[Congressional Record Volume 151, Number 95 (Thursday, July 14, 2005)]
[Senate]
[Pages S8294-S8296]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEARING HEALTH
Mr. JOHNSON. Mr. President, today I want to address this body in
order to help raise awareness about an important health problem in our
society. Hearing loss impacts the lives of 28 million men, women, and
children in the United States. As baby boomers reach retirement age,
that number will rapidly climb and nearly double by 2030.
The combined effects of noise, aging, disease, and heredity have made
hearing impairments a reality for many Americans. Children with hearing
loss may lack speech and language development skills. Seniors may find
it difficult to talk with friends, listen to the
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television, or hear an alarm. For all Americans, recognizing and
treating hearing loss can be the difference between dependence and
independence.
Across the country, awareness campaigns have identified hearing loss
as a major public-health issue. Last month, Newsweek had a cover story
discussing the impact of hearing loss on young Americans. Experts
estimate that 21 million people could benefit from a hearing aid, but
do not use them or have access to them. I will ask unanimous consent to
insert this important news article in the Record, so that all of our
colleagues can read and learn more about this issue. In addition to
educating themselves, I also ask that Members educate their loved ones
and constituents about this important issue.
To ensure that Medicare beneficiaries receive direct access to
services, I have introduced the Hearing Health Accessibility Act of
2005, S.277 in February of this year. I would like to take this moment
to thank all of my colleagues that have cosponsored and supported this
legislation. I urge other Senators to consider cosponsoring my
bipartisan bill which will become increasingly important as baby
boomers enter retirement.
I ask unanimous consent the editorial to which I referred be printed
in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From Newsweek, June 6, 2005]
A Little Bit Louder, Please
(By David Noonan)
Kathy Peck has some great memories of her days playing bass
and singing with The Contractions, an all-female punk band.
The San Francisco group developed a loyal following as it
played hundreds of shows, and released two singles and an
album between 1979 and 1985. Their music was fun, fast and
loud. Too loud, as it turned out. After The Contractions
opened for Duran Duran in front of thousands of screaming
teeny-boppers at the Oakland Coliseum in 1984, Peck's ears
were ringing for days. Then her hearing gradually
deteriorated. ``It got to the point where I couldn't hear
conversations,'' says Peck, now in her 50s. ``People's lips
would move and there was no sound. I was totally freaked
out.''
Peck the punk rocker lived out one of her generation's
musical fantasies two decades ago; Peck the hearing-impaired
has been living out one of its fears ever since.
Over the years she has battled her problem, a combination
of noise-induced hearing loss and a congenital condition
(diagnosed after the traumatic concert), with a variety of
strategies and interventions, including sign language, lip
reading, double hearing aids and, eventually, surgery on the
tiny bones in her middle ears. Today Peck, who used to cry
with frustration at movies because she couldn't hear the
dialogue, still has ringing in her ears (tinnitus) and mild
hearing loss, but gets by , without help.
Aging rockers aren't the only ones struggling with
diminished hearing these days. More than 28 million Americans
currently have some degree of hearing loss, from mild to
severe, and the number is expected to soar in the coming
years--reaching an astounding 78 million by 2030. While that
looming surge is mostly a baby-boomer phenomenon, the threat
of hearing loss--and the need for prevention--isn't limited
to a single age group. We are all caught in the constant roar
of the 21st century. It's the rare kid today who doesn't have
wires snaking out of her ears as she rocks through the day to
her own personal soundtrack. Televisions are bigger and
louder than ever, and so are movie theaters. One study
estimates that as many as 5.2 million children in the United
States between 6 and 19 have some hearing damage from
amplified music and other sources. If they don't take steps
to protect their hearing, the iPod Generation faces the same
fate as the Woodstock Generation. Or worse.
