WARNING SIGNS OF HEARING LOSS
- You must shout in order to be heard by someone working near you.
- Your hearing is dulled immediately after your work shift.
- After your work shift, you experience noises in your head or ringing in your ears.
- You, family members or friends notice that your hearing is getting worse.
- You have difficulty hearing people when others are talking around you.
- You regularly experience headaches during or after your work shift.
Source: Fire & Emergency Service Hearing Conservation Program Manual, Federal Emergency Management Agency/U.S. Fire Administration
I usually write about wildland and wildland/urban interface firefighting. So, writing about the subject of Tinnitus is quite different for me. I am no authority on Tinnitus. I do, however, suffer from chronic severe Tinnitus with some hearing loss that has been documented to have been caused by noise-induced exposure to excessively loud sounds. The loud sounds, in my case, were and still are from sirens, air horns, diesel motors and other loud noises that are germane to the fire service.
I have been on the job for 31 years and began to notice a low level of Tinnitus sound around 1980. Some months ago, the Tinnitus noise level increased dramatically, causing me great emotional stress and anxiety. Through this writing I hope to reach and warn as many firefighters as possible about this preventable and insidious malady called Tinnitus.
A Little About Tinnitus
Have you ever heard of the word Tinnitus? Probably not. When I mention the word, most people tell me that they've never heard of it. Then, I'll mention noises in the ears or in the head and most people say that they have heard of that and do experience infrequent ringing in the ear or ears that disappears after a few seconds.
According to the American Tinnitus Association (ATA), located in Portland, OR, Tinnitus is a subjective experience that can be described as chronic ringing, hissing or other noise in the ears and/or head. The word is of Latin origin and it means to "ring like a bell." It is pronounced as "tin-night-us" or "tin-nit-us"; either is correct.
Tinnitus can be of little or no consequence to you. However, in the extreme cases Tinnitus is insidious and debilitating. It has literally driven some people to insanity and to suicide. It can be like a "gorilla on one's back."
Says Randy L. Tubbs, Ph.D, of the National Institute for Occupational Safety and Health (NIOSH), "When people think of hearing loss and partial deafness, they immediately think about a quiet world that they will be forced to live in. In some cases, that cannot be further from the truth. Few people realize that noise-induced deafness results in a loud, annoying sound inside one's head that just never quits. It interferes with sleep, watching TV, listening to people, reading a book, almost all facets of daily living. So … loss of hearing does not equal a quiet day of fishing during our retirement years. It can be a screaming inside our heads that never stops."
According to the ATA, approximately 12 million people in this country experience Tinnitus so severely that they seek medical help. It is also estimated that another 50 million adults in this country have Tinnitus to some degree. At present, there is NO cure.
The known causes of Tinnitus are many - i.e., ear infection, earwax buildup, disorders of the neck vertebrae, jaw problems, allergies, cardiovascular problems and high blood pressure. However, one of the most common causes of Tinnitus is exposure to excessively loud sounds, especially repeatedly over periods of time. Noise-induced Tinnitus is caused by damage to the inner ear's microscopic hair-like nerve endings called hair cells or cilia. Tinnitus is usually associated with some hearing loss in the high-frequency range.
Tinnitus can be made worse by continuous or intermittent additional loud noises; excessive alcohol consumption; caffeine found in coffee, tea, chocolate and cola drinks; nicotine; aspirin and some other drugs; and stress - especially the stresses inherent in the fire service. Firefighters' bio-rhythms are constantly in flux because our sleep patterns are continually broken. Even when we are "sleeping" during a night shift, that "sleep" is not restful and this has a negative effect on our body's need for rest and rejuvenation. While we are on duty, our adrenaline levels are up and are higher during responses. Depending on the incident that we are at, our adrenaline levels can be even higher. This affects our nervous system to a high degree. It is also known as the "fight or flight syndrome."
According to doctors and medical researchers, high levels of stress and adrenaline will cause the autonomic nervous system to stimulate and aggravate Tinnitus. Additionally, loud noises release more adrenaline, causing an exacerbation of Tinnitus. The very nature of a firefighter's work is fertile ground for developing Tinnitus. Fatigue is also known to cause Tinnitus noise to worsen. Once a firefighter is diagnosed with occupational noise-induced Tinnitus and remains on regular duty, Tinnitus is more difficult to treat for obvious reasons. And the Tinnitus will probably get worse. It did for me.
