On Health with Houston Methodist

Headphones: How to Use Them & Protect Your Hearing

• Houston Methodist • Season 9 • Episode 2

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Wireless headphones and earbuds have become a part of everyday life: commuting, gym workouts, video calls, even sleep aids. But while they’ve made listening more personal and portable, that convenience comes with a risk. Audiologists are reporting a rise in noise-induced hearing loss linked to unsafe listening practices, particularly among younger people. So how much sound can your ears really handle? Is noise-induced hearing damage ever reversible? And what habits will protect your hearing so you don’t have to stop using your headphones? In this episode, we break down the dangers and share expert advice on listening safely.

Expert: Dr. Kelsey Roy, Audiologist

Notable topics covered:

  • A primer on the different types of personal listening devices
  • Statistics on noise-induced hearing loss in the wireless headphone era
  • Are earbuds more dangerous because they go directly in the ear canal?
  • How loud, how long: The lowdown on boundaries for listening to headphones safely
  • Podcasts and audio books can’t cause as much damage as music, can they?
  • Why noise-cancelling headphones are a good way to go
  • Is falling asleep listening to earbuds dangerous?
  • The cumulative effect of decades of listening to headphones
  • The early warning signs your headphones are hurting your hearing
  • Does headphone overuse exhaust and put pressure on the brain? 


If you enjoy these kinds of conversations, be sure to subscribe. And for more topics like this, visit our blog at houstonmethodist.org/blog.

♪ ♪

ZACH MOORE:

Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.

TODD ACKERMAN:

I'm Todd Ackerman. I'm a former medical reporter, currently an editor at Houston Methodist.

ZACH:

And Todd, do you use headphones?

TODD:

I have very limited experience with headphones. Growing up, most of my life, wireless headphones were not -- had not been invented for most of that, so.[Laughter] But there was a point at which I had fallen off my workouts and I bought a pair of Bluetooth wireless headphones. The bulky ones that you wear over your head and on top of your ears. And I loved them, I thought it was just great for getting me back into my workouts, it would fire me up, play the music I liked while I was working out. I did always notice that not that many people out there were wearing them, and I kinda felt like I really belonged at a airport on the tarmac directing --[Laughing] Yeah, directing airplanes which terminals go to. I notice now there's like no one that wears headphones.

ZACH:

It is a trendy, kind of, throwback almost now when you see people with the big headphones on.'Cause they make all kinds of -- as we'll talk about. They make all kinds of headphones these days.

TODD:

The ones I had, this was a few years ago, and I remember I had them on when I was at a concert and some young guy there told me that he used to have them, he was so proud of them. I thought that was pretty good that I was like, you know, three years ago, I was fairly, probably, you know, relatively hip. But who knows? ZACH: Being hip. That's the goal.[Laughter] As technology has evolved, you stuck with the kind of the over the year headphone as your preference? That's what I used until they broke down and I haven't really used them since.

ZACH:

Okay, okay. So you never adopted the earbud.

TODD:

I tried -- I bought some and the fit wasn't great, they would come out a lot, I had some difficulty syncing, and I just haven't really been using them.

ZACH:

Syncing is an issue sometimes. That's why I use one certain brand that syncs with everything that I own because I am sold out to that brand. TODD: Yeah. But no, I can see how that's a frustration as well because you know, when you just plug something in, it works.

TODD:

Right. ZACH: Right. Right. Well, how about you, Zach? I know you're a big earbud guy. I remember from a previous podcast.

ZACH:

Yeah. Earbuds for me are the way to go, especially now that the technology has evolved where you can just wear one, and that's kinda my preferred way.'Cause I like, doing laundry, doing dishes, or walking the dog, you're riding your bike, stuff like that, I pretty much have at least one headphone in at all times.

TODD:

So, in having at least one in at all times, you worry ever about the safety for your ears?

ZACH:

I didn't until we had this conversation, Todd.[Laughter]

TODD:

Never before were you worried about that?

ZACH:

Well, I keep it at a good volume. Like, I would worry about,"Oh, I don't wanna make it too loud," right?'Cause that really was my only point of concern. Like, you're gonna, you know, blow out your eardrum or that sort of thing. But no, I never really crank it too loud 'cause again, I'm always trying to keep that, you know, awareness. If I really wanna, like, listen to music at a loud volume, like, that's what speakers are for, you know, not headphones. So, no I really hadn't any health concerns.