Thanks to their years of living loudly, many boomers are
ahead of schedule when it comes to hearing loss, showing
symptoms in their late 40s and 50s. (In the past, patients
usually weren't diagnosed until their 60s or later.) ``We're
seeing hearing loss from noise develop at an earlier age than
we used to,'' says Dr. Jennifer Derebery, immediate past
president of the American Academy of Otolaryngology--Head and
Neck Surgery. ``It's a huge problem.'' The good news: though
hearing loss can't be reversed, reducing exposure to
excessive noise, like quitting cigarettes, can improve your
health and quality of life, no matter your age.
Of course, noise isn't the only culprit. ``Even if you
spent your life in the library, you wouldn't hear as well
when you're 70 as you do when you're 20,'' says Dr. Robert
Dobie, professor of otolaryngology (ear, nose and throat) at
the University of California, Davis. But who spent their
lives in the library? Not Kathy Peck and her fans; not the
folks riding jackhammers on road crews, and not the
firefighters and cops dashing to the rescue with their sirens
screaming. Even pediatricians have been known to develop
hearing problems after years spent around crying babies. When
you combine the excessive noise they have experienced at
work, home and play with the natural effects of aging,
boomers end up on the receiving end of what Dr. Peter
Rabinowitz at the Yale School of Medicine calls a ``double
whammy that makes people much more symptomatic.''
But progress is being made on many fronts. Awareness and
prevention efforts--community-based, state and nationwide
programs--are gaining support around the country as hearing
loss is increasingly recognized as a public-health issue.
Advances in digital technology have dramatically improved
hearing aids; they are smaller than ever, with far better
sound quality. And clinical trials are now underway on
permanent, implantable hearing aids for the middle ear which
will offer sound that is superior even to the best external
aids. On the biological front, scientists are busy trying to
unlock the genetics of hearing to find a way to regenerate
the sensitive hair cells, essential for hearing, that line
the cochlea, the spiral, seashell-like structure located in
the inner ear. And way out on the horizon of the cutting
edge, researchers have created an experimental brain-implant
system that bypasses the ear altogether and sends sound from
an external receiver to the part of the brainstem that
processes sound.
The product of extraordinary, even beautiful, anatomy,
hearing is a natural wonder and exactly the sort of gift we
tend to take for granted. ``Unfortunately, a lot of people do
not value their hearing,'' says Dr. William Slattery,
director of clinical studies at the House Ear Institute in
Los Angeles. Hearing may also be too good for its own good.
Human ears were originally meant to pick up the faintest
sounds of predators stalking our long-ago ancestors--the snap
of twigs in the forest, the rustle of grass on the savanna.
The crash and racket of modern life, both urban (motorcycles,
subway trains, car alarms) and rural (chain saws,
snowmobiles, shotguns), assault and insult these gorgeous
instruments.
Most common types of hearing loss occur at the higher
frequencies and are caused by damage to hair cells. Slattery
describes the cochlea as ``a piano, with 15,000 keys rather
than 88.'' Different parts of the cochlea process different
frequencies of sound, so when you have hearing loss at a
certain frequency, it's as if that part of the keyboard is
not functioning. Various levels of noise affect hair cells in
various ways. If a rocket-propelled grenade goes off right
next to you, you can experience ``acoustic trauma'' that
kills hair cells and causes the instant loss of a great deal
of hearing. (Hearing loss is the third most commonly
diagnosed service-related ailment, according to the
Department of Veterans Affairs.) Hanging out directly in
front of the speakers at a Green Day concert could result in
a less serious ``temporary threshold shift,'' in which the
hair cells are stressed but not permanently damaged. Such
stress is often accompanied by ringing in the ears that can
last for hours or even days. (Derebery notes that repeated
threshold shifts can lead to permanent hearing loss.) And
then there's what might be called noisy-world syndrome. While
an individual's noise exposure may not reach the official
danger zone, the worry is that the chronic din of daily life
could lead to deterioration over time. ``There's not a lot of
data about it,'' says Rabinowitz, ``but our concern is that
there is less and less time for the ears to rest, and so the
hair cells are going to be prematurely exhausted.''
