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Lef.org/magazine/mag2012/may2012_Strategies-Protect-Preserve-Your-Hearing_01.htm

Life Extension Magazine May 2012

Strategies to Protect and Preserve Your Hearing

By Alexander Brookner

Preamble

Just One Mistake Caused My Tinnitus

By William Faloon

So much of what we term “science” emanates from real-world experiences.

In my case, I was recently exposed to loud noise that resulted in me developing acute tinnitus that has not fully gone away. I am compelled to relate this incident to spare others the same fate.

About six months ago, a group of doctors were in South Florida attending a medical conference. I was invited to go out with them to dinner and they asked me afterwards to join them at a nightclub.

When we entered the nightclub, the music was rather subdued and I was able to engage in good scientific discussions with these doctors over drinks. As the night wore on the music was slowly “cranked up.” We nonetheless continued our discussions by talking louder.

During the last hour, the music decibels increased so much that one of the doctors had to scream in my ear to be heard. If I had to do it over, I would have walked out.

The next day I woke up with severe tinnitus. When I did a Google search to see if one incident of loud noise could cause permanent ringing in the ears I was surprised as to how many people develop tinnitus because of one exposure to loud noise.

In my case, it was not just the doctor screaming in my ear over very loud music. When one ingests ethanol, the tiny bones in the ear lose their ability to close in response to loud sounds. Aging also plays a role in our vulnerability to ear damage caused by loud noises.

So because of this one confluence of mishaps, I am left with mild tinnitus. To sleep, I turn up my air purifier so it covers up the ringing. I do this sometimes in the daytime also. For the most part I just try to ignore it.

One major change I made is to carry ear plugs with me whenever I may be exposed to any kinds of excess noise. Putting in these ear plugs enables me to hear conversation, but drastically reduces the background noise that enters my ears.

So the take-home lesson I want to relay to Life Extension® members is:

1.As we age the delicate anatomical structures in our ears become increasingly vulnerable to loud noises.
2.Ethanol reduces our natural protective mechanism against damage caused by loud noise.
3.If one knows they are going to be exposed to loud noise, wear ear plugs designed for rock musicians who use them to protect against deafening loud music.
4.Since we do not always know when we may be exposed to loud music, keep ear plugs in your car or another place that you can easily access.

The following article discusses partial solutions for mitigating tinnitus.

Strategies to Protect and Preserve Your Hearing

According to the Environmental Protection Agency, noise pollution “adversely affects the lives of millions of people.”1 The EPA warns that health problems related to noise can include high blood pressure, sleep disruption, stress related illnesses along with countless other adverse health issues.2 Noise Induced Hearing Loss (NIHL) is the most recognized damaging impact of loud noise. Part of the reason that noise pollution has not received the critical public attention of air or water pollution is because you cannot see it or taste it. Yet, if you are one of the 10 million American adults who experiences noise-induced hearing loss, or one of the 40 million with chronic tinnitus (ringing in the ears), you already understand the stressful impact of noise on your life.3,4 What most doctors and audiologists don’t tell you is what you can do to help restore some of your lost function, and prevent further damage. In this article, we will provide specific steps you can take to shield yourself and your family from the growing dangers of chronic noise.

Long-Term Health Risks of Noise Pollution

Experts estimate that 30 million Americans are exposed to dangerous levels of noise each day.5

Chronic loss of hearing, especially in the higher frequencies where we perceive speech, is becoming increasingly common, with 10 million adults and 5.2 million children suffering from irreversible noise-induced hearing loss in the US alone.4 Frighteningly, people are developing measurable hearing loss at earlier and earlier ages.6

Tinnitus, the most common auditory disorder, affected about 40 million people in the US in 2010.3 There’s no medical cure for tinnitus, and its incidence is rising, chiefly due to noise in the environment.3

