Question: How loud does a sound have to be before it damages your hearing?

Q & A-2


A sound needs to be over 80 dB before it can potentially cause permanent hearing damage.  However, it is not as simple as just the loudness of the sound.  The duration of exposure and how the sound enters the ears are equally important.

The louder the sound, the less time it takes before damage can occur.  For example, it is safe to listen to sounds under 80dB indefinitely.  Sounds at 85dB can start to cause damage after 8 hours of exposure.  This time drops by half to 4 hours just by increasing the sound level to 90dB.  Increasing the sound level to 95dB reduces this safe listening time to just 2 hours.  The average preferred volume of portable media players is about 94dB.  Sounds over 100dB may cause hearing damage within 15 minutes of exposure and sounds louder than 130dB damage hearing instantly.

As well as the sound level and the duration of exposure, how the sound enters the ear also plays a part in how likely the sound will cause hearing damage.  Supra-aural headphones (the larger headphones that completely cover the entire ear) are safest.  Tests show in-ear earphones are more than three times more likely to cause hearing damage than supra-aural earphones.

What Will Hearing Aids Sound Like?

How to get the most from your hearing assessment-3

If you have, or suspect you have, a hearing loss, you might be considering trying hearing aids.  Many people are reluctant to take the first step because of concerns, reservations or even fear of what using hearing aids might involve.  Many people have concerns about how the hearing aid might look, some worry they might not manage with today’s modern technology, while others assume they won’t like the sound of hearing aids.  The latter barrier to hearing aids is most often a misconception – most people who believe they won’t like the sound of hearing aids wrongly assume that they will sound loud and some even believe a hearing aid will make them talk louder.

While these are all normal, human concerns, today’s digital hearing aids provide a more natural sound than ever before.  Modern technology has become so intelligent that hearing aids process and amplify sound using very clever electronic systems, which can carry out several automated changes at once without the hearing aid wearer having to adjust any manual controls or even being aware of the hearing aid’s sound processing changes.

The most common type of hearing loss is high-frequency (or high-pitch) – this means that the person can hear lower frequency sounds easily, even if they are very quiet.  However, as the frequency of a sound increases, the louder the sound has to be before the person can hear it.  At some frequency, which will vary from person-to-person, the sound cannot be heard at all, no matter how loud it is and no matter how much it is amplified.  The speech frequencies span from about 250Hz to 6,000Hz.  A standard hearing test will test across 250Hz-8,000Hz.  Hearing aids tend to amplify sound across 100Hz-10,000Hz, however this does vary, depending on the spec of the device and how it is fitted in the ear canal.

Most people with a high-frequency hearing loss tend to make similar complaints – speech sounds unclear or “mumbled”, even minor background noise makes it extremely difficult to understand speech, the need for people to repeat becomes more frequent, and increased volume is required to hear speech on television, usually much to the annoyance of better-hearing family members!  So if that is what a high-frequency hearing loss sounds like, what do hearing aids sounds like?


I’m lucky to have normal hearing myself, so can’t speak from personal experience, but I have fitted hundreds, if not thousands, of hearing aids, so I can tell you about how my patients report their experiences of wearing hearing aids.  Many people report the hearing aids’ sound to be “tinny” – some patients do not take to this quality initially and prefer less volume in the high frequencies that causes this effect.  However, many patients understand that this is normal – if s/he has had a high-frequency hearing loss for many many years, the brain is inevitably going to sense a “tinny” sound when the hearing aids are amplifying high-pitch sounds so that they can be perceived by the brain.  Patients also report speech as sounding “sharp”, “crisp” or “clear” and they become more aware of quieter surrounding sounds, such as rustling paper, air conditioning or a ticking clock.  Many patients note they can hear their own voice more (which people may or may not like!), however, sometimes this can be remedied by trying a different fitting in the ear canal.  Because new hearing aid users can hear their own voice louder, they worry that they are talking louder – reassuringly, it is actually the opposite.  Hearing loss can cause a person to talk louder because they cannot hear their own voice properly.  However, because hearing aids amplify sound, the hearing aid wearer can hear his/her own voice more clearly and at a normal level.  Most people with hearing loss who routinely raised their voice when talking prior to using hearing aids notably lower their voice as soon as their hearing aids are in their ears.  Some patients perceive the new sound as being loud – such patients have usually put off getting hearing aids until their hearing loss has become more severe.  As the brain becomes accustomed to being deprived of sound, adapting to amplification can be more of a challenge.


Overall, and most commonly, new hearing aid users report that the sound of their hearing aids is just different.  Often people find it difficult to explain how the sound is different, but once they become aware of how much clearer speech is, how much easier it is to communicate with people, how their aids may allow them to bring previously lost pleasures back into their life, such as music, and how general listening requires less effort, they stop worrying about the sound of their aids and instead start anticipating how hearing aids may positively impact their quality of life.