Tinnitus & The Firefighter
Noise-induced hearing and inner-ear damage to firefighters (and to other emergency service workers) has been documented for many years. This occupational damage is commonly manifested by hearing loss that gets worse with the passing of time for the individual. Oddly, very little has been mentioned over the years about Tinnitus. Thankfully, that is changing and Tinnitus is finally being recognized for what it is and what it can do to firefighters both in terms of physical and psychological damage. The ravages of Tinnitus are only just beginning to be realized by the fire services.
The Federal Emergency Management Agency (FEMA) and the U.S. Fire Administration (USFA) in concert with the International Association of Fire Fighters (IAFF) have produced a document entitled, Fire & Emergency Service Hearing Conservation Program Manual. This document recognizes the dangers of noise-induced trauma to the hearing system and outlines a program to reduce and/or prevent the occupational noise-induced hearing damage associated with sirens, air horns, motors and other loud noises associated with emergency services.
The following are excerpts from this document:
"Noise is probably the most underrated health hazard affecting fire and EMS personnel … The dangers of excessive noise exposure to emergency service personnel are finally being addressed … The cases of hearing loss are irreversible and incurable. They are also PREVENTABLE! The effects of noise are cumulative and often take a long time to become permanent and then it is too late … Noise-induced hearing loss is recognized as a significant health hazard throughout the fire services … Another result of occupational noise exposure is a complication known as Tinnitus. It is often associated with hearing loss. This 'ringing' in the ears can become so loud as to disturb one's ability to sleep …"
The document describes the hearing process; effects of noise; standards for noise exposure; noise-control practices; firefighter noise exposures; worker's compensation and hearing loss; and other information on the subject. The manual can be obtained by contacting FEMA or the IAFF.
NFPA 1500 & Hearing Damage
"To comply with the requirements of NFPA 1500, a fire department MUST provide hearing protection for all firefighters riding on apparatus who are subject to noise levels above 90 decibels. (A decibel is a unit of measurement used to express sound levels. OSHA has developed an occupational noise-exposure standard.) NFPA 1500 considers the use of hearing protection as an interim measure only until engineering controls can be instituted to reduce noise levels produced by vehicles, warning devices and radios ... When hearing protective devices are utilized as an interim measure, protective ear muffs are recommended since ear plugs can be difficult to fit and insert. For those firefighters that must listen to the radio, NFPA 1500 recommends the use of earmuffs with built-in speakers and volume controls for radio and intercom communications.
"Hearing protection is required by NFPA 1500. Firefighters are often exposed to noise levels above 90 decibels while using power tools or equipment … Finally, NFPA 1500 requires a fire department to establish a hearing conservation program that identifies potential sources of harmful noise and seeks to reduce or eliminate them ... A hearing conservation program should address as a minimum, monitoring noise sources, audiometric testing (to be administered in an annual physical and included in a data base), noise reduction engineering controls, noise reduction techniques and hearing protection devices."
According to Occupational Safety and Health Administration (OSHA) standards, the acceptable noise level in the work place is not to exceed 90 decibels for an eight-hour period. The action level is 85 decibels, which is the level at which a hearing conservation program must be offered to employees. Firefighters and other emergency service personnel are often exposed to decibel levels well above 100.
A rule-of-thumb is that if you have to shout to talk to a co-worker, the noise probably exceeds OSHA's acceptable levels. Noise levels during emergency responses/incidents exceed safe decibel levels. If you are not wearing ear/hearing protection during times when decibel levels are high, you ARE damaging your ears and your hearing.
Other Sources Of Damaging Noise
Sirens, air horns and loud diesel motors produce damaging high-decibel noise. This is a matter of factual record. The disturbing results are that many firefighters and other emergency service workers suffer from either hearing loss or Tinnitus, or both. And this gets worse with aging and the length of damaging cumulative noise exposure time.
There are other sources of potentially damaging noises that are subtle and not often thought about. The use of power tools, especially when operated inside a building or other enclosure where high-decibel sounds cannot readily dissipate or be absorbed, is an example. Other examples are in-house and apparatus department radios whose volume is turned up loud enough to wake the dead; loud and harsh alert tones broadcast over radios or through microphone speakers on portable radios; TVs and radios whose volumes are turned up too loudly because the firefighters or other emergency personnel are simply either hard of hearing or trying to hear over loud background noises; and the momentary high-impact noises of steel forcible entry tools hitting each other causes sudden high decibel level noises.