TODD:

You're young though. I don't think I would've at your age either, but when you reach a certain age, and you have friends that have tinnitus or you hear people say constantly saying, "What?" I think that, kind of, sensitizes you to, like,"I need to be careful about this."

ZACH:

Mm-hmm.

TODD:

I can remember someone when I was in my late 40s telling me about wearing earplugs to concerts, and I said, "Oh no, is that the next thing I have to worry about? ZACH: Yeah. So. While I have not been a great devotee of headphones, earbuds, I have spent a lot of my years at rock concerts, so that loud volume has not been good for my ears.

ZACH:

You can still just fine? TODD: Well, I think so, but...[Laughter] What do your friends say?[Laughter]

TODD:

I don't know if I saw an audiologist if that would -- if she would agree.

ZACH:

Well, speaking of audiologists, Todd, who did we talk to today about this topic?

TODD:

We talked to Dr. Kelsey Roy, who's a audiologist at Houston Methodist, and who talked us through how to use them safely and what the dangers are. We're here to talk about headphones, AirPods, earbuds. Let me cut to the chase. As useful as these things are, socially, practically, have they had a negative impact on ear health?

DR. KELSEY ROY:

Over time, yes. Noise-induced hearing loss is based on the amount of time in which you are listening to loud sounds. Noise-induced hearing loss is 100% preventable but it is more prevalent over the past 10, 15 years.

TODD:

Are there specific statistics out there about hearing injuries because of headphones? Has there been any rise in tinnitus or?

DR. ROY:

There was some research from the early 2000s by the Pediatric Association, and they found that there were 17% of teenagers between 12 and 19 that have some degrees of noise-induced hearing loss, and that is from data based in 2005 and 2006. So, that was a long time ago. And then in 2011, there was another report that said that there has been a significant increase in prevalence of adolescents and young adults with noise- induced hearing loss.

TODD:

Is that reversible at that age?

DR. ROY:

No. The noise-induced hearing loss is permanent.

TODD:

Yeah, I saw the World Health Organization warning that 1.1 billion young people are at risk.

DR. ROY:

Yeah. The Hearing Loss Association of America also reports that one in eight people between six and nineteen have hearing loss due to noise exposure specifically.

TODD:

Goodness. All right, so before we get into how to use them safely, can you define the different types of headphones, earphones, earbuds, on-ear, over-ear, bone conduction. I'm not much of a devotee of these things so, kind of, trusting you to, kinda, lay this out.

DR. ROY:

So, there are, kind of, two categories. Ones that are worn over the ears and then the ones that are going into the ear canal. So, when it comes to the over the ears, there are two types, the complete over the ear where the ear cup of the device covers the entire ear, which usually helps with background noise and noise cancellation. And then there are on-ear headphones, which are usually smaller, they don't cover the entire ear, they usually cover just the portion above the earlobe. More kind of like mp3, CD players in the early 90s, those types of headphones. Another different type of headphone are bone conduction devices which are open-ear listening devices. So, it is a piece that is usually either in front of the ear or behind the ear that sends vibration through the bones to transmit sound to the inner ear. That is really helpful for people that need to be aware of their environment such as cyclists, runners, things like that. And then with the ones that go into the ear canal, there are earphones, which are more like AirPods and etcetera where they're either wired or wireless, but they fit deeply in the ear canal and there are tips that are different sizes for different shapes and size ears. And then earbuds are the ones that don't completely go all the way into the ear canal. They are more just at the entrance. Think more like headphones or earbuds that are passed out on an airplane to passengers.

TODD:

Okay, very good. For the purpose of this conversation, I'm just, kinda, generally gonna refer to headphones, but whenever it's appropriate just break it down to each one.

DR. ROY:

Mm-hmm.

TODD:

So, generally how loud -- how long can you listen to headphones safely? I've heard of the 60/60 rule.

DR. ROY:

That is, kind of, debated between different groups. I found one that says Cleveland Clinic says that if you are listening to headphones at 80% maximum volume, then you can only listen to it 90 minutes a day total. And so that means even if you were listening to it at a lower volume throughout the day, you've hit your 90 minute mark. And then the World Health Organization recommends a default volume of 70-80, which is generally good if you're about 60% maximum volume limit, which brings you to the 60/60 rule.

TODD:

So -- But 60 refers to maximum volume, not decibels?

