[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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