How To Get The Most From Your Hearing Assessment and Hearing Aid Fitting.

How to get the most from your hearing assessment-2Whether you’ve raced straight to your audiologist at the first signs of hearing loss, or you’ve put off the inevitable for decades, your hearing assessment and hearing aid fitting appointments often lay the foundations of your entire hearing aid experience.  The information you provide to your audiologist guides the selection of hearing aid manufacturer, style, model, amplification strategy, programmes, controls, wireless accessory options, etc., so it is important to use your appointment time wisely and provide the concise and highly relevant information your audiologist needs to provide you with a hearing aid that is perfectly tuned to your individual needs.  Read on for a guide on how to get the most from your hearing aid assessment and fitting.

1.  Answer consultation questions with concise and highly relevant answers

Every good audiologist will conduct an initial consultation, which should involve a medical history questionnaire and further questions about your lifestyle and problem listening situations.  The purpose of the medical history questionnaire is to screen for any symptoms that may need onward referral, for example to an ENT specialist, and also to guide further diagnostic tests.  Avoid giving too much detail on less relevant information, such as unrelated or historic illness or other people’s experiences.  Instead, try to answer questions with concise responses that answer the question directly.  This allows your audiologist to cover all the questions they need to ask and get a clear understanding of your hearing needs.

2.  Be honest

Most audiologists want to help people with hearing loss.  While there are of course some hearing aid dispensers who are just out to make money, the vast majority of audiologists have a good understanding of the negative impact hearing loss can have on someone’s life and a strong belief in the potential benefits of today’s hearing technology.  It is not at all uncommon for people with hearing loss to be in denial, and this is very human, but playing down your hearing difficulties or blaming other factors only serves to prolong your struggle and prevent your audiologist from providing help.

3.  Give specific examples of typical difficult listening situations

When it comes to your hearing aid fitting, your audiologist will programme your hearing aids in a way that best compensates for your individual lifestyle and challenging listening situations.  Today’s hearing aid technology is highly advanced and, in most cases, devices can be programmed to work automatically, including volume changes, noise reduction and how the aids focus their microphones forwards in noisy environments.  Think about your lifestyle day-to-day.  Is most conversation 1-2-1 or in groups?  Are you most often in quiet or sometimes in noisy environments?  Do you spend much time outdoors?  Do you listen to music or play a musical instrument?  Do you struggle to hear speech when watching television or talking on the telephone?  Do you particularly struggle to hear speech clearly in background noise?  If you can provide a clear and concise description of your daily lifestyle and difficult listening situations, your audiologist can prescribe your hearing aid fitting more accurately and finely tuned to your individual needs.

4.  Further fine-tuning – try to provide clear descriptions of problems and give specific examples

Most audiologists will invite clients back to the clinic a few weeks later for a follow-up appointment, especially if after an initial trial period.  If you are having a few problems and want some further fine-tuning of the sound or some changes made, try to provide clear descriptions of your experiences.  Your audiologist cannot experience your hearing first-hand, but instead has to make adjustments in the fitting software purely based on your feedback.  Vague comments such as “it sounds a bit strange” or “sometimes I can’t hear” give the audiologist nothing to go on.  Instead, use logical descriptive words such as “traffic is too loud”, “speech sounds very tinny or harsh” or “speech on TV is not clear”.  Specific examples are always helpful, for example, “I went to a restaurant on Saturday and, while using the Restaurant programme, I could not hear conversation clearly because of the background noise of all the other people talking” is more informative than “I can’t hear in noise”.

5.  Embrace modern technology!

Hearing aid technology is advancing at a faster pace than ever before.  While this can be daunting to some, newer technology in hearing aids often makes using a hearing aid easier, not more difficult.  Historically, a hearing aid wearer would face the challenge of having to press a button to change programmes or volume, whereas today, not only are hearing aids much more intelligent and change settings automatically, most manufacturers now offer smartphone apps, which allow end-users to abandon the need to feel around their ear to fiddle with ear-level controls and instead adjust simple-to-see controls on a smartphone or tablet.  Most hearing aid manufacturers also offer other wireless streaming devices to connect to your television and many now offer tele-audiology technology, which allows you to request hearing aid sound adjustments through your app.

We never lose Grandad anymore, now

The key to a successful and productive hearing assessment and hearing aid fitting appointment is good communication.  If you can provide clear, concise and relevant information to your audiologist, he or she will be more equipped to conduct a thorough assessment and provide a finely tuned hearing aid that is personalised to your individual needs.