DR. ROY:

So, the limit of the volume. So, it's 60% of the maximum volume of whatever you are listening to for 60 minutes at a time.

TODD:

Those are all uniform? DR. ROY: Mm-hmm. But talk a little bit about decibel levels and translate that into a -- relatable terms for us.

DR. ROY:

Yeah. Seventy decibels, which is one of the things that the World Health Organization recommends to be loud, is an environment like a noisy restaurant. But then when you go to that 80 decibel level, it's more like a vacuum cleaner or like household things. Then when you get to 90 decibels, that is a like a tractor. And the World Health Organization says, -- and OSHA, say that you can be around that environment for 8 hours a day, with hearing protection, maximum before it could potentially damage your hearing. Then going up from there at 110, you get your really heavy power tools, and you can be in that environment for 30 minutes or less before it can cause some kind of ear damage, and then around 140, which is close to the pain threshold of sound is where a rock concert front row is, and you should not be around that. They say zero time before any kind of ear damage.

TODD:

So, what if you're back some, but you're still -- you've seen your share of rock concerts, that's like 120 or something? DR. ROY: 110 to 120. And how dangerous is that for a two and a half hour concert? DR. ROY: Pretty bad. That is the number one thing that causes noise- induced hearing loss. A lot of people tend to have a temporary threshold shift, which is what it's called when you leave a noisy environment and you have that ringing in your ear and muffled hearing. That is, essentially, your hearing has changed. Usually comes back in a day or two but those, over time will lead to a permanent damage in the ear. So, anybody going to a rock concert or some of these other high number activities should be using some sort of earplugs? DR. ROY: Absolutely. There are actual certain hearing protection that are custom plugs that have a filter for music. So, it filters how much noise is being in, however you can still appreciate the music. And how much do these decibel levels guidelines go down for kids, adolescents?

DR. ROY:

When it comes to children, their environments in a school, such as a cafeteria, are actually surpassing a noisy restaurant at 70 decibels. But when we're talking about what they should be listening to through headphones, it is a little bit lower of a maximum volume, like 50%. It is recommended to use over the ear headphones because the fit for a child is a lot harder with the earbud devices.

TODD:

So, all these different types that you laid out, can you talk about if there's some that are more dangerous or risky than others? My colleague, Zach, loves the earpods. To me, intuitively, they seem like you're going right into the canal there. They seem like they're more dangerous.

DR. ROY:

So, the in the ear ones, they are closer in proximity to the eardrum. So in theory, yes they could cause more damage. However, again, it matters about the length of time and the volume at which you're listening. So, over the ear headphones can cause the exact same amount of damage if you're listening to it at the same volume. A lot of times, the in-ear cause more damage in terms of skin irritation and ear infections, especially if moisture gets trapped, like doing exercise. So, that can become the bigger issue.

TODD:

So, how often do you need to clean them?

DR. ROY:

I would say any time you see any kind of visible debris, you should clean them.

TODD:

Generally, are there pluses and minuses to each type?

DR. ROY:

I mean, sound quality and fit are the big plusses and minuses for each different type. So, usually the ones that have more noise cancellation features, people appreciate more because of the sound quality aspect of it. When it comes to the earbuds, the fit and the seal of the ear canal is really important, which is why those types of earbuds with silicone or rubber tips come in different sizes. It's usually more about how it sounds and how they fit.

TODD:

And should you look for ones with special noise cancellation technology or they pretty much all have that these days.

DR. ROY:

I wouldn't say that they all have it, especially like the airplane earphones that are wired, because that allows a lot more ambient sound in, which causes people to increase the volume to be louder than the sounds around them. So, noise cancellation is a good feature because it allows the listener to listen at a softer volume, however it's still up to user discretion. And just because it allows a lower volume does not mean that someone listens to it at a lower volume.

TODD:

So, are auditory devices at a loud volume any more or less dangerous than say loud volumes without the noise?

DR. ROY:

Nope. They're both the same amount of damage, depending on how long you are in that environment and how loud the environment actually is.

TODD:

So, if I'm listening to music using earpods at a high level, that could be the same as being at a rock concert? DR. ROY: Yep. And some people do experience that temporary threshold shift after using AirPods for two hours. And you mentioned fit, but angle is also something that the wearer needs to be concerned with?

DR. ROY:

If the angle is incorrect, you're not gonna hear as well as if it were appropriate. So, most people just adjust the earbuds to make the fit be correct because that's where they will hear the best.