While progressive hearing loss and tinnitus have obvious impact on your quality of life, there is now growing evidence that these problems can also trigger sleep disturbance, high blood pressure, elevated heart rate, and increased psychological and physiologic stress.4,7 Elevated levels of the dangerous stress hormone cortisol are found in people with hearing loss and tinnitus — and cortisol elevations lead to cardiovascular disease, diabetes, bone loss, and early death.4

Scientists once thought that hearing loss and tinnitus were inevitable and irreversible consequences of aging itself. Not so, according to recent studies.8 The majority of hearing abnormalities in adults are now understood to be the result of two major kinds of noise: chronically elevated noise of the kind found in many industrial settings, nightclubs, and rock concerts along with “impulse noise,” or the sudden, sharp onslaught of a loud noise.

Ironically, it has been soldiers returning from recent wars who have advanced our scientific understanding of noise injury, especially those caused by impulse noise.9,10 Their exposure to gunshots, blasts, and other explosions has triggered an outpouring of research on how sound energy damages hearing.

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Personal Listening Devices A Growing Threat

That iPod or other MP3 music player your grandchild is using could be posing a serious threat to hearing. Use of such personal listening devices has increased exponentially in the past decade, and the consequences are piling up. Consider these frightening statistics:

•Ninety percent of adolescents report listening to music through earphones on MP3 players.12
•It is estimated that 29% of those have exposure of greater than 90 dB for more than an hour per day, and 58% exceeded 85 dB, sufficient to cause hearing loss.12,13
•High-frequency hearing loss doubled, to 19.2% from 10.1%, in the period 1985-2008.14
•Incidence of tinnitus in MP3 player users was 28%; in non-users it was just 8%.69
•Use of MP3 players with headphones is significantly associated with abnormal hearing testing in high school students.15
•State hearing screens frequently omit the high-frequency testing needed to detect noise-induced hearing loss in teens.15

How Noise Harms Hearing

Your ear is a complex organ with a deceptively simple task: turning the energy from sound waves into nerve impulses that your brain can interpret. Here’s what happens, in a nutshell: Sound waves, which transmit energy through the air, strike your eardrum, which vibrates very slightly as a result. Tiny bones in your middle ear, called ossicles, then amplify that slight movement by acting as little levers. The last part of that system of levers then pushes fairly strongly on a thin membrane, transmitting the vibrations to your spiral-shaped cochlea, or inner ear.

Your cochlea is filled with fluid and lined with specialized nerve cells called hair cells, which are sensitive to movement. When the fluid moves in response to pressure from the ossicles, hair cells generate minute electrical impulses. Those impulses then travel up your auditory nerve to the brain’s sound-processing areas. From there, higher-functioning parts of your brain interpret the sounds and respond to them appropriately.

Most of the time, this system works flawlessly, but like any system with moving parts, there is gradual deterioration. The bulk of the damage caused by loud noises is done at the level of the hair cells.15 To transmit a loud sound accurately, those cells must generate a burst of metabolic activity, consuming energy and generating reactive oxygen and nitrogen species.8,9 They also release copious amounts of the excitatory neurotransmitter glutamate, which is intrinsically damaging over the long haul.16,17

With each exposure to loud noise—whether continuous or sudden—your hair cells are literally working themselves to death. Free radicals and glutamate toxicity conspire to reduce blood flow to the cochlea, which produces additional oxidative stress, in the now-familiar cycle of tissue destruction.16,18-23

Ultimately, hair cells die, and when you lose hair cells, you lose hearing.9,20 Scientists now understand that the typical “age-related” hearing loss is nothing more than a drawn-out version of the destruction wrought by sound energy, spread out over a lifetime.8,23

Sudden loud noise also known as impulse noise seems to produce greater risk of hearing loss than continuous noise.9 If you encounter a very loud sound, especially on a background of already loud noise, you may suffer from acoustic shock injury (ASI). Symptoms of this sudden loud noise can produce ear pain, tinnitus, hyper-acute hearing or phonophobia (apprehension of loud noises), vertigo, and numbness or burning sensations around the ear.24 Psychological reactions to acoustic shock injury can include emotional trauma, anxiety, and even depression.24