A Review of Tinnitus Treatments

A Review of Tinnitus TreatmentsTreatments used in the management of tinnitus are aimed either at reducing the intensity of the tinnitus directly or at relieving the annoyance and distress caused by tinnitus (Han et al., 2009). Audiologists are generally concerned with the latter and management of tinnitus in clinic typically involves a combination of strategies: (1) habituation of perception, which aims to alleviate the intrusiveness of the tinnitus signal and (2) habituation of reaction, a psychological approach, which aims to adjust any negative and irrational reactions to tinnitus (Hobson et al., 2012).

1. Habituation of Perception

Sound Therapy or Sound Enrichment

Table-top or body-worn in-ear sound generators can present broadband noise, such as white or pink noise, or relaxing environmental sounds, such as rain or waves, which are intended to be relaxing and to alleviate the intrusiveness of the tinnitus signal. The main principle of sound-enrichment is that the therapeutic sound should be perceived as less disturbing than the tinnitus sound (Langguth et al, 2013).

Tinnitus Retraining Therapy

Tinnitus Retraining Therapy, or TRT, is a combination treatment of both counselling and sound therapy that was developed by Pawel Jastreboff and Jonathan Hazell in the 1980s. TRT is based on the neurophysiological model of tinnitus and its implementation is based on the plasticity of the brain and its natural tendency to eliminate (habituate) reactions to unimportant stimuli (Jastreboff & Hazell, 2004). Put simply, sound therapy induces habituation by reducing the strength of the tinnitus signal, while counselling aims to encourage the patient to reclassify their tinnitus into a neutral category to further facilitate habituation.

Hearing Aids

Hearing aids are cited to offer relief from tinnitus in some patients who have hearing loss (Andersson et al., 2011) and are widely used in Audiology clinics. Amplification compensates for the absence of auditory input in the frequency range of the hearing deficit. However, the 2013 literature review by Langguth et al. cite research that observes the limitation of hearing aids in the high-frequency range and the issue of dead regions in the cochlea. Research suggests that hearing aids may only provide benefit to tinnitus patients whose tinnitus is of a frequency that is within the amplification capabilities of a hearing aid and this is often less than 6kHz. However, hearing aids often help to enhance speech and environmental sounds, thereby drawing attention away from tinnitus (Han et al, 2009).

2. Habituation of Reaction

Counselling and Education

Patient counselling and education should form the foundation of all tinnitus treatments and can incorporate the provision of information, which should aim to explain and demystify the condition and correct any false beliefs, as well as empower and encourage patients to cope with the emotional consequences of tinnitus (Langguth et al., 2013).

Cognitive Behavioural Therapy

Cognitive-Behavioural Therapy, or CBT, aims to reduce the tinnitus-related disability by modifying dysfunctional cognitive, emotional and behavioural responses to tinnitus (Langguth et al, 2013). The main components of CBT include relaxation training, mindfulness training, psychoeducation, imagery training and attention-control techniques.

Relaxation Therapy

Research demonstrates an association between tinnitus and psychological disorders, with some studies reporting a high prevalence of tinnitus in patients with psychiatric illness, depressive disorder and anxiety when compared with the general population (Milerová et al, 2013). Relaxation therapy has long been judged to play an important part of a multi-strategy tinnitus in the psychological treatment of tinnitus, but appears to offer little benefit to tinnitus on its own (Baguley et al., 2013a).


In a health service that always faces the challenge of time restraints and long waiting lists, self-help interventions are becoming more frequently used in the clinical setting. CBT has been researched historically mainly in the face-to-face setting, but more recent literature has investigated the efficacy of self-help tinnitus treatments. A systematic review by Nyenhuis et al. (2013) concluded that self-help interventions are effective in the reduction of tinnitus distress and depressiveness in tinnitus patients, however, it is not known with any certainty as yet, how this efficacy compares with face-to-face treatments. Therefore, self-help CBT treatments are recommended in the healthcare setting to support tinnitus patients who are unable or unwilling to attend face-to-face counselling, which still remains the preferred method of administering CBT.


Tinnitus is difficult to assess and research. It is therefore a challenge to treat successfully. Research using human subjects, particularly trials, is scarce and the use of multi-disciplinary treatment approaches or combination rehabilitation strategies complicate the process of drawing scientific conclusions on the efficacy and value of each intervention (Baguley et al, 2013b). However, animal research and neuroimaging techniques have improved understanding of the pathophysiological mechanisms of the different types of tinnitus (Langguth et al., 2013). Despite the lack of research on tinnitus that is truly isolated from other influencing factors, a multidisciplinary approach that includes all of the treatment strategies discussed above remains the preferred treatment strategy for tinnitus. Indeed, while the benefits of such treatments may be small in most cases, and the perception of tinnitus is not eradicated, they do appear to have a significant and positive effect on quality of life (Baguley et al, 2013b).