TODD:

So, are there any radiation concerns, any -- with Bluetooth headphones?

DR. ROY:

With Bluetooth headphones, I mean there's a very, very minimal amount of radiation which is much less than a cell phone, but there is gonna need to be a lot more research about that to see if there are any long-term effects of that.♪ ♪

TODD:

After the break, more with Dr. Roy on headphones and hearing health.

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TODD:

For me, thinking about headphones and what you listen to, I mostly think of music but also like audiobooks or podcasts. They can't possibly pose the same decibel threat that music can, can they?

DR. ROY:

They actually can. Music has a wider frequency range, so that's when you associate those really bass sounds that you hear from other cars on the street. But if you are listening at the same volume to a song versus a audiobook, versus a podcast, it's still doing the same amount of damage.

TODD:

So, some people like these earbuds because you can fall asleep with them. To me, that seems kind of dangerous.

DR. ROY:

I agree. We do not recommend sleeping with any kind of earbuds in. Your ear canals need a break to heal and have time to allow moisture and wax to move out of the ear canal. So, if you need something like sleep ASMR kind of devices, there are things that are specific for sleep like pillow speakers are a thing, or noise machines, especially ones that have a timer where they turn off after a certain time amount.

TODD:

Are those just as bad as using earplugs?

DR. ROY:

No, because earplugs are blocking sound whereas earphones are playing sound. So, some people use earplugs if their partner snores. But some people in that situation could also use earbuds and that could cause more damage than the earplugs would.

TODD:

Earplugs, earmuffs, any of these, sort of, just noise cancellation technology, is that generally a good idea? DR. ROY: Yes, always. If you are in an environment where there is a lot of noise, it's always a good idea to use either earplugs and then muffs on top of them especially for shooting and things like that. There are different types of earplugs that go in the ear. Some are foam and some are silicone. The foam ones are not a one size fits all type of hearing protection. But most places that offer hearing protection only have one size. The silicone devices that have, like, flanges on them come in different sizes, and those usually allow more protection because they're more suitable for your ear canal. So, what are potential early warning signs of too loud of headphones? I'm thinking that once you start experiencing certain things like ringing in the ears, some damage is already done.

DR. ROY:

Yep.

TODD:

What is the -- are there early warning signs?

DR. ROY:

Mm-hmm. So, tinnitus is one of the earliest signs of any amount of damage in your ear. Just because you have tinnitus doesn't mean that a hearing test is going to show any hearing loss. Typical hearing tests only test up to about 8,000 hertz. But there are ultra-high frequency hearing tests that test up to about 20,000 hertz. So, sometimes in those ultra-high frequency tests, if there's damage there, that means that there's damage and it will likely continue if you continue listening to the volumes you are listening to. Which brings into the conversation, something that is very heavily researched recently, which is hidden hearing loss. Meaning on a typical hearing evaluation, you have normal hearing, but you feel you cannot hear or understand when there's noise present. What is usually happening there is that the synapse between the inner ear and the auditory nerve is damaged, which doesn't show those typical frequencies that are tested in a hearing test. But the signal coming from the environment is not clear to the auditory nerve.

TODD:

This is when the ambient noise is fairly low'cause I think we've all been in a bar or something where it's hard to hear the other person talk,'cause it seems so loud around you.

DR. ROY:

Yep. But a lot of times, that's because of hearing loss or that hidden hearing loss that is really being researched because that comes from being exposed to very loud noises.

TODD:

If you catch tinnitus early enough, you can, sort of, reverse that? It seems like I've talked to some people who've said that they had it but they got over it, where the other people I've talked to said,"No, this is lifelong now."

DR. ROY:

So, tinnitus itself is not necessarily reversible. The majority of tinnitus is subjective so a lot of people that say they, kind of, get over it, they generally just start to ignore it, whereas some people can't. It is the sole focus of every day. I wouldn't say that it's reversible, but a lot of times, masking strategies can be used to help your brain focus on sounds that are actually in the environment.

TODD:

How much of an insidious effect is there from headphones? Like, say you listened to them at fairly loud volumes in your teens, early 20s, but then became more responsible as you got older. Is there some accumulative effect from all that that at some point, it's gonna start affecting your hearing? DR. ROY: So, damage is damage. If you listen to it consistently in your 20s, you are more likely to have hearing loss earlier in your life. So, at the age of 50, you might have hearing loss that looks like someone who is 80 now. So, headphones are very dangerous if you are listening to them consistently very loud. And is, kind of, headphone overuse at all hard of the brain? It kinds just puts a lot of pressure there?