Tinnitus is far and away the most common and irritating symptom that follows sudden noise exposure; 94% of soldiers studied on a firing range reported experiencing tinnitus.10

Tinnitus has many causes, not all of which are well understood, and no definitive cure.3,25,26 Tinnitus results at least in part from the excitatory stimulus of glutamate, which leaves hair cells producing electrical signals long after the original stimulus has gone.27,28 It may also result from impaired inhibitory signals from deep brain areas that normally “tune out” abnormal impulses arising from damaged hair cells.3,26

Finally, many people who suffer exposure to impulse noise are left with a condition called tonic tensor tympani syndrome, or TTTS.24 This disconcerting syndrome is caused by excessive sensitivity to loud noises, leaving the eardrum in a constant state of alertness, ready to tense up in response to the next burst of sound. The result is ear pain, often with a fluttering sensation or sense of fullness in the ear.

With all of the threats to your hearing from our noisy world, what can you do to protect yourself? More than you might think. Good physical protection is important and readily attainable through the use of low-cost earplugs, and boosting your intake of certain antioxidants and minerals can markedly reduce both short and long-term damage to your hearing, as we are about to see.

Preserving Your Hearing

•Our noisy society threatens your hearing.
•Noise-induced hearing loss affects millions of Americans, and both continuous and sudden loud noises are to blame.
•Noise causes direct physical and biochemical damage to delicate structures in your inner ear, releasing a burst of oxidant molecules.
•Death of the sound-transducing hair cells of the inner ear is the result, producing either gradual or sudden loss of hearing.
•Tinnitus (ringing in the ears) is another common consequence of noise damage; it can cause anxiety, depression, and raise stress levels.
•Good, comfortable hearing protection is available at low-cost and should always be carried.
•Antioxidant nutrients such as magnesium, n-acetylcysteine, and others have proven effectiveness at preventing (and in some cases reversing) noise-induced hearing loss and tinnitus.

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Defend Your Ears Physically: The Role of Hearing Protectors

Physical ear protection has long been considered the “last line of defense” after noise reduction and regulations.29,30 But until recently, most studies focused on noise in the workplace, where the threats are predictable and the solutions largely controllable. Recent evidence suggests that noise in everyday environments, like busy streets or entertainment venues poses equally great hazards. Nightclubs, for example, often produce peak sound levels as high as 107 decibels (dBA), while the maximum safe industrial sound level is considered to be 85 dBA, and for regular environmental exposure is 70 dBA.6,31-34 Urban dwellers may be exposed to chronic sound levels above 74 dBA simply during their daily activities, and above 79 dBA on public transit.6,31

Even if you stay out of noisy clubs, your leisure activities may put you at risk for unacceptable sound levels. Using power tools, driving loud vehicles, and hunting or target shooting are all examples of common activities that generate continuous or impulse sound that can hurt your hearing.36

Industrial workers often use “earmuff” type hearing protection, and some fields now even use advanced technologies like active noise reduction or noise cancellation, in which electronic circuits blunt the impact of noise. Such solutions are impractical for the average citizen, however.

The best hearing protection available to most of us is the simple earplug, which produces passive noise reduction just by blocking or dampening excessive sound energy before it lands on the eardrum. Experts believe that comfort should be the number one consideration, even above technical reduction of noise level. The argument, essentially, is that the “perfect” earplug that doesn’t get worn is of little use compared to a comfortable one that will be worn regularly.32

Another important feature of your hearing protection should be that it allows normal, natural communication. Too much sound reduction can reduce your ability to perceive speech naturally, or to hear and respond to sounds that warn of hazards.37 Excellent hearing protection is now available in the form of “social ear plugs” that allow you to reduce ambient noise levels while remaining attentive to the speech of those nearby.