Andersson, G., Keshishi, A. & Baguley, D. 2011. Benefit from hearing aids in users with and without tinnitus. Audiol Med. 9. pp73-78.

Baguley, D., Andersson, G., McFerran, D. & McKenna, L. 2013a. Tinnitus: A Multidisciplinary Approach. Wiley-Blackwell, UK.

Baguley, D.M., McFerran, D. & Hall, D. 2013b. Tinnitus. The Lancet. 382, pp1600-1607.

Han, B.I., Lee, H.W., Kim, T.Y., Lim, J.S. & Shin, K.S. 2009. Tinnitus: Characteristics, Causes Mechanisms, and Treatments. Journal of Clinical Neurology. 5, pp11-19.

Hobson, J., Chisholm, E. & El Refaie, A. 2012. Sound therapy (masking) in the management of tinnitus in adults (Review). The Cochrane Database of Systematic Reviews. Issue 11. Art. No.: CD006371. DOI: 10.1002/14651858.CD006371.pub3.

Jastreboff, P.J. & Hazell, J.W. 2004. Tinnitus Retraining Therapy. Cambridge University Press, New York.

Langguth, B., Kreuzer, P.M., Kleinjung, T. & De Ridder, D. 2013. Tinnitus: Causes and Clinical Management. Lancet Neurology. 12, pp920-930.

Milerová, J., Anders, M., Dvořák, T., Sand, P.G., Kniger, S. & Langguth, B. 2013. The influence of psychological factors on tinnitus severity. General Hospital Psychiatry. 35, pp412-416.

Nyenhuis, N., Golm, D. & Kröner-Herwig, B. 2013.  A Systematic Review and Meta-Analysis on the Efficacy of Self-Help Interventions in Tinnitus, Cognitive Behaviour Therapy, 42:2, pp159-169.


5 Signs You May Have Hearing Loss

5 Signs you have hearing lossAge-related hearing loss, known as presbycusis, happens very slowly.  So slowly and subtly that we often don’t notice it happening until it reaches the stage where we are having significant difficulty.  Even then, many people still do not accept they have any hearing deficit and continue to blame external causes for their difficulties.  Here are five signs that you may have hearing loss:

1. You struggle to understand people’s speech in any background noise

When we are in our teens and 20s and have normal hearing, we have little difficulty understanding group conversations with our friends, even in the most challenging of environments, such as a loud bar or night club.  Our brains have the incredible ability to filter out background noise and fill in the gaps in speech, which allows us to follow conversation in noisy environments.  Even a mild hearing loss causes us to lose the ability to filter out speech in noise.

2.  Speech tends to sound as if people are mumbling

When hearing loss happens due to wear and tear (i.e. ageing!), it is the high pitches that deteriorate first.  This means that the most common pattern of age-related hearing loss is a high-pitch (or high-frequency) hearing loss.  As speech is a mixture of high-frequency sounds (for example the syllables that do not require the voice, such as the sounds for “sss”, “sshh”, “fff”, “t”, “p”, “k”, etc.) and lower-frequency sounds (for example, the voiced syllables, such as “ooo”, “aahh”, “eee”, “mmm”, “rrr”, etc.) a high-frequency hearing loss most often results in speech having less clarity because the high-frequency information is missing.

3.  Family and friends complain you have the TV volume too loud

Loss of hearing causes speech to sound quiet and/or lacking in clarity – this most often means you require the TV volume turned up louder.  If you turn the volume up to compensate for your hearing loss, family members who have normal hearing may find this level uncomfortably loud and comment accordingly.

4.  You misunderstand what people say more often

A high-frequency hearing loss causes some consonant sounds to effectively disappear from perception.  If a hearing loss is only mild, the brain can usually fill in the gaps based on other information, such as the context of the conversation, lip-reading, etc.  However, when a hearing loss progresses to a point where there are more high-frequency speech sounds missing, there are more gaps that have the potential to be filled in incorrectly.  For example, the words “feed the cat” may be misunderstood as “eat the hat”!  While such misunderstandings often cause a laugh, if it happens more often it can become tiring and you can feel isolated from conversation.

5.  Listening to speech is generally tiring

When you have a hearing loss, the brain has to expend more energy focussing your attention and maintaining concentration than someone with normal hearing.  Therefore, listening to speech can cause you to feel tired and drained.

If you can relate to any of these hearing loss signs, then it might be a good idea to have your hearing tested.  Hearing loss often causes tiredness, social isolation and can reduce the pleasure you normally get from activities such as watching TV and listening to music.  Remember, you don’t know what you can’t hear!