DR. ROY:

It can be. If you are constantly listening to something, there is such a thing as listening effort. So, if you're consistently are listening to something for let's say 30 minutes to an hour, later in the day, a few hours later, you are more tired. So listening and understanding is harder.

TODD:

But generally, does using them a lot just -- is that constant activity just, kind of, exhausting to the brain? DR. ROY: Yes. Most importantly, limit the time and the volume when you're using headphones. If someone around you can hear any amount of sound coming from your headphones, it's too loud. You are damaging your hearing. That's a good tip. That's the big takeaway that you would have is --

DR. ROY:

Yeah. TODD: You know -- okay. All right, very good. I appreciate you taking time out with us. This has been very educational. Of course.

ZACH:

So Todd, off the top there, you asked me if I was concerned about hearing health and -- with how often I listen to headphones, and apparently there's a time limit on how long you should be wearing headphones each day, and that concerns me. TODD: Yeah, I'll bet. As someone who wears headphones all the time, I am concerned. TODD: Yeah, I'll bet. My takeaway was that as much as I kinda miss listening to music while I'm working out, since my headphones went on a blink, I think it's probably a good thing. And one thing she talked about, how your noise causes you to -- around you causes you to crank up the volume. I was definitely guilty of that. The gym would have some hip hop in the background and I really wanted to listen to my -- You don't want that. You wanted your own music.

TODD:

Yeah.[Laughter] So, I would -- I'd go to them and complain about it, but I'd still --

ZACH:

You would go to them and complain about it. That is incredible. I can see you doing that."Could you turn down that music please? I have my own music. TODD: Yeah. Get of my lawn -- Did you hand them some records when you're up to the desk and say,"Can you play these instead?"

TODD:

No, I just told them to get off my lawn.[Laughter]

ZACH:

Maybe the lesson here is just, you know, be okay with just being alone in your thoughts every now and then. Not having constant input because we're not made for that. We're not made to have constant input into our ears, and much less, you know, that close. But, you know, not even that close, just anywhere really. TODD: Yeah, absolutely. I can only speak for myself but I feel like a lot of people are in this situation, right? We just, kinda, fall into,"Oh yeah, let me -- I'll listen to this music," or, "Oh, here's a podcast I wanna listen to," and it's just constant.

TODD:

Yeah. And I was struck her saying that just listening to a podcast or an audiobook, as long as it's fairly loud, that does just as much potential damage as listening to music...

ZACH:

Right. TODD: At that same sound level. Also, I was a little struck by it's not a great sign if you're a restaurant or a bar, and to me it seems kind of loud and you're having some trouble hearing the person.'Cause I thought everybody kind of experienced that. Even when I was younger, I kind of remember not really loving bars 'cause it would be loud and it would be hard to have a conversation with someone. But lo and behold that might not be a good sign. Yeah.[Laughter] Yeah, I mean, hearing is one of those, kinda undercover health issues where I think, you know, you don't go somewhere specifically regularly, right?'Cause you're supposed to go to the dentist for your teeth...

TODD:

Right.

ZACH:

And the optometrist or ophthalmologist for your eyes, right? For your ears, I mean, we have ENTs, but we don't have a regularly scheduled, "Your annual ENT appointment," right? And that's why I think hearing health is something that falls through the cracks. TODD: Yeah. That's a good point. I definitely plan on being a little bit more proactive now. Certainly I'm gonna look into earplugs for going to rock concerts. I like the idea that you said, there are ones that you can adjust them so you can still hear the music well. It kinda just filters out a lot of the ambient noise. Mm-hmm.

TODD:

But like I said, it does concern me the amount of time I've spent in arenas listening to Bruce Springsteen.

ZACH:

Yeah. No, I'm really gonna have to think about how much I listen to. Because I really do. Between music, and podcasts, and -- I always have something on it seems. You know, that there are a lot health reasons that you should probably take some time away from the speaker, whether it be in or outside of your ear, your headphone. Kind of unplug, really. TODD: Yeah, yeah. Even though your headphones are wireless, you're still plugged in if you're listening to headphones, right? TODD: Right, exactly. All right, well that's gonna do it for this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings. So, until next time, stay tuned and stay healthy.♪ ♪