Personal alert safety system (PASS) devices emit extremely loud noise, but for a good reason. Here's a real Catch 22: smoke/ fire alarms in buildings can emit a variety of sounds that can be so loud that they distort radio communications on portable radios. Just think of the noise-induced damage that is being caused to firefighters' ears when we are in a building where the alarms are sounding loudly and continuously.
Yet another location where loud noise is a major problem is at the street level at the front of a fire building or other emergency incident. Pump operators and incident commanders are subjected to high-decibel noises, over extended periods of time, from the sirens and air horns of incoming emergency vehicles, apparatus motors running at high rpm and loud radio chatter.
If your fire station is next to a busy highway, then you are experiencing the additional din of nearly constant high-decibel traffic noises. Is there a bus stop only a few feet from your station? More loud motor noises! If your fire station is close to a medical center or hospital, you can bet that there will be additional high-decibel noises from the sirens of ambulances.
Help & Hope
Even though there is no cure for Tinnitus sufferers, there is help for some relief and a hope for a cure. I suggest starting with an ear, nose and throat (ENT) specialist who is aware of and sensitive to the Tinnitus sufferer. If you visit an ENT specialist and he or she tells you that "nothing can be done to help" or to "try and live with it," immediately find another ENT specialist who will give you help and hope. There ARE treatments that can give you relief. I am presently being treated with what is called Tinnitus Retraining Therapy, or TRT. And there are anti-depressant and anti-anxiety medications now being used to help sufferers deal with Tinnitus.
Next, search the Internet under TINNITUS. You will be amazed at how much information about Tinnitus is available. However, be aware that there are also a few charlatans out there who will promise relief, but all they want is your money.
One of the best resources for information about Tinnitus and relief from it is the American Tinnitus Association, P.O. Box 5, Portland, OR 97207; telephone 800-634-8978; at the website www.ata.org; or via e-mail at [email protected].
A few years ago, very little research was being done to find a direct cause and a cure for Tinnitus. Today, much more research is taking place due to the realization of just how huge the Tinnitus crisis is and how so many people are suffering with it. Some familiar and influential people are Tinnitus sufferers - Tony Randall (Felix from the "Odd Couple" TV series), William Shatner (Captain Kirk of "Star Trek" fame) and Barbra Streisand, to name but a few. Tinnitus is not a political hot-button disease that gets attention and the millions of dollars needed for research. Tinnitus is invisible and those in Congress and elsewhere who have the authority and power to release research funds are reluctant to do so. Tinnitus needs to become a "hot button" in order to get those desperately needed research funds.
One Tinnitus researcher told me, "If we had just 1% of the money that is spent on trying to put a probe onto Mars, we could find the cause and the cure for Tinnitus. But, they just won't give us the research money. We try and try. We can't understand this, since there are so many millions of people suffering with Tinnitus."
The fire service does have political power. If the IAFF, the International Association of Fire Chiefs (IAFC), National Volunteer Fire Council (NVFC), National Fire Protection Association (NFPA) and the other politically connected organizations would realize what Tinnitus in the fire service means, they would and could help to release those funds for Tinnitus research. Firefighters with job-related hearing damage and Tinnitus need help.
Our ears and auditory systems are being bombarded with potentially damaging environmental noises. We live in a world of increasing noise pollution. Many of those noises can be controlled and attenuated. Any efforts to reduce loud noises now will produce both immediate and long-term health benefits. The warning is clear. Loud noises will damage our bodies permanently. Losing your ability to hear or hear well is one of the consequences of the inaction to reduce damaging noise levels. The horror of Tinnitus is one lesser-known and lesser-understood reason to … STOP THE NOISE!
Chief Concerns is a forum addressing issues of interest to chief fire officers. Opinions expressed are those of the writer. We invite all volunteer and career chief fire officers to share their concerns, experiences and views in this column. Please submit articles to Chief Concerns, Firehouse Magazine, 445 Broad Hollow Road, Melville, NY 11747.
Robert M. Winston, a Firehouse® contributing editor, is a district fire chief in the Boston Fire Department. Questions and comments may be sent to him via e-mail at [email protected]
