal lifelong disability, and help us reach the moment when hearing preservation becomes the new normal.

The fact that hearing loss is an incurable chronic disability should make it a strong candidate for public health legislation, government policymaking that has been pivotal to solving other large and complex public health problems. It's time to get that done. I want to be clear that our company has a dog in this hunt, but the change we seek is hard and well beyond what Soundbites pills and the software, digital tools, and devices in development can hope to accomplish. To be successful, we need to hunt in a pack. Please DM me if you're in a position to help.

Believe the data.

• About 25% of adults aged 20-69 already have noise-induced hearing damage, according to the U.S. Centers for Disease Control and Prevention (CDC). Not "at risk." Already damaged. Mainly from noise exposure.
• About 1.4 billion young people globally, ages 12-34, about half the 2.8 billion in that age group, are at risk of permanent hearing loss due to unsafe listening practices, mainly personal music players and loud music in bars and clubs and at live performances, according to the World Health Organization (WHO).
• Tinnitus, incurable, chronic brain noise, is suffered by about 20% of the entire worldwide adult population of 5.5 billion, or 1.1 billion. That population increasingly skews young. Hyperacusis, intolerance to normal sound levels, often comes along with tinnitus because it's also a synaptopathy symptom.

These aren't projections or worst-case scenarios. This is today's reality. If you aren't alarmed yet, maybe this will push you over the edge. All these trends are accelerating. Perhaps that explains why you're likely seeing so many ads for hearing aids, which can be helpful if your hearing is impaired. They selectively amplify sound to compensate for hearing deficiencies, but they can't prevent or fix biological hearing system damage, which is pretty much a one-way street.

Why now?

Four powerful social trends have converged to create a perfect storm for hearing damage at a scale we've never seen, and the urgent need to change its trajectory.

1. Earbuds and personal listening. For the first time, humans are inserting sound-delivery devices directly into their ear canals for hours. We're plugged in every single day. Your parents' generation listened to music on speakers across the room. Maybe they had headphones for special occasions. Sony introduced the Walkman in Japan in 1979. About two decades later, in 2001, Apple introduced the iPod. "1,000 songs in your pocket." Earbuds required. Today's young adults have earbuds in for an average of 4-6 hours per day. Repeat: average. The human auditory system evolved over more than a quarter billion years to process sounds from the environment, not to process high-intensity sound delivered directly into the ear canal. We are running a massive, uncontrolled experiment on human hearing. Overwhelmingly, the subjects are under 40. The experiment isn't going well. Their hearing data is not great. Which brings us to the second trend.


2. No upper limit on loud listening. The way we're listening adds intensity to duration, creating an exponentially exploding hearing damage problem. Sound is measured in decibels, dB. I'll summarize the exponential math this way. Click the volume setting once, and you've likely doubled the sound power by raising it 3dB. To double the perceived volume, you likely need to click the volume setting three or four times, which means you've multiplied the sound power reaching your inner ears by three or four times. Normal conversation is 60 dB. All good. But hearing damage starts happening quickly at 85 dB. A noisy bar or club can be 90 dB. Live music performances routinely hit 110-120 dB. Earbuds, and yes, hearing aid outputs can hit 100 or 115 dB. Not good at all. Loud sound can damage hearing in minutes or even seconds. Your brain has feedback systems to inform you about the damage. Your ears will begin to hurt. Normal hearing will become muffled, like your ears are underwater. Your brain will begin to make noise, called tinnitus. You may become overly sensitive to normal sound levels. We've learned to ignore all these warnings. The platforms and devices that deliver amplified audio have every incentive to make it louder, more immersive, more engaging. They have no incentive to protect your hearing.


3. We behave as if we believe loud is good. Restaurants deliberately play music at volumes that make conversation difficult, encouraging you to eat faster, drink more, and leave sooner, all of which is not so great for you, but good for business. Look it up. Fitness classes blast music at concert levels. Cars have high-powered audio systems, and the latest high-horsepower combustion cars can be heard a mile away. Quiet offices actually aren't. They hum with HVAC systems, open floor plans, and constant notification sounds. These three factors are accelerating the rate of progressive, incurable hearing disability on a vast scale. The damage can be traumatic and sudden blast injury, but more often it's steady exposure to damagingly high sound levels we consider part of normal life. This is where we bump into the current paradigm.