When it comes to how much sound will be blocked, not all earplugs are the same. Like sun tan lotion with different SPFs, there are different protection factors for earplugs. This is known as the Noise Reduction Rating (NRR). The NRR is a rating system that has been set up by the Environmental Protection Agency (EPA) to represent how much noise the earplugs will block when worn properly. An important factor in determining a product’s NRR is its attenuation. The opposite of amplification, attenuation is any reduction in signal strength. Attenuation for hearing protection devices is determined by a panel of human subjects over a range of frequencies. The average attenuation is then used in calculating the NRR. The higher the NRR the more noise the earplug will block out.

Rock musicians are constantly exposed to high decibel sound and now an entire generation is experiencing tinnitus or noise induced hearing loss. The most famous example is Pete Townsend of The Who. Because musicians have to hear what they are singing and what their band mates are playing they need a well designed ear plug that allows them to hear the high notes and low notes of the music yet protect them from destructive sound. Musician earplugs should have an NRR of at least 12.

Choose your hearing protection, then, based on its comfort, its “social graces,” and of course its cost. Comfortable, effective, musician-grade earplugs can be found for less than $20 per pair from reputable manufacturers.

Noise-Induced Hearing Loss Strikes Celebrities

What do Neil Young, Barbara Streisand, Steve Martin, and William Shatner have in common? They all suffer from noise-induced tinnitus and hearing loss.71 The difference? The singers got theirs from chronic high-level noise exposure during hundreds of loud concerts, while the actors can recall just one single loud gunshot or explosion (impulse noise). Such noise exposure seems to be an occupational hazard for those in the public eye; one website that tracks celebrities lists nearly 80 well-known individuals with hearing loss, tinnitus, or both.71

Defend Your Hearing With Supplements

Given the major role of oxidant stress in triggering noise-induced hearing loss, it’s natural to ask if antioxidant supplements might alleviate the risk. Once again, we can thank our soldiers for a large part of the answer; studies show that antioxidants administered before sound exposure can mitigate hearing loss in combat situations.9 What follows is a summary of readily-available supplements that you should use on a daily basis to optimize your body’s defenses against oxidant-mediated, noise-induced hearing loss.

Are You At Risk for Noise-Induced Hearing Damage?

In addition to protecting your hearing with comfortable earplugs and using appropriate supplements, you should periodically run through the following checklist to determine your current risk for hearing damage. A series of simple questions may indicate if an individual is at risk for hearing damage. If your answer to one or more of these questions is ‘‘yes,’’ you are considered at risk for hearing loss and should seek a complete hearing evaluation by a qualified audiologist:7

A. Do you notice ringing in your ears for hours or 24 hours after sound exposure?
B. Do your ears sometimes feel full or stopped up?
C. Do voices sound muffled after you have been around music for an extended time?
D. Does music sound distorted toward the end of the day?
E. Do you have difficulty listening to the radio or in noisy or group settings?

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Magnesium

Magnesium treatment has been repeatedly shown to reduce the incidence of both temporary and permanent noise-induced hearing loss.38 Magnesium readily penetrates the cochlea from the blood.39 It improves blood flow around the cochlea, and is a vital cofactor in the body’s major antioxidant defense enzyme systems; it may have other mechanisms of action as well.39,40

Laboratory studies show dramatic reduction in noise-induced hearing loss when animals receive magnesium supplements prior to impulse noise such as gunshots.41,42 When human military recruits took 167 mg of magnesium daily during a two-month basic training period, the rate of substantial hearing damage was half that of a control group of soldiers.43 Recruits in this study were exposed to daily mean peak sound levels of 164 dBA, a very high value.

Similar results have been found in other studies in military settings, with magnesium supplements reducing both the frequency and the severity of significant hearing loss.44,45 Recruits with the highest blood magnesium levels had the least severe hearing damage, and effects were similar on both temporary and permanent hearing loss.

N-acetylcysteine (NAC) and Acetyl-L-Carnitine

N-acetylcysteine (NAC) is a potent antioxidant capable of repleting the body’s own antioxidant defenses, and acetyl-L-carnitine is a well-known mitochondrial nutrient that supports cellular energy metabolism. Both nutrients are emerging as leading candidates for hearing protection both before and after exposure to loud noises.