Protecting your hearing starts with understanding how noise
works. The classic ``formula'' for assessing the risk of
hearing loss is the intensity of the noise, measured in
decibels (the danger starts at 85 decibels, roughly the sound
of a lawn mower), multiplied by duration, the time of
exposure. In other words, the louder the noise, the less time
you should be exposed to it. Prolonged exposure to any noise
above 85 decibels can cause gradual hearing loss. According
to what experts call the ``five-decibel rule,'' for each
five-decibel increase, the permissible exposure time is cut
in half. So one hour at 110 decibels is equivalent to eight
hours at 95 decibels. And sound levels above 116 decibels
(snowmobiles are about 120, rock concerts about 140) are
unsafe for any period of time.
For millions of Americans, excessive noise in the workplace
is a daily threat. Angelo Iasillo, 45, has worked in road
construction since 1989, operating jackhammers and a ``road
grinder'' to tear up Chicago's streets. He first noticed a
problem with his hearing when he was in his early 30s and
found himself asking more and more people to repeat
themselves. He also demonstrated another classic symptom. ``I
was always putting the TV up louder,'' he recalls. Worried,
he went to the doctor and was told, at 32, that he had the
hearing of an 80-year-old. Today, Iasillo wears a hearing
aid, uses a vibrating alarm clock that he keeps under his
pillow and has his doorbell rigged to a lamp--it blinks when
someone rings.
While the Occupational Safety and Health Administration
(OSHA) has made great headway against noise-induced hearing
loss in the past 20 years, compliance with federal
regulations can be a problem in some occupations. Earplugs
would certainly help protect road workers like Iasillo,
but to be safe at busy work sites they also need to hear
what is happening around them. And some professions are
louder than we think. Truckdrivers, for example, have a
high incidence of hearing loss in their left ears from
traffic noise, says Hinrich Staecker, professor of
otolaryngology at the University of Maryland School of
Medicine.
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The National Institutes of Health runs a campaign against
noise-induced hearing loss, called ``Wise Ears,'' that
emphasizes basic steps like wearing earplugs when operating
power tools and moderating the volume on personal listening
devices. The ubiquitous music players, which send sound
directly down the ear canal, are a potential problem for
millions of Americans, young and old. In a recent informal
study at the House Ear Institute, researchers found that the
new generation of digital audio players, with their
exceptional clarity, allow listeners to turn up the volume
without the signal distortion that occurs with traditional
analog audio. Without distortion, which serves as kind of
natural volume governor, listeners may be exposed to unsafe
sound levels without realizing it. In preliminary
observations, the music at the eardrum topped 115 decibels.
Exposure to noise that loud for more than 28 seconds per day,
over time, can cause permanent damage.
Kathy Peck, who learned the hard way about the dangers of
loud music, has dedicated herself to helping other musicians
avoid her fate. Along with Dr. Flash Gordon, the physician
from the Haight Ashbury Free Clinic who helped with her
hearing loss 20 years ago, Peck cofounded Hearing Education
and Awareness for Rockers (HEAR). Since its inception in 1988
(with seed money from the Who's Pete Townshend, whose hearing
was also trashed by loud music), the group has helped
thousands of young rockers, distributing free earplugs at
clubs, concerts and music festivals, and providing free
screenings by audiologists.
For more than 6 million Americans, hearing aids are the
best available solution for everything from mild to profound
hearing loss. Today's digital devices, like the analog
instruments that preceded them, amplify sound and transmit it
down the ear canal to the eardrum. But the similarities end
there. Thanks to digital technologies, modern aids offer
better sound quality (above). Top-of-the-line models feature
``directional'' or ``high definition'' hearing. These devices
use two microphones and an algorithm to enhance sound coming
from the front (the person you are talking to), while tuning
down sound coming from behind (the rest of the noisy party).