4. We believe this is normal. We are mostly unaware of progressive deafness while it's happening, because our big brains adjust until they can't. We typically don't notice, or don't pay attention, to subtle degradations in our ability to distinguish speech from background noise. We ignore temporary brain noise after a night out or a concert. We don't know that's a warning of inner ear ischemia reperfusion injury, the equivalent of an inner ear ministroke, an early warning sign of permanent damage. Life goes on until the day you decide not to go to the lively hot spot because it's too loud and you can't follow the conversations. Or your brain noise keeps you awake at night and distracts you during the day. Or your spouse tells you it's time to think about hearing aids.

Collateral damage is looming

The hearing damage happening to young adults today contributes to a looming dementia crisis in the coming decades. This isn't fringe science. The data analysis comes from the Lancet Commission, one of the most respected public health research organizations. Their 2020 and 2024 reports on dementia identified hearing loss as the single most significant modifiable risk factor for dementia, a bigger modifiable risk factor than smoking, hypertension, obesity, or physical inactivity.

The leading theories are compelling. When you can't hear well, your brain works harder to process audio signals. This "cognitive load" draws resources away from other functions, including memory formation and retrieval. You receive less auditory stimulation. The auditory cortex begins to atrophy. You tend to withdraw from social interactions, a major risk factor for cognitive decline.

We've been here with other preventable harms. And we stepped up.

Seat belts. In 1965, there were about 75 million cars on American roads, and 50,000 Americans died in car accidents every year. Seatbelts existed, but almost no one wore them. The auto industry resisted safety features. The public thought accidents happened to other people. Then the data became undeniable. The images of crash test dummies became impossible to ignore. Laws were passed. Norms shifted. Today, seatbelt use is over 90%, and traffic fatalities have dropped by more than half, even with nearly 300 million cars on the road.

Sunscreen. Skin cancer rates were climbing rapidly in the 1970s. Sunscreen existed, but was seen as something for lifeguards and beach vacations. The tanning industry promoted bronzed skin as healthy. The ozone layer was deteriorating. Then the data became undeniable. The images of melanoma became impossible to ignore. Attitudes shifted. Today, sunscreen is part of daily skincare routines for millions. "Base tans" are recognized as damage, not protection.

This is the sunscreen moment for hearing.

Clinical medicine is astonishing in many arenas. Minimally invasive outpatient surgery is available for heart disease. Advanced targeted drug treatments are available for many forms of cancer. Diabetes can be managed with medication.

The same cannot be said for hearing loss. Prevention is imperative because there are no drug treatments. The hearing loss data is undeniable. The damage is accelerating. The technology driving the crisis is expanding. Will we respond as we did with car safety and sun protection? Or worse, will we fail to respond at all?

References

The claims in this article are supported by the following peer-reviewed sources and official reports:

1. "Vital Signs: Noise-Induced Hearing Loss Among Adults — United States 2011–2012." MMWR Morbidity and Mortality Weekly Report, 2017. U.S. Centers for Disease Control and Prevention (CDC)
2. "1.1 billion people at risk of hearing loss." WHO News Release, 2015. Updated data in World Report on Hearing, 2021. World Health Organization (WHO)
3. Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England), 396(10248), 413–446. Permalink
4. Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., Samus, Q., … Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet (London, England), 404(10452), 572–628. Permalink
5. Bhatt, J. M., Lin, H. W., & Bhattacharyya, N. (2016). Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngology–Head & Neck Surgery, 142(10), 959–965. Permalink
6. National Institute for Occupational Safety and Health (NIOSH). Criteria for a Recommended Standard: Occupational Noise Exposure. DHHS (NIOSH) Publication No. 98-126, 1998.
7. Liberman, M. C., & Kujawa, S. G. (2017). Cochlear synaptopathy in acquired sensorineural hearing loss: Manifestations and mechanisms. Hearing Research, 349, 138–147. Permalink
8. Vogel, I., Verschuure, H., van der Ploeg, C. P., Brug, J., & Raat, H. (2009). Adolescents and MP3 players: too many risks, too few precautions. Pediatrics, 123(6), e953–e958. Permalink
9. National Highway Traffic Safety Administration (NHTSA). "Seat Belt Use in 2022—Overall Results." Historical data from the NHTSA Fatality Analysis Reporting System. DOT HS 813 407, 2023.
10. Lin, F. R., Yaffe, K., Xia, J., Xue, Q. L., Harris, T. B., Purchase-Helzner, E., Satterfield, S., Ayonayon, H. N., Ferrucci, L., Simonsick, E. M., & Health ABC Study Group (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine, 173(4), 293–299. Permalink

Photo credit: Pete Souza, Public domain, via Wikimedia Commons. Obama senior advisor David Axelrod gave the "Hard things are hard" plaque to President Obama during the fight to pass the Affordable Care Act (health care reform) in Obama's first term. Seemed appropriate.