Studies with NAC and acetyl-L-carnitine in combination demonstrate less hair cell loss, lower oxidant levels, and reduced temporary and permanent hearing loss in animals exposed to loud impulse noise.46,47 The effect is so strong that the combination is still effective if used 1-4 hours after the noise exposure.46

Multiple studies demonstrate powerful protection of hair cells and cochlear blood flow in animals treated with NAC alone, resulting in reduced permanent hearing loss, both prior to and following impulse noise.48-50 Human studies using 1,200 mg of NAC daily for two weeks in military recruits exposed to impulse noise at peak levels as high as 165 dB, and in civilian workers exposed to industrial noise at as high as 89 dB, have shown similar protection, with substantial reduction in hearing loss, especially in the higher frequencies where we perceive speech.51,52

Melatonin

Melatonin is an intriguing hormone naturally produced in the pineal gland. Its multiple effects tend to balance out disturbances in the biological environment, including oxidant stress.53 Melatonin also decreases activity of dopamine, an excitatory neurotransmitter.54

Studies with melatonin show potent effects at reducing cochlear damage and preventing hair cell loss in animals, with concomitant protection of hearing thresholds. Melatonin was more effective than either of two powerful steroid anti-inflammatory drugs, methylprednisolone or dexamethasone.55,56

Melatonin may be uniquely effective in reducing both the perception of tinnitus, and the sleep disturbances tinnitus can produce.53 At doses of 3 mg/day, human studies show a 40% reduction in tinnitus perception.54 The same dose also improved sleep quality in a group of patients with chronic tinnitus.57

Other Nutrients

A variety of other antioxidant vitamins and nutrients have shown promise in reducing noise-induced hearing loss and/or the hair cell damage that produces it. Seventy-nine percent of patients with sudden hearing loss treated with vitamin E had significant hearing gain, compared with just 45% of those in a control group.58 Laboratory studies show less destruction in the cochleae of vitamin E-treated animals than in controls, with concomitant improvement in hearing.59,60

Lipoic acid is an antioxidant nutrient with proven benefit against the oxidant stress induced by impulse noise and blast injury.61,62 Animals treated with lipoic acid have substantially lower levels of oxidant molecules in blood and cochlea, and their hearing is protected significantly compared to untreated ones.63,64

Studies have shown that serum levels of toxic homocysteine are elevated in humans with noise-induced hearing loss or tinnitus, while levels of the anti-homocysteine nutrients folate and vitamin B12 are lowered.65-67 Raising plasma B12 levels to slightly above normal range with oral cyanocobalamin supplements at 1,000 mcg/day resulted in significant improvement in hearing levels in human subjects, compared with placebo recipients.68

Summary

Noise-induced hearing loss and tinnitus are major public health problems, and their incidence is rapidly rising in our noise-saturated society. Noise causes dramatic physical changes in the delicate structures of your inner ear, changes driven by oxidant stress.

Previously thought to be irreversible, both noise-induced hearing loss and tinnitus are now showing signs of yielding to prompt treatment with nutrients that can boost your antioxidant levels, including magnesium, N-acetylcysteine, acetyl-L-carnitine, and others.

Using a good, comfortable earplug can also reduce your exposure to hearing-threatening noises—keep a pair handy at all times.

CoQ10 May Alleviate Chronic Tinnitus

Tinnitus can result from even a single exposure to a sudden loud noise. Tinnitus has many causes and few management options, but clinical trials have shown promise for one of the most vital nutrients in the body—CoQ10. A 16-week human clinical study evaluated the effects of CoQ10 levels on presentation of tinnitus revealing that for chronic tinnitus sufferers with low levels of CoQ10, raising blood levels of CoQ10 may help alleviate the expression of tinnitus.70

If you have any questions on the scientific content of this article, please call a Life Extension® Health Advisor at 1-866-864-3027.

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