Despite such encouraging technical advances, there are
about 21 million people in the United States who could
benefit from hearing aids, but don't use them. Many simply
can't afford them. Their costs range from a few hundred
dollars for a basic analog device to $3,500 for high-end
instruments, and are rarely covered by insurance. Another
reason some folks eschew aids is discomfort--they simply
don't like the feeling of walking around with a plugged ear
canal. And even with digital technology, people can still
have difficulty separating speech they want to hear from the
background noise, a common hearing-aid problem. Yet another
obstacle to wider use is stigma--many people associate
hearing aids with aging, Slattery says, and would just as
soon cup a hand behind their ear. ``They're afraid to look
old, but they don't mind looking dumb.''
A new generation of implantable and semi-implantable
hearing aids, currently being developed and tested, could
solve many of these problems. Unlike conventional aids, the
new devices transmit sound vibrations directly to the bones
in the middle ear, bypassing the eardrum and improving speech
perception. ``You can amplify the higher frequencies without
feedback problems,'' says Slattery, ``and that gives a
richness to the sound. It's the high frequencies that help
you localize sound and hear better in noisy situations.''
Other pluses: no clogged ear canal and no visible sign of
infirmity. But until insurance companies start paying for
hearing aids (they are under increasing pressure to do so),
the $15,000-to-$20,000 devices--intended for those with
moderate to severe hearing loss--will remain out of reach for
most.
A more permanent solution to hearing loss--regenerating
damaged cochlear hair cells--is the shared goal of a
scattered band of researchers around the country. Unlike
birds and other lower vertebrates, which can regenerate hair
cells, humans and other mammals get one set, and that's it.
If scientists can discover a way to grow new hair cells in
humans, exciting new treatments could be devised.
Already, researchers at the University of Michigan have
used gene therapy to grow new hair cells in guinea pigs.
At the House Ear Institute, Andrew Groves and Neil Segil
are studying the embryonic development of hair cells in
genetically engineered mice. If they can unravel the
process, figure out how it starts and why it stops in
mammals, they may eventually be able to reactivate the
cells and have them make new hair cells. In a related
experiment, they have managed to coax some embryonic
cochlear cells in mice to restart and become hair cells.
``This is new stuff,'' says Segil, with the calm that
often masks excitement in scientific circles.
``If you are going to have a hearing loss, this is the best
time to do it,'' says Char Sivertson, who began to lose her
hearing without discernible cause when she was a teenager.
Sivertson is downright enthusiastic about things like closed
captioning. ``It's incredible; now I'm not left out of TV,''
she says, and ticks off other high -tech advances, such as
digital hearing aids and phones that can be ``tuned'' to
improve the clarity of the caller's voice.
But Sivertson, an activist member of the Association of
Late-Deafened Adults (ALDA), a support group, wasn't always
so gung-ho. ``I was in denial for years and years,'' she
says. ``I tried to pass for hearing, which was ridiculous.''
Sivertson was using hearing aids by the age of 24, but it was
another 20 years before she fully accepted her fate. And
there were some dark days in between. Every few years, her
hearing would suddenly get worse. After one such drop, ``I
was very depressed,'' says Sivertson, now 57. ``I wasn't
exactly suicidal, but I was thinking, `I'm not sure life is
going to be very meaningful for me from this point on'.''
Sivertson faced a myriad problems while raising her two
sons, Dak and Matt. When there was a school matter or some
other issue to discuss, her sons tended to bypass her and go
to their dad, Larry, who has normal hearing. ``Kids don't
want to repeat themselves and stuff like that,'' says Larry
Sivertson. ``It's up to the hearing spouse to make sure that
the person with hearing loss is involved.'' Char Sivertson
found peace of mind through her association with ALDA.
Joining such a group, she says, ``is the No. 1 thing you can
do for yourself'' if you develop hearing loss later in life.
And here's something you can do before you reach that
point--learn to appreciate what you already have. Says Yale's
Rabinowitz: ``If you are watching your diet, if you are
exercising, then protecting your hearing should be part of
your lifestyle.'' Sounds good